How Face Transplants Work

Believe it or not, scientists and doctors have discovered a way to transplant part -- or all -- of a face from one person to another. Tune in to this podcast from HowStuffWorks.com to learn more about the astonishing practice of face transplants.

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Episode Transcript

Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to Stuff you should know
from house Stuff Works dot Com. Hey, and welcome to
the podcast. I'm Josh Clark. There's Chuck Bryant. I gotta
come up with something new, Chuck. Now you say there's
like there, it goes like I run by the Ah, yeah,

(00:23):
we'll figure this out. Maybe when we're not recording, we'll
just take the extra effort. That means we'll have to
speak outside of this room. Now, Yeah, we don't do that.
We're like Pete Townsend and Roger Daltery they do that,
or like the Gallagher brothers from Oasis. Yeah, they hate
each other, but when they get together it's like your gold.
You know, it's magic man. So, Chuck, have you ever

(00:45):
seen then John wou movie Face Off? I have not
good Chuck. You want to talk about face transplants? Yes,
you remember Travis the Chimp. It was like my first
blog post ever. Ah yeah, yeah, that chimp that went
crazy and Hampshire. Yeah, well apparently he tore that woman's
face off. Yeah. There There was a transcript of the

(01:05):
of the nine eleven call and one of the cops
is like, you need to send an ambulance out here.
There's a man down. He is in trouble. The guy
couldn't even tell it was a woman, like her face
was pulled off. Um and uh. One of the things,
one of the first things I heard after the detail
at Grizzly Detail emerged was that this woman would likely
get a face transplant. Right. And I'd heard of him,

(01:28):
but vaguely, and hadn't really put much thought into a
face transplant, you know, I remember just from and we'll
talk about her later. But the French woman was the
one that came to mind. I hadn't heard about her.
I wasn't paying attention, I guess. And what two thousand five,
That was a rough year for you, it was, let
me think, pretty hazy. Huh, Holy cow, I lost two

(01:49):
thousand five. I'm gonna have to give some thought to
this while we're practicing new intros, right, okay, so um,
so yes, this this poor woman who was attacked by
this rampaging chimp, who was eventually shot to death by
the police. Um, we'll likely get a face transplant. And
we just so happened to have an article on the
site appropriately titled how face transplants work. And that's what

(02:10):
we're gonna talk about today, right. Yeah. I love this article.
By the way. It was gruesome. It was gruesome, but
it was really I don't know, Stephanie Watson wrote, it's
just really well written. It is well written. I agree wellheartedly. Um,
there's all sorts of pictures, um. And actually there's an
illustration like that I did too. Yeah. Um, the faces
kind of draped over the skull. I like the face

(02:32):
on ice. Yeah. Yeah, that was the best one. I think.
I wonder if Marcus did that one. We'll never know.
We'll never know, no, so chuck um there. The first
successful transplant of any kind was what nineteen and there
was a physician I think he was in Boston named
Joseph Murray, and he carried out the first successful kidney transplant.

(02:53):
And he did it using identical twins, which was the
key early on, like people had tried transplanting things before.
But you know, in the transplant went well, but ultimately
the body rejected it. You know why, Uh, I want
to hear your explanation, pal, Well, it's because the body
isn't very receptive to foreign tissue. So when you get

(03:14):
we're back in those days when you would get something transplanted.
Your body sees that as a foreign invader, just like
it would a disease or something, and the white blood
cells kick into gear and just go into attack mode.
The body no likely foreign invaders now, But if you're
identical twins, um, you had enough of a match to
where it worked out. Right. The problem is that most
people who need transplants don't have identical twins, so it's

(03:36):
a it's a terrible way to you know, establish medical procedure,
but it was a good way to starting well sure,
and it was successful. He showed that you can transplant
human tissue from one person to another and it be successful.
So that was like the real milestone. Uh. And then
after that, you know, people started exploring other ways to
do this without uh, you know, um, identical twins. You

(03:59):
know how I want to hear your explanation. Well, you're
really piping up today, aren't Uh. By the nineteen sixties,
what they figured out is that they could suppress your
immune system. Then you could using drugs like a cyclosporine,
you could you could be successful with the transplant. And
what they're trying to suppress their things called and egens,
which are proteins. They're found on the exterior of uh

