Stuff You Should Know - How Face Transplants Work

Episode Date: April 23, 2009

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. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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only I can see you. What you're doing is larger than yourself, almost like a religion. Like, he was a god. Listen to The Turning Room of Mirrors on the iHeart Radio app, Apple podcasts, or wherever you get your podcasts. Brought to you by the reinvented 2012 Camry. It's ready, are you? Welcome to Stuff You Should Know from HowStuffWorks.com. Hey, and welcome to the podcast. I'm Josh Clark. There's Chuck Bryant. I gotta come up with something new, Chuck. I know. You say there's like, there it goes. Like, I run by the studio. Chuck, thanks for coming by. Yeah, we'll figure this out, maybe when we're not recording. Sure. We'll just take the extra effort. That means we'll have to speak outside of this room, though. Yeah, we don't do that. We're like Pete Townsend and

Roger Daltrey. They do that? Or like the Gallagher Brothers from Oasis. Yeah, they hate each other. Right. But when they get together, it's like, you're gold, you know? It's magic, man. So, Chuck, have you ever seen the 1997 John Woo 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? Yeah, yeah. That Chimp that went crazy in New Hampshire? Yeah. Well, apparently he tore that woman's face off. Oh, really? Yeah. There was a transcript of the 9-11 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. Wow. And one of the things,

one of the first things I heard after that detail, that grisly detail, emerged was that this woman would likely get a face transplant. Right. And I'd heard of them, but vaguely and hadn't really put much thought into a face transplant, you know? Right. I remember just from, and we'll talk about it 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, in what, 2005? That was a rough year for you. It was, let me think. Very hazy. Huh. Holy cow, I lost 2005. I'm going to have to give some thought to this while we're practicing new intros, right? Sure. Okay. So yes, this poor woman who was attacked by this rampaging chimp who was eventually shot to death by the police will 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 we're going to 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. It's all heartedly. There's all sorts of pictures. Yes. And actually, there's an illustration. Yeah, I like that. I did too. Yeah. The face is kind of draped over the skull. Right. I like the face on ice slide. 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, the first successful transplant of any kind was what, 1954. And there was a physician, I think he was

in Boston named Joseph Murray. Yes. And he carried out the first successful kidney transplant. 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? I want to hear your explanation, pal. Well, it's because the body isn't very receptive to foreign tissue. So when you get, or 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. Yeah. The body no likey foreign invaders. No. But if you're identical twins, you had enough of a match to

where it worked out. Right. The problem is, is most people who need transplants don't have identical twins. Yeah, exactly. So it's a terrible way to, you know, establish medical procedure. But it was a good way to start. 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. 1954. 1954. Yeah. And then after that, you know, people started exploring other ways to do this without, you know, identical twins. You know how I want to hear your explanation. Well, you're really piping up today, aren't you? I know. By the 1960s, what they figured out is that they could suppress your immune system. Then you could using drugs like cyclosporine, you could,

you could be successful with a transplant. And what they're trying to suppress are things called antigens, which are proteins. They're found on the exterior of tissue, tissue cells, right? Yeah. And those are the things that create that prompt and immune response. They're the ones that sense like, whoa, 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 Calvary. Yeah, which is awesome. I mean, it's great. It's cool that your body does this because that means you have a robust and violent immune system. Right. Of course, if you're trying to get a transplant, it's no good. Right. But you want your body to go after things with vigor

like that. Sure. Yeah, like MRSA. You don't want that. No. No. But yeah, if you have a hand, you wish you could tell your antigens to just settle down. It's your new hand and you're pretty fond of it. Right. I'd like to keep it. Right. So the problem is the drugs that they came up with were immune suppressive, meaning, okay, the antigens are no longer being prompted to attack the hand or send the white blood cells to attack the hand, but they're also not being prompted to go attack the MRSA bacteria that's in your body now. It left you susceptible to other problems down the road. Well, pretty much everything else. I mean, how many bacteria and viruses, just germs in general, do we come in contact with any every day? A lot. And we don't even notice.

Like we did that one on Toads Causing Warts and like 20 million people have the human pavlova virus. Right. And you know, very few are actually suffering from it. We don't even know where carriers because our 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 them a slightly more refined, right? Exactly. Once we had that down, we started really going crazy with heart transplants, long transplants. The 80s and 90s is when they 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'm going to tell you, I find that fascinating.

