Face transplant

Face transplant
MeSH D054445

A face transplant is a medical procedure to replace all or part of a person's face using tissue from a cadaver. The world's first partial face transplant on a living human was carried out in France in 2005. The world's first full face transplant was completed in Spain in 2010.[1] Turkey,[2] France, the United States and Spain (in order of total number of successful face transplants performed) are considered the leading countries in the research into the procedure.

Beneficiaries of face transplant

People with faces disfigured by trauma, burns, disease, or birth defects might aesthetically benefit from the procedure.[3] Professor Peter Butler at the Royal Free Hospital first suggested this approach in treating people with facial disfigurement in a Lancet article in 2002.[4] This suggestion caused considerable debate at the time concerning the ethics of this procedure.[3]

An alternative to a face transplant is facial reconstruction, which typically involves moving the patient's own skin from their back, buttocks, thighs, or chest to their face in a series of as many as 50 operations to regain even limited functionality, and a face that is often likened to a mask or a living quilt.

History

Self as donor ("face replant")

The world's first full-face replant operation was on 9-year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep's mother witnessed the accident. 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."[5] The operation was successful, although the child 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.[6]

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.[7]

Partial face transplant

In Canada

In May 2018, the first Canadian face transplant was completed by Dr. Daniel Borsuk and his team at the Hopital Maisonneuve Rosemont, in Montreal, Quebec.[8][9] The transplant took over 30 hours and replaced the upper and lower jaws, nose, lips and teeth on Maurice Desjardins, a 64 year old gunshot victim. At that time, Mr. Desjardins was the oldest person to benefit from a face transplant.[10][11]

In France

The world's first partial face transplant on a living human was carried out on 27 November 2005[12][13] by Bernard Devauchelle, an oral and maxillofacial surgeon, Benoit Lengelé, a Belgian plastic surgeon, and Jean-Michel Dubernard in Amiens, France. Isabelle Dinoire[12] underwent surgery to replace her original face, which had been mauled by her dog. A triangle of face tissue from a brain-dead woman'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.[14][15] Dinoire died on April 22, 2016 at the age of 49 following a long illness.[16]

In China

In April 2006, Dr Guo Shuzhong at the Xijing military hospital in Xi'an, China, similarly transplanted the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep.[17][18] 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 immuno-suppressant drugs in favour of herbal medication; a decision that was likely a contributing factor to his death, according to his surgeon.[19]

In France

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly.

In March 2008, the treatment of 30-year-old Pascal Coler of France, who has neurofibromatosis, ended after he received what his doctors call the world's first successful almost full face transplant.[20][21] 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).

In 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, the first woman-to-woman and the first three-dimensional 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, and was since then unable to eat. She had undergone around 35 reconstructive plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin in Istanbul, who had committed suicide.[22][23][24] Nergis died in Ankara on 15 November 2016 after she was hospitalized two days prior due to strong pains.[25]

Full face transplant

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant, on a man injured in a shooting accident.[26] It became the first full face transplant in the world.[1]

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.[27]

In March 2011, a surgical team, led by Bohdan Pomahač at Brigham and Women's Hospital in Boston, Massachusetts, USA, performed a full face transplant on Dallas Wiens who was badly disfigured 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 has been able to talk on the phone and smell.[28]

In April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women’s Hospital face transplant team, led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter, 30, of Indiana, including the nose, muscles of facial animation and the nerves that power them and provide sensation. Hunter suffered a severe shock from a high voltage electrical wire following a car accident in 2001.[29]

On 19 March 2012, one of the longest and most extensive facial transplants ever (36 hours, from 4 am 19 March to 2–3 PM 20 March; the 23rd ever to occur; from the hairline to the neck, replacing essentially everything but the eyes and the back remnants of the throat) took place on Richard Lee Norris of Hillsville, Virginia, who had suffered a gunshot wound in 1997 that left him with extensive facial trauma, at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, Maryland.[30][31] Seven months after the procedure, Norris exhibits remarkable progress. Norris can smile and show facial expressions, and also smell, taste and eat. The motor function on the right side of his face is about 80 percent of normal and motor function on the left side is about 40 percent, according to his doctors.[32]

