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課程來源:TED
     

 

Iain Hutchison 談拯救容貌

Iain Hutchison: Saving faces

 

講者:Iain Hutchison

2010年7月演講,2011年2月在TEDGlobal上線

 

翻譯:洪曉慧

編輯:朱學恆

簡繁轉換:洪曉慧

後製:洪曉慧

字幕影片後制:謝旻均

 

注意:本篇演講含暴力及手術圖片,可能令人極度不安,圖片播放前不一定會事先提醒。

 

影片請按此下載

MAC及手持裝置版本請按此下載

閱讀中文字幕純文字版本

 

關於這場演講

整容外科醫生Iain Hutchison治療臉部嚴重損毀的人。藉由手術技巧的提升,他幫助病人改善了生活,並委託畫家繪製病人肖像以頌揚他們的人性。注意:本演講含損毀及嚴重受傷臉孔照片,可能令人感到不安-Hutchison對「為什麼一張損毀的臉孔能讓我們如此震驚及不適?」這個問題提出令人深思的答案。遮住12:10 -13:19這段影片畫面,但請繼續聆聽。此演講中的畫像為Mark Gilbert的作品。

 

關於Iain Hutchison

Iain Hutchison是一位具前瞻性的口腔及整容外科醫生,他的基金會Saving Faces,致力於探索人類臉孔的特質。

 

為什麼要聽他演講

Iain Hutchison對人類臉孔進行深刻思考。

 

「作為一名記者,我至少應該裝作具有客觀性,但請原諒我在這個情況下的偏見:我確實相信,只要是對藝術稍有興趣的人,或對我們共同人性有稍有感覺的人,都應該去看這個展覽。」

David Thomas,《每日電訊報》

 

Iain Hutchison的英語網上資料

 

[TED科技‧娛樂‧設計]

已有中譯字幕的TED影片目錄(繁體)(簡體)。請注意繁簡目錄是不一樣的。

 

Iain Hutchison 談拯救容貌

我們的臉非常重要,因為它是大家眼中所見的外觀部分,別忘了它是一個功能性構造,我們擁有堅硬的頭骨,保護我們身體最重要的器官:大腦,即我們感官所在位置,特殊感官,視覺、說話,我們的聽覺、嗅覺、味覺。這頭骨佈滿孔洞,如你所見,燈光穿過有著鼻腔、鼻竇的頭骨,使我們呼吸的空氣變得溫暖及濕潤。但也可以想像,如果它們被堅硬的骨骼填滿,我們的頭將重的不得了,我們將無法使它保持直立,無法觀看我們周圍的世界。

 

(這篇演講包含暴力及手術圖片,可能令人極度不安,圖片播放前不一定會事先提醒)

 

這名婦女正慢慢走向死亡,因為她臉骨的良性腫瘤完全摧毀了她的嘴和鼻子,所以她不能呼吸和進食。

 

附在臉部骨骼上,決定了我們臉部結構,是傳達我們臉部表情的肌肉,表達我們情感的共通語言,我們社會的信號系統。覆蓋在其上的是皮膚,它是一個非常複雜的3D結構,以正確角度在各處彎曲,有薄的區域,如眼瞼,厚的區域,如臉頰,有不同顏色。我們臉上有感覺因子,我們喜歡親吻何處?嘴唇,也許輕咬耳朵,臉部是吸引我們這麼做的地方。

 

但別忘了毛髮,看看你們左邊的圖片,這是我兒子有眉毛的照片,當他沒眉毛時看上去多奇怪,有極大差異。試想一下,如果他的頭髮從鼻子中間長出,他看起來會更奇怪。

 

醜狀畏懼症是以下事實的一個極端版本,我們無法像其他人看到我們一樣地看到自己,這是一個令人震驚的事實,我們只能看到自己鏡中的影像,只能看到自己在定格照片中的影像,這僅捕捉了我們生存時的一小部分時間。醜狀畏懼症是一種心理病態,即某人可能非常好看,卻認為自己極醜,而不斷進行手術,來修正他們的臉部外觀。他們不需要這個,他們需要心理幫助。Max慷慨地捐出自己的照片給我,他沒有醜狀畏懼症,但我使用他的照片來說明一個事實,即他看起來很像有醜狀畏懼症,換句話說,他看起來完全正常。

 

