*Purpose: The purpose of this study is to determine the feasibility of using 3D facial stereography to monitor volume changes in a facial allograft, and we hypothesize that 3D facial stereography could quantify allograft volume changes in a face transplant recipient during an acute rejection episode.

*Methods: The Vectra H1 (Canfield, Fairfield, NJ) portable scanner was used to capture 3D facial images of a face transplant recipient at eight clinical timepoints. The 3D facial scans were analyzed using the Vectra Canfield Analysis Module Software (Canfield, Fairfield, NJ). The first time point of data capture on post-operative week (POW) 49 was designated as the control. To analyze volume changes, each consecutive image was overlaid on the control using artificial intelligence. Volume changes were analyzed in the periorbital region and inferior third of the face bilaterally.

*Results: The recipient was a 22-year-old male who underwent a face and bilateral hand transplant in August of 2020. Data was gathered over the course of an acute rejection episode (onset and resolution). Analysis of volume changes demonstrated progressively increasing edema leading up to admission and a subsequent decrease following treatment. Compared to the control scan, facial volume trended upwards through the following weeks (POW 49, 52, 53, 56, 58, and 60), reaching maximal values of +7.65cc for the left periorbital area, +5.19cc for the right periorbital area, +67.22cc for the left inferior third of the face, and +33.16cc for the right inferior third of the face. The patient was treated for rejection between POW 59 and 62. Following treatment, the subsequent scan on POW 64 demonstrated reduced volume in all regions, reaching levels below the control scan in all regions except for the left inferior third of the face, which remained above the control (+9.13cc). Of note, the periorbital region demonstrated a reduction in edema prior to the more dependent areas of the face (POW 60).

*Conclusions: This study demonstrates the feasibility of analyzing 3D facial stereography to quantify volumetric changes in a facial allograft over time. Three-dimensional facial stereography shows promise in providing a longitudinal baseline for facial volume in face transplant recipients and may serve as a useful tool for rejection monitoring in vascularized composite allotransplantation.

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