It’s almost shocking that Front/Off (the sci-fi thriller, not to be confused with the special effects makeup contest) was never made. It’s hard to imagine how that pitch meeting must have turned out, but it resulted in one of the wackiest and funnest thrillers of the late ’90s. In it, Sean Archer and Castor Troy ( both played alternately by John Travolta and Nicolas Cage) swap faces before engaging in a fight to the death.

When Front/Off came out in 1997, full face transplants were still an imaginary future medical procedure. The first partial face transplant wouldn’t have happened in the real world for eight years, and the first full face transplant didn’t happen until 2010. When the movie was released, the idea that someone else could take your face was the ultimate in fictional stolen identities, but that’s not exactly how they work. Get someone’s face – and then on to another person – is a complicated medical marvel.

FROM IDEA TO REALITY

While face transplants aren’t exactly routine, they certainly aren’t entirely the stuff of fiction anymore. By 2021, 47 face transplants had been performed worldwide, two of which were retransplantations. These grafts are the result of research that began in 1991 when the U.S. Department of Veterans Affairs’ Rehabilitation Research and Development Service held the first conference to discuss composite tissue grafts – grafts involving multiple tissues, including fat , skin, muscles, nerves, etc. .

It’s perhaps unsurprising that the military has a particular interest in these types of operations, since military veterans are as likely a demographic as any to benefit from life-enhancing transplants. In 1997, at the second Composite Tissue Allotransplantation (CTA) conference, the details of the operation itself had been worked out, but it was unclear whether immunosuppressive therapies were up to the task. prevent rejection of the skin, which is the most immunogenic of all organs.

Before the first face transplant could take place, other CTA operations were performed, including hand and limb transplants. These were seen as necessary first steps because they involve many of the same challenges.

Then, in November 2005, all this work fell into place. The recipient of the first partial face transplant was Isabelle Dinoire, a patient who had suffered dog bites to the face while unconscious. The operation was a success, although Dinoire experienced bouts of rejection, kidney disease and cancers, which may have been linked to the immunosuppressive drugs.

Details of all the face transplants that have been performed since Dinoire are not fully available, due to patient confidentiality and differences in the availability of medical records around the world, but there have been some pretty amazing results recently. .

Patrick Hardison is a firefighter who suffered severe burns in 2001. He spent the next 14 years unable to fully close his eyes, blink, and rely on breathing and feeding tubes. Then, in 2015, he received a face donation from David Rodebaugh, a 26-year-old man who died in a bicycle accident. The operation, which took place at NYU Langone Medical Center, lasted 12 hours and included transplantation of the scalp, ears and face, including the eyelids and muscles to control them. A year later, doctors were able to remove Hardison’s breathing and feeding tubes.

HOW IT WORKS

The operation as depicted in the film is almost laughable. It takes place in just a few minutes. Surgeons use a laser to trace the outline of the face, then lift it up, as if there were no other connective tissues underneath. At one point, they even cut and die Archer’s hair while his face is removed. So much for a sterile operating room.

In reality, the process is much more complex and the results are not as consistent. According to John’s Hopkins Medicine, a face transplant operation involves two surgical teams working in tandem. The first prepares the recipient patient for the new face while the second prepares the donor.

Rather than just lifting the giver’s face and placing it over the receiver, there are a whole host of connections that need to be made for the new face to work the way you want it to. Plates and screws must be locked and surgeons will connect the donor’s face to the veins, arteries and nerves of the body using a surgical microscope. Once they confirm that the blood flow is connected, they meticulously connect all additional nerves and muscles. Without it, the recipient would not get any of the functions that constitute the main medical use of a face transplant.

Recovery times can take several weeks as the body acclimates to the new tissues. Transplant recipients also likely experience significant swelling that will change the shape of the face over time. It is also likely that additional operations will be needed once the swelling subsides to make minor adjustments so that the patient gets the most out of their transplant.

Above all, even if everything goes without a hitch, the receiver will not look exactly like his donor. The soft tissues of the face are only part of the equation. The way in which these characteristics are based on the skeletal structure of the recipient is also essential.

In order to pull off the kind of face swapping we see in Front/Off, you would need massive advances in surgical techniques, immunosuppressive technologies, and the ability to make fine adjustments to donors and recipients so that the end result is a perfect match. While face transplants are no longer fiction and have brought significant improvements to patients’ quality of life, the operation seen in the film remains a fantasy.

It’s probably for the best. We cannot imagine a scenario, even medical, where you would want the transplant recipient to look exactly like the donor.