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Face Transplants Face Reality

Experts are wary as some surgeons seek to attempt a face transplant -- a procedure that probably isn't what you think it is.

Face Transplants: Serious Surgery for Serious Situations

"The risks are just awesome," Papel tells WebMD. "If a kidney transplant is rejected, you go back on dialysis. If all the skin on your face is rejected, what do you do? If it just sloughs off, what are you left with? That's a horror-movie situation."

There's about a 10% risk that a transplant won't take. Over the next two to five years, the risk of rejection is much higher. Historically, one-third to one-half of transplants eventually are rejected.

That's too much of a risk, says Douglas Hanto, MD, chief of the division of transplantation at Boston's Beth Israel Deaconess Hospital.

"The real question is whether the benefits and expected success rate are worth the long-term immune suppression," Hanto tells WebMD. "Clearly these patients will require life-long immune suppression. If the outcome is not much better than a 30% rejection rate, it will be hard to justify."

There are situations in which face transplants could save lives.

For example, Pearlman suggests, what if some hypothetical child suffered a terrible, slow-spreading cancer of the face? By the time that child became a teen, the tumor would not only have destroyed the face, but would also be life threatening. If, however, a surgeon had the chance to cut away the tumor -- and replace the face -- recovery might be possible.

It's for cases such as this that doctors around the world are honing their skills. In December 2002, U.K. surgeon Peter Butler, MD, announced that medical science had advanced to the point where a face transplant might be attempted. But in November 2003, the Royal College of Surgeons of England issued a report saying that the technique was not ready for prime time.

Last month, John Barker, MD, director of plastic surgery research at the University of Louisville, Ky., announced that he is seeking a green light from his ethics panel to prepare for a face transplant. Experts in the field tell WebMD that surgeons at other institutions are also seeking approval to begin planning the operation.

To date, no such approval is known to have been granted.

But Barker may have opened a can of worms with statements that the technique might be appropriate for burn victims. Many burn victims have their entire faces destroyed. Skin grafts save their lives. But even multiple operations leave them with such a distorted appearance that many patients feel unable to leave home.

"There are burn patients that have lost all the skin on their faces," Papel says. "But at this point, they are probably better off with skin grafts."

Pearlman agrees that face transplants should be reserved only for people with fatal conditions.

"The first candidate should be one of those patients with no other alternatives," he says. "Especially those with cranial facial cancer or severe craniofacial deformity where there is no other surgical procedure that could cure them."

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