Wednesday, August 18, 2010

Silicone, Magnets and Clips. Oh my.

Chrissy Steltz, then and now (ABC)

Acquired facial deformity, whether by disease, violence or other calamity, whether attended by evil or not, challenges survivors to face the rest of their lives without a profile of any kind, quite literally for some. Here are two who, for their courage and sorely tried patience, have been rewarded with a brand new face.
If Bibi Aisha's surgical team at The Grossman Burn Foundation opts for a prosthetic solution, her facial reconstruction could follow a course like that of these survivors, showcased by television news magazines this summer

Listening to Chrissy Steltz tell her story on ABC's 20/20, it is hard to realize that she is also completely blind—her entire midface, including her beautiful eyes, blown away by an errant shotgun blast, over a decade ago. Said maxillofacial surgeon Dr. Eric Dierks of Head & Neck Surgical Associates in Portland, OR,"It's unique to have an injury of this magnitude to the middle part of the face that removes the vision of both eyes [and]the nose, yet allows the injury to the base of the brain to heal."
Chrissy and son Geoffery     (ABC)
In the years since those deadly teenage shenanigans, Steltz has grown up and found her way with intrepid spirit, even as medical technology has advanced to a degree that offers her a real solution for facing the outside world. Using "autografts" of bone and skin from elsewhere in her body, augmented with dozens of screws and metal plates, Steltz's doctors prepared her decimated midface to receive a kind of snap-on-snap-off mask made by maxillofacial prosthedontists Dr. Larry Over, of Oregon, and Dr. David Trainer, of Florida.
"To be looked at as a plain Jane," said Steltz, was exactly what she wanted—to be "treated just like everyone else." And to give her new baby boy a mother's face to gaze into. As Steltz told CBS 60 Minutes, "This is going to be the end of one chapter, and the beginning of a whole new one."

Donnie and Sharon Fritts    (
Meanwhile, on NBC's Today Show, Donnie Fritts, of Georgia, sat beside his indefatigable wife Sharon, looking exactly like an unremarkable middle aged man—and that is remarkable. Mr. Fritts has lost two thirds of his facial features to ameloblastic carcinoma, an aggressive cancer of the facial bones and connective tissues, so rare that of only sixteen known cases in the world, Mr. Fritts is the only person to have survived.
For Fritts, maxillofacial prosthdontist Michael Singer of the Besthesda Temporomandibular Joint And Facial Pain Treatment Center led a pick-up team of facial reconstruction specialists in creating a facial field of bone and tissue, titanium implants, gold subframe, and maxillary prosthesis which would be capable of supporting a mask of silicone, magnets and clips. That final component, the mask fashioned by former Senior CIA Disguise Specialist Robert R. Barron, would become Fritts' ticket to rejoin the full society of family and friends.

Such medical "miracles" are staggeringly expensive, partly because they are the combined efforts of multidisciplinary teams of prodigious talents, cooperating on the frontiers of medical technology, in the service of a special patient—another human being. But these two cases are only the most recent and famous cases among many performed in the United Staes. Often, the required hours, services and supplies are donated.

And in cases that succeed, the physicians always credit the steadfastness of the patients, without whose active perseverance, dedication, and constant, deliberate rededication to the project—and its outcome—everything comes to nought.
Click here for Dr. Singer's exceptionally clear and thorough description of these reconstructive procedures. Click here to watch Dr Trainer at work.

Thursday, August 12, 2010

The Face of an Afghan Miracle

Bibi Aisha has arrived in the United States for reconstructive facial surgery, reported the LA Times this week. The face of the Afghan teenager, barbarically mutilated by Talib relatives, has already become iconic, especially in the clamorous aftermath of the August 9, 2010, issue of TIME Magazine which dared to display Aisha's haunting features on its cover without apology.

Vigorous debate continues on the political and ethical imputation, the wisdom or cynical opportunism of such an editorial choice—does her image rivet the gaze or repel us—and surely this debate is one of the services rendered by managing editor Richard Stengel.

First reported in the Daily Beast by Gayle Tzemach Lemmon, deputy director of the Women and Foreign Policy Program at the Council on Foreign Relations, Aisha's harrowing saga began to rise to the surface of global consciousness only when it intersected with a U.S. military-run hospital, whose staff helped the young woman find safe haven at a shelter run by the NGO Women for Afghan Women, based in New York and Kabul.

Aisha will now be shepherded through facial surgeries and recovery by the combined resources of California's Grossman Burn Foundation and its Afghan Reconstructive Surgery and Burn Center Project. Co-director Dr. Peter H. Grossman told the Los Angeles Times that Aisha‘s treatment could include “a prosthetic nose, or reconstruction of her nose and ears using bone, tissue and cartilage from the rest of her [own] body...” And from there, on to a new life, of what shape she can not imagine. The surgeon's skill, the physician's art, the medical technology, all really do exist to make this excoriated young woman whole. In the absence of evil, miracles abound, even for such as Aisha.

