Surgeon Says Face Transplants a Reality

Aspherical Cow writes "A New York Times Magazine article about how a London surgeon is planning on performing an experimental full-face transplant. The face would be harvested like any other donor organ and used on a disfigured person. Lots of issues of identity come up with something like this, but they say that this won't turn Nicholas Cage into John Travolta."

Comments

Correct Link

[Captain Chad]

HERE

I just read that article a few minutes ago.

[kmellis]

I was utterly astonished at the then-current results of the accompanying little web survey: Do face transplants change a person's identity? Yes and No have each received 46% of the vote.

Why in the world does anyone think that identity depends upon someone's face? Are people really that simple-minded?

Also, from the article:

"Butler told me of a psychological survey that he conducted of 120 people at his own hospital, one-third of them doctors, one-third nurses and one-third laypeople. The majority answered that they would accept someone else's face if they required one. No one, however, not even his closest colleagues, said they would donate their own."

I'm no more reluctant to donate my face for organ harvesting as I am my liver or kidneys. That is to say, I'm not reluctant at all.

To the people who've asked about how much the recipient would look like the donor:

"''Certainly, identity is a central issue -- 'will I look like the donor?''' he explained in a rapid-fire, silken Irish brogue. ''But what we're proposing is taking the skin envelope with or without some muscle. So if I were to transplant my face onto you, it would look much more like you than me, because the skin envelope is elastic. It would redrape around your bone and cartilage structure. The things you would have of mine are skin tone, texture, eyebrow color, beard, things of that nature. That's why what I'm doing now is establishing a database for what is essentially a matching process. You and I, for example, are reasonably well matched, but obviously. . . .'' He gestured to a dark-skinned gentleman who had just stepped up to a nearby side counter to stir cream into his coffee. ''I wouldn't transplant your face onto his.''"

However, later in the article it's mentioned that more complicated procedured could harvest some of the cartilage and bone as well as the skin and muscle. I imagine that eventually they could probably come very close to recreating someone's face on someone else, so the idea isn't completely far-fetched. Still, though, our ability to recognize a face is still somewhat of a mystery, although it's understood that our brains put together a great many different subtle clues. My point is that even though we see faces as near monolithic and emminently identifiable structures, the truth is that even a small differences in muscle or bone structure might make a large difference in the overall recognizability of the face. So, I suspect that a surgeon would probably have to be intending to duplicate someone's face via a transplant in order to achieve such an effect.

skin grafting

[The Tyro]

To a certain degree, you're right, but differences in skin do exist, depending on body location.

Some skin is hair-bearing, some has different sweat glands, some is thicker, and some has more or fewer nerve endings. For instance, the skin on your elbows has far fewer nerve endings than the skin of the lip.

It sounds like the surgeon is simply doing a large, complex skin graft... that's something burn surgeons have been doing for years. Burn surgeons use a device called a dermatome... in essence a large electric shaver that you can set to shave off very precise depths of skin (to thousandths of an inch) to achieve a split-thickness graft. It's worth noting that skin grafts for burn victims are often meshed to cover a larger area (if you are burned >95% of your body, there isn't much to work with, so you have to make every bit count). The cosmetic results are nowhere near normal skin, but the primary purpose of a graft in a burn patient is to reestablish the protection that intact skin gives you. Absence of skin not only makes you extremlely vulnerable to death from infection, it also causes you to evaporate off enormous amounts of fluid, resulting in rapid dehydration. Cosmesis is often secondary to simply saving a person's life... it's not pretty, but it works. If you were burned, and your ass was spared, you can be damned sure the burn surgeon would harvest the bejeesus out of your ass to cover the rest of you...

I'd be interested to know how he's selecting his patients, and whether he'll do these transplants on smokers. There are some plastic surgeons that won't do skin grafts on a smoker, since the act of smoking can actually lower your capillary oxygen transport enough to endanger the survival of a skin graft.

I'd also be interested in knowing the surgical technique he's planning on using to harvest the skin. Clearly he'll have to do it by hand, use a bit of microsurgery to reconnect the vessels... I can see this being a looong procedure.

I'd probably donate my face, if someone else needed it and I didn't (I'd donate it, just like any other "organ"... and their different bone structure should destroy any resemblance).

Now whether someone would actually *want* my face... wow, I don't know... they'd have to be pretty desperate...

Re:skin grafting

[Isldeur]

It sounds like the surgeon is simply doing a large, complex skin graft... that's something burn surgeons have been doing for years.

Um, no. But thanks for your discussion on skin types. This operation (and I believe the surgeon is Irish actually, just working in London) is much much more complex. It involves a lot more careful work, both with the placement of the folding lines as well as reattachment of the loads of muscles and nerves, including both the facial (CN VII) and trigeminal (CN V) cranial nerves.

Burn surgeons use a device called a dermatome... in essence a large electric shaver that you can set to shave off very precise depths of skin (to thousandths of an inch)

While I don't know the surgeon's exact approach, I am certain they are not using those razors. It's the entire facial skin they're transplanting, not shavings of it.