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Life After a New Face

After a face transplant, avoiding psychological problems and reintegrating into society are the next big challenges.

By Anita Slomski // Winter 2006
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One look at the patient consent form enumerating every possible risk of a face transplant and it’s obvious that only the deeply courageous would dare sign. Yet something even more heroic is asked of candidates: proof that they’re coping with their disfigurement.

“Someone with very low self-esteem and a poor support network will have more difficulty reintegrating into society” after a face transplant, says psychiatrist Joseph Locala, who provides psychiatric care for Cleveland Clinic patients. “I’ll want to make certain that face-transplant candidates have developed a personal identity based upon attributes other than appearance.” And though critics question whether it makes sense to subject a healthy person to such an extreme experiment, Locala notes that facial disfigurement brings with it a fivefold greater risk of psychiatric problems.

Still, a successful face transplant is likely to pose numerous psychological issues. Recipients may need therapy to learn how to interact without automatically assuming that each encounter will be emotionally painful. Transplant surgery, postoperative pain and the effects of medications could set off a recurrence of post-traumatic stress disorder, which afflicts as many as 30% of disfigured burn patients. And episodes of anxiety and depression, common in a third of transplant patients, are possible, says Locala.

Yet, after years of managing transplant patients, Locala is confident that any psychiatric problems can be treated. “Patients who have received solid-organ transplants initially complain about the burden of their medication regimen and the fear of complications or immediate graft rejection, but within six months to a year, their lives typically begin to regain a sense of normalcy,” he says.

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