(04:25):
tissue tissue cells, right yeah, um, and and those are
the things that create that prompt an immune response. So
they're the ones that sense like, well, whoa, whoa, I
don't remember this hand being here before we lost our hand.
What's going on here? Go get rid of that hand, right,
And then the white blood cells attack like the cavalry,
which is awesome. I mean, it's great. It's cool that
your body does this because that means you have a

(04:47):
robust and violent immune system. Of course, if you're trying
to get a transplant, it's no good. But you want
your body to go after things with bigger like yeah,
like mersa, you don't want that, no, no, but yeah,
if you have a hand, you you you wish you
could tell your your antigens to just settle down. It's
your new hand and you're pretty fond of it to

(05:08):
keep it right. So, so the problem is the the
drugs that they came up with were immune suppressive, meaning
okay that the antigens are no longer being prompted to
attack the hand or send the white bloods also attack
the hand, but they're also not being prompted to go
attack the mersa bacteria that's in your body. Now, Um,

(05:29):
you left you susceptible to other problems that pretty much
everything else. I mean, how many uh, bacteria and viruses
just germs in general do we come in contact with
any every day and we don't even notice? Like we
did that one on toads causing wards and like twenty
million people have the human pablova virus and um, you know,

(05:51):
very few are actually suffering from it. We don't even
know where carriers because their bodies can ward it off, right,
So we had to come up with something better, and
they did, but it was along the lines of immunosuppressive drugs.
We just got the most slightly more refined, right Exactly.
Once we had that down, we started really going crazy
with heart transplants transplants. Eighties and nineties is when they

(06:14):
really kind of started mastering this whole technique, right, And
then after that, after the vital organ transplants, we started
getting into those hand transplants. I gotta tell you, I
find that fascinating. Very Look, Skywalker, S know you're gonna
say that, thank you. You know me so well, well,
the way you're doing your hand, it was like the
scene from the movie. Yeah, it looks like it. Oh yeah,
they can't see okay. Um. So, so inevitably we end

(06:38):
up at facial transplants and it took a little while,
but really, if you think about it, we went from
the first successful kidney transplant to the first successful face
transplant about fifty years. Not bad. That's pretty quick. Yeah. Yeah,
So so let's talk about you want to talk about
that poor girl in uh sound deep coo are or Josh.

(07:00):
She was nine years old in northern Indian. She was
chopping grass to feed her buffalo, her family buffalo, which
is a noble pursuit very much, and her hair got
caught in the threshing machine and basically pulled her entire
face and scalp and hair right off of her, clean
off of her. Yeah, and and her family reacted promptly.

(07:20):
They threw her face into a bag, put the girl
on the back of a moped and drove to the
closest hospital, which was three hours away. So they drove
their faceless, scalpless, hairless daughter to the hospital on a
moped for three hours, and the doctors took a look
at her and we're like, we can't do skin grass.
This girl is never going to function properly again. So

(07:42):
they actually put her face, scalp and hair back on
and she she's functioning. Yeah. Actually, just I saw a
picture of her at nineteen on the internet. She looks good,
you know. I mean, there's some scars, obviously, and I
think her right eye has a little bit of a
droop to it, so, I mean you can tell, but
you know, if your face has been pulled clean off
by a treasure, you really can't complain about the little droopy.

(08:05):
I so that that was technically the first facial transplant,
but the first real transplant from a donor came in
two thousand five. Can I handle the grizzly details on
this one please. There's something that I noticed in researching
how face transplants work, and that is that all face
transplants begin with a horrible, gruesome event. Yeah, there's really

(08:28):
no way to lose your face unless there's some horrible accident.
And even if there's like a disease, it's a ravaging,
horrible disease to like tumors or something, or the well,
the elephant man disease. I think it is what they
call it. Yes, he was not an animal, no um.
So this woman was named Isabelle Dean Noir and uh,

(08:49):
she's a frenchwoman. And in two thousand five, she popped
some sleeping pills, passed out on her couch and she
woke up. I don't know if this is a normal
habit of hers or not, but she woke up, and uh,
I went to go light a cigarette and found that
it kept falling out of her mouth. She didn't know
what was going on. So she goes to the mirror
and the lower half of her face I took from

