The First Face Transplant in the USA

Dr. Niamtu with Dr. Maria Siemionow 

There are a lot of disadvantages of lecturing all over the world in terms of travel, inconvenience and time away from home, but this is greatly outweighed by the advantages of making friends with special people.  While serving as the co-chair of the American Academy of Cosmetic Surgery meeting in Phoenix in 2007 one of my duties was to procure world class experts to discuss topics of interest for cosmetic surgery.  This had been right around the time of the French performing the world’s first face transplant.  I became aware of Dr. Maria Siemionow, a transplant surgeon from the Cleveland Clinic.  I was thrilled when Maria agreed to be the featured speaker for our meeting which led to a friendship.  This was several years ago and she detailed her work with animal models in preparation for the first U.S. transplant.  It was pretty fascinating as an incredible amount of work from all walks of medicine are needed to coordinate such an undertaking.  On the surgical side there are transplant, vascular, plastic, ENT, maxillofacial, craniofacial and other surgeons.  On the medical side there are numerous specialties that deal with the host and donor rejection issues and there are psychologists that counsel the patient, families, etc.  More work than you would ever imagine.  Most people think that the work is what happens in the operating room for 20 plus hours of surgery, but that may be the easy part.

This is a very emotional issue with incredible medical ethical implications.  There is much less emotion when transplanting tendons in the knee, corneas in eye or even heart transplants, as these organs are hidden and do not express emotion.  Ethicists do not accept this type of surgery for cosmetic reasons, but rather as last ditch efforts to correct deformities so horrific that the patient has no chance of a normal life in their current state.  The lady in France was mauled by dogs, the patient in Cleveland was a victim of severe trauma.  These unfortunate patients are disfigured to the point of being unable to cope with the isolation of not being able to leave their home.

Think about the psychological ramifications of this type of surgery.  The recipient patient may resemble the deceased donor.  What about the relatives of the donor possibly seeing someone with a new face that resembles their deceased loved ones?  What about the recipient patient knowing that their face is part of someone who is not living?  None of this is to be taken lightly.  Many problems exist with tissue rejection as human immune systems vigorously reject foreign tissue and patients must undergo extensive pharmacologic treatment including massive steroid doses.  The treatment can be worse than the cure.  This is not a procedure where you simply go have an operation and simply heal.  This is not a facelift, this is a face transplant.  There are good possibilities that many of the functions of the transplanted face will not work.  The muscles may not move, the new face may be expressionless.  No taste, no smell, no feeling.  In effect the new face may be a living mask, but to the recipient it may be the only possible option to appear human, just as a donor heart may be the only chance a patient with heart disease has to live. 

Also the fact exists that the entire transplant may fail and the patient could be more disfigured than they were before the surgery, or they could become so sick from the medical treatment they could die.  Again, there are many considerations with this type of surgery.

What will the future hold?  If we can work out the rejection problems, it could be possible that these procedures could be predictable.  If that happens, replacing missing facial anatomy may be a possibility.  On the other hand, as cloning and stem cell research develop, we may be able to “grow” new anatomy and the entire transplant situation may go down in history as weird science.  In any event, it is a very situation that challenges all aspects of medical and human ethics.  In the movie “Face Off” John Travolta and Nicholas Cage exchanged faces seemingly as simple as putting on a Halloween mask.  This technology may never happen but if it does where does it stop?  Assuming it became an extremely predictable, would an older patient ethically be able to have a younger face transplanted?

All of this makes for deep thinking and undoubtedly will be the plot of more movies and books.  Maria Siemionow and her team deserve the greatest respect for their unfaltering research and work leading to this historic event.  I am honored to have her as a friend.  Time will tell how society views the process.

To find out about cosmetic facial surgery in Richmond, Virginia visit  www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Latisse & Lovely Long Lashes

Latisse is here!

…..and Dr. Niamtu is the first office in richmond to have it!

 

 

 

Grow thick eyelashes and eyebrows in weeks with this amazing new, effective and safe product. Latisse can only be purchased from a licensed doctor and cannot be bought in stores. Dr. Niamtu will offer a $20 discount (normal price $120) for the next 60 days to introduce patients to the best kept secret in Hollywood.

