Current concepts and future challenges in facial transplantation

Facial allotransplantation has become a surgical reality. The first successful segmental human face transplants have demonstrated that facial allografts are reliable, their rejection can be prevented by low-dose immunosuppression, and their neurologic recovery enables oral and expressive functions of the face to be restored. Clinical facts have shown that the risk-benefit balance is acceptable in the medium term, that at the neurocognitive level the allograft is reintegrated in the body scheme of the recipient, and that it does not engender a donor identity transfer. This article presents a classification of facial allografts and discusses the technical, immunologic, and ethical challenges that lie ahead.