If a person has suffered a serious facial injury, a facial transplant may be required. The cause is often trauma such as an accident or the patient’s face is disfigured by, for example, a tumor. In a face transplant, the face of a donor is transplanted to the patient. The patient will receive a face that contains the characteristics of both the donor and the patient.
The transplant
A face transplant is the transplantation of all or part of the face from a clinically deceased donor to the patient. The facial muscles, connective tissue layer and skin are transplanted. If there is a serious deformity, pieces of bone can also be transplanted. A face transplant is a very rare operation. In 2005, a face transplant was performed for the first time on a woman who had lost her face as a result of a dog bite.
When will the transplant take place?
Only if there is very serious mutilation as a result of, for example, burns, cancerous growths, gunshot wounds or another form of trauma, is the person eligible for surgery. This concerns patients who can no longer breathe, speak or swallow independently and who can do this again through a face transplant. In that case, the vital functions of the face can only be restored by means of a transplant. It is a very major operation, often requiring years of rehabilitation.
The donor
Not every donor is suitable. Not only the blood group must match, but also the skin type, gender and skin color. The donor’s face will be removed. The donor must be clinically dead and the heart must still be beating to ensure blood flow to the tissue. When removing the face, the blood vessels and nerve pathways must not be damaged. Finding a donor for a face transplant is much more difficult than finding an organ transplant donor.
The operation
Once the donor’s face is removed, it is placed on a specially designed mold that fits snugly. When the face is applied to the patient, the attachments of the blood vessels, nerves, oral mucosa and any bone tissue will be attached. The skin is then secured with dissolvable sutures. It is determined in advance exactly how much bone tissue is needed from the donor. This is a very complicated operation that takes a lot of time.
Repulsion
There are risks associated with a face transplant. The risk of rejection of the new tissue is much higher than with organ transplants. The patient must take medication for life to prevent rejection symptoms. This medication suppresses the immune system, which reduces resistance and increases the risk of infections.
Acceptance
How the face looks is one of the most important forms of a person’s identity. With a face transplant you run the risk of losing this. It is often difficult to accept the new appearance. The patient must also take into account a painful and often long rehabilitation. The new face no longer looks like the patient had before the operation, but it is also not the face of the donor. The appearance is often somewhere in between. To guide the patient as best as possible, psychological help is very important.