In 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 (aged 33) after he lost the front of his head in a machine accident at work. The surgery took 27 hours and was directed by Professor Adam Maciejewski. There had not been much planning or prep time before the surgery, which was performed about one month after the accident, because the transplantation was done as an urgent life-saving surgery 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 (his eyes survived the accident untouched).[33]

Seven months later, on 4 December, the same Polish medical team in Gliwice transplanted a face onto 26-year-old female patient with neurofibromatosis. Two months after the operation, she left the hospital.[34][35]

In 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, was badly burnt in a house fire when he was a baby. The donor was 39-year-old Ahmet Kaya, who died on 20 January.[36] The Turkish doctors declared that his body had accepted the new tissue.[37]

Almost one month later on 24 February 2012, a surgical team led by Serdar Nasır conducted the country's second successful full face transplant at Hacettepe University's hospital in Ankara on 25-year-old Cengiz Gül. The patient's face was badly burned in a television tube implosion accident when he was two years old. The donor was 40-year-old N. A. (his family did not permit the identity of the donor to be revealed), who experienced brain death two days before the surgery following a motorcycle accident that occurred on 17 February.[38]

On 16 May 2012, surgeon Ömer Özkan and his team at the Akdeniz University Hospital performed the country's fourth and their second full face transplant. The face and ears of 27-year-old patient Turan Çolak from Izmir were burnt when he fell into an oven when he was three and half years old. The donor was Tevfik Yılmaz, a 19-year-old man from Uşak who had attempted suicide on 8 May. He was declared brain dead in the evening hours of 15 May after having been in intensive care for seven days. His parents donated all his organs.[39]

On 18 July 2013, the face of a Polish man was successfully given to a Turkish man in a transplant performed by Özkan, at Akdeniz University hospital following a 6.5-hour operation, making it the fifth such operation to take place in the country. It was the 25th face transplant operation in the world. The donor was Andrzej Kucza, a 42-year-old Polish tourist who was declared brain dead following a heart attack on July 14 while swimming in Turkey's sea resort Muğla. The 27-year-old patient Recep Sert came immediately from Bursa to Antalya for the surgery in late July 2017.[40]

On 23 August 2013, surgeon Ömer Özkan and his team at Akdeniz University performed the sixth face transplant surgery in Turkey. Salih Üstün (54) received the scalp, eyelids, jaw and maxilla, nose and the half tongue of 31-year-old Muhittin Turan, who was declared brain dead after a motorcycle accident that took place two days before.[41]

On 30 December 2013, Özkan and his team conducted their fifth and Turkey's seventh face transplant surgery at the hospital of Akdeniz University. The nose, upper lip, upper jaw and maxilla of braindead Ali Emre Küçük, aged 34, were successfully transplanted to 22-year-old Recep Kaya, whose face was badly deformed in a shotgun accident. While Kaya was flown from Kırklareli to Antalya via Istanbul in four hours, the donor's organs were transported from Edirne by an ambulance airplane. The surgery took 4 hours and 10 minutes.[42]

In the United Kingdom

In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out face transplants. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six-month intervals.[43]

In the United States

In 2004, the Cleveland Clinic became the first institution to approve this surgery and test it on cadavers.

In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Pole Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Steven Bernard, Dr Mark Hendrickson, Robert Lohman, Dan Alam and Francis Papay) performed the first face transplant in the US on a woman named Connie Culp.[44][45] It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a brain-dead donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved.

Face transplant recipient Jim Maki (left) with Bohdan Pomahač

The second partial face transplant in the US took place at Brigham and Women's Hospital in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by MUDr. Bohdan Pomahač, replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result.[46] This procedure was also shown in the eighth episode of the ABC documentary series Boston Med.

