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Face off - getting to grips with face transplants

With the news that full-face transplants could be possible in the next six months, many people are worried about the ethical and moral implications, and want answers before the first operation takes place.

But is it really possible to transplant a face? Is it a tricky operation, and would anyone actually want to have their face put on someone else? Is this not the stuff of science fiction?

Peter Butler, a consultant plastic surgeon at London's Royal Free Hospital, created a furore last month when he told delegates at a British Association of Plastic Surgeons' meeting that face transplants were only months away. He said the question was not can we do it, but should we?

Mr Butler claims that doctors will be able to remove the skin, subcutaneous fat, muscle, veins and bone of a recently deceased person's face and then successfully reconnect the nerve endings and blood supply on a live patient, giving them an entirely new face.

Putting it into practice

The technique would only be used for people with severe facial injuries, he argued, as the surgery is so complex and the risk so significant that it would not be worthwhile for anyone else. Inevitably though, if a face transplant is even a possibility, the cosmetic application will surely be only a step behind.

The idea of having a new face has been part of human culture since Roman times. Most recently in the film "Face Off", a policeman swapped faces with a criminal in order to infiltrate a gang. In real life, face transplants would have to involve someone recently deceased, meaning they would need to have signed a donor card offering their face for re-use.

Although some people's vanity is such that this would seem an excellent idea, it is safe to assume (and recent surveys have confirmed as much) that most of us would feel distinctly uncomfortable with donating the part of ourselves that identifies us the most. And that is not even considering the effect on a friend or relative seeing the face of a recently deceased love one on an entirely different person.

Never judge a book

But what do possible recipients think about the idea? Christine Piff, the founder of support network Let's Face It and sufferer of a rare facial cancer, thinks it's a good idea. "We are all so much more than just a face," she says. "If we can donate other organs of the body, why not the face?"

James Partridge, the chief executive of another charity dealing with severe facial trauma Changing Faces, is less sure. "It is important to have a full public debate about whether whole face transplants would ever be acceptable for people with disfigurements," he says. "Today, people of all ages can be very effectively enabled to face their disfigurement with confidence."

The fact that people are so enthusiastic about face transplants could actually be harmful to those who could benefit from the procedure, he argues.

"The notion that people with severe disfigurements are not acceptable or will find life too difficult to live in today's society could be construed as offensive and is unhelpful to those affected."

But perhaps we will not actually have to deal with the issue of face transplants for some time, despite what Mr Butler says. Consultant plastic surgeon Mr Nicholas Parkhouse, based in London, is convinced they remain a long way off.

Perhaps surprisingly, it is not the removal of the entire face in one piece that is his sticking point; it is the acceptance of that face on a new body.

"The major problem is the skin being rejected," Mr Parkhouse says. "The immune rejection of a face is similar to problems with liver transplants but then the consequences of a body rejecting a face are too horrible to imagine."

Don't take transplants at face value

In order to make the operation work, Mr Parkhouse explained, the patient would have to take large doses of immuno-supressants for the rest of their life and these come with fairly heavy side effects including cancer.

Then there is the issue that many people with severe facial injuries will have damaged facial nerves and arteries, making the job of reconnecting a new face overwhelmingly difficult.

Even assuming this works, a face transplant is not a swift option. "There would be a tremendous problem with swelling. Then there's stiffness - you wouldn't get movement back for months, if not years," he says.

Mr Parkhouse sums up that "in the fullness of time, there may be the potential for someone to have a face transplant". Which is perhaps just as well, since the ethical debate has only just started.

Further information:

Changing Faces
Let's Face It

Link to this story on Discovery Health

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