[RD (OP)]

The middle "before" photo  [:0]  [if squeamish don't click on these links] ...


http://news.sky.com/skynews/Home/World-News/Video-Face-Transplant-Man---Dallas-Wiens-First-American-Face-Transplant-Recipient-Speaks-About-Op/Article/201105215988810

[graham.d]

Like something from the "X Files".

[CliffordK]

Most interesting procedure.

I wonder if he will have to take anti-transplant rejection medications forever, or if the foreign cells will eventually be replaced by his own cells.

This was from from a severe electrical burn.  However, some of the worst facial reconstructions can be due to botched suicide attempts.  If you choose to attempt a suicide using a handgun, DON'T MISS!!!

[RD (OP)]

I wonder if he will have to take anti-transplant rejection medications forever, or if the foreign cells will eventually be replaced by his own cells.

The anti-rejection treatment (immune suppression) will probably be forever, and has iatrogenic cancer risk*.

Given that the poor guy cannot see what he looks like I'm not sure that the procedure was worth it:
the "benefit" of this life-threatening (and expensive) cosmetic exercise is for onlookers.

If the anti-rejection treatment fails at some point what then ?. His previous "blank" face wasn't pretty but had the advantage that it wasn't going to fall off.

BTW

The 25-year-old Texan was given a new nose, lips, skin, muscle and nerves from an anonymous donor.

How can the donor be "anonymous" when the recipient is wearing thier fizzog ?.


*

A meta-analysis of 5 population-based studies published before March 2007 demonstrated a 3-fold increased risk of cancer in solid organ transplant recipients compared with the general population matched for age, sex and calendar period

http://www.natap.org/2010/HIV/cancertransplant.pdf

[CliffordK]

Given that the poor guy cannot see what he looks like I'm not sure that the procedure was worth it:
the "benefit" of this life-threatening (and expensive) cosmetic exercise is for onlookers.

Benefit to onlookers including the family as well as how he is treated by society.

The kid is growing up, but think of what it would be like for a grade-school kid to to have a father that looks like a monster.  Still, "caregiving" will likely be part of her life for a very long time.

The Donor's family likely knows about the procedure.  However, grooming & beard may be different between the two (undoubtedly all the hair was shaved during the operation).  The facial expressions are likely different.  The droopy lip would be different.  He may be taking steroids giving a rounder face.  It doesn't say if the eyes were transplanted (although non functional).  It may be difficult to recognize the original donor. 

[RD (OP)]

… think of what it would be like for a grade-school kid to to have a father that looks like a monster

If this is for the benefit of his young daughter, (not just to compete with other countries who have already performed this operation),  consider these scenarios …

"Daddy got iatrogenic cancer, suffered and died because I didn't like his disfigurement"

"Daddy got rid of a serviceable (but blank) face, got a better looking one which his body rejected and he suffered and died from septicaemia because I didn't like his disfigurement".

or "Daddy spent my college fund and mortgaged the house to get a better looking face, which he can't see".  (* US taxpayers picked up the tab on this occasion: he’s a guinea pig for the US military ).


IMO this operation was performed primarily because of international competition, rather than for the benefit of the patient or his family.


[BTW When people donate their eyes only the cornea is transplanted. ]

[Variola]

The risk of cancer in people taking immunosuppressant drugs is higher, but not so high that it is considered a major risk factor. It depends very much on the drugs they are taking and combinations of.

The benefit to the man can be likened to women who have breast reconstruction after mastectomy, it is not that they want to look at their boobs all day, anymore than that chap wants to be able to see his face all day long. It is about how you feel as a person, sight is not the only sense, he can feel his face now, feel some sensation, shave, moisturise, and importantly he can smell, anyone who has lost their sense of smell during a cold will relate to how much you miss it when eating.

He can now accompany his daughter to the park, on days out, be there in public to listen to her sing or take part in a school play. When he cuddles her, he will be able to smell the shampoo scent in her hair, or the odour of cookies she has been munching. These are small things but huge when you miss out on them.


RD your reaction is one of being squeamish, a knee-jerk reaction to something you don't like the look of, and therefore you are trying to justify that reaction by making up scenarios that are are a possibility of ANY transplantation, not just one of the face.

Personally I think it is a great achievement, and gives hope to others who have been disfigured. We live in an unforgiving society, quick to pick up on the slightest imperfection, and stare unashamedly at people who are disfigured, like they are some kind of freak show.

[RD (OP)]

RD your reaction is one of being squeamish, a knee-jerk reaction to something you don't like the look of, and therefore you are trying to justify that reaction by making up scenarios that are are a possibility of ANY transplantation, not just one of the face.

My objection was not based on the “yuck factor”,  my point was if a transplant was life saving then the risk of life threatening surgery and toxic medications would be worth taking: you'd have nothing to lose, (except your bank balance). A face transplant isn’t life saving, it’s cosmetic.

