Cleveland surgeon prepares for first-ever face transplant

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CLEVELAND (AP) -- In the next several weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that's never been tried anywhere in the world.

Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.

Then she will ask, "Are you afraid that you will look like another person?"

Because whoever she chooses will endure the ultimate identity crisis: Dr. Siemionow wants to attempt a face transplant.

This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do.

It is this: to give people disfigured by burns, accidents or other tragedies a chance at a new life. Today's best treatments still leave many of them with freakish, scar-tissue masks that don't look or move like natural skin.

Dr. Siemionow's supporters note her experience, careful planning, the team of specialists assembled to help her and the practice she has done on animals and dozens of cadavers to perfect the technique.

But her critics say the operation is too risky for something that is not a matter of life or death, such as organ transplants. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.

Such qualms recently scuttled face transplant plans in France and Britain.

The "consent form" says the surgery is so novel and its risks so unknown that doctors don't think informed consent is even possible.

Here is what it tells potential patients:

Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last eight to 10 hours; the hospital stay, 10 to 14 days.

Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bones and muscles, which give a face its shape.

Despite its shock factor, the face transplant involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient's scalp and neck, and areas around the eyes, nose and mouth.

Dr. Joseph Locala, a clinic psychiatrist, will decide whether candidates are mentally fit.

"I'm looking for a psychologically strong person. We want people who are going to make it through," he explained.