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Modern advances in medical technology have brought miracles from sci-fi adventure films closer to reality. While the world’s first full face re-plant is said to have been done in India itself — by micro-surgeon Abraham Thomas who reattached nine-year-old Sandeep Kaur’s face which was hacked into two by a threshing machine — face transplants are yet to come to India. A medical procedure to replace all or part of a person’s face, the world’s first partial face transplant on a living human was carried out in France in 2005. France, the United States and Spain are considered the leading countries in face transplants, though the procedure is still in its infancy. An alternative to a face transplant is facial reconstruction achieved through surgery. This commonly involves moving the patient’s own skin from other parts of the body and grafting in on the face in a series of operations to reinstate limited functionality and some presentability.
Reva, a state-of-the-art aesthetics clinic recently launched in New Delhi, will be offering services for face and body enhancement (in phase I) and surgical procedures (in phase II, six months later). Led by Devinder S Mangat, a cosmetic surgeon with a successful practice in Chicago, Reva’s doctors, all trained in the US, will try to help people with facial disfigurements. As a part of a social responsibility initiative, Reva’s founder, Jaz Brar, is in the process of tying up with NGO Stop Acid Attacks “to reach out to victims, in order to bring normalcy to the lives of girls who have been traumatised by such attacks”. One victim every year will be treated for free at Reva.
The Indian subcontinent, Vietnam and Cambodia are infamous for the highest incidence of acid attacks in the world. According to London-based charity Acid Survivors Trust International, 80 per cent of the victims are women. An acid attack burns the face, damaging skin tissue, exposing and sometimes dissolving the bones. The long-term consequences of these attacks include permanent scarring of the face and body. “Ideally, a full face transplant would be the best solution for such patients. But globally, we are not yet at that stage where face transplants can be commonly carried out,” Mangat adds.
Reva’s facial reconstruction will include skin grafting, using tissue expanders to cover burnt tissue with normal tissue, reconstruction of ear, nose and lip, hair and eyebrow transplant, and treating traumatic deformities resulting out of assault, automobile accidents and animal attacks. The type of deformities that can be treated include hypertrophic scars, eyelid, ear and mouth distortions, congenital deformities, nasal deformities and general scars. According to Mangat, “Because of newer surgical techniques, facial reconstruction is constantly progressing and over the last decade or two, the availability of tissue expanders and the use of lasers have allowed us to do a much better job of reconstructing difficult areas. In some situations, micro-vascular techniques have allowed us to treat deformities that previously could not be treated.”
Devinder S Mangat, cosmetic surgeon and head of medical team at Reva
Even though, facial reconstructive surgery is covered under medical insurance, most of the victims in India are unable to afford the treatment. This is where donors and benefactors step in. Alok Dixit, co-founder, Stop Acid Attacks, has high hopes from the tie-up with Reva. “It sounds like a good initiative, it’s heartening to see a response from civil society,” he says. In the most severe case of acid burns, rehabilitation can take 20-30 surgeries over 3-4 years. Government medical professionals, according to Dixit, neither plan the surgeries well nor give cosmetic appearance any priority. Often, therefore, a victim’s face starts to look like a patchwork after all the multiple surgeries have been performed. Rupa, who survived an acid attack in Faridabad in 2007, has already undergone seven surgeries from different hospitals and hopes to finish the ultimate one at Reva.
Mahesh Mangal, chairman, Plastic and Reconstructive Surgery, Ganga Ram Hospital, New Delhi, explains why face transplants have not come to India yet: “The face is not defined within the Transplantation of Human Organs Act, 1994.” A full face transplant involves a medical body taking the initiative and an ethics committee reviewing it — losing your facial features and taking on somebody else’s may seriously affect the patient’s mind on psychological, emotional, social and physical levels.
While the technical operation itself is very significant, it is the post-operative care and rehabilitation (both mimetic and psychological) that play a major role, according to Mangat. A normal organ transplant, be it liver, heart or kidney, lasts 10-15 years on average. So, in the case of a face transplant of someone who is 20-30 years old, there is a good chance of the transplant failing within a decade or so. Acceptance of the transplanted tissue by the body is another facet. Despite finding a good match, there are always chances that the body’s immune system will reject the transplant. The patient then has to be put on a high doses of immunosuppressant drugs, which are very expensive as well as toxic. Hence, Mangal concludes, “It’ll be some time before the idea of face transplants for non-threatening problems finds acceptance in medical society in India.”
