Face Transplants

In 2008, Dallas Wiens lost his face when he was electrocuted while painting a church. Although the surgeons of Parkland Memorial Hospital did the best of their ability, he was left without his eyes or nose. Most of Wiens' face was a veil of skin, with the exception of his mouth, which was crooked and lipless. Wiens was ostracized by his Texas community, often hearing conversations about his facial deformity, especially during his time with his daughter Scarlette. Fortunately for Wiens, he was able to receive a face transplant in Boston by Dr. Bohdan Pomahač, and although he is still unable to see, he can feel, smell, and move the muscles in his new face. Wiens was the first to receive a full face transplant in the United States and is now able to live a more comfortable lifestyle.

How do face transplants work?

First, donors need to be found for face transplants. Potential donors must be brain dead and on life support, since the facial tissues must still be connected to an active blood source. The donor's blood and tissue must match the recipient's in order to keep the new face from being rejected. Doctors also try to match age and skin tone to make the face seem as natural as possible.

Next, the doctors will remove the face from the donor. Not only will the skin be removed, but so will the fat, nerves, muscles, cartilage, arteries, and veins. In some cases, bone will also be removed in order to replace missing pieces in the recipient. The face is then packed in ice and transported to the recipient, where the doctors have removed the damaged tissue on the recipient's face.

Doctors use microscopic needles and thread to attach arteries and veins. All of them do not have to be attached, but there must be enough blood flow to keep the new tissue alive. Then the nerves and muscles are attached in order for the recipient to feel and move his or her face. The new face will be draped over the recipient's skull and finally sewn into place.

What are the risks?

As with any surgery, there are risks of bleeding and infection, but because face transplant surgeries are more complicated and few have ever been conducted, there are more issues that could arise. A potential blood clot in the face could block blood circulation and kill the tissue, or the recipient's body could also reject the new tissue, even with the use of immunosuppressant drugs. If patients disobey their doctor's orders, there could be severe consequences. A man lost an appendage when he refused to continue taking his anti-rejection medication.

There are also psychological issues that may occur. Since the recipient is wearing another person's face, it can become traumatic. Future recipients of face transplants may need psychological counseling.

There have been very few face transplants, mostly because of ethical concerns, such as the donor's family turning off the life-support machines while the donor still technically lives. However, face transplants could help disfigured veterans receive new faces and allow them to have more normal lifestyles. Dallas Wiens is incredibly grateful to the donor family who gave him his new face, and he claims that there "...are no words to describe" his happiness. Wiens' face continues to change as the facial tissue continues to attach itself onto his skull, looking less like the original donor and more like Wiens.

Sources:

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Dallas Wiens