Last November, surgeons in France successfully performed the world’s first face transplant surgery. Ten days later, Chen Huanran in Beijing began soliciting patients who were ready to accept a face transplant, searching for China’s first such patient through an advertisement on his website and other channels.
Chen, chief orthopedic surgeon at the Plastic Surgery Hospital under the Chinese Academy of Medical Sciences, has conducted more than 300 transsexual operations and was considered one of the top competitors in the running to perform China’s first facial transplant surgery. However, surgeons at Xijing Hospital in Xi’an were first, performing a partial face transplant on Li Guoxing in April.
Beijing Review reporter Feng Jianhua recently spoke with Chen on the future of face transplants in China.
Beijing Review: There are reports that China’s first face transplant surgery has been a success and it is claimed as the world’s first male face transplant. As an experienced plastic surgeon, what do you think of this event?
Chen Huanran: The success of the face transplant operation is a breakthrough for plastic surgery in China so we should admit its positive value. However, we should also give a concrete analysis of the discussion of the world’s first male face transplant surgery. If a female face is successfully transplanted onto a man’s face, the surgery will have history-making significance. If the surgery only transplants a male face to another man’s face, it is pointless to make a fuss about the gender of the recipient. In fact, China’s male face transplant surgery is no different from France’s female face transplant surgery in terms of clinical technique.
China still has no integrated national certification system to establish whether surgery can be performed or not and what are the standards of success. I think the face transplant in Xi’an has only achieved success in terms of changing a face and has no practical meaning because such an operation can be successfully undertaken at almost all provincial hospitals. The key of the surgery, and the biggest problem as well, is for the patient to regain all kinds of facial functions and this takes at least six months. Hence, I think that we should not be too optimistic about China’s face transplant.
At present, face transplant surgery has become a hot topic around the world. How do you define “face transplant” and what do you consider the standard of success?
Face transplant surgery is a hot topic mainly because, compared to other parts of the body, the face has many special features and is always paid more special attention as an important symbol of a person’s contact with others.
According to reports, an international definition of “face transplant” will be determined in the near future. I think that a real “face transplant” refers to the anatomical transplant of the whole face, including all organs of face, but not a partial transplant.
In my opinion, the success of face transplant surgery relies on the thorough change and reconstruction of the facial skin, subcutaneous tissue, muscles, bones and nerves and blood circulation systems.
What are the main difficulties for face transplant surgery at present?
There are many problems that have not been solved. We can even say that we have only edged toward a proper face transplant. The first problem is immuno-suppression and rejection. Although such a reaction will appear in transplants of all kinds of organs, it will be much more serious for the skin because skin is the most sensitive part of the body.
Face transplant surgery faces four main problems--recovery of nervous function, facial expressions, and color and sensitivity of the skin. After the surgery, although all blood vessels have been connected, the nervous system may still have no function because nervous cells cannot regenerate themselves. Take muscles for example. Facial muscles have a memory function so that they still remember the original body’s information and it is difficult for them to adapt to their new hosts. Under such conditions, psychologists and rehabilitation experts are required to participate in the treatment.
Since face transplant surgery is so problematic, why are you still actively preparing for it? Now that the first transplant has taken place in China, do you intend to further promote your plan?
As a kind of scientific exploration, everybody wants to be the first to do it. Such factors as underdevelopment in technology cannot stop us pushing forward to face transplants. However, we must abide by the principle that the advantages must outweigh the disadvantages. Given the problems I mentioned, the result of this operation may be harmful to patients but the exploratory spirit should be encouraged. Hence, if we keep the operation within a certain range, its advantages will be more than its disadvantages. That is, we should regard the operation as a scientific exploration but not as an experiment aiming to push the surgery into larger practice.
If there are suitable face sources, I will conduct such an operation. I believe that facial transplant surgery will be generalized to a larger range of cases after applicable laws are developed and completed. However, when we conduct such operations, we must first and foremost respect the patients’ privacy and tell them the worst possible scenario because there will be many more problems after the face transplant than before the surgery, according to current surgical techniques.
Can you share some details of how surgeons prepare for a face transplant? Have you encountered any pre-surgery problems?
At present, the biggest problem I’m facing is a lack of face transplant sources. After I put the “face donation” announcement on my website, more than 10 people contacted to say they want to donate their faces after death. However, these persons are still alive so I don’t have access to the sources right now.
It’s a very complicated process to obtain face sources. Although the government has established an administrative regulation on organ transplants, it is hardly workable and does not include face transplants, presenting many obstacles to our work. For example, an old man in Beijing said he was ready to donate the face of his wife, who had been dead for a few days. However, because there is no clear law or regulation concerning facial transplants, as a hospital, our hospital had to abandon this opportunity. To the contrary, maybe some local medical institutions have more flexible methods to grasp such chances.
What is the current process for face transplant surgery?
Because of the lack of applicable laws and regulations, there is no uniform process for facial transplant surgery. According to the principle of “no penalty without a law,” any hospital can conduct a face transplant without the authorization of an administrative department.
However, in practice, regarding the principle of self-discipline, hospitals will apply to their senior administrative departments of health. At our hospital, for example, we should go through three steps. We should first apply to the academic committee of the Plastic Surgery Hospital. After this application has passed, we should apply to the professional committee of the Chinese Academy of Medical Sciences. At last, when that application has passed, we should apply to the Ministry of Health and wait until the proposal has been approved by its ethics and legal committees before performing the surgery.
Some worry that lower quality medical institutions will abuse the capacity to perform face transplants in order to earn money, taking advantage of the lack of relevant laws. What do you think of this concern?
I have no such worry. At present, face transplant surgery still remains in the experimental phase, and most hospitals will not continue to undertake such surgeries after conducting one or two face transplants. I have mentioned that there are many complications after the surgery. So hospitals will be cautious in conducting such surgeries and they will not take chances.
How do you think the Chinese Government should regulate and promote the development of face transplants?
A related issue is that the practice of recognizing a person’s identity by his or her face in our country must be changed. In 2001, one of my patients went to New York for higher education. When she was ready to leave the airport customs, the police stopped her because the photo on her identity card looked unlike her. She had just received cosmetic surgery in my operating room and the police could not recognize her. At last, the customs let her go, after our hospital provided a medical certification with Chinese and English explanations, but she had missed her airplane and had to take the next one.
As well, I have met many people who want to avoid legal responsibilities and have asked for a face transplant. As a doctor, I have no thoughts of refusing them because they are only patients in my eyes and I do not distinguish between good and bad people. According to this condition, I think the government should establish a regulation to prescribe that people who want to undergo face transplant surgery must receive a certificate from the local public security agency. Of course, because face transplants involve many problems, the Central Government ought to establish a special law or regulation.
A face transplant is such a complicated procedure that no one hospital has the ability to do it alone. It takes the cooperation of many scientific fields to achieve it. In my opinion, in the next eight to 10 years, face transplant surgery will not make big breakthroughs and, because there is no chance of the surgery becoming popular, the government will not pay much attention to such a matter.