The Real Face/Off

The mind boggled when Travolta and Cage swapped mugs in the 1997 blockbuster Face/Off but today reality and science fiction have moved ever closer as a Texas construction worker disfigured in a power line accident has undergone America's first full-face transplant.
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Texas construction worker Dallas Wiens, 25, received a completely new face from an unidentified corpse in an operation paid for by the US military, which wants to use what is learned to help disfigured soldiers. This was only the twelfth face transplant ever carried out globally.

The first face transplant, three years ago, was conducted on a Frenchwoman who had been savaged by a dog. The fact that these experimental operations have been reconstructive rather than cosmetic does not lessen the shock value; the face remains somehow sacrosanct, even if may have become accustomed to the idea of plastic surgery - members of the British Association of Aesthetic Plastic Surgeons (appropriately abbreviated to BAPS) conducted over 32,000 procedures last year, up 12% on the previous year. More men are having surgery too, up 17.5%, with a 36% increase in rhinoplasty, or ‘nose jobs’ as they’re better known. More striking is the fact that last year facelifts recorded an all-time high - up 36%.

“There’s a big trend for facial surgery now because men as well as women want to look younger and, while you can look after the body with diet and exercise, you can’t do much for the face without surgery,” explains Robert Viel, co-founder of the London Centre for Aesthetic Surgery. “Facial surgery has advanced rapidly over recent years too, in part due to consumer demand and the ability to make a patient look rejuvenated rather than operated on, but also because the influence of cosmetic surgery from innovations in other areas, including the techniques and materials.”

"Surgeons are now suggesting that face transplants could become as common as kidney or liver transplants."

The face, in other words, will increasingly be the site for ever more advanced procedures; Viel notes that already a face-lift can be conducted in day surgery, with local anesthetic and with minimal scarring. The face is also, as ever, the primary indicator of youth in a youth-obsessed society, and the idea of making often drastic changes to it is being increasingly normalised. Yet the idea of a face transplant takes plastic surgery into what seems the realm of science fiction: facial skin, underlying fat and some muscle is removed from a living, though brain-dead donor and reattached to the patient using micro-surgical techniques, the patient not destined to look like their donor, nor like themselves, but a hybrid.

Indeed, the idea has always been the stuff of science fiction: 1964 Japanese cult novel The Face of Another has the protagonist seeing the world anew after a face transplant, the villain in the film Once Upon a Time in Mexico undergoes the procedure, while director Jon Woo’s movie Face/Off makes it central to the plot. A face transplant has even featured in the US surgery drama series Nip/Tuck.

Although the procedure may prove an undoubted benefit to the 250,000 people in the UK with severe facial disfigurement, including its 10,000 severe burns victims, the idea is certainly ghoulish - while donor organs are hidden away, perhaps it is no wonder Clint Hallam, who underwent the world’s first hand transplant in 1999, eventually successfully campaigned to have it removed, claiming that he felt “mentally detached” from it. Maybe the man who this October underwent the world’s first double arm transplant may feel the same.

But with the face the outward seat of our identity, the psychological impact is so much the greater: can we relate to ourselves, or can others relate to us in the same way, with another face? Respected plastic surgeons conduct rigorous psychological assessments of their patients prior to agreeing to conduct a mere face-lift, so small wonder permission to carry out a face transplant in the UK has had to be passed by the NHS ethics board. And yet surgeons, such as Dr. Laurent Lantieri, one of the procedure’s pioneers, are now suggesting that face transplants could well become as common as kidney or liver transplants.

Not everyone, however, is so sure that face transplants will become as common or as simple as science fiction suggests. The problems are not just medical. The cultural, social and religious issues, especially provocative in relation to the idea of wearing another’s face, or giving up one’s own near death, means finding donors is likely to remain extremely difficult - as it was when the transplant of internal organs began. That, of course, may similarly change with time, the buying of a new face an option for the wealthy.

"The idea of a face transplant takes plastic surgery into the realm of science fiction: the patient not destined to look like their donor, nor like themselves, but a hybrid."

“The applications of face transplant procedures in cosmetic procedures does become possible if the problem of rejection by the immune system is overcome,” Viel notes. That, however, is some hurdle. And while Simon Withey, a consultant plastic surgeon and BAPS member, notes that “over the next ten years there will be significant advances [in facial procedures] - we haven’t reached the surgical limits yet,” he believes that the body’s readiness to reject foreign tissue, though manageable, is unlikely to ever allow the face transplant, a phenomenally difficult operation, to become the new face-lift.

But that is not to say that it is unlikely medicine will uncover new ways to improve, or tamper with, the way we look to the point of what psychologists call ‘psychic dislocation’ - the disabling inability to recognise the face in the mirror. In the time it takes to overcome the rejection issue, Withey suggests, it is possible that the effects of aging may be suppressible through genetic manipulation and the new science of stem cell and tissue engineering. “We’ve seen how an ear can be grown on the back of a mouse,” he says. “That has been done. We may be able to grow an entire new face in the lab from our own tissue samples. That is not inconceivable.”

A Texas construction worker horribly disfigured in a power line accident has undergone the nation's first full-face transplant in the hope of smiling again and feeling kisses from his three-year-old daughter.

Dallas Wiens, 25, received a new nose, lips, skin, muscle and nerves from an unidentified dead person in an operation paid for by the US military, which wants to use what is learned to help soldiers with severe facial wounds.