Boston Med -- Bohdan Pomahac

On the final episode of Boston Med surgeon Bohdan Pomahac can be seen conducting the only second face transplantation ever performed in the United States. The series director Terence Wrong films the remarkable surgery and follows Pomahac around Brigham and Women's as a remarkable drama unfolds around them. While Pomahac had prepared for this innovative procedure for many years, it somehow becomes the right moment for a number of firsts to emerge within this historic city already with an amazing array of medical firsts. Within this show alone would occur the first New England face transplantation, the first time a face transplant donor is identified, the first time a donor's wife meets a recipient wearing her husband's face, and the first time two face transplant patients meet -- Isabelle Dinoir and James Maki.

A perfect storm is required and each player in this storm is intriguing and moving. Joseph Helfgot and his family are waiting for a heart to become available and when one does Wrong films the transplant team collecting the organ and bringing it back to the hospital. Like all transplant patients and their families, they are so grateful and feel full of hope. Sadly, Helfgot never wakes from his operation and his family is asked if they would like to donate not only his internal organs, but also his face. Susan Helfgot decides that her husband would want to help continue the tradition of organ donation and agrees for her husband's face to be used to replace another's. James Maki, a Vietnam veteran had gravely injured and lost his nose, lips, cheeks and surrounding bone structure after falling onto the third rail in a Boston subway station approximately 4 years earlier. After 10 operations Maki learned to live without a face, at least without one we could recognize as a face. Taunted by others he lives in isolation with his wife and daughter doing the best they can.

I first met Bo Pomahac after emailing him in the spring of 2008 asking if I could speak with him about face transplantation. I had hoped that I could simply talk with a surgeon who wished to perform the procedure, to learn more about the actual operation, but also just to talk about the topic with someone who understood it and with whom I could engage my thoughts on the subject. Only a handful of research and literature had been published to date and I think at some level I needed to be in the presence of somebody who know a lot about it, believed in it, and found it full of potential. Bo emailed me quickly back saying that it would be fine. In the writing of the book, I began to see some trends in some of these remarkable surgeons, sets of behaviors that would catapult them towards innovation and compassion and one of these traits, I believe, is a sense of openess and generousity.

After Maki's surgery, Dr. Pomahac hands him the mirror to survey his brand new face. Wrong is there to film what might be one of the most captivating scenes ever recorded by film. Just before the mirror is handed to Maki, Pomahac is asked what he thinks might happen. I knew from the medical literature we had discussed that studies had shown that the recipient would not look like their old selves, nor the donor -- that bone structure would play a large role in the way the new face looked. I had however wondered much about this during the writing of our book on the topic. I knew from Sander Gilman's work on identity and the nose, and from the literature on rhinoplasty, that we place a great value and meaning on noses and that a transplanted nose would always be the nose of the donor. I also wondered if the self was an entity that could be captured simply by having a face, maybe any face would complete that gap between the faceless and the faced. As Maki glanced into the mirror he first remarks on his nose, that he indeed has one. He then, after a few seconds of reflection, says that he can see his old self in there. At first the two statements do not seem to blend, he sees this new nose, one that marks the donor (later in the show Susan Helfgot meets Maki and says that she did not see her husband in the face except for his nose) yet he also feels like himself. Bo reflects upon this later and one can sense that he too is moved, that one can replace a face and an entire sense of selfhood in this one amazing act of face transplantation. "What else could one want," he poignantly remarks.

Towards the end of the episode, Bo sits in his house with his children looking at pictures of James Maki explaining how special Jim is as a patient. Yet what I caught was his "World's Greatest Dad" T-Shirt, perhaps a gift from his children that he chose to wear for filming that day. I think that is what makes him stand out, not just because he is now clearly a famed, history making, surgeon who conducted a face transplantation, but because he embodies traits such as the ability to blend sensitivity with celebrity and to balance compassion and conviction with a drive to doing what is right and fair.

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 . . .