What happens before a face transplant?
Before your face transplant procedure, you must go through very thorough evaluations, including:
- Physiology: Your healthcare provider will evaluate your body and face functions. The muscles and nerves in your face must be healthy enough to support the growth of new nervous tissue. You must also be able to tolerate the surgery, as well as the lifelong immunosuppressive therapy and major physical and rehabilitative therapy after the transplant.
- Physical: Your healthcare provider will evaluate your physical health. A physical evaluation may include checking your overall physical health, family health history, what medications you’re taking, an assessment of your heart and other organ systems, blood tests, X-rays, computed tomography (CT) scans and other tests and screenings. X-ray and CT scan images can create a 3D printed model of your skull. With a 3D-printed skull, your healthcare provider can develop the most thorough surgical plan possible.
- Psychological: Psychiatrists and social workers will discuss potential causes of stress you and your support system may encounter as part of the face transplant process and recovery. Stressors may include public attention and possibly media attention, a new facial appearance and any recovery setbacks.
Once your healthcare providers have finished their evaluations and determined you’re a good candidate for a face transplant, they’ll put you on a face donation list. A face donation isn’t part of the organ donor registry you may sign up for when you get a driver’s license or state identification card. A face donor’s surviving family members must grant special permission to allow a face donation. In some cases, a donor may share their decision to allow a face donation in the event of their death.
More than any other organ, the face has emotional value — it helps identify others and convey feelings. Many people waiting for a face transplant have mixed feelings because they know that someone must die before a face becomes available. When processing these feelings, it’s helpful to remember that many donor families feel a sense of peace knowing that their loved one’s death may help others.
You must match the following requirements with your donor:
- Blood type.
- Tissue type.
- Biological sex.
- Skin color, tone and texture.
- Similar age.
- Similar size face.
- Located no more than four hours away from the donor and surgical facility.
In addition, you must also have enough healthy skin elsewhere on your body to serve as a skin graft if your body rejects the face transplant.
As a result of these strict requirements, you may be on a face donation list for months or even years.
Once you have matched with a donor, you must quickly head to the surgical facility.
What kinds of healthcare providers make up a surgical staff for a face transplant?
The healthcare providers on your face transplant team generally include:
- Plastic surgeons.
- Head and neck surgeons.
- Microvascular surgeons.
- Anesthesiologists.
- Surgical nurses.
- Immunologists.
- Immunosuppression specialists.
If you need eye or dental care, your team may also include ophthalmologists and dentists.
What happens during a face transplant?
Your donor may have recently died or be brain-dead. If someone is brain-dead, machines keep their body alive but the brain has no signs of life. During a face transplant, your team of healthcare providers first completely removes the donor’s face, including:
- Arteries.
- Cartilage.
- Fat.
- Muscles.
- Nerves.
- Skin.
- Tendons.
- Veins.
Healthcare providers then cool the face and store it in a special solution to preserve it.
During a face transplant procedure, you’re sedated (put under) so you aren’t awake and won’t feel any pain.
Once you’re asleep, healthcare providers may need to prepare the area by shaving your face or scalp. They’ll use an alcohol-based pen to mark your face. The marks will help guide their incisions and identify veins and arteries that they’ll connect to the donated face.
Healthcare providers will remove your damaged skin and tissues. The most important part of the surgery is connecting all of your many blood vessels to the donor’s face with very small surgical needles and thread. Blood vessels allow your transplanted face to receive blood (vascularization), which keeps the tissue alive.
Once your healthcare providers have confirmed that blood is flowing to your transplanted face, they’ll connect (graft) your nerves and muscles. The nerves allow your face to have feeling and sensitivity, including touch, heat, cold and pain. Facial muscles allow your face to move, including chewing, smiling, frowning, blinking and moving your eyebrows. Healthcare providers may also connect cartilage and bones with screws and plates.
Finally, your healthcare providers will stitch (suture) your soft tissues and skin together.
How long does a face transplant take?
A face transplant is a delicate procedure that requires a lot of time. Its length depends on the extent of damage to your face. It may take anywhere from 10 to 36 hours.
What happens after a face transplant?
After the face transplant procedure is complete, your anesthesiologist will stop putting anesthesia into your body to keep you asleep. You’ll move to an intensive care room, where healthcare providers wait for you to wake up and monitor your overall health. Once your healthcare providers believe it’s safe, they’ll move you to a transplant unit.
In the transplant unit, you’ll start to work with physical therapists to develop facial movements. You may also talk to psychiatrists about any psychological issues you may have during the recovery process, including anxiety and depression.
Once your healthcare providers believe it’s safe, they’ll discharge you (let you go home). On average, you’ll be in the hospital between one and four weeks after surgery.
