Face Transplant

What is face transplant surgery?

A face transplant is a type of surgery that replaces all or part of your face with donated facial tissue from a deceased person. This type of surgery is a vascularized composite allograft (VCA), an experimental surgery involving skin, bone, nerves and blood vessels. To receive a face transplant, you must have a serious facial disfigurement. There’s a limited amount of facial tissue donors, so you must meet strict requirements to qualify for this type of transplant.

Face transplants are difficult and complex procedures. They may involve many different characteristics, including your nose, lower eyelids, skin, muscles, bony structures, arteries, veins and nerves. After receiving a face transplant, you’ll need extensive medical care, including physical therapy and medications.

Who is a good candidate to have a face transplant?

In general, you’re a good candidate for a face transplant if:

• You have a serious facial disfigurement or trauma that plastic surgery or reconstructive surgery can’t treat. A serious facial disfigurement often includes a lack of a nose, eyelids and lips.
• You’re between 18 and 60.
• You’re not pregnant and are willing to put off pregnancy for at least one year.
• You don’t have any major infections, such as HIV or hepatitis.
• You don’t smoke.
• You don’t have a history of cancer or conditions that affect your heart and blood vessels (cardiovascular disease).
• You’re able to take immunosuppressive drugs.

Why do people get face transplants?

Getting a face transplant is a personal decision. There are many serious risks involved in getting a face transplant. You must dedicate yourself to intense rehabilitation for up to a year after the procedure and regular checkups for the rest of your life.

People who get a face transplant wish to improve a serious facial disfigurement. The disfigurement may also affect the ability to breathe, speak, chew or swallow.

How common are face transplant surgeries?

Face transplants are rare procedures. The first face transplant took place in 2005. As of 2022, healthcare providers have performed fewer than 50 face transplants throughout the world.

Cleveland Clinic performed the first partial face transplant in the United States in 2008. In 2017, Cleveland Clinic performed its first total face transplant.

How long can you live with a face transplant?

There isn’t enough data to accurately calculate life expectancy after a face transplant because the procedure is rare. The survival rate for a face transplant is about 89%.

What happens before a face transplant?

Before your face transplant procedure, you must go through very thorough evaluations, including:

• Physiology: Your healthcare provider will evaluate your body and face functions. The muscles and nerves in your face must be healthy enough to support the growth of new nervous tissue. You must also be able to tolerate the surgery, as well as the lifelong immunosuppressive therapy and major physical and rehabilitative therapy after the transplant.
• Physical: Your healthcare provider will evaluate your physical health. A physical evaluation may include checking your overall physical health, family health history, what medications you’re taking, an assessment of your heart and other organ systems, blood tests, X-rays, computed tomography (CT) scans and other tests and screenings. X-ray and CT scan images can create a 3D printed model of your skull. With a 3D-printed skull, your healthcare provider can develop the most thorough surgical plan possible.
• Psychological: Psychiatrists and social workers will discuss potential causes of stress you and your support system may encounter as part of the face transplant process and recovery. Stressors may include public attention and possibly media attention, a new facial appearance and any recovery setbacks.

Once your healthcare providers have finished their evaluations and determined you’re a good candidate for a face transplant, they’ll put you on a face donation list. A face donation isn’t part of the organ donor registry you may sign up for when you get a driver’s license or state identification card. A face donor’s surviving family members must grant special permission to allow a face donation. In some cases, a donor may share their decision to allow a face donation in the event of their death.

More than any other organ, the face has emotional value — it helps identify others and convey feelings. Many people waiting for a face transplant have mixed feelings because they know that someone must die before a face becomes available. When processing these feelings, it’s helpful to remember that many donor families feel a sense of peace knowing that their loved one’s death may help others.

You must match the following requirements with your donor:

• Blood type.
• Tissue type.
• Biological sex.
• Skin color, tone and texture.
• Similar age.
• Similar size face.
• Located no more than four hours away from the donor and surgical facility.

In addition, you must also have enough healthy skin elsewhere on your body to serve as a skin graft if your body rejects the face transplant.

As a result of these strict requirements, you may be on a face donation list for months or even years.

Once you have matched with a donor, you must quickly head to the surgical facility.

What kinds of healthcare providers make up a surgical staff for a face transplant?

The healthcare providers on your face transplant team generally include:

• Plastic surgeons.
• Head and neck surgeons.
• Microvascular surgeons.
• Anesthesiologists.
• Surgical nurses.
• Immunologists.
• Immunosuppression specialists.

If you need eye or dental care, your team may also include ophthalmologists and dentists.

What happens during a face transplant?

Your donor may have recently died or be brain-dead. If someone is brain-dead, machines keep their body alive but the brain has no signs of life. During a face transplant, your team of healthcare providers first completely removes the donor’s face, including:

• Arteries.
• Cartilage.
• Fat.
• Muscles.
• Nerves.
• Skin.
• Tendons.
• Veins.

Healthcare providers then cool the face and store it in a special solution to preserve it.

During a face transplant procedure, you’re sedated (put under) so you aren’t awake and won’t feel any pain.

Once you’re asleep, healthcare providers may need to prepare the area by shaving your face or scalp. They’ll use an alcohol-based pen to mark your face. The marks will help guide their incisions and identify veins and arteries that they’ll connect to the donated face.

Healthcare providers will remove your damaged skin and tissues. The most important part of the surgery is connecting all of your many blood vessels to the donor’s face with very small surgical needles and thread. Blood vessels allow your transplanted face to receive blood (vascularization), which keeps the tissue alive.

Once your healthcare providers have confirmed that blood is flowing to your transplanted face, they’ll connect (graft) your nerves and muscles. The nerves allow your face to have feeling and sensitivity, including touch, heat, cold and pain. Facial muscles allow your face to move, including chewing, smiling, frowning, blinking and moving your eyebrows. Healthcare providers may also connect cartilage and bones with screws and plates.

Finally, your healthcare providers will stitch (suture) your soft tissues and skin together.

How long does a face transplant take?

A face transplant is a delicate procedure that requires a lot of time. Its length depends on the extent of damage to your face. It may take anywhere from 10 to 36 hours.

What happens after a face transplant?

After the face transplant procedure is complete, your anesthesiologist will stop putting anesthesia into your body to keep you asleep. You’ll move to an intensive care room, where healthcare providers wait for you to wake up and monitor your overall health. Once your healthcare providers believe it’s safe, they’ll move you to a transplant unit.

In the transplant unit, you’ll start to work with physical therapists to develop facial movements. You may also talk to psychiatrists about any psychological issues you may have during the recovery process, including anxiety and depression.

Once your healthcare providers believe it’s safe, they’ll discharge you (let you go home). On average, you’ll be in the hospital between one and four weeks after surgery.

What are the advantages of a face transplant?

A face transplant positively affects your overall quality of life. In addition to treating facial disfigurements, a face transplant can help improve other functions, including:

• Breathing.
• Chewing and swallowing.
• Making expressions.
• Smelling.
• Speaking.
• Tasting.

What are the risks or complications of a face transplant?

A face transplant has many risks, including:

• Surgical risks. All surgeries have risks. Risks may include anesthesia complications, bleeding, blood clots, breathing complications, infection and death.
• Transplant rejection. Your immune system protects your body from foreign invaders that cause your body harm, including bacteria, viruses, parasites and fungi. Transplant rejection occurs when your body’s immune system attacks the transplanted facial tissues. It interprets them as foreign invaders. Transplant rejection may cause death. You must take immunosuppressive drugs for the rest of your life to reduce the risk of your immune system destroying the new tissue.
• Infection. Immunosuppressive drugs slow down or stop your immune system from rejecting your new face. However, a suppressed immune system has a hard time fighting off infections. You’ll have a higher risk of developing dangerous blood, fungal, skin and respiratory infections while on immunosuppressive drugs.

What is the recovery time?

For at least three months after you leave the hospital, you must return for regular treatment, therapy and monitoring. Your appointments will include physical therapy, blood tests, imaging tests and mental evaluations.

Each situation is unique for every person, but facial swelling should go down after two to three months. Within about six months, feeling should return to your face. And within about 12 months, most facial functions should return to most of your face.

When should I see my healthcare provider?

After a face transplant, schedule regular follow-up appointments with your healthcare providers. You may require multiple appointments every week for testing and therapy. Once you’ve healed and regained facial functions, follow-up appointments are usually only needed once a year.

Will I look like my donor after a face transplant?

You won’t look exactly like your donor because your bone structures are different. However, you’ll retain certain skin features, including freckles, moles or scars.

What questions should I ask my healthcare provider?

• Am I a good candidate for a face transplant?
• Do I need a partial face transplant or a full face transplant?
• How long will the face transplant surgery take?
• Have you ever done a face transplant?
• What are the possible risks or complications?
• What will I look like after my face transplant?
• How should I treat swelling and pain?

A note from Cleveland Clinic

A face transplant is major surgery with the potential to improve your quality of life after facial disfigurement. You must go through exhaustive evaluations before you’re on a face donor list. And once you’re on the list, you may have to be very patient — it can take months or even years to find the perfect donor. The recovery process is also long, and you may experience some difficult setbacks. It’s important to have a support system that can help you talk through the pros and cons of such a major surgery and recovery process, as well as advocate on your behalf. Your healthcare provider is also available to answer your questions and make sure you’re comfortable with your choices.