QS3: The Ideal Match: Optimizing Partial Face Transplants In Terms Of Skin Tone Discrepancies

• Main Authors: Pooja S. Yesantharao, MS, Jordan Garcia, MD, Carisa M. Cooney, MPH, Damon Cooney, MD PhD
• Format: Article
• Language: English
• Published: Wolters Kluwer 2021-07-01
• Series: Plastic and Reconstructive Surgery, Global Open
• Online Access: http://journals.lww.com/prsgo/fulltext/10.1097/01.GOX.0000770116.45695.3e

Background: Partial face composite allotransplantation poses a unique aesthetic challenge. Namely, partial face transplants need to resemble the patient’s native skin. The degree of resemblance considered acceptable is a prominent variable and may depend on the gender and underlying skin tone of the recipient. The primary aim of this study was to investigate the degree of skin tone matching deemed aesthetically tolerable, recipient gender, and recipient skin tone. Two populations were queried: (1) the general public and (2) plastic surgeons. Few studies have investigated this topic from either of these standpoints. A secondary aim was to determine whether participant characteristics such as demographics, skin color, and history of having had facial surgery impacted their perceptions. Methods: This was a cross-sectional investigation of perceptions on skin tone matching. Participants from the general public were recruited through Amazon Mechanical Turk and surgeons were recruited through the American Council of Academic Plastic Surgeons. Participants were queried for aesthetic preferences using frontal face photos from age-standardized models. Skin tones of transplanted segments were varied using the Munsell color scale via Adobe Photoshop (Adobe Inc., San Jose, CA). Results: In total, 550 lay participants from Amazon Mechanical Turk and 21 plastic surgeons provided complete survey responses. On average, plastic surgeons tolerated a lesser degree of skin tone discordance than the lay public: 87% of lay participants and 33% of plastic surgeons believed a change of 4 hues was acceptable (p=0.02). Additionally, all survey respondents tolerated less of a degree of skin tone discrepancy on female faces when compared to male faces (mean difference tolerated: 2 hues for females, 4 hues for males). Participants tended to tolerate less skin tone discrepancy in subjects with similar skin tones as their own (mean difference tolerated: 2 hues for own versus 4 hues for different skin tones, p=0.04). Conclusion: This study highlighted the intensely- subjective nature of aesthetic preferences surrounding skin tone matching on the face, which varied by demographics and between surgeons versus the lay public. Surgeons should ensure that they truly elicit their patients’ preferences, especially given that our results demonstrated a greater tolerance for discrepancies among the lay public compared to plastic surgeons. Procuring a graft for facial allotransplantation is challenging; understanding what level of skin tone discrepancy is tolerable to the recipient can help surgeons improve patient satisfaction and may also lessen time-to-transplant by enlarging the potential donor pool for this type of transplant.