The first full face transplant performed in the US was done on a construction worker named Dallas Wiens in March 2011. He was burned in an electrical accident in 2008. This operation, performed by Bohdan Pomahač and Jeffrey Janis,[47] was paid for with the help of the US defense department. They hope to learn from this procedure and use what they learn to help soldiers suffering from facial injuries.[48] One of the top benefits of the surgery was that Dallas has regained his sense of smell.[49]

The second full face transplant was done on Mitch Hunter in April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women’s Hospital face transplant team, led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter, 30, of Indiana, including the nose, eyelids, muscles of facial animation and the nerves that power them and provide sensation. Hunter suffered a severe shock from a high voltage electrical wire following a car accident in 2001 after saving a young woman's life following a car wreck in Thomasville, North Carolina on November 31, 2001. Mitch Hunter was a passenger in a single cab pick-up style truck, upon exiting the vehicle and pulling another passenger off a downed line, Hunter was then struck by a 10,000-volt 7-amp power line for a little under five minutes. The electricity entered his lower left leg, with the majority exiting his face, leaving him severely disfigured. He also lost part of his lower left leg, below the knee, and lost two digits on his right hand (pinkie and ring finger). Hunter has regained almost 100% of his normal sensation back in his face and his only complaint is that he looks too much like his older brother.[29]

57-year-old Charla Nash, who was mauled by a chimpanzee in 2009, underwent a 20-hour full face transplant in May 2011 at Brigham and Women's Hospital in Boston. Nash's full face transplant was the third surgery of its kind performed in the United States, all at the same hospital.[1]

In March 2012, a face transplant was completed at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center under the leadership of plastic surgeon Eduardo Rodriguez and his team (Amir Dorafshar, Michael Christy, Branko Bojovic and Daniel Borsuk MD[50]).[51] The recipient was 37-year-old Richard Norris, who had suffered a facial ballistic injury in 1997. This transplant included all facial and anterior neck skin, both jaws, and the tongue.[52]

In August 2015, a face transplant was completed at the NYU Langone Medical Center under the leadership of the chair of plastic surgery Eduardo D. Rodriguez and his team. A 41 year old retired fireman named Patrick Hardison received the face of cyclist David Rodebaugh.[53]

In June 2016, a multidisciplinary team of surgeons, physicians and other health professionals completed a near-total face transplant at Mayo Clinic’s Rochester campus. Patient Andrew Sandness, a 32-year-old from eastern Wyoming, had devastating facial injuries from a gunshot wound in 2006. The surgery, which spanned more than 50 hours, restored Sandness’ nose, upper and lower jaw, palate, teeth, cheeks, facial muscles, oral mucosa, some of the salivary glands and the skin of his face (from below the eyelids to the neck and from ear to ear). The care team lead by Samir Mardini, and Hatem Amer, the surgical director and medical director, respectively, for the Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, devoted more than 50 Saturdays over 3½ years to rehearsing the surgery, using sets of cadaver heads to transplant the face of one to the other. They used 3-D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on the transplant recipient. Today, in addition to his physical transformation, Sandness can smell again, breathe normally and eat foods that were off-limits for a decade.[54]

In a 31-hour operation starting on May 4, 2017, surgeons at the Cleveland Clinic transplanted a face donated from Adrea Schneider, who had died of a drug overdose, to Katie Stubblefield, whose face had been disfigured in a failed suicide attempt by rifle. As of 2018, Katie is the youngest person in the United States to have had a face transplant, age 21 at the time. Surgeons originally planned to leave her cheeks, eyebrows, eyelids, most of her forehead, and the sides of her face alone. However, because the donor face was larger and darker than Katie's, they made the decision to transplant the donor's full face. This holds the risk that in case of acute rejection in which the face must be removed, she would not have enough tissue for reconstructive surgery. Katie was featured on the cover of National Geographic in September 2018 for an article entitled "The Story of a Face."[55][56]

Ethics, surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (sometimes including the underlying fat, nerves, blood vessels, bones, and/or musculature). The surgery may last anywhere from 8 to 36 hours, followed by a 10- to 14-day hospital stay.

There has been a substantial amount of ethical debate surrounding the operation and its performance. The main issue is that, as noted below, the procedure entails submitting otherwise physically healthy people to potentially fatal, lifelong immunosuppressant therapy. So far, four people have died of complications related to the procedure. Citing the comments of various plastic surgeons and medical professionals from France and Mexico, anthropologist Samuel Taylor-Alexander suggests that the operation has been infused with nationalist import, which is ultimately influencing the decision-making and ethical judgements of the involved parties.[57] His most recent research suggests the face transplant community needs to do more in order to ensure that the experiential knowledge of face transplant recipients is included in the ongoing evaluation of the field.[58]

After the procedure, a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could damage the transplanted face and require a second transplant or reconstruction with skin grafts.

