Face Reconstruction
Identity Transfer
Altered Identity
Altered identity is often the first concern when a face transplant is discussed with both lay and health professional audiences. There is no doubt that the face, as the central organ of communication, the focus of sexual attractiveness and the means of immediate recognition by others, has a symbolic as well as a functional significance. However the issue of identity is one with which the potential patient group will have already been confronted as a result of their original injury. Severe burns results in a very different facial appearance to which the individual must adapt, and most do so, particularly if they have good social support and develop positive non-avoidant coping strategies.
The question then becomes not altered identity per se, but repeated alteration in appearance. People who have undergone disfiguring injuries such as burns comment on the length of time for resolution and a recognition of the new face as one’s own. Eventually, and this may take many years, identity and appearance become concordant, and people who have lived with an altered face sometimes for longer than with the original become familiar with it and positive about their unusual appearance. In one sense facial transplant is a familiar journey for the recipient, but in another sense, change represents an additional loss and a repeat of a process that may once again last for many years.
The issue of taking on a different identity rather than simply a change in one's own appearance has been argued to be potentially deeply disturbing, not only for potential recipients but for donor families. The extent to which a new face will resemble the donor is dependent on the surgical procedure employed, but this remains a focus of anxiety in both the literature and in sampling of the general public. Popular films such as 'Face Off' do not help in their wildly inaccurate portrayal of probable outcome, not least the complete ignorance of basic anatomy and wound healing.
Butler and colleagues have attempted to model the potential identity transfer involved in face exchange with the use of laser scanning and photography to produce a computer model of the likely recognition potential. Interestingly, researchers in Louisville have employed a different technique, i.e. transfer of free tissue on cadaver to model the same process. Both groups have suggested that the resulting image whilst retaining some of the superficial characteristics of the donor, e.g. facial hair, produces a third face with an identity of its own. This is entirely logical for procedures which preserve the bony architecture of the face and add a tissue envelope with superficial facial characteristics such as facial hair.
How merging the faces of Peter Butler and Alex Clarke appears when the facial skin of one is placed over the bone and muscle structure of the other using computer graphics.
Similarly, Fergus Walsh , the BBCs Medical Correspondent, tested this theory out during his own investigation of the identity issue in February 2006. You can see from the merging of Peter Butler's face with Fergus Walsh's, that again a third identity is created and the original donor cannot be recognised.
To see the whole of the BBC report on facial transplantation please click on the following link: