The first face transplant in the United States was performed this week at the Cleveland Clinic. What is significant other than being the first face transplant in the U.S. is the amount of defect which was reconstructed. Approximately 80% of the face (including skin and bone) was reconstructed with the transplant. The previous three face transplants performed in the world only covered small areas of the face.
The surgery lasted 23 hours, involving multiple teams, which is predictable, given the complexity of the face. Multiple small vessels and nerves have to be attached to the patient’s face to assure survival of the transplant, and to have some hope of facial movement. These vessels and nerves are attached using an operating room microscope, using sutures which are thinner than a human hair.
As remarkable as this surgery is, several areas of concern remain. We are not technologically at the level to obtain a result such as in the movie Face-Off, where Nicolas Cage had a face transplant. In the movie, the new face looks completely natural, without any scars from the surgery, and the actor has perfect facial movement. The result of this surgery is unpredictable. There is no way to predict how much of the facial movement will return, and if it will be symmetrical. There will be scars where the transplant is attached to the patient’s face and only time will tell if the scars will be noticeable or not. There is also the potential long-term psychological effect on the patient. We have to remember, the patient has lost 80% of her face, and, therefore, the new transplant will result in a drastic change in the patient’s facial characteristics. How is the patient going to cope with this dramatic change? Only time will tell.
The final issue which was not discussed in the article or the video is the long term effect of immunosuppression. Since the patient has received a transplant from a different person, her immune system must be suppressed to minimize (not eliminate) the risk of rejection. Therefore, she is at risk of infections and cancers typically seen in AIDS patients. Even with immunosuppression, there is always the potential of graft failure or rejection.
Face transplant is and will remain a controversial topic until technology and surgical techniques improve. However, I think we must push the envelope in order to progress. This procedure was done in an academic environment, where the latest technology exists. The patient was carefully selected and had a defect which permitted face transplant to be considered as a viable option. Who knows what lies in the future: brain transplants any one!?
To read and watch the video about this procedure, please click here.
Michael Jazayeri, M.D. is a board certified plastic surgeon and member of American Society of Plastic Surgeons, with over 20 years of experience. His office is centrally located in Orange County, in the city of Santa Ana. To schedule a complimentary consultation, please contact (714) 834-0101.
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