Now, thanks to the near universal visibility of TIME, Inc., Aisha's face is likely not just to become a graphic representation of the plight of Afghan women, but also to be co-opted for purposes from the worthy to the ignoble. That may be as she herself now wishes, reports Lemmon. “When I meet the doctor I will tell him all of my story,” she says. “My father told me not to tell anyone the full truth... not to tell anyone anything. But I will tell them all these things because I am not such a person to lie; I will tell them because I think my story must be told.”


The wider moral, political or humanitarian aspects of this story demand informed, thoughtful and compassionate consideration. But for the moment, speaking entirely from my own experience, I will say this about the prospect of Aisha's facial reconstruction:

It is miraculous. It can be done. And for them that dare, it's always right to strive toward the unlikely miracle.

*Photograph by Jodi Bieber / INSTITUTE for TIME/ August 9, 2010

Tuesday, May 18, 2010

Mark Gilbert, Painter of Faces

Get to know to this extraordinary artist. I first met Mark Gilbert when he was in the midst of the Saving Faces Art project, collaborating with London head and neck cancer surgeon Iain Hutchison. And for three years in residence at the University Medical Center in Omaha, Nebraska, he continued his work from the American heartland.

A Portrait Of Healing - CBS Evening News - CBS News
CBS Evening News: A Portrait Of Healing - One Artist Is Working In A Hospital - Painting Patients And Promoting Understanding

Mark Gilbert does portraits of patients and caregivers as part of a research project exploring the connections between art and medicine. Many of the patients featured are coping with facial disfigurement. 

In a segment from Nebraska Educational Television, we are in Mark's studio as he sketches a charcoal portrait of someone who is both a patient and a caregiver at UNMC....

See more of Mark Gilbert's work at

Saturday, May 01, 2010

Communicating Through A Mask

Singers trained in the Italian classical vocal technique are drilled to place the voice in the mask, meaning in the resonating chambers of the facial bones.  But even for non-singers, the face is the single most important organ of human interaction. And when, for some reason of injury or disability, the face can’t perform its primary functions of transmitting and receiving information critical to navigating the social world, all sorts of things can go wrong.

One young psychology researcher at Tufts University uses first hand experience to study what happens to interpersonal communication when the face is a mask stripped of all expression. Kathleen Rives Bogart has Moebius syndrome, a rare congenital condition named for a 19th-century neurologist, that causes facial paralysis, striking at birth and causing nearly total facial paralysis. She learned early to suffer children's taunts without flinching—because she couldn’t.  It was “like having a deformity and not being able to communicate, all in one,” Ms. Bogart told the New York Times' Benedict Carey.

Now Ms. Bogart has teamed with David Matsumoto, a psychologist at San Francisco State University, for a new study which suggests that people with long-term impairment are able to adapt through compensation strategies, “just like for blind people, whose senses of touch, smell, hearing become sharper,” said Dr Matsumoto—strategies which include gestures and tones, as well as other systems in pre-motor areas of the brain.

Research to date has shown that we understand others in large part by small unconscious imitations of others’ facial expressions in our own facial muscles. With this optimistic finding, says Ms Bogart, “the idea is that if we could learn what the best nonverbal communication techniques are, we could teach those to people who are socially awkward for any reason.”

Read the entire article here

Friday, February 12, 2010

Rescuing Faces in Haiti

One American physician is responding to the overwhelming misery in earthquake-stricken Haiti by committing "at least" the next year to reconstructive surgeries for survivors there. 

Fifty-five-year-old plastic surgeon Dr. Craig Hobar repairs children's facial deformities and catastrophic injuries at Baylor University Medical Center and Dallas Children's Medical Center, in addition to his busy practice at  Dallas Plastic Surgery Institute. Now the Dallas Morning News reports that within a week of the catastrophy, Dr. Hobar had cleared his schedeule to lend a hand in Port-au-Prince for a week. And then he decided to stay on, where he was needed so urgently. 

"Craig [Holen] immediately said, 'I'll take care of this,' " reported Dr. Renato Saltz,  president of the American Society of Aesthetic and Plastic Surgery, speaking of the largest-ever emergency response by the ASAPS.

Through Dallas-based medical foundation Life Enhancement Association for People (LEAP), Dr. Hobar has been able to commit to a long-term presence in Haiti, with rotating shifts of volunteer medical teams from around the world. Dr. Hobar founded LEAP in 1991, with the express mandate to send annual medical missions throughout the world, charged with fixing facial and limb deformities in children of developing countries. When the 7.0-quake leveled Port-au-Prince on January 12, LEAP was ready to mobilize.... 

