Face Transplants: Amazing Progress

But After 2nd Such Operation In U.S., MDs Say It's Long Road To Their Becoming Even Fairly Common

(CBS/AP)  Five years ago, it was the stuff of science fiction: Replace someone's face with one from a dead donor. But on Thursday, Boston doctors performed the world's seventh such transplant - less than a week after one in France - and plans are in the works for more.

It was the second face transplant done in the United States.

"Society is allowing us to do this. I think you're going to see more and more," especially in soldiers disfigured in recent wars, said Dr. Frank Papay, a surgeon who helped perform the nation's first face transplant, in December at the Cleveland Clinic.

Some of the successes have been dazzling. People who couldn't eat, speak normally, or go out in public now can walk the streets without being recognized as someone who got a new face.

Even so, face transplants are likely to remain uncommon, used on only the most severely disfigured, because of the big risks and lifelong need to take medicines to prevent rejection.

"It's not going to be like some people imagine - routine, like people getting a facelift, or cosmetic surgery," said Stuart Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.

"We have what appears to be success," he noted, but there is always the chance that some patients may experience serious rejection problems or refuse to stay on the required lifetime of drugs.

Boston doctors stressed the care and psychological screening they required before performing the nation's second face transplant on Thursday. The operation, at Harvard-affiliated Brigham and Women's Hospital, was on a man who suffered traumatic facial injuries from a freak accident.

Face transplants go far beyond the transfer of skin and facial features, using things like bone and cartilage for reconstruction. The team led by plastic surgeon Dr. Bohdan Pomahac replaced the man's nose, palate, upper lip, and some skin, muscles and nerves with those of a dead donor.

The hospital would not identify the recipient or donor, but the donor's family members released a statement saying they hope the procedure convinces others to donate.

"The fact that we are able to give this gift was a tremendous comfort in our time of grief," the statement said.

At a news conference on Friday, Pomahac said: "There is no risk of recognizing the donor on the new patient. There's a 60 percent chance the patient will look how he used to look."

In a phone interview earlier Friday, Pomahac said the man's injury occurred some years ago, and it left him with "no teeth, no palate, no nose, no lip."

"It was difficult for him to speak, to eat, to drink. It certainly caused a lot of social problems," Pomahac said.

On The Early Show Saturday Edition, Dr. Joseph McCarthy, director of the NYU Institute of Reconstructive Plastic Surgery, says he believes the latest recipient will regain full use of his facial muscles. "The first transplant, the lady in France, is now three-and-a-half years post-op, and she can smile and she can use her lips and she can drink and eat. And there's no reason why this patient cannot do the same," McCarthy told co-anchor Erica Hill.

The man had been Pomahac's patient for a long time, and doctors decided to pursue a face transplant because previous attempts to treat him left him still badly deformed. It took three months to find a suitable donor, who also provided some organs for transplant in other patients, Pomahac said.

The 17-hour operation began at 1:15 a.m. Thursday, with the recipient and the donor in operating rooms across the hall from each other. The patient was still recovering from anesthesia on Friday.

"He's still not fully awake so he has not seen himself. We have not really had a meaningful conversation so far," Pomahac said.

"He was incredibly motivated to go forward with it," and was extensively evaluated psychologically by doctors in and outside of Brigham, Pomahac said. "We really made sure that nothing was left to chance."

The seven primary surgeons and other assistants all donated their time and services, Pomahac said.

"We are essentially making a lifelong commitment to help him," the surgeon said.

Pomahac was born in Ostrava in the Czech Republic, and graduated from Palacky University School of Medicine in Olomouc, Czech Republic. He came to Brigham for a surgical research internship in 1996 and now, at 38, is associate director of its burn center, where he treats trauma and plastic surgery cases.

The Boston hospital's board approved Pomahac's plans to offer face transplants a year ago.

The world's first transplant in 2005 was led by Dr. Jean-Michel Dubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had been mauled by a dog and grotesquely disfigured. Dinoire's appearance today is virtually normal.

The first U.S. face transplant, and the most extensive operation so far, was done in December by doctors at Cleveland Clinic. They replaced 80 percent of a woman's face with that of a female cadaver. The woman's identity has not been revealed, nor the circumstances that led to the transplant.

The woman left the hospital in February, and is doing "phenomenally well," Papay said. "Her speech is improved so everyone can understand her now, and she has a great outlook on life. She's very comfortable with the way she looks now and she's very happy."

The early successes are encouraging, but should not lead to over-exuberance, and extending the operation too fast, said Finder, the Los Angeles ethicist.

"This is still very new and hence requires a hyper-vigilance about helping patients understand what they're getting into," he said.

People who have received other transplants - organs, hands - have sometimes discovered they traded one set of problems for another, and get sick of taking the medicines needed to maintain the transplant. At least one hand transplant recipient later had the hand amputated for this reason.

Pomahac originally was considering only people who had already received a kidney or other organ transplant, because they already would be on immune-suppressing medicines and would therefore have a low risk of rejecting a new face.

"I still think that's the best group of patients but we have enlarged the protocol" to include others with severe facial deformities, he said.

"It's really in its infancy in terms of knowing what will happen," he added. "Each of the cases is its own unique story."

Eventually, surgeons hope to form waiting lists of face transplant candidates "just like for any other organ," Pomahac said.

[puzzler125]

Transplant patients have to take anti-rejection drugs for the rest of their lives. What's the difference with facial transplant patients who would have to do the same thing. Why should this prevent patients from getting the surgery? For those who get organ transplants I have never heard any comments on their use of rejection medication.

[barbaraf4]

b"arbaraf4 - Look here Butch, you worry about what your own wife wants and I'll worry about what my wife wants. " Posted by familyguy38
~~~~~~~~~~~~~~~
Just a guess, but I suspect your wife is looking for (or has already found) someone with brains and sensitivity.

[citizen_us123]

Face transplant patients do not assume the physical appearance of the donor for any number of reasons. The underlying bone structure of the patient. What tissue is actually transplanted. A new mouth, nose ,etc. Remember, a person's eyes are the same and the eyes are what gives a person their distinct identity.

[familyguy38]

barbaraf4 - Look here Butch, you worry about what your own wife wants and I'll worry about what my wife wants.

[barbaraf4]

"Where can I sign my wife up for this procedure?" Posted by familyguy38
~~~~~~~~~~~~~
I wonder what part of your anatomy your wife would like to have upgraded.

[familyguy38]

Where can I sign my wife up for this procedure?

[JoetheDumbass]

We have used cadaver skin to heal severe burn victims, why so much debate about skin from the face?

[45ford]

one other thought and it seems to have scary consequences.... what happens if the body rejects the facial transplant?

[45ford]

barbaraf4 - your post at 1:31 PM on Apr 11, 2009 makes a very good point.

[45ford]

the thought of allowing doctors to surgically peel or skin the face off a loved one who has died is more than a bit squeamish. i realize that such an act is not for the faint at heart and it unquestionably requires written consent from the family, yet it very much seems like a lack of dignity for the decedent and desecration of a corpse. the act completely removes the opportunity for the family to have an open casket. and in some cases, it may have never been an option anyway. but still, one has to wonder about the psychological factors survivor's may encounter when they see someone on the street who looks like their deceased loved one in the face. granted people have varying facial bone structures so it may not be an exact facial match on the transplant recipient, but one wonders if survivor's mentally question if that was "Tom's" face on the guy we just walked past. it isn't the same as heart, liver, kidney, lung and cornea transplants where their organs and the recipients are readily identifiable in someone's facial or body features.

so what happens if you walk past someone on the street and their face looks like your loved one whose face was donated for transplant? wouldn't that be mentally conflicting knowing you buried or cremated a loved one, yet their face may have just walked past them?

it's great for science, the medical community and the lives of the receipients, yet it all seems very creepy too.