What can facial surgery truly achieve today?
The face; the readable manifestation of our character; the centre of attention and our senses. Facial surgery is complex dealing with delicate skin and bones, nerves and blood vessels. New advances like facial transplantation are experimental with serious physical risks and unknown psychological outcomes. But what can facial surgery truly achieve today? What are the ethical dilemmas posed by this innovation and what are the psychological hazards of meddling with identity?
Followed by a drinks reception
Hosted by BioCentre in partnership with Saving Faces: The Facial Surgery Research Foundation
On Thursday 7th May 2009, BioCentre hosted an exciting series of events in partnership with The Facial Research Foundation - Saving Faces at the London Science Museum’s Dana Centre, London.
Whilst the date had been set towards the end of last year, the timing of the events could not have been better. During the 24 hour period running up to the event taking place, the high profile news story broke of the recipient of the first US almost-total face transplant. Surgeons in at a clinic in a Cleveland, Ohio, replaced 80% of Connie Culp's face with that of a dead female donor .
As a result of this news story, a number of national newspapers contacted BioCentre for details about the events and went on to cover the event and related questions surrounding the issue of facial surgery. There was also a sudden influx of people wishing to attend the afternoon symposium as a result of reading about the story.
The afternoon symposium ‘Saving Face’ was held in the dstudio of the Dana Centre and was designed for postgraduate students, academics, public policy specialists and health care professionals interested in the implications of facial surgery to come together and learn about the latest developments in this field and to capture a glimpse as to where we might heading in terms of the future.
When one considers the face many different ideas and thoughts come to mind. The readable manifestation of our character; the centre of attention and our senses. In contrast, disease, disfigurement, despair, unjust perceptions and prejudices are not spaces you would happily choose to contemplate, let alone inhabit. Yet when the two meet, it presents a situation which simply cannot be ignored.
Facial surgery is complex dealing with delicate skin and bones, nerves and blood vessels. New advances like facial transplantation are experimental with serious physical risks and unknown psychological outcomes. Informed consent will be difficult with these new techniques Also, unlike clinical trials for pharmaceuticals, where drugs can be stopped or changed, surgery is irreversible. Therefore, surgical clinical trials comparing different techniques are difficult to run, but essential if best treatment is to be determined.
The field of innovative facial surgery including stem cell and donor transplantation will continue to develop. Yet hand in hand with this enthusiasm and excitement must come informed discussion in order to form a realistic vision of the indications and outcomes of new facial surgery techniques.
Therefore, the afternoon symposium afternoon sought to bring together experts who would discuss what facial surgery can (and cannot) achieve today; where laboratory and clinical research will lead us; the ethical dilemmas posed by this innovation; and the psychological hazards of meddling with identity.
Following introductions by Professor Nigel Cameron, Executive Chairman of BioCentre and Matt James, Associate Director of BioCentre, Professor Iain Hutchison, guest chair for the afternoon was welcomed to the platform. Professor Hutchison is Chief Executive and Founder of Saving Faces; Consultant Oral & Maxillofacial Surgeon St Bartholomew's, The Royal London Hospital & University College Hospitals.
The afternoon consisted of short 10-15 minute presentations made by the various speakers each discussing some of the most pertinent topics associated with the development of facial surgery and transplantation.
Dr. David Veale, Consultant Psychiatrist in Cognitive Behaviour Therapy at the Maudsley Hospital and Honorary Senior Lecturer at the Institute of Psychiatry, was the first to speak and gave a very lucid and engaging presentation on the psychological implications of facial surgery. Dr. Veale explained some key principles and concepts, not least the crucial concordance between identity and appearance, which in turn challenged the audience afresh to reflect on the positive psychological impact of facial surgery and transplantation.
Having set the scene, Mr. Simon Holmes, Consultant Oral & Maxillofacial Surgeon, Bart’s and the London NHS Trust, followed on from Dr. Veale’s presentation by addressing the current status of facial surgery and where developments in this field are heading. In particular, his illustration of skeleton of the face as the tent frame, the tissue as the lining and skin as the fabric was a helpful analogy to use in explaining to the audience the intricacies and skills necessary in order to carry out surgery. Added to this, Mr Holmes showed some fascinating media clips and models which vividly illustrated the kind of facial trauma work which he is engaged with at Bart’s hospital.
