# Face transplants for the horribly disfigured -- should it be tried? **URL:** \ **Category:** Great Debates\ **Created:** [September 18, 2005, 2:34am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174 "2005-09-18T02:34:34Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![EddyTeddyFreddy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eddyteddyfreddy/32/18796_2.png) [@EddyTeddyFreddy](https://boards.straightdope.com/u/EddyTeddyFreddy)\ **Post date:** [September 18, 2005, 2:34am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/1 "2005-09-18T02:34:34Z")
There’s [a story today on cnn.com](http://www.cnn.com/2005/HEALTH/09/17/face.transplant.ap/index.html) about a surgeon’s plans to attempt a full-face transplant. > [@](#): > > Siemionow wants to attempt a face transplant. > > This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do: give people horribly disfigured by burns, accidents or other tragedies a chance at a new life. Today’s best treatments still leave many of them with freakish, scar-tissue masks that don’t look or move like natural skin. > > These people already have lost the sense of identity that is linked to the face; the transplant is merely “taking a skin envelope” and slipping their identity inside, Siemionow contends. > > Her supporters note her experience, careful planning, the team of experts assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique. > > But her critics say the operation is way too risky for something that is not a matter of life or death, as organ transplants are. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before. The article goes into detail on the groundwork that’s been laid for this, the possible complications, the informed-consent issues, the kind of patients who’d be candidates. I’ve seen, I’m sure we’ve all seen people with faces terribly ravaged by some accident. Reading this article reminded me of one man I used to see now and then in Boston, for example, a man whose whole face was a seamed red mass of fire scars. What must it be like to go through life behind such a mask of horror? Does the suffering of such disfigurement justify the huge risks of a face transplant? ---
**Author:** ![SnakesCatLady](https://avatars.discourse-cdn.com/v4/letter/s/4af34b/32.png) [@SnakesCatLady](https://boards.straightdope.com/u/SnakesCatLady)\ **Post date:** [September 18, 2005, 4:21am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/2 "2005-09-18T04:21:46Z")
I don’t think I could do it - I’ve read too much science fiction. If, and this is a big if, the candidate is aware of the risks - it could teach medical science a lot. If this is not a whooosh, and is serious, I hope there are lots of mental health professionals aboard. It could be a blessing for young children scarred by war or fire, or adults who are scarred in the line of duty. I just have so many \>ick\< ethical problems. My mother was a full body donor - how would I react to seeing someone wearing her (my) face? Would her face appear different on a different skull? Are doctors skilled enough to make the face _work_, or would it be just an unscarred mask? ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [September 18, 2005, 4:31am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/3 "2005-09-18T04:31:47Z")
> [@Snakescatlady](#): > > My mother was a full body donor - how would I react to seeing someone wearing her (my) face? Would her face appear different on a different skull? Are doctors skilled enough to make the face _work_, or would it be just an unscarred mask? Well, it’s really a skin transplant, not a face transplant and the article says: > [@](#): > > Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape. But if the donor skin had distinguishing marks (eg, moles) those would obviously be there. ---
**Author:** ![EddyTeddyFreddy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eddyteddyfreddy/32/18796_2.png) [@EddyTeddyFreddy](https://boards.straightdope.com/u/EddyTeddyFreddy)\ **Post date:** [September 18, 2005, 4:39am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/4 "2005-09-18T04:39:38Z")
> [@Snakescatlady](#): > > If this is not a whooosh, and is serious, I hope there are lots of mental health professionals aboard. From the article: > [@](#): > > It took more than a year to win approval from the 13-member Institutional Review Board, the clinic’s gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face. > [@](#): > > It could be a blessing for young children scarred by war or fire, or adults who are scarred in the line of duty. One case cited by the article: > [@](#): > > Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull dog was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training. > > Other doctors had tried to reattach part of the boy’s mauled face but it didn’t take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy’s thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth. > > “He’ll never be normal,” said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison. > [@](#): > > Are doctors skilled enough to make the face _work_, or would it be just an unscarred mask? > [@](#): > > Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient’s scalp and neck, and areas around the eyes, nose and mouth. I’d like to believe that the positive answers the article offers will be the reality, but I can’t see Murphy’s Law being revoked for such a high-risk experiment. ---
