Faces, when transplanted, change their appearance based on the bone structure of the recipient, and they seem to age at an accelerated rate, according to a new study published in the American Journal of Transplantation.

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More than 30 face transplants have now been performed.

The National Organ Transplant Act was revised last year to expand the definition of organs to include vascularized composite allografts, including faces.

Since face transplantation is a non-life-saving procedure with potentially life-threatening side effects, it involves unique ethical challenges. Long-term studies are needed to bring better understanding of the risks and benefits involved.

Over 30 face transplants have been carried out so far, the most recent being that of volunteer firefighter Patrick Hardison.

Medical News Today recently reported on this, the most extensive face transplant surgery to date.

Dr. Pomahac, of Brigham and Women’s Hospital (BHW) and Harvard Medical School, MA, previously led the team that performed the first full-face transplant in the US and the third overall in the world. BHW is a world leader in promoting and performing facial transplants, and a number of interventions have been carried out there.

However, little is known about the long-term outcomes for recipients.

In this study, Dr. Pomahac and colleagues followed three full-face transplant recipients over 36 months.

There was an average loss of facial volume of 19.55% between 6-36 months after transplant. Bone and nonfat soft tissue volumes decreased by 17.22% between months 6-18, and 25.56% between months 6-36. Fat did not decrease.

The changes resembled premature aging, but were driven by a reduction in volume of bone and muscle rather than facial fat or skin thickness, as is seen with normal facial aging.

The findings suggest the need for effective countermeasures to reverse, delay, or even prevent muscle and bone atrophy in order to sustain the aesthetic outcomes of face transplants.

Dr. Pomahac says:

“The field of face transplantation is young, and we are all learning about our interventions and their outcomes. We studied why transplanted faces seem to age fast as well as we could, but we don’t really know many other things: When does this process end? Is it possibly a sign of inadequate blood supply or ongoing rejection? As often occurs in science, our study raises more questions than it answered.”

He adds that the findings have implications for patients and their expectations, and they may impact the way surgeons plan face transplant operations. But there is still a long way to go to understand what happens.

The first full facial transplant, on Dallas Wiens, was reported by MNT in 2011. The procedure involved a team of over 30 physicians, nurses, anesthesiologists and residents, and took more than 15 hours to complete.