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A face transplant is a medical procedure to replace all or part of a person's
face The face is the front of an animal's head that features the eyes, nose and mouth, and through which animals express many of their emotions. The face is crucial for human identity, and damage such as scarring or developmental deformities may aff ...
using tissue from a donor. Part of a field called "Vascularized Composite Tissue Allotransplantation" (VCA) it involves the transplantation of facial
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...
, the nasal structure, the
nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passe ...
, the
lip The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be ...
s, the
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of mus ...
s of facial movement used for expression, the
nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the ...
s that provide sensation, and, potentially, the
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
s that support the face. The recipient of a face transplant will take life-long medications to suppress the
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
and fight off rejection. 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 Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
,
burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur ma ...
s, disease, or
birth defect A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities ca ...
s might aesthetically benefit from the procedure. Professor Peter Butler at the
Royal Free Hospital The Royal Free Hospital (also known simply as the Royal Free) is a major teaching hospital in the Hampstead area of the London Borough of Camden. The hospital is part of the Royal Free London NHS Foundation Trust, which also runs services at Bar ...
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 A quilt is a multi-layered textile, traditionally composed of two or more layers of fabric or fiber. Commonly three layers are used with a filler material. These layers traditionally include a woven cloth top, a layer of batting or wadding, ...
.


History


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 ''The Guardian'' is a British daily newspaper. It was founded in 1821 as ''The Manchester Guardian'', and changed its name in 1959. Along with its sister papers '' The Observer'' and '' The Guardian Weekly'', ''The Guardian'' is part of the ...
'' recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a
threshing machine A threshing machine or a thresher is a piece of farm equipment that threshes grain, that is, it removes the seeds from the stalks and husks. It does so by beating the plant to make the seeds fall out. Before such machines were developed, thr ...
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 Victoria most commonly refers to: * Victoria (Australia), a state of the Commonwealth of Australia * Victoria, British Columbia, provincial capital of British Columbia, Canada * Victoria (mythology), Roman goddess of Victory * Victoria, Seychelle ...
, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.Seattle Times ''The Seattle Times'' is a daily newspaper serving Seattle, Washington, United States. It was founded in 1891 and has been owned by the Blethen family since 1896. ''The Seattle Times'' has the largest circulation of any newspaper in Washington st ...
">


Partial face transplant


France

The world's first partial face transplant on a living human was carried out on 27 November 2005 by
Bernard Devauchelle Bernard Devauchelle is a French oral and maxillofacial surgeon, best known for successfully completing the first face transplant in November 2005 at Amiens Amiens (English: or ; ; pcd, Anmien, or ) is a city and commune in northern Franc ...
, an oral and maxillofacial surgeon, Benoit Lengelé, a Belgian plastic surgeon, and
Jean-Michel Dubernard Jean-Michel Dubernard (; 17 May 1941 – 10 July 2021) was a French medical doctor specializing in Organ transplant, transplant surgery who served as a Deputies of the 12th French National Assembly#D, Deputy in the French National Assembly. He ...
in
Amiens Amiens (English: or ; ; pcd, Anmien, or ) is a city and commune in northern France, located north of Paris and south-west of Lille. It is the capital of the Somme department in the region of Hauts-de-France. In 2021, the population of ...
, France.
Isabelle Dinoire Isabelle Dinoire (3 February 1967 – 22 April 2016) was a French woman who was the first person to undergo a partial face transplant, after her Labrador retriever cross breed mauled her in May 2005. She underwent a 15-hour operation in November ...
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 ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one. His ...
'' 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 22 April 2016 at the age of 49 following cancer from medications. A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a
neurofibroma A neurofibroma is a benign nerve-sheath tumor in the peripheral nervous system. In 90% of cases, they are found as stand-alone tumors (solitary neurofibroma, solitary nerve sheath tumor or sporadic neurofibroma), while the remainder are found in p ...
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 Pascal Coler of France, who has neurofibromatosis, 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 Laurent Lantieri and his team (Jean-Paul Meningaud, Antonios Paraskevas and Fabio Ingallina).