**Author:** ![OliverTwistofLime](https://avatars.discourse-cdn.com/v4/letter/o/b487fb/32.png) [@OliverTwistofLime](https://boards.straightdope.com/u/OliverTwistofLime)\ **Post date:** [September 18, 2005, 5:28am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/5 "2005-09-18T05:28:09Z")
It is not up to you or me to decide whether the operation should be done. This should be left up to the patient in this case and her physicians…as long as the benefits, risks, complications are explained to the patient and all her questions are answered. ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [September 18, 2005, 5:43am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/6 "2005-09-18T05:43:22Z")
Why shouldn’t it be tried? ---
**Author:** ![Seven](https://avatars.discourse-cdn.com/v4/letter/s/3d9bf3/32.png) [@Seven](https://boards.straightdope.com/u/Seven)\ **Post date:** [September 18, 2005, 5:48am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/7 "2005-09-18T05:48:45Z")
If it works, great. Do it. ---
**Author:** ![OtakuLoki](https://avatars.discourse-cdn.com/v4/letter/o/ac8455/32.png) [@OtakuLoki](https://boards.straightdope.com/u/OtakuLoki)\ **Post date:** [September 18, 2005, 6:27am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/8 "2005-09-18T06:27:57Z")
I see no reason that it shouldn’t be tried. As the OP said, facial scarring for burn victims can have horrific social and psychological costs. If this even gives simply an unscarred mask (which doesn’t seem to be the intent or prognosis) that’s still better than what some of these burn sufferers go through. Having said all that, if I were a potential patient, I’d want to be damned sure that I wouldn’t have any marks to identify me as having person X’s face. I’m not sure it’s logical, but that’s my gut reaction at the moment. ---
**Author:** ![OliverTwistofLime](https://avatars.discourse-cdn.com/v4/letter/o/b487fb/32.png) [@OliverTwistofLime](https://boards.straightdope.com/u/OliverTwistofLime)\ **Post date:** [September 18, 2005, 7:03am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/9 "2005-09-18T07:03:03Z")
> [@Marley23](#): > > Why shouldn’t it be tried? Who said it should NOT be tried? The final decision is not yours…not mine…it is that of the patient and her Drs. My personal opinion is it should be tried if it were me with the same or similar problem. ---
**Author:** ![Cervaise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cervaise/32/16693_2.png) [@Cervaise](https://boards.straightdope.com/u/Cervaise)\ **Post date:** [September 18, 2005, 7:53am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/10 "2005-09-18T07:53:35Z")
Am I the only one hoping Michael Jackson doesn’t hear about this? ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 18, 2005, 8:30am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/11 "2005-09-18T08:30:46Z")
> [@OliverTwistofLime](#): > > Who said it should NOT be tried? No one (except some of the scientists in the linked article, perhaps.). But the OP did \*ask \*if it should be tried. In the title. I’m not sure why you ask this as if no one would consider whether or not this was a good idea. I read **Marley** ’s post two ways: a verbal shrug “Eh. Why shouldn’t it be tried?” or an honest question “Well, we’ve had lots of interesting answers for why it should be tried. Now, why _shouldn’t_ it be tried?” > [@](#): > > The final decision is not yours…not mine…it is that of the patient and her Drs. I don’t see anything in the OP asking if we should move to ban such procedures, or perform such procedures under duress, though. Simply an intellectual curiousity and point of discussion. You’re coming across as bent out of shape for very little or no reason. > [@](#): > > My personal opinion is it should be tried if it were me with the same or similar problem. ditto. With extensive burn or injury treatment as it stands currently, skin sloghing and tissue rejection are already very real problems. It would have to be order of magnitude more potential with this technique for me to refuse it, if it can be done with far less scarring. I do wonder why this would be preferable to a large skin graft from some other place, say the thigh or the buttock. Is it because the skin on the face is different, in thickness or in elasticity? ---
**Author:** ![EddyTeddyFreddy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eddyteddyfreddy/32/18796_2.png) [@EddyTeddyFreddy](https://boards.straightdope.com/u/EddyTeddyFreddy)\ **Post date:** [September 18, 2005, 2:07pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/12 "2005-09-18T14:07:12Z")
> [@WhyNot](#): > > I don’t see anything in the OP asking if we should move to ban such procedures, or perform such procedures under duress, though. Simply an intellectual curiousity and point of discussion. Exactly. Thank you for putting my intent so clearly. > [@](#): > > I do wonder why this would be preferable to a large skin graft from some other place, say the thigh or the buttock. Is it because the skin on the face is different, in thickness or in elasticity? According to the article, > [@](#): > > Surviving such wounds can be “life by 1,000 cuts.” Patients endure dozens of operations to graft skin inch-by-inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding. > > Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries As to skin on the face being different, consider this, also from the article: > [@](#): > > Matthew Teffeteller might seem an ideal candidate. > > Hair is driving him crazy. What used to be a beard can’t grow through the skin-graft quilt that Vanderbilt University doctors stitched over parts of his face that were seared off in a car crash. Trapped under this crust, hair festers, leading to staph infections, pain and more surgeries. Not a problem I would have ever thought of, but there it is. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 18, 2005, 3:46pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/13 "2005-09-18T15:46:11Z")
