Plastic surgery: Most people believe their faces intimately reflect their identities. This is why news of the world's first face transplant in France last week raises such questions of self-identity and brings researchers into long-running debate about whether the procedure is worth the risks.
Much public reaction centred on the possible transfer of appearance from donor to the patient.
Doctors asked whether the operation was worth the risk as it requires the patient to take immunosuppressant drugs for life to stop their body rejecting the new face. This medication increases a patient's risk of cancer.
The Irish-born consultant plastic surgeon at the Royal Free Hospital in London, Peter Butler, said the fear of identity transfer could be discounted. Mr Butler and his team plan to carry out a transplant using the whole face shortly. They have produced computer models to show there is no chance of relatives seeing the face of a recently deceased loved one. "The different facial bone structures mean there is no identity transfer."
Mr Butler also researched the issue of consent. "With a new procedure it is always difficult, the dangers are largely unknown. Consent is where you get the patient to a point where they know as much as you do and can made a valid decision based on risk," he said.
The ethics committee at the Royal Free Hospital will shortly reach a decision on the operation and Mr Butler hopes the procedure will be approved.
He said the transplant had a "4 per cent chance of technical failure and this failure is usually apparent within 24 hours". So the main practical concern with face transplants surrounds immunosuppressant drugs.
Mr Butler said research in managing immunosuppressant for external transplants, such as hands, had shown that it was possible to minimise the risks. There have been more than a dozen hand transplants.
New techniques to reduce reliance on immunosuppressant are being developed in France, where the transplant team plans to inject bone marrow into the body of the patient to help her body accept the implant.
External transplants such as the hand also raised a number of psychological issues, with some patients having difficulty accepting the transplant. Mr Butler stressed that only a very small number of patients would be suitable for a face transplant and they would require extensive counselling. He plans to concentrate on patients with very severe burns.
"We will be dealing with patients at the end of the reconstructive process for whom there is no other option.
"This is not a cosmetic procedure. The patient will only have 80 per cent functionality in the face at best."
Michael Earley, consultant plastic surgeon at the Mater and Temple Street Children's Hospitals in Dublin, dealt with many of the concerns when compiling a report on facial transplantation for the Royal College of Surgeons in 2003, as president of the British Association of Plastic Surgeons.
That report found the risks to the patient were unacceptably high.
However, since then, advances in immunosuppression had made the procedure more viable, Mr Earley said.
"It is always difficult to be the first. Dr Christian Bernard came under huge criticism when he did the first heart transplant. Now it is commonplace and I expect there will more face transplants."
While the medical expertise for face transplants exists in Ireland, Mr Earley said the number of suitable Irish candidates would be so small that they should be referred to hospitals abroad doing the procedure regularly.