China

In April 2006, Guo Shuzhong at the Xijing military hospital in
Xi'an Xi'an ( , ; ; Chinese: ), frequently spelled as Xian and also known by other names, is the capital of Shaanxi Province. A sub-provincial city on the Guanzhong Plain, the city is the third most populous city in Western China, after Chongqi ...
, transplanted the cheek, upper lip, and nose of Li Guoxing, who was mauled by an
Asiatic black bear The Asian black bear (''Ursus thibetanus''), also known as the Asiatic black bear, moon bear and white-chested bear, is a medium-sized bear species native to Asia that is largely adapted to an arboreal lifestyle. It lives in the Himalayas, sout ...
while protecting his sheep. On 21 December 2008, it was reported that Li had died in July in his home village in
Yunnan Yunnan , () is a landlocked province in the southwest of the People's Republic of China. The province spans approximately and has a population of 48.3 million (as of 2018). The capital of the province is Kunming. The province borders the ...
. Prior to his death, a documentary on the
Discovery Channel Discovery Channel (known as The Discovery Channel from 1985 to 1995, and often referred to as simply Discovery) is an American cable channel owned by Warner Bros. Discovery, a publicly traded company run by CEO David Zaslav. , Discovery Chan ...
showed he had stopped taking immuno-suppressant drugs in favour of herbal medication; a decision that was likely a contributing factor to his death, according to his surgeon.


Turkey

Selahattin Özmen Selahattin Özmen is a Turkish plastic surgeon. A full-professor of Plastic Surgery at the Koç University School of Medicine, Department of Plastic Surgery and American Hospital Department of Plastic Surgery in İstanbul, he performed Turkey' ...
performed a partial face transplant on 17 March 2012 on Hatice Nergis, a twenty-year-old woman at
Gazi University Gazi University ( tr, Gazi Üniversitesi) is a public university primarily located in Ankara, Turkey. It was established in 1926 by Mustafa Kemal Atatürk as Gazi Teacher Training Institute. In 1982, it was reorganized by merging with the Bolu ...
's hospital in
Ankara Ankara ( , ; ), historically known as Ancyra and Angora, is the capital of Turkey. Located in the central part of Anatolia, the city has a population of 5.1 million in its urban center and over 5.7 million in Ankara Province, maki ...
. It was Turkey's third, the first woman-to-woman and the first three-dimensional with bone tissue. The patient from
Kahramanmaraş Marash (Armenian: Մարաշ), officially Kahramanmaraş () and historically Germanicea (Greek: Γερμανίκεια), is a city in the Mediterranean Region of Turkey and the administrative center of Kahramanmaraş Province. Before 1973, Kahra ...
had lost her upper jaw six years prior in a firearm accident, including her mouth, lips, palate, teeth and nasal cavity, and was since then unable to eat. She had undergone around 35 reconstructive plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin in
Istanbul ) , postal_code_type = Postal code , postal_code = 34000 to 34990 , area_code = +90 212 (European side) +90 216 (Asian side) , registration_plate = 34 , blank_name_sec2 = GeoTLD , blank_i ...
, who had died by suicide. Nergis died in
Ankara Ankara ( , ; ), historically known as Ancyra and Angora, is the capital of Turkey. Located in the central part of Anatolia, the city has a population of 5.1 million in its urban center and over 5.7 million in Ankara Province, maki ...
on 15 November 2016 after she was hospitalized two days prior complaining about acute pain.


Belgium

In December 2011, a 54-year-old man underwent a partial face transplant to the lower two-thirds of the face (including bone) after a ballistic accident. The operation was performed by a multidisciplinary team led by plastic surgeon Phillip Blondeel; Hubert Vermeersch, Nathalie Roche and Filip Stillaert were other members of the surgical team. For the first time 3D CT planning was used to plan the operation that lasted 20 hours. The patient is alive, functional doing well and has a full reintegrated life in society.


Italy

In September 2018, a 49-year-old woman affected by Neurofibromatosis type I received a partial face transplant from a 21-year-old girl at Sant'Andrea Hospital of Sapienza University in Rome. The procedure took 27 hours and was carried out by two teams led by Fabio Santanelli di Pompeo and Benedetto Longo. Unfortunately, the patient had a complication and after two days the surgeons had to replace the facial graft with autologous tissue. The patient is still alive and waiting for a second face transplantation.