(09:10):
below her nose down was gone. She was nothing but
like tissue and teeth. And apparently, from what I understand,
and I know you know something different, I'd like to
hear it. From what I understand, her black lab chewed
the bottom of her face off while she was sleeping. True.
Is that true? It is true, But there's and I

(09:30):
couldn't get a straight answer. I read a bunch of
articles and follow up articles on this today and I
still didn't get what I think is the absolute truth
of what happened. Some people um claimed she was committing suicide,
and then the doctors denied it, but then one doctor
said that she had tried to commit suicide. And um,
then the the whole dog situation. You know, black labs,

(09:53):
I mean, you're a dog guy. They aren't to believe
that a lab would do that, right, So what they
think might have happened was she was out and the
dog was concerned because they thought she was dead, and
was pawing at her face and became really agitated and
upset and pawed and scratched to the point where you know,
there was blood probably, and then started chewing up like

(10:16):
trying to evidently trying to wake her up. But there's
speculation about that too. But they but they think the
dog did do it for some reason or another. They
think the dog did it for a reason, trying to
arouse her from her slumber. Um, because I think I
read someone else said that you'd have to be so
far out of it to not wake up with that
kind of pain sensation that it had to have been

(10:38):
a suicide attempt. So I thought it was a little
odd that she took pills and fell asleep on the couch, right,
I mean, yeah, And then she came out later and
said that she hit her head and was knocked out,
so I'm not exactly sure what happened. All I know
is the dog was put to sleep, which really is
upsetting to me. That is upsetting, especially if it was
trying to rescue her. I mean, the whole thing is upsetting.
Regardless of what happened. Isabel Dean Noir got a face transplant.

(11:02):
She did. Indeed, h this is the first major news
uh worthy face transplant, which I still didn't hear about.
That was a rough here for you. Um so uh.
Apparently they could have taken tissue from her chest to
repair the damage, but she wouldn't have had very much movement, right,

(11:22):
It would have just looked like a face, but not
really exactly a fake eye or something. Right. But they
what they want is feeling and function going on. They
wanted to be able to smell and feel and have
all the senses reacting, and that's the ideal. Most surgeons
are perfectionists. Yeah, So, so what they did was they
found a donor. Here's what we're getting to, the ethical aspects.

(11:44):
Can we jump ahead and move around a little bit please? Okay,
there's the only person who can be a face donor
is one who has to be on life support on
life support, Well, someone has to be alive, right, but
but you wouldn't give up your face? Sure, no, no
one's that. I just want to get specific. It has

(12:05):
it has to come from a live donor, and the
only scenario where that could happen is if you're brain
dead on life support and then the family has to
agree to pull the plug essentially, right, And remember we
did the how comas work and we were we were
positing whether or not people feel pain in deep vegetative states,
and you gotta hope not when they're taking your face,

(12:25):
because that's exactly what they do. They go to the donor,
they moved the donor into the operating theater, they take
the face off. I imagined they cut around the scalp
and then down behind the ears, maybe in front of
the ears, whatever, below the chin, and that would be
a full face transplant, as our illustration shows, they put
it on ice. Well, this was a partial face transplant, okay,

(12:47):
so it would have been like the lower part of
the face. But whatever part of the face you need,
whether it's full or partial, it would be cut off removed,
depending on whether or not any of the connective tissue
was needed. Still any bone, any fat muscles, all of
that stuff may be taken as well, and then it's
again put on ice or whatever, transported to wherever the

(13:09):
recipient is. And then all of these things are reattached.
Blood vessels are reattached, a connective tissue, all this stuff. Um,
and you have to do it in such a way. Well.
Number one, skin tones kind of a big, a big consideration.
To find a match. Um, you want to find somebody,
you have to do h l a testing or matching,
which is that antigen testing to make sure that that

(13:30):
you have a similar enough immune system that there won't
be a rejection. Um, you may have to put bone down,
as was the case with a Chinese guy in what
two thousand six and uh, he was malled by a bear? Right,
what what is going on? Right? He was malled by
a bear. And this was a unique case different from
the French woman because he was missing skin and part

(13:54):
of the bone in his nose and cheeks. He was
a huge challenge. Hers was just skin in and his
required quite a bit more. And we're talking like teams
of fifteen to twenty doctors over the course of fifteen
to twenty hours. Well with Madame de Noir. She had
a team of fifty doctors. They started at ten thirty

