Life is often measured with smiles and the ability to express ourselves. And the face has that precious ability to smile and make others smile. Face is more than just an identity for recognition – it’s the central body part of communication and moreover the focal point of sexual attractiveness.

People with faces disfigured by trauma, burns and disease rarely come out of their homes and are often hidden way from the public eye. Many develop other illnesses or become victims of psychological difficulties. Surgical reconstruction or facial transplantation could be an option for some.

Dallas Wiens after the transplant

Until now surgical reconstruction was the only option available, using the patient’s own skin and tissue. But the results are termed functionally and cosmetically pitiable. Facial transplantation is proposed as the next option in facial reconstruction where the facial skin of a donor is used to rebuild a disfigured face of the recipient.

Ever since Hettiaratchy and Butler wrote about the possibility of face transplantation in an article in the Lancet in July 2002, there has been widespread debate around the ethics of this procedure. It has turned out to be a moral dilemma for people with serious facial injuries to consider facial transplantation.

Oscar before and after surgery

In 2005, the Cleveland Clinic became the first hospital in America to approve the procedure. They performed the first near-total face transplant successfully on a woman. The second partial face transplant in the US took place at Brigham and Women’s Hospital in Boston in 2009.

The first full face transplant in the United States was performed in March 2011 and paid for with the help of the US defense department. The 15-hour operation was done on 25-year-old Dallas Wiens, a Texan construction worker who was badly disfigured in an accident. Doctors transplanted a completely new face, including a nose, lips, skin and muscles and nerves.

Wiens is delighted to have undergone the transplant for just one reason – so that he will now be able to feel his daughter’s kisses.

What does the operation involve?

Face transplantation consists of connecting many small blood vessels from the donor’s tissue to the patient’s face. The patient would, however, not have the same skeletal and facial shape as the donor. Although it’s unlikely that the patient would not look like the donor, but surprisingly they wouldn’t look as they did before.

Ethical and moral fears

Face transplantion has been in the limelight for reasons that can be debatable forever. It’s hard to decide what’s the general consensus when ethical and moral issues are still being argued for and against it.

Ethical worries with regard to a face transplant are different to surgical reconstruction and other cosmetic procedures  – both on the patient and on the donor’s family. Would the donor’s family give consent to have the face of their loved one removed? If they did approve, how would they react on seeing the patient after the procedure? Most importantly, how would the patient react on seeing his/her new face? Can the success of the operation be assured? These are genuine fears that cannot be easily brushed under the carpet.

According to a report published by the The Royal College of Surgeons, doctors have warned about how patients could be affected psychologically after undergoing face transplantation. They estimate the risk of complete rejection is about one in ten and up to half could suffer chronic rejection after a year.

Benefits and Risks

There are people who think of committing suicide after they have suffered severe facial trauma in car crashes and fires. When surgical reconstruction has failed, face transplantation gives them another option and opportunity to live. They can finally  hope to rebuild not only their faces, but also their lives!

A few things that can go wrong in facial transplantation are the risks of graft rejection that could put a patient’s life at serious risk after the procedure, anti-rejection drugs may increase the chances of cancer and the vascular obstructions in microvessels could hamper the graft. On top of it, there are psychological issues to consider after the procedure. Would the patient like their new face?

The equation of risk and benefit of facial transplantation varies from one case to another. The decision rests solely on the patient to choose their quality of life, bearing in mind the cost of the operation and the risks of dealing with long-term immunosuppression.

It is a calculation made by patients on a regular basis. Take for example, kidney transplants. Patients can choose whether to have the transplant or live with continuous dialysis. Some patients decide not to go ahead, and others go ahead with support coming from their family members and
with the assistance of the clinical team who ensure enough information is provided pre- and post-operation.

So it might not be a simple straightforward decision even for those whose faces have been heavily disfigured following an accident of some sort.

National Consultative Ethics Committee for Health and Life Sciences (CCNE)



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