年齡是另一件讓我們對外表的態度產生變化的因素,所以孩子們衡量自己,學會衡量自己,受他們周圍成年人的行為影響。這裡有一個經典例子:Rebbecca有良性血管瘤,已長出她的頭骨,毀了她的鼻子,讓她看東西有困難。如你所見,它擋住她的視線,她也會有危險,當她弄傷它的時候,會造成血流不止。我們的研究顯示,這些兒童的父母和親人很寵愛這樣的特殊之處,他們已習慣他們的臉,認為它很特別,事實上,有時父母會爭辯是否應該將這些兒童的病變切除,偶爾他們會有強烈的悲傷反應,因為孩子已對它產生喜愛之情,要歷經如此巨大的改變,他們會認不出自己。但其他成年人說出極度傷人的話,他們說,「你們怎麼敢把這個孩子帶出門,嚇壞其他人,你不是該做些什麼嗎?為什麼你不把它切除?」其他孩子好奇的一擁而上,戳這個病變處,因為天生的好奇心。這顯然提醒了這個孩子它的不正常,手術後,一切恢復正常,成年人表現出更自然的樣子,這個孩子更容易和其他孩子玩在一起。

 

以青少年來說,回想一下你的青少年時代,我們歷經一個巨大的、且往往是不成比例的變化,在我們的臉部外觀上。我們試著努力找到自我認同,我們渴望得到同儕的認可,因此,我們的容貌對我們至關重要,我們試圖將自己投射到這個世界。還記得只要一顆青春痘就可以讓你消沉幾天,你每天花多少時間照鏡子?練習你嘲諷的表情、嚴肅的表情,試著讓自己看起來像史恩康納萊,像我一樣,試著挑起一邊眉毛,這是一段可能帶來嚴重問題的時間。

 

我選擇展示這張Sue的側面輪廓,因為它展現的是她向前凸出的下顎及向前凸出的下唇,我希望現場所有聽眾將你們的下顎向前伸,轉向身旁的人,將你的下顎向前伸,轉向身旁的人,看看他們-他們看起來很悲慘,這正是人們常對Sue說的。她一點也不悲慘,但人們常對她說,「妳為什麼這麼悲慘?」人們總是對她的心情作出錯誤的判斷,老師和同儕看不起她,她在學校飽受戲弄,於是她選擇接受臉部手術。臉部手術後,她說,「我的臉現在反映出我的個性,人們現在知道我是熱情的,我是個快樂的人。」這是可以讓青少年如願以償的改變。

 

這個變化是真正的改變呢?抑或是病人本身虛構的想像?我們研究了青少年對於接受這種臉部矯正手術患者照片的態度,我們發現,我們將照片混在一起,這樣他們就認不出是之前還是之後的,我們發現的是,他們認為病人手術後更吸引人,這並不奇怪,但我們也請他們來判斷病人,在誠實、智慧、友善、暴力方面,在手術前,病人被認為在所有這些特點上,都比正常人更差,更加暴力等等。在手術後,他們被認為更聰明、更友善、更誠實、較不暴力,但我們並沒有矯正他們的智慧或他們的個性。

 

當人們變老時,並不需要選擇進行此類型的手術,他們出現在諮詢室是遭受厄運打擊的結果,他們會發生的是,可能罹患癌症或外傷。這是Henry的照片,這是他從左臉、頰骨、上顎骨、眼窩割除惡性腫瘤幾星期後,他在這個階段看上去相當不錯,但之後十五年期間,他又做了十四次手術,疾病蹂躪他的臉,不時摧毀我的重建工作。我從Henry身上學到很多,Henry告訴我,你可以繼續工作,他的工作是辯護人,他繼續打板球,充分享受生活,這可能是因他有個成功、滿意的工作,和一個溫馨的家庭,並能夠參與社交活動。他保持一種漫不在乎的冷靜,我不會說他克服了這個;他不是克服它,不只是如此,他忽略它,他忽略發生在他生命中的毀容,並持續地遺忘它,而這正是這些人能做到的。

 

Henriapi也說明了這個現象,他是一位20多歲的男性,他第一次到奈及利亞以外的地方,就是帶著這個惡性腫瘤來英國動手術。這是我做過最長的手術,花了23小時,由我跟我的神經外科醫生一起進行。我們移除了他右臉所有骨頭,他的眼睛、鼻子、頭骨骨骼、臉部皮膚,用後方的組織重建他的臉。他繼續擔任精神科護士,他結婚了,有個兒子叫Jeremiah,同樣的,他說,「這幅我和我的兒子Jeremiah的畫,告訴我我是個成功的男人,正如我對自己的感覺。」他的臉部毀容並沒有影響到他,因為他有家庭支持,他有成功、滿意的工作。

