19/02/2016 09:16 GMT | Updated 18/02/2017 05:12 GMT

Face Off, Face On

Some individuals can bear a literal loss of face, usually survivors, heroes, soldiers. Heroic individuals, with valiantly acquired injuries that are mighty testaments to survival.

Symbolic interaction theory tells us that people form identity and self-esteem through interpreting how others behave towards them, so in matters of war and valour, the context may help some people better accept their disfigurement.

Plastic surgery in the UK originally developed in response to the grotesque injuries of the 'great' world wars and the consequent medical ingenuity required to keep tissues alive whilst moving them from place to place. Flaps using the wrist as a carrier were devised to move tissues from distant uninjured sites to the area of injury. However the ability to move local tissues for example to reconstruct a nasal defect has been documented in the literature since at least 1500BC)

The 'Guinea Pig' Club was an affectionate nod to the 'experimental techniques' conducted on these RAF airmen. Flaps of tissue were tubed and 'waltzed' from place to place until they arrived where they were needed to. Patients underwent dozens of procedures over many years. The years of procedures and scarring often left a stiff, painful mask with photogenic aesthetic units which despite being elegantly pristine, had only limited function and therefore limited social re-assimilation.

Today face transplants continue the tradition of medical ingenuity and surgical prowess. They were only ever envisaged as a last resort for when there were no more tissues left to move. The initial ethical debate raged for years around what the transplanted face would look like - would you look like your original self because of underlying bone structure and the play of muscles...or would you look like the deceased donor? Th fear was of a moving 'death mask' overlying a scarred face.

All that changed in November 2005 when the world's first partial face transplant was carried out. Patient ID had most of her nose, lips, chin and cheeks gnawed off by her pet dog, whilst unconscious.. The transplant was of soft tissue only and an excellent match from a similarly aged woman who had hung herself. Astonishingly she regained almost full use of her facial muscles within 18 months and was reported smiling within a year. The real reconstructive achievement is undoubtedly the surgical reawakening of the human spirit.

The improvement in form and function achieved by face transplants has been huge, much bigger and quicker than anticipated or imagined. Face transplants have catapulted reconstruction to a different era. The dangers and difficulties are evident, mortality rates are identical to solid organ transplants which are life-saving rather than life-enhancing; but this is a potential second chance in life.

The need for face transplants are mercifully rare. The ethical discussions have now moved on to patient selection and timing: the caliber of person required for a successful outcome to a face transplant is someone who has been through Hell but still has the forbearance to weigh up the benefits for themselves and decide if it's a risk worth taking for a life worth living?