NYU Surgeons Create Realistic 3D Printed Masks for Facial Transplant Donors and Their Families

In the case of some transplants, the organ donor is still alive and can lead a normal life post-surgery, such as someone who donates their kidney. But for many transplant surgeries, this is not possible, especially when it comes to a donated heart or face. A team of 3D printing experts at NYU are embarking on a mission with the plastic surgery department of NYU Langone Medical Center that could benefit the loved ones of people whose faces are donated to someone in need of a transplant.

Typically, deceased facial donors have only been able to receive a silicone mask, cast from a mold, with painted features as a replacement face. But a lifelike 3D printed facial mask offers far more accuracy, which is important for the family and friends of the deceased.

Even if you check the organ donor box on your driver’s license, families must give surgeons direct permission to remove a person’s face; as this can be an incredibly difficult decision to make, the list of possible donors is limited. That’s why the NYU Langone surgeons are hopeful that a more accurate 3D printed facial replacement will encourage more people to agree to donate the faces of their dying family members for transplant purposes.

The mask is made of hard plastic but captures the subtleties of a flesh and blood face.

According to transplant procurement groups, asking a family to remove their loved one’s face is akin to an additional loss, on top of their death. But for the small pool of candidates in need of a facial transplant, every second counts, so the faster the decision can be made, the better. Helen Irving, the president of the LiveOnNY network which matches organ donors and recipients together, explained that a more accurate 3D printed mask could “make the donation journey more comfortable, and perhaps a bit easier, for the loved ones of donors.”

Dr. Eduardo Rodriguez. [Image: NYU Langone]

Dr. Eduardo Rodriguez, Director of NYU Langone’s face transplant program, said, “Maybe a silicone mask approximates 75 percent accuracy. A 3-D printed mask can approximate 95 percent.”

It all started back in 2015, when Dr. Rodriguez performed an extensive full face transplant, with the help of 3D printed surgical planning models, on former Mississippi firefighter Patrick Hardison. Hardison’s face had melted off in a mobile home fire, and he had been on the transplant waiting list for over a year. According to New York Magazine, one family had withdrawn their consent to donate their child’s face at the last minute, but the family of 26-year-old Brooklyn bicycle mechanic David Rodebaugh, comatose after a cycling accident, later agreed.

They asked Dr. Rodriguez before the operation what his body would look like after, and he told them about the silicone mask, as well as its limitations in accuracy, but they still said yes.

Dr. Rodriguez said, “Their primary focus was to see their son help out as many people as possible.”

Knowing how hard it must be to agree to such a procedure, he set out to make a better 3D printed face replica mask in order to show appreciation for the family’s decision and sacrifice.

A 3D printer puts down thousands of layers of plastic to build the mask.

Dr. Rodriguez said, “We try to respect the dignity of an individual who gave up his face or her face.”

Here’s how the process works – when a brain-dead person, whose family has consented to a facial transplant, comes into the NYU Langone Medical Center’s plastic surgery department, a technician uses a handheld scanner to slowly scan the donor’s face, using five camera lenses to capture every detail and contour from several angles.

Leslie Bernstein, an NYU Langone administrator, had her face scanned to make a demonstration mask.

Recently, NYU Langone administrator Leslie Bernstein had her face scanned in order to make a 3D printed demonstration mask. The scanner is able to build a 3D map from a grid projected onto the donor’s face, and technicians at NYU’s 3D printing center, LaGuardia Studio, will then tweak the files on computers in what the studio’s manager Andrew Buckland calls “the equivalent of spot-touching your print.” The files are then sent to a large 3D printer, which uses acrylic-based photopolymer to print the face.

With each pass of the scanner over the subject’s face, the image grows more detailed.

LaGuardia Studio usually 3D prints arts and engineering projects, but the facial replica 3D printing process is basically the same process, but performed faster, as the donor’s body needs to be released to the family quickly once their face has been removed and attached to the transplant recipient.

Buckland explained, “We’re essentially condensing what we like to do in two weeks into 36 hours.”

It can take the 3D printer over 24 hours to lay down the thousands of layers required to make the face, but it’s worth it when you see the hard, realistic plastic mask. Even the lower resolution mask of Bernstein’s face was able to capture tiny variations in texture, reflectivity, and color.

Buckland said, “With a higher-res version, you would literally see the pores.”

Cartridges of liquid polymer are used to print the 3-D mask.

The studio technicians then rush the mask to NYU Langone, where Dr. Rodriguez is waiting with the donor, whose face and other organs were removed while they were still on life support, in an effort to, as he puts it, “procure the face while it is still being perfused by a beating heart.”

Once the donor has passed away, the mask is placed on top of their “stripped face,” and the seam where it meets the skin or hairline is respectfully covered with a bandage, just like an incision with a sterile cover.

Each time, the goal is make a replica of the donor’s face, using 3D printing and scanning technology, that so accurately resembles their face that the family feels comfortable enough to use it for burial, or even open casket funerals.

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