(14:16):
at night and they finished at four the next day,
four after four in the afternoon, went straight through the
irony is as if she did try to commit suicide.
Her face was donated by a woman who failed in
a suicide attach. Yeah, how about that. Yeah it's a
little odd, but yeah, okay. So they they also practice
the people of rats, cadavers, rabbits. There's a picture of

(14:39):
I guess one of their test subjects, a rabbit with
a face transplant on page zero, the first page of
this article, and it's just cute as a button. But
it's also furry. We don't have the luxury of fur
as humans, so they kind of have to do a
relatively good job reconstructing a face, and it usually takes
more than once. They'll be several phases of surgery. Yeah,

(15:02):
it shows, uh, And I've seen pictures of the frenchwoman
over the course of different surgeries, getting better and better. Um.
What I thought was interesting was that once you have
the surgery, you need to be on these immuno suppressant
drugs for the rest of your life. So it's it's
good that you're able to live through this and get
a new face. But these drugs also put a serious
DNT and your ability to survive and live a long

(15:24):
life right, And apparently Madame de Noir is not really
helping things along. She refuses to quit smoking, and I
thought you might respect that, and the doctors are like,
come on, she smoked pretty soon afterward too. Yeah. Well,
I mean, if you're a smoker, you're a smoker, dude,
face transplant or no, I guess. So. Yeah, my first
father in law got like shunts put in. He was
smoking and golfing like a couple of days later. Really,

(15:47):
he just wouldn't stop heart shunts. I should say, okay,
cardiac shunts. Um. Now, Josh, these are all partial transplants,
even in the case of the one from China, and
as of the writing of this article, we actually need
to update this article. There were no full transplants, but
there have been since then. Chuck, I have to say
you were killing it today the external research. You corrected

(16:08):
me at least once, if not twice. I am proud
of Chuckers compass head hearts Chuckers um. So yes, Josh,
I'm ignoring your praise there have been two transplants that
I know of. There may be more, but I've noted
a couple that have happened that are full facial transplants.
One of them was a woman in Chicago who they
haven't named, keeping that quiet, who the doctor basically said

(16:31):
she didn't have a nose, she didn't have a midface
at all. And they were able to transplant Josh almost
eighty three square inches of skin with muscle bone, upper lip,
and nose from the donor still attached. Isn't that amazing?
And Uh, the Cleveland clinic is where all this is
going on. Man, if you need a face transplant, you

(16:52):
want to be in Cleveland. Uh. And then there was
a man, a Frenchman who had the elephant man disease. Yeah,
I see you have a sure there, kenseee wow played
a difference yea. And this was just um March of
two thousand and eight. He had a transplant and new lips,
new cheeks, new nose, new mouth. We should we should

(17:15):
publish this that that before and after photo and a blog.
After the blog, this podcast comes out. What do you think? Yeah,
let me look and see if we can get right. Yeah,
I think we can. But yeah, though, so apparently they
can do full facial transplants now, it's it's an amazing
and amazing thing. Well, that brings up another ethical concern besides,
you know, taking the face of somebody who's not dead

(17:35):
but his brain dead. Um. The other ethical concerned that
that some parts of the medical community worry about is
what happens when the wealthy are like, you know, I
don't want collagen or botox. I'm just gonna get a
facial transplant from a poor, brain dead person. You know,
I'll pay the family like dollars and take the face.

(17:58):
I saw that in the article and don't buy it
because right now, like, they do a good job with
these transplants, but the end results certainly doesn't. You know.
If you're like, if your aim is to be extremely
handsome or beautiful, that's not what you're gonna get right
now with a face right now. Sure, but again, Chuck,
we went from the first kidney transplant to face transplants

(18:19):
in fifty years. Where are we going to be fifty
years from now? And I mean, really, is there anything
stopping vanity? No, there's not. And it's especially especially if
we harness um genetics so that we can age right,
we can we we we harness longevity, um, but we
still kind of age poorly. You don't think that people

(18:39):
are going to pay for a face transplant by e
D if we're living to like one twenty on average.
What I think will happen by in fifty years is
there will be other ways to make yourself beautiful. Like
you said, to stop the aging process, there will be
other ways besides uh, finding a beautiful brain dead person
to take their face. I think that's just that's just me.
We'll see, of course, you know, learning I'll be long gone.

