Dallas Wiens -- U.S. Face Transplantation #3

Dallas Wiens' face transplantation is destined to become the one that is remembered, not only for the utterly remarkable transformation, but for his touching reunion with his young daughter post surgery. Movingly, she stared at his newly donated face and whispered in his ear "I missed you Daddy."

The father of this young daughter lost his facial features and eyes during an accidental brush against power lines while painting a church in 2008. While his plastic surgeons did a remarkable job covering his skull with numerous skin transfer operations, his face was, well, not really a face at all. To survive that horrific accident was amazing, and having one's sinus, eye sockets, and jaw covered in skin was a miracle in and of itself, but it was not a face. Wiens' little daughter grew up and loved her father regardless, even in his faceless form he was accepted by his little girl and family. Yet, he wanted to become a more public person to help his developing daughter deepen her engagement in the world. He desired to be a more visable presence in her life by offering his public support and companionship without the stares and fears that always follow the facially disfigured.

On May 10, 2011 the Brigham and Women's Hospital released Dallas to return to Texas to resume his life with a new face -- a facial allotransplant more extensive and altering of appearance than any before. In a new series of firsts for surgeon and team Bo Pomahac, Dallas received a full facial replacement, from the crown of the head to the neck region. For the first time, the surgery appeared seamless, scars hidden under his chin and beneath a crown of hair blending into his own hair. For the first time, a non-sighted individual had been given the gift of a face transplant. For the first time, the patent's "reveal" presented a breathtaking transformation, a beautiful replacement of facial features without the usual, and of course insignificant to face transplant recipients, differences of skin tone and texture. To "replace like with like" has always been the mantra of plastic surgeons since the first attempts to surgically repair damaged tissues. Plastic surgeons simply cannot replicate the delicate features of the face, the curves, details found at the edges of the mouth, intricacies of the eyelids, and so forth. Dallas Wiens' operation is the first to replace "like with like" demonstrating the promise of face transplantation to heal the emotional and social wounds associated with loss of face.

"You're handsome Daddy." Wiens' little girl approached him yesterday on camera and "sees" her father, she does not run away, cry, or otherwise fear the father in front of her with a completely different face, the face of another as her father. Even Dallas reported her acceptance of him as her father "amazing." He gently cradles her in his lap rubbing her back and telling her that he missed her so much. One just has to wonder about how we identify each other, is it by face, voice, body posture? How can this little girl feel secure in the lap and arms of her father with another face? Yet, she knows, you can see her amazement, one can sense the healing that the transplantation has offered this family, she is re-falling in love with him in his transformed form.

Face transplantation is still so new and fresh yet you can tell by the post operation photos that the surgical techniques have progressed quickly. While each patient is different in the way they heal and accept the transplanted face, there just seems to be evidence of advances in the procedure itself this time. It appears that less skin tissue was left over in this surgery. Both Connie Culp and James Maki appeared to have excess skin tissue that required tightening a year or so after the transplant. Dallas appears to have tighter skin suggesting that Bo Pomahac may have realized through experience that the need for the excess skin was unnecessary -- perhaps concerns of tissue rejection and excess tissues needed for repair have been somewhat alleviated. Additionally, fears that a non-sighted person would not benefit from the procedure, or that rejection detection would become an additional burden for a non-sighted person, have dissolved.

Indeed, the Boston team is emerging as the real pioneers in exactly the right ways, and from their resolve has emerged growth and healing. In an ironic way, the fame brought onto Connie Culp, James Maki, Dallas Wiens, and the pending Charla Nash surgery, has offered many American's the unique -- at least for Americans -- opportunity to witness, discuss, and observe facial trauma. Thousands of veterans live in hospitals full time, unable to venture outside for very real fears of social rejection and emotional harm. Facial trauma patients have told Bo Pomahac that all they really want is to be restored simple social graces, such as being picked up by a taxi cab. Yesterday, the entire world saw the startling before and after photos of Dallas posted on the front page of CNN and the like. The faceless are now becoming seen, discussed and cheered on. Certainly of the many thousands who would qualify for the miracle of face transplantation, face the challenges of a lack of donorship and medical expertise and expense. And while we cheer the transformation, perhaps the real gift, in the long run, will be like Dallas' little girl who loved her daddy completely before the face transplantation. The real hope is that everyone can be loved, looked at, and accepted. Ultimately and hopefully the long term benefit of face transplantation is that it may offer us the gift of human growth and acceptance.

Face Transplant #12 -- Surgeon Laurent Lantieri

On June 26th French Sugeon Laurent Lantieri conducted the 12th face transplantation on an anonymous patient with an undisclosed medical condition. As remarkable as all the face transplantations have been to date, this operation broke new ground with the addition of eye lids as part of the facial allograft. The eyes, in a way, have become the fulcrum on which the future of face transplants sit.

The eyes are surgically difficult to navigate for a couple of reasons. First, imagine the challenges for the face transplant patient if the eyelids never become mobile. Typically it can take 6 months to animate the face in a satisfactory manner, e.g. smiling, speaking, etc. Surgeons have been wary of replacing the eye lids not only because it can take up to a year to develop adequate facial movement in the transplanted tissue, but also because if the nerves never generate proper movement, the patient will be left with a significant visual deficit -- not a enviable position. Thus far, as with the case of chimpanzee attack victim Charla Nash, surgeons have not wanted to conduct face transplantations on the severely visually impaired. Nash is an interesting test case in the US. Rejected by the Cleveland Clinic, she has now relocated to Boston and is currently being evaluated by famed surgeon Bohdan Pomahac. What makes Charla's story even more remarkable is that she was not only blinded by the rogue primate, she possess no eyes -- yet she desires a transplanted face.

What is the meaning of a face? Why might a blind woman desire a transplanted face if she will never be able to see it? Face transplantation in many ways raises the everything question: who are we? Here will be explored the meaning of face, losing face and gaining face. How has this innovative procedure that is slowly gaining acceptance in the the surgical world -- watch Boston Med. Thursday nights at 10PM to see the story of face transplant recipient James Maki -- forcing us all to consider what it means to have a facial identity, lose it, and desire the face of another.

In the meanwhile, the most recent face transplant recipient has been reported to cry tears through his transplanted tear ducts . . .