The First Face Transplant in the USA
Dr. Niamtu with Dr. Maria Siemionow
There are a lot of disadvantages of lecturing all over the world in terms of travel, inconvenience and time away from home, but this is greatly outweighed by the advantages of making friends with special people. While serving as the co-chair of the American Academy of Cosmetic Surgery meeting in Phoenix in 2007 one of my duties was to procure world class experts to discuss topics of interest for cosmetic surgery. This had been right around the time of the French performing the world’s first face transplant. I became aware of Dr. Maria Siemionow, a transplant surgeon from the Cleveland Clinic. I was thrilled when Maria agreed to be the featured speaker for our meeting which led to a friendship. This was several years ago and she detailed her work with animal models in preparation for the first U.S. transplant. It was pretty fascinating as an incredible amount of work from all walks of medicine are needed to coordinate such an undertaking. On the surgical side there are transplant, vascular, plastic, ENT, maxillofacial, craniofacial and other surgeons. On the medical side there are numerous specialties that deal with the host and donor rejection issues and there are psychologists that counsel the patient, families, etc. More work than you would ever imagine. Most people think that the work is what happens in the operating room for 20 plus hours of surgery, but that may be the easy part.
This is a very emotional issue with incredible medical ethical implications. There is much less emotion when transplanting tendons in the knee, corneas in eye or even heart transplants, as these organs are hidden and do not express emotion. Ethicists do not accept this type of surgery for cosmetic reasons, but rather as last ditch efforts to correct deformities so horrific that the patient has no chance of a normal life in their current state. The lady in France was mauled by dogs, the patient in Cleveland was a victim of severe trauma. These unfortunate patients are disfigured to the point of being unable to cope with the isolation of not being able to leave their home.
Think about the psychological ramifications of this type of surgery. The recipient patient may resemble the deceased donor. What about the relatives of the donor possibly seeing someone with a new face that resembles their deceased loved ones? What about the recipient patient knowing that their face is part of someone who is not living? None of this is to be taken lightly. Many problems exist with tissue rejection as human immune systems vigorously reject foreign tissue and patients must undergo extensive pharmacologic treatment including massive steroid doses. The treatment can be worse than the cure. This is not a procedure where you simply go have an operation and simply heal. This is not a facelift, this is a face transplant. There are good possibilities that many of the functions of the transplanted face will not work. The muscles may not move, the new face may be expressionless. No taste, no smell, no feeling. In effect the new face may be a living mask, but to the recipient it may be the only possible option to appear human, just as a donor heart may be the only chance a patient with heart disease has to live.
Also the fact exists that the entire transplant may fail and the patient could be more disfigured than they were before the surgery, or they could become so sick from the medical treatment they could die. Again, there are many considerations with this type of surgery.
What will the future hold? If we can work out the rejection problems, it could be possible that these procedures could be predictable. If that happens, replacing missing facial anatomy may be a possibility. On the other hand, as cloning and stem cell research develop, we may be able to “grow” new anatomy and the entire transplant situation may go down in history as weird science. In any event, it is a very situation that challenges all aspects of medical and human ethics. In the movie “Face Off” John Travolta and Nicholas Cage exchanged faces seemingly as simple as putting on a Halloween mask. This technology may never happen but if it does where does it stop? Assuming it became an extremely predictable, would an older patient ethically be able to have a younger face transplanted?
All of this makes for deep thinking and undoubtedly will be the plot of more movies and books. Maria Siemionow and her team deserve the greatest respect for their unfaltering research and work leading to this historic event. I am honored to have her as a friend. Time will tell how society views the process.
To find out about cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery