When John Travolta and Nicholas Cage "swapped" faces in John Woo's blockbuster "Face/Off," it was dismissed as Hollywood fantasy.
But now, only days after the world's first arm transplant, a group of leading American surgeons are promising a breakthrough straight from the plot of the movie: the face transplant.An international team last week took the right arm from a Frenchman killed in a road accident and attached it to New Zealander Clint Hallam. John Barker and plastic surgeons at the University of Louisville in Kentucky claimed in this week's edition of New Scientist that full face transplants will soon be possible.
Barker says that the pioneering technology and techniques used in the arm transplant will allow facial skin, muscles, nerves and lips to be taken from dead donors. The break-through with the arm transplant was in the development of drug combinations to suppress the patient's immune system and stop the body rejecting the new limb.
Unlike other transplants, which involve grafting only single organs or tissues, a hand transplant requires skin, muscles, nerves and bones to be transferred at the same time. Skin has been particularly subject to rejection.
"The ability to make skin not reject opens up a world of possibilities," Barker, the university's director of plastic surgery research, said. "We will be able to do virtually any part of the body."
But it is the potential to help people whose faces have been damaged by fire, car accidents, dog attacks or disease which raises the most intriguing possibilities.
At the moment, faces are repaired by grafting skin or bone from other parts of the body. "While what we do now is really miraculous, even after 10-15 operations, the person still won't look like a real person because you can't make another part of the body look like a face," he said. "But if you take the face from a cadaver then we would have not only function, but it would also be cosmetically perfect."
He dismissed fears that the operation will allow wealthy people to get the face of their choice from a dead person. "That type of thing is more from science fiction movies. In most cases there would be no bone damage so all we are talking about is laying the other tissues across the existing scaffolding. Even where we had to use a bit of bone, it would be very unlikely that the whole facial structure would be replaced."
Vivienne Nathanson, head of ethics policy at the British Medical Association, welcomed the potential benefits of the transplants but said their use would have to be carefully thought through.