Self as donor ("face replant") The world's first full-face replant operation was on 9-year-old Sandeep Kaur, whose face was lost to a traumatic injury. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in
The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although she was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was
Abraham Thomas, one of India's top
microsurgeons. In 2004, Sandeep was training to be a nurse. In 1996, a similar operation was performed in the Australian state of
Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.
Partial face transplant France The world's first partial face transplant on a living human was carried out on 27 November 2005 by
Bernard Devauchelle, an
oral and maxillofacial surgeon, Benoit Lengelé, a Belgian plastic surgeon, and
Jean-Michel Dubernard in
Amiens, France. Isabelle Dinoire Dinoire died on 22 April 2016 at the age of 49 due to cancer induced by medications she was taking. In March 2008, the treatment of 30-year-old Pascal Coler of France, who has neurofibromatosis, ended after he received what his doctors call the world's first successful almost full face transplant. The operation, which lasted approximately 20 hours, was designed and performed by Laurent Lantieri and his team (Jean-Paul Meningaud, Antonios Paraskevas and Fabio Ingallina).
China In April 2006, Guo Shuzhong at the Xijing military hospital in
Xi'an, transplanted the cheek, upper lip, and nose of Li Guoxing, who sustained severe injuries after being attacked by an
Asiatic black bear while protecting his sheep. On 21 December 2008, it was reported that Li had died in July in his home village in
Yunnan. Prior to his death, a documentary on the
Discovery Channel showed he had stopped taking his immuno-suppressant medications in favour of herbal remedies; a decision that was likely a contributing factor to his death, as stated by his surgeon.
Turkey Selahattin Özmen performed a partial face transplant on 17 March 2012 on Hatice Nergis, a twenty-year-old woman at
Gazi University's hospital in
Ankara. It was Turkey's third facial transplantation, the first woman-to-woman and the first three-dimensional transplantation with bone tissue. The patient from
Kahramanmaraş had lost her upper jaw six years prior in a firearm accident, including her mouth, lips, palate, teeth and nasal cavity, leading to significant impairment. She had undergone around 35 reconstructive plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin. Nergis died in Ankara on 15 November 2016 after she was hospitalized two days prior complaining about acute pain.
Belgium In December 2011, a 54-year-old man underwent a partial face transplant to the lower two-thirds of the face (including bone) after a ballistic accident. The operation was performed by a multidisciplinary team led by plastic surgeon Phillip Blondeel. Hubert Vermeersch, Nathalie Roche and Filip Stillaert were also members of the surgical team. For the first time, 3D CT planning was used to plan the operation, which lasted 20 hours. As of 2014, the patient is alive, with "good recovery of motor and sensory function and social reintegration".
Italy In September 2018, a 49-year-old woman affected by Neurofibromatosis type I received a partial face transplant from a 21-year-old female donor at Sant'Andrea Hospital of Sapienza University in Rome. The procedure took 27 hours and was carried out by two teams led by Fabio Santanelli di Pompeo and Benedetto Longo. The patient had a complication and after two days the surgeons had to replace the facial graft with autologous tissue. The patient is still alive and waiting for a second face transplantation.
Canada In May 2018, the first Canadian complete face transplant was performed under the leadership of
plastic surgeon Daniel Borsuk at the Hopital Maisonneuve Rosemont, in
Montreal,
Quebec. The transplant took over 30 hours and replaced the upper and lower jaws, nose, lips, and teeth on Maurice Desjardins, a 64-year-old man that sustained an accidental gun-shot wound to the face. At that time, Mr. Desjardins was the oldest person to benefit from a face transplant.
