A Lifeline, Not a Lifetime

It would have to be the stuff of fearfully grisly science fiction. An unfortunate accident, to begin with, that would have the result of destroying someone's face. A death sentence, surely. If means could be found to surgically restore some function to whatever remained of a face which contains someone's vital features, organs allowing one to breathe, to see, to hear, to consume liquid and food, then survival, albeit awkward, could be achieved.

Means found, through medical-surgical intervention to reconstruct vital organs allowing someone to breathe on their own, to eat, ensure survival. If sight and hearing are impaired, an individual can still learn to use alternative means of replacing those senses to inform him/herself and be capable of living a public life. That public life becomes complicated, however, with the reality of that disastrous accident resulting in a monstrous distortion of facial features.

Pat Semansky, The Associated Press

Enough so that to the public coming face to face with a victim of a personally cataclysmic accident, the immediate, reaction is shock and revulsion. It is a vicarious human reaction. With some people adding their own particular brand of cruelty in offhand comments measured to inform the individual whose face has become monstrously contorted that they should be confined to an interior where no one would have to see them.

This is what happened to Richard Norris, 38, of rural Virginia, who fifteen years ago was the victim of a shotgun blast that utterly and savagely ravaged the lower half of his face. "I've heard all kinds of remarks. A lot of them were really horrible", he said. The result of that accident was a face absent a nose, teeth, and leaving him with a partial tongue, and no sense of smell.

Dozens of surgeries later he was still left using a hat and face mask, going out into the public arena only at night. "You can create a semblance of something, but I can guarantee you it's not normal by any means", explained Dr. Eduardo Rodriguez, head of plastic surgery at the University of Maryland Medical Centre, R. Adams Cowley Shock Trauma Center.

A relative handful of facial transplants have been attempted worldwide, under 30 in total. Four recipients died. Survivors can anticipate a lifetime of being reliant upon immunosuppressant drugs to ensure their facial transplant is not rejected by their own body's immune system. The drugs themselves take a toll on people's health; they suppress the immune system, after all.

Face transplants are optional. Like cosmetic surgery. Richard Norris, like others who have suffered catastrophic accidents that have robbed them of their birthright facial characteristics that make them physically uniquely themselves, would have been capable of continuing to live with the face he was left with after reconstructive surgery which did not restore his former face, but did allow him to use whatever was left of it.

The surgery involved is complex. Face transplant patients are informed forthrightly that when they make the decision to proceed with their transplants they risk death. "If you talk to these patients, they will tell you it is worth the risk", says Dr. Rodriguez. He informed Richard Norris's mother that her son faced a 50-50 chance he would not survive surgery.

"We looked at Richard and we told him we loved him the way he was and it didn't matter to us, but it was his life. That was what he wanted to do and we supported him", his mother explained.

Richard Norris, now living with a transplant gift he received when a 21-year-old died after he was hit by a minivan crossing a street, contacts the family of the young man part of whose face he wears, to keep them informed about his progress. His transplant surgery took 36 hours to complete. It included teeth transplantation, upper and lower jaw, part of the tongue and all the tissue from scalp to base of the neck.

Immunosuppressant medications come complete with patient risks. Patients know in addition that it is an unknown how long the transplant itself may survive. If all proceeds according to optimistic expectations, says Dr. Rodriguez, a transplanted face may last 20 to 30 years.

It is a lifeline, but it is not a lifetime.