Read more....

Thursday, February 04, 2010

World Cancer Day 2010

World Cancer Day 2010: Cancer can be prevented too

World Cancer Day is launched every year on February 4th by the International Union Against Cancer (UICC). This year’s campaign aims to increase public awareness of the many simple steps that can significantly reduce the risk of developing cancer later in life. According to the International Agency for Research on Cancer, up to 40% of cancers are considered preventable through currently available knowledge. That is, 40% of 12.4 million annual cancer diagnoses—and 7.6 million cancer deaths—are avoidable, through vaccination and/or simple lifestyle changes (UICC has produced some provocative campaign materials to drive home the point).

Lifestyle changes??  That’s right, and if you live in any part of the developed world, you ought to have some idea what they are: regular physical activity, eating healthily, limiting alcohol consumption, reducing sun exposure and avoiding tobacco. Hellooooo?!

The United Nations World Health Organization lists tobacco use as the single largest preventable cause of cancer in the world, followed closely by excessive exposure to the sun’s harmful rays. Make no mistake, even with important medical and technological advances of recent years, the cancers that result from smoking and tanning are spectacularly disruptive. When they occur in the face, head and neck, they are disfiguring, and uniquely difficult to control, sometimes hijacking years, even decades of life and livelihood. Not to adopt simple, acknowledged preventive practices is patently irrational. Not to disseminate that knowledge globally is indefensible.

World Cancer Day is a response to a 2005 World Health Assembly resolution on cancer prevention and control, which calls on all countries to share the global burden of cancer. WHO provides practical advice on how to implement effective cancer control programs, particularly in low-and-middle-income countries, where cultural heritage and misinformation continue to hold sway over modern science. Based in Geneva, Switzerland, the UICC partners with the United Nations World Health Organization and the International Atomic Energy Agency to unite more than 280 member organizations in over 90 countries in the global fight against cancer.

For more on World Cancer Day including the 2010 World Cancer Campaign Report Protection against cancer-causing infections, visit: For more facts on cancer in the developing world visit:
And in the spirit of World Cancer Day, tell the smokers you love:
you stink.

Friday, January 29, 2010

The Face of Success (the rest of the story)

Quick update on that trio of spectacular facial phenomena:

1. Susan Boyle? Well on her way to fulfilling her celebrity promise, which some estimates figure at around eight million smackers. After turning Simon Cowell’s famously bristled head with her Britain’s Got Talent audition, and setting records in cyber-views of her clips, Boyle was snatched up by the Columbia label. Her debut album became the most pre-ordered album of all time, and sold an astounding 3 million copies around the world in its opening week, including 701,000 copies in the U.S., giving her the best-selling debut album by any woman since SoundScan began tracking in 1991. A U.S. concert tour was hastily calendared. Larry King and Oprah lined her up. When her first CD was listed on, pre-orders of the CD brought it to #1 within three days, nearly three months prior to its release. “It seems long-term success is hers to accept or reject,” said Gaylord Fields, Senior Editor of AOL Music.

2.  With her repertoire of more than thirty of opera’s most demanding roles, Angela Meade is booked through summer 2010 in such venues as The Metropolitan Opera and the Caramoor Festival. She has been described as “a lavishly gifted young soprano” who sings with “uncommon beauty and strength of tone” (The New Yorker), and praised in the New York Times for her fine coloratura technique, her voluminous voice, her intelligence and elegance, her expressive ease. Angela Meade may never, alas, be rolling in the dough generated by a “reality” show multi-media frenzy [NB that deserves a post all its own--stay tuned]. She is nevertheless a rising star in the rarefied galaxy of great voices, whose opulent gifts quite simply bedazzle her fans.

3. Brigham and Women's Hospital Partial Facial Transplant in Boston was awarded a grant of  $3.4 million from the Department of Defense, to pay for face transplants for veterans of wars in Iraq and Afghanistan, who have survived catastrophic war injuries, but with serious deformities.  Early in 2009, doctors at Brigham and Women's performed America's second face transplant, giving James Maki a new face after a disfiguring subway accident. With the new grant, the hospital will be able to perform six to eight more operations over the next year and a half, and immeasurably advance face transplant technology.

Sunday, January 10, 2010

2009 - On The Face Of It

Indulge me as I revisit three banner spectacles of 2009 — each has or will have a high profile update early in 2010. Coming hard upon one other last spring — at first glance, worlds apart — one compelling common element became apparent: Appearances. Especially facial appearance. And how profoundly we are impacted by what we see when we look at other human beings.

