Facial transplantation: where it is now and its future in reconstructive surgery

Facial transplantation has emerged in recent years as a promising treatment option for patients with severe facial disfigurement and is of wider interest to the lay community. In its short history, many technical, ethical and management challenges have been overcome. Over 15 transplants have been performed across the world for traumatic injuries, burns and congenital defects, with good functional and aesthetic outcomes being reported from cases. Significant issues involving the procedure persist, including the use of appropriate immunosuppressive regimes, statistics on long-term outcomes and patient selection processes. Patient selection is perhaps the most important factor in the success of the procedure, as the individual must endure difficult rehabilitative, psychological and social issues in the postoperative recovery period, including the adverse effects and complications associated with immunosuppression. Knowledge about long-term outcomes is still limited, with the first operation having only been performed in 2005. Follow-up and prospective studies are required before facial transplantation can become a widely offered treatment. Current progress in addressing these therapeutic issues suggests that it should not be long before facial transplantation becomes a realistic treatment option for a wide range of patients suffering from facial disfigurement, offering them an improved quality of life and the chance to successfully reintegrate into society.