Face transplant

Face transplant is an advanced technology which enables doctors to transplant part, or all, of a face from a donor. Earlier, the only ­way t­o fix severe facial disfigurement was with skin grafts which involved taking pieces of healthy skin from elsewhere on the body or from a cadaver and placing them over the missing parts of the face. Face transplant looks and acts far more realistic than skin grafts.

Why should I be aware of this?

• Face transplant is not a routine operation like getting a facelift, or cosmetic surgery
• As face transplants involve big risks and lifelong need to take medicines to prevent rejection, they are likely to remain uncommon and used on only the most severely disfigured.

All about face transplant

Face transplants go far beyond the transfer of skin and facial features, using things like bone and cartilage for reconstruction.

The idea of replacing a diseased organ with a healthy one from a donor was under consideration for very long but could not be implemented as the human body is not particularly receptive to foreign tissues. The immune system, which is always on guard against any invasion of bacteria, viruses or other potentially dangerous substances, sees it as invasion and resists the invasion. White blood cells attack and destroy the unknown tissue in a process known as rejection.

Eventually, scientists realized that when there was genetic similarity between the problem of rejection didn’t occur.

World’s first partial face transplant

The world’s first partial face transplant was performed in Amiens, France, in late November 2005 on Isabelle Dinoire, 38, who was seriously disfigured by her Labrador retriever. The first U.S. face transplant, and the most extensive operation so far, was done in December 2008 when the doctors at Cleveland Clinic replaced 80 percent of a woman's face with that of a female cadaver.

Though the early successes are encouraging, there is call for hyper-vigilance about helping patients understand what they're getting into. People who have received other transplants -- organs, hands -- have sometimes discovered they traded one set of problems for another, and get sick of taking the medicines needed to maintain the transplant.

The process

The donor chosen should be alive on life support, but brain dead with no hope of recovering. The donor should alive because the tissues must still be connected to an active blood source. Doctors try to match recipients with a donor of a similar age and skin tone. More important is matching the blood and tissue, because a poor match will end in the recipient rejecting the new tissues.

The risks

As with any other surgery, the main risks with face transplant are excessive bleeding and infection. There is also the risk of blood clot forming in one of the reattached blood vessels. This may block the blood supply to the new face and kill the tissue.

Even if the tissue type matches those of the donor, there is still the possibility of rejection. There are also risks to the drugs used to prevent rejection because they suppress the immune system and lower its ability to fight off infection. People who take immunosuppressive drugs are more likely to develop diabetes, kidney disease, infections and cancer.

Apart from physical complications there are a number of psychological issues too. Having a totally different face can be traumatic, and people who undergo this operation may need counseling to regain some normalcy in their lives.

The controversies

Though the technology has been around, doctors attempted the procedure only recently mainly because of ethical concerns. The first concern is over the donor, whose family must be willing to turn off life-support machines while the person is still technically alive. Other ethicists are concerned about patients assuming the risks of major surgery when their lives are not technically in danger. How the technology, and the debate, evolves will become clearer in the coming years.

90 degrees

One big question everyone asks is: Will the face transplant recipient look exactly like the donor? The answer is no. Your looks are not defined solely by your skin -- the underlying bone structure also is an important factor. After the procedure, the patient will actually look like a combination of him- or herself and the donor.

References:

• Face transplants gain ground in US
• First U.S. Face Transplant Described
• How Face Transplants Work