By: Joanna Connors – nationalgeographic.com – September 2018
This story is difficult to look at. Yet we are asking you to go on the remarkable journey of how a young woman received a face transplant because it reveals something profound about our humanity. Our face conveys who we are, telegraphing a kaleidoscope of emotions. It’s our doorway to the sensory world, allowing us to see, smell, taste, hear, and feel the breeze. Are we our faces? Katie Stubblefield lost hers when she was 18. When she was 21, doctors gave Katie a new face. This is a story of trauma, identity, resilience, devotion, and amazing medical miracles.
This story appears in the September 2018 issue of National Geographic magazine.
The face lies on a surgical tray, eyes empty and unseeing, mouth agape, as if exclaiming, “Oh!”
Sixteen hours ago surgeons in Operating Room 19 at the Cleveland Clinic began the delicate work of removing the face from a 31-year-old woman who was declared legally and medically dead three days earlier. Soon they will take it to a 21-year-old woman who has waited more than three years for a new face.
For a moment, the face rests in its astonished solitude.
Surgeons, residents, and nurses, suddenly silent, gaze at it in awe as clinic staff, like unusually polite paparazzi, move in with cameras to document it. The face, deprived of blood, grows pale. With each second of detachment, it looks more like a 19th-century death mask.
Frank Papay, a veteran plastic surgeon, picks up the tray, carrying it carefully in his gloved hands, and walks to Operating Room 20, where Katie Stubblefield waits.
Katie will be the youngest person to receive a face transplant in the United States. Her transplant, the clinic’s third and the 40th known in the world, will be one of the most extensive, making her a lifelong subject in the study of this still experimental surgery.
Looking down at the face he carries, Papay feels a kind of reverence. It’s an amazing thing, he thinks, what some people will do for others—to give them a heart or a liver, even a face. He says a silent prayer of thanks and takes the face to its next life.
We are members of an exclusive group: animals that recognize their own faces in a mirror. Besides us, great apes, Asian elephants, Eurasian magpies, and bottlenose dolphins are the only other animals known to recognize themselves. Dolphins as young as seven months will pose, twirl, and put their eye right up against the mirror to stare at their faces. Only humans are known to express dismay when looking at their reflections.
As we scrutinize our own faces for wrinkles and flaws, we can fail to notice what a marvelous organ the face is. Our faces are the most distinctive part of our visible body, a mysterious mosaic of the physical and the psychical. Faces are the body’s workaholics: They confer and confirm identity, express emotion, communicate meaning, perform basic functions necessary for life, and enable us to experience the world through our senses.
We are born seeking faces. Newborns turn toward them during their first moments out of the womb. Babies observe, respond to, and mimic our expressions as though it’s their job. And in a way, it is. This close study of faces is the way we all begin to understand the curious business of being human. Faces, in evolutionary terms, helped us become social animals.
Take a moment to look in a mirror. What do you see? Most of us would answer, “Myself.”
My. Self. Our faces are the outer image we attach to our inner sense of self, to who we are and where we fit in the world. Faces root us in our culture, in the rituals and rules about how we present ourselves and how we see others. In some cultures, faces are veiled and hidden. Other cultures draw attention to faces with displays of tattoos, piercings, and scarification. In the contemporary world, faces are often a blank canvas to be manipulated with cosmetic surgery, injections, and intricate makeup techniques learned on YouTube. If we allow them to age, our faces will tell our life story. They connect us to the past in our ancestors and to the future in our children.
At the simplest level of identity, our faces function as our passport photo to the rest of the world. But they’re also the way others seek to know us more deeply, to discover who we are behind that photo. “Appearance is the most public part of the self. It is our sacrament, the visible self that the world assumes to be a mirror of the invisible, inner self,” wrote Harvard Medical School psychologist Nancy Etcoff in her book Survival of the Prettiest.
Whether the emotions we express with our faces are evolutionary adaptations or learned social behaviors is a topic hotly debated among social scientists. Charles Darwin argued in 1872 that facial expressions displaying some emotions are universal adaptations. In the late 1960s the psychologist Paul Ekman concluded that Darwin was correct. Human beings, across cultures, recognize specific facial displays associated with basic emotions: anger, disgust, fear, joy, sadness, and surprise.
Look in the mirror again. Think about what you can do with that face. You can kiss the ones you love, bite into an apple, sing, and sigh. You can smell freshly cut grass. You can gaze at your newborn and touch your cheek to his. Beyond showing (or not showing) our emotions, faces enhance our ability to communicate with language. We smile, we wrinkle our noses, we wink, we grimace, we perform countless expressions as we converse, often without even realizing it.
Now visualize what goes on beneath that astonishing face. We have 43 mimetic muscles to express emotion and articulate speech. We have four major muscles on each side of the face that move the jaws and complex lingual muscles that assist in swallowing and speech. The face is also made up of layers of blood vessels, sensory and motor nerves, cartilage, bone, and fat. Cranial nerves control the motor muscles and transmit sensory information to the brain, enabling us to see, smell, taste, hear, and feel sensation on the skin.
Go back to the mirror one more time. Look at your incredible face.
Imagine what it would mean to lose it.
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