What Face Transplants Can, Can't Do
Woman Mauled by Chimp Latest in Growing Number of Face Transplants
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What Happens During a Face Transplant continued...
"Currently, face transplant can involve soft tissues, nerves, and some of the bony elements from the upper jaw, around the eyes, the mid-face, and the palate," Girotto says. "The facial nerve comes out through that soft tissue and helps you move the muscles, so you must reattach nerve channels to the new tissue. Then the body and the brain must grown new nerve down those tunnels you created. That is the part that takes the longest to heal."
Siemionow notes that outside the U.S., two face transplants have also included the lower jaw.
It's far from a simple operation. Two teams work simultaneously, one on the donor and the other on the recipient. In the donor's case, a cast is made of the face so that an artificial face can be applied to preserve the appearance of the corpse.
"In our case, there were over 50 medical personnel, including eight reconstructive surgeons, four anesthesiologists, and two transplant surgeons," Siemionow says.
Heightening the drama is the fact that surgeons don't know whether the 22-hour operation has worked until the last two hours.
"For 20 hours you don't know. You know only when you connect the arteries," Siemionow says. "Then when the white face gets blood and becomes pink, this is when you know the surgery works."
Siemionow says she's calculated that the face transplant performed by her team cost $350,000. But that astronomical figure is actually about $4,000 less than the cost of the 20 failed surgeries her patient underwent before the transplant.
Who Does a Face Transplant Patient Look Like?
So who does a face transplant recipient look like: the donor, or the patient?
"Each patient differs, because it depends on the deformity. We do not replace the normal part of the face, just the missing pieces," Siemionow says. "So the patient will never look like himself or herself -- but will not look like the donor, either. It will be a mix of donor and recipient, like a chimera, a little of their own tissue and tissue from the donor."
"They will resemble the donor with respect to skin texture and color," Girotto says. "They have more of the donor's nose than their own nose. But depending on how much bone has to be moved, the skin will re-drape and find the skeletal structure of the transplanted person. The skin will adapt to your bony skeleton over time."
Who the patient actually is does not change.
"The identity of the patient will be the same," Siemionow says. "The patient still has the same gestures, the same voice, the way the eyes look, so it is never a situation where the face of the patient will be transformed totally into the donor -- although many of the features of the donor will be preserved."