Facial Disfigurement and Identity: A Review of the Literature and Implications for Facial Transplantation

William J Rifkin, Rami S Kantar, Safi Ali-Khan, Natalie M Plana, J Rodrigo Diaz-Siso, Manos Tsakiris, Eduardo D Rodriguez

Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FT's effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.