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function after revascularization of the organ is immediately Post-trasplant complicacions
detected, the FAT is initially viable after reperfusion in the Despite the complexity of the procedure, no cases of
operating room, but facial motor activity and sensitivity are allograft loss by surgical failures, such as arterial or venous
absent. Therefore, in the first months of follow up, nerve thrombosis or tissue damage by cold ischemia time, have
regeneration and muscle rehabilitation becomes a challenge been reported. The most important complications derived
as well as patient’s ability to reintegrate allograft in sensory from immunosuppressive therapy and drug toxicity leading to
and motor cortex in the central nervous system. Between metabolic disorders, opportunistic infections and increased
6-9 months, patients recovered discriminative sensitivity of incidence of malignancy. Tacrolimus, a potent calcineurin
[63]
the face. The recovery of active and passive movements of inhibitor, is well known for its severe nephrotoxicity.
the lips was obtained between 6 and 12 months, but results The majority of patients have suffered from opportunistic
differed between full or partial FT. [45,48,54,57] The functional infections such as cytomegalovirus, herpes simplex, herpes
improvements have been proportional to motor recovery, zoster, candida albicans and bacterial infections, most of
reaching even in some cases to restoration of near normal them have been treated successfully. [55,75] Due to an increased
functional capacity. [72] risk of carcinogenesis in the context of a suppressed
immune system, it was likely that a correlation between
The long-term results are yet to be assessed and reported by immunosuppressive medication and the appearance of
different FT teams and therefore a final assessment of the tumors was established. In this sense, neurofibromatosis
[82]
results cannot be offered now. Almost all patients have type 1 or post-oncological sequelae are indications that may
been able to breathing through the nose, smelling, chewing, be critically questioned. Finally, at least 5 deaths associated
with the FT procedure have been collected so far caused by
swallowing, eating and speech and phonation recovering to failure of the immunotherapeutic regime, sepsis, recurrent
a greater or lesser extent. [50,55,63,82-84]
malignant tumor, multiple organ failure and suicide, [34,96]
which for some researchers reopens the question of risk
Psycho-social outcomes versus benefit in the FT. [3,97]
Psychological long-term results are not known with accuracy
because the novel nature of the procedure, although ETHICAL IMPLICATIONS
preliminary results have reported positive outcomes. In
general, patients experienced an acceptable improvement From the ethical point of view, a crucial issue widely
of quality of life with social reintegration and meaningful discussed in the literature has been the obligation to subject
changes for having recovered their body image, without individuals to immunosuppressive treatment during patient’s
psychological disorders. [40,63] All patients have accepted their life, leading to increased risk of developing complications,
[33]
new face and some patients returned to work. [45,53,72] The when it is not a procedure to “save lives”, unlike solid
favorable outcome is probably a consequence of the strict organ transplant that often have an urgent indication to
preoperative selection with a psychiatric and psychological save a person life. From that point of view, the risks of
evaluation of motivated and compliant patients. [85-87] immunosuppressive therapy may outweigh the benefits of
the procedure due to recipients are exposing to the risks
After the inset of the donor face on the recipient, no problems of immunosuppression. However, all transplant teams
were detected with regard to identity transfer or change in have reported that the reestablishment of the functional
body image in FT recipients. What is obtained is a mixture capabilities and the restoration of the face “have changed
of both subjects, and due to differences in the characteristics the lives of patients”, and a significant improvement in
of each facial bony structures, a new face is formed. patient’s quality of life has occurred. [45]
Therefore, the initial concerns about appearance of feelings
of depersonalization to the new face and the transfer or An ethical unsolved problem would arise if a total loss

separation of the donor’s identity have not been substantiated. allograft occurs as a result of a surgical complication or
[55]
According to donor families, recipients and transplant teams, irreversible rejection. Confronted with this catastrophic
the recipients do not resemble the donor. [72,88,89] situation, very few reconstructive options would remain
for that patient and hypothetically, patients would return
[54]
to a starting situation much worse as consequence of the
Post-transplant revisions and refinements procedure FAT.
To the extent that the number of FT has increased, various
surgical refinements have been planned to optimize Informed consent is crucial before performing a FAT for
the aesthetic and functional results. [30,90] The functional the reasons discussed above. Moreover, the question
and aesthetic improvement can be supported in various has arisen whether consent can be truly informed if the
secondary procedures as such as the re-alignment of the candidate previously does not coexist with the facial
jaws, restoration of teeth, re-suspension of the soft tissues, disfigurement for some time. Something as outlined in
fat injections and dermabrasion. [91-95] These revisions did not breast reconstruction, where a period of post-mastectomy
seem to have caused major complications or affected in any waiting gives the woman the opportunity to accept a
way the immunological rejection. [40] complex reconstruction. [98] Pediatric age creates an ethical
Plast Aesthet Res || Volume 3 || June 24, 2016 215