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Facial Transplantation for an Irreparable Central and Lower Face Injury: A Modernized Approach to a Classic Challenge

Kantar, Rami S. M.D., M.P.H.; Ceradini, Daniel J. M.D.; Gelb, Bruce E. M.D.; Levine, Jamie P. M.D.; Staffenberg, David A. M.D.; Saadeh, Pierre B. M.D.; Flores, Roberto L. M.D.; Sweeney, Nicole G. N.P.; Bernstein, G. Leslie M.P.A.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic and Reconstructive Surgery: August 2019 - Volume 144 - Issue 2 - p 264e-283e
doi: 10.1097/PRS.0000000000005885
Reconstructive: Head and Neck: Special Topic
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Background: Facial transplantation introduced a paradigm shift in the reconstruction of extensive facial defects. Although the feasibility of the procedure is well established, new challenges face the field in its second decade.

Methods: The authors’ team has successfully treated patients with extensive thermal and ballistic facial injuries with allotransplantation. The authors further validate facial transplantation as a reconstructive solution for irreparable facial injuries. Following informed consent and institutional review board approval, a partial face and double jaw transplantation was performed in a 25-year-old man who sustained ballistic facial trauma. Extensive team preparations, thorough patient evaluation, preoperative diagnostic imaging, three-dimensional printing technology, intraoperative surgical navigation, and the use of dual induction immunosuppression contributed to the success of the procedure.

Results: The procedure was performed on January 5 and 6, 2018, and lasted nearly 25 hours. The patient underwent hyoid and genioglossus advancement for floor-of-mouth dehiscence, and palate wound dehiscence repair on postoperative day 11. Open reduction and internal fixation of left mandibular nonunion were performed on postoperative day 108. Nearly 1 year postoperatively, the patient demonstrates excellent aesthetic outcomes, intelligible speech, and is tolerating an oral diet. He remains free from acute rejection.

Conclusions: The authors validate facial transplantation as the modern answer to the classic reconstructive challenge imposed by extensive facial defects resulting from ballistic injury. Relying on a multidisciplinary collaborative approach, coupled with innovative emerging technologies and immunosuppression protocols, can overcome significant challenges in facial transplantation and reinforce its position as the highest rung on the reconstructive ladder.


New York, N.Y.

From the Hansjörg Wyss Department of Plastic Surgery and the Transplant Institute, New York University Langone Health.

Received for publication November 16, 2018; accepted February 7, 2019.

This study is registered under the name “Craniomaxillofacial Allotransplantation,” identification number NCT02158793 (

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Rodriguez has received speaker honoraria for unrelated activities from DePuy Synthes CMF and KLS Martin. The face transplant was funded by two separate mechanisms, including a Reconstructive Transplantation Research Award (W81XWH-15-2-0036) from the Department of Defense, and institutional support.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

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Eduardo D. Rodriguez, M.D., D.D.S., Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 305 East 33rd Street, New York, N.Y. 10016,, Twitter: @RamiKantar1

Copyright © 2019 by the American Society of Plastic Surgeons