How Face Transplants Work

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Josh Clark: Hey, and welcome to the podcast. I'm Josh Clark. There's Chuck Bryant. I gotta come up with something new, Chuck.

Chuck Bryant: I know. You say there's like, "There it goes." Like I ran by the studio!

Josh Clark: So long, Chuck thanks for coming by. Yeah, we'll figure this out. Maybe when we're not recording sometimes! Just take the extra effort.

Chuck Bryant: That means we'll have to speak outside of this room, though.

Josh Clark: Yeah, we don't do that. We're like Peter Townsend or Roger Daltrey. Or the like the Gallagher brothers from Oasis. Yeah, they hate each other, but when they get together, it's like gold. It's magic, man. So Chuck, have you ever seen the 1997 John Woo movie Face Off?

Chuck Bryant: I have not.

Josh Clark: Good. Chuck, you want to talk about face transplants?

Chuck Bryant: Yes.

Josh Clark: Do you remember Travis the chimp? He was like my first blog post ever.

Chuck Bryant: Yeah, yeah.

Josh Clark: That chimp that went crazy in New Hampshire. Well, apparently, he tore that woman's face off.

Chuck Bryant: Oh, really?

Josh Clark: 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. Her face was pulled off. And one of the first things I ever heard about that grisly detail emerged was that this woman would likely get a face transplant. And I had heard of them, but vaguely, and I hadn't really put much thought into a face transplant. You know?

Chuck Bryant: Right. I remember just from - and we'll talk about her later, but the French woman was the one that came to mind.

Josh Clark: I hadn't heard about her. I wasn't paying attention, I guess, in what? 2005?

Chuck Bryant: That was a rough year for you.

Josh Clark: It was. Let me think. Very hazy! Huh. Holy cow, I lost 2005. I'm gonna have to give some thought to this while we're practicing new intros. Right?

Chuck Bryant: Sure.

Josh Clark: Okay, so yes, this poor woman who was attached by this rampaging chimp who was eventually shot to death by the police will likely get a face transplant, and we just so happen to have an article on the site appropriately titled How Face Transplants Work. And that's what we're going to talk about today.

Chuck Bryant: Yeah. I love this article, by the way.

Josh Clark: It was gruesome.

Chuck Bryant: It was gruesome, but it was really - I don't know. Stephanie Watson wrote it. It's just really well written.

Josh Clark: It is well written, agree, whole heartedly. There's all sorts of pictures, and actually, there's an illustration.

Chuck Bryant: I like that.

Josh Clark: I do, too. The face is kind of draped over the skull.

Chuck Bryant: Right, I like the face on ice slide, too, actually.

Josh Clark: Yeah, that was the best one, actually. I wonder if Marcus did that one? We'll never know.

Chuck Bryant: We'll never know.

Josh Clark: So Chuck, the first successful transplant of any time was in what, 1954. And there was a physician. I think he was in Boston named Joseph Murray.

Chuck Bryant: Yes.

Josh Clark: And he carried out the first successful kidney transplant, and he did it using identical twins.

Chuck Bryant: Which was the key early on?

Josh Clark: Like people had tried transplanting things before, but you know, and the transplant went well, but ultimately, the body rejected it.

Chuck Bryant: You know why?

Josh Clark: I want to hear your explanation, pal.

Chuck Bryant: It's because the body isn't very receptive to foreign tissue.

Josh Clark: No.

Chuck Bryant: 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.

Josh Clark: Yeah, the body no likey foreign invaders.

Chuck Bryant: No. But if you're identical twins, you had enough of a match to where it worked out.

Josh Clark: Right. The problem is most people who need transplants don't have identical twins. So it's a terrible way to establish medical procedure.

Chuck Bryant: But it was a good way to start.

Josh Clark: Well, sure. It was successful. It showed that you can transplant human tissue from one person to another and it be successful. So that was like the real milestone.

Chuck Bryant: '54.

Josh Clark: 1954, yeah. And then after that, people started exploring other ways to do this without identical twins.

Chuck Bryant: You know how?

Josh Clark: I want to hear your explanation. Boy, you're really piping up today, aren't you?

Chuck Bryant: I know. By the 1960s, what they figured out is they could suppress your immune system. Then using drugs like Cyclosporine, you could be successful with a transplant.

Josh Clark: And what they're trying to suppress are things called antigens, and they're found on the exterior of tissue cells. And those are the things that create and prompt an immune response, and they're the ones that sense like, "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." And then the white blood cells attack like the cavalry.

