The ultimate prognosis for face allotransplantation: fantasy or reality?

In spite of our sometimes impressive egos, all reconstructive surgeons are quite aware that we are limited in our abilities to completely restore the normal appearance of all those disfigured, in spite of the expectation or perhaps fantasy of the layperson that we are somehow magicians that can transform even the most grotesque into a beauty to behold. Tissue engineering has been suggested as a better means to manufacture any necessary body parts, but quite frankly, little pragmatic progress has occurred in the past decade. For this reason, vascularized composite allotransplantation (VCA) may at the present be the more practical solution for those clinical challenges that cannot be solved with traditional procedures. This extraordinary advance to date has not been without some ethical concern, as Marchac et al. (1) pointed out that all articles on this subject before 2002 categorically stated that face transplantation was not ethically justifiable; but since 2008 these concerns have been counterbalanced by a recognition of potential benefits for some patients.