Digital technology is revolutionising our lives in so many different ways and the field of surgery is no exception. Mr. Andrew Dawood, Clinical Director of Cavendish Imaging, introduced some ‘blue sky thinking’ to the afternoon by giving a very interesting presentation on the use and application of digital technology in helping to develop facial surgery techniques. In particular, the analogy he used of the home PC, scanner and printer and how in many respects this illustrates the approach by which he is carrying out pioneering work in terms of facial reconstruction and modelling was fascinating. His presentation helped to point to how future rehabilitation techniques could progress and develop a better quality of life for patients.
Professor Francis Hughes, Professor of Periodontology, Barts & The London School of Medicine and Dentistry, Queen Mary University of London picked up on the analogy used by Mr Holmes in terms of ‘scaffolding’ and facial surgery. In the short time available, Professor Hughes concisely covered the issue of application and development of tissue engineering in terms of presenting a far more successful way forward for the development of facial surgery.
At this juncture, Professor Iain Hutchison stepped aside from his guest chair responsibilities in order to make his own address on the subject of the patient and surgical research. Professor Hutchison shared from his vast wealth of experience in facial surgery and spoke candidly addressing points such as the philosophical and practical obstacles to surgical research. In turn, this helped to emphasis the crucial role of the surgeon-patient alliance.
Sir Professor Ian Kennedy, Emeritus Professor of Health Law, Ethics and Policy at University College London, helpfully brought the various presentations together by offering comments and reflections on the ethical implications involved with facial surgery and research. In particular, his comments on the physical and psychological outcomes in terms of patient involvement and the need to tease these out so that the patient is informed as much as possible were particularly useful.
Perhaps one of the key things to emerge from the afternoon was the fact that despite the media and public interest in the seemingly ‘ground breaking’ area of facial transplants this is just the start of reconstructive surgery and could even be regarded as ‘old technology’. Face transplants do serve their purpose but patients have to take immunosuppressants for the rest of their lives and which in turn weakens their immune system, increasing the risk of infection and cancer and generally weaken muscles and bones. These problems are highlighted by the young Chinese man who received the world’s third face transplant and who stopped taking the drugs, lost the transplant and died. Tissue engineering could help to regenerate the patient’s own bone and tissues which removes the need for drugs and rejection problems with the donor’s face.
To close, Professor Hutchison chaired a Q&A session where various members of the audience were able to ask questions of the speakers in response to their various presentations. A drinks reception was held for all guests which served to provide further time for discussion of the issues presented amongst guests and speakers alike.
Following the afternoon symposium, an evening event was also as part of the summer events programme at the Dana Centre. ‘Facing Up’ which was open to everybody and explored the same issues in more general terms. Following fairly short ‘witness statement’ style presentations from Dr. David Veale, Mr. Simon Holmes, Mr. Andrew Dawood and Professor Roger Brownsword, Director of the Centre for Technology, Ethics and Law in Society at King’s College London, Professor Iain Hutchison chaired an extensive Q&A session where the audience were able to ask questions of the panel and engage with many aspects of the facial surgery conversation. An extended report on the symposium will be published shortly. MP3 downloads from the afternoon symposium can be downloaded.
Professor Iain Hutchison has been Consultant Oral & Maxillofacial Surgeon St Bartholomew's, The Royal London Hospital & Homerton Hospitals since 1989. Iain was appointed to a professorship in 2007. He founded the United Kingdom Oral Cancer Research Group. Iain has written for many publications and is in great demand as a lecturer and expert media commentator. He has been nominated for the 2008 Beacon Award for New Initiatives in charity.
Iain believes that cross-fertilisation of ideas between specialties, and even across the artistic/scientific divide, often leads to major advance. Consequently he has initiated local co-operation with other specialities leading to collaboration in, for example, skull-base surgery for access and ablation with the neurosurgeons as well as developing a surgical service for children with facial haemangiomata with the paediatric surgeons.
In terms of research, Iain has also built collaborative links with Professor Christine Godfrey and Dr Marjon van der Pol at the Institutes of Health Economics at York and Aberdeen Universities, The Institute of Education, Professor Ania Korszun at QMUL Dept of Psychiatry, Professor Stephen Sutton at The Department of Behavioural Psychology at Cambridge University, Dr Ken Gannon at The Department of Clinical Psychology at The University of East London, Allan Hackshaw at The CRUK Trials Centre at UC London, The Schools Research Group at Exeter University, Professor Emeritus Ann Charlton at Manchester University, Basingstoke Police, the Metropolitan Police and the Assoc of Chief Police Officers Alcohol and Violent Disorder Units.