Yeah, me too. It's very Luke Skywalker-esque. I knew you were going to say that. Thank you. You know me so well. Well, the way you're doing your hand, it was sort of like the scene from the movie. Yeah, it looks like it. Oh yeah, they can't see, can they? Okay. So inevitably, we end up at facial transplants. Right. 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 in about 50 years. Not bad. That's pretty quick. Yeah. Yeah. So, so let's talk about, you want to talk about that poor girl in 1994, Sandeep Kuar. Yeah, this is just all power in 1994, Josh. 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 scalp. Yeah. Yeah. And her family reacted promptly. 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. Yeah. 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 were like, we can't do skin grafts. This girl's never going to function properly again. Right. So they actually put her face, scalp, and hair back on. And she, she's functioning. Yeah. I actually just saw a picture of her at 19 on the internet. How's she looking? 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 fresher, you really can't complain about the little droopy eye. I was impressed. Yeah. I was about that way. So that was technically the first facial transplant. But the first real transplant from a donor came in 2005. 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 that all face transplants begin with a horrible gruesome event. Yeah. There's really 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 too. Right. Like tumors or something like that. Sure. Well, the elephant man disease, I think is what they call it. Yes. He was not an animal. No. No. So this woman was named Isabelle Dinoir. And she was a French woman. And in 2005, 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 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 below her nose down was gone. She was nothing but like tissue and teeth. Yeah. 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 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 claim she was committing suicide. And then the doctors denied it. But then one doctor said that she had tried to commit suicide. And then the whole dog situation, you know, black labs, I mean, you're a dog guy. They aren't attack dogs. I couldn't 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 on it. It's like, oh, blood. Evidently trying to wake her up. But there's speculation about that, too. 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. 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 a suicide attempt. Gotcha. 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. Right. I mean, the whole thing is upsetting. Regardless of what happened, Isabel Dinoir got a face transplant. She did indeed. And this was the first major news worthy face transplant. Which I still didn't hear about. That was a rough year for you. In 1968, five black girls dressed in oversized military fatigues were picked up by the police in Montgomery, Alabama. I was tired and just didn't want to take it anymore. The girls had run away from a reform school called the Alabama Industrial School for Negro children. And they were determined to tell someone about the abuse

they'd suffered there. Picture the worst environment for children that you possibly can. I believe Mt. Meigs was patterned after slavery. I didn't understand why I had to go through what I was going through and for what. I'm writer and reporter, Josie Duffy Rice. And in a new podcast, I investigate how this reform school went from being a safe haven for black kids to a nightmare. And how those five black girls changed everything. All that on unreformed. Listen to unreformed on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. They start pulling out pictures of Clay Williams' body taken out in the Everglades. A world orbiting around a mysterious man with a controversial claim.

This drug pilot by the name of Lamar Chester. He never ran anything but grass until I turned over that load of coke to him on the island. Chester would claim he did it all for this CIA. Pulling many into a sprawling federal investigation. So, Clay wasn't the only person who was murdered? Oh, no, not by a long shot. I'm Lauren Bright Pacheco. Join me for murder in Miami. Listen to Murder in Miami on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. So, apparently they could have taken tissue from her chest to repair the damage, but she wouldn't have had very much movement. Right. It would have just looked like a face, but not really like a fake eye or something. Right. But what they want is feeling and function

going on. They want to be able to smell and feel and have all the senses reacting. That's the ideal. Most surgeons are perfectionists. Yeah. So, what they did was they found a donor. Here's where we're getting to the ethical aspects. Can we jump ahead and move around a little bit? Please. Okay. The only person who can be a face donor is one who has to be on life support, right? Sure. On life support. Well, someone has to be alive, but you wouldn't give up your face. Sure. No. No one's that. I just want to get specific. 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 positing whether or not people feel pain in deep vegetative states. Right. And you've got to hope not when they're taking your face, because that's exactly what they do. They go to the donor. They move the donor into the operating theater. They take the face off. I imagine 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. Right. As our illustration shows, they put it on ice. Well, this was a partial face transplant. Okay. So, it would have been like the lower part of the face. Right. 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. Right. Any bone. Right. Any fat. Muscle. Yeah. All of that stuff may be taken as well. And then it's, again, put on ice or whatever, transported to wherever the recipient is. And then all of these things are reattached. Blood vessels are reattached. Right. A connective tissue, all this stuff. And you have to do it in such a way. Well, number one, skin tone is kind of a big consideration. To find a match, sure. You want to find somebody you have to do HLA testing or matching. Right. Which is that antigen testing to make sure that you have a similar enough immune system that there won't be a rejection. Right. You may have to put bone down. As was the case with a Chinese guy in, what, 2006. Yes.