Full face transplant On 20 March 2010, a team of 30 Spanish doctors led by plastic surgeon Joan Pere Barret at the
Vall d'Hebron University Hospital in
Barcelona carried out the world's first full face transplant, on a man injured in a shooting accident. On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the
Henri-Mondor hospital in
Créteil. In March 2011, a surgical team, led by
Bohdan Pomahač at
Brigham and Women's Hospital in
Boston, Massachusetts, performed a full face transplant on
Dallas Wiens, who sustained severe physical injuries to the face in a power line accident that left him blind and without lips, nose or eyebrows. The patient's sight couldn't be recovered but he was able to talk on the phone and smell. In April 2011, less than one month after the hospital performed the first full face transplant in the country, the
Brigham and Women's Hospital face transplant team, led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anaesthesiologists and residents worked for more than 14 hours to replace the full facial area of the patient, including the nose, muscles of facial animation and the nerves that power them and provide sensation. Hunter had a severe shock from a high voltage electrical wire following a car accident in 2001.
Spain Spain has played a leading role in the development of facial transplantation. In March 2010, the Hospital Vall d'Hebron in Barcelona performed the world’s first total face transplant. The procedure was carried out on March 20 by a multidisciplinary team of 30 professionals led by Dr. Joan Pere Barret and lasted approximately 22 hours. Unlike the previous face transplants performed which had involved partial grafts, this operation consisted of a full facial allograft. The recipient was a young man with severe facial trauma that caused impairment in his breathing, swallowing, and speech. The transplant included the complete facial skin and musculature, nose, lips, upper jaw (maxilla), mandible, cheekbones, palate, and teeth. The procedure required complex reconstructive and microvascular surgery to ensure proper revascularization of the graft.
Poland On 15 May 2013, at the
Maria Skłodowska-Curie Institute of Oncology branch in
Gliwice, Poland, an entire face was transplanted onto a male patient, Grzegorz (aged 33) after he sustained severe facial injury in a machnining accident. The surgery took 27 hours and was directed by Professor Adam Maciejewski. There had not been much planning or preparation before the surgery, which was performed about one month after the accident, because the transplantation was done as emergency procedure due to the patient's difficulty in eating and breathing. Shortly after the donor's death, the decision to perform the surgery was made and his body was transported hundreds of kilometers to Gliwice once his relatives gave their consent. The doctors believe that their patient has an excellent chance to live a normal, active life after surgery, and that his face should operate more or less normally. Seven months later, on 4 December, the same Polish medical team in Gliwice transplanted a face onto a 26-year-old female patient with
neurofibromatosis. Two months after the operation, she left the hospital.
Turkey On 21 January 2012, Turkish surgeon
Ömer Özkan and his team successfully performed a full face transplant at
Akdeniz University's hospital in
Antalya. The 19-year-old patient, Uğur Acar, sustained severe burns as a baby. The donor was 39-year-old Ahmet Kaya, who died on 20 January. The Turkish doctors declared that his body had accepted the new tissue. Almost one month later on 24 February 2012, a surgical team led by
Serdar Nasır conducted the country's second successful full face transplant at
Hacettepe University's hospital in
Ankara on 25-year-old Cengiz Gül. The patient's face sustained severe burns when he was two years old. The donor was an undisclosed 40-year-old deceased donor. On 16 May 2012, surgeon Ömer Özkan and his team at the Akdeniz University Hospital performed the country's fourth and their second full facial transplantation. The face and ears of 27-year-old patient Turan Çolak from
İzmir were burnt when he fell into an oven when he was three and half years old. The donor was Tevfik Yılmaz, a 19-year-old man from
Uşak who had been declared brain dead in the evening hours of 15 May after having been in intensive care for seven days. On 18 July 2013, A donors face was successfully transplanted onto a Turkish man in a transplant performed by Özkan, at Akdeniz University hospital following a 6.5-hour operation, making it the fifth such operation to take place in the country. It was the 25th facial transplantation in the world. The donor was Andrzej Kucza, a 42-year-old Polish tourist who was declared brain dead following a heart attack on 14 July while swimming in Turkey's sea resort
Muğla. The receiver was 27-year-old patient Recep Sert from
Bursa. On 23 August 2013, surgeon Ömer Özkan and his team at Akdeniz University performed the sixth face transplant surgery in Turkey. Salih Üstün (54) received the scalp, eyelids, jaw and maxilla, nose and the half tongue of 31-year-old Muhittin Turan, who was declared brain dead after a motorcycle accident that took place two days before. On 30 December 2013, Özkan and his team conducted their fifth and Turkey's seventh face transplant surgery at the hospital of Akdeniz University. The nose, upper lip, upper jaw and maxilla of brain dead Ali Emre Küçük, aged 34, were successfully transplanted to 22-year-old Recep Kaya, whose face was severely injured in a shotgun accident. While Kaya was flown from
Kırklareli to Antalya via Istanbul in four hours, the donor's organs were transported from
Edirne by an ambulance airplane. The surgery took 4 hours and 10 minutes.
