Blood & Guts – A History of Surgery: Fixing Faces

Michael Mosley performing a facial surgery technique on a Mannequin/dummy

Michael Mosley performing facial surgery on a mannequin/dummy

In the fourth part of the BBC 4 Blood and Guts series, Fixing Faces looks at the evolution of plastic surgery. True to form, Michael Mosley presents a graphic account of how brutal attempts to reconstruct patients’ diseased or damaged faces have led to a modern medical speciality which is now believe to be on the eve of the first full face transplant. This episode describes and illustrates the history of this area of surgery: showing the work of the 16th century Italian doctor Gasparis Taliacotii (00:05:06 – 00:18:02); the beginning of the Botox era (00:18:02 – 00:30:00); and the work of Sir Harold Gillies and Sir Archibald Mclndoe, who developed both surgical techniques and the need for psychological support for patients undergoing reconstructive facial surgery (00:30:00 – 00:50:00) (Please see this Student BMJ article – ‘A brief histoy of plastic surgery’).

This episode highlights two main ethical topics for discussion: functional Magnetic Resonance Imageing (fMRI) and Neuroethics (00: 01:54 – 00:05:06); and face transplants or facial allograft transplantation (00:50:00 – End).

fMRI and Neuroethics (00: 01:54 – 00:05:06)

Michael Mosley being shown images of faces in the MRI scanner

Michael Mosley being shown images of faces in the MRI scanner

MRI scanner images of Michael Mosley

MRI scanner images of Michael Mosley

 

Michael Mosley undergoes an experiment to establish how his brain responds when he sees normal-looking faces compared to disfigured faces, to try and discover why people with disfigured faces are so willing to try anything to improve how they look. He has a MRI scan of his brain while he is exposed to a variety of images. Dr Brad Duchaine, University College London, discusses with Michael how a particular part of his brain, the  amygdala, controls the natural response to fear and disgust, and that when he was shown images of disfigured faces the activity in the amygdala increased significantly. Michael reflects on the results of the experiment and is disappointed in himself as he has always believed that he is a very compassionate person, and never thought he would respond so negatively when seeing the images.

Despite the absence of direct reference to the ethical implications of fMRI, this section of the programme would be useful as a discussion starter. fMRI has raised a number of ethical concerns, in particular the invasiveness of the procedure has implications for individual privacy. Like DNA, the brain has personal and sensitive information locked up inside it and any act to access this can be seen as intrusive. In addition the incidental discovery by a researcher of abnormal brain function or structure raises some ethical issues: Is there an onus on the researcher to tell the participant or their doctor what has been discovered? Further, fMRI could be used to help fight crime by revealing a criminals true thoughts, like a modern day lie detector. Is this a step to far breaching an individuals privacy rights.

  • Do you think fMRI is too intrusive to use?
  • Are your personal thoughts private?
  • Would you take part in a research using fMRI?
  • Should fMRI be used to help fight crime? Who should be protected: the criminal or society?

Full face transplants (00:50:00 – End)

3D image of Michael Mosley

3D image of Michael Mosley

Michael Mosley (left) and Dr Butler discussing Mosley's face digitally superimposed on Dr Bulter's face

Michael Mosley (left) and Dr Peter Butler (right) discuss Mosley's face digitally superimposed on Dr Bulter's face

 

Michael Mosley meets with Dr Peter Butler , who has an ambition to perform a full face transplant believing methods of using tissue from other parts of the body to fix the face is limited because the tissue “looks like where it has came from not where it is going” (Please see Time News article: ‘Full face transplants could be less then a year away, says surgeon’). The programme discusses some of the major ethical arguments  presented by people whom are concerned with full face transplant surgery:

  • Does taking someone’s face take part of their identity too? Is this fair on the dead person?
  • How would the donor’s family feel, knowing that their loved one’s face and identity was with someone else?
  • How would the recipient’s family feel about the new face?
  • If you change your face do you lose your identity?

In an attempt to try and dispel concerns about the recipient assuming the identity of the donor, Dr Butler’s team uses high-tech cameras to superimpose Dr Butler’s face on Michael Mosley’s, and visa versa to illustrate who the recipient would look like. Having seeing Dr Butler’s face on his, Mosley concludes that he in fact still looks very similar to how he did originally, and his identity is not lost. However Dr Butler believes this argument will be irrelevant in 10 years time, with scientists being able to construct an entirely new face using the DNA of the patient via tissue engineering, therefore removing the need of the face donor.

Please also see all other posts transplantation(including face transplants) on the BioethicsBytes website.

Blood and Guts - A History of Surgery: Fixing Faces was first broadcast on BBC 4 10th September 2008 at 21:00 (60 minutes), and repeated 11th September 2008, BBC 4, 00:00 and 22:00, 12th September 2008 BBC 4 03:00. TRILT identfier 00AE933C

(DJW)

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