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Updated: Apr 30, 2026
Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation
Published on: December 30, 2025
Facial transplantation: the first 9 years
Saami Khalifian1, Philip S Brazio2, Raja Mohan2
1Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Reconstructive Transplantation Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Facial transplantation offers life-changing results for recipients, with 28 procedures performed globally. Advances in surgical techniques and immunosuppression manage risks like acute rejection, though ethical considerations regarding lifelong immunosuppression remain.
Area of Science:
- Surgical Innovation
- Transplantation Medicine
- Immunology
Background:
- Facial transplantation has advanced significantly since 2005, with 28 global cases reported.
- The procedure offers life-changing outcomes, impacting function, aesthetics, and psychological well-being.
- Ethical debates persist regarding the necessity of lifelong immunosuppression for non-life-saving procedures.
Purpose of the Study:
- To review the outcomes and challenges of facial transplantation.
- To assess the current state of immunomodulatory and immunosuppressive protocols.
- To evaluate the impact of surgical advancements on the application of facial transplantation.
Main Methods:
- Review of global facial transplantation cases since 2005.
- Analysis of immunological, functional, psychological, and aesthetic outcomes.
- Evaluation of immunosuppressive strategies and surgical techniques.
Main Results:
- Encouraging outcomes reported across immunological, functional, psychological, and aesthetic domains.
- Acute skin rejection episodes are a significant threat but manageable with current immunosuppression.
- No cases of chronic rejection have been documented in reported facial transplants.
Conclusions:
- Facial transplantation is a viable, life-changing procedure with improving outcomes.
- Advances in immunosuppression and surgical planning facilitate broader application.
- Ongoing ethical considerations regarding immunosuppression require continued attention.