  • The procedure was envisioned in Georges Franju's 1960 cult horror film Les Yeux sans visage, which translates to "Eyes Without a Face."
  • Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.
  • The plot of the 1997 film Face/Off is based on a face transplant operation that involved switching the skin of the face, making the transplant recipient look indistinguishable from the donor, with immediate and complete use of the transplanted tissue. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face.

References

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  3. 1 2 "Face transplants 'on the horizon'". BBC News. 27 November 2002. Retrieved 10 May 2011.
  4. ↑ Face transplantation—fantasy or the future? Lancet 360:5–6; 2002.
  5. ↑ Radford, Tim (27 May 2004). "Scientists prepare to turn fiction into fact with first full-face transplant". The Guardian. London. Retrieved 25 November 2007.
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  8. ↑ Kirkey, Sharon (12 September 2018). "CANADA'S FIRST FACE TRANSPLANT". Postmedia© 2018 National Post. Retrieved 30 September 2018.
  9. ↑ Lemieux, Danny (12 September 2018). "The face of a stranger". Canadian Broadcasting Company. Retrieved 30 September 2018.
  10. ↑ Hachey, Isabelle (12 September 2018). "L'homme au deux visages". La Presse. Retrieved 30 September 2018.
  11. ↑ Rosenberg, Eli (14 September 2018). "His face was severely damaged on a hunt. Now he's the world's oldest face transplant recipient". Washington Post. Retrieved 30 September 2018.
  12. 1 2 Austin, Naomi (17 October 2006). "'My face transplant saved me'". BBC News. Retrieved 25 November 2007.
  13. ↑ "Woman has first face transplant". BBC News. 30 November 2005. Retrieved 10 May 2011.
  14. ↑ Outcomes 18 Months after the First Human Partial Face Transplantation, New England Journal of Medicine, 13 December 2007
  15. ↑ Face-Transplant Patient 'Satisfied': Some Who Criticized Procedure Are Impressed With Results, By Rick Weiss, Washington Post, Thursday, 13 December 2007; Page A22
  16. ↑ http://www.cnn.com/2016/09/06/health/france-face-transplant-patient-dies/index.html
  17. ↑ "China's first human face transplant successful". Xinhua. 15 April 2006. Retrieved 25 November 2007.
  18. ↑ "'First face transplant' for China". BBC News. 14 April 2006. Retrieved 25 November 2007.
  19. ↑ Chinas first face transplant recipient dies
  20. ↑ Watt, Nick (25 March 2008). "World's First Full Face Transplant Hailed". abcnews.go.com. Retrieved 25 March 2008.
  21. ↑ Franklin, Katie (25 March 2008). "Man has first full-face transplant". The Daily Telegraph. UK. Retrieved 25 March 2008.
  22. ↑ Cantürk, Safure (23 March 2012). "Gazi, yüz naklini 'damardan' bağladı". Sabah (in Turkish). Retrieved 26 March 2012.
  23. ↑ "Üçüncü yüz nakli Gazi Üniversitesi Tıp Fakültesi Hastanesi'nde başladı". Zaman (in Turkish). 17 March 2012. Archived from the original on 19 March 2012. Retrieved 26 March 2012.
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  25. ↑ "Türkiye'nin yüz nakli yapılan ilk kadını Hatice Nergis öldü". Hürriyet (in Turkish). 2016-11-15. Retrieved 2016-11-15.
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  27. ↑ "French doctors carry out world's first full-face transplant". RFI. 8 July 2010. Retrieved 11 October 2010.
  28. ↑ "Boston hospital performs full face transplant". USA Today. 21 March 2011. Retrieved 10 May 2011.
  29. 1 2 "Mitch Hunter: Second Full Face Transplant in U.S". Brigham and Women’s Hospital. April 2011.
  30. ↑ "36-Hour Face Transplant 'Most Extensive' Ever". CNN. 27 March 2012.
  31. ↑ http://www.sciencedebate.com/science-blog/face-transplant-university-maryland-transplant-included-jaws-teeth-and-tongue