And he was mauled by a bear. Right. What is going on? Right. He was mauled by a bear. And this was a unique case different from the French woman because he was missing skin and part of the bone in his nose and cheeks. Right. He was a huge challenge. Right. Hers was just skin. And his required quite a bit more. Yeah. And we're talking like teams of 15 to 20 doctors over the course of 15 to 20 hours. Well, with Madame Dinoire, she had a team of 50 doctors. Wow. They started at 1030 at night and they finished it for the next day, for in the afternoon. Right. Went straight through. The irony is, is if she did try to commit suicide, her face was donated by a woman who failed in a suicide attempt. I know. Yeah. How about that?

Yeah. It's a little odd. But yeah. Okay. So these, they also practice the people. Right. On mice and cadavers. Rats, cadavers, rabbits. There's a picture of, 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. Yeah. 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. Right. And it usually takes more than once. There'll be several phases of surgery. Yeah. Sure. Yeah. It shows. And I've seen pictures of the French woman over the course of different surgeries getting better and better. What I thought was interesting was that once you have the surgery, you need to be on these

immunosuppressant 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 dent in your ability to survive and live a long life. Right. And apparently Madame Dior is not really helping things along. She refuses to quit smoking. 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 days later. Really? He just wouldn't stop. Wow. Heart shunts, I should say. Okay. Cardiac shunts. Now Josh, these are all partial

transplants, even in the case of the one from China. And as of the writing in this article, we actually need to update this article that there were no full transplants, but there have been since then. Chuck, I have to say you are killing it today. The external research, you corrected me at least once, if not twice. I am proud of Chuckers. Thank you, Josh. Compass Head, Hearts, Chuckers. 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. They're keeping that quiet who the doctor basically said she didn't have a nose. She didn't have a mid-face at all.

Wow. And they were able to transplant, Josh, almost 83 square inches of skin with muscle, bone, upper lip and nose from the donor still attached. Wow. Isn't that amazing? Yeah. And the Cleveland Clinic is where all this is going on, man. If you need a face transplant, you want to be in Cleveland. Sure. And then there was a man, a French man who had the elephant man disease. Yeah, I see you have a picture there. Can I see? Yeah. Wow. Wow. Quite a difference, yeah. And this was just March of 2008. He had a transplant and new lips, new cheeks, new nose, new mouth. We should publish that before and after photo on a blog after this podcast comes out. What do you think? Yeah, let me look and see if we can get

rights. Okay. In 1968, five black girls dressed in oversized military fatigues were picked up by the police in Montgomery, Alabama. I was tired and just didn't want to take it anymore. The girls had run away from a reform school called the Alabama Industrial School for Negro children, and they were determined to tell someone about the abuse they'd suffered there. Picture the worst environment for children that you possibly can. I believe Mt. Mays was patterned after slavery. I didn't understand why I had to go through what I was going through and for what. I'm writer and reporter Josie Duffy Rice. And in a new podcast, I investigate how this reform school went from being a safe haven for black kids to a nightmare and how those five black girls

changed everything. All that on unreformed. Listen to unreformed on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. In 1980, cocaine was captivating and corrupting Miami. Miami had become the murder capital of the United States. They were making millions of dollars. I would categorize it as the Wild Wild West. Unleashing a wave of violence. My God took a walking into the devil's stand. The car killed everybody that was home. They start pulling out pictures of Clay Williams body taken out in the Everglades. A world orbiting around a mysterious man with a controversial claim. This drug pilot by the name of Lamora Chester. He never ran anything but grass

