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How 3D Printing Made Face Transplants Possible

Without 3D printing, the surgery would either be impossible or the recovery so dangerous and grueling that the risks would be far too high for most to consider.
​Image: ​RSNA

​ A full facial transplant is a delicate kind of operation that's just as new and experimental as the technology that enables it: 3D printing.

The first full transplant was performed in 2010 in S​pain. The​ first full face transplant in the US came in 2011. Just eight more have been completed in the country since then, seven of which were done at Boston's Brigham and Women's Hospital. All of them made use of 3D printing technology.

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Frank Rybicki, director of the Applied Imaging Scie​nce Laboratory at BWH, and his colleague, Amir Imanzadeh, have assessed the effectiveness of 3D printing during this period, and they've concluded that it's an indispensable part of the process. Their full report is forthcoming.

Candidates for facial transplants often have catastrophic injuries as well as bone defects, and Rybicki told me they may rack up 60 surgeries before they even consult with the doctor performing the transplant. Often, the facial structure of a patient needs to be modified or reconstructed before the transplant can happen.

What lies beneath the skin can be a bit of a mystery at this early stage, which can lead to unwelcome surprises or a lengthened operating time on the table. By constructing a 3D model of the patient's head using X-ray CT scans (also referred to as CAT scans) and printing them out, doctors can plan ahead to make the surgery as quick and effective as possible.

"The imaging will tell you where the vessels are to hook up the tissues and the imaging will tell you what is actually underneath the skin," Rybicki said. "We can match the tissues perfectly, and the healing process is mostly about how the tissues map into each other."

A full facial transplant involves removing the patient's face, correcting their bone deformities, and connecting the existing nerves, muscles, and arteries with those in the new face. With a 3D model of a patient's head before the surgery, Rybicki said, this can be done with far greater accuracy.

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We will never know what facial transplants would be like without the aid of 3D printed models, but Rybicki told me that they would be much more unpleasant than they are now—even though that seems nearly impossible. For instance, Richard Norris, a man who shot himself in the face and lived, is on a lifetim​e diet of drugs that keep his body from rejecting his implant while decimating his immune system.

Even so, without 3D printing the surgery would either be impossible or the recovery so dangerous and grueling that the risks would be far too high for most to consider.

The ability to quickly manufacture models that can help preempt last-minute design challenges that can result in costly mistakes—in terms of money and, much more importantly, a life—is one of 3D printing's greatest virtues. This is as true f​or a rocket scientist or army engineer as it is for a highly skilled surgeon performing a risky operation like a full facial transplant.

Image: RSNA

"It's the same story over and over again with 3D printing," Rybicki said. "It's helpful for the surgeon, it's helpful for the patient, and it cuts down on operating room time, so it's an effective cost-saver, also."

3D printing is finding increasing use in medicine, and not just in the realm of experimental surgery. Doctors at New York City's Morgan Stanley Children's Hospital recent​ly printed a tiny 3D model of a baby's heart to practice a life-saving operation before attempting the real thing. Surgeons have also taken to printing mode​ls of patient's skulls to plan out how to better reconstruct parts of a person's face like a nose or jaw.

Now that several facial transplants have been successfully performed using the technology, Rybicki said, we can safely add full facial transplant to the list of medical applications for 3D printing. Moreover, all of these advancements indicate that 3D printing has become an indispensable tool for doctors, and it will only continue to gain prominence in the field. This is only beginning.

"With one patient you can tell a story, but with multiple patients, we have what we can call a cohort," Rybicki told me. "3D printing is here to stay. It's advantageous. It helps whatever procedure that you want to do, and when used properly, it's an incredibly powerful tool. In our case, it improves the quality of life for many of our patients."