Brainwave: The Face Transplant Surgeon

This past Wednesday, as part of the Rubin Museum’s Brainwave series, face transplant surgeon Eduardo Rodriguez talked about the mental and physical aspects of his profession with Princeton neuroscientist Timothy Buschman. The first face transplants took place in 2005, Rodriguez said; roughly 30 have taken place since then. One of the few people capable of doing this surgery, Rodriguez gave great detail about what it takes to transplant a face, what it means for people involved, and what the future holds for this type of surgery.

Successful face transplantation requires teamwork. In the case of his patient Richard, Rodriguez said, 150 professionals tended to various aspects of the case, including psychiatrists, neuroethicists, sociologists, pathologists, radiologists, and dozens of surgeons. [Read more about Richard’s experience in this ABC News story]

Another essential aspect of the preparation is training. Rodriguez and his surgical team rehearsed the operation 15 times before they performed it. The first practice surgeries were conducted on a cadaver; each operation lasted more than 12 hours. The team’s final practice surgery was “like a dress rehearsal, for lack for a better term:” the team operated on a brain-dead donor on life support. They did all this practice because the surgery, repairing so many parts so severely damaged, had never before been successfully completed.

With the team assembled and trained, the next step was to wait. As with any other transplant surgery, face transplant patients must wait for a matching donor—a brain-dead organ donor with an appropriate blood type and facial bone structure.

After spending an entire Saturday moving into a new home with his wife, Rodriguez got the call at midnight that there was a potential donor for him to examine. At the hospital he stayed up all night examining donor records and fielding calls from experts around the world. At 6 am, he gave the call for his patient Richard and the surgical team to assemble for the real performance.

The transplant took 36 hours to complete. With the brain-dead donor on life support and Richard under anesthesia, Rodriguez and his team transplanted the skin, muscle, and nerves of the “…forehead, everything in front of the ears, the eyelids, the nose, the lips, all the way down to the neck. Everything inside the jaw bones, the bones around the eye sockets, the upper teeth, lower teeth, lower jaw, tongue, palate.”

After successfully completing the surgery, Rodriguez had been awake for three days straight. When asked how he maintained his focus throughout the operation, he responded, “When your children are sick, I can guarantee you that the last thing on your mind is worrying about how much sleep you need, and that was what this was like to go through.”

What does it mean for the patient and families involved?

For the patient, too, face transplantation is serious surgery; it is preceded by prior surgeries and often severe psychological hardship. Along with a suitable medical background, the patient selected must have a strong social support system, resilient characteristics, and show evidence that he or she will commit to a lifetime of “medical compliance,” following doctor instructions on taking medicines and returning for checkups, for example.  According to Rodriguez, the two recorded face transplant fatalities likely stemmed from patients who stopped taking their immune system suppressing drugs. As do other people who get transplants, face transplant patients must be prepared to take medication for the rest of their lives.

After the surgery, Rodriguez visited Richard’s family. During this emotional visit, Rodriguez noticed that the family kept two pictures of Richard on the mantel; one from before the accident that maimed his face, and one from after his transplant operation. Richard is a man of three faces, each face altering his sense of self. It was touching to hear that Richard’s family supports every facet that makes their son unique.

[Photos courtesy of the University of Maryland Medical Center]

[Photos courtesy of the University of Maryland Medical Center]

What is the direction of face transplant medicine?

Rodriguez’s breakthrough surgery paves the way for new medical research and improved surgical methods. Rodriguez now consults the US Surgeon General and the Department of Defense on the topic of facial transplantation. He also helps train the next generation of face transplant surgeons.

Contemplating the future of his discipline, Rodriguez believes that face transplants will remain rare for the time being, and he looks forward to a future where tissue rejuvenation therapies play a larger role in facial surgery.

The next Brainwave event is Sunday, March 16, at 3 pm,  when Personality psychologist John D. Mayer gets some tips from star poker player Vanessa Selbst about how to avoid a bad read, limping in, and when to bluff the pot. 

–Charles Sadle

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