In June 2000, Professor Hutchison founded The Facial Surgery Research Foundation - Saving Faces (FSRF). The charity seeks to raise funds for and lead research into the prevention and treatment of all facial diseases and injuries. The charity’s model is to conduct prospective randomised surgical trials to improve the evidence base for best treatment practice in these conditions. In addition, Professor Hutchison now leads sociological school research studies designed to prevent smoking and binge drinking. He has also set up a help line for patients and organised public information campaigns on stem cell research and science and face transplants.
Andrew joined a long established restorative dental practice in 1987, which he later took over with his partner Susan Tanner. Initially his work encompassed the full range of restorative procedures, but more recently, his time has been devoted almost entirely to dental implants, imaging, and surgical planning.
The need for exemplary imaging and computer planning for complex dental implant treatments led to the development of cavendishimaging.com, an imaging and surgical planning facility, which has operated as a freestanding entity for 15 years. Staffed by a team of scientists and 3D technologists cavendishimaging.com now provides imaging, computer planned surgical solutions, and rapid prototype models, guides, and craniofacial implants for implant and maxillofacial Surgeons, and hospital departments around the UK.
Andrew Lectures extensively in the UK and abroad on topics related to imaging, dental Implants, and restorative dentistry. He also operates a centre for postgraduate education, and hosts regular meetings and seminars from the cavendishimaging.com premises in London, Oxford, and Birmingham.
Professor Sir Ian Kennedy was Chairman of the Healthcare Commission from 2002-09. Prior to that, he led a number of Inquiries, in particular, the Public Inquiry into paediatric cardiac surgery at Bristol Royal Infirmary. He is a specialist in health law and ethics, founding the Centre for Medical Law and Ethics in 1976 at King's College, London where he was the Head of the Law School for 10 years. He was a founder member and later Chairman of the Nuffield Council on Bioethics.
Simon Holmes is a Consultant Oral and Maxillofacial Surgeon with a special interest in facial trauma at St Bartholomew's and the Royal London Hospital. The Royal London Hospital is a designated trauma centre for London and in addition, receives a large trauma workload from the locality of the east end of London. Simon has developed facial trauma and has pioneered a multidisciplinary approach to high energy trauma that has established an international reputation. He has lectured nationally and internationally on craniofacial trauma management, and convened the facial trauma module at the Royal College of Surgeons. He has published numerous articles and chapters on the subject and is currently subeditor with respect to facial trauma for the British Journal of Oral and Maxillofacial Surgery.
Professor of Periodontology, Barts & The London School of Medicine and Dentistry, Queen Mary University of London.
Speaking on: Stem Cells and Tissue Engineering for Facial reconstruction – the way forward ?
Francis Hughes completed his undergraduate training at Guys Hospital in 1979 and then carried out his postgraduate clinical and research training at the London Hospital Medical School and as a Postdoctoral research fellow at the University of Toronto. He was appointed to the Chair in Periodontology at Barts & The London in 1999.
His research interests concern the understanding of the regulation of bone formation at the cell and molecular level, and the application of stem cells, bioactive molecules and tissue engineering techniques for regenerative treatments of the oral tissues.
He is a very active member of the International Association for Dental Research (IADR); he is the immediate past - President of the Pan European Federation of IADR. In addition he is President-Elect of the British Society of Periodontology. He serves on the Editorial Boards of the Journal of Dental Research and Journal of Periodontal Research.
Speaking on: Body image problems Dr David Veale is Consultant Psychiatrist in Cognitive Behaviour Therapy at the South London and Maudsley Trust and The Priory Hospital North London. He is an Honorary Senior Lecturer at the Institute of Psychiatry, Kings College London. He was a member of the group that produced the NICE guidelines on Obsessive Compulsive Disorder and Body Dysmorphic Disorder published in 2005. He has published about 70 articles and three self-help books. He is Past President of The British Association of Behavioural and Cognitive Psychotherapies. He is Trustee of OCD Action and OK2b. His website is www.veale.co.uk
