The Cleveland Clinic Experience With the First US Face Transplantation

  • Maria Z. Siemionow
  • Risal Djohan
  • Steven Bernard
  • Frank Papay


The ability to perform a complicated craniofacial reconstruction without the need for multiple surgical procedures is appealing. The putative application of composite face allograft transplantation in patients with complex, composite facial defects may be a viable alternative to conventional reconstructive options. In December 2008, the first near-total face transplantation in the USA was performed at the Cleveland Clinic. At that time, this was the largest and most complex face allograft reported in the world and included over 535 cm2 of facial skin; full nose with nasal lining and bony skeleton; lower eyelids and upper lip; underlying muscles and bones, including orbital floor, zygoma, maxilla, alveolus with teeth, hard palate, and parotid glands; and pertinent nerves, arteries, and veins. Immunosuppressive treatment consisted of thymoglobulin, tacrolimus, mycophenolate mofetil, and prednisone. There have been no major complications and two rejection episodes on posttransplant days 47 and 452, which were effectively reversed by with corticosteroids and immunosuppression adjustment. The functional outcome has been excellent, with marked improvement in breathing, smell, taste, speech, drinking, and eating solid foods. We have demonstrated the feasibility using composite face allotransplantation in the treatment of the severely disfigured patient.


Mycophenolate Mofetil External Jugular Vein Radial Forearm Free Flap Organ Procurement Organization Facial Graft 
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Copyright information

© Springer London 2011

Authors and Affiliations

  • Maria Z. Siemionow
    • 1
  • Risal Djohan
  • Steven Bernard
  • Frank Papay
  1. 1.Department of Plastic SurgeryCleveland ClinicClevelandUSA

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