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Last Updated: Friday, 9 December 2005, 12:16 GMT
'No barrier' to face transplants
Face ops
French surgeons operate on the first face transplant patient
Patients with facial injuries cannot now be denied transplants following last week's ground-breaking operation in France, UK experts say.

Dr Peter Butler and colleagues want to carry out face transplants in the UK.

In the British Medical Journal, they say denying transplants because of concerns over drugs and psychological impact could be hard to justify.

Doctors who carried out the first face transplant have said the 38-year-old patient is doing well.

Instead of considering why facial transplantation cannot be justified, we may find it hard to justify why it should not be done
Dr Peter Butler, plastic surgeon, and colleagues

Dr Butler and his colleagues say such an operation has long been technically possible.

But concerns over patient selection, the life-long need to take immunosuppressant drugs after the transplant and over the psychological impact of changing someone's appearance held surgeons back.

'Misplaced' concerns

Dr Butler, a consultant plastic surgeon at the Royal Free Hospital in north London, said that one of the main areas of concern had been the risk from the side-effects of long-term use of immunosuppressant drugs which have to be taken after any kind of transplant to prevent their body rejecting the foreign tissue.

The doctors said many of the fears have proved unfounded, citing the experience of patients who have had hand transplants - who have not experienced any major complications during up to six years of follow-up after their operation.

They said that a patient having a face transplant would probably need a similar level of immunosuppression as someone having a kidney transplant.

"One of the main qualifications for renal transplantation is improvement in quality of life, and the same argument should apply to facial transplant," they said.

There have also been concerns raised about the psychological impact of a patient coming to terms with having someone else's face.

The experts said these fears were also misplaced.

Dr Butler and his colleagues said: "A psychological change is not necessarily a psychological problem.

"When reading about the potential psychological effects of facial transplant it is easy to lose sight of the fact that facial transplantation is being proposed as a potential benefit for a patient with combined functional, aesthetic and psychological impairment."

'Concept now a reality'

The surgeons said members of the public often worried that the recipient would look like the donor.

But they said laser scanning and photography modelling techniques had shown this did not happen.

They add: "Indeed, preoccupation with altered identity risks becoming too much of a distraction from the important issue of managing immunosuppression."

The doctors added: "Now that research has made the concept of facial transplant a reality, concerns about long-term immunosuppression do remain.

"But, instead of considering why facial transplantation cannot be justified, we may find it hard to justify why it should not be done."

However, following the French face transplant, Michael Earley of the Royal College of Surgeons of England said: "It is not only a question of technical achievement but also raises the issues of long-term immunosuppression and psychological impact."

Speaking to French newspaper Le Parisien earlier this week, the first face transplant patient said she felt "very well".

But she added she felt "bombarded", and asked that she and her family be left in "peace and quiet."

The woman lost her nose, both lips and her chin after she was mauled by her dog while she slept.

FACE TRANSPLANT
Graphic showing portion of face removed and transplanted on to recipient
1 Triangle of skin and muscle tissue is cut away from donor's face
2 Blood vessels and nerves from face section are connected to recipient using microvascular surgery




SEE ALSO:
Woman has first face transplant
30 Nov 05 |  Health
Q&A: First face transplant
30 Nov 05 |  Health


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