What Face Transplants Can, Can't Do
Woman Mauled by Chimp Latest in Growing Number of Face Transplants
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When Face Transplant Is an Option continued...
"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.
"At least from reports we get, most transplant patients are happy to get back a normal human face," she says. "They are happy when they wake in the morning that they can feel a nose instead of a hole."
But for an operation performed on people whose lives are not in danger, it's an extremely high-risk procedure. Of the 17 patients known to have received face transplants, Siemionow says, two have died.
Balancing the risk are substantial potential rewards.
"Our patient, Connie Culp, before transplant did not have a nose so she was breathing through a tube in her neck. She did not have a palate, so she could not eat solid foods and used a feeding tube in her abdomen. She could not smell. She could not smile," Siemionow says. "But after transplant she can breathe through her new nose and also speak intelligibly and eat with the return of a normal palate. She actually is smiling, she is kissing her grandchild, she can make funny faces. It is amazing how great is her functional recovery."
What Happens During a Face Transplant
Exactly what gets transplanted from the donor to the recipient during a face transplant depends on the needs of an individual patient. Technically, the face extends from the bottom of the eyes to below the chin. The brow is not transplanted, as it is part of the skull and has a different blood supply than the lower face. Eyes are not transplanted, either, although eyelids may be part of a face transplant.