Chuck Bryant: Which is awesome? It's cool that your body does this because it means you have a robust and violent immune system. Of course, if you're trying to get a transplant, it's no good, but you want your body to go after things with vigor like that.

Josh Clark: Yeah, like merca. You don't want that.

Chuck Bryant: No.

Josh Clark: 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.

Chuck Bryant: Right, I'd like to keep it.

Josh Clark: So the problem is the drugs they came up with were immune suppressive, meaning that 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 merca bacteria that's in your body now.

Chuck Bryant: It left you susceptible to other problems down the road.

Josh Clark: Well, pretty much everything else. How many bacteria and viruses, just germs in general, do we come in contract with every day?

Chuck Bryant: A lot.

Josh Clark: And we don't even notice. We did that one on toads causing warts. Like 20 million people have the human papilloma virus, and you know, like very few are actually suffering from it. We don't even know we're carriers.

Chuck Bryant: Thank you, body.

Josh Clark: 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 immune suppressive drugs. We just got them as slightly more refined. Right?

Chuck Bryant: Exactly.

Josh Clark: Once we had that down, we started really going crazy with heart transplants, lung transplants.

Chuck Bryant: Yeah, the '80s and '90s is when they really kind of started mastering this whole technique.

Josh Clark: Right, and then after that, after the vital organ transplants, we started getting into those hand transplants. I gotta tell you, I find that fascinating. It's very Luke Skywalker-eque.

Chuck Bryant: I knew you were going to say that.

Josh Clark: Thank you. You know me so well, Chuck.

Chuck Bryant: Well, the way you were doing your hand, it was sort of like the scene from the movie.

Josh Clark: Yeah, it looks like it. Oh, yeah, they can't see. Can they? So inevitably, we end up at facial transplants. 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.

Chuck Bryant: Not bad.

Josh Clark: That's pretty quick. So let's talk about it. You want to talk about that poor girl in 1994? Sandeep Kaur.

Chuck Bryant: Yeah, this is just awful. In 1994, Josh, she was nine years old in Northern India, and she was chopping grass to feed her buffalo, her family buffalo.

Josh Clark: Which is a noble pursuit?

Chuck Bryant: 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.

Josh Clark: Clean off of her skull. 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. 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 is never going to function properly again." So they actually put her face, scalp, and hair back on. And she was functioning.

Chuck Bryant: Yeah, I actually just saw a picture of her at 19 on the internet.

Josh Clark: How is she looking?

Chuck Bryant: She looks good, you know. I mean there are some scars, obviously, and I think her right eye has a little bit of a droop to it. So I mean you can tell.

Josh Clark: You know, if your face has been pulled clean off by a thresher, you really can't complain about he little droopy eye.

Chuck Bryant: I was impressed. Let's put it that way.

Josh Clark: So that was technically the first facial transplant. But the first real transplant from a donor came in 2005. Can I handle the grisly details in this one?

Chuck Bryant: Please.

Josh Clark: There's something that I noticed in researching how face transplants work, and that is that all face transplants begin with a horrible, gruesome event.

Chuck Bryant: Yeah, there's really no way to lose your face unless there's some horrible accident.

Josh Clark: And even if there's like a disease, it's a ravaging, horrible disease, too. Like the tumors or something like that.

Chuck Bryant: Well, the Elephant Man disease I think is what they call it.

Josh Clark: Yes. He was not an animal.

Chuck Bryant: No.

Josh Clark: So this woman was named Isabelle Denoir. 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 tissue and teeth. 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.

Chuck Bryant: True.

Josh Clark: Is that true?

Chuck Bryant: 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. Then the whole dog situation! You know, black labs. I mean you're a dog guy. They aren't attack dogs.

Josh Clark: I couldn't believe that a lab would do that.

Chuck Bryant: Right. So what they think might happen is she was out, and the dog was concerned because it thought she was dead and was pawing at her face and became really agitated and upset and pawed and scratched to the point where there was blood, probably, and started chewing on it, trying to - evidently, trying to wake her up, but there was speculation about that, too. But they -

Josh Clark: But they think the dog did do it for some reason or another.

Chuck Bryant: 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.

Josh Clark: Gotcha. I thought it was a little odd that she took pills and fell asleep on the couch.

Chuck Bryant: 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.

Josh Clark: That is upsetting, especially if it was trying to rescue her.

Chuck Bryant: Right. I mean the whole thing is upsetting.

Josh Clark: Regardless of what happened, Isabelle Denoir got a face transplant.

Chuck Bryant: She did indeed. And this was the first major newsworthy face transplant.

