Ahmed: Face transplants a reality — not science fiction

An undercover agent undergoes an advanced medical procedure to transform into the country’s most wanted terrorist, allowing him to infiltrate a criminal organization. An undercover agent undergoes an advanced medical procedure to transform into the country’s most wanted terrorist, allowing him to infiltrate a criminal organization. The procedure: to replace his benevolent face with the chilling face of the terrorist.

In 1997, Hollywood offered this unthinkable premise of a full face transplant in the film “Face/Off”. After the procedure, John Travolta, playing an FBI agent, assumes the persona of a terrorist mastermind, played by Nicolas Cage. The transplant was at the crux of the plot. Confused identities, strained emotions and novel psychologies resulted — not that Cage needs a transplant to convince us that he is borderline.

The Hollywood theatrics have translated into the surgical theatre, and face transplants are now actually being performed by plastic surgeons across the country, even on our own campus. The Shock Trauma Center of the University of Maryland Medical Center performed the first full face transplant in America just recently, according to The Washington Post. And as with the majority of scientific advancements, this new opportunity brings with it new questions and considerations.

Face transplants are performed for people with facial disfigurement. Trauma, burns, diseases and birth defects can all result in disfigurement. The process of finding a donor is a complicated one. There must be a medical match to reduce tissue rejection, a structural match to mimic the patient’s face and an agreement with the donor’s family, as the donor is typically either deceased or brain-dead.

Even with all the public’s interest in this new medical ability, there is still an aspect missing from the conversation. Other considerations, like the possibility of resulting psychological issues, are often overlooked in the excitement of the science itself. Though Hollywood exaggerated the consequences, “Face/Off” gives us a hint of what we already know about medicine: psychology is always a consideration in every medical treatment and procedure. This holds true for face transplants as well.

Organ transplants and psychiatric treatments have been around long enough for relevant psychological considerations to develop in the public’s mind. Psychologists and philosophers have had enough time with these treatments to offer physicians and surgeons a less hard-scientific aspect to consider. For example, in the case of organ transplants, recipients of organs from anonymous or identity-protected donors might always wonder by whose graces they still live. Face transplants are not simple organ transplants, however, as anonymity is impossible to maintain. This procedure is new, and so such considerations are sparse.

Alan Meisel, Professor of law, psychiatry and bioethics at the University of Pittsburgh, offered insight on the different components of face transplants.

“The technical aspects of facial transplants are far more complicated than of other organ transplants, and in addition, the aesthetics of the result are paramount, whereas in internal organ transplants they are of little or no concern. Of course, aesthetic considerations are also a consideration in the transplantation of limbs and fingers, but of far less concern.”

The title “plastic surgeon” often conjures up images of celebrity makeovers and everlasting smiles. However, plastic surgeons do not only specialize in cosmetics. They can alternatively specialize in reconstructive surgery, which is the specialty that face transplantation falls under. Nonetheless, cosmetics are still important in reconstructive procedures, such as face transplantation. The results have an effect on how people perceive the patient and how the patient perceives himself.

Even the idea of receiving someone else’s body part is different for face transplants than organ transplants.

“While psychological consequences of transplantation are always a very important consideration, in facial transplants, they are critical,” Meisel said.

“A person who receives someone else’s heart may consider from time to time that another person’s death is responsible for their being alive — on balance, they are usually grateful for it even if they are a little bit ‘freaked out’ by having someone else’s heart beating within them. However, with a facial transplant, the recipient is constantly reminded that he or she has taken on the external persona of the donor and has shed his or her own.”

Face transplants are not simple. No medical transplants are. However, there is something special about this procedure. Men’s and women’s magazines abound with questions like, “What’s more important, body or face?” The face largely forms one’s private and public identity. Ideologically, the word “face” can sometimes represent dignity or respect, like in the phrase, “to save face.” We can often remember a face but not a name. Indeed, the face is a central part of one’s identity and social persona.

Another question this procedure probes is where the medical community is headed next. Face transplants are a remarkable feat and a blessing for these unfortunate patients. What else can we expect?

“The ability to successfully transplant a face suggests that even bigger accomplishments may be in store in the future,” Meisel said. “The ultimate transplant — indeed the stuff of science fiction — is a head or a brain transplant. However, for those students whose grades are less than they’d like them to be and contemplate this as a possible solution, I wouldn’t hold my breath.”

Indeed, such a transplant would test the accepted standards of medicine. Our brains, and specifically, our memories, which are encoded within, afford us what we call our personality and identity. This is why Alzheimer’s Disease is so unfortunate, as the patient loses memories of who he is and to which family he belongs.

Still, I’m always entertained by the way science mimics science fiction.

Write Abdul at aba24@pitt.edu.