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 became the first U.S. hospital to perform a face transplant. At the time, it was considered the largest and most complex face transplant in the world, integrating different functional components such as nose and lower eyelids, as well as different tissue types including, skin, muscles, bony structures, arteries, veins and nerves.
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
In a 31-hour surgery in May, 11 Cleveland Clinic surgeons and multiple specialists performed the hospital’s third face transplant – and its first total face transplant – on a 21-year-old female who suffered severe facial trauma and other complications from a gunshot wound as a teenager.
The surgery included transplantation of the scalp, the forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of lower jaw, upper teeth, lower teeth, partial facial nerves, facial muscles, and skin, effectively replacing 100 percent of the patient’s facial tissue.
When the Cleveland Clinic face transplant team reviewed this patient’s case, they had the end goal of face transplantation in mind – as facial reconstruction alone would not correct her facial disfigurement or improve her quality of life. With a face transplant at the forefront, the surgeons were able to safeguard any potential blood vessels that could be used for the transplant during her initial stages of reconstruction.
This surgery will give the patient the capability to speak more clearly, and breathe, chew, and swallow more effectively. She’ll also be able to use her face to better express emotions. In addition to significantly improved physical function, the patient will also have enhanced physiological, psychological and social function.
Since the surgery, the patient is recovering well and getting accustomed to her new face. She is walking, talking and will begin eating orally shortly. She will continue to go through extensive rehabilitative therapy, including physical therapy, speech and swallowing therapy and occupational therapy. Doctors continue to monitor her closely for signs of tissue rejection. The patient, like all transplant patients, will remain on immunosuppressant medication for the rest of her life to prevent rejection.
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
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
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 hotline, available from 7 a.m. to 7 p.m. EST, every day — 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.