(19:01):
Both of us will check. Yeah, I think I'm going
first too. Don't make your face no, And actually, let
me also say this. This is such a tangential aside.
Did you know that if you are an organ donor,
you should and you have a problem with your head
being used for cosmetic surgery practice, you have to specify
I do not want my head use for cosmetic surgery practice. Yeah,

(19:25):
because they if you go into a med school that
focuses on cosmetic surgery heads and they practice on you
doing faceless and stuff. Interesting. Yeah, so organ donor, and
actually I need to make that little caveat there, like,
do not use my face, it's too pretty. I wonder
if I noted that you can use my face, but

(19:46):
let me wear my flat cap. That would be cool. Yeah,
it would like your tongue hanging out in one eye
open still but your flat caps on cool to the end. Nice. So,
of course, the best thing you could do is learned
to be pretty on the inside, and then you wouldn't
have to worry about anything unless you're all. Buy a bear,
your black live, choose the bottom of your face off.
Then you get a pass for the face transplant thing.
You want to learn more about that. It's a really

(20:07):
cool article. You can type how face transplants work into
the handy search bar and how stuff works dot com?
And are we still doing plug fest? Alright? Our producer
Jerry says yes, So let's do it, Chuck. Let's start
with the blog abbreviated version. Yes, blog good, blog fun
Josh Chuck Right, blog fans read blog fire bad? All right?

(20:32):
Moving on, Okay, the stuff you should know super Stuff
Guide to the Economy that's on iTunes, worth the money
getting good feedback. Type in super stuffed on the search
bar on iTunes and you can get it all right,
plug fest is over, Okay, so then it's time for
reader mail. And uh, I see that that podcast finally

(20:56):
came out where we said hi Ku is dead once
and for all. Yeah, yeah, that was great. It's interesting
we still have some people writing in that are upset
about the lack of hikus, and then um many others
writing in saying thank you because I was tired of
it as well. Well. In case anyone didn't get the memo,
let's play that little clip from that that listener mail
where we do say that hi Ku theaters dead. Here

(21:17):
it is right, Josh. This is significant because today is
the day where we retire Haiku Theater. Thank you. Did
everyone here that we are retiring Hiku Theater. We love
your high Kus and you can still send him if
you want, but we're not going to read him anymore. Agreed.
Thank you, Chuck, Thank you, Thank you Chuck. So as

(21:39):
you can see, I'm not lying, Hiku Theater is clearly dead.
I don't see any reason for anybody sending Hiku. But
what is not dead, Josh, are mistakes that we occasionally
make that will never will never die. And we got
a correction, um from one we just did on the
World ending in twelve and this is a good one,
and I'd like to read the good ones. Yeah, the
good science one. Um. I just wanted to make a

(22:01):
small correction. You mentioned that the lava flows can be
used to determine the direction of magnetic north in the past,
which is true, but it is not because the lava
actually flows toward the pole. So evidently, Josh, there are
magnetic properties of some of the individual mineral grains. And
I know someone mentioned iron in one of their emails
inside the molten lava, and that becomes a line with

(22:22):
the direction of the pole. So when the lava cools
and hardens, that direction is locked in. So the lava
doesn't necessarily have to be flowing north, but the iron
particles and other minerals in there are pointed north. And
evidently you said the lava flows north, then that's not true, buddy.
So samples of the lava, if collected with care to
note the original orientation, can then be brought into the

(22:44):
lab and GEO referenced. And we get a big cheers
from Jessica for that one. And also Peter wrote in
about that, and John the Yellow Dart, thank you. John
the Yellow Darts and we're not allowed to say last
things anymore. That's why. If you're wondering gonna get in
trouble for the Yellow Dart, then no, that was it
was actually John the Yellow Dart blank. Oh got you? Okay,

(23:06):
well thanks, can we say blank? Then sure, John the
Yellow Dark blank. So his last name is not blank?
We know for a fact. Okay, because wouldn't that be ironic?
All right, Well, thanks to all of you wrote in
to correct me. You know how much I love that.
And if you want to send a correction in or
tell Chuck that his hair is beyond awesome, you can
do that by sending an email to Stuff Podcast at

(23:28):
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