This document discusses the possibility and ethics of performing a full face transplant. It presents the case study of Ms. Poonam Singhal, who suffered severe facial disfigurement from an acid attack. The document outlines the medical feasibility of a full face transplant using modern techniques like microsurgery, immunosuppressants, and tissue matching. It also considers ethical issues like finding an appropriate donor and managing post-operative care. Hypothetical imaging is presented to illustrate what Ms. Singhal's face could look like after a successful full face transplant. The debate on this procedure is just beginning.

1. Debate on “Face On”
Full Face Transplant
A Science Fiction or Reality
by
Dr. Vijay Sharma
President - International College of Cosmetic Surgery
16 October 2000
Before Acid Attack
17 October 2000
After Acid Attack
27 October 2000
During Treatment When …?

2. 17 October 2000,
the sky was blue,
birds were singing,
butterflies flying in
the garden, sun
spreading the shine
of happiness of life.

3. A beautiful girl
having dreams in her
eyes, courage in her
heart, and passion for
the surroundings.

4. Everything was going
the way she wanted.
She had never
thought an accident
could change her
entire life drastically.

5. A heinous crime of
acid attack on her
face committed by
local goons, turned
this beautiful child
into a life long
sufferer and threw
her into a prison of
ugliness forever. This
is a real story of a
beautiful child,
Ms. Poonam Singhal.

6. There are thousands of
young girls with
beautiful looks paying
the penalty for not
accepting the offers of
street Romeo’s and
thereby becoming
victims of crime in
developing countries
like India, Pakistan,
Bangladesh and other
third world countries.

7. The law has still not
formulated sufficient
punishment to curb
this heinous crime of
throwing acid on
somebody’s face and
therefore the entire
responsibility falls on
the medical world.
Doctors, hospitals and
nurses keep dressing
these victims for years
and years together.

8. Subjected to torturous
humiliation, painful
surgical sessions,
associated with terrible
sleepless nights, cries and
tears, she had been
operated for :
1. Debridement of
devitalized tissue over
face, both eye lids, left
side of chest, multiple
drill holes over the outer
table of frontal bone.

9. 2. Skin grafting done over face, left breast, neck and left arm.
Bilateral Tarosoraphy done. Delay of groin flap done for
future use on forehead.

10. 3. Skin grafting of raw areas done. Correction of ectropion of
both eyelids done and raw areas were skin grafted.
Both angles of mouth were released and skin grafted.

11. 4. Neck contracture released and skin grafted. Ectropion of
upper and lower lip released and grafted with split skin.

12. TODAY QUESTION IS ?
Is this the only treatment available…………………………………
Or……………………………
Scope for some new innovative………………………………..
If yes …………………………….
Then ……………………….
What………………………?
What best………………………….?
And what next……………………………..?
IS FULL FACE TRANSPLANT
A FEASIABLE CONCEPT…….?

13. Full Face Transplant A Science Fiction or Reality
Today I want to begin a world debate on “Full Face Transplant”. The
question, “Technically can we do it ?”, is not important but
“Ethically should we do it and for whom ?” is more important
Today
Acid Burn Victim
Future
Full Face Transplant

14. Yes, today the world leaders of Restorative and Cosmetic
Surgery, learned veteran surgeons and all invited guests are
welcome to give their valuable opinions & suggestions about this
debatable matter of “Full Face Transplant” which is no more a
science fiction but a reality.

15. With the availability of computer advance imaging, microsurgical techniques,
immuno-suppressive drugs, endoscopic surgery, laser therapy and new surgical
techniques, “Full Face Transplant” is no more a dream but a reality which is
possible now.
There are still a lot of other aspects to be seen, discussed and concluded.

16. WHY PARTIAL DERMOLIPOMATOUS
GRAFT AND HOMOLOGOUS
TRANSPLANTATION IS NECESSARY?
•Any other Superficial Skin Graft does not give
the same configuration
•Continuity of face is broken
•Aesthetically does not do justification.

17. FIRST AUTOLOGUS FULL FACE TRANSPLANT DONE IN INDIA ON 23RD
JULY 1994
BY DR. ABRAHAM THOMAS IN CHRISTIAN MEDICAL COLLEGE IN LUDHIANA.