United Kingdom In October 2006, surgeon
Peter Butler at London's Royal Free Hospital in the UK was given permission by the
NHS ethics board to carry out face transplants. His team were to select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six-month intervals. As of 2022, neither Butler nor any other UK surgeon has performed a face transplant.
United States In 2004, the
Cleveland Clinic became the first institution to approve this surgery and test it on cadavers. In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by
Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Steven Bernard, Dr Mark Hendrickson, Robert Lohman, Dan Alam and Francis Papay) performed the first face transplant in the US on a woman named
Connie Culp. It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a deceased donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had sustained injuries to the extent that she could no longer eat or breathe independently, which had left her without a nose, right eye or upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved. Connie died 29 July 2020. The second partial face transplant in the US took place at
Brigham and Women's Hospital in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by
Bohdan Pomahač, replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result. This procedure was also shown in the eighth episode of the ABC documentary series,
Boston Med. The first full face transplant performed in the US was done on a construction worker named
Dallas Wiens in March 2011. He was burned in an electrical accident in 2008. This operation, performed by Bohdan Pomahač and BWH plastic surgery team, was paid for with the help of the US defence department. They hope to learn from this procedure and use what they learn to help soldiers with facial injuries. One of the top benefits of the surgery was that Dallas regained his sense of smell. The Brigham and Women's Hospital transplant team led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. Hunter, who is a US war veteran, was left disfigured in a car accident, burning about 94% of his face. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anaesthesiologists and residents worked for more than 14 hours to replace the full facial area of the patient, Mitch Hunter, including the nose, eyelids, muscles of facial animation and the nerves that power them and provide sensation. Mitch Hunter was a passenger in a single cab pick-up truck, upon exiting the vehicle and pulling another passenger off a downed line, Hunter was then struck by high voltage. The electricity entered his lower left leg, with the majority exiting his face, leaving him with severe burns. He also lost part of his lower left leg, below the knee, and lost two digits on his right hand (pinkie and ring finger). Hunter has regained almost 100% of his normal sensation back in his face and his only complaint is that he looks too much like his older brother. In March 2012, a face transplant was completed at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center under the leadership of plastic surgeon
Eduardo Rodriguez and his team (Amir Dorafshar, Michael Christy, Branko Bojovic and
Daniel Borsuk). The recipient was 37-year-old Richard Norris, who had sustained a facial gunshot injury in 1997. This transplant included all facial and anterior neck skin, both jaws, and the tongue. In September 2014, another face transplant was performed by the Cleveland Clinic group. The patient had had complex trauma that masked the development of a rare type of autoimmune disease (
granulomatosis with polyangiitis and
pyoderma gangrenosum) affecting the face. It was the first face transplant in a patient with an autoimmune disease involving the craniofacial region. Prior to surgery, an analysis of kidney transplant outcomes in granulomatosis with polyangiitis was conducted to evaluate allograft outcomes in these cohorts. That literature established feasibility and encouraged the Cleveland Clinic team to proceed with the surgery. The intervention was reported successful up to three years post-transplantation. In August 2015, a face transplant was completed at the NYU Langone Medical Center under the leadership of the chair of plastic surgery
Eduardo D. Rodriguez and his team. A 41-year-old retired fireman named Patrick Hardison received the face of cyclist David Rodebaugh. In June 2016, a multidisciplinary team of surgeons, physicians and other health professionals completed a near-total face transplant at
