How a Face Transplant Works (and How Risky the Procedure Is)

In May 2017, TIME notes 21-year-old Katie Stubblefield became the 40th face transplant recipient in history — and she also stands as the youngest. This life-saving procedure came after a self-inflicted gunshot wound back in 2014. Now, Stubblefield is aiming to rebuild her life and influence those around her in ways she never before thought possible.

With 40 face transplants occurring total, the procedure is still quite new in the world of medicine. Here’s how it all works, including the high risks.

The procedure

French medicine professor Laurent Lantieri (R) with face transplant recipient Jerome Hamon

French medicine professor Laurent Lantieri (R) with face transplant recipient Jerome Hamon | Philippe Lopez/AFP/Getty Images

The Telegraph explains a face transplant involves attaching the face of someone who’s deceased on to a person who’s still alive. Both the donor and the patient receiving the face need to have the same blood and tissue type for the operation to work, and they should also have similar in age and skin tone. As you can imagine, finding a donor can be quite a task — and the surgery itself is also incredibly complex.

For the surgery to work, the donor is kept on a heart and lung machine for their tissue to stay usable. The team of surgeons then removes the damaged skin and muscle from the recipient to make way for the donor’s face to attach.

When it comes to connecting the donor’s face to the recipient’s, that’s when the surgery gets tricky. First, the arteries, veins, and nerves are reattached using thread and microscopic needles. The nerves in the face are particularly complex, as they can branch off in 40 different directions and are vital for simple facial expressions, like smiling.

Once everything’s connected, the skin is attached to the face. And it can take from six months to a year for the nerves to provide function to the muscles.

The physical risks

The risks that come with this procedure are quite serious. The Telegraph notes most complications that occur happen within the first 48 hours post-surgery, but transplant recipients can face physical difficulties for the rest of their lives.

Mayo Clinic notes the procedure is incredibly complicated, and there’s a lot of room for error. It can take over 10 hours to complete the transplant, and blood loss, clots, or infection can be life-threatening at any time.

After the surgery is deemed successful, there are also rejection risks to consider. If the body’s immune system rejects the new face, the recipient can lose all of the face, part of it, or functionality completely. And if rejection occurs and isn’t controlled, it can result in death. For this reason, transplant recipients are given anti-rejection drugs to be taken for the remainder of their life to try and combat an immune system response.

As for the anti-rejection drugs, these also come with risks. They weaken the immune system, which puts the recipient at greater risk for many different types of illnesses and infections. Additionally, immunosuppressant drugs can increase the risk of kidney damage, cancer, and diabetes.

The mental risks

Face transplant recipient Patrick Hardison

Patrick Hardison, a former firefighter from Mississippi, speaks about his recovery | Drew Angerer/Getty Images

As you can imagine, having a new face can come with a wide variety of mental health challenges. Psychologist Carla Bluhm interviewed a 38-year-old facial transplant recipient who said she found it difficult to know who she was post-surgery, the American Psychological Association reports. The patient also found it difficult to look at old photos since they knew their face would never look that way again.

Bluhm said facial transplants can completely challenge a person’s identity, but she also said the impact can greatly depend on how much “they feel their identity is tied to their appearance.” Additionally, she feels psychologists should be the ones to step in and help recipients feel at home within themselves after surgery. “A face transplant will only be helpful for its recipient insofar as it offers the possibility of enriching the narrative of one’s life through putting a new face to one’s identity,” she said.

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