  32. ↑ "Most comprehensive face transplant patient doing well after seven months". ZME Science. 19 October 2012.
  33. ↑ "Polish man gets quick face transplant after injury". Yahoo! News. 22 May 2013. Retrieved 29 May 2013.
  34. ↑ http://www.nydailynews.com/life-style/health/graphic-pics-polish-woman-full-face-transplant-article-1.1547027
  35. ↑ http://www.rynekzdrowia.pl/Uslugi-medyczne/Slaskie-pacjentka-po-przeszczepie-twarzy-opuszcza-szpital,138503,8.html
  36. ↑ "Turkish surgeons in country's first face transplant". Hürriyet Daily News. 23 January 2012. Retrieved 4 March 2015.
  37. ↑ "İlk kez başın karşısında". Hürriyet (in Turkish). 21 February 2012. Retrieved 4 March 2015.
  38. ↑ Özgenç, Meltem & Turaç Top (25 February 2012). "İlkinin izi geçmeden 2'nci yüz nakli". Hürriyet (in Turkish). Retrieved 4 March 2015.
  39. ↑ Öztürk, Erdoğan (15 May 2012). "Özkan ve ekibinden 2. yüz nakli". Sabah (in Turkish). Retrieved 4 March 2015.
  40. ↑ "Patient given Polish tourist's face in fifth face transplant operation in Turkey". Hürriyet Daily News. 2013-07-19. Retrieved 2013-07-19.
  41. ↑ "Turkey's 6th transplant performed in Antalya". Hürriyet Daily News. 2013-08-23. Retrieved 2014-01-01.
  42. ↑ "Türkiye'nin 7'inci yüz nakli yapıldı". Hürriyet (in Turkish). 2013-12-30. Retrieved 2014-01-01.
  43. ↑ "UK gets face transplant go-ahead". BBC News. 25 October 2006. Retrieved 25 November 2007.
  44. ↑ "US plans first face transplant". BBC News. 19 September 2005. Retrieved 25 November 2007.
  45. ↑ "Cleveland Clinic Performs Second Face Transplant". Archived from the original on 12 January 2015. Retrieved 24 January 2015.
  46. ↑ usatoday Archived 23 May 2009 at the Wayback Machine. article Face transplant recipient 'happy' with results
  47. ↑ Keiper, Lauren (9 May 2011). "U.S. man shows off first full face transplant". Toronto Sun. Retrieved 10 May 2011.
  48. ↑ Fayetteville Observer article Full-face transplant a first in U.S.; military helps pay for operation
  49. ↑ "Face transplant: Dallas Wiens hails regained smell". BBC News. 9 May 2011. Retrieved 10 May 2011.
  50. ↑ http://hospitalnews.com/canadian-doctor-on-team-who-performed-extensive-full-face-transplant/
  51. ↑ Jaffer Khan, Nasheet (29 March 2012). "The team of five worked miracle". gulfnews. Retrieved 13 April 2012.
  52. ↑ Carroll, Linda (27 March 2012). "Virginia man gets extensive face transplant after gun accident". MSNBC. Archived from the original on 30 March 2012. Retrieved 5 April 2012.
  53. ↑ https://www.washingtonpost.com/news/to-your-health/wp/2015/11/16/nyu-surgeons-announce-most-comprehensive-face-transplant-to-date-on-volunteer-firefighter-photos/
  54. ↑ "AP Exclusive: Twin tragedies give survivor a new face". The Big Story. Retrieved 2017-04-12.
  55. ↑ Connors, Joanna (September 2018). "How a Transplanted Face Transformed Katie Stubblefield's Life". National Geographic. Retrieved 19 August 2018. See also: "Katie's New Face". Katie's New Face. 2018. National Geographic U.S. TV network. Retrieved 26 August 2018.
  56. ↑ Jereb, Leah; Taylor, Kelsey (14 August 2018). "The Story of a Face: National Geographic Unveils Youngest Full-Face Transplant Recipient in American History". National Geographic Partners Press Room (Press release). Retrieved 15 September 2018.
  57. ↑ Taylor-Alexander, S. (2013). "On Face Transplantation: Ethical Slippage and Quiet Death in Experimental Biomedicine". Anthropology Today. 29 (1): 13–16. doi:10.1111/1467-8322.12004.
  58. ↑ Taylor-Alexander, Samuel. On Face Transplantation: Like and Ethics in Experimental Biomedicine. London: Palgrave Macmillan
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