Inclusion Criteria:

• Age 18 through 65 years
• Signed written informed consent
• patient with a loss of substance of the median third of the face by traumatisms or not carrying the totality of the lips with or without the nasal pyramid.
• validation of the feasibility by a committee of expert in plastic surgery and maxillofacial
• patient with a positive psychologic evaluation
• patient with an anatomical evaluation and assessment pretransplantation positive normal infectious assessment
• Good compliance and capacity of adaptation to the assessment difficulties
• Patient with renal, hepatic, hematologic ,cardiac normal
• Patient profiting from a Social Security cover
• Patient informed patient, having signed a free assent lit with inclusion in the study

Exclusion Criteria:

• patient minor under supervision or deprived of freedom by court order or administrative.
• person remaining in a medical or social establishment
• pregnant. or breast-feeding women
• patient presenting a sever cardiac pathology having a risk of decompensation into pre, per and post operational
• patient presenting a hepatic pathology
• Any cancer that has been in complete remission for > 5 years malignancies tumoral lesion of the face with 2 years deadline of remission respected

renal insufficiency chronic clearance of creatin < 60l ml/mn

• chronic respiratory insufficiency
• patient presenting an active infection which can be worsened by the immunosuppression
• patient presenting an active infection which can be worsened by the corticoïd
• patient with affection being able to compromise post-operative survival
• patient with digestive ulcer
• No known HIV infection
• serology hepatitis B with circulating DNA highlighted quantitatively
• personality emotional unstable
• schizophrenic or not schizophrenic psychosis