Canada

In May 2018, the first Canadian complete face transplant was performed under the leadership of
plastic surgeon Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniof ...
Daniel Borsuk Daniel Evan Borsuk (born January 19, 1978) is a Canadian plastic surgeon in Montreal, Quebec, who is a pioneer in facial reconstruction. The first Canadian face transplant was performed under his leadership. He is also an advocate for pet s ...
at the Hopital Maisonneuve Rosemont, in
Montreal Montreal ( ; officially Montréal, ) is the second-most populous city in Canada and most populous city in the Canadian province of Quebec. Founded in 1642 as '' Ville-Marie'', or "City of Mary", it is named after Mount Royal, the triple- ...
,
Quebec Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirte ...
. The transplant took over 30 hours and replaced the upper and lower jaws, nose, lips and teeth on Maurice Desjardins, a 64-year-old man that shot himself in a hunting accident. At that time, Mr. Desjardins was the oldest person to benefit from a face transplant.


Full face transplant

On 20 March 2010, a team of 30 Spanish doctors led by plastic surgeon Joan Pere Barret at the
Vall d'Hebron University Hospital The Vall d'Hebron University Hospital is a public and university affiliated hospital founded in 1955. It belongs to the Catalan Health Institute and is the hospital complex with the highest volume of interventions in Catalonia, Spain. It is located ...
in
Barcelona Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within c ...
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 Créteil () is a commune in the southeastern suburbs of Paris, Île-de-France. It is located from the centre of Paris. Créteil is the ''préfecture'' (capital) of the Val-de-Marne department as well as the seat of the Arrondissement of Cr� ...
. In March 2011, a surgical team, led by
Bohdan Pomahač Bohdan Pomahač (; born 8 March 1971) is a Czech plastic surgeon. He led the team that performed the first full face transplant in United States and the third overall in the world. Biography Pomahač's parents were a chemical engineer and a scho ...
at
Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two ...
in Boston, Massachusetts, 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 Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two ...
face transplant team, led by 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 had a severe shock from a high voltage electrical wire following a car accident in 2001.


Poland

On 15 May 2013, at the Maria Skłodowska-Curie Institute of Oncology branch in
Gliwice Gliwice (; german: Gleiwitz) is a city in Upper Silesia, in southern Poland. The city is located in the Silesian Highlands, on the Kłodnica river (a tributary of the Oder). It lies approximately 25 km west from Katowice, the regional capi ...
,
Poland Poland, officially the Republic of Poland, is a country in Central Europe. It is divided into 16 administrative provinces called voivodeships, covering an area of . Poland has a population of over 38 million and is the fifth-most populou ...
, an entire face was transplanted onto a male patient, Grzegorz (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 Neurofibromatosis (NF) is a group of three conditions in which tumors grow in the nervous system. The three types are neurofibromatosis type I (NF1), neurofibromatosis type II (NF2), and schwannomatosis. In NF1 symptoms include light brown ...
. Two months after the operation, she left the hospital.


