Reflections on a Decade of Face Transplantation

Abstract

On November 27, 2005, Isabelle Dinoire underwent the world's first partial face transplant in Amiens (France) after a dog attack had left her face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal implications of a surgical procedure that was striving to transition from sci-fi novels to science. Today, 10 years and over 35 transplants later, public opinion has become accustomed to the concept of "face restoration" through transplantation. However, face transplantation is far from being a safe "routine" surgery and the science behind it is still mostly unknown. Patients and multidisciplinary teams of physicians confront daily medical challenges, life-threatening risks, and personal struggle that only in part come to light. Could (or should) this be the laborious, uncertain, and high-risk trajectory of disruptive medical innovation? Over the last decade, some medical discoveries and surgical advancements in the field have been closely accompanied by partial regulatory frameworks, intense ethical discussions, and meaningful changes in social beliefs across cultures and continents. Yet, a very long way is to come and the questions we still have today greatly outweigh the answers we can offer. Here, we take the chance of the 10-year anniversary of face transplantation to reflect on the path traveled and to look forward to the challenges lying ahead.

Tissue-Engineered Grafts from Human Decellularized Extracellular Matrices: A Systematic Review and Future Perspectives

“…Face allotransplantation has recently been developed for severe disfigurement [354] but concerns remain for the need of lifelong immunosuppression and chronic rejections, which may occur even after many years. The possibility to develop engineered face grafts involving human ECM recellularized and autologous cells would represent a valid alternative.…”

Face allotransplantation for various types of facial disfigurements: A series of five cases

“…However, as the numbers of patients have increased, more difficulties and challenges have also been encountered. More refinements and better results have now been achieved in all new cases, especially in centers with higher levels of experience (Giatsidis, Sinha, & Pomahac, ; Khalifian et al, ; Lantieri et al, ; Petruzzo et al, ; Pomahac et al, ; Siemionow, Gharb, & Rampazzo, ).…”

Costimulation Blockade in Vascularized Composite Allotransplantation

“…Opportunistic infections due to viruses, such as EBV, CMV, HSV-1, have been extensively reported and investigated in SOT recipients and have been identified as major complications affecting VCA patients ( 6 , 70 – 72 ). Cancer commonly affects transplant recipients and is an emerging issue in VCA transplantation, in the form of de novo tumorigenesis, associated with immunosuppression per se or viral reactivation (EBV related lymphomas), or tumor recurrence ( 20 , 73 ). The most commonly used induction agent in VCA is antithymocytic globulin (ATG) and acts through T-cell depletion as a polyclonal antibody directed against the CD2, CD3, CD4, and CD8 molecules.…”

“…Hand transplantation is currently the most common VCA performed clinically. In 2005, the first face transplantation was reported by the Amiens transplantation team in a woman suffering from traumatic amputation of the lower face, including distal nose, lips, chin, and lateral face parts (19). Since then at least 46 facial transplantations have been performed worldwide in patients with burn injuries, animal bites or malignancies (20-23).…”

“…In 2005, the first face transplantation was reported by the Amiens transplantation team in a woman suffering from traumatic amputation of the lower face, including distal nose, lips, chin, and lateral face parts ( 19 ). Since then at least 46 facial transplantations have been performed worldwide in patients with burn injuries, animal bites or malignancies ( 20 – 23 ). Face transplantation re-establishes the ability of patients to speak, feed themselves and express their emotional status, thus facilitating an adequate social life ( 6 ).…”