The first near-total face transplant in the U.S. was performed at the Cleveland Clinic in 2008 on Connie Culp who was injured when her husband shot her in 2004. Since then, a growing number of face transplants have been performed in the United States and abroad, giving people with severely deformed faces a new option. In addition to the risks associated with the surgery, there are many ethical and psychological issues that need to be worked out. A group of surgeons work together to provide a safe and successful outcome.
Understanding the Surgery
A face transplant is a surgery that replaces part or all of a person’s face. A face transplant requires a multidisciplinary team of surgeons working together to complete this complex surgery.
Candidates may include individuals whose faces were severely disfigured due to trauma, cancer or a birth defect and have failed or cannot tolerate any other treatment options. Psychological testing is required to make sure a person is emotionally healthy enough for face transplant surgery. This process can take up to three years.
In general, the first step in a face transplant surgery is to procure healthy, matching tissue from a donor. The face transplant candidate is then prepped for surgery. This includes removing any compromised or injured tissue. The surgeon must attach the new tissue and restore blood flow to the ‘new’ face. This involves reattaching nerves, muscles and bony structures, and reconnecting each layer of the new face. There are usually other surgeries that are undertaken before and after the transplant. There is a complex and lengthy rehabilitation process after surgery that involves the patient learning how to eat, speak and make facial expressions.
A person who undergoes a face transplant will need to take immunosuppressant drugs for the rest of their life. These drugs prevent the body from rejecting the new face. There is a trade off, however, as immunosuppressant drugs may increase the long-term risk of cancer, infection and organ failure. Face transplant patients are often otherwise healthy, which alters the risk-benefit profile of immunosuppressant use. Other potential complications of face transplants may include permanent loss of feeling or movement in the transplant, and tissue death or necrosis. The latest research has shown that some people do regain the ability to speak, chew and smile within one year of their face transplant.
What to Expect After Surgery
A person who has a face transplant will not look exactly like the donor. Instead, the final result is more of a hybrid of facial features. Facial features are a key part of a person’s identity and sense of self. There are ethical and psychological issues that patients and physicians consider regarding one’s identity prior to and after face transplant.
For all of the reasons and concerns noted above, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) believes that face transplants be reserved for individuals who have failed all other options.