Trisha Shetty (Editor)

Face transplant

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Face transplant

A face transplant is a medical procedure to replace all or part of a person's face using tissue from a cadaver. The world's first partial face transplant on a living human was carried out in France in 2005. The world's first full face transplant was completed in Spain in 2010. Turkey, France, the United States and Spain (in order of total number of successful face transplants performed) are considered the leading countries in the research into the procedure.


Beneficiaries of face transplant

People with faces disfigured by trauma, burns, disease, or birth defects might aesthetically benefit from the procedure. Professor Peter Butler at the Royal Free Hospital first suggested this approach in treating people with facial disfigurement in a Lancet article in 2002. This suggestion caused considerable debate at the time concerning the ethics of this procedure.

An alternative to a face transplant is facial reconstruction, which typically involves moving the patient's own skin from their back, buttocks, thighs, or chest to their face in a series of as many as 50 operations to regain even limited functionality, and a face that is often likened to a mask or a living quilt.

L. Scott Levin, M.D., FACS, Chair, Department of Orthopaedic Surgery at University of Pennsylvania School of Medicine, has described the procedure as "the single most important area of reconstructive research".

Self as donor ("face replant")

The world's first full-face replant operation was on 9-year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas, one of India's top microsurgeons. In 2004, Sandeep was training to be a nurse.

In 1996, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.

In France

The world's first partial face transplant on a living human was carried out on 27 November 2005 by Bernard Devauchelle, an oral and maxillofacial surgeon, Benoit Lengelé, a Belgian plastic surgeon, and Jean-Michel Dubernard in Amiens, France. Isabelle Dinoire underwent surgery to replace her original face, which had been mauled by her dog. A triangle of face tissue from a brain-dead woman's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient was happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response. Dinoire died on April 22, 2016 at the age of 49 following a long illness.

In China

In April 2006, Dr Guo Shuzhong at the Xijing military hospital in Xi'an, China similarly transplanted the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep. On 21 December 2008 it was reported that Li had died in July in his home village in Yunnan. Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favor of herbal medication—a decision that was likely a contributing factor to his death, according to his surgeon.

In France

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly.

In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after he received what his doctors call the world's first successful almost full face transplant. The operation, which lasted approximately 20 hours, was designed and performed by Professor Laurent Lantieri and his team ( Dr Jean Paul Meningaud, Dr Antonios Paraskevas and Dr Fabio Ingallina ).

In Turkey

Assoc Prof. Selahattin Özmen performed Turkey's third face transplant, first women to women and first three dimensional (with bone tissue) face transplant, a partial face transplant, on March 17, 2012 on Hatice Nergis, a twenty-year-old woman, at Gazi University's hospital in Ankara. The patient from Kahramanmaraş had lost six years prior her upper jaw including mouth, lips, palate, teeth and nasal cavity by a firearm accident, and was since then unable to eat. She had undergone in the past around 35 reconstructative plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin in Istanbul, who committed suicide. Nergis died in Ankara on November 15, 2016 after she was hospitalized two days prior due to strong pains.

Full face transplant

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant, on a man injured in a shooting accident. It became the first full face transplant in the world.

On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the Henri-Mondor hospital in Créteil.

In March 2011, a surgical team, led by MUDr. Bohdan Pomahač at Brigham and Women's Hospital in Boston, performed a full face transplant on Dallas Wiens who was badly disfigured in a power line accident that left him blind and without lips, nose or eyebrows. The patient's sight couldn't be recovered but he has been able to talk on the phone and smell.

In April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women’s Hospital face transplant team, led by MUDr. Bohdan Pomahač, performed the nation’s second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter, 30, of Indiana, including the nose, muscles of facial animation and the nerves that power them and provide sensation. Hunter suffered a severe shock from a high voltage electrical wire following a car accident in 2001.

On 19 March 2012, one of the longest and most extensive facial transplants ever (36 hours, from 4 am 19 March to 2–3 PM 20 March; the 23rd ever to occur; from the hairline to the neck, replacing essentially everything but the eyes and the back remnants of the throat) took place on Richard Lee Norris of Hillsville, Virginia, who had suffered a gunshot wound in 1997 that left him with extensive facial trauma, at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, Maryland. Seven months after the procedure, Norris exhibits remarkable progress. Norris can smile and show facial expressions, and also smell, taste and eat. The motor function on the right side of his face is about 80 percent of normal and motor function on the left side is about 40 percent, according to his doctors.

