Hacker News Reader

Comment by sethhochberg | Hacker News Reader

Also amazing to read in the article that this was done as part of a face transplant which is now considered standard care for severe disfigurement instead of experimental! It doesn't feel like all that long ago we were reading about the first successful face transplant ever performed.

Love the patient's attitude about already getting a new face, so why not try the eye too and see how well it works since he'd be doing transplant care regardless. Seems like he completely understands it might not work fully or at all, but that there was stuff to be learned regardless.

View on HN

It's not the standard of care, a doctor said it SHOULD be standard of care. Transplants for nonvital organs are very rare. It has been possible to transplant things like arms and legs for a long time- see Guðmundur Felix Grétarsson, who is able to feel things in his arms now and use them for light tasks.

https://en.wikipedia.org/wiki/Gu%C3%B0mundur_Felix_Gr%C3%A9t...

But maybe 100 people total have transplanted arms. They are rare because insurance doesn't cover them; medically they're considered investigational. Growing nerves back is still a complete crapshoot, and you'll certainly never get back normal function.

That's a pretty significant issue, because even arm transplants compromise your life in new and terrible ways. You're required to take prednisone, ciclosporin etc for the rest of your life. You trade off one crippling disability for another- a massively compromised immune system. Potentially that can kill you, if you get sick and are unlucky.

You can open a door and use a broom with a hook. You get very little quality of life from feeling tingles in your elbow. Is that worth risking your life and taking expensive steroids every day which can drastically change the way you think and feel? Probably not.

Is it worth it to be able to hold hands with your wife? To be able to feel the heat of a coffee mug? To not need help putting your arms on? Medical literature does not typically value those things. Objectively they're small, momentary inconveniences. Many, many people are happy without them. They might mean the world to others.

In cases like the OP it's cut and dry, IMO. Look at him (image fairly disturbing): https://static.scientificamerican.com/sciam/assets/Image/202...

That tissue on his face, even after 50+ surgeries, is agonizing. There just isn't enough skin and what's left is fragile. Cuts and blisters get pulled open and don't want to heal. Every movement sucks. That person would not mind wearing someone elses face; they aren't wearing their own face any more. It's completely unsurprising that their quality of life is improved, even with all the immunosupressants.

Just commenting to thank you for the before/after picture and to say wow to the incredible work of giving this man literally a new face. Even if the eye doesn't ever see, it's still a beautiful thing that he can have normal facial features again instead of a painful reminder of his injury.

Wow that image looks completely primitive, like something out of Bioshock. I’m actually surprised our medical system is not able to do something better than that.

By all means, apply to medical school, complete all the training, and try for yourself. Or continue to shit remotely from a distance on other people’s work you can’t possibly comprehend.

They absolutely can do a much better job, but the patient has to have enough material remaining for them to work with.

This man took 7200 volts directly to the face.

It's a face transplant, not surgery to make someone else's face look like his. Of course it doesn't look natural.

Natural isn't good. Rotationplasty is way, way better than any of the alternatives (amputation, transderal prosthesis etc). It involves reattaching the foot to the knee backwards so that the ankle acts like a new knee.

https://walkwithoutpain.com.au/wp-content/uploads/2016/05/ba...

You walk almost naturally and keep more strength than any electronic prosthesis. It's has less pain than an amputation and no phantom limb sensation. It may look primitive, but it's far and away superior to anything else right now.

I hope face transplants become a routine procedures. We need an equivalent to password resets for biometric authentication.

The amount of elective cosmetic surgery to the body and face this last decade and the normalization of it has made that statement sounds too obvious to me.

"Transplant" is the critical factor here. Introducing foreign tissue is significantly more complicated than shuffling around native tissue.

You're right I confused it with grafting. I thought that facial transplants meant grafting 'extra' skin onto the face. Still think there's carryover from other fields like plastic surgery and probably cancer treatments to make this easier.

Plastic surgery isn't inherently cosmetic; plastic surgery training includes things like facial reconstruction/burn grafts, plus some minor training in related cosmetic procedures. Cosmetic surgery training OTOH focuses strictly on cosmetic procedures.

It's not uncommon for a single doctor to be both a licensed plastic surgeon and a licensed cosmetic surgeon, but they are distinct licenses.

If you're speaking about the US, you are incorrect on the legality.

A license is issued by a state to a physician, and carries no qualification of specialty. A licensed physician can do anything for which they have informed consent.

A board certification is a piece of paper put out by an Academy or Society or College that says a physician has been trained in a particular specialty and passed their post-training exams.

I am a board certified anesthesiologist. I also hold a license to practice medicine in the state where I live. I can do neurosurgery, if I can find a facility and a patient willing to let me (and although that sounds like a joke, how else would you describe placing an epidural for labor during childbirth but "minor neurosurgery"? Which is why a license to practice medicine is necessarily broad.). That doesn't mean anyone would insure me, or that any sane hospital would let me, but it would be legal.

Ah, good terminology catch there—I did indeed mean "board certified" :)

And re. epidurals, "minor neurosurgery" honestly sounds about right! Doesn't that thing literally go in your spinal cord? You can't mess around there unless you know what you're doing...

Inside the spinal column (the bones), not into the cord itself but just outside a thin layer (the dura mater - Latin for "tough mother") around it (thus "epidural" - "outside the dura"). Labor epidurals (which are most epidurals) are placed in the lower lumbar region. The five lumbar vertebrae are creatively named L1 through L5; the spinal cord itself ends around L2, and below that level the spinal column just provides a space for the nerve roots to be protected. Whatever; the local anesthetic diffuses across it just fine.

But yes, you do have to keep in mind things like timing of anticoagulant usage (it's bad if you have a bleeding spot that doesn't want to stop, but it's catastrophic if you have a bleeding spot inside a bony cavity that can't expand - you can easily have a big bleed whose pressure compresses and damages the spinal cord higher up).

I believe that historically the direction is the other way around - that elective cosmetic facial surgery was enabled by the experience of the many surgeons performing the many reconstructive surgeries for facial injuries which were needed on a mass scale in the years during and after the world wars.

Reply on news.ycombinator.com