title: Facial appearance transfer and persistence after three-dimensional virtual face transplantation.
abstract: BACKGROUND
  Facial appearance transfer from donor to recipient in face transplantation is a concern. Previous studies of facial appearance transfer and facial appearance persistence (preservation of the recipient's facial likeness) in face transplants simulated using two-dimensional photographic manipulations found low facial appearance transfer (2.6 percent) and high facial appearance persistence (66 percent). Three-dimensional computer simulation of complex facial transplant patterns may improve the accuracy of facial appearance transfer and facial appearance persistence estimations.
  
  
  METHODS
  Three-dimensional virtual models of human faces were generated from deidentified computed tomographic angiographs and used as "donors" or "recipients" for virtual face transplantation. Surgical planning software was used to perform 73 virtual face transplantations by creating specific facial defects (mandibular, midface, or large) in the recipient models and restoring them with allografts extracted from the donor models. Twenty independent reviewers evaluated the resemblance of each resulting posttransplant model to the donor (facial appearance transfer) and recipient (facial appearance persistence). The results were analyzed using tests for equal results with one-sample and pairwise Rao-Scott Pearson chi-square testing, correcting for clustering and multiple testing.
  
  
  RESULTS
  Overall rates of facial appearance persistence and facial appearance transfer were high (69.2 percent) and low (32.4 percent), respectively. The mandibular pattern had the highest rates of facial appearance persistence and lowest rates of facial appearance transfer. Facial appearance persistence and transfer were similar across sexes.
  
  
  CONCLUSIONS
  Facial appearance persistence is high and facial appearance transfer is low after virtual face transplantation. Appearance transfer and persistence after virtual face transplantation are more dependent on the anatomy than on the size of transplanted facial aesthetic units. This information may reassure recipients of partial face transplants and donor families.
authors.affiliation: Boston, Mass. From the Division of Plastic Surgery, the Center for Surgery and Public Health, and the Division of Neuroradiology, Brigham and Women's Hospital and Harvard Medical School.
authors.forename: Akash A
authors.initials: AA
authors.lastname: Chandawarkar
authors.forename: J Rodrigo
authors.initials: JR
authors.lastname: Diaz-Siso
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Camille K
authors.initials: CK
authors.lastname: Jania
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Mukundan
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D005145:Face / Q000033:anatomy & histology* / Q000601:surgery*; D054445:Facial Transplantation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010781:Photography; D011237:Predictive Value of Tests; D055815:Young Adult