What’s in a face?

Saving Face: Face transplants for the “socially-crippled”

Don’t look now, but a woman in Ohio has a new face. And the world has a new kind of medicine: socially necessary surgery.

The operation, announced yesterday at the Cleveland Clinic, was a face transplant from a corpse. Similar procedures have been done three times before, but this was the biggest. Doctors replaced 77 square inches of the patient’s face, from her eyelids to her chin. Go look at yourself in the mirror. That’s practically the whole you.

Medically, it’s a triumph. Transplants used to be mortally necessary and relatively simple: kidneys, livers, hearts. Patients got these surgeries because if they didn’t, they’d die. And though the surgeries were risky, the tissues involved were straightforward. The blood vessels that had to be connected were manageable in number and size.

Today, transplantation has advanced to parts that are less vital and sometimes much trickier: ovaries, uteruses, penises, hands, arms, and now faces. As surgeons venture closer to the body’s surface, two things happen. The recipient’s body becomes more likely to reject the transplant, increasing the need for drugs that suppress the immune system, which in turn raises the risk of infection and cancer. By some estimates, the price can be a decade of life. And the muscles, nerves, and blood vessels involved become ever smaller and more intricate. One doctor involved in the Cleveland transplant calls it “the most complex surgical procedure ever performed.”

Then why do it? Why spend hundreds of thousands of dollars and risk a patient’s life to fix a nonlethal defect? The Cleveland doctors give three reasons. First, this patient had facial damage that impaired her physical functions. She couldn’t eat normally, and she could breathe only through a hole in her windpipe. Second, faces, unlike kidneys, have social functions. “They are essential to our communication with the world,” argues Maria Siemionow, the doctor who led the Cleveland team. They convey emotion as well as speech.

Read the rest here.

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