A face transplant is a rarely done surgery that uses donor facial tissues from someone who has died to replace all or part of a damaged face. It’s a complex procedure that requires multiple surgical teams.
For someone living with severe facial deformities, a face transplant can be life-changing. It can restore movement and function in your face and improve your quality of life.
Reasons for a Face Transplant
A face transplant can be transformative when your day-to-day life is greatly impacted by a face deformity. You may have lost certain important functions or feel socially isolated by your appearance.
Some of the common causes of facial deformities include:
- Severe trauma
- Burns
- Disease
- Birth defects
Who are face transplant candidates?
They are typically people whose facial deformities can’t be fixed with typical reconstructive plastic surgery. This means your facial disfigurement is so severe, it affects your ability to do things like:
- Talk
- Chew
- Swallow
- Blink
- Make simple facial expressions such as smiling
Most hospitals have other criteria for face transplants, such as:
- You’re at least 18 years old and younger than 60.
- You’ve lost at least 25% of your facial tissue.
- You can take immunosuppressants for the rest of your life.
- You’re at least 6 weeks post-pregnancy.
- You agree not to get pregnant for at least a year after the surgery.
- You don’t have major infections, such as HIV or hepatitis.
- You don’t smoke.
- You don’t have a history of cancer or conditions that affect your heart and blood vessels.
Before a Face Transplant
Preparing for a face transplant takes multiple steps and some lead time. First, you’ll go through an approval process for the procedure. Once you’re approved, you’re put on a waiting list for a donor face.
In order to be matched with a donor, your team will look at your:
- Blood type
- Tissue type
- Skin color
- Biological sex vs. your donor’s biological sex
- Age vs. your donor’s age
- Facial size vs. donor’s facial size
They’ll also want to be sure you have enough healthy skin elsewhere on your body, which they can use in case your face transplant isn’t successful.
Doctors can’t predict when a match will be available, but when it is, surgery needs to happen quickly. They’ll do necessary evaluations ahead of time so you’re ready.
Face transplant screening
When you’re being considered for a face transplant, you need many evaluations to see if your body and mind can handle the surgery.
Muscles and nerves. Your team will look at the way your body and face function. They’ll decide whether your muscles and nerves are healthy enough to support new nervous tissue growth.
Physical health. Doctors will consider your whole health. That includes whether you can tolerate the surgery, as well as lifelong immunosuppressive drugs. You also need physical therapy after the transplant. They’ll ask about your family health history. They’ll check your organs and blood, and they’ll take images of your face with X-ray and CT scans to create a 3D-printed skull for guiding the surgical plan.
Psychological health: You’ll meet with psychiatrists and social workers to talk about any stress you may face during the process of surgery and recovery. Because face transplants are rare, you may deal with public and even media attention.
Face transplant donors
Because face donation is a sensitive and intimate matter, your decision process is separate from the typical organ donation registry you opt into on your driver’s license. Faces have emotional meaning for loved ones of the deceased. In some cases, donors choose to give their face in the event of their death, but other times, the family is the decision-maker.
What to Expect From a Face Transplant
Every face transplant is different. How long and complex your surgery is will depend on how much of your face and other structures are involved. Surgery may take as long as 30 hours or as few as 10.
During a face transplant
Two surgical teams work at the same time during a face transplant. One team works on the donor face to remove tissue, while the other team prepares your body. You’ll start immunosuppressive drugs before surgery so that your body doesn’t try to attack the new tissue after the transplant.
Once the donor’s face has been removed, surgeons put it in a special solution and cool it to preserve it. When you’re the recipient, you’ll go under general anesthesia so you aren’t awake and can’t feel anything.
To attach the donor face to you, as the recipient, surgeons start with any bone involved. They’ll use titanium plates and screws to attach the donor bone to your face. Then they’ll use a microscope to connect blood vessels and nerves between the donor tissue and your tissue.
Last, they’ll attach other tissues, such as tendons, ligaments, and muscles, and stitch the donor skin to your skin to close the opening.
After a face transplant
You’ll move to the intensive care unit after the surgery is complete. It’ll take a while for you to wake up. Your health care team will monitor your vital signs as you do. Once you’re stable, your team will move you to the transplant unit.
It takes 1 to 6 weeks, or longer, for you to recover in the hospital. You’ll get your food through a tube, and your team will give you pain medication.
You’ll work with physical therapists and other therapists who can help you learn to speak, swallow, chew, and move different parts of your face. You’ll meet with therapists and psychiatrists to work through the emotional side of having a new face. They’ll support your mental health as you recover and learn new skills.
Life After a Face Transplant
Once you leave the hospital, you’ll continue rehabilitation. Your doctor will set up a schedule for you to come back for tests and monitoring for at least 3 months. Your team may:
- Take blood to test transplant drug levels (immunosuppressants)
- Do imaging tests to look at the structures of your face
- Check on your quality of life
- Test the return of sensation to your face
- Look at small samples of tissue to check for rejection
Your face swelling may take 2 to 3 months to get better. Typically, feeling comes back to your face after 6 months. It takes about 12 months for most facial functions, such as smiling, to come back.
Over time, you’ll need to visit the hospital less and less. But a face transplant requires lifelong care and monitoring, as well as immunosuppressant drugs.
What Loved Ones Should Know
You’ll go through a significant transformation, both physically and emotionally. You won’t look exactly like your donor, and you won’t look exactly as you used to. You’ll be a hybrid of the two.
The results are somewhat unpredictable. But a successful face transplant may improve your quality of life drastically enough that your mood changes. You may feel more prepared to be social and take part in things you previously avoided.
Still, it’s a major surgery that takes a long time for recovery. Patience and support are key.
Face Transplant Risks
All surgery comes with risk, and the length and complexity of face transplants increase those risks. Ultimately, your body could reject the new tissue, but the surgery itself has risks, such as:
- Complications with anesthesia
- Bleeding
- Blood clots
- Infection
- Death
After the surgery, the required immunosuppressant drugs can weaken your immune system and increase your risk of infection. Taking immunosuppressant drugs also raises your risk of kidney damage, cancer, diabetes, and other serious conditions.
Face Transplant Rejection
Like other organ transplant surgeries, the biggest risk is that your body will reject the new tissue. This happens when your body’s immune system sees the donor face as a threat and attacks it as it would a germ or infection.
Rejection of a face donation may happen in stages, or episodes. Rejection may look like a rash that’s spotty, patchy, or blotchy. The rash can show up anywhere on your face and is painless.
Your doctor will biopsy skin that looks like it’s being rejected. They can give you an intensive IV dose of anti-rejection drugs. In rare cases, you may need a new transplant. If your rejection isn’t controlled, you could die.
Takeaways
A face transplant is a rarely done surgery that replaces damaged facial tissue with donated tissue from someone who’s no longer living. It’s a complex and long procedure that requires rehabilitation and taking immunosuppressive medications for the rest of your life. Risks include rejection and infection.
Face Transplant FAQs
Has anyone ever had a full-face transplant?
Yes. The first person to have a full-face transplant was Dallas Wiens in March 2011. It took a team of 30 doctors, nurses, anesthesiologists, and residents 15 hours to replace the nose, lips, facial skin, muscles, and nerves.
How long do face transplants last?
Because there have been so few procedures, it’s hard to predict how long face transplants will last. Results vary, based on how extensive the surgery is, rejection episodes, and infection.
Is a facial transplant possible?
For people who fall under the right criteria and match with a donor, a face transplant is possible.
Is the person who got the first face transplant still alive?
The first face transplant was a partial face transplant, performed on a French woman, Isabelle Dinoire, in 2005. She died in 2016, at age 49.
What is the survival rate for those who have a face transplant?
Survival rates for the procedure are around 89%. Since the first face transplant in 2005, surgeons have performed over 40. Only a few people who got them have died due to infection or rejection.
Who is the youngest person to get a face transplant?
In 2017, Katie Stubblefield became the youngest face transplant recipient at age 21.
Who is the longest-living person with a face transplant?
The longest-living person with a face transplant was Connie Culp, who received the first partial face transplant in the U.S. in 2008. Culp died in 2020 at age 57.
Why can't eyes be transplanted?
Researchers hope to someday perform whole-eye transplants that can restore lost sight, but that’s not yet possible. Most eye transplants are corneal transplants, where a surgeon replaces your damaged cornea with a donor cornea.