Facing the Future

What will life be like for the latest face transplant candidate?

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Facing the Future

What will life be like for the latest face transplant candidate?

-Susan Crandell

The 55-year-old woman who was mauled by a pet chimpanzee two weeks ago has been MedEvaced to the Cleveland Clinic, where the world’s fourth face transplant was performed in December. She is still in critical condition and in a coma. But here’s what Charla Nash has in prospect if the decision is eventually made to do a facial transplant.

Charla NashThe first facial transplant was done four years ago on a 38-year-old French woman who had been mauled by her dog. A partial reconstruction was done, including nose, lips and chin. Though the woman reportedly had had some difficulty with the powerful immunosuppresant drugs, the transformation is remarkable. She looks very, very good.

The previous patient (whose name and age have not been disclosed), a woman who was disfigured by a traumatic injury several years ago, could neither smell nor eat nor even breathe without assistance.

NY PostWhen she went home February 5, just 11 days before Nash was attacked, she could do all of these things, and even wink an eye. Maria Siemionow, M.D., Ph.D., lead doctor on the case, says that the transplant, which replaced 80 percent of the woman’s face with tissue from a cadaver, is so natural that people might not realize that she’s had surgery.

The operation is controversial because it improves the quality, not the quantity, of life, which it may in fact shorten due to side effects of the powerful immunosuppressant drugs that must be taken for the rest of the patient’s life. The drugs are essential; the Chinese farmer who received the second face transplant in 2006 after being mauled by a bear, died in December, reportedly because he did not have access to the proper medications.

The surgery is intricate and complex, stitching together intimate facial structures (nose, eyelids, lips) and underlying tissues (muscles, veins and arteries and nerves). An illustration on the medical center’s site shows the operation they performed in December in stunning detail.

We’re haunted by the future Charla Nash faces because our face is so central to who we are. It’s hard to imagine the psychological impact when you lose your looks, quite literally. Even women who have had unsuccessful cosmetic surgery remain recognizable. Should Nash undergo a transplant, she will not be. She will look different because the underlying muscles and bones will be someone else’s, not her own. She will probably look neither like the donor nor like herself. Some have described the result as a hybrid face.

But the movements of the face – the personality it expresses – are governed by the brain, so they will be her own. I can only imagine it will be a comfort to Nash to see her unfamiliar, new face take on familiar expressions. It will no doubt be hugely reassuring to talk to the woman who received the Cleveland Clinic’s first face transplant, and to see the happy results. I wish them both well.

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