until I turned over that load of coke to him on the island. Chester would claim he did it all for this CIA. Pulling many into a sprawling federal investigation. So Clay wasn't the only person who was murdered? Oh no, not by a long shot. I'm Lauren Bright Pacheco. Join me for murder in Miami. Listen to Murder in Miami on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Yeah, I think we can. Okay. But yeah, so apparently they can do full facial transplants now. 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 but is brain dead. Right. The other ethical concern 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 going to get a facial transplant from a poor brain dead person. You know, I'll pay the family like $20,000 and take the face. You know, I saw that in the article and I don't buy it because right now, like they do a good job with these transplants, but the end result 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 going to get right now with the face transplant. Right now, sure. But again, Chuck, we went from the first kidney transplant to face transplants in 50 years. Where are we going to be 50 years from now? And I mean, really, is there anything stopping vanity? No, there's not. And it's a

good point. Especially if we harness genetics so that we can age. Right. We harness longevity, but we still kind of age poorly. You don't think that people are going to pay for a face transplant by 80 if we're living to like 120 on average? What I think will happen by in 50 years is there'll be other ways to make yourself beautiful. Like you said, to stop the aging process. There'll be other ways besides finding a beautiful brain dead person to take their face. I think that just, that's just me. We'll see. Of course, you know, learning to be... I won't see, buddy. I'll be long gone. Both of us will, Chuck. Yeah. I think I'm going first too. Donate 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 used for cosmetic surgery practice. Really? Yeah. Because they, if you go into a med school that focuses on cosmetic surgery, heads, and they practice on you doing facelifts and stuff. Interesting. Yeah. So I'm an 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 let me wear my flat cap. That would be cool. Yeah. It would be like your tongue hanging out or one eye open still, but your flat cap's on. Cool to the end. Nice. So of course, the best thing you could do is learn to be pretty on the

inside and then you won't have to worry about anything. Unless you're all by a bear, your black lab choose the bottom of your face off. Then you get a pass for the face transplant thing. Absolutely. You want to learn more about that. It's a really cool article. You can type how face transplants work into the handy search bar on howstuffworks.com. And are we still doing plug fest? All right. 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 Wright blog. Fans read blog. Fire bad. All right. Moving on. Okay. The stuff you should know. Superstuff guide of the economy. That's on iTunes 399 worth the money. Getting good feedback. Type in super stuff 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 I see that that podcast finally came out where we said Haiku 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 Haiku's and then 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 Haiku theater is dead. Here it is. Right. Josh, this is significant because today is the day where we retire Haiku theater. Thank you. Did everyone hear that? We are retiring Haiku theater. We love your Haiku's and you can

still send them if you want, but we're not going to read them anymore. Agreed. Thank you, Chuck. Thank you. Thank you, Chuck. So as you can see, I'm not lying. Haiku theater is clearly dead. I don't see any reason for anybody sending Haiku. No, but what is not dead, Josh, are mistakes that we occasionally make. That will never die. That will never die. And we got a correction from one we just did on the world ending in 2012. And this is a good one. I don't like to read the good ones. Yeah. The good science one. Sure. Just wanted to make a 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 aligned with 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. And 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 lab and georeferenced. And we get a big cheers from Jessica for that one. Cheers back, Jessica. Also, Peter wrote in about that. And John the Yellow Dart. Thank you,

John the Yellow Dart. And we're not allowed to say last sentence anymore. That's why you're wondering. Oh, are we going to get in trouble for the Yellow Dart then? No, that was, it was actually John the Yellow Dart blank. Oh, gotcha. Okay. Well, thanks, John the Yellow Dart. Can we say blank, then? Sure, John the Yellow Dart blank. So his last name was not blank. We know for a fact. Yeah. Okay. Because wouldn't that be ironic? It would. 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 StuffPodcast at howstuffworks.com. For more on this and thousands of other topics,

visit howstuffworks.com. Brought to you by the reinvented 2012 Camry. It's ready. Are you? Be sure to listen to the War on Drugs on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. On the new podcast, The Turning, Room of Mirrors, we look beneath the delicate veneer of American ballet and the culture formed by its most influential figure, George Balanjean. He used to say, what are you looking at, dear? You can't see you. Only I can see you. What you're doing is larger than yourself, almost like a religion. Like he was a God. Listen to The Turning, Room of Mirrors on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts.