What Face Transplants Can, Can't Do

Aug. 12, 2011 -- What, exactly, is a face transplant?

The question is being asked anew with the release of dramatic before-and-after images of Charla Nash, the Connecticut woman mauled by a chimpanzee and the latest person to receive a face transplant.

Some 17 people in the world now have undergone the experimental and still misunderstood procedure, says Maria Siemionow, MD, PhD, director of plastic surgery research at the Cleveland Clinic.

Siemionow, who led the team that performed the first U.S. face transplant, says that in one way, a face transplant is like a kidney transplant: It comes from a human donor.

"But a face you can see and a kidney you cannot," Siemionow tells WebMD. "So this becomes much more of an issue. The face has many arteries, veins, muscles, and nerves which have to be reconstructed to the extent they will bring back facial motion. The patient has to be able to smile, to purse the lips, to present happy expressions. This is very different from any other transplant."

Nash, who was initially under the care of Cleveland Clinic surgeons, eventually received the transplant at Brigham and Women's Hospital in Boston. She is still recovering from complications of surgery, but issued a dramatic statement thanking her doctors -- and most of all thanking the anonymous deceased woman who donated her face.

"I will now be able to do things I once took for granted," Nash says in the statement. "I will be able to smell. I will be able to eat normally. I will no longer be disfigured. I will have lips and will speak clearly once again. I will be able to kiss and hug loved ones. I am tremendously grateful to the donor and her family."

Facial reconstruction surgeon John Girotto, MD, director of the craniofacial anomalies center at the University of Rochester's Golisano Children's Hospital, says face transplants can indeed fulfill such expectations.

"Does it really work? Yes. Do you look like the donor? A little bit, but you still look like yourself," Girotto tells WebMD. "We are not quite there yet -- it is still an experimental thing -- but face transplant holds great promise for people with terrible injuries and no other established options."

When Face Transplant Is an Option

Who is a candidate for a face transplant?

"It is a very drastic procedure, so you need to have an extremely disfiguring facial injury or birth defect for which other standard reconstructive techniques aren't good enough," Girotto says. "Things like shotgun wounds to the face; large, full-skin-thickness burns; and in Asia, it's also been used for people with neurofibromatosis [a disfiguring genetic disease]."

But not every disfigured person is a candidate for face transplant. As with other transplants, face recipients must stay on immunity-suppressing drugs for the rest of their lives in order to keep their bodies from rejecting the face.