In Poland

On 15 May 2013, at the Maria Skłodowska-Curie Institute of Oncology branch in Gliwice, Poland, an entire face was transplated onto a male patient (aged 33) after he lost the front of his head in a machine accident at work. The surgery took 27 hours and was directed by Professor Adam Maciejewski. There had not been much planning or prep time before the surgery, which was performed about one month after the accident, because the transplantation was done as an urgent life-saving surgery due to the patient's difficulty in eating and breathing. Shortly after the donor's death, the decision to perform the surgery was made and his body was transported hundreds of kilometers to Gliwice once his relatives gave their consent. The doctors believe that their patient has an excellent chance to live a normal, active life after surgery, and that his face should operate more or less normally (his eyes survived the accident untouched).

Seven months later, on 4 December, the same Polish medical team in Gliwice transplanted a face onto 26-year-old female patient with neurofibromatosis. Two months after the operation, she left the hospital.

In Turkey

On 21 January 2012, Turkish surgeon Dr. Ömer Özkan and his team successfully performed a full face transplant at Akdeniz University's hospital in Antalya. The 19-year-old patient, Uğur Acar, was badly burnt in a house fire when he was a baby. The donor was 39-year-old Ahmet Kaya, who died on 20 January. The Turkish doctors declared that his body had accepted the new tissue.

Almost one month later on 24 February 2012, a surgical team led by Dr. Serdar Nasır conducted the country's second successful full face transplant at Hacettepe University's hospital in Ankara on 25-year-old Cengiz Gül. The patient's face was badly burned in a television tube implosion accident when he was two years old. The donor was 40-year-old N. A. (his family did not permit the identity of the donor to be revealed), who experienced brain death two days before the surgery following a motorcycle accident that occurred on 17 February.

On 16 May 2012, surgeon Dr. Ömer Özkan and his team at the Akdeniz University Hospital performed the country's fourth and their second full face transplant. The face and ears of 27-year-old patient Turan Çolak from Izmir were burnt when he fell into an oven when he was three and half years old. The donor was Tevfik Yılmaz, a 19-year-old man from Uşak who had attempted suicide on 8 May. He was declared brain dead in the evening hours of 15 May after having been in intensive care for seven days. His parents donated all his organs.

On 18 July 2013, the face of a Polish man was successfully given to a Turkish man in a transplant performed by Dr. Özkan, at Akdeniz University hospital following a 6.5-hour operation, making it the fifth such operation to take place in the country. It was the 25th face transplant operation in the world. The donor was Andrzej Kucza, a 42-year-old Polish tourist who was declared brain dead following a heart attack on July 14 while swimming in Turkey's sea resort Muğla. The 27-year-old patient Recep Sert came immediately from Bursa to Antalya for the surgery late July 17.

On 23 August 2013, surgeon Ömer Özkan and his team at Akdeniz University performed the sixth face transplant surgery in Turkey. Salih Üstün (54) received the scalp, eyelids, jaw and maxilla, nose and the half tongue of 31-year-old Muhittin Turan, who was declared brain dead after a motorcycle accident that took place two days before.

On 30 December 2013, Prof. Özkan and his team conducted their fifth and Turkey's seventh face transplant surgery at the hospital of Akdeniz University. The nose, upper lip, upper jaw and maxilla of braindead Ali Emre Küçük, aged 34, were successfully transplanted to 22-year-old Recep Kaya, whose face was badly deformed in a shotgun accident. While Kaya was flown from Kırklareli to Antalya via Istanbul in four hours, the donor's organs were transported from Edirne by an ambulance airplane. The surgery took 4 hours and 10 minutes.

In the United Kingdom

In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out face transplants. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six-month intervals.

In the United States

In 2004, the Cleveland Clinic became the first institution to approve this surgery and test it on cadavers.