Turkey

On 21 January 2012, Turkish surgeon
Ömer Özkan Ömer Özkan (born 1971) is a Turkish plastic surgeon. An associate professor at the Akdeniz University in Antalya, he led the team that performed in 2012 the first full face transplant in Turkey. Education He finished in 1988 Cumhuriyet High Sc ...
and his team successfully performed a full face transplant at
Akdeniz University Akdeniz University ( tr, Akdeniz Üniversitesi) is a public research university established in Antalya, Turkey. It has been chosen as the second most beautiful university in Turkey, after Boğaziçi University, with its campus having a wide and gr ...
's hospital in
Antalya la, Attalensis grc, Ἀτταλειώτης , postal_code_type = Postal code , postal_code = 07xxx , area_code = (+90) 242 , registration_plate = 07 , blank_name = Licence plate ...
. 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 Serdar Nasır conducted the country's second successful full face transplant at
Hacettepe University Hacettepe University is a leading state university in Ankara, Turkey. It was established on 8 July 1967. It is ranked first among the Turkish universities by URAP in 2021. The university has two main campuses. The first campus is in the old t ...
's hospital in
Ankara Ankara ( , ; ), historically known as Ancyra and Angora, is the capital of Turkey. Located in the central part of Anatolia, the city has a population of 5.1 million in its urban center and over 5.7 million in Ankara Province, maki ...
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 Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...
two days before the surgery following a motorcycle accident that occurred on 17 February. On 16 May 2012, surgeon 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 Uşak (; el, Ουσάκειον, Ousakeion) is a city in the interior part of the Aegean Region of Turkey. The city has a population of 500,000 (2016 census) and is the capital of Uşak Province. Uşak city is situated at a distance of from İz ...
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 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 14 July while swimming in Turkey's sea resort
Muğla Muğla () is a city in southwestern Turkey. The city is the center of the District of Menteşe and Muğla Province, which stretches along Turkey's Aegean coast. Muğla's center is situated inland at an altitude of 660 m and lies at a dista ...
. The 27-year-old patient Recep Sert came immediately from
Bursa ( grc-gre, Προῦσα, Proûsa, Latin: Prusa, ota, بورسه, Arabic:بورصة) is a city in northwestern Turkey and the administrative center of Bursa Province. The fourth-most populous city in Turkey and second-most populous in the ...
to Antalya for the surgery in late July 2017. 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, 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 brain dead 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 Kırklareli () is a city within Kırklareli Province in the European part of Turkey. Name It is not clearly known when the city was founded, nor under what name. The Byzantine Greeks called it Sarànta Ekklisiès (''Σαράντα Εκκλησι� ...
to Antalya via Istanbul in four hours, the donor's organs were transported from
Edirne Edirne (, ), formerly known as Adrianople or Hadrianopolis ( Greek: Άδριανούπολις), is a city in Turkey, in the northwestern part of the province of Edirne in Eastern Thrace. Situated from the Greek and from the Bulgarian borders ...
by an ambulance airplane. The surgery took 4 hours and 10 minutes.


United Kingdom

In October 2006, surgeon Peter Butler at London's
Royal Free Hospital The Royal Free Hospital (also known simply as the Royal Free) is a major teaching hospital in the Hampstead area of the London Borough of Camden. The hospital is part of the Royal Free London NHS Foundation Trust, which also runs services at Bar ...
in the UK was given permission by the
NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
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.


