A face transplant is performed to try to improve the quality of life for a person badly disfigured by facial trauma, burns, disease or birth defects. It is intended to enhance both appearance and functional abilities, such as chewing, swallowing, talking and breathing through the nose. Some people seek this surgery to reduce the social isolation they experience while living with severe facial disfigurement.
Face transplant is a challenging procedure. It's fairly new and very complex. Between 2005 and 2014, approximately 30 people are known to have undergone a face transplant, ranging in age from 20 to 60. At least three have died as a consequence of the infection on rejection.
Complications can result from:
- The surgery
- Your body's rejection of the transplant tissue
- Side effects of immunosuppressant drugs
You may need further surgeries or hospital visits to treat complications.
This is a complicated, lengthy procedure. You could be in surgery for 10 or more hours. Surgical and post-surgical risks can be life-threatening. They include blood loss, blood clots and infection.
Your body's immune system may reject the new face and other donor tissues. You could lose part or all of your new face and some function.
You may experience more than one episode of rejection. To control a rejection response, you may need to go to the hospital for an intensive IV dose of anti-rejection drugs. And your doctors may switch the type of anti-rejection drugs you take. Rarely, tissue rejection requires a new transplantation. Rejection that isn't controlled could cause death.
You'll need to learn the signs and symptoms of rejection so that you can take timely and appropriate action. They include swelling and a change in the color of your skin.
The anti-rejection drugs (immunosuppressants) you'll need to take daily for the rest of your life will weaken your immune system. This helps prevent tissue rejection, but it also puts you at risk of a variety of infections. Immunosuppressant drugs are also linked to an increased risk of kidney damage, cancer, diabetes and other serious conditions.
Evaluating whether to have a face transplant
Before you receive a face transplant, reflect on these questions:
- Have you weighed the risks of face transplant?
- Can you be fully committed to intense, lifelong follow-up care?
- What benefits do you hope to gain from this surgery?
- Have you tried or talked with your doctors about other treatment options, such as a facial prosthesis or conventional facial reconstruction?
You'll be evaluated by a transplant team. Candidates must:
- Have severe facial disfigurement
- Have a loss of facial function, such as chewing or talking
- Undergo a comprehensive exam that may include X-rays, CT and MRI scans, blood tests, and other measures of physical health
- Undergo an evaluation of their mental and emotional health, coping skills, family and social support, expectations, communication skills, and ability to manage post-transplant care
- Have no history of chronic nerve conditions
- Not be pregnant
- Have no serious medical problems, such as diabetes, heart disease or untreated cancer
- Have had no recent infections
- Be nonsmokers
- Not abuse alcohol or illegal drugs
- Complete a financial evaluation of post-transplant care expenses with a member of the transplant team
Getting ready for your face transplant
Once you're approved for a face transplant, you'll be placed on a waiting list for a donor face. When matching you with a donor face for a transplant, surgeons consider:
- Blood type
- Tissue type
- Skin color
- Comparable ages of donor and recipient
- Compatible facial size of donor and recipient
Your wait time can be unpredictable because it's usually not known when a donor face that matches your needs will become available.
In the meantime, you can prepare by:
- Undergoing pre-surgery evaluations. You'll need to visit the transplant center periodically so that your transplant team can do blood tests and evaluate whether you're ready for a transplant.
- Arranging for travel and lodging. Your transplant team will ask you to stay at a location that allows you to arrive at the hospital within a short time once you are contacted about your transplant date. After your surgery, you'll likely be asked to stay near your transplant center for two to three months. Your transplant team may have recommendations for long-term lodging if you need it.
- Staying in touch with your transplant team. Let your transplant team know immediately if you have any changes to your medical care, such as starting new medications, having a blood transfusion or receiving a diagnosis of a chronic medical condition.
The extent and length of your surgery depends on how much of the face and its underlying structures are involved. Your surgical team may transplant various tissues from the donor, such as skin, fat, muscles, tendons, cartilage, bone nerves and blood vessels.
The transplant will take 10 to 30 hours. Your surgical team will include plastic surgeons highly skilled in microsurgery and craniofacial surgery, anesthesiologists, ophthalmologists, surgical nurses, surgical technicians, imaging experts and others.
After surgery, you'll likely spend two to four weeks in the hospital. During this time, you will:
- Be fed through a tube
- Begin taking your daily doses of immunosuppressant drugs to prevent your body from rejecting the transplanted tissue
- Be given medications to manage pain
- Begin physical and speech therapy, as you are able
Your transplant team — including physicians, a transplant coordinator, social worker, therapist, pharmacists, dietitians and others — will work with you to develop a post-surgery treatment plan and provide the care you need.
Your daily post-surgical routine will include taking immunosuppressant medications and managing the side effects. These drugs can help stop your immune system from rejecting your donor face.
You can decrease the risk of rejection and medication side effects by:
- Committing to regularly taking immunosuppressant medications for the rest of your life unless directed to stop by a doctor
- Making regular appointments with your transplant team for blood tests and checkups
- Contacting your transplant team or your primary care doctor if you notice that you're becoming ill with an infection or tissue rejection.
You and your transplant team can't know for sure what the results of your surgery will be. Each previous face transplant recipient has had different experiences with the post-surgical appearance and function. Most experienced improved ability to smell, eat, drink, talk, smile and make other facial expressions. Some regained the ability to feel a light touch on the face. Because this surgical technique is still fairly new, the long-term results for face transplant recipients are yet to be determined.
Your results will be affected by:
- The extent of your operation
- Your body's response to the new tissue
- Nonphysical aspects of your recovery, such as your emotional and psychological response to living with a new face
You will increase your chance of a positive outcome by carefully following your post-transplant care plan and seeking the support of friends, family and your transplant team.