Overview

Overview

The face is integral to what makes us human. When the face has been destroyed through trauma or disease, surgeons must consider both form (how the skin, bones and the underlying musculature looks) and function of remaining tissues (are all of the major components, such as lips, jaws, eyelids, and nose still intact). While there are many excellent plastic and reconstructive techniques to address any one of these deficits, a patient who is missing more than one facial component may not have enough of his or her own tissues to rebuild all of the intricate structures of the face. In these cases, the patient may have better outcomes using transplanted tissues from a deceased donor.

In 2008, Cleveland Clinic plastic and reconstructive transplant surgeons completed a near-total face transplant for a woman with severe facial disfigurement from a gunshot wound. The patient regained her ability to eat, smell and open and close her eyes, as well as her ability to express emotion. These changes have given her the self-confidence to interact with society.

For patients in whom conventional plastic and reconstructive surgery is insufficient to produce acceptable results, face transplantation may offer patients the possibility of restoring facial form and function.

About

About

About the First Near-total Face Transplant in the U.S.

On December 8, 2008 a multi-disciplinary team of Cleveland Clinic doctors and surgeons performed the first near-total face transplant in the United States.

About the Patient

The patient - Connie Culp of Unionport, Ohio - had suffered severe facial trauma after a gunshot blast destroyed the middle part of her face in 2004. She had no nose and no palate after her injury. She was unable to eat or breathe on her own, without a tracheostomy, and was missing bone support. Cleveland Clinic doctors have been treating her for several years, and she has undergone several reconstructive procedures; however, none of the available, conventional treatment options could restore her facial function.

About the Procedure

In a 22-hour procedure, a team of eight surgeons replaced 80 percent of trauma patient Connie Culp's face – essentially transplanting the full face except her upper eyelids, forehead, lower lip, and chin.

When performed, this was known as the largest and most complex face transplant in the world. The surgery integrated different functional components, such as nose and lower eyelids as well as different tissue types including, skin, muscles, bony structures, arteries veins and nerves. Approximately 500 square centimeters of tissue were transplanted onto the recipient.

About the Surgery

The procedure began at 5:30 p.m., when doctors checked Ms. Culp's blood vessels within the neck region to ensure she was capable of receiving the transplant. Once it was confirmed, surgeons began recovering the donor’s facial tissue at about 8 p.m. The 9-hour-and-10-minute donor surgery paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures, to preserve circulation and the integrity of the facial graft.

In an adjacent operating room, a second surgical team prepared the recipient – removing scar tissues to create a space for the facial graft inset. The donor’s facial tissue was transferred to Ms. Culp's operating room at 5:10 a.m. the next morning. Over the next 2 hours and 40 minutes, surgeons connected the patient’s blood vessels to the facial graft vessels in order to restore blood circulation in the reconstructed face. This was the most critical moment of the surgery, because as blood flow from the recipient reaches the graft, immediate rejection may occur. In this case, though, the tissue turned pink, signifying a successful transplantation.

At this point, surgeons still had nearly nine hours of surgery ahead of them to complete facial graft attachments to Ms. Culp's face, including microsurgical connections of arteries, veins, and nerves. During the entire transplantation procedure, surgeons rotated turns at the operating table to rest, to sleep, or to share expertise. By 4:30 p.m., Ms. Culp was wheeled out of the operating room in stable condition.

One year after her surgery, Ms. Culp could finally smell, taste and breathe normally again.

Download the press release (PDF)

Cleveland Clinic's renowned medical staff combines research, education and clinical practice to provide innovation and scientifically based treatments that improves the lives of our patients.

Cleveland Clinic has a rich history of innovation, from performing the world's first coronary angiography to completing the first near-total face transplant in the United States.

If you would like more information about becoming a face transplant candidate or how to refer a patient, please email Cleveland Clinic at DPSIresearch@ccf.org.

Members of the media can call the Media Relations Department at 216.444.0141.

Patient Criteria

Patient Criteria

Becoming a Patient

Candidates for facial transplantation include those patients with severe facial deformities which cannot be successfully restored using currently available standard reconstructive procedures. Transplantation of the face allows for reconstruction of functional units such as nose with nasal lining, lips, eyelids, or ears. Becoming a Reconstructive Transplantation patient:

  • Patients interested in being considered for facial reconstructive transplantation at Cleveland Clinic are carefully screened for psychological health, family support, understanding of complications and medication compliance.
  • Patients must be healthy enough to tolerate surgery and the extensive immunosuppression therapy required after surgery to prevent rejection.
  • Patients must undergo extensive psychiatric evaluation to ensure their mental stability and ability to handle the treatment and recovery from transplantation.
  • Patients are required to show a sufficient social support network to cope with the stress and possible complications of transplantation.
  • Patients with a previous history of cardiovascular disease or cancer may not be eligible due to an increased risk of complications and recurrence from immunosuppression therapy.

