Related Experiment Video
Updated: May 8, 2026
Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation
Published on: December 30, 2025
Overcoming cross-gender differences and challenges in Le Fort-based, craniomaxillofacial transplantation with
Chad R Gordon1, Edward W Swanson, Srinivas M Susarla
1From the *Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA; ‡Department of Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore; §The Johns Hopkins University Applied Physics Laboratory, Laurel; and ∥3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD.
Background:
Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation.
Methods:
Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results.
Results:
Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown.
Conclusions:
On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
