From the time we begin our search for a qualified face transplant recipient to the continuing care we provide following surgery, a significant amount of time, expertise, and attentiveness is contributed toward making the procedure a progressive success. Below is an overview of what happens before, during and after a face transplant procedure. For a more thorough discussion of what a Brigham and Women's Hospital face transplant patient should expect, please review our Face Transplant Patient Guide.
Face transplant candidates go through an extensive screening process that is likely to last several months. This screening includes a psychiatric and social support evaluation and a series of imaging tests to help determine a patient’s physical and mental readiness for the procedure.
If, upon completion of the screening process, it is determined that a patient is a suitable candidate, we will place the patient on a transplant waiting list. We will then begin working with the New England Organ Bank (NEOB) team to find a donor who matches the recipient’s tissue requirements – e.g., similar age, right blood type. This search could take many months, and, if a suitable donor is not found within one year, we will speak with the patient to determine whether they’re willing to continue waiting.
When a donor is found, we will immediately inform the patient about when to arrive at the hospital for the operation. As the timing for this type of procedure is extremely important, patients are expected to be readily available, i.e., reside within a 12-hour travel radius of BWH.
What happens during face transplant surgery?
The area most likely to be reconstructed in a partial face transplant is the central region of the face, which includes the nose and lips, as these facial structures are the most difficult to reconstruct with conventional plastic surgery techniques.
One surgical team will work on removing the facial graft from the donor as another team simultaneously prepares the facial defect on the recipient. In our most recent case, the graft included the entire nose; the soft tissues of the mid-face, including all its blood vessels, muscles, and nerves; and a significant portion of the mid-facial skeleton. Surgeons will then connect the facial graft blood vessels to the patient's blood vessels under a microscope to restore blood circulation before connecting nerves and other tissue, such as bone, cartilage and muscles, as needed.
While the face transplant is taking place, a separate, smaller surgery will also be performed. We will take a skin sample (graft) from the arm of the donor and then attach the sample to the patient’s chest or abdomen. The intent is to have the graft behave like the face transplant tissue, eventually becoming part of the patient’s own skin. This is done so that later we can take tiny samples (biopsies) of the new chest/abdomen tissue to look for signs of rejection, thereby minimizing the need to disturb your new face tissue after surgery.
What happens after face transplant surgery?
Immediately after surgery, the face transplant recipient will be taken to the Intensive Care Unit (ICU) for observation. The patient will typically stay in the ICU for one or two days and then be moved to a private room. At this point, a physical therapist will help the patient regain as much facial movement as possible, and a psychiatrist will discuss any psychological concerns.
The patient will stay in the hospital until both the plastic surgery and medical transplant teams agree that it is safe for the patient to return home. This post-operative stay is anticipated to be approximately 7-14 days, but can vary due to a number of factors.
Following their discharge, face transplant patients will need to return to BWH for routine visits. These visits will include monitoring transplant drug levels (immunosuppressants) through regular blood tests, imaging tests, assessing quality of life and checking for the return of sensation and movement to the face. We will also periodically examine small tissue samples from the chest/abdomen graft under a microscope to look for any signs of rejection. These visits will typically take place on a weekly basis for the first three months and then at least once a month for the first year following surgery. In case the patient lives far away, we are anticipating that video conferences with the collaborating medical centers could replace lengthy commutes.
After the first year, it is expected that face transplant patients will need to visit the hospital less and less as time passes. However, patients should be prepared to make a lifetime commitment to immunosuppressants to help prevent the rejection of the transplanted face tissue.