AIIMS launches facial transplant programme, offers hope for acid attack and burn survivors

Speaking with The Indian Express, Dr Sinha describes facial transplantation as a highly complex, multidisciplinary reconstructive procedure and not a cosmetic surgery. “The primary goal is to restore critical functions such as eating, speaking, breathing, blinking and expressing emotions. It is considered a last-resort option for patients with devastating functional loss,” he says. Excerpts:

What does a facial transplant involve and what structures are excluded?

The procedure involves transplanting facial skin, muscles, sensory and motor nerves, arteries, veins, and structures such as the lips, nose and eyelids. It does not include the eyeballs or tongue. Dental implants, if needed, are performed later. When harvesting a donor face, surgeons typically retrieve the full facial unit first and then tailor it to the recipient to ensure no critical anatomical structures are missed.

What are the major phases of facial transplantation?

There is pre-operative preparation. Since the surgery is complex, patients must understand lifelong commitment to immunosuppressive medication and continuous follow-up to prevent rejection. Mandatory psychiatric evaluation ensures mental preparedness and long-term compliance. Besides, everybody does not qualify. Patients with a history of cancer are not eligible because immunosuppression increases cancer risk. Those with substance abuse histories may be excluded due to the strict medication discipline required.

Surgical preparation includes multiple cadaver dissections, detailed CT imaging to map anatomy and blood vessels, and extensive coordination between donor and recipient teams. Every team member must clearly understand their role before surgery begins.The surgery itself is a long, technically demanding procedure. The most challenging phase is post-operative care, requiring intensive monitoring and lifelong management.

What does post-operative recovery and long-term care involve?

Patients typically spend about one week in the ICU and another two weeks in the hospital, followed by at least two months of close monitoring. Around three months after surgery, most patients begin to feel significantly better.

Approximately 95 per cent of patients experience at least one episode of acute rejection, requiring hospitalisation and additional treatment. While rejection episodes are common, graft failure is rare. At Brigham and Women’s Hospital, most facial transplants have remained viable for more than ten years, with one graft replacement being done around the ten-year mark. Although the field is still relatively young, survival beyond a decade is expected.

What are practical limitations?

Facial transplantation cannot be used to change identity. The procedure requires constant medical supervision, strict adherence to medication and repeated hospital visits. Missing follow-up or immunosuppressive therapy can lead to complications. Ethnic matching is not strictly required but immune compatibility is essential. In practice, matches often occur within similar ethnic groups due to donor availability patterns.