United States

In 2004, the
Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...
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
Maria Siemionow Maria Siemionow (born 1950 in Krotoszyn, Poland) is a Polish transplant surgeon and scientist who led a team of eight surgeons through the world's first near-total face transplant at the Cleveland Clinic in 2008. The patient, Connie Culp, a 45-ye ...
and including a group of supporting doctors and six plastic surgeons (Steven Bernard, Dr Mark Hendrickson, Robert Lohman, Dan Alam and Francis Papay) performed the first face transplant in the US on a woman named
Connie Culp Connie Culp (March 26, 1963 – July 29, 2020) was the first United States recipient of a partial face transplant, performed at the Cleveland Clinic in December 2008. Facial disfigurement Culp was shot in the face by her husband Thomas G. "Tom" C ...
. 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. Connie died July 29, 2020. The second partial face transplant in the US took place at
Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two ...
in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by
Bohdan Pomahač Bohdan Pomahač (; born 8 March 1971) is a Czech plastic surgeon. He led the team that performed the first full face transplant in United States and the third overall in the world. Biography Pomahač's parents were a chemical engineer and a scho ...
, replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. 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 ''Boston Med'' is an eight-part documentary television series that premiered on ABC in the United States on June 24, 2010. It follows the stories of doctors, nurses, patients and their families at Mass General, Brigham and Women's and Children' ...
. 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 Bohdan Pomahač and BWH plastic surgery team, 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 with facial injuries. One of the top benefits of the surgery was that Dallas has regained his sense of smell. The
Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two ...
transplant team led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. Hunter, who is a US war veteran, was left disfigured in a car accident, burning about 94% of his face. 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 including the nose, eyelids, muscles of facial animation and the nerves that power them and provide sensation. Mitch Hunter was a passenger in a single cab pick-up 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). Hunter 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 named Travis in 2009, after the owner gave the chimp
Xanax Alprazolam, sold under the brand name Xanax, among others, is a fast-acting, potent tranquilizer of medium duration in the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring. It is most commonly ...
and wine. She underwent a 20-hour full face transplant in May 2011 at
Brigham and Women's Hospital Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two ...
in
Boston Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...
. 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 and his team (Amir Dorafshar, Michael Christy, Branko Bojovic and
Daniel Borsuk Daniel Evan Borsuk (born January 19, 1978) is a Canadian plastic surgeon in Montreal, Quebec, who is a pioneer in facial reconstruction. The first Canadian face transplant was performed under his leadership. He is also an advocate for pet s ...
). The recipient was 37-year-old Richard Norris, who had sustained a facial gunshot injury in 1997. This transplant included all facial and anterior neck skin, both jaws, and the tongue. In September 2014, another face transplant was performed by the Cleveland Clinic group. The patient had had complex trauma that masked the development of a rare type of autoimmune disease (granulomatosis with polyangiitis and pyoderma gengrenosum) affecting the face. It was the first face transplant in a patient with an autoimmune disease involving the craniofacial region. Prior to surgery, an analysis of renal transplant outcomes in granulomatosis with polyangiitis was conducted to evaluate allograft outcomes in these cohorts. That literature established feasibility and encouraged the Cleveland Clinic team to proceed with the surgery. The intervention was reported successful up to three years post-transplantation. In August 2015, a face transplant was completed at the NYU Langone Medical Center under the leadership of the chair of plastic surgery Eduardo D. Rodriguez and his team. A 41-year-old retired fireman named Patrick Hardison received the face of cyclist David Rodebaugh. In June 2016, a multidisciplinary team of surgeons, physicians and other health professionals completed a near-total face transplant at
Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staf ...
's Rochester campus. Patient Andrew Sandness, a 32-year-old from eastern Wyoming, had devastating facial injuries from a self-inflicted gunshot wound in 2006. The surgery, which spanned more than 50 hours, restored Sandness' nose, upper and lower jaw, palate, teeth, cheeks, facial muscles, oral mucosa, some of the salivary glands and the skin of his face (from below the eyelids to the neck and from ear to ear). The care team led by Samir Mardini, and Hatem Amer, the surgical director and medical director, respectively, for the Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, devoted more than 50 Saturdays over years to rehearsing the surgery, using sets of cadaver heads to transplant the face of one to the other. They used 3-D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on the transplant recipient. Today, in addition to his physical transformation, Sandness can smell again, breathe normally and eat foods that were off-limits for a decade. In a 31-hour operation starting on 4 May 2017, surgeons at the Cleveland Clinic transplanted a face donated from Adrea Schneider, who had died of a drug overdose, to Katie Stubblefield, whose face had been disfigured in a suicide attempt by rifle on 25 March 2014. , Katie is the youngest person in the United States to have had a face transplant, age 21 at the time. Surgeons originally planned to leave her cheeks, eyebrows, eyelids, most of her forehead, and the sides of her face alone. However, because the donor face was larger and darker than Katie's, they made the decision to transplant the donor's full face. This holds the risk that in case of acute rejection in which the face must be removed, she would not have enough tissue for reconstructive surgery. Katie was featured on the cover of
National Geographic ''National Geographic'' (formerly the ''National Geographic Magazine'', sometimes branded as NAT GEO) is a popular American monthly magazine published by National Geographic Partners. Known for its photojournalism, it is one of the most widel ...
in September 2018 for an article entitled "The Story of a Face." In July 2019, 68-year-old Robert Chelsea became the oldest person, as well as the first black person, to receive a full face transplant. It was performed at Brigham and Women's Hospital.


Combined procedures

A number of combined VCA procedures, such as bilateral hand transplants, have been described in the literature and media sources. These combined procedures also include attempts at triple-limb and quadruple-limb transplants, however, only three face transplants have been attempted in combination with other allografts.


