Facial transplantation: the next frontier in head and neck reconstruction

Facial reconstruction poses a unique surgical challenge-restoring the aesthetic form and function of the face. Established techniques for reconstruction include skin grafts, local cutaneous tissue flaps, and free flap autografts. The anatomic complexity of the face renders it challenging, however, to obtain a successful cosmetic and functional result. The success of recent hand, knee joint, and larynx allotransplantation and advances in immunosuppressive regimens have pushed the technical frontiers of composite tissue transfer to include partial facial transplantation. This article reviews current techniques for reconstruction of facial defects, with a focus on the microsurgical, immunologic, and ethical considerations of facial allotransplantation.