Face Transplants and Reconstruction

There is an old photo of a soldier wounded during one of the European wars at the end of the 19^th or beginning of the 20^th century. How he survived his wound is a good question because his face was blown off. He is missing most of the middle of his face. His profile looks like a half-moon: all forehead, eyes and chin. Ordinarily, this would fall into the realm of another soldier forced to spend the rest of his life worrying about people staring at him, as well as the tangential concern of what battle wounds do to people. And, in a sense, it is, because of the visceral reaction viewers have to it. However, the doctors of the day found a way to make him appear more “normal” by attaching a face made of plaster, paper and wood. It isn’t perfect, but it seemed to make the soldier happier about his situation. He lived for a long time.

Boston’s Big Decision: Face Transplants

This story actually does have a link to what is going on today. Brigham & Women’s Hospital in Boston, Massachusetts has given surgeon Bohdan Pomahac the go-ahead to set up a surgical unit to conduct face transplants. This is the first of its kind in the U.S. There have only been three previous face transplants. Two in France, and one in China. The first one, done in France, is probably the more newsworthy of the three.

Isabelle Dinoire was given a new nose, mouth and lips after her dog gnawed them off. These were transplanted from the face of a woman who was brain dead. Dinoire needs to take immunosuppressant drugs for the rest of her life to avoid rejection of the transplant. She has already come close twice to this.

While face transplants are still questioned for their ethical and logistical issues, there are a few surgeons willing to tread this fine line. For now, face transplants are seen as “non-life-threatening,” or optional, procedures, by medical ethicists, unlike heart or kidney transplants. However, Brigham & Women’s Pomahac, as well as others, must abide by certain conditions.

Conditions Imposed on Pomahac

• Potential patients must already be taking immunosuppressant drugs
  
• Donors will come from families who have a “take anything” clause written into what can be taken from the deceased. Regular donors will not be allowed to be touched in this way
  
• The face must be harvested and transplanted within four hours of a match
  
• Recovering patients should be released from the hospital after a week, but must continue to see a doctor for psychological and physical therapy
  

These conditions make it hard to find viable patients. In fact, Pomahac has yet to find even one since proposing this procedure at Brigham & Women’s last summer. There is also the matter of weighing the side-effects and risks that go into surgeries like this. Obviously, every surgical procedure has risks, but due to the relatively new nature of face transplants, not all risk factors are known. Pomahac believes the potential benefits outweigh the risks. As a side effect of the immunosuppressant drugs that kidney transplant patients must take, several have developed face cancer, seriously disfiguring them. Don’t these people deserve a new face? And here we enter another dynamic.

The Cosmetic Surgery Question

Cosmetic surgeons are sometimes seen as less-than-admirable for changing people’s appearances in sometimes radical ways for a price. Nevermind that those who undergo the cosmetic surgery voluntarily decide to walk through the door themselves. What is often overlooked is that, while a cosmetic surgeon might offer breast augmentation, they also offer reconstructive surgery for women who have gone through a mastectomy. They offer function as well as beauty by fixing things like cleft palates and reducing large scars.

Yes, there will always be people who will be forever unsatisfied with their appearance and visiting cosmetic surgeons as much as they possibly can (and cosmetic surgeons who are more than happy to take their money and perform the procedures). But there are also cosmetic surgeons who feel legitimate empathy for the teenage patient who wants rhinoplasty because he or she has been made fun of throughout school, or the aging patient who wishes she had the face she did twenty years before. Cosmetic fixes, yes, but the goal is to perhaps make these individuals more confident about themselves. Is that wrong? After all, cosmetic surgeons, too, must follow the first medical principle: “Primum non nocere.” Do no harm.

If you are interested in reconstructive cosmetic surgery, or simply want to find out more information about the different procedures available, please contact an experienced cosmetic surgeon.