Face transplant

A face transplant is a still-experimental procedure to replace all or part of a person's face.

Beneficiaries of face transplant

People with faces disfigured by trauma, burns, disease, or birth defects might benefit from the procedure.

The alternative to a face transplant is to move the patient's own skin from their back, buttocks or thighs to their face in a series of as many as 50 operations to regain even limited function and a face that is often likened to a mask or a living quilt.

L. Scott Levin MD FACS, Chair, Department of Orthopaedic Surgery at Penn Medicine, has described the procedure as "the single most important area of reconstructive research."

History

Self as donor ("face replant")

The world's first full-face replant operation was on nine year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas, one of India's top microsurgeons. In 2004, Sandeep was training to be a nurse.

In 1997, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.

Partial face transplant

The world's first partial face transplant on a living human was carried out on November 27, 2005 by Dr Bernard Devauchelle, an Oral and Maxillofacial Surgeon, and Dr Jean-Michel Dubernard in Amiens, France. Isabelle Dinoire underwent surgery to replace her original face that had been ravaged by her dog. A triangle of face tissue from a brain-dead human's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient is happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response.

In April 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep.

On 21 December 2008 it was reported that Li Guoxing had died in July in his home village in Yunnan Province. Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favor of herbal medication.This was suggested to be a contributing factor to his death by his surgeon, Dr Guo Shuzhong.

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly.

In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after he received what his doctors call the world's first successful almost full face transplant.

Full face transplant

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant on a man injured in a shooting accident. On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, had been carried out at the Creteil Henri-Mondor hospital.

In the United States

In 2004, the Cleveland Clinic in Ohio, United States, became the first institution to approve this surgery and test it on cadavers.

In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out the face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals.

In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Dr Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Dr Steven Bernard, Dr Mark Hendrickson, Dr Robert Lohman, Dr Dan Alam and Dr Francis Papay) performed the first face transplant in the US on a woman named Connie Culp. It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a brain-dead donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved.

The second partial face transplant in the US took place at Brigham and Women's Hospital in Boston on April 9, 2009. During a 17-hour operation, a surgical team led by Bohdan Pomahac, MD, replaced the nose, upper lip, cheeks, and roof of the mouth - along with corresponding muscles, bones and nerves - of James Maki, age 59. Mr. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result. This procedure was also shown in the eighth episode of the ABC documentary series Boston Med.

Surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (including the underlying fat, nerves and blood vessels, but no musculature). The surgery may last anywhere from 8 to 15 hours, followed by a 10–14 day hospital stay.

After the procedure a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could turn the new face black and require a second transplant or reconstruction with skin grafts.

The transplant does not give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different. Facial movements are controlled by the brain, so the personality as expressed by the face remains that of the patient.

Popular culture

• The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju's 1960 cult horror film Les Yeux sans visage, which translates to "Eyes Without a Face".
• Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.
• The plot of the 1997 film Face/Off is based on a face transplant operation that involved changing the underlying structure and actual face shape. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face if desired.
• An episode of The Simpsons, The Bob Next Door, features Sideshow Bob using face transplants to exchange his face with a cellmate as part of an elaborate prison escape plan so he can murder Bart.
• The procedure is included in the eighteenth episode of fifth season of Grey's Anatomy, titled Stand By Me.
• Episode 9 of Season 3 of Nip/Tuck includes the procedure.

External links

World's first full face transplant (July 2010)

• Face Transplant Surgery at Brigham and Women's Hospital
• University of Louisville Plastic Surgery Research

• BBC News - Q&A: First face transplant
• Research Ethics Blog - Facial Transplantation
• Saving Faces: The Facial Surgery Research Foundation
• CTV News - Face transplant woman goes public for first time
• UK Face Transplant Information Website
• Face transplants inch toward reality
• New York Times
• Cleveland Clinic Face Transplant Video and Surgery Fact Sheet