A facial transplant is a medical procedure in which a significant portion of tissue is grafted onto the donor recipient's face, typically involving the use of facial tissues from a deceased donor. It is a form of Vascularized Composite Tissue Allotransplantation (VCA), a surgical technique involving the transplantation of multiple types of tissues as a functional unit. Facial transplantation may include the grafting of skin, lips, facial musculature, sensory nerves, and, potentially, underlying facial bones such as those of the nose. Recipients of face transplants require lifelong immunosuppressive therapy to prevent rejection of the transplanted tissue by the immune system.
The first successful partial face transplant on a living human was performed on Isabelle Dinoire in November 2005 at the Amiens-Picardie University Hospital in France. The 15‑hour surgical operation transplanted a triangular graft comprising the nose, lips, and chin from a deceased donor onto Dinoire, who had suffered a traumatic facial injury earlier that year. The first full face transplant was completed in Spain in March 2010 by a team at Vall d'Hebron University Hospital in Barcelona, Spain, onto a male recipient with significant facial abnormalities. This was done across several procedures.
Turkey, France, the United States, and Spain are considered leading countries in performing and conducting further research into the procedure. As of 2025, it is estimated that approximately 50 facial transplants have been successfully performed internationally.
The ethical, psychosocial, and medical aspects of face transplantation are still subject to debate, particularly concerning topics such as long-term immunosuppression, changes in identity and in quality of life. In October 2019, the UK Research and Innovation (UKRI) funded AboutFace, led by British cultural historian Fay Bound Alberti (University of York). The project convened surgeons, ethicists, and patients globally to determine potential future developments in the field of facial transplantation. This groundwork contributed to a subsequent report by the National Academies of Sciences, Engineering, and Medicine (NASEM), who proposed updated guidance aiming to improve patient care and procedural outcomes.
Beneficiaries of face transplant People with faces altered by trauma, burns, illness, or birth abnormalities may benefit from the procedure. Professor Peter Butler at the Royal Free Hospital in London, England first suggested this approach in treating survivors of facial traumas in a Lancet article in 2002. This suggestion caused considerable debate at the time concerning the ethics of this procedure.
Some patients may benefit from facial reconstruction as an alternative to facial transplantation, which typically involves grafting the patient's own tissues from their back, buttocks, thighs, or chest to their face in a series of operations to regain some functionality, although this often leads to considerably poorer cosmetic outcomes.
History
Self as donor ("face replant") The world's first full-face replant operation was on 9-year-old Sandeep Kaur, whose face was lost to a traumatic injury. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although she was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas, one of India's top microsurgeons. In 2004, Sandeep was training to be a nurse.
In 1996, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.
Partial face transplant France The world's first partial face transplant on a living human was carried out on 27 November 2005 by Bernard Devauchelle, an oral and maxillofacial surgeon, Benoit Lengelé, a Belgian plastic surgeon, and Jean-Michel Dubernard in Amiens, France. Isabelle Dinoire underwent surgery to replace her original face, which had sustained a traumatic injury. A triangle of face tissue from a deceased donor's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient was happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response.Outcomes 18 Months after the First Human Partial Face Transplantation , New England Journal of Medicine, 13 December 2007"Face-Transplant Patient 'Satisfied': Some Who Criticized Procedure Are Impressed With Results", By Rick Weiss, The Washington Post, Thursday, 13 December 2007; p. A22 Dinoire died on 22 April 2016 at the age of 49 due to cancer induced by medications she was taking.
In March 2008, the treatment of 30-year-old Pascal Coler of France, who has neurofibromatosis, ended after he received what his doctors called the world's first successful almost full-face transplant. The operation, which lasted approximately 20 hours, was designed and performed by Laurent Lantieri and his team (Jean-Paul Meningaud, Antonios Paraskevas and Fabio Ingallina).
China In April 2006, Guo Shuzhong at the Xijing military hospital in Xi'an, transplanted the cheek, upper lip, and nose of Li Guoxing, who sustained severe injuries after being attacked by an Asiatic black bear while protecting his sheep. On 21 December 2008, it was reported that Li had died in July in his home village in Yunnan. Prior to his death, a documentary on the Discovery Channel showed he had stopped taking his immuno-suppressant medications in favour of herbal remedies; a decision that was likely a contributing factor to his death, as stated by his surgeon.
