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."
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 April, 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of Li Guoxing, who was mauled by a bear while protecting his sheep.
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.
In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.
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.
1964: Kōbō 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 film of the same name by Hiroshi Teshigahara in 1966.
1990: In the 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 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 an 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.
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