Wednesday, 27 November, 2002, 13:39 GM

A leading plastic surgeon is calling for a debate about whether face transplants should take place.

Peter Butler said surgical techniques would allow the procedure to take place within the next six to nine months.

But he said it was essential for a moral and ethical debate to take place before anyone underwent the operation.

I would be wearing another face that didn't belong to me

Christine Piff, Let's Face It He told the BBC: "It is not 'Can we do it?' but 'Should we do it?'"

Mr Butler, a consultant plastic surgeon at London's Royal Free Hospital, will discuss the issues surrounding face transplants at the British Association of Plastic Surgeons in London on Wednesday.

Expression

Patients whose faces have been seriously disfigured by cancer, burns or accidents could be helped by such transplants.

It can be very difficult for surgeons to reconstruct a patient's face, because it needs to be able to move so people can convey expressions and feelings, particularly the lips, eyes and cheeks.

Skin grafts taken from other parts of the body, which patients can currently have, do not allow movement or sensitivity, creating a mask-like effect, said Mr Butler.

Peter Butler Peter Butler says the surgical technology needed for face transplants is just months away But he said face transplants, which could involve muscle and nerves as well as skin, would allow animation.

However, numbers are likely to be small. Mr Butler said there were likely to be just 10 to 15 patients in the country now who might be eligible for the procedure.

Once his research is complete, Mr Butler plans to ask permission to carry out a face transplant at his hospital, but expects the request to be forwarded on, perhaps to the Department of Health.

Connecting nerves

The microsurgical procedure, a technique already used by doctors, could involve a patient being given new lips, chin, ears, nose, skin and bone from a recently deceased person.

While people would accept a face transplant if they required it, they would actually not be willing to donate

Mr Peter Butler, Royal Free Hospital Blood vessels, arteries and veins would have to be taken from the donor's face.

At the same time, the recipient would have to have their face, facial muscles, skin and subcutaneous fat removed.

In order for the face transplant to work, nerves that control feeling and movement would have to be attached to be successful.

In addition, advances in suppressing the immune system's response to foreign tissue would give the procedure a better chance of success.

But Mr Butler admitted that a survey of people's attitudes, including doctors, nurses and lay people, had highlighted some serious concerns about face transplants.

"While people would, in general, accept a face transplant if they required it, they would actually not be willing to donate."

He added: "In the end, I think that technically, we will be able to do this within the next six to nine months.

"But it's whether we should do it. It's the moral and ethical debate that needs to be raised in a public way to find out what the issues are that need to be addressed to make this possible."

He accepted that face transplants raised different issues to kidney or heart transplants, but said when these first took place there was resistance which was later overcome.

'Aesthetic reasons'

Christine Piff, of Let's Face It, a support group for people who are facially disfigured, who herself had facial cancer 25 years ago and who wears a facial prosthesis, said she would not choose a face transplant.

"There's a hesitancy on my part, thinking that I would be wearing another face that didn't belong to me.

"But when I look at it logically, this is 2002, this is going to happen."

Dr Aric Sigman, a psychologist, said the operation would be aimed at people with seriously disfigurements: "What we don't know is what happens when they wake up with someone else's face."

But he warned: "The chances are, it won't be long before it's used for aesthetic reasons."

-- Anonymous, November 27, 2002