> [@EddyTeddyFreddy](#): > > According to the article, > > > [@](#): > > > > Quote: > > Surviving such wounds can be “life by 1,000 cuts.” Patients endure dozens of operations to graft skin inch-by-inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding. > > > > Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries Sorry, I should have been more clear. They can’t take more than a few inches at a time from a \*living \*donor (ie, the patient donates his own skin from his arse a few inches at a time). My wonderment was whether there were benefits to taking skin from a cadaver-donor \*face \*as opposed to a cadaver-donor \*thigh \*(mine are sure big enough to cover a face!) or butt. I suppose the face would be roughly the right dimensions, so maybe that’s a benefit. But I wonder if there are other reasons, since they’re essentially just doing a large skin graft. Possible drawbacks: “buttface” would become an insensitive, un-PC phrase. ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [September 18, 2005, 7:45pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/14 "2005-09-18T19:45:37Z")
There’s a special about this that they’ve shown on Discovery Health in the past. I bet they will rerun it again soon. The doctors on that program, who were trying to pioneer the procedure, stated that the only reason a face transplant hasn’t yet been done is political. People are afraid that if they donate their loved one’s face, that the recipient will look exactly like the donor, and that it would be too traumatic to contemplate. However, they did simulations and asked people to match up the donor face with the post-surgery recipient face, and people couldn’t do it. The underlying bone structure was the primary influence on the actual appearance of the face. The real medical concern is that the recipient would have to take anti-rejection medication for the rest of their life. Also, in order to do the transplant, the scar tissue that makes up the current face would have to be removed. If the transplant failed, which they sometimes do, the patient would literally have no skin covering the face, and the likelihood of death would be quite high. The risk of rejection would be similar to that of a hand transplant, though, and the doctors on the program state that there are at least 40 people out there who have had successful hand transplants. The difference is that if a hand is rejected, it can be lopped off relatively easily. On the program, a woman who was severely burned in a fire was interviewed. Her entire face was made up of scar tissue. She couldn’t even close her eyes. She’d been housebound for something like 8 years. IIRC, she feels that the improvement to her quality of life is worth the risk. Fascinating documentary–I highly recommend it. ---
**Author:** ![cwthree](https://avatars.discourse-cdn.com/v4/letter/c/9de0a6/32.png) [@cwthree](https://boards.straightdope.com/u/cwthree)\ **Post date:** [September 19, 2005, 10:45pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/15 "2005-09-19T22:45:11Z")
> [@Q.N. Jones](#): > > The real medical concern is that the recipient would have to take anti-rejection medication for the rest of their life. Also, in order to do the transplant, the scar tissue that makes up the current face would have to be removed. If the transplant failed, which they sometimes do, the patient would literally have no skin covering the face, and the likelihood of death would be quite high. How is this different from the risks associated with the transplant of any other non-paired organ (heart, liver)? The patient must take medication to prevent rejection of the transplanted organ. Failure of the transplanted organ is likely to result in death, since there’s no “other” organ (e.g., the other kidney) to perform the functions of the failed organ. The biggest difference I can imagine is that there are tools (dialysis, artificial heart) that may allow the patient to live long enough for another transplant to be found. Failure of a skin transplant over any large area (such as the trunk or thighs) would be functionally equivalent to failure of the facial skin transplant. ---