20. EXISTING PLANNING OF SKIN GRAFTING AFTER DEBRIDEMENT

21. EXISTING AUTOLOGOUS FULL THICKNESS SKIN GRAFTING

22. AESTHETIC DISTRIBUTION OF UNIT AUTOLOGOUSGRAFTS

23. PLANNING OF FULL FACE TRANSPLANT
Partial dermolipomatous graft
Homologous transplantation (human to human)

24. ARTERIAL STRUCTURAL DERMOLIPOMATOUS VASCULAR PEDICLE
FOR FULL FACE TRANSPLANT

25. COMPOSITION OF FACE SOFT TISSUE
SOFT TISSUE OF FACE IS MADE UP OF FIVE COMPONENTS
•SKIN
•FAT
•MUSCLE
•VESSELS
•NERVES

26. FACE CAN BE CLASSIFIED IN TWO AREAS
1. Where skin is directly attached to the muscles – Skin
Muscle Fat - SMF
2. Places where fat exist between skin and muscles – Skin
Fat Muscle - SFM

27. WHY
FULL FACE TRANSPLANT IS NEEDED?
HOW
FULL FACE TRANSPLANT CAN BE DONE?

28. PLANNING OF VASCULAR DERMO-LIPOTUS PEDICEL
GRAFT OF FACE MASK FROM DONOR

29. NERVES OF THE FACE AND THEIR CATCHMENT AREA

30. IN FULL FACE TRANSPLANT IMPORTANT GLANDS TO BE TAKEN CARE

31. IN FULL FACE TRANSPLANT IMPORTAMNT MUSCLES
RESPONSIBLE FOR FACIAL EXPRESSION

32. DIFFERENT EXPRESSIONS OF THE FACE

33. Debatable Points
a). Medical Technique
Dermolipomatus Graft with
vascular pedicle,
Micro Surgery,
Laser Surfacing,
Immunosuppressive therapy
Computer Imaging.
Tissue Matching
b) Donors
Terminally ill patient
Accidental victim
Clone

34. Here is a hypothetical presentation of advanced computer imaging for
“Full Face Transplant” operation to transform existing histological
dermo lipomatous tissue of Ms. Poonam Singhal based on imaginary
“Full Face Transplant” from a donor, who could be a terminally ill
young female child or recently died female child or an accident victim
with preserved face and whose tissue should match the recipients
tissue.The transplant should be done in a well equipped hospital.
Face Today Face Tomorrow
HYPOTHETICAL PRESENTATION OF “FULL FACE TRANSPLANT”

35. THE TRANSPLANTATION OF HUMAN ORGANS
ACT 1194
Assented to on 8-7-1994
Act No. 42 of 1994
Bill No. LIX-F of 1994
(AS PASSED BY THE HOUSE OF PARLIAMENT –
RAJYA SABHA ON 5TH MAY 1993)
LOK SABHA ON 14TH JUNE, 1994.
AMENDMENTS MADE BY THE LOK SABHA
AGREED TO BY THE RAJYA SABHA ON
15TH JUNE 1994
GOVERNMENT OF INDIA

40. TODAY TOMORROW

41. Debate on “Face On”
Full Face Transplant
A Science Fiction or Reality
16 October 2000
Before Acid Attack
17 October 2000
After Acid Attack
20 October 2000
During Treatment When …?

42. COSMETIC SURGERY CENTER OF INDIA
Vishal Mandir Plot No.350 6th
Road Off Linking, Road Khar (W) Mumbai-400052. INDIA
Tel.: +91-22-26491022 / +91-22-26044543 Fax: +91-22-26041353 Mobile: 9869006534
www.changinglooks.com Email: drvijaysharma@vsnal.com
Brief Introduction of Maharashtraratna
Dr. Vijay Sharma, M.B.B.S, M.S. Cosmetic Surgeon
• Best Aesthetic Doctor in Asia – 2000, Tokyo, Japan
• World Leader of Cosmetic Surgery in India 2001 Berlin, Germany
• Fellowship of Australian College of Cosmetic Surgery, 2002
• President – Indian Association of Cosmetic Surgery
• President – Federation of Restorative And Cosmetic Surgery
• Among the Top Ten Cosmetic Surgeon of The World, 2003, (NBSAS)
• Professor and Board Examiner of International Board of Cosmetic Surgery
• Eminent Personalities of India by International Biographical Research Foundation
• Eminent Author – International Journal of Cosmetic Surgery & Aesthetic Dermatology
• Author of books, Changing Faces, Saundarya, USSA , Hyper aesthetic tension
• Record Holder in Limca Book of World Records for highest Cosmetic Surgeries, 2003
• Holder of Limca Book of World Records for First Human Fat Tissue Bank,2003