Face transplant: what is it



A series of tragic accidents in a person’s life can not only disfigure his face, but also completely deprive him.

As a result of accidents and irreversible damage to facial tissues, patients often could not see, eat, or even breathe. Therefore, all operations carried out on the face transplant, pursued not only giving aesthetic appeal to the face, but also the restoration of lost functions.

The first operation was carried out in France. Isabelle Dinoire decided to commit suicide and drank a huge dose of sleeping pills. But from this dose she did not die. When she regained consciousness, she discovered that she was lying in a pool of her own blood. Her dog, Labrador, in an attempt to wake the hostess, gnawed her lower part of her face.



The damage was so severe that the reconstruction was impossible to do. Therefore, surgeons offered to make a face transplant. It was a partial transplant, her nose, lips, chin was transplanted.

Already in 2010, a full face transplant was performed in Spain, with a skin, nose, cheekbones, jaws with teeth, throat transplantation. It was a patient who was injured due to a gunshot wound to the face. He could not speak, but breathed and ate with the help of special devices. Currently, more than 30 operations have been performed. Tragic outcomes have also been recorded. The Chinese Gosin Li escaped from the hospital after a transplant and soon died due to home treatment.

This operation is very difficult and painful, carries a greater threat to the life of the patient. During the operation, each organ on the face takes the right place, and in its absence, surgeons create it again. This was made possible thanks to the latest technology in medicine, which appeared not so long ago. When the transplantation is performed, the nerve fibers are stitched together, the stitched organs begin to function as if they are the patient’s own organs.

The main problem with skin grafts is the need to find a donor. As a rule, donors are relatives of the victim, ready to provide facial tissue to help a loved one. For face transplantation, donor material from deceased people is used.

With a wide area of ​​damage, not only skin fragments are required, but also bone tissue. Such a transplant is carried out only for medical reasons, bone tissue is taken from dead people. The transplanted tissues must be compatible with the patient’s tissues, otherwise a rejection will occur. A number of doctors believe that in the near future, such operations will be attributed to the number of ordinary plastic surgeries, and will be available to all. That is, if desired, each person will be able to replace the face with a new one. Although other sources refute this opinion, and say that this operation is too unique to put on stream.



Methods for carrying out a face transplant operation and possible risks

There are many legal and ethical nuances in the process of transplantation. When using tissues of a deceased person, death must be recorded in the prescribed manner by a forensic expert. After this, a team of transplant doctors is called. An important condition is the consent of relatives, certified in the manner prescribed by law. Transportation of the material must be properly prepared and carried out in compliance with all rules. Otherwise, donor tissue may not settle down.

The main danger during a face transplant operation is the possibility of tissue rejection. The patient's immune system can identify donor as foreign and will respond to this with the production of antibodies, resulting in tissue necrosis. As a result, this can turn into not just failure, but the death of the patient. Therefore, the choice of a donor is approached very carefully, they conduct a number of necessary studies. Even with a successful outcome of a face transplant, the patient will have to take immunosuppressants for the rest of his life.

Face transplant is used in cases where reconstructive surgery remains impotent, a large amount of tissue is required.

Full face transplantation allows you to transplant all tissues, muscles, nerve and vascular fibers, as well as a number of facial skeleton elements to another person.

In some cases, the team of surgeons planning a transplant, conducts trial operations on the corpses, working out the stages of the operation.

The selection of a donor can take quite a long time, since the requirements are very strict, the antigenic structure of its tissues must correspond to the recipient, it should not have chronic diseases and be a carrier of viral diseases. Also, it must be of the same sex, have the same blood type, face size and facial skeleton.

As a rule, the donor is a person who recently died in a car accident, or a patient with a damaged brain, whose livelihoods are supported only with the help of hardware. Unfortunately, the laws of several countries prohibit transplantation.

In addition to the consent of relatives, the death of the donor is required. In this case, the donor and his relatives have the full right to preserve anonymity, information about the identity of the donor is not covered. Doctors are the only ones aware of this, but they are obliged to respect professional secrets. There are cases of lawsuits against journalists who have discovered the secret.

How is face transplantation performed?

Face transplantation is still experimental, due to the small number of operations performed. Despite this, surgeons developed an approximate sequence of its implementation. Initially, the patient must undergo a medical examination, after which a decision is made about the possibility of surgery. Then surgeons, using 3D modeling, create a new face of the patient. In parallel, a plan of operation.

