Face transplant surgery is perhaps the single most complex type of surgery currently possible. The face is comprised of dozens of muscles, bones, nerves, arteries, and pieces of cartilage. Under ideal circumstances, these structures work in unified harmony to produce countless facial expressions and provide the full range of verbal and non-verbal human communication. Simply smiling or frowning requires the activation of several muscles and muscle groups. Also, our face is one of the most distinctive features that we have—when you consider what a person looks like, you generally envision the face before the body. Therefore, when French doctors reported the first partial face transplant in 2005, it captivated the imaginations of physicians, science fiction buffs, and patients alike.
The first partial face transplant was performed in France in November 2005 by a team of surgeons led by Bernard Devauchelle and assisted by Jean-Michel Dubernard. In this face transplant surgery, surgeons took a triangle-shaped piece of face, including the nose and mouth, from a human cadaver and attached it to a French woman who had lost part of her face. This facial transplant is notable in that it was the first to successfully attach the nose and mouth. Rather than simply placing skin (with blood supply) over the region as would be done in standard facial reconstruction surgery, the nerves and muscles needed to be attached in such away the they restored a functional mouth. Soon after the face transplant, the woman was able to eat and talk in a limited capacity and, one year after partial face transplant, reports indicate that she was able to smile.
Since November 2005, surgeons in various countries have attempted face transplant surgery to varying degrees. Surgeons in China reported similar partial face transplant results soon after the French procedure made world press. The Cleveland Clinic in the United States and London’s Royal Free Hospital in the United Kingdom were the first centers in these respective countries to obtain approval to perform face transplant surgery. The Cleveland Clinic, under the direction of Dr. Maria Siemionow, has the distinction of performing the first near total face transplant in December 2008. This surgery was by far the most extensive face transplant surgery to date since it included bones along with other facial structures.
Face transplant surgery is hardly routine—fewer than half a dozen procedures have been performed around the world. Part of the reason for this low number is that many of the techniques required to perform such delicate surgery are relatively new and are being pioneered with each face transplant. There are also issues of obtaining the proper consent from patients. It is difficult for patients to comprehend the ramifications of having another person’s face transplanted onto their skull.
Also, there are certain ethical considerations that need to be tackled before the surgery becomes widespread. It is one thing to perform face transplant surgery on someone that has been horribly disfigured from disease or trauma. It is a far different thing to perform face transplant surgery on someone who wishes to resemble someone else. As the technology becomes more routinely performed, we may be forced to deal with those unique ethical questions as a society. For now, though, face transplantation continues to fascinate us, for what it is and what it could be.