Massive injuries to the face usually require several face lift surgery procedures to try and restore a sense of normalcy for patients.
But results from a five-year study by plastic surgery researchers at the Cleveland Clinic published in the January issue of the Plastic and Reconstructive Surgery journal suggests facial transplants may be a workable alternative for those with extreme facial injuries.
A multidisciplinary team of plastic surgeons, psychiatrists, immunologists and bioethicists spent 5 years preparing for the procedure, starting the process in 2003. The team garnered the world’s first institutional board approval to perform a face transplant in humans in 2004. After years of arduous approval, research and preparation, surgeons successfully performed the first near-total face transplantation in the United States in December, 2008.
Using a composite allograft from a brain-dead donor, plastic surgeons successfully replaced 80% of the patient’s traumatic facial defect. The patient was a 45-year old woman who sustained a close-range blast from a shotgun and after several face lift surgery procedures, she still had major disabilities.
The donor’s facial allograft represented the largest, most complex facial allograft in the world and included the following: 535 cm2 of facial skin, functional units of a full nose including naval lining and bony skeleton, upper lip, lower eyelids along with underlying muscles and bones.
“We are pleased to report an excellent functional, psychological, and social outcome for our patient at 8 months following transplantation,” says Dr. Maria Z. Siemionow of the Cleveland Clinic.
Extensive physical therapy, rehabilitation and re-education for the patient took place after the pioneering face lift surgery procedure. After 8 months of recovery, the patient has regained most facial functions, including her sense of smell, speech and ability to eat solid foods and drink from a cup. Motion is recovering slowly but surely and the patient is increasingly confident about going out in public.
While the study was a success, researchers caution about the risks of facial transplants and express concern about moving too fast, especially after two similar procedures in France and China resulted in the patients’ death.