Debate on “Face On”Full Face Transplant

A Science Fiction or Reality

by

Dr. Vijay SharmaPresident - International College of Cosmetic Surgery

16 October 2000Before Acid Attack

17 October 2000After Acid Attack

27 October 2000During Treatment When …?

17 October 2000, the sky was blue, birds were singing, butterflies flying in the garden, sun spreading the shine of happiness of life.

A beautiful girl having dreams in her eyes, courage in her heart, and passion for the surroundings.

Everything was going the way she wanted. She had never thought an accident could change her entire life drastically.

A heinous crime of acid attack on her face committed by local goons, turned this beautiful child into a life long sufferer and threw her into a prison of ugliness forever. This is a real story of a beautiful child, Ms. Poonam Singhal.

There are thousands of young girls with beautiful looks paying the penalty for not accepting the offers of street Romeo’s and thereby becoming victims of crime in developing countries like India, Pakistan, Bangladesh and other third world countries.

The law has still not formulated sufficient punishment to curb this heinous crime of throwing acid on somebody’s face and therefore the entire responsibility falls on the medical world.

Doctors, hospitals and nurses keep dressing these victims for years and years together.

Subjected to torturous humiliation, painful surgical sessions, associated with terrible sleepless nights, cries and tears, she had been operated for :

1. Debridement of devitalized tissue over face, both eye lids, left side of chest, multiple drill holes over the outer table of frontal bone.

2.      Skin grafting done over face, left breast, neck and left arm. Bilateral Tarosoraphy done. Delay of groin flap done for future use on forehead.

3.      Skin grafting of raw areas done. Correction of ectropion of both eyelids done and raw areas were skin grafted. Both angles of mouth were released and skin grafted.

4.      Neck contracture released and skin grafted. Ectropion of upper and lower lip released and grafted with split skin.

TODAY QUESTION IS ?Is this the only treatment available…………………………………

Or……………………………

Scope for some new innovative………………………………..

If yes …………………………….

Then ……………………….

What………………………?

What best………………………….?

And what next……………………………..?

IS FULL FACE TRANSPLANT A FEASIABLE CONCEPT…….?

Full Face Transplant A Science Fiction or RealityToday I want to begin a world debate on “Full Face Transplant”. The question, “Technically can we do it ?”, is not important but “Ethically should we do it and for whom ?” is more important

TodayAcid Burn Victim

Future Full Face Transplant

Yes, today the world leaders of Restorative and Cosmetic Surgery, learned veteran surgeons and all invited guests are welcome to give their valuable opinions & suggestions about this debatable matter of “Full Face Transplant” which is no more a science fiction but a reality.

With the availability of computer advance imaging, microsurgical techniques, immuno-suppressive drugs, endoscopic surgery, laser therapy and new surgical techniques, “Full Face Transplant” is no more a dream but a reality which is possible now. There are still a lot of other aspects to be seen, discussed and concluded.

WHY PARTIAL DERMOLIPOMATOUS GRAFT AND HOMOLOGOUS

TRANSPLANTATION IS NECESSARY?

•Any other Superficial Skin Graft does not give the same configuration

•Continuity of face is broken•Aesthetically does not do justification.

FIRST AUTOLOGUS FULL FACE TRANSPLANT DONE IN INDIA ON 23RD JULY 1994 BY DR. ABRAHAM THOMAS IN CHRISTIAN MEDICAL COLLEGE IN LUDHIANA.

EXISTING PLANNING OF SKIN GRAFTING AFTER DEBRIDEMENT

EXISTING AUTOLOGOUS FULL THICKNESS SKIN GRAFTING

AESTHETIC DISTRIBUTION OF UNIT AUTOLOGOUSGRAFTS

PLANNING OF FULL FACE TRANSPLANT

Partial dermolipomatous graft

Homologous transplantation (human to human)

ARTERIAL STRUCTURAL DERMOLIPOMATOUS VASCULAR PEDICLE FOR FULL FACE TRANSPLANT

COMPOSITION OF FACE SOFT TISSUESOFT TISSUE OF FACE IS MADE UP OF FIVE COMPONENTS

•SKIN•FAT•MUSCLE•VESSELS•NERVES

FACE CAN BE CLASSIFIED IN TWO AREAS

1. Where skin is directly attached to the muscles – Skin Muscle Fat - SMF

2. Places where fat exist between skin and muscles – Skin Fat Muscle - SFM

WHY FULL FACE TRANSPLANT IS NEEDED?