Josh Clark: Which I still didn't hear about.

Chuck Bryant: That was a rough year for you. Apparently, they could have taken tissue from her chest to repair the damage, but she wouldn't have had very much movement.

Josh Clark: Right, it would have just looked like a face, but not really. Like a fake eye or something.

Chuck Bryant: Exactly. But what they want is feeling and function going on. They wanted to be able to smell and feel and have all the senses reacting. And that's the ideal.

Josh Clark: Most surgeons are perfectionists. So what they did was they found a donor. Here is where we're getting to the ethical aspects. Can we jump ahead and move around a little bit?

Chuck Bryant: Please.

Josh Clark: There's the only person who can be a face donor is one who has to be on life support. Brain dead, on life support.

Chuck Bryant: Well, someone has to be alive. But you wouldn't give up your face.

Josh Clark: Sure, no.

Chuck Bryant

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.

Josh Clark: Right. And remember, we did the how comas work. And we were positing whether or not people feel pain in deep vegetative states, 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, and below the chin. And that would be a full face transplant. As our illustration shows, they put it on ice.

Chuck Bryant: Well, this was a partial face transplant, so -

Josh Clark: So it would have been like the lower part of the face.

Chuck Bryant: Right.

Josh Clark: Well, 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, any bone, any fat, muscle, all of that stuff may be taken as well. And then it's put on ice or whatever, transported to wherever the recipient is, and then all of these things are reattached. Blood vessels are reattached, connective tissue, all this stuff. And you have to do it in such a way - well, No. 1, skin tone is kind of a big consideration.

Chuck Bryant: To find a match, sure.

Josh Clark: You want to find someone - you have to do HLA testing or matching, which is the antigen testing to make sure that you have a similar enough immune system that there won't be a rejection. You may have to put bone down, as was the case with a Chinese guy in, what, 2006. And he was mauled by a bear. What is going on?

Chuck Bryant: 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 cheek. So he -

Josh Clark: He was a huge challenge.

Chuck Bryant: Right, hers was just skin and his required quite a bit more. And we're talking teams of 15 to 20 doctors over the course of 15 to 20 hours.

Josh Clark: Well, with the Madame Denoir, she had a team of 50 doctors. They started at 10:30 at night, and they finished at 4:00 the next day, 4:00 in the afternoon. They went straight through. The irony is if she did try to commit suicide, her face was donated by a woman who failed in a suicide attempt.

Chuck Bryant: I know, how about that.

Josh Clark: Yeah, it's a little odd. But yeah, so they also practice -

Chuck Bryant: Right, on mice and cadavers.

Josh Clark: Rats, cadavers, rabbits. There's a picture of, I guess, one of their test subjects, a rabbit with a face transplant on Page 0, the first page of this article, and it's just cute as a button, 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. And it usually takes more than once. There will be several phases of surgeries.

Chuck Bryant: 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 this surgery, you need to be on these immune suppressant drugs for the rest of your life. So 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.

Josh Clark: Right. And apparently, Madame Denoir is not really helping things along. She refuses to quit smoking.

Chuck Bryant: I know. I thought you might respect that.

Josh Clark: And the doctors are like, "Come on."

Chuck Bryant: She smoked pretty soon afterward, too.

Josh Clark: Well, I mean if you're a smoker, you're a smoker, dude. Face transplant or no.

Chuck Bryant: I guess so.

Josh Clark: My first father in law got like shunts put in. He was smoking and golfing a couple days later. He just wouldn't stop. Heart shunts I should say. Cardiac shunts!

Chuck Bryant: Now, Josh, these are all partial transplants, even in the case of the one from China. And as of the writing on this article, we actually need to update this article that there were no full transplants, but there have been since then.

Josh Clark: 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.

Chuck Bryant: Thank you, Josh.

Josh Clark: Compass head hearts Chuckers.

Chuck Bryant: So yes, Josh. I'm ignoring your praise. There have been two transplants that I know of. There may be more. But I 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, 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. Isn't that amazing?

Josh Clark: Yeah.

Chuck Bryant: And the Cleveland clinic is where all this is going on, man. If you need a face transplant, you want to be in Cleveland. Then there was a French man who had the elephant man disease.

Josh Clark: Yeah, I see you have a picture there. Can I see?

Chuck Bryant: Yeah.

Josh Clark: Wow.

Chuck Bryant: Looks a lot better. Doesn't he?

Josh Clark: Wow. Quite a difference! Yeah.

Chuck Bryant: And this was just March of 2008. He had a transplant, and new lips, new cheeks, new nose, new mouth.

