If an implant of skin from a corpse could give you lips like Kim Basinger or a schlong like Dirk Diggler's, would you opt for the operation? Would it matter to you that some poor kid in a burn unit was dying for lack of the skin that you bought to improve your pout, or your boudoir clout?
If so, then you are probably not one of the 500,000 people who got collagen injections last year to puff up their lips, cheeks and other body parts. Most of the collagen came from cows, but perhaps 20 percent came from dead people. Yes, that's right: Flesh derived from the skin of the dead is being injected and sewn into the bodies of the living -- at times for reconstructive purposes, at times for aesthetic ones.
"When we tell the patients where it comes from, a fair number say, 'I don't think I can do that.' But the others accept it," says Ron Perlman, a Washington plastic surgeon who has done about 140 lip enlargements using Alloderm, a product made from processed skin. He says he knows of beauty queens and magazine models with lips aquiver in Alloderm.
This may appear repulsive and almost cannibalistic, but the donors, at least, aren't complaining. What may be most worrisome about the practice, which was laid out in a five-part Orange County (Calif.) Register report last month, is that demand for the skins of the dead for cosmetic purposes may be taking away skin from burn victims.
The Register series depicted the world of tissue donation as peopled by greedy entrepreneurs sidestepping federal laws that prohibit profiteering from body parts. It pointed out that while tight federal protocols require that transplantable livers, kidneys, lungs and other organs go to the people who need them most, this is not the case with the rest of the body.
Once certain viable organs have been removed, it's open season on the corpse, providing its donor hasn't set specific limits. And some of the scavenging is for-profit. Commercial companies and nonprofit tissue banks have set up chop shops at hospitals and morgues that strip down cadavers for parts.
Lurid as this sounds, most of the material is put to good use, whether or not someone makes a profit along the way. Bones are ground up for reconstructive surgery and dental implants, eyes removed for corneal transplants and skin is flayed for burn patients as well as to rebuild damaged flesh.
But the Register reported that some burn centers are short on skin because they can't compete with companies such as LifeCell, in Texas, and Collagenesis, in Massachusetts, which convert the skin into a product that can be transplanted without allergic rejection.
"It used to be that skin and tissue banks were little mom and pop organizations associated with burn centers," says Dr. Glenn Warden, chief surgeon at Shriners Burn Center, which treats about 1,000 severe burn victims each year in Cincinnati. "Now, some of the tissue banks send their skin to the manufacturers because they can get more money for it. That's a problem."
Neither Warden nor the American Burn Association could point to specific cases in which a burn patient died because skin had been sold to a commercial company instead of a burn center. But Warden says he wouldn't be surprised at such a case, given the disparity in prices paid by commercial skin companies and burn centers.
Shriners and a handful of other big burn centers have affiliated tissue banks devoted to serving their patients. But officials at the Cincinnati tissue bank have told Warden they could get three times as much money from the collagen companies as they get from the hospital, he says.
"There's always been a shortage of skin for grafts. The poor burn patients in general do not have much money," he says. "They are not the wealthy people. They may not have insurance. They may not have anything."
LifeCell and Collagenesis officials deny they are robbing the sick to puff up the vain. Eighty percent of Alloderm, LifeCell's product, goes to treat burn victims, according to Glenn Greenleaf, a company official. While the remaining 20 percent is shipped to plastic surgery offices, not all their operations are frivolous.
To be sure, cosmetic surgery offices are swelled to bursting with patients seeking tummy tucks (up 75 percent since 1997), boob jobs (up 89 percent) and Botox injections (up 665 percent). Nearly 325,000 women had their breasts surgically adjusted in America last year, according to the Society for Aesthetic Plastic Surgery.
But "the cosmetic portion is a small portion of the overall market" for skin, says Judith Bednarz of Collagenesis, which makes Dermologen. And to the extent that poor body image fuels her company's business, she adds, "It helps support research and development for more critical needs."