In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Pole Prof. Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Dr Steven Bernard, Dr Mark Hendrickson, Dr Robert Lohman, Dr Dan Alam and Dr Francis Papay) performed the first face transplant in the US on a woman named Connie Culp. It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a brain-dead donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved.

The second partial face transplant in the US took place at Brigham and Women's Hospital in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by MUDr. Bohdan Pomahač, replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. Mr. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result. This procedure was also shown in the eighth episode of the ABC documentary series Boston Med.

The first full face transplant performed in the US was done on a construction worker named Dallas Wiens in March 2011. He was burned in an electrical accident in 2008. This operation, performed by Dr. Bohdan Pomahač and Dr. Jeffrey Janis, was paid for with the help of the US defense department. They hope to learn from this procedure and use what they learn to help soldiers suffering from facial injuries. One of the top benefits of the surgery was that Dallas has regained his sense of smell.

The second full face transplant was done on a Vet named Mitch Hunter in April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women’s Hospital face transplant team, led by MUDr. Bohdan Pomahač, performed the nation’s second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter, 30, of Indiana, including the nose, eyelids, muscles of facial animation and the nerves that power them and provide sensation. Hunter suffered a severe shock from a high voltage electrical wire following a car accident in 2001 after saving a young woman's life following a car wreck in Thomasville, North Carolina on November 31, 2001. Mitch Hunter was a passenger in a single cab pick-up style truck, upon exiting the vehicle and pulling another passenger off a downed line, Hunter was then struck by a 10,000-volt 7-amp power line for a little under five minutes. The electricity entered his lower left leg, with the majority exiting his face, leaving him severely disfigured. He also lost part of his lower left leg, below the knee, and lost two digits on his right hand (pinkie and ring finger). Mitch has regained almost 100% of his normal sensation back in his face and his only complaint is that he looks too much like his older brother.

57-year-old Charla Nash, who was mauled by a chimpanzee in 2009, underwent a 20-hour full face transplant in May 2011 at Brigham and Women's Hospital in Boston. Nash's full face transplant was the third surgery of its kind performed in the United States, all at the same hospital.

In March 2012, a face transplant was completed at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center under the leadership of plastic surgeon Eduardo Rodriguez, DDS, MD and his team (Amir Dorafshar MBChB, Michael Christy MD, Branko Bojovic MD, and a Canadian doctor Daniel Borsuk MD). The recipient was a 37-year-old man who had suffered a facial ballistic injury in 1997. This transplant represents the most extensive to date, and included all facial and anterior neck skin, both jaws, and the tongue.

In August 2015, the most extensive face transplant ever was completed at the NYU Langone Medical Center under the leadership of the chair of plastic surgery Eduardo D. Rodriguez, DDS, MD and his team. A 41 year old retired fireman from Senatobia, MS named Patrick Hardison received the face of cyclist David Rodebaugh

Ethics, surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (sometimes including the underlying fat, nerves, blood vessels, bones, and/or musculature). The surgery may last anywhere from 8 to 36 hours, followed by a 10- to 14-day hospital stay.

There has been a substantial amount of ethical debate surrounding the operation and its performance. The main issue is that, as noted below, the procedure entails submitting otherwise physically healthy people to potentially fatal, lifelong immunosuppressant therapy. So far, four people have died of complications related to the procedure. Citing the comments of various plastic surgeons and medical professionals from France and Mexico, anthropologist Samuel Taylor-Alexander suggests that the operation has been infused with nationalist import, which is ultimately influencing the decision-making and ethical judgements of the involved parties. His most recent research suggests the face transplant community needs to do more in order to ensure that the experiential knowledge of face transplant recipients is included in the ongoing evaluation of the field.

After the procedure, a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could damage the transplanted face and require a second transplant or reconstruction with skin grafts.

Popular culture

  • The procedure was envisioned in Georges Franju's 1960 cult horror film Les Yeux sans visage, which translates to "Eyes Without a Face."
  • Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.
  • The plot of the 1997 film Face/Off is based on a face transplant operation that involved switching the skin of the face, making the transplant recipient look indistinguishable from the donor, with immediate and complete use of the transplanted tissue. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face.
  • References

    Face transplant Wikipedia

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