 

Actual Patient of Dr. Joe Niamtu after using Latisse for 90 days

 

Every once in a while something really cool comes along in cosmetic surgery.  Something that is affordable, is safe, works well and has no recovery.  Latisse for eyelash enhancement is an example of a cool new procedure.  Latisse(bimatoprost ophthalmic 0.3%) is an eye drop medication produced by Allergan Inc. (the makers of Botox) used to treat glaucoma by lowering intraocular pressure.  This drug was called Lumigan and was FDA approved for that purpose in 1996 and has been proven safe in hundreds of peer reviewed articles. Allergan has now obtained FDA approval and for the topical cosmetic use of this drug and have named it Latisse.  A clinical trial at Miami University, in which the drug was given to subjects to use in one eye and a placebo in the other, confirmed the findings. Eyelashes treated with Lumigan grew 2 millimeters in 6 weeks, which was twice as quickly as placebos.

 

 

The cost of Latisse is $120 but Dr Niamtu will offer it to to patients for $100 for the first 60 days.  The 2.5 milliliter bottle will last about 3 months.    For lash lengthening one drop is applied to a clean eyeliner brush and brushed through the upper lashes.  A single drop will treat both lashes and patients should wait at least 15 minutes before wearing contact lenses.  Latisse will also make the eyebrows grow (although it is not FDA approved for this purpose and its use for that is off label) and this drug has been used to treat eyebrows and lashes that have been lost to chemotherapy or other reasons.  In order for Latisse to work the patient must have active hair follicles in the lashes or brows. Latisse works at the bases of the eyelashes and when the follicles are in the growth phase (anagen) it stimulates the hair growth. The results are apparent in 1 to 4 weeks and sometimes works in as fast as 2 days.  The medication (a prostaglandin analogue) stimulates follicles in the resting stage (telogen) to transition to the growth phase as well as keep the follicles in the growth phase longer.  It also makes the follicles hypertrophic which causes thicker lashes.

 

No serious effects have been reported.  Temporary side effects can include inflammation (hyperemia) resulting in redness of the white of the eye (15-45% of patients) and 15% of patients report itching.  Latisse is not to be used in patients with chronic eye inflammation or patients who have very recently had eye surgery.  Patients who have had complicated cataract surgery should not use Latisse.  Latisse also stimulates melanocytes (pigment cells) which causes the lashes to become darker as well as longer and thicker.  Due to the stimulation of pigment cells Latisse can darken the iris (center of the eye around the pupil) in some patients.  This occurs mostly in patients with hazel colored eyes.  If Latisse contacts the eyelid skin or cheek, it can also darken the skin, which can be treated with bleaching cream.  It is important to only put the drug on the base of the eyelashes and not in the eye or on the skin.  The darkening of the iris has been seen mostly in patients that use the drops in the eye, and not the more conservative method of applying with an eyeliner brush.  If the drug is stopped, the iris does not continue to darken, but will not reverse to normal color.  Any patient with a history of eye disease or other eye problems should consult their ophthalmologist before using Latisse.

 

The effects of Latisse only last as long as the drops are being used.  If the drops are stopped abruptly, many of the lashes will phase out simultaneously and the lengthening result will be lost, so it is recommended to wean off the drops slowly so the lashes will be in different phases of the nongrowth phase (catagen).  There is no downside to stopping using Latisse, the lashes will simply revert to their original length, thickness and color.  This is similar to quit coloring ones hair, nothing bad happens, the roots simply go back to the normal color.

 

Women put a lot of energy into their eyelashes using mascara, curling devices, false lashes and over the counter “enhancers”.  Long eyelashes have historically been favored by women and this new use of a safe and effective medication is sure to become a very popular cosmetic treatment.  Patients I have witnessed using Latisse simply love it and some of them have had to actually trim their lashes because of the impressive growth. 

 

Wonder what will be next!

 

To find more about cosmetic facial surgery procedures by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia