Face transplant: What you need to know

A Spanish hospital performed the world's first full face transplant on a man, according to media reports.

It took 24 hours for Dr. Joan Pere Barret and his 30 colleagues to complete the operation at Barcelona’s Vall d’Hebron University Hospital.

The patient's face had been disfigured in an accident.  Post-transplant, his face now has a new nose, lips, tear ducts, cheekbones and jaw.

Doctors deemed the surgery a success.

A face transplant is considered a last resort surgery for those with severe disfigurement,  as the risk for the patients is great.  The surgery should be only used for patients who suffer from grave injury caused by burns, trauma, cancer extirpation or congenital birth defects. Not all patients are eligible for the surgery.

Coffman K.L and colleagues from Cleveland Clinic published an article in the April 15, 2010 issue of Current Opinion in Organ Transplantation, offering some guidance on facial composite tissue transplantation.

The authors disclosed that previously published face transplant reports did not reveal the patients' body image, mood changes, perception of teasing, quality of life, self-esteem, or social reintegration quantitatively.

While face transplantation seemed to decrease depression and verbal abuse while it simultaneously improved quality of life and social reintegration, it did not alter anxiety or self-esteem levels.  The patient had to face new medical and psychological challenges after the operation.

Coffman reported that two of eight patients who received face transplants died (the mortality rate is 25%), and the surgery may result in blindness.  How long the patients can survive after the surgery remains unpredictable.

The American Society for Reconstructive Microsurgery and the American Society of Plastic Sugeons have in place a set of guiding Principles on facial transplantation, indicating that the surgery is highly experimental.

Immunosupression

Face transplant recipients need to take immunosupressants, which can result in increased incidence of opportunistic infections, increased risk of malignancies and end-organ toxicity. Although the anti-rejection drugs are readily available, it remains unknown whether a particular patient would experience organ rejection episodes.

Transplant Rejection

The guiding principles estimate that about 10 percent of facial transplant recipients will experience an episode of rejection within the first year after the surgery; another 30 to 50 percent experience 2 to 5 years of the operation . Increasing dosages of immunosuppressive drugs may help anti-rejection and when this approach fails, removing a rejected face transplant would be warranted.  However, in this instance patients will experience additional surgeries and his face will be further deformed or disfigured with new facial scarring.

Technical Challenges

The transplanted tissue will need at least two arteries and veins from the donor's face to help restore facial animation. The face transplantation may use a combination of skin, soft tissue, muscle and or bone, meaning that no two operations are the same.

Psychological Challenges

Facial transplantation itself can cause psychological stress.  Patients need to deal with the burden of strict postoperative medical regimes, accept many side effects and risks from immunosupression, and experience swings in emotion and stress of self-perceived responsibility for success or failure of the operation.

Jimmy Downs and editing by Rachel Stockton