Susan Boyle1. Singing sensation Susan Boyle went viral, to the tune of 85 million hits (and counting) on the top YouTube clip of her performance on Britain’s Got Talent, sister series to American Idol, both properties of TV producer Simon Cowell’s “Got Talent” franchise.

2. The Audition, from award-winning director Susan Froemke, opened at 400 movie theaters nationally, in a one time only HD event. The full-length documentary film is an intimate look at the dramatic final week of the Metropolitan Opera National Council Auditions.

3. The nation’s second-ever face transplant operation (seventh in the world) was accomplished at Brigham and Women's Hospital in Boston, by Dr. Bohdan Pomahac and his team.

Susan Boyle was simultaneously hooted and ballyhooed in backhanded headlines (Unlikely Singer is YouTube Sensation) and described all over cyberspace as a “middle-aged church volunteer”, a “living troll-doll”, a “warbling gremlin”, spinster (when was the last time you heard that hoary reproach?). She was compared most relevantly, perhaps, to former cell phone salesman Paul Potts, not just a passionately dedicated tenor who won the 2008 contest, but “tubby, dentally challenged, and cripplingly shy”. 

The Met Auditions have been called the “American Idol” of the opera world—like “Idol”, they are open to all, offer enormous exposure, prize money, and the “shot” of a lifetime. The winners have glorious voices, every one—and look at them. In the requisite gown and bling, Susan Boyle wouldn’t be out of place among them.

Jonathan Friend, a National Council judge, says “the judges listen to see what a singer sounds like in  [the Met] auditorium, but the judges are looking for [singers who] … are connected to the music, the words. They use their body, their face, everything, to convey what the composer wanted to say.” But, “Hollywood has come to the opera,” says Sheri Greenawald, director of the San Francisco Opera Center (SFO's training wing), “and we now want our young singers to look like starlets.” Gina Lapinski, a drama coach at the Met, says judges are looking for a package.  “If they sing well but are boring as batshit, we don’t care about them. It’s about communication, not just singing.”

In her blog The Classical Beat, music critic Anne Midgette endorsed Boyle “to demonstrate that lovers of classical music… want to hear good voices and musical expression, and [Boyle ] appears…to have both." Still, Angela Meade, who ultimately triumphed in the Metropolitan Opera auditions, worried aloud about her own lifelong struggle with her appearance.

And later that month, The Associated Press reported  “seven face transplants…worldwide, three of those occurring in just the past two weeks.” It’s not likely that any of these singers has ever considered a wholesale trade-in. But others are lining up. Less than five years ago, desperate survivors of disfiguring accidents, disease or combat head wounds were doomed to confront the rest of their lives with no face at all. Instead, today, they wait for organ donors, and prepare themselves for a miracle.

Said Dr. Maria Siemionow, head of plastic surgery research at the Cleveland Clinic and leader of the first American transplant team (December 2008), "I believe this procedure is justified because you need a face to face the world". At Boston’s Brigham and Women’s Hospital (February 2009), Dr. Bohdan Pomahac led a 35-member medical team that transplanted a man’s nose, the roof of his mouth, his upper lip, facial skin, muscles and the nerves that power them. “It was almost scary,” Pomahac said later, how eager the patient was to submit to a 17-hour, radically new operation which would sew him into another man's face. “I said, the face might not match exactly… He said any face is better than none."

Now consider this. A worldwide flurry of commentary followed the Susan Boyle phenom, lamenting how quickly we stereotype each other, how biased we are toward youth and beauty, and that books ought not be judged by their covers. But social scientists, reported the New York Times, agree these snap judgments are unremarkable, consistent with nature, and crucial to the way we function in community — even when our assessments are completely wrong.

“Stereotypes are seen as a necessary mechanism for making sense of information,” said David Amodio, assistant professor of psychology at New York University. According to John F. Dovidio, a psychology professor at Yale, encountering discrepancies to stereotypes probably “creates a sort of autonomic arousal” in our peripheral nervous system, triggering spikes of cortisol and other indicators of stress. Helen Fisher, an anthropology professor at Rutgers, further theorizes that in Ms. Boyle’s case, the audience also experienced a pleasurable “rush of dopamine” from the surprise of a positive auditory experience so inconsistent with negative expectations. David Berreby, author of “Us and Them,” says, “It’s not something we came up with because of TV… It’s not connected to modern life at all. It is inherent in the mind.”

As Ms. Boyle herself said after her performance, while society is too quick to judge people by appearance, “There is not much you can do about it; it is the way they think; it is the way they are.” For in real life, whether or not we understand its scientific underpinnings, most human beings are keenly attuned to the appearance experience.

And any who are not so attuned struggle mightily.