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Background: Although non-vital to life, face disfigurement is vital to quality of life. Two options are currently available for face restoration: facial allotransplantation and traditional facial reconstruction. Because of series of profound problems associated with immunosuppression and psychological issues, facial allotransplantation is only indicated for highly selected patients. On the other hand, the results of traditional facial reconstruction are far from ideal although risks are few. Therefore, restoration of the face poses a great challenge to the reconstructive surgeons. The purpose of this study was to develop a sound approach to face restoration with the integration of the established and emerging technologies.
Methods: The cervicothoracic skin was chosen as donor graft for match of color and texture. To obtain a super-thin flap of full-face size with reliable blood supply, we prefabricated the cervicothoracic skin flap with the descending branch of the lateral circumflex femoral vessels. The flap then underwent a series of expansion. Bone marrow derived mononuclear cells (BM-MNCs) were injected into the expanded flap to promote skin regeneration and angiogenesis. To enhance blood supply and ensure flap survival, we used delaying and super-charging techniques during flap transfer. For complex structures like nose and lips, three-dimensional modeling was performed to precisely fashion the missing structures which were then prelaminated with the flap. In the primary stage, the integration plan varied based on individual patients. Secondary revisions were performed to further improve facial shape and contour.
Results: Between 2006 and 2012, a total of 7 facial restorations using this technique were performed including 5 full face and 2 complex partial face restorations. The patients, 2 male and 5 female, had presented with severe facial burn or trauma and significant disfigurement. After primary surgery and secondary revisions, six faces achieved “near-normal” appearance and could impart basic facial expressions such as smile, blink, and frown. These patients and their family members were highly satisfied with the results. Long-term follow-up showed sustained results without deterioration. Partial necrosis of 1/6 of the flap occurred in one patient as a result of our misjudgement of the venous return.
Conclusion: Our integrated approach for face restoration with the combination of traditional flaps, regenerative medicine, and digital medicine is effective, reliable, affordable, and readily available without the complications of long-term immunosuppression as in allotransplantation. This approach may benefit a larger target population.

Figure1.pre-operation appearance with sulfate acid burn scar

Figure2.10 months post-operative appearance with light makeup.