**Author:** ![Belowjob2.0](https://avatars.discourse-cdn.com/v4/letter/b/b9e5f3/32.png) [@Belowjob2.0](https://boards.straightdope.com/u/Belowjob2.0)\ **Post date:** [September 20, 2005, 3:24am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/16 "2005-09-20T03:24:27Z")
I don’t have any ethical objections to facial transplants. If it works, fine. I am curious, though, as to the benefits of facial transplants versus reconstruction with cloned skin. Recosntruction with cloned skin is standard procedure if there isn’t enough skin for grafts, and it avoids the immune rejection issues inherent in facial transplants. I was burned on half my body, most of the front, and around to the back, about eight years ago. I have extensive skin grafts, though the second degree burns covering my face and head healed well enough not to require any grafts. I looked scary for the first six months or so, and then noticeabley burned but not particularly scary in the first couple of years after that. Now, you can’t tell that I was burned unless you look closely. My face is still significantly stiffer than a normal person’s face, and I do facial exercises several times daily to maintain at least a basic level of facial expression. If facial transplants give a burn victim the full range of facial expression, and connections in terms of nerves and blood vessels well above those available to graft recipients, then it should be the preferred method of treatment. But it may become an obsolete approach as cloning technology improves. Labs have been able to clone skin from burn victims for a decade or so now, but cloning the nerve cells, muscle tissue, and circulatory tissue is, I believe, a different story. Doing a complete facial reconstruction with the burn victim’s own cloned tissue would be the ideal, using alginate molds to shape the victims face, and borrowed fat and collagen to fill out facial structure. I’m guessing that this would be impossibly expensive and time consuming in comparison to facial transplantation. I do question the quality of life available to someone who has to take anti rejection drugs for the rest of his life. ---
**Author:** ![treis](https://avatars.discourse-cdn.com/v4/letter/t/bc79bd/32.png) [@treis](https://boards.straightdope.com/u/treis)\ **Post date:** [September 20, 2005, 3:36am UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/17 "2005-09-20T03:36:46Z")
> [@cwthree](#): > > How is this different from the risks associated with the transplant of any other non-paired organ (heart, liver)? The patient must take medication to prevent rejection of the transplanted organ. Failure of the transplanted organ is likely to result in death, since there’s no “other” organ (e.g., the other kidney) to perform the functions of the failed organ. The biggest difference I can imagine is that there are tools (dialysis, artificial heart) that may allow the patient to live long enough for another transplant to be found. > > Failure of a skin transplant over any large area (such as the trunk or thighs) would > be functionally equivalent to failure of the facial skin transplant. It isn’t the risk that is different its the benefit. If you don’t have a liver, kidney, lung etc. etc. you die. On the other hand you can live with a horribly disfigured face. My standard response to these types of situations is that it a person’s body and life is the property of that person and, barring mental incapacitation issues, should be allowed to do what they wish with it. ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [September 21, 2005, 1:39pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/18 "2005-09-21T13:39:06Z")
I"m all for it but with one qualification: I think future donors should be made specifically aware of the possibility of their face being used because it’s a hell of a lot different than having an organ or other body skin used (at least to me it is; and I’m sure for some others as well). I’ve read in other articles that in spite of the fact that the appearance of a face is defined more by the bone structure, doctors have said that the end result would be a “combination” of the two faces. ---
**Author:** ![EddyTeddyFreddy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eddyteddyfreddy/32/18796_2.png) [@EddyTeddyFreddy](https://boards.straightdope.com/u/EddyTeddyFreddy)\ **Post date:** [September 21, 2005, 4:43pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/19 "2005-09-21T16:43:42Z")
[aside] I wonder if Michael Jackson’s had a nose transplant? [/aside] ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [September 23, 2005, 2:19pm UTC](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174/20 "2005-09-23T14:19:32Z")
> [@KidCharlemagne](#): > > I"m all for it but with one qualification: I think future donors should be made specifically aware of the possibility of their face being used because it’s a hell of a lot different than having an organ or other body skin used (at least to me it is; and I’m sure for some others as well). I’ve read in other articles that in spite of the fact that the appearance of a face is defined more by the bone structure, doctors have said that the end result would be a “combination” of the two faces. Of course it would be a combination. But the issue most people are hung up on is this: am I going to recognize the face of my dead relative if I see the recipient on the street? The answer has been pretty overwhelmingly shown to be “no.” I’m all for informed consent, but I think it should be truly informed, and that would mean telling people that studies show that the face will not be recognizable as having come from the dead person. > [@cwthree](#): > > How is this different from the risks associated with the transplant of any other non-paired organ (heart, liver)? Some types of organ transplants have higher rejection rates than others. Lung recipients, for example, are more likely to suffer rejection than are recipients of other internal organs. My sister, a doctor, says skin and limb transplants also have a higher risk of rejection. [Next page](https://boards.straightdope.com/t/face-transplants-for-the-horribly-disfigured-should-it-be-tried/322174.md?page=2)