Facial transplants

A big step ahead but technical/ethical challenges remain

The number of cases of plastic surgery for purely cosmetic benefits is so high that we often forget that for many people, it is their only hope for a normal appearance or lifestyle. For instance, victims of burn or accidents often need extensive surgery to regain their normal look and/or bodily functions.

That is why the recent news from France that plastic surgeons have carried out the first facial transplant on a woman who had lost her nose, lips, and chin after being savaged by a dog. In the procedure, tissues, muscles and blood vessels were taken from a donor and attached to the patient's lower face. In fact, this is the major ethical concern that many people have. Not everyone is comfortable with the idea of using body parts from a dead person, particularly when it means that the face of the dead person will be disfigured in the process.  (Related article:  New facelift technique without scars)

John Barker, director of plastic surgery research at University of Louisville, said if the pioneering procedure is successful, it could offer a “new and potentially better option” for facially disfigured people for whom other treatments are not viable. “This is an exciting development, and we will be following the outcome closely for the medical, psychological and ethical information that may be gained,” Barker said.

Indeed there are many technical and ethical issues to be addressed related to face transplants but Dr. Butler says that as an alternative to the current options for facial reconstruction, and as a means of offering a vastly improved quality of life for a few severely disadvantaged people, it is hard to argue that face transplantation will not soon justify its place on the reconstructive ladder.  "What is not ethical about helping to restore a person's quality of life?" asks Dr. Anthony Griffin, Director of the Beverly Hills Cosmetic Surgery Institute and star of ABC's hit show Extreme Makeover.   "Face Transplants are an outstanding part of the future of Plastic Surgery. We have the technology and we will use it, and it is absolutely ethical. However, the debate as to whether or not it is appropriate will continue to rage on," he adds.

Dr. John Grossman, director and founder of Grossman Plastic Surgery, says, "There must be a compelling reason to warrant this kind of surgery, such as a massive burn or severe disfigurement. For most people, the face is the most personal piece of recognition and self- identity. Altering it completely can be extremely traumatic. There are also medical issues with rejection of the tissue and exposing the patient to anti-rejection medication. If a facial transplant is performed for primarily aesthetic purposes, it amounts to little more than showboating and grandstanding, rather than responsible medicine." 

Dr. Andrew Jacono, surgical director of the New York Center for Facial Plastic and Laser Surgery, is also hoping that for those patients who could benefit from this procedure, it is a good idea. He says, "Major facial reconstruction can take dozens of operations to remove tissues from other parts of the body and graft them to the face, with a 'mask-like' face as a result. The possibility of face transplanting offers hope to such patients. Small muscle fibers, vessels and several cranial nerves must be carefully reattached. Although gross facial movements are possible, precise facial expressions are unattainable. The face survives after transplant with modern immunosuppressive medicine. He or she cannot go out in public without a sense of shame and isolation. The hope of this surgery outweighs the potential risks."   Dr. Sam Speron, a plastic surgery expert, agrees and predicts that the first transplant in the United States will occur in 2006.

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