Face transplant

A face transplant is a skin graft that involves replacing part or all of a patient's face with a donor face.

Purpose
People with faces disfigured by burns, trauma, disease or birth defects might benefit from the procedure. The alternative to a face transplant is to move the patient's own skin from their back, buttocks or thighs to their face in a series of as many as 50 operations to regain even limited function and a face that is often likened to a mask or a living quilt.

Dr. L. Scott Levin, chief of plastic and reconstructive surgery at the Duke University Medical Center, has described the procedure as "the single most important area of reconstructive research."

Self as donor (face replant)
The world's first full-face replant operation was on nine year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag.

An article in the The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas, one of India's top microsurgeons. In 2004, Sandeep was training to be a nurse.

In 1997, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.

Mouth and nose from another
The world's first partial face transplant on a living human was carried out on November 27, 2005 by Professor Bernard Devauchelle a maxillofacial surgeon in Amiens, France. Isabelle Dinoire underwent surgery to replace her original face that had been ravaged by her dog. A triangle of face tissue from a brain-dead human's nose and mouth was grafted onto the patient. On December 13, 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient is happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response.

In April, 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of a farmer who was mauled by a bear while protecting his sheep.

Full face from another
Scientists at the Utrecht University and the University of Louisville are seeking approval for an experimental face transplant operation to be performed in the Netherlands.

In 2004 the Cleveland Clinic in Ohio, USA, became the first institution to approve this surgery and test it on cadavers. A group led by Dr. Maria Siemionow, located at the Cleveland Clinic, is searching for its first patient.

In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals.

Surgery and post-operation treatment
The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (including the underlying fat, nerves and blood vessels, but no musculature). The surgery may last anywhere from 8 to 15 hours, followed by a 10–14 day hospital stay.

After the procedure a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that would turn the new face black and require a second transplant or reconstruction with skin grafts. Psychological effects of the procedure may include remorse, disappointment, or grief or guilt toward the donor.

The transplant does not give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different. Facial movements are due to the brain so the personality as expressed by the face remains that of the patient. Only the skin of the face is transferred from the donor, not the three dimensional shape nor the personality it expresses.

Popular culture
1960: The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju's 1960 cult horror masterpiece called Les Yeux sans visage which translates to "Eyes Without a Face".

1964: Kobo Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a movie by Hiroshi Teshigahara in 1966.

1990: In the 1990 movie Darkman, the central character Peyton Westlake grafts himself a synthetic face after his skin was burned in a lab accident. He uses this new material to disguise himself and hunt down the criminals responsible for his mutilation.

1996: Facial transplant surgery was featured in an episode of Star Trek: Voyager.

1997: The plot of the 1997 movie Face/Off was based on a face transplant operation that involved changing the underlying structure and actual face shape. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face if desired.

2003: The villain in the movie Once Upon A Time In Mexico underwent a face transplant.

2005: Facial transplant surgery was featured in a 2005 episode of Nip/Tuck.

2007: In the nonfiction book Heroes With a Thousand Faces, an entire chapter is devoted to facial transplant, including the pros and cons of the procedure. The chapter also includes interviews with Dr. Maria Siemionow of Cleveland Clinic and Christine Piff, founder of Let's Face It, an organization based in the UK that supports people with facial differences.