Mayo Clinic's Rochester campus. Patient Andrew Sandness, a 32-year-old from eastern Wyoming, had devastating facial injuries from a self-inflicted gunshot wound in 2006. The surgery, which spanned more than 50 hours, restored Sandness' nose, upper and lower jaw, palate, teeth, cheeks, facial muscles, oral mucosa, some of the salivary glands and the skin of his face (from below the eyelids to the neck and from ear to ear). The care team led by Samir Mardini, and Hatem Amer, the surgical director and medical director, respectively, for the Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, devoted more than 50 Saturdays over years to rehearsing the surgery, using cadavers to practice the procedure. They used 3-D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on the transplant recipient. Today, in addition to his physical transformation, Sandness can smell again, breathe normally and eat foods that were off-limits for a decade. In a 31-hour operation starting on 4 May 2017, surgeons at the Cleveland Clinic transplanted a face donated by Adrea Schneider, to Katie Stubblefield, whose face had been sustained severe injuries caused by gunshot wound on 25 March 2014. , Katie is the youngest person in the United States to have had a face transplant, age 21 at the time. Surgeons originally planned to leave her cheeks, eyebrows, eyelids, most of her forehead, and the sides of her face alone. However, because the donor face was larger and darker than Katie's, they made the decision to transplant the donor's full face. This holds an increased risk of acute
rejection in which case, the face must be removed. she did not have enough tissue for reconstructive surgery. Katie was featured on the cover of
National Geographic in September 2018 for an article entitled "The Story of a Face." In July 2019, 68-year-old Robert Chelsea became the oldest person, as well as the first black person in the world, to receive a full face transplant. On 6 August 2013, Robert was involved in a car accident, leaving burns over 75% of his body. The severe injuries meant that Robert was missing significant facial elements such as a part of his nose, which limited his ability to eat and drink. Functionality was important to Robert and was a key reason behind his pursuit of the surgery. In 2016, a face transplant was first discussed. Yet, health care disparities have led to a lack of black organ donations. This meant that Robert waited two years to find a face that matched something close to his own complexion. The surgery was performed on 27 July 2019 at Brigham and Women's Hospital. In February 2024, 30-year-old Derek Pfaff received a full-face transplant from an anonymous donor. Pfaff had previously sustained a gunshot wound in March 2014, 10 years prior to the surgery. The results of the surgery were later revealed in November 2024.
Combined procedures A number of combined VCA procedures, such as bilateral
hand transplants, have been described in the literature and media sources. These combined procedures also include attempts at triple-limb and quadruple-limb transplants, however, only three face transplants have been attempted in combination with other allografts.
France In 2009, Laurent Lantieri and his team attempted a face and bilateral hand transplant on a 37-year-old man who sustained extensive injuries during a self-immolation attempt one year prior. The patient ultimately died of anoxic brain injury two months after his initial transplant during surgical management of infectious and vascular complications. Autopsy revealed no signs of rejection in any of the allografts.
United States On 12 August 2020, at NYU Langone Health in New York, New York,
Eduardo D. Rodriguez led a team of over 140 personnel in successfully transplanting the face and bilateral hands of a brain dead donor onto 22-year-old Joe DiMeo, who sustained substantial burns after a car accident in 2018. The procedure lasted approximately 23 hours, and involved the entire facial soft tissue (extending from the anterior hairline to the neck, including the eyelids, nose, lips, and ears, along with strategic skeletal components), as well as both hands at the distal forearm level. Charla Nash's face transplant, described above, also initially included bilateral hands from the same donor. Circulation to Nash's transplanted hands was compromised after she was started on
vasopressors as part of treatment for sepsis. ==Ethics, surgery and post-operation treatment==