We live in an unforgiving society, quick to pick up on the slightest imperfection, and stare unashamedly at people who are disfigured, like they are some kind of freak show.

Following that principle we can eliminate racism in Europe by having coloured people bleach their skin.

People shouldn’t have to risk their health so their face fits in … http://www.changingfaces.org.uk/About-Us/Mission-and-vision

IMO this face transplant is a matter of national prestige not patient welfare: the medical equivalent of the space/arms race.

[Variola]

My objection was not based on the “yuck factor”,  my point was if a transplant was life saving then the risk of life threatening surgery and toxic medications would be worth taking: you'd have nothing to lose, (except your bank balance). A face transplant isn’t life saving, it’s cosmetic.   

It is life changing, not cosmetic, its not like having a nose job or a chin tuck, this man had no face.

Following that principle we can eliminate racism in Europe by having coloured people bleach their skin.

Yeah because that is totally what we are talking about isn't it RD??  [] []

People shouldn’t have to risk their health so their face fits in

Agreed. But the no one should have to live a life without a face whatsoever, it is up to them.

IMO this face transplant is a matter of national prestige not patient welfare: the medical equivalent of the space/arms race.

As a scientist, from that perspective I see no problem with that, prestige/ego often drives science, and because of it some of the greatest achievements have come from it.You have to take a broader and longer view. What has been achieved and learnt from that one transplant can go on to help others.

[RD (OP)]

Following that principle we can eliminate racism in Europe by having coloured people bleach their skin.

Yeah because that is totally what we are talking about isn't it RD??  [] []

We were taking about of changing a person's face to "fit in" : to avoid being stared at and rude comments, which coloured people in Europe often have to suffer. Mr Wiens's face change could knock decades off his life expectancy, and if he was paying for it, about $500,000 off his bank account. Too much risk and too much cost for what is essentially a cosmetic exercise : the functional gains seem negligible IMO and not worth the risks & cost.   


Maybe it's fortunate that Mr Weins can't see his new face, (perhaps that's why he was chosen) ...

Some commentators have argued that the psychological trauma resulting from the surgery [face transplant] would be so great that the procedure would cause more harm than good.

http://www.nytimes.com/2004/06/16/opinion/16iht-edsokol_ed3_.html

According to Dr. Hutchison, the transplantation process carries significant practical risks. In the first few postoperative days, there is a 5% to 10% risk of transplant failure from thrombosis of the surgical junctions that pump blood from the carotid artery through the donor's blood vessels into the transplanted skin. The immunosuppressant drugs may fail to control the immune response, leading to rejection at any stage, even months after the transplant. Estimates of risk of rejection are 10% failure in the first year and 30% to 50% over the next 5 to 10 years.

http://www.medscape.com/viewarticle/520031

[Variola]

We were taking about of changing a person's face to "fit in" : to avoid being stared at and rude comments, which coloured people in Europe often have to suffer. Mr Wiens's face change could knock decades off his life expectancy, and if he was paying for it, about $500,000 off his bank account. Too much risk and too much cost for what is essentially a cosmetic exercise : the functional gains seem negligible IMO and not worth the risks & cost.   
 

No you are talking about that, and assuming the pressure came from wanting to fit in, that reasoning is far too simplistic. I am looking upon it from the patients pov, which you have over-generalised about, and are putting up quotes about how risky the op was, and future consequences. Yes the op was risky, and? Try getting inside the man's head, and imagine what it is like to have no face, and to not be able to smell, to put your hand to your face and not be able to feel a nose, your eyes, hair. Given the shocking failures in previous controversial transplants, he was well prepared, with a lot of therapy beforehand.
Functional gains are negligible, huh? Have you ever lost your sense of smell for any length of time? It is torturous and we don't realise how much we rely on it.
BTW cherry picking from news/media articles does nothing for me, I already know the risks from any non-self transplant procedure, and particularly of the immunosuppression involved.

[RD (OP)]

BTW cherry picking from news/media articles does nothing for me, I already know the risks from any non-self transplant procedure, and particularly of the immunosuppression involved.

Other readers may not know the high odds of failure, (up to an even-money bet his new face will fall off in the next decade), a failure which could kill him. The high risk to the patient was my objection to this primarily cosmetic procedure.
Normal life expectancy with a disfigured face , or risk decades being knocked off your life as a result of a face transplant ?
  (Mr Wiens is only 25, his "new" face looks older). 

I still think the operation was performed as a surgical tour de force to compete with other "superpowers", and not in the patent's best interest.
 

[CliffordK]

I believe that the news release indicated that Mr Wiens actively pursued the facial reconstruction, and if this hadn't been done, he likely would have had a series of plastic surgeries. 

You can look at the age thing a number of ways.

At 25, he has a lot to loose.
But, he also has a lot to gain from a "new look".