"How many people have you seen who are missing part or all of their face?" asks Dr. John Barker, a plastic surgeon at the University of Louisville in Kentucky. "Not many. They're so traumatized, they don't go out on the street."

Barker wants to change that -- by pioneering the field of human face transplantation. "The first face transplant will probably be done within a year," he says. "It could be done anytime. We have the know-how."

But will disfigured patients be willing to undergo such a drastic procedure? Ashley Allen of Chattanooga, Tenn., was born with Crouzon Syndrome, a hereditary condition that causes extreme cranial and facial malformations. "I had a lack of bone in the face, no eye sockets, large bulging eyes, teeth in my sinus cavity." Now 24, Allen has undergone 22 reconstructive operations to normalize her appearance. If she were back at square one, would she endure a transplant to get a new face? "Oh yeah," she says. "In a minute."

As thousands of transplant surgeons convene in Chicago this week for the annual meetings of the American Society of Transplantation and the American Society of Transplant Surgeons, the topic of face transplantation will be on the tips of a lot of tongues. Will the procedure really work? Is it worth the risk of dosing a patient with immunosuppressive drugs to enhance appearance? Will donors come forward? Is it ethical to graft one human being's face onto the skull of another? Is it taboo?

To begin at the beginning, let's say your face is badly damaged in a fire, or a car wreck, or say some rare disease destroys it, or you destroy it yourself in a botched suicide attempt. Up until now, the options for recovery have been limited to the patchwork restoration done with tissue grafts and reconstructive surgery. The most common procedure for rebuilding shattered faces is known as a "lateral arm flap," a process that involves taking part of the victim's arm -- the bone, muscle, nerves and skin -- and molding it onto what's left of the ruined face. This procedure requires 10 to 16 hours of preliminary surgery, followed by dozens of subsequent operations to make the face resemble a somewhat normal face, aesthetically and functionally.

But with a face transplant you would undergo just one operation, followed by a protracted regimen of drug therapy. And the comparative simplicity of transplant surgery would exponentially boost the surgeon's odds of giving the patient a good-looking end product. As Barker succinctly puts it, "You're making a face into a face, not an arm into a face."

Barker says the medical community has possessed the technical know-how to transplant faces for 20 to 30 years, but until now obstacles associated with immunosuppression have stopped transplant surgeons from attempting multiple tissue grafts.

Because a hand or face transplant requires grafts of bone, tissue, nerves and skin, doctors must first create a flawlessly balanced prescription of drugs to keep the body's immune system from rejecting all the different types of grafts. For the past three years, Barker and his colleagues at the University of Louisville have been conducting animal research in their quest to find that perfect pharmaceutical recipe.

"The goals of our research," Barker says, "were to maximize immunosuppression, and to minimize systemic toxic side effects." In other words, they had to identify a drug cocktail that would sufficiently suppress the immune system while ensuring tolerable levels of toxicity in the patient.

They mixed together three drugs commonly used in other types of transplants -- FK506, MMF and prednisone -- and the resulting concoction seemed to spell success. Barker's findings were published in the journal "Transplantation," and in early 1998 his team presented its pioneering research at a hand surgery conference in Vancouver. A team of surgeons from France attended that meeting, and, according to Barker -- who hints at a trans-Atlantic rivalry -- it was those surgeons who brought his research to fruition on the arm of a man named Clint Hallam, when they performed the first successful human hand transplant last September. Today, eight months down recovery's road, Clint Hallam and his new hand are doing fine. When asked at a press conference if the new hand felt like his own, Hallam emphatically replied, "Of course it does."

Next page | Will the recipient look like the donor?