Imagine going from having no face to having someone else's face.
Face transplantation is the process of removing part or all of a donor's face and attaching it onto a patient who has suffered devastating facial injury. With its just-launched face transplantation program, UCLA Medical Center will become the first hospital in the western U.S., and one of only a handful in the nation, to offer the procedure.
"The face is the most exposed body part. It's what makes us human. So you can only imagine what it's like to not have a face," Dr. Kodi Azari, chief of reconstructive transplantation at UCLA's school of medicine, told The Huffington Post. The program will help respond to as many as 200 veterans in need of face transplants.
The program has begun to set up a database of people seeking a new face, with photos and descriptions. Qualifying patients will then be placed on a waiting list until a donor is found with matching blood type, gender, age, ethnicity, skin tone, hair color and other criteria.
Once a match is made, surgeons will remove the damaged part of the patient's face and replace it with the donated face. Surgeons will work for more than 20 hours joining skin, fat, muscles, tendons and ligaments, and securing bones with screws and other hardware. The most painstaking part of the procedure is stitching the nerves and blood vessels — too small to be seen by the naked eye, according to program website.
The result will leave the transplant patient looking significantly different than before their injury. "The patient will look like a hybrid between himself and the donor," said Azari, the program's principal investigator.
The team hopes to conduct its first transplant by the end of the year.
Facial reconstruction with donated facial tissue, rather than tissue from another part of the patient's body, results in significantly improved appearance and function. Patients who cannot smile and have difficulty breathing, speaking and eating should regain all of those functions after a transplant, Azari said.
The UCLA program includes an extensive process to make sure donors and their loved ones are treated with dignity. The program will create a mask of each donor's face to be put on the donor after the face is removed. "It's like Hollywood. We have a whole facial prosthetics team who will create these nearly-identical masks, in the event that the family wants an open casket," Azari said.
The face transplant program is currently seeking patients who want to participate in the surgery and five years of follow-up. The clinical trial is open to military veterans as well as to civilian victims of facial gunshot wounds, burns or other injuries. The program partners with UCLA's renowned Operation Mend, which has offered facial and hand reconstructive surgery to veterans since 2007.
The program also offers psychiatric support. "Many patients eligible for a face transplant experience social isolation and depression," Dr. Reza Jarrahy, surgical co-director of the new program, told HuffPost. Psychiatric evaluations are done on candidates before they qualify and psychiatric support for recipients is provided throughout the process. "Understanding that a person's identity and sense of self are closely tied to their facial appearance, the team will also support the patient's emotional adjustment to their new face after the surgery," the program website says.
The "gorilla in the room," Azari said, is the anti-rejection medications transplant patients will have to take for life.
"Is it ethical to put somebody on anti-rejection drugs for life for a procedure that is not life-saving?" Azari asked. His team of more than 50 physicians, including ethics specialists, believes it is. "Now the holy grail is to modulate the immune system, to fool it somehow, so we don't have to give it as much medicine," he added.
The program will cover the entire cost of care, at no expense to the patient. Azari, who also performs hand transplants, said the cost of a face transplant would be about the same, at $600,000 for the first six months of care. Click here to donate to the program.
Only six face transplants have been performed in the U.S., and 19 have been performed worldwide. Click through amazing photos (WARNING: GRAPHIC) of a few face transplants that have been completed across the country :
Photos by Associated Press.