Turkey Selahattin Özmen performed a partial face transplant on 17 March 2012 on Hatice Nergis, a twenty-year-old woman at Gazi University's hospital in Ankara. It was Turkey's third facial transplantation, the first woman-to-woman and the first three-dimensional transplantation with bone tissue. The patient from Kahramanmaraş had lost her upper jaw six years prior in a firearm accident, including her mouth, lips, palate, teeth and nasal cavity, leading to significant impairment. She had undergone around 35 reconstructive plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin. Nergis died in Ankara on 15 November 2016 after she was hospitalized two days prior complaining about acute pain.
Belgium In December 2011, a 54-year-old man underwent a partial face transplant to the lower two-thirds of the face (including bone) after a ballistic accident. The operation was performed by a multidisciplinary team led by plastic surgeon Phillip Blondeel. Hubert Vermeersch, Nathalie Roche and Filip Stillaert were also members of the surgical team. For the first time, 3-D CT planning was used to plan the operation, which lasted 20 hours. As of 2014, the patient is alive, with "good recovery of motor and sensory function and social reintegration".
Italy In September 2018, a 49-year-old woman affected by Neurofibromatosis type I received a partial face transplant from a 21-year-old female donor at Sant'Andrea Hospital of Sapienza University in Rome. The procedure took 27 hours and was carried out by two teams led by Fabio Santanelli di Pompeo and Benedetto Longo. The patient had a complication and after two days the surgeons had to replace the facial graft with autologous tissue. The patient is still alive and waiting for a second face transplantation.
Canada In May 2018, the first Canadian complete face transplant was performed under the leadership of plastic surgeon Daniel Borsuk at the Hôpital Maisonneuve-Rosemont, in Montreal, Quebec. The transplant took over 30 hours and replaced the upper and lower jaws, nose, lips, and teeth on Maurice Desjardins, a 64-year-old man that sustained an accidental gun-shot wound to the face. At that time, Desjardins was the oldest person to benefit from a face transplant.
Full face transplant
On 20 March 2010, a team of 30 Spanish doctors led by plastic surgeon Joan Pere Barret at the Vall d'Hebron University Hospital in Barcelona carried out the world's first full face transplant, on a man injured in a shooting accident.
On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the Henri-Mondor hospital in Créteil.
In March 2011, a surgical team, led by Bohdan Pomahač at Brigham and Women's Hospital in Boston, Massachusetts, performed a full face transplant on Dallas Wiens, who sustained severe physical injuries to the face in a power line accident that left him blind and without lips, nose or eyebrows. The patient's sight couldn't be recovered but he was able to talk on the phone and smell. In April 2011, the same surgical team at Brigham and Women's Hospital performed a second full face transplant on Mitch Hunter of Speedway, Indiana.
Spain Spain has played a leading role in the development of facial transplantation. In March 2010, the hospital Vall d'Hebron in Barcelona performed the world’s first total face transplant. The procedure was carried out on March 20 by a multidisciplinary team of 30 professionals led by Joan Pere Barret and lasted approximately 22 hours. Unlike the previous face transplants performed which had involved partial grafts, this operation consisted of a full facial allograft. The recipient was a young man with severe facial trauma that caused impairment in his breathing, swallowing, and speech. The transplant included the complete facial skin and musculature, nose, lips, upper jaw (maxilla), mandible, cheekbones, palate, and teeth. The procedure required complex reconstructive and microvascular surgery to ensure proper revascularization of the graft.
Poland
On 15 May 2013, at the Maria Skłodowska-Curie Institute of Oncology branch in Gliwice, Poland, an entire face was transplanted onto a male patient, Grzegorz (aged 33) after he sustained severe facial injury in a machining accident. The surgery took 27 hours and was directed by Adam Maciejewski. There had not been much planning or preparation before the surgery, which was performed about one month after the accident, as the transplantation was done as emergency procedure due to the patient's difficulty in eating and breathing. Shortly after the donor's death, the decision to perform the surgery was made and his body was transported hundreds of kilometers to Gliwice once his relatives gave their consent. The doctors believe that their patient has an excellent chance to live a normal, active life after surgery, and that his face should operate more or less normally.
Seven months later, on 4 December, the same Polish medical team in Gliwice transplanted a face onto a 26-year-old female patient with neurofibromatosis. Two months after the operation, she left the hospital.
Turkey On 21 January 2012, Turkish surgeon Ömer Özkan and his team successfully performed a full face transplant at Akdeniz University's hospital in Antalya. The 19-year-old patient, Uğur Acar, sustained severe burns as a baby. The donor was 39-year-old Ahmet Kaya, who died on 20 January. The Turkish doctors declared that his body had accepted the new tissue.