Extreme makeover
AU.S. clinic is entering uncharted territory in its efforts to perform the world’s first face transplant For the critically disfigured, the once-unthinkable operation offers new hope, writes Isabel Teotonio
In what’s being dubbed by some the “ face race,” 12 severely disfigured people will visit the renowned Cleveland Clinic over the next few weeks for a shot at a radical operation never tried anywhere in the world: a face transplant. But before someone is chosen to receive a new face from a dead donor, Dr. Maria Siemionow will meet with each of the candidates, five men and seven women. “ Are you afraid that you will look like another person?” she will ask, knowing that whomever she selects will undergo the ultimate identity crisis. But this isn’t an extreme makeover made for TV. This is a medical frontier Siemionow is braving in the hopes of giving those left horribly disfigured by burns, accidents or other tragedies the chance at a new life. These people have already lost any sense of identity linked to their face, she said, adding a transplant is merely taking a “skin envelope” and slipping their identity inside.
If the candidate is a burn victim, Siemionow will look closely at eyelids that are frozen in place, a mouth that can’t close properly and a face that is a quilt of multi-coloured skin grafts. She will also study the movements of eyebrows, lips and even cheeks. The procedure involves taking skin and underlying tissues from a donated cadaver and placing it on a living recipient. The chance of it working hovers at around 50 per cent. But Siemionow, who studied in Poland and trained in Europe and the United States, believes the success of this depends largely on choosing the right patient.
“ You want to choose patients who are really disfigured, not someone who has a little scar,” yet with enough healthy skin for traditional grafts if the transplant fails, she said.
After years of scientific debate, heated by the ethical concerns and technical feasibility of such an operation, the 13-member Institutional Review Board, the Ohio clinic’s gatekeeper of research, last fall became the first institution to approve this surgery.
Proponents note the clinic’s expertise, Siemionow’s experience, the careful planning involved, the team of experts assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique. But critics argue that the operation is too risky in a matter where life and death aren’t hanging in the balance. Instead, they’re fearful about a transplanted face being rejected and sloughing away, leaving the patient worse off than before. And because the recipient would have to take powerful anti- rejection drugs for life, they worry about the long- term health risks. Furthermore, a patient with unrealistic expectations could be psychologically impacted even more so. Such anxieties quashed plans for face transplants in France and England.
Although when imagining a face transplant, many are likely to think of the 1997 movie Face/ Off, starring John Travolta and Nicolas Cage, whose characters swap faces, nothing could be further from the truth, said Dr. Martin McKneally, a former surgeon who now teaches at the University of Toronto’s Joint Centre for Bioethics.
“ There’s been some fear that the transfer of the face will transfer identity,” McKneally said yesterday, adding he supports exploring this new treatment so long as it’s done “ cautiously and carefully.
“ The skin envelope won’t transfer all the characteristics of the donors — it won’t transfer any of the muscular movements — the smile, or even the way skin crinkles around the eyes during laughter — that’s determined by the muscles and nerves underneath the skin.
“ Patients whose muscles and nerves are damaged would have a mask- like face, much as they do now. But the mask they ( currently) hide from the world is
too frightening. . . .
With a smooth, more
familiar-looking skin
envelope over their
face, they will be more
presentable. . . . It’s
not going to make
them beautiful, but they’ll be much more presentable to society.” Former patients of his who’ve been left severely disfigured would surely welcome the opportunity for a face transplant, he said, adding that some of today’s treatments still leave them with scar-tissue masks that don’t look or move like natural skin.
“ I had one patient who cried every time she came to see me, because that was the only time she went out,” he recalled of a woman with severe facial scars. “ She couldn’t get a job, not even as a babysitter . . . Her life was almost unlivable.”
While some ethicists have argued that a failed face transplant could unleash unknown psychological trauma, McKneally argues there’s little to lose because the patient would be back to where he or she was before the operation.
Despite the shock factor, a face transplant involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor new tissue to the scalp and neck, and areas around the eyes, nose and mouth.
Skin will be matched for tissue type, age, sex and skin colour. Surgery may last about 15 hours, with a hospital stay of two weeks. Complications could include infections that turn one’s new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.
“ I hope nobody will be frivolous or do things just for fame,” Siemionow said, insisting she’s not competing to do the first case. “ We are almost over- cautious.”