Patient data is entered into the donor registry only after the preparatory stage. Doctors must find a suitable donor and make sure that they can perform the operation. When the donor is found, there is no going back. The patient should arrive at the clinic where he is placed in the operating room. At the same time, the donor's corpse lies in another operating room.

One of the teams is engaged in collecting donor material, exfoliating the necessary tissue. Other doctors prepare the field for surgery by carefully removing the patient’s damaged tissue. Then the face of the donor is transferred to the unit with the patient and the transplantation begins. First of all, the veins and arteries are stitched together, this allows you to provide nutrition to the newly acquired person. With a successful connection, the donor mask should turn pink from the surging blood of the patient. According to this method, doctors conclude that the face has come to life. After that, nerves, muscles and ligaments are stitched together sequentially, and then the skin itself, stitches are applied.

The connection of tissues is done in several ways:

• sewing on;
• gluing;
• skin and fat are attached to the muscular base of the face using a special green laser that has a specific wavelength;
• nerve fibers are stitched with medical suture.

Facial transplantation is very time consuming. The surgeon must be a real virtouz in his business, and at the same time be very hardy. The operation of complex cases can take up to one and a half days, and this is not surprising. The surgeon with maximum accuracy should model and sew a new face. The number of surgeons participating in the operation can reach up to 30 people.

After the manipulations, the patient is assigned immunosuppressive therapy, it does not allow the process of tissue rejection to develop. To avoid infections and suppuration, several types of antibiotics may be prescribed to the patient. Drugs are taken for about a year, then some of them are canceled. A number of them must be taken for life.

For face transplantation, special preparations are used that allow skin and fat splicing. Special components relieve inflammation, prevent scar removal.

It takes a long time to restore sensitivity and motor functions. The patient has to re-learn to talk, eat, smile.

Surgery to replace the face: indications and contraindications

Surgery to replace the face is shown only to patients with serious defects of the face, which are not corrected by plastic surgery. All operations were performed on patients whose faces were severely disfigured by burns, flame, acid, dog bites, and gunshot wounds.

After the operation, almost 80% of the lost facial functions of the face are restored , many can normally talk, eat not through a tube, but as normal people, with the help of a fork and knife. The operation literally returns people to a normal life, which they were deprived of.

But the ethical side of the operation to replace the face is still causing heated debates. A number of scientists believe that it is quite possible to live with facial injuries, except for deformities, they often do not constitute a danger to the patient. Opponents of the operation argue that transplantation is primarily a cosmetic operation.

But at the same time, the question was not considered what kind of psychological state of people living with such injuries, because in fact they fall out of ordinary life. Many of them suffer from depression, including suicide attempts. Therefore, at present, despite the small number of facial transplants performed, surgeons have no doubt about their necessity. The patient returns a lost standard of living, while doctors receive invaluable experience in the field of transplantology.

A big disadvantage of the operation is the need to take immunosuppressants throughout life. They are taken to suppress the action of the immune system and avoid tissue rejection. These drugs are not as harmless as we would like, they can trigger cancer and kidney diseases. In addition, they can cause complications in the form of infections that cause opportunistic pathogens. A number of doctors believe that these drugs literally make a healthy person (not counting facial injuries) disabled.

But even taking immunosuppressants does not exclude the possibility of face rejection in a few years. Tissue rejection is quite painful, therefore, in a number of countries, legislative amendments are being considered regarding the resolution of euthanasia for such patients.

Patients taking immunosuppressants are being monitored to assess the effects on health.

Patients present and psychological complications. He will never see his own face in the mirror, he will have to get used to the new look. Will the patient be able to live with this new image, get used to it? In this regard, the field of face transplant surgery is provided to patients with psychological assistance. Psychologist services are included in the rehabilitation scheme. Fortunately, doctors say that the chances of taking a new face are quite high. This person will not be a complete copy of the donor, the appearance will be affected by the features of the patient’s facial skeleton. In addition, features facial expressions, look preserved.

The face transplant procedure is not only a skillfully performed operation, it is an opportunity for many patients to return to full-fledged life.

Unfortunately, the problems of lack of donor organs and organization of donor services remain unresolved. An important role is played by the ethical issues that are unavoidable during transplantation.