Face Transplants & Reconstructive Surgery

Face Transplants – Stuff of Fiction

In the 1997 movie hit, “Face/Off”, one character’s face was replaced by another’s, all for the sake of plot (and movie profits). Fewer than ten years later, fiction becomes fact. In only four years, from 2005-2009, reconstructive plastic surgeons around the world have performed at least five face transplants on people who were seriously disfigured by trauma or, in at least one case, by disease.

First Face Transplants

The first face transplant took place in France in 2005; the patient was Isabelle Dinoire (her face was mauled by her Labrador dog). The second face transplant surgery was performed in 2006 in China on a Chinese farmer. The third case also occurred in France in January 2007.

The first U.S. facial transplant took place in December 2008 on Connie Culp, whose face was torn away by a shotgun blast. Culp had 80% of her face replaced at the Cleveland Clinic in Ohio. She was released from the hospital on February 5, 2009, following her landmark surgery. The second U.S. face transplant and the fifth in the world, was performed on James Maki in April 2009.

Organ and limb transplants have become increasingly popular. Patients often receive kidneys, hearts and livers from donors. Those who have lost limbs are also now benefiting from hand transplants. But until recently, the concept of face transplants has remained on the fringe of medicine.

Physical Constraints & Consequences

Of course, going through any prolonged surgical procedure is potentially risky to the patient; being under anesthesia for upwards of twenty hours puts quite a strain on the body. In addition, having to deal with lifelong immune-suppression following a face transplant (or indeed any transplant) is not easy from either a physical or psychological standpoint. However, dealing with the emotional and sociologic issues of living with “someone else’s face” with the impact on one’s identity and sense of self may prove to be far more difficult than the physical issues.

Psychosocial Results of Facial Disfigurement

Researchers at the University of Louisville in Kentucky have been studying the ethical dynamics of this revolutionary medical treatment. According to research, the face is central to individual identification and sexual attraction as to clues concerning gender, ethnicity and age as well as social status and health. Reading facial expressions is key to understanding social situations. In some cultures and social settings, for example, direct eye contact equals engagement and care while in others it can mean provocation and challenge.

According to reports, because of the importance of the face in human social exchanges, disfigurement takes on a role that leads to prejudice, discrimination and social isolation. Victims are often treated with disdain and can be socially powerless. Social mores do not provide “rules” for interpreting a disfigured face, often leading to embarrassing and threatening social interactions.

Discrimination

Research has shown the following prejudices against facially disfigured people:

• Job recruiters have a negative perception of facially disfigured applicants.
• Pedestrians stand father away from a disfigured person while waiting to cross a street.
• Teachers’ academic expectations of disfigured children are lower than for non-disfigured pupils.
• People spend less time and give less money to disfigured charity workers.
• Users of public transportation sit farther from disfigured riders than from non-disfigured riders.

It is possible, according to this research, that face transplantation may be a valuable tool to remedy a medical situation. However, this may lead to undesirable social and psychological consequences for patients. The issue of prejudice also comes into play; is it the duty of the “disfigured” to conform to normal social mores or is it society’s responsibility to accept the “disfigured” (and others) as they are. Also, all people who are facially disfigured may not physically be candidates for a face transplant nor may they even desire one.

Transplants in the U.S. Military

On April 17, 2009, the U.S. Department of Defense awarded $85 million in grant funding to the Armed Forces Institute of Regenerative Medicine (AFIRM) to support medical research for the treatment of troops injured in Iraq and Afghanistan. One AFIRM plastic surgeon stated that these grants are the beginning of an expanding effort to help wounded soldiers and that they will lead to medical discoveries that will help the general public.

These grants will enable surgeons to work with emerging technologies including composite tissue allografts for face and limb transplants, burn treatments and treatments for injuries of the nerves, muscles, blood vessels, tendons and bones.

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