‘A Procedure Without a Problem’, or the face transplant that didn’t happen. The Royal Free, the Royal College of Surgeons and the challenge of surgical firsts

Face transplants are an innovative and unusual form of modern surgery. There have been 47 face transplants around the world to date, but none as yet in the UK. Yet in 2003, the UK was poised to undertake the first face transplant in the world. The reasons why it didn't take place are not straightforward, but largely unexplored by historians. The Royal College of Surgeons, concerned about the media attention given to face transplants and the ethical and surgical issues involved, held a working party and concluded that it could not give approval for face transplants, effectively bringing to a halt the UK’s momentum in the field. This extraordinary episode in medical history has been anecdotally influential in shaping the course of British surgical history. This article explores and explains the lack of a face transplant in the UK and draws attention to the complex emotional, institutional and international issues involved. Its findings have implications beyond the theme of face transplants, into the cultural contexts and practices in which surgical innovation takes place.

Life Quality of Patients with Face Transplant

"The face is the feature which best distinguishes a person, the shape of it being influenced by the bone-structure of the skull. Facial trauma, known as maxillofacial trauma, is any physical trauma to the face that can involve soft and hard tissue having the potential to cause disfigurement. The last resort solution after major facial trauma, when conventional reconstruction techniques have failed is now represented by face transplant. The aim of this paper is to underline the life quality and psychological implication of patients that were face transplanted. Our material and method involved studying the most relevant medical literature for this issue and also using our personal experience of patient with face cancer that underwent radical oncological surgery followed by reconstruction. Based on these data we can conclude that face transplantation appears to decrease depression and to improve patient’s quality of life and societal reintegration. Also, in our opinion a very important factor involving the success of face transplantation is represented by the psychological outcomes of the patients, their follow up for a minimum 6 months period with regular psychological counselling sessions being very important. Furthermore, there is a critical need for modification of existing rating scales to allow effective assessment of face transplant candidates before and after transplantation. "

Software-based Detection of Acute Rejection Changes in Face Transplant

Background An objective, non-invasive method for redness detection during acute allograft rejection in face transplantation (FT) is lacking. Methods A retrospective cohort study was performed with 688 images of 7 patients with face transplant (range, 1 to 108 months post-transplant). Healthy controls were matched to donor age, sex, and had no prior facial procedures. Rejection state was confirmed via tissue biopsy. An image-analysis software developed alongside VicarVision (Amsterdam, Netherlands) was used to produce R, a measure of differences between detectable color and absolute red. R is inversely proportional to redness, where lower R values correspond to increased redness. Linear mixed models were used to study fixed effect of rejection state on R values. Estimated marginal means of fitted models were calculated for pairwise comparisons. Results Of 688 images, 175, 170, 202, and 141 images were attributable to Banff Grade 0,1,2, and 3, respectively. Estimated change in R value of facial allografts decreased with increasing Banff Grade (p = 0.0001). The mean R value of clinical rejection (Banff Grade ⅔) (16.67, 95% Confidence Interval [CI] 14.79–18.58) was lower (p = 0.005) than non-rejection (Banff Grade 0/1) (19.38, 95%CI 17.43–21.33). Both clinical and non-rejection mean R values were lower (p = 0.0001) than healthy controls (24.12, 95%CI 20.96–27.28). Conclusion This proof-of-concept study demonstrates that software-based analysis can detect and monitor acute rejection changes in FT. Future studies should expand on this tool's potential application in telehealth and as a screening tool for allograft rejection.

‘That is the skin of my brother’: alterity, hybridity and media representations of facial transplantation

In this paper, I explore the 2012 face transplant performed on US recipient Richard Norris and how it was represented by the media as a ‘makeover story’. Informed by press coverage from the date of the transplant to the present day, I examine a widely viewed and critically acclaimed investigative report that aired on CBS’s 60 Minutes entitled ‘My Brother’s Keeper’. Through a close reading of both its form and content, I claim that the report’s makeover story consists of four key themes: heroic medicine and miraculous science; appearance-based stigma and social alienation; appearance-based conformity and social assimilation; and subjective alterity and embodied hybridity. In doing so, I contend that the report’s themes contain the widespread ambivalence about facial transplantation by confirming prevailing assumptions about medical science and how it creates normal people who live good lives. That said, I also contend that the report’s themes complicate these assumptions by highlighting how facial transplantation invariably involves immediate encounters with otherness and corporeal interconnectedness. I conclude that the report’s makeover story—characterised as it is by the constraints of the before-and-after format—must be rethought and, ultimately, reworked if we wish to do justice to face transplant recipients.