France

In 2009, Laurent Lantieri and his team attempted a face and bilateral hand transplant on a 37-year-old man who sustained extensive injuries during a self-immolation attempt one year prior. The patient ultimately died of anoxic brain injury two months after his initial transplant during surgical management of infectious and vascular complications. Autopsy revealed no signs of rejection in any of the allografts.


United States

On August 12, 2020, at NYU Langone Health in New York, New York, Eduardo D. Rodriguez led a team of over 140 personnel in successfully transplanting the face and bilateral hands of a brain dead donor onto 22-year-old Joe DiMeo, who sustained disfiguring burns after a car accident in 2018. The procedure lasted approximately 23 hours, and involved the entire facial soft tissue (extending from the anterior hairline to the neck, including the eyelids, nose, lips, and ears, along with strategic skeletal components), as well as both hands at the distal forearm level. Charla Nash's face transplant, described above, also initially included bilateral hands from the same donor. Circulation to Nash's transplanted hands was compromised after she was started on
vasopressors An antihypotensive agent, also known as a vasopressor agent or simply vasopressor, or pressor, is any substance, whether endogenous or a medication, that tends to raise low blood pressure. Some antihypotensive drugs act as vasoconstrictors to in ...
as part of treatment for sepsis. The hands were ultimately amputated, however the patient survived, as did her facial allograft.


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. As of October 2019, th
AboutFace Project
funded by
UKRI Future Leaders Fellowship
awarded to Dr Fay Bound Alberti, is exploring these debates as part of its wider research into the emotional and cultural history of face transplants. After the procedure, a lifelong regimen of
immunosuppressive Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reacti ...
drugs is necessary to suppress the patient's own
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
s 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 Georges Franju (; 12 April 1912 – 5 November 1987) was a French filmmaker. He was born in Fougères, Ille-et-Vilaine. Biography Early life Before working in French cinema, Franju held several different jobs. These included working for a ...
'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 A protagonist () is the main character of a story. The protagonist makes key decisions that affect the plot, primarily influencing the story and propelling it forward, and is often the character who faces the most significant obstacles. If a st ...
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 was a Japanese avant-garde filmmaker and artist from the Japanese New Wave era. He is best known for the 1964 film '' Woman in the Dunes''. He is also known for directing other titles such as '' The Face of Another'' (1966), ''Natsu No Heitai'' ( ...
in 1966. * In the 1990
Sam Raimi Samuel M. Raimi ( ; born October 23, 1959) is an American filmmaker. He is best known for directing the ''Spider-Man'' trilogy (2002–2007) and the ''Evil Dead'' franchise (1981–present). He also directed the 1990 superhero film ''Darkman'' ...
film ''
Darkman ''Darkman'' is a 1990 American superhero film directed and co-written by Sam Raimi. Based on a short story Raimi wrote that paid homage to Universal's horror films of the 1930s, the film stars Liam Neeson as scientist Peyton Westlake, who i ...
'',
Liam Neeson William John Neeson (born 7 June 1952) is an actor from Northern Ireland. He has received several accolades, including nominations for an Academy Award, a British Academy Film Award, and two Tony Awards. In 2020, he was placed 7th on '' Th ...
plays a scientist who depends on his own face transplant technology, but finds that it only lasts for 99 minutes. * The plot of the 1997 film ''
Face/Off ''Face/Off'' is a 1997 American science fiction action thriller film directed by John Woo, written by Mike Werb and Michael Colleary, and starring John Travolta and Nicolas Cage. The first Hollywood film in which Woo was given major creativ ...
'' 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. * In the episode "Faces" from Season 2 of '' The Good Doctor'' (2019), a teenaged girl whose face was disfigured in an accident receives a full face transplant from a brain dead girl. * The 2019 Tamil movie ''
Boomerang A boomerang () is a thrown tool, typically constructed with aerofoil sections and designed to spin about an axis perpendicular to the direction of its flight. A returning boomerang is designed to return to the thrower, while a non-returning ...
'' plot line has the lead character undergoing a face transplant.


References


External links


Cleveland Clinic Face Transplant Video and Surgery Fact Sheet
{{Organ transplantation Tissue transplants Organ transplantation Plastic surgical procedures Oral and maxillofacial surgery French inventions