For more information to schedule an appointment, please email DPSIresearch@ccf.org.

FAQs

What are the ethical concerns of a face transplant?

The surgery is not without serious risks, including rejection of the tissue, and a lifelong commitment to immunosuppressing medications, which can lead to infection and other diseases. Some experts question the value of such risk, considering that facial disfigurement is not a life-threatening situation.

However, Dr. Maria Siemionow, Director of Plastic Surgery Research, notes that facial disfigurement is life-altering, affecting a person’s quality of life. Many people with facial disfigurement become recluses, choosing not to be exposed to a public that will stare, taunt, or react with fear.

Who is a good candidate for a face transplant?

Candidates must demonstrate strong psychological stability, resiliency, responsibility, and self-reliance. They must have exhausted all other possible approaches to correct function and disfigurement. And they must have enough healthy skin elsewhere on their bodies to serve as a skin graft if the transplant is rejected.

Finding both a proper candidate, as well as donor, is difficult. Matches need to be made with the recipient’s gender, race, approximate age, and blood type. Even when a match is found, the donor family needs to be willing to donate facial tissue, which can be an emotional decision for the family.

What is the risk of the recipient’s immune system rejecting the new face?

Every patient has an episode of rejection, which may manifest itself as a change in color, patchiness, swelling, or redness. If caught quickly, the rejection can be tamed by making changes to the immunosuppressive medication.

The patient will likely need to take immunosuppressing, anti-rejection drugs similar to those used in organ transplant patients, for the rest of their life.

What if the transplant fails?

The transplant would be replaced with a skin and other required grafts taken from different parts of the patient’s body.

What should the patient expect after surgery?

While each situation is different for different patients, within a few months the face transplant patient should expect initial swelling to subside. Within about six months, feeling should return to the face. And within about a year, function should return to most of the face.

Will the patient look like the donor?

No. The underlying facial structure of any two people is very different. Plus, a person’s identity is more than skin and bones, relying on expression, animation, and social interaction.

Surgical Team Videos

Videos

Watch Cleveland Clinic’s Face Transplant playlist on YouTube to see more videos.

Armed Forces

Armed Forces

Armed Forces Partnership

Cleveland Clinic has taken a strong leadership role in the Armed Forces Institute of Regenerative Medicine (AFIRM), a multi-institutional consortium funded by the Department of Defense, the Department of Veterans Affairs and the National Institutes of Health, with mandate to develop new regenerative medicine therapies to treat our war wounded. The Armed Forces Institute of Regenerative Medicine supports technologies to regenerate or rebuild tissues such as bone, cartilage, muscle, tendon and skin. But sometimes, the best and most direct way to reconstruct very extensive wounds to the face or hands is to transplant tissue from a donor. Cleveland Clinic is working to make composite tissue transplants safer and more accessible for wounded service members who need this kind of reconstruction.

Cleveland Clinic is one of only a few centers in the country that is screening patients for reconstructive transplant of the face, arms and hands.

Becoming a Patient

Patients interested in being considered for reconstructive transplantation at Cleveland Clinic are carefully screened for psychological health, family support, understanding of complications and medication compliance.

  • Patients must be healthy enough to tolerate surgery and must undergo extensive psychiatric evaluation to ensure their mental stability and ability to handle the treatment and recovery from transplantation.
  • Patients are required to show a sufficient social support network to cope with the stress and possible complications of transplantation.
  • Patients with a previous history of cardiovascular disease or cancer may not be eligible, due to an increased risk of complications and recurrence from immunosuppression therapy.

For more information, or to see if you are a candidate please call us at 216.445.2405.

Referral

Referral

Refer a Patient

Cleveland Clinic Department of Plastic Surgery and Center for Reconstructive Transplantation strives to ensure prompt management of all patients and timely responses to our referring physician and health care professional colleagues.

Referring Physician Center and Hotline

Cleveland Clinic’s Referring Physician Center has established a 24/7 hotline — 855.REFER.123 (855.733.3712) — to streamline access to our array of medical services. Contact the Referring Physician Hotline for information on our clinical specialties and services, to schedule and confirm patient appointments, for assistance in resolving service-related issues, and to connect with Cleveland Clinic specialists.

You also may contact our Department of Plastic Surgery physicians and surgeons directly through the online staff directory.

Critical Care Transport

Cleveland Clinic’s Critical Care Transport team serves critically ill and highly complex patients around the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft.