Facing the Future

Nine years have passed since the first partial face transplant was performed in France but the questions regarding both the physical and psychological ramifications for patients remain.

One of my first contributions to Brain Blogger examined the debate surrounding face transplantation, written in 2008 after the completion of the first partial procedure in the United States. A few days ago, GQ Magazine announced that Richard Norris, the recipient of the first successful complete face transplant, had been photographed and interviewed for the latest edition of the monthly publication. His surgery was performed in 2012 by Dr. Eduardo Rodriguez, a Baltimore plastic surgeon, in a 35 hour procedure.

Unlike a presentation in a medical journal which would focus more on clinical outcomes, the GQ feature is a short narrative of a day in Norris’ life spent with journalist Jeanne Marie Laskas. It addresses some of the questions raised in the beginning when this procedure was proposed.

From Laskas’ account, Norris and his family are proud of the role that he has played in the advancement of medicine despite the many restrictions imposed on him. Like any other transplant, there is a risk of rejection and he will require a strict lifelong regimen of medications that leave him at risk of disease due to being immunocompromised. However Norris enjoys being able to walk through life without a mask over his face as he did in the past. While article reports his difficulties as a patient, he also attends medical meetings as an example of how positive this surgery can be for patients and as a role model for further developments.

Earlier this year in April, Dr. Rodriguez and his colleagues were published in scientific journal The Lancet reviewing the 28 face transplantation cases that have been performed around the world. The study shows that none of the patients have reported any psychiatric difficulties, have accepted their new physical appearance and that some have returned to work. Functional and neurological results have also been favorable.

However, some data are limited as there is not currently a standardized reporting method for outcomes to be measured and follow-up to date remains short-term. As the medical teams involved perform more of these surgeries and the number of patients increase, we will begin to have a clearer picture of the effects on all aspects of their lives.

The benefits of facial transplantation lie beyond the aesthetic for patients who have sustained severe trauma. The ability to see, begin the process of food digestion, and speech can all be affected by injury or disease. The ability to restore all of these functions and others requires transplantation of soft tissue, bone, nerves and blood vessels from the recipient to the donor in a technically complex surgery. The key to successful long-term outcome lies not only with the operation itself but also in establishing a multidisciplinary team to monitor patients mental and physical well-being following recovery.

The debate is certainly not over regarding the long-term implications of this surgery, but for patients like Richard Norris the risk appears to be worth it.

Khalifian S, Brazio PS, Mohan R, Shaffer C, Brandacher G, Barth RN, & Rodriguez ED (2014). Facial transplantation: the first 9 years. Lancet PMID: 24783986

Laskas, Jeanne Marie. July 2014. The New Face of Richard Norris. GQ Magazine

Image via ChaNaWiT / Shutterstock.

Maria Goddard, MD

Maria Goddard, MD, is a medical doctor who has worked in medical research and clinical practice for several years. Her interests include traditional and alternative medicine as well as the sociological implications of certain diseases in particular populations.
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