What Face Transplants Can, Can't Do
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When Face Transplant Is an Option
Who is a candidate for a face transplant?
"It is a very drastic procedure, so you need to have an extremely disfiguring facial injury or birth defect for which other standard reconstructive techniques aren't good enough," Girotto says. "Things like shotgun wounds to the face; large, full-skin-thickness burns; and in Asia, it's also been used for people with neurofibromatosis [a disfiguring genetic disease]."
But not every disfigured person is a candidate for face transplant. As with other transplants, face recipients must stay on immunity-suppressing drugs for the rest of their lives in order to keep their bodies from rejecting the face.
"Like all transplants, a face can be rejected, and this can happen any time: three, five, even 20 years later," Siemionow says. "This is very important when accepting patients, to check if they have enough normal skin and muscle and bone in their body so we can cover their face, maybe not perfectly but enough to save their lives, if the transplanted face rejects."
Another issue is psychological. A person's face is, after all, a person's identity. There are very complex emotional decisions a patient must face, Girotto says.
"Getting a new face to replace your disfigured one seems easy, right? But it is not your face that you get," he notes. "The vast majority of interactions with people around you involve your face and facial expression. When that is taken away, your interaction with people outside your house is extremely limited. Then when you have a transplant, when tissues of someone else's face are applied to you, you are truly a new person. You are not back to the person you were before your injury."
Another issue is maintaining the transplant. Anti-rejection medications must be taken every day at the prescribed time, and the transplant must be constantly inspected for signs of rejection. Moreover, nerves and muscles don't grow back correctly unless the patient constantly exercises his or her facial muscles as part of rehabilitation therapy.
But Siemionow says most face transplant recipients accept the downsides of the procedure.