Youngest person in U.S. receives full face transplant by Cleveland Clinic team

By Dr. Ananya Mandal, MDJul 18 2017

A team of surgeons and doctors at the Cleveland Clinic made history after operating upon a 21 year old woman for 31 hours to give her a full face transplant. The operation held in May this year was a successful one with the woman receiving a completely new face from a donor.

Her scalp, forehead, upper and lower eyelids, sockets of the eyes, nose, cheeks, upper and lower jaws, both sets of teeth, nerves, muscles, blood vessels and skin of the face was completely replaced to give her a new face. With this she also becomes the youngest person in the U.S. to receive a full face transplant. Before the actual surgery the team rehearsed on 3-D-printed models and virtual reality to improve their outcomes from this surgery.

The patient recounted her difficult journey in a statement and went on to thank her donor and family and the whole team of caregivers who made this possible for her. She called this an “incredible gift”. The woman had suffered a gunshot injury to her face as a teenager that left her face completely damaged. Her disfigurement was so severe that facial reconstruction surgery alone was not enough to give her facial muscles an actual improvement, nor would it help improve the quality of her life believed the surgeons. Dr. Frank Papay, chairman of the Clinic's Dermatology and Plastic Surgery Institute and who co-directed the surgery said that this surgery attempts to restore the function of her face more than form of her face. He explained that her face had lost both form and function and this was a risk benefit analysis situation whether she would benefit from the transplant more or from a reconstruction surgery.

This new face would allow her to express emotions on her face – something she was not able to do before. Her ability to speak, chew, breathe etc. would also be restored completely. Dr. Brian Gastman, one of her surgeons said that this surgery would give her a “functional life”. She would now be able to live a normal life of any other person and this could do a lot for her self-esteem he added. She would be able to socialize normally now with confidence he said. At present she is recovering well from her transplant and would be able to use her face muscles to eat soon the team of caregivers have said in their statement. However she would take a long time to recover fully they added. She would need rehabilitation therapy, speech and swallowing physical therapy and occupational therapy. Her body might reject the tissues from the donor that have been implanted onto her face. So she would need to be monitored closely and need immunosuppressing medications to stop her immune system from rejecting the transplanted tissues. Like in most organ donation recipients she would need these medications for life.

Face transplant has been performed in only a very few set ups worldwide. In the United States alone there are six centres where these are performed. Nearly a decade back, Cleveland Clinic performed the first near total face transplant in the U.S. This was their first complete face transplant. This was the third face transplant held at this clinic. Face transplant was and remains till date one of the most complex surgeries because of the millions of tiny blood vessels, nerves and muscles that need to be perfectly joined to form a new face. For a face to show expressions, the tiniest muscles may be at play and each of these need meticulous surgery.