HOWFULL FACE TRANSPLANT CAN BE DONE?

PLANNING OF VASCULAR DERMO-LIPOTUS PEDICEL GRAFT OF FACE MASK FROM DONOR

NERVES OF THE FACE AND THEIR CATCHMENT AREA

IN FULL FACE TRANSPLANT IMPORTANT GLANDS TO BE TAKEN CARE

IN FULL FACE TRANSPLANT IMPORTAMNT MUSCLES RESPONSIBLE FOR FACIAL EXPRESSION

DIFFERENT EXPRESSIONS OF THE FACE

Debatable Points a). Medical Technique Dermolipomatus Graft with vascular pedicle, Micro Surgery,Laser Surfacing, Immunosuppressive therapy Computer Imaging. Tissue Matching

b) DonorsTerminally ill patientAccidental victimClone

Here is a hypothetical presentation of advanced computer imaging for “Full Face Transplant” operation to transform existing histological dermo lipomatous tissue of Ms. Poonam Singhal based on imaginary “Full Face Transplant” from a donor, who could be a terminally ill young female child or recently died female child or an accident victim with preserved face and whose tissue should match the recipients tissue.The transplant should be done in a well equipped hospital.

Face Today Face Tomorrow

HYPOTHETICAL PRESENTATION OF “FULL FACE TRANSPLANT”

THE TRANSPLANTATION OF HUMAN ORGANS ACT 1194

Assented to on 8-7-1994 Act No. 42 of 1994

Bill No. LIX-F of 1994

(AS PASSED BY THE HOUSE OF PARLIAMENT – RAJYA SABHA ON 5TH MAY 1993) LOK SABHA ON 14TH JUNE, 1994. AMENDMENTS MADE BY THE LOK SABHA AGREED TO BY THE RAJYA SABHA ON 15TH JUNE 1994

GOVERNMENT OF INDIA

TODAY TOMORROW

Debate on “Face On”Full Face Transplant

A Science Fiction or Reality

16 October 2000Before Acid Attack

17 October 2000After Acid Attack

20 October 2000During Treatment When …?

COSMETIC SURGERY CENTER OF INDIA

Vishal Mandir Plot No.350 6th Road Off Linking, Road Khar (W) Mumbai-400052. INDIA Tel.: +91-22-26491022 / +91-22-26044543 Fax: +91-22-26041353 Mobile: 9869006534

www.changinglooks.com Email: drvijaysharma@vsnal.com

Brief Introduction of Maharashtraratna

Dr. Vijay Sharma, M.B.B.S, M.S. Cosmetic Surgeon

• Best Aesthetic Doctor in Asia – 2000, Tokyo, Japan

• World Leader of Cosmetic Surgery in India 2001 Berlin, Germany

• Fellowship of Australian College of Cosmetic Surgery, 2002

• President – Indian Association of Cosmetic Surgery

• President – Federation of Restorative And Cosmetic Surgery

• Among the Top Ten Cosmetic Surgeon of The World, 2003, (NBSAS)

• Professor and Board Examiner of International Board of Cosmetic Surgery

• Eminent Personalities of India by International Biographical Research Foundation

• Eminent Author – International Journal of Cosmetic Surgery & Aesthetic Dermatology

• Author of books, Changing Faces, Saundarya, USSA , Hyper aesthetic tension

• Record Holder in Limca Book of World Records for highest Cosmetic Surgeries, 2003

• Holder of Limca Book of World Records for First Human Fat Tissue Bank,2003