In 1954 Dr. Joseph Murray performed the first successful kidney transplant at the Peter Bent Brigham Hospital in Boston. In 1967 Dr Christian Barnard performed the first heart transplant at the Groote Schuur Hospital in South Africa. Now in 2004 the Cleveland Clinic may be the first to perform a face transplant. The clinic’s director of plastic surgery, Dr. Maria Siemionow, reported that they are the first medical facility to receive permission from a review board to perform the procedure. 

Initiatives to carry out the world’s first face transplant have been in the works for some time. Plans of conducting the cosmetic procedure were on hold due to the controversies surrounding the operation. Critics of the face transplant operation claim the risks of the experimental procedure may outweigh the potential benefits.

The physical and psychological effects of performing a face transplant are unknown.

"Until there is further research and the prospect of better control of these complications, it would be unwise to proceed with human facial transplantation," it says.

James Partridge, chief executive of the charity Changing Faces voiced his concerns about the possible psychological effects of a face transplant.

"Psychologically, I think face transplants are very different from having somebody’s kidney or liver. To take somebody’s face is to take part of their identify and to lose part of yours." Partridge added: "I would certainly want a lot more research into what the impact of that would be."

The controversial procedure involves removing facial muscles and skin from a dead donor and placing them on a living person, someone whose face is severely disfigured. More is involved to this procedure than just a simple face swap; there is an everlasting phase two.

After the operation patients will have to take immune-suppressing drugs (which are potent drugs that cause life-threatening problems of their own) to keep their new faces from being rejected for the rest of their lives.

A central question in debate over the procedure has been whether patients should be subjected to risks of transplant failure and life-threatening complications from anti-rejection drugs for an operation that is not lifesaving.

Dr. Maria Siemionow stated that she would warn patients that there is as much as a 50 percent chance of failure because of tissue rejection or other complications.

Despite the multiple risks involved with this operation, many people who have face injuries or disfigurations are willing to go through with the procedure. Siemionow explained that finding willing patients to operate on would not be a problem. The real challenge lies in finding a donor. Siemionow said that since families of potential donors could be reluctant to allow the donation, finding an appropriate cadaver could prove more difficult.

Doctors at the clinic said finding an appropriate donor cadaver for the facial skin and underlying tissue could take up to two years. "It may not happen in our life, or it may happen sooner than you expect," Siemionow said. However and whenever this procedure finally takes place, it will certainly change the face of cosmetic surgery.