Josh Clark: We should publish that before and after photo on our blog after this podcast comes out. What do you think?

Chuck Bryant: Yeah, let me look and see if we can get rights to do so. Yeah, I think we can. But apparently, they can do full facial transplants now. It's an amazing, amazing thing.

Josh Clark: Well, that brings up another ethical concern besides taking the face of somebody who is not dead but is brain dead. The other ethical concern that some parts of the medical community worry about is what happens when the wealthy are like, "I don't want collagen or Botox. I'm just going to get a facial transplant from a poor, brain dead person. I'll pay the family like $20,000.00 and take the face."

Chuck Bryant: 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 - if your aim is to be extremely handsome or beautiful, that's not what you're going to get right now with a fa ce transplant.

Josh Clark: 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?

Chuck Bryant: No, there's not.

Josh Clark: Especially if we harness genetics so that we can age - 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?

Chuck Bryant: What I think will happen in 50 years is there will be other ways to make yourself beautiful. Like you said, to stop the aging process, there will be other ways besides finding a beautiful brain dead person to take their face. But that's just me.

Josh Clark: We'll see. Of course, you know -

Chuck Bryant: I won't see, buddy. I'll be long gone.

Josh Clark: Both of us will, Chuck. I think I'm going first, too.

Chuck Bryant: Donate your face.

Josh Clark: 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?"

Chuck Bryant: Really?

Josh Clark: Yeah because if you go into a med school that focuses on cosmetic surgery, heads. And they practice on you doing face lifts and stuff.

Chuck Bryant: Interesting.

Josh Clark: Yeah. 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.

Chuck Bryant: I wonder if I noted that you can use my face, but let me wear my flat cap.

Josh Clark: That would be cool with like your tongue hanging out and one eye open still, but your flat cap is on.

Chuck Bryant: Cool to the end.

Josh Clark: Nice. So of course, the best thing you could do is learn to be pretty on the inside, and then you wouldn't have to worry about anything. Unless you're mauled by a bear or your black lab chews the bottom of your face off. Then you get a pass for the face transplant thing.

Chuck Bryant: Absolutely.

Josh Clark: 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 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.

Chuck Bryant: Abbreviated version. Blog good, blog fun! Josh, Chuck write blog. Fans read blog.

Josh Clark: Fire bad.

Chuck Bryant: All right, moving on. The Stuff You Should Know Super Stuff Guide to the Economy.

Josh Clark: That's in iTunes, $3.99, worth the money, getting good feedback. Type in Super Stuff on the search bar on iTunes, and you can get it.

Chuck Bryant: Plug fest is over.

Josh Clark: 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. That was great.

Chuck Bryant: Yeah. It's interesting. We still have some people writing in that are upset about the lack of haikus, and then many others writing in saying, "Thank you because I was tired of it as well."

Josh Clark: Well, in case anyone didn't get the memo, let's play a little clip from that listener mail where we do say that haiku theater is dead. Here it is.

Chuck Bryant: Right, Josh. This is significant because today is the day where we retire haiku theater.

Josh Clark: Thanks [beep].

Chuck Bryant: Did everyone hear that? We are retiring haiku theater. We love your haikus, and you can still send them if you want, but we're not going to read them anymore.

Josh Clark: 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 to send in haiku.

Chuck Bryant: No, but what is not dead, Josh, are mistakes that we occasionally make that will never die.

Josh Clark: They will never die.

Chuck Bryant: And we got a correction from one we just did on the world ending on 2012. And this is a good one. I like to read the good ones, the good science ones. 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 e-mails 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 geo referenced, and we get a big cheers from Jessica for that one.

Josh Clark: Hey, cheers back, Jessica.

Chuck Bryant: Also, Peter wrote in about that, and John the yellow dart.

Josh Clark: Thank you, John the yellow dart.

Chuck Bryant: And we're not allowed to say last names anymore. That's why if you're wondering -

Josh Clark: Oh, are we going to get in trouble for the yellow dart then?

Chuck Bryant: No, it was actually John the yellow dart blank.

Josh Clark: Oh, okay. Well, thanks John the yellow dart. Can we say blank then?

Chuck Bryant: Sure. John the yellow dart blank!

Josh Clark: So his last name is not blank.

Ch uck Bryant: No.

Josh Clark: We know for a fact.

Chuck Bryant: Yes. I do know that.

Josh Clark: Because wouldn't that be ironic?

Chuck Bryant: It would.

Josh Clark: Thanks to all of you who 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 e-mail to

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