Imagine that a person's face has been completely disfigured due to a serious accident, burn, or some serious illness. Perhaps even essential parts like the nose, eyelashes, and lips have been lost. This condition cannot be restored with ordinary plastic surgery. It is in such a serious situation that the most complex and advanced surgery in modern medicine, 'face transplantation', comes into question.
Simply put, what is a face transplant?
A face transplant is a surgical procedure that uses facial tissue from a deceased donor to replace all or part of a patient's face. This is not a typical operation. In medicine, we call this a vascularized composite allograft (VCA) . This means that not only the skin but also the underlying muscles, bones, nerves, and blood vessels are transplanted together.
This is a very rare, extremely complex surgery. And there are a limited number of donors who will donate a face. Therefore, to qualify for this type of surgery, you have to meet very strict criteria. After the surgery, you will have to receive special medical care, physical therapy, and medications for the rest of your life.
Who is suitable for this type of surgery?
This is not a surgery that everyone can undergo. To be eligible for this, the following requirements must be met.
| Qualification | Description |
|---|---|
| Severe facial deformity | A severe facial deformity or injury that cannot be treated with conventional plastic or reconstructive surgery. This often includes conditions such as the loss of a nose, eyelids, and lips. |
| Age | Be between 18 and 60 years of age. |
| Pregnancy | Not being pregnant and willing to postpone pregnancy for at least one year after surgery. |
| Existing infections | No major infections such as HIV or hepatitis . |
| Smoking | It is mandatory to be a non-smoker. |
| Other illnesses | No history of cancer or cardiovascular disease . |
| Access to medicines | Being physically and mentally capable of taking immunosuppressive drugs for the rest of your life. |
Why would someone resort to such major surgery?
Getting a face transplant is a very personal decision. It involves serious risks. You will need to participate in an intensive rehabilitation program for about a year after the surgery. You will also need to undergo regular medical checkups for the rest of your life.
The main hope of those who undergo this surgery is to get a solution to the severe deformity on their face. It can also be a solution to other problems caused by this deformity. For example:
- Difficulty breathing
- Difficulty speaking
- Difficulty chewing and swallowing
This surgery also helps restore these functions.
What happens before the surgery? Is there much preparation?
Yes, before deciding on surgery, you have to undergo a very extensive and thorough series of tests. This can be divided into three parts.
1. Physiology
Your doctor will carefully examine your body and facial function. Your facial muscles and nerves must be healthy enough to support the new tissue being transplanted. Your body must also be able to withstand this major surgery, take lifelong immunosuppressant medications, and participate in intensive rehabilitation programs.
2. Physical health check-up (Physical)
This involves looking at your overall health. This includes your family history of medical conditions, the medications you are currently taking, the condition of your heart and other organs, blood tests, X-rays, and computed tomography (CT) scans . With today's technology, it is even possible to create a 3D printed model of your skull to plan exactly how the surgery will be performed.
3. Psychological preparation
Psychiatrists and social workers will talk to you about the psychological stresses that may be experienced by you and those who support you during this journey. For example, preparing you mentally for the social attention and possibly media attention after surgery, getting used to a new face, and possible setbacks during the healing process.
How to find a donor?
If, after all these tests, the doctors decide that you are suitable for this operation, you will be put on a list for face donation. This is different from the organ donation document that we usually sign when we get our driver's license. In order to donate a face, you must get special permission from the family of the deceased.
The face is something that expresses our identity, our emotions. So the fact that someone has to die in order for a transplant like this to have a face can be mentally difficult for the person waiting. But for the donor's family, knowing that their loved one's death will help someone else is a great relief.
There must be several matches between the donor and the patient.
| Matching Factor | Description |
|---|---|
| Blood type | Blood type matching is mandatory. |
| Tissue type | This is important to reduce the risk of rejection by the body. |
| Femininity/masculinity | Often, a match is made between people of the same sex. |
| Skin color and nature | It is important to have as similar a skin tone and texture as possible. |
| Age and face size | Being of a similar age group and similar in facial size. |
Because of these strict criteria, you may have to wait months, even years, to find a suitable donor.
What happens during the surgery?
Once you find a matching donor, you will need to come to the hospital immediately. The donor is often deceased or brain-dead.
During the surgery, the medical team first carefully removes tissue (skin, fat, muscle, nerves, blood vessels, cartilage) from the donor's face. It is then placed in a special solution, cooled, and preserved.
You will be fully anesthetized and put to sleep, so you won't feel any pain. Once you're asleep, the doctors will remove your damaged skin and tissue. The most important and complex part of the surgery is connecting your blood vessels to the blood vessels in the new face using very fine surgical instruments. This is called vascularization . When this is done properly, the new tissue will have blood supply and will be alive.
After ensuring that blood circulation is working properly, doctors reconnect the nerves and muscles. When the nerves are connected, the face receives sensation (touch, heat, cold, pain). When the muscles are connected, the face can move (smile, frown, blink). Finally, the skin and soft tissues are stitched together.
This entire surgery can take a very long time, from 10 to 36 hours .
What are the benefits and risks of this surgery?
Like any major surgery, this one has both benefits and risks.
| Advantages | Risks & Complications |
|---|---|
|
|
How long does it take to heal?
After going home from the hospital, you will need to return to the hospital for regular treatment, physical therapy, and medical checkups for at least three months.
- Facial swelling usually decreases within two to three months .
- After about six months, feeling in the face begins to return.
- After about a year, most facial functions return to normal.
Will I look exactly like the donor?
No. You will not look exactly like the donor. This is because the bone structure of the skull beneath your face is unique to you. However, some features of the donor's skin, such as spots, birthmarks, or scars, may appear on your new face.
Take-Home Message
- A face transplant is an extremely complex and rare surgery performed to treat severe facial deformities.
- You must undergo a very long and thorough series of tests to determine whether you are physically and mentally fit for this.
- It can take months or years to find a suitable donor.
- After surgery, you will need to take immunosuppressive drugs for the rest of your life to prevent your body from rejecting the new face, which can increase your risk of other infections.
- The recovery process is very long and requires intensive physical therapy, dedication, and strong family support.
- If you or someone you know is facing this situation, it is extremely important to discuss all matters very openly and clearly with your doctor .
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