A face transplant is a surgical procedure in which all or part of a patient’s disfigured face is replaced with facial tissue taken from a deceased donor.
It’s a life-changing procedure for people who have suffered a significant facial injury or who were born with a serious facial deformity. A face transplant is not just about how a person looks, however. Facial disfigurement can make it difficult for people to perform everyday tasks. They may find it hard to eat, speak, smell, or even breathe. They may not be able to show emotion through facial expressions, and they may not have sensation in their face.
People with facial disfigurement can face social and psychological difficulties, too. Social isolation and stigmatization are common, as is anxiety and depression.
For these people, a face transplant can be transformative, restoring their control over facial movement and function, and helping them return to a normal social life.
“At Yale, we are able to take care of patients with issues ranging from minor facial deformities or aesthetic imperfections to the most devastating ones,” says Bohdan Pomahac, MD, division chief of Yale Medicine Plastic & Reconstructive Surgery and director of the Face Transplant Program. “We are able to restore active smile, symmetry, and function, as well as repair three-dimensional facial defects.”
What is a face transplant?
Face transplants are used to treat people who have substantial facial injuries or deformities that cannot be repaired using traditional reconstructive plastic surgery techniques.
For a person to consider a face transplant, facial disfigurement is typically so extensive that it interferes with their ability to talk, chew, swallow, blink, and even make simple facial expressions like smiling or grimacing. One of the main goals of face transplant surgery is to restore these functions and give people control over the movement of the mouth, nose, eyelids, and other parts of the face. But face transplants also have aesthetic benefits, including restoration of a more normal appearance, which can help boost the recipient’s self-confidence and self-image. A face transplant can enable them take part in everyday social activities without stigmatization or unwanted attention from others.
Depending on the extent of the disfigurement, face transplants can be partial (involving only part of the face) or complete (involving the entire face). In both cases, it’s a complex procedure that often involves not only transplantation of the skin, but also of the underlying bones, cartilage, tendons, ligaments, muscles, nerves, and blood vessels.
Face transplant surgery usually lasts fifteen hours or longer, and involves a multidisciplinary team of plastic surgeons, anesthesiologists, ENT (ear, nose, and throat) doctors, transplant specialists, critical care doctors, infectious disease doctors, nurses, technicians, and other healthcare providers.
The first face transplant was done in 2005 and through 2022, there have been over 40 face transplants throughout the world.
Who is a good candidate for face transplant surgery?
Face transplant candidates undergo an extensive screening process. Screening tests involve blood work and imaging tests such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI) scans that help doctors assess bones and other underlying tissues. Mental health assessments are also an important part of the screening process.
In general, candidates for face transplant surgery must meet the following requirements:
- 18 years of age or older
- Not have a current psychological disorder or infections (e.g., depression, hepatitis)
- Have not had cancer within the previous 5 years
- Does not use tobacco products
- Does not have a current substance use disorder (including alcohol, opioids, or other drugs)
Candidates must be prepared for regular follow ups with their providers, as well as a daily regimen of immunosuppressive medications for the rest of their lives.
Patients who are approved for a face transplant surgery are put on a waiting list. It may take days, weeks, or months for a donor face to become available. They must also undergo additional testing to identify their blood and tissue type, which are then matched to a donor to minimize the risk of rejection of transplanted tissue.
How long is the waiting list for a face transplant?
People approved for a face transplant are placed on a waiting list for a donor face. Donor faces are matched to the recipient based on blood and tissue type, age, sex, and size. While it can take anywhere from days to over a year to find a suitable donor, candidates can be called into surgery at any time, as soon as donor tissue becomes available.
What is involved in a face transplant procedure?
Once a face transplant donor has been identified and the patient is at the hospital for the procedure, two surgical teams will operate simultaneously. One team will remove facial tissue from the donor while the other prepares the patient for the procedure. The patient will be given immunosuppressive medications to prevent rejection of the donor tissue, and surgeons will remove parts of the patient’s face that will be replaced with donor tissue.
Surgeons then begin the transplant procedure. Surgeons attach bone using titanium plates and screws. Next, using a microscope, they connect blood vessels and nerves between the patient’s body and the donor tissue. Then, other tissues—tendons, ligaments, and muscles—are implanted and attached. At the end of the surgery, the donor skin is stitched to the patient’s skin to close the wound.
During the procedure, surgeons will also transplant a small section of donor’s skin to the patient’s chest, groin, or another inconspicuous area to help doctors monitor potential rejection of donor tissue. If the transplant recipient’s immune system rejects the donor tissue, it typically affects both the face and this section of transplanted tissue. Because this transplanted skin is in a less visible area, tissue samples can be collected without the need to biopsy the patient’s face.
What happens after face transplant surgery?
After surgery, patients may spend one to six weeks or sometimes longer in the hospital, where their health and recovery can be closely monitored. Patients will be given drugs to control pain as well as immunosuppressive medications.
Rehabilitation begins while the patient is still in the hospital. Physical therapists and speech and swallow therapists work with patients to help restore their ability to move different parts of their face, as well as to swallow, chew, and speak. Psychiatrists and psychologists meet with patients to help them adjust to their new appearance—face transplants tend to look like a mix between donor and recipient faces—and provide support for any other mental health issues that arise. Social workers and other specialists will also educate patients and their families about the recovery and rehabilitation process.
After leaving the hospital, the rehabilitation process may continue for six months or longer. It can take six months to a year for patients to gain control over facial movements. Regular check-ups are also necessary after returning home. These follow-up visits may involve blood work, imaging tests, and physical exams.
What are the risks of face transplant surgery?
Like all surgical procedures, face transplant surgery comes with some risks for complications. Some of these risks are associated with the surgical procedure itself, such as infection, bleeding, and blood clots.
Other complications may include:
- Rejection of the transplanted tissue. When a person receives a tissue transplant from a donor, their immune system will recognize it as foreign—something that doesn’t belong to the body—and attack it. Rejection of donor tissue can occur within minutes of the transplant or weeks or even years later. Signs of tissue rejection can include redness, swelling, and skin rash. Tissue rejection can often be treated using steroids and other medications, and by making adjustments to a patient’s immunosuppressive drug dose.
- Side effects from immunosuppressive medications. Immunosuppressive drugs suppress a person’s immune system. While this reduces the risk that the immune system will reject the transplanted tissue, it also reduces its ability to fight off infections and detect and eliminate cancer cells. Because of this, people who take immunosuppressive drugs may be at increased risk for infections and certain kinds of cancer, as well as kidney damage and diabetes.
What is the outlook for people who undergo face transplant surgery?
For people who have significant facial disfigurement, face transplant surgery can be transformative. It not only gives recipients a new appearance, but it can also improve their ability to breathe, eat, swallow, speak, smell, make facial expressions, and even feel sensation in their face. Face transplant recipients broadly report improved quality of life and body image, lower levels of depression, and a return to social life and everyday activities.
Face transplant surgery involves a significant commitment from patients—it’s a complex procedure and may require additional facial surgeries. The recovery is long and transplant recipients must take immunosuppressive medications for the rest of their lives. But the surgery also has the potential to substantially improve the quality of life for people with facial disfigurement.
What makes Yale’s approach to face transplant surgery unique?
“Yale has a strong multidisciplinary approach to transplantation in general; face transplant is one of the new programs that follows those principles,” says Dr. Pomahac. “We have a talented team of surgeons, medical doctors, nurses, and all support staff.”