Psychosocial Changes 6 Months after Face Transplantation

Abstract

The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients. The purpose of this study is to describe such changes as captured on a variety of psychosocial measures three and six months after full facial transplantation among three adults who all completed a comprehensive psychiatric assessment before the procedure. We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF-12. While the recipients experienced a decline in their physical quality of life in the three months immediately after surgery, they had improvement by six months (p=.02). Overall mental health showed steady improvement from the time before surgery to six months later (p=.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants’ self-esteem or dyadic function over the same period of time. As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.

Facial and Hand Allotransplantation

“…Results from a psychosocial analysis of quality-of-life measures using the MOS-SF-12 showed that patients at our institution who underwent facial allotransplantation had a significant improvement in their mental health in the 6 months posttransplantation (Chang and Pomahac 2012). Clearly for patients requiring facial transplantation the devastating nature of their injuries severely limits their ability to interact in society, and improvement both aesthetically and functionally is welcome.…”

Pediatric Vascularized Composite Allotransplantation

“…79,80 An increase in appearance ratings together with decreased anxiety, depression, and chronic pain in these patients has significantly contributed to an improvement in the QoL. 81,82 These promising outcomes created the ground for the debate on extending the indications of VCA to pediatric patients, as children display superior nerve recovery due to both central and peripheral factors. 83 The distance that axons must travel peripherally is shorter and the nerve regeneration is faster; therefore, muscle reinnervation and sensory recovery of the allograft are expected to occur earlier.…”

Surgical, ethical, and psychosocial considerations in human head transplantation

“…In studies on face transplantation outcomes, identity confusion or disruptions in self-identity have yet to be reported. For some, the opposite has been noted: self-esteem, social integration, and overall mental health have improved after transplantation [59–62]. Face transplantation appears to enable psychological health by allowing patients to approach a normal appearance and correct some of the physical limitations that often accompany severe disfigurement.…”