In 2005, Jim Maki was traveling through Boston when he fell face first onto an energized subway track. The terrible tragedy not only severed his nose, but it also ripped off his top lip, cheeks, and the roof of his mouth, leaving him with a gaping hole where his nose used to be. In the year 2009, Maki traveled to the Brigham and Women’s Hospital in Boston in order to have face transplantation surgery. Maki said that the opportunity to live life normally once more was what convinced him to go through with the operation despite the post-operative dangers associated with the treatment and the fact that the first one was conducted less than five years earlier.
James Maki has no recollection of the specific events that led to the loss of his face.
In June of 2005, the man, then 60 years old, suffered a fall onto an electric subway track in Boston, which resulted in the loss of his nose, top lip, and cheeks in addition to the destruction of the roof of his mouth.
Maki had to face the murmurs and looks of strangers who were fascinated on the huge hole that used to be his nose for a period of four years while also having to eat via a tube.
During this whole time, significant headway was being made in the development of a groundbreaking medical technique that would alter the course of his life. This treatment has the potential to restore a sense of wholeness to some of the most seriously injured American warriors.
In April 2009, at Brigham and Women’s Hospital in Boston, Maki had a face transplant, which at the time was just the second such procedure performed in the whole United States. By the end of the year, his physician would be directing a program for veterans of the wars in Iraq and Afghanistan that was financed to the tune of $3.4 million by the Defense Department.
Dr. Bohdan Pomahac, who was in charge of the face transplant team at Brigham, was quoted as saying at the time that “We really want to help them.” They have made the ultimate sacrifice for our nation by covering their faces.
The United States Department of Defense is the primary funder of face transplant research in the United States. It has contributed millions of dollars to the Brigham and The Cleveland Clinic, which performed the first face transplant in the United States in 2008, in order to assist service members who have been severely disfigured in combat and for whom traditional surgery has been of limited or no benefit.
Dr. Marie Siemionow, who led the first face transplant team at The Cleveland Clinic, where the military has paid around $1.5 million in the treatment, said that “every war brings something new to medicine.”
Both Brigham and Cleveland get funding from the military, with the former receiving it via the Biomedical Translational Initiative and the latter receiving it through the Armed Forces Institute of Regenerative Medicine. Both of these initiatives are geared at providing assistance to service members who have been wounded in the line of duty and include partnerships with dozens of hospitals and other medical facilities, both public and private.
Despite the fact that face transplantation is still in its early stages, officials from the Department of Defense believe that up to 200 injured service members might be candidates. Due to the lack of a complete war injury registry, medical personnel in the military have began searching through the lists of injured servicemembers in order to locate potential candidates. Dr. Robert Hale, an Army colonel who is leading those efforts at the Army Institute of Surgical Research in Texas, said in an e-mail to Stars and Stripes that the service anticipates having one in place by the next year. This will include a new categorization for penetrating facial trauma.
The first possible patient from the military was chosen in April; he is a contender to have his complete face, which was severely damaged in war, replaced.
When it comes to delivering face transplants to injured service members, the military is taking what it refers to as intentional “baby steps.”
“Primarily to protect our patients, because it’s still considered experimental,” said Dr. Barry Martin, an Army lieutenant colonel and the head of plastic surgery at Walter Reed Army Medical Center. Martin works at the U.S. Army’s Walter Reed Army Medical Center.
He has been asked to serve on a brand-new military advisory group that is responsible for ensuring that prospective applicants can fulfill the procedure’s stringent mental and physical standards.
“It is a new thing to wrap our minds around,” said Martin, who will help with the first military transplant at Brigham when it is expected to take place. “It is a new thing to wrap our minds around.”
Before the soldier who was reviewed by the panel in April can be considered for the transplant, he must first go through stringent examinations at either Cleveland or Brigham, which are the only two institutions in the United States that are authorized to do the procedure.
According to Pomahac, war veterans who may be candidates for a face transplant have often sustained severe deformity as a consequence of injuries such as burns, gunshot wounds, or explosives. Because such injuries are so severe to the bones, tissue, and cartilage that constitute the nose, lips, jaws, and cheeks, normal surgical techniques are unsuccessful in treating them. The most viable candidates for military service will be those who have suffered severe burns.
“Thank God, it’s not an overwhelming number,” Martin said of the approximately 200 veterans who would be eligible for the program. But even if we just help one person over the course of ten years, it will have been worth it.
In April 2009, a donor was located for Maki, and despite the hazards involved, the Vietnam veteran did not hesitate to take advantage of the opportunity for a new face.
The operation, which was performed for the first time in 2005 in Paris, is accompanied by a reliance on anti-rejection medicines for the rest of one’s life, the long-term ramifications of which remain unclear. Drugs are used to suppress the immune system in order to stop the body from rejecting the new face that was transplanted. Patients with a compromised immune system have an increased risk of developing diabetes, cancer, and other diseases.
According to Siemionow, who is doing research at Cleveland to find less hazardous anti-rejection drugs, “Right now, we cannot legitimately tell the patient what the final outcome will be.”
According to Pomahac, the fact that there is a limited donor pool and it is difficult to match donors and recipients is another factor that contributes to the difficulty of face transplants. Living your life with the face of another person might also have a significant impact on your mental health.
“On the bright side,” he remarked, “we do have something to offer.” On the down side, we do not know how things are going to turn out ten or fifteen years from now. If they are already leading terrible lives, many people will not be willing to wait 10 or 15 years before signing up for it.
In the end, patients are required to evaluate the risk of the treatment against their overwhelming desire to lead at least some semblance of a regular life.
Maki describes the choice to undergo the transplant as a “no-brainer” on his part.
The prospect of having a new face and regaining a feeling of normality more than made up for the potential risks involved in the process, which would take around twenty hours to complete. Surgeons have to meticulously join bundles of nerves and blood arteries, implant cartilage, and eventually attach the skin in order to restore not only the appearance of the face but also its functions, which include eating, drinking, breathing, and smiling. All of these procedures are aimed at restoring not just the appearance of the face but also its functionality.
According to Pomahac, the patient will need to undergo extensive rehabilitation as they learn to move and talk with their new face. This process is based on the development of the intricate facial nerves.
A few days following Maki’s operation, he inquired about the availability of a hand mirror. When they found one of them, he was taken aback by the excellent work that Pomahac and his crew of thirty-five had accomplished.