Having someone else’s face in place of a patient’s severely marred one, due to reasons such as burns, birth defects or assaults, has been carried out in less than 40 operations in just seven different countries. Face transplants first came into limelight in 2005 when 38-year-old Frenchwoman, Isabelle Dinoire had a 46-year-old donor face transplanted in place of hers, which was severely mauled by her own dog. After the transplant, she said, “it may be someone else’s face, but when I look in the mirror, I see me.”

Isabelle Dinoire, made international headlines after undergoing the landmark operation in 2005 – becoming the first-ever face transplant recipient. Isabella passed away in 2016. Photo credit: The Independent
Isabelle Dinoire, made international headlines after undergoing the landmark operation in 2005 – becoming the first-ever face transplant recipient. Isabella passed away in 2016. Photo credit: The Independent

A face transplant is done not merely for aesthetics—but also to mend the quality of the patient’s life. Severe facial disfigurement can lead to a life of social isolation and a face transplant might just be saving more than face. It can improve abilities to chew, talk, breathe and display facial expressions such as smiling and frowning. Though it is relatively new and a very high-risk procedure, with at least six deaths since the first-ever face transplant, the procedure continues to break grounds.

Double face transplant

Fast forward to more than 12 years since Isabelle Dinoire’s ground-breaking face transplant surgery, France have once again made medical history in this field as doctors recently carried out a double face transplant—replacing one transplanted face with another—on a man in his 40s, in a Paris hospital. The anonymous man has rejected his donor face, which was received in a face transplant surgery seven years prior. Thus, the original graft was removed in November 2017 and he was put in an induced coma with life support until he once again went under the knife in a procedure that took almost a full day to complete in mid-January.


A statement by France’s biomedical agency and the national hospital service summed up what this historical double face transplant means for the future, highlighting “This graft shows for the first time that re-transplantation is possible in the case of chronic rejection of a donor face.”

Rejection of the new foreign tissue is a major risk for facial transplantation and may be faced on more than one episode, thus defaulting the patient to a life-long immunosuppressant therapy. It is however a double-edged sword, as immunosuppressant drugs may control for rejection, but weakens the immune system and subjects the patient to a plethora of infections and increased risk of serious conditions such as kidney damage and cancer.

Such was the case for Isabelle Dinoire. In April 2016, 11 years since her face transplant, she passed on at the age of 49 due to cancer. However, a hospital in northern France suggested that the cause was related to long-running complications from the facial transplantation, with loss of sensation and control in her lips when she died. Dinoire had been on immunosuppressant drugs to curb rejections and suffered infections, and the cancer had recurred even after its removal in 2015. The hospital said the recurrence could be scientifically linked to immunosuppressive therapy and that, “Ms Dinoire’s death perfectly illustrates the challenges of facial transplants.”

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3D death mask: A mask for the dying, but a 'new face' for the living

Since introduced to the market, 3D printers have been up to remarkable feats. In facial transplantations, the advancement of technology has allowed 3D printers to play an important role in the operations. 3D-printed facial replicas are used as a guide, making the procedure faster and improving the outcome.

A 3D-printed face replica that was used in surgical planning of a face transplant. Credit: RSNA/Live Science
A 3D-printed face replica that was used in surgical planning of a face transplant. Credit: RSNA/Live Science

Dr Frank Rybicki, a radiologist and the director of the Applied Imaging Science Laboratory at Brigham and Women's Hospital in Boston said, "typically, by the time they come to us, they've had 20 or 30 surgeries already, just to save their lives. That means that patients may have plates, screws, bone grafts and dozens of other small modifications in their faces, and the new face has to fit perfectly around these. 3D printing allows the team to see exactly where these elements are, making the surgery, which can take up to 25 hours go more quickly and smoothly.”

Despite its complications and perhaps due to its advancements, face transplants continue to be in demand, only to be faced with a low supply of willing donors. Donating a face is not like other organ donations, as family members of the dying—usually on life support—would have to consent to the face donation request. With the grief surrounding the request, this can prove to be difficult, leaving the request unheeded.

Enter New York University (NYU)’s 3D-printer to aid the situation. NYU aims to produce a life-like replica of the donor face—a 3D-printed death mask—so that it can be put on the stripped face of the donor, allowing the donor’s family to proceed with the funeral arrangements, with the face and dignity of their loved one completely intact.

A 3D-printed mask to be used as a death mask for facial transplant donors. Credit: The New York Times
A 3D-printed mask to be used as a death mask for facial transplant donors. Credit: The New York Times

To date, a mask made of silicone with features painted on replaces the stripped face of the donor. “Maybe a silicone mask approximates 75% accuracy,” said Eduardo Rodriguez, the director of NYU Langone’s face transplant program. “A 3D-printed mask can approximate 95%.”

The process begins with a technician running a hand-held scanner over the donor face and capturing the data onto a grid, which is then tweaked for several hours before it is sent to the 3D printer, where it will take more than a full day to complete. The finished face is hard and plastic, but it highly mimics the details and imperfections that is reality. The mask is then placed on the donor’s stripped face after his death and the seams are covered with a bandage.

It is hoped that more families would be willing to consent to donating their dying loved one’s face with this alternative; hence, shortening the waiting period for face transplant candidates. MIMS


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Sources:
https://www.3ders.org/articles/20180109-realistic-3d-printed-masks-encourage-families-to-donate-loved-ones-faces-for-transplantation.html
http://www.telegraph.co.uk/news/2018/01/20/french-surgeons-make-medical-history-first-double-face-transplant/
https://futurism.com/double-face-transplant-surgery/
https://www.capitalfm.co.ke/news/2018/01/second-face-transplant-frenchman-world-first/
https://www.nytimes.com/2018/01/05/nyregion/face-transplant-3-d-printed-mask-donor-nyu.html
https://www.theguardian.com/science/2012/mar/28/face-transplants-history
https://www.researchgate.net/publication/276290444_Facial_Transplantation_History_and_Update
https://www.livescience.com/48950-3d-printing-face-transplants-models.html
https://www.nytimes.com/2016/09/09/world/europe/isabelle-dinoire-recipient-of-first-partial-facial-transplant-dies-at-49.html