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. 2025 Nov 1;95(5):576-581.
doi: 10.1097/SAP.0000000000004487. Epub 2025 Aug 15.

Psychological Outcomes of Facial Transplantation: A Systematic Review of Depression and Mental Health-Related Quality of Life

Andie P Blankenstein  1 , Sid H Osborn, Natalie N Aguilar, Miranda C Manzo, Beth Bailey, Anthony Zacharek
Affiliations

Psychological Outcomes of Facial Transplantation: A Systematic Review of Depression and Mental Health-Related Quality of Life

Andie P Blankenstein et al. Ann Plast Surg. .

Abstract

Background: Facial injuries can cause severe functional and aesthetic impairments that significantly affect mental health and quality of life. Facial vascularized composite allografts (fVCAs) have emerged as an advanced reconstructive option, but research on their psychological effects remains limited. This systematic review evaluates the mental health outcomes in fVCA recipients.

Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. PubMed, PsycINFO, and MEDLINE (Ovid) were searched up to April 2024, using keywords related to facial transplantation, fVCA, psychological outcomes, and mental health. Ten studies met the PICOT (population, intervention, comparison, outcome, and timeframe) criteria focusing on mental and psychological aspects of fVCA. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Method and Mixed Methods Appraisal Tool.

Results: Most studies reported improved mental health post-fVCA. Depression scores mostly declined over time, although temporary increases occurred due to immunosuppressive complications or life stressors. Mental health-related quality of life improved overall, with fluctuations tied to surgical complications and transplant rejection. Patients with preexisting psychiatric conditions or self-inflicted injuries had more variable psychological outcomes.

Conclusion: fVCA significantly enhances mental health, self-esteem, and social integration, but complications and psychiatric history influence outcomes. Long-term psychiatric support and standardized assessment tools are essential to optimize recovery. Future research should focus on improving patient selection, mental health interventions, and long-term psychological adaptation in fVCA recipients.

Keywords: depression; facial transplantation; facial vascularized composite allograft; mental health; psychological aspect; quality of life; transplantation.

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Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

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