- The Washington Times - Thursday, December 5, 2002

The idea of transplanting an entire face from a dead person to a living one sounds bizarre, but it may happen within a year. Respectable surgeons as well as the technical press are taking the idea seriously.
They are talking about transplanting the whole face: lips, nose, ears, eventually muscles and subcutaneous fat, perhaps some bone. The hope is that blood vessels could be reconnected from donor to recipient and nerves regenerated. The result, if all went well, would be a face that would move normally, smile, and have normal sensation. At an upcoming meeting of the British Association of Plastic Surgeons, Peter Butler, a plastic surgeon of the Royal Free Hospital in London, will present the case for the surgery.
Why would you want to perform a face transplant? Occasionally people have their own faces utterly ruined by burns or machinery. The psychological effects are devastating: One minute a pretty young woman, the next a grisly horror. The damage to the patient's life are far worse than those caused by, say, the loss of a limb. So, argue some doctors, a transplant might by a reasonable choice.
In the Lancet for July, Mr. Butler says, "The idea of taking off a dead person's face and putting it on someone else appears to have come straight out of science fiction." However, he says, "if face transplantation is shown to be the only effective way of treating severely disfigured patients, then doctors would have a duty to use the technique."
Reconstructive surgery to repair facial damage is far from new. The problem is that for severely damaged faces it doesn't work. The heavily reconstructed face looks like a mask. Worsening the problem is that people are acutely sensitive to any oddity in faces, and facial behavior is complex. The result tends to be a mess.
If it worked, all agree that the recipient would not look like the donor. For example, Martin Evison, an authority on forensic facial reconstruction who works at the University of Sheffield in England, points out that the appearance of a face depends heavily on the shape of the skull, underlying musculature, and fat deposits. But the idea isn't to replicate the original but to produce a functioning face.
This isn't a done deal. Questions remain. Will people donate their faces? Mr. Butler conducted a mini-survey of about 120 people, including medical people. Some said they would be willing to receive a transplant, but none would donate. Whether the figures would change if the procedure became common is anyone's guess.
Nor is it clear that families of the recently deceased will want the dead to be skinned. Since bodies deteriorate rapidly, the decision would have to be made in advance or quickly after death.
Further, because the body tries to reject foreign tissue, the recipient would be on large doses of immunosuppressants for life. These have side effects. In the case of, say, a liver transplant, the choice is between immunosuppressants and death, so the decision isn't difficult. Things would not be so clear for what would really be cosmetic surgery.
Hooking up nerves and blood vessels isn't a sure thing, either. Getting the recipient's facial nerves, which necessarily will be cut during the surgery, to regenerate will be crucial. Nobody says this will be easy. If this doesn't happen, the face will look better than the badly scarred one it replaces, but it won't be remotely natural looking.
Many point out that a successful hand transplant has been done, and argue that the facial transplant should also be doable.
Much of the technology being developed is still well removed from routine use, but we are getting closer to regarding the human body as if it were an automobile, with parts to be replaced at will. Maybe we need to think about it carefully.

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