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Saving Face

Read Wednesday, 18 Dec 2019

Georgia Rose Phillips examines questions of identity and self-image raised by the still experimental field of facial transplants.

Content warning: this article mentions suicide and depression. If you require immediate assistance, free 24/7 crisis support is available: Lifeline (13 11 14),  beyondblue (1300 22 4636). Some external links in this article may take readers to confronting images.

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When Katie Stubblefield woke from her 31-hour-long surgery, she was wearing the face of Adrea Schneider, who had been pronounced clinically dead three days earlier. As she slowly emerged from the unconscious fog of operative anesthesia, her parents watched her movements materialise through a new face. It was a procedure that Katie herself had described as ‘a second chance at life’, before she was wheeled towards the operating theatre.

In 2017, 21-year-old Katie became the youngest successful recipient of a full face transplant (neck to forehead) in the United States. Her features had been left heavily disfigured following a suicide attempt with a gun in 2014. The operation was funded by the US Department of Defense’s Armed Forces Institute of Regenerative Medicine. 

Despite some initial reconstructive surgeries following her injury, in 2017 Katie’s still had a patchwork of skin where there was once a ski jump nose and a gap in the flesh where there was once a broad and inviting smile. Her doctor at the Cleveland Clinic in Ohio, Brian Gastman, described Katie’s facial trauma as one of the most severe he had ever seen.

The extraordinary process of Katie’s surgery was documented in detail by journalists at National Geographic in a long interactive feature article and a video special called Katie’s New Face. The story throws into relief some of our ideas about the cultural and symbolic value of faces. Human faces are inextricably connected, in most people’s minds, with individual identity. But the face in question here – originally the face of Adrea Schneider, now the face of Katie Stubblefield – acquired an additional value as an object, separate from the identity of its original owner. 

‘The face is not only caught between two bodies, two identities and two realities, but it also straddles a realm that is both alive and dead.’

The surgeons begin the intricate procedure by removing Adrea’s face before placing it onto a surgical tray. Katie’s new face waits beneath the clicking cameras and murmuring physicians who congregate to document the process. 

They take pictures of the flesh against the robin-egg blue of the tray’s antiseptic liner. Their cameras peer into the grave stillness of a face that lacks the vivid animation we call life. 

The face is not only caught between two bodies, two identities and two realities, but it also straddles a realm that is both alive and dead. In this moment the face belongs to nobody. It is just a face. Removed from all the social and cultural meaning we assign to faces. The face is waiting to be reconnected and resuscitated by its connection to a human body, its vital organs and its movements. 

The National Geographic documentary special makes clear the extent to which communication is complicated without the freedom of facial mobility. Katie speaks with difficulty, both before and after her surgery. Yet through the video we learn more of Katie’s essence beneath the surface of her features.  

The video offers an intimate glimpse into her family’s inexhaustible devotion to her recovery, too. The pill stacks amount to a modest occupational hazard on the sideboard. Her family reflect on the nature of the life of a professional in-patient. The constant tweaking and revising of medication dosages. The weeks punctuated by medical appointments. The familial bonds they’ve developed with doctors and nurses. Katie’s resilience and commitment to her healing. 

‘This is the beginning of another chapter,’ Katie tells the documentary-makers. Then she pokes fun at her own ‘poetic’ choice of words. We get a glimpse of her light, humorous nature and the moment imbues the transplant with an air of narrative promise. We begin to understand more of Katie’s personality and what a new face means to her. It’s a new beginning; a chance to start over.

As humans, we are the only known species to look in the mirror and form a sense of identity and worth based on what looks back at us. The human face is a palette of expressions, an assemblage of moving features which convey – and sometimes betray – some of the complex mystery of our internal worlds. 

There was much media celebration of the scientific innovation in Katie surgery. There was less consideration, however, of how her experience illuminates some of the deeper prejudices we as a society maintain when we interpret the appearances of others. The phenomenon of face transplants calls into question some culturally embedded ideas connecting our concern for physical identity with wellbeing. 

Eleven months after the surgery, Katie tells her doctors, ‘I feel like people don’t look at me like I am a monster anymore’. The comment suggests Katie feels a sense of obligation to align her appearance closer to the norm, not just for herself but for those she interacts with. 

Collage of dried leaves and torn paper

The first hurdle of transplant recipients is the operation itself. Then it is vital for recipients to undergo lifelong immunosuppressive therapy. While necessary to minimise the risk of the body’s immune system rejecting the foreign tissue, it can lead to increased risks of infection, kidney damage, and cancer. 

The first successful partial face transplant recipient was Isabelle Dinoire, whose operation took place in France in 2005. The relative newness of the procedure means that the long-term side effects and complications are relatively unknown. 

Isabelle’s transplant used tissue, arteries and muscles from an organ donor to reconstruct her nose, mouth and chin. While the procedure restored biological function and sensitivity to her mouth and lips, Isabelle died in 2016 after experiencing two bouts of tissue rejection, kidney failure and, eventually, cancer believed to have been caused by immunosuppressive therapy.

Facial transplant surgeries like Katie’s are still mostly categorised as ‘experimental’ medical procedures. What are the measures of success? In a culture that mobilises around the goal of ‘longevity’, facial allograft transplantation forces us to rethink how we prioritise social and physical wellbeing. It forces us to reconsider whether it is more important to live a long life, or a life that is potentially shorter with greater social conformity.

Face transplants have been subjected to vigorous ethical debates concerning the moral nature of (in some instances) submitting physically healthy people to potentially fatal procedures, mostly for aesthetic gain. On top of this, there is a growing concern for the ethics of deceased donor consent, the psychological challenges of inheriting a deceased individual’s face, and further, the complex privacy regulations regarding donor and recipient familial interactions. 

For most of us, the thought of donating our faces, or accepting a donated face, agitates a conundrum of competing questions. The true implications of facial transplants won’t be truly understood until more recipients like Katie and Isabelle can provide accounts of their experiences. At the moment, fewer than 50 people across the world are believed to have undergone these procedures.

In an interview some years after her surgery, Isabelle Dinoire spoke about what it felt like to look in the mirror and see both herself and the donor. ‘I see a mixture of the two [of us],’ she said. ‘The donor is always with me … She saved my life.’ For Isabelle, receiving a new face seems to have meant if not integrating, then at least honouring, a separate identity. ‘When I feel down, or depressed, I look at myself in the mirror again and think of her. And I tell myself, I’m not allowed to give up. She gives me hope.’

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