Breakthroughs in medicine during 2015: Face Transplants

Hi everyone! I would like to apologise for the lack of pieces I’ve written recently as it has been a very busy past couple of weeks!

To continue with my review over last year’s most influential medical breakthroughs, I am going to talk about the most extensive face transplant to date, although I will also comment on various ethical issues and risks associated with this procedure. This topic interests me greatly as although surgery was being performed before 2015, last year saw the most advanced surgery to fully recover a firefighters face to date!

I recently gave a small presentation upon the advancement of facial surgery and thus, face transplants to my fellow classmates, in my school’s Enrichment programme where I chose the Biomedicine option, which further shows my through interest upon the topic!

Background knowledge and some facts 

A face transplant is a “medical procedure to replace all or part of a person’s face using tissue from a cadaver”

  • The world’s first partial face transplant performed on a living human was carried out in France in 2005 on a woman called Isabelle Dinoire. Dinoire had attempted to take an overdose in order to end her life, when she awoke and found that her Labrador had gnawed away at her face in an attempt for her to regain consciousness. Dinoire’s injuries to her mouth, nose and chin were so extreme that doctors immediately dismissed a facial reconstruction and announced the worlds first face transplant was to be done.
  • The world’s first full facial transplant was completed in Spain in 2010. The patient was identified only as Oscar, who was a farmer that has accidentally shot himself in the face. Doctors on the case lifted an entire face, including nose, jaw, cheekbones, muscles, eyeballs and teeth and transplanted this onto Oscar, where it was estimated that the patient would regain up to 90% of his facial features and would need a year of physiotherapy.
  • Spain, in order of the total number of successful face transplants performed, is considered the leading country in face transplants in the world.

Benefits and risks of the procedure 

Benefits:

  • Life changing. A facial transplant not only restores facial features, but encourages  confidence in the patient, where some have said this has allowed them to move on from the accident more easily.
  • Improves functionality. The transplant restores physical functionality of the human face, including the ability to breathe, speak, swallow and smile which enables an easier recovery.
  • Restoration of appearance. There is the ability to restore near normal facial appearance which of course helps patients regain confidence, which encourages them to return more easily to their former lifestyle.
  • Less pain and discomfort than the procedure of facial restoration. Firstly, facial transplant surgery is a single, longer procedure in comparison to facial reconstruction. Moreover, facial transplants do not involve the removal of the patients own skin from other areas for use on the face, and thus, overall the patient endures less pain.

Risks:

  • Rejection. The transplant may be rejected by the patients immune system as a result of recognition of foreign antigens on the transplanted cells, thus the procedure wouldn’t be able to occur. To avoid this, extensive tissue typing would need to be done to ensure the surgery can take place.
  • Identity issues that could result in pyschological issues in patients . There are many concerns that patients will be upset over essentially using their own identity, as your facial features are a large proportion of how others identify you. However, there is evidence that the donors appearance is not transferred to the recipient as a result of different underlying bone structure and facial shape.
  • Ethical worries. Many concerns exist over the ethical debate concerning the deceased’s body parts to be used for surgery, or whether this is considered wrong and disrespectful. What are your thoughts upon the ethical side of face transplants?
  • Drug side-effects. Immunosuppressants are given to patients to help prevent rejection, however, these will further weaken their immune system and thus, make the patient more susceptible to disease.  

The world’s most extensive face transplant 

patrick-hardison-before-and-after

Volunteer firefighter Patrick Hardison was badly burnt in a house fire after he attempted to save a women from the blaze. The fireman faced severe third-degree burns and was visually unrecognisable from whom he used to be, where he lost his ears, his eyebrows and all of the hair from his head.

Dr Eduardo Rodriguez, whom specialises in microsurgery and plastic surgery, transplanted donated tissue which included the entire scalp, forehead, face, eyelids and ears alongside some underlying nerves, muscles and blood vessels onto Hardison in the procedure. Moreover, in order to ensure that the facial features would have a better scaffold to hold on to, and thus, could be held in the correct anatomical place, Rodriguez also transplanted various pieces of the facial skeleton such as the tip of the chin, parts of the cheekbones and the bridge of the nose. The donated upper and lower eyelids were attached to the patient and the inner linings of the nose and mouth were stitched into place, to complete the transplant.

“Our goal is to restore function as well as have aesthetically pleasing results”

-Dr Eduardo Rodriguez.

It was immediately evident that the surgery was a success. Hardison’s hair on his scalp, alongside his facial hair, began to instantly grow back, whilst it was evident from the rosy cheeks of the patient that his blood supply had been restored. Hardison was sitting upwards in his chair within a week! Of course, he will have to continue to take immunosuppressants for the entirety of his life, but the procedure, and the anti-rejection medication is surely worth it!

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