 

因此我們看到,我們可以改變人們的臉孔,但當我們改變人們的臉孔,我們也改變了他們的認知。是好是壞?例如,有兩種不同類型的臉部手術,我們可以如此歸類,我們可以說,有病人選擇臉部手術,像Sue,當他們進行臉部手術,他們覺得生命改變了,因為別人視他們為更好的人,他們並未感覺不同,他們感覺事實上已獲得他們從未擁有過的東西,他們的臉現在反映了他們的個性,事實上這可能是整容手術和這類手術的區別。因為你可能會說,「嗯,這類手術或許可被視為化妝品。」如果做整容手術,患者往往較不快樂,他們試圖使生活有所不同。

 

(以下演講圖片顯示前不一定會事先提醒,此演講包含暴力及手術圖片,可能令人極度不安)

 

Sue並未試圖使生活有所不同,她只是想使她的臉符合她的個性。

 

但還有其他人並未選擇做臉部手術,他們是臉部中槍的人,我把它移除,用空白幻燈片代替,避免你們當中有人反胃。他們被迫遭遇這些。再次地,我告訴你們,如果他們有個溫馨的家庭和良好的工作生涯,就可以過正常和滿意的生活,他們的認知不會改變。

 

這個關於外觀和偏見的事業是一種西方現象嗎?Muzetta的家人證明了這個是謊言。這是一個來自倫敦東部的孟加拉小女孩,她右臉有一個巨大的惡性腫瘤,已使她失明,它正迅速成長,很快就會讓她死亡。在她做手術切除腫瘤後,她父母給她穿著美麗的綠色天鵝絨禮服,將粉紅色絲帶繫在她頭髮上,他們希望將這幅畫展現給全世界。儘管他們是正統的穆斯林,母親全身穿著罩袍,所以這不僅是西方現象。

 

我們對人們的臉做判斷,一向如此,這是一直存在的現象。我們可以想想Lombrosso以及他對罪犯臉孔所下的定義。他說,你可以看出罪犯的臉孔,只要看照片上所顯現的就能判斷。好看的人總是被判斷為更友善,看看O.J.,他是個好看的傢伙,我們喜歡跟他在一起,他看起來很友善,現在我們知道他是個被定罪的虐妻者,事實上他不是好人。美並不等於善良,當然也不等於滿足。

 

我們已談論了靜態的臉及判斷靜態的臉,但事實上,我們對於判斷動態的臉更加自在,我們認為我們可以用表情判斷人。英國司法系統的陪審團希望看到一個在場證人,看看他們是否可以揪出謊言中的蛛絲馬跡,如眨眼、猶豫等表情,因此他們希望看到在場證人。Todorov告訴我們,在十分之一秒內我們可以根據某人的臉做出判斷。我們對這張圖片感到不舒服嗎?是的,沒錯,我們喜歡我們醫生、律師、財務顧問的臉是蒙著的嗎?我們會很不舒服,但我們善於根據臉部外觀和動作做判斷嗎?事實是,有一個五分鐘規則,不是Todorov的十分之一秒規則,而是五分鐘規則。如果你花五分鐘跟某人在一起,開始觀察除了他容貌之外的東西,這個最初吸引你的人可能看起來乏味,你會對他失去興趣。你一開始沒有立刻追尋的人,是因為你並未發現他們特別有吸引力,人們變得有吸引力是因為他們的個性。

 

我們已談了很多關於臉部外觀的事,現在我想分享一些我們做過的手術,手術前後的圖片。這是一張Ann的照片,她的右下顎已切除,頭骨的基部也已切除,你可以看到手術後的照片,我們已經成功地重建了她的臉。但還不夠好,這是Ann所希望的,她想外出划小艇,想外出爬山,這是她想達到的成果,也是我們要達到的。

 

這是一張可怕的相片,所以我現在舉起手。這是Adi的照片,奈及利亞的銀行經理,臉在武裝搶劫中被槍擊,他失去了下顎、嘴唇、下巴和上顎及牙齒,這是他給我們設的標準,「我希望看起來像這樣,這是我以前的樣子。」因此,使用現代科技,我們用電腦製作模型,我們做了一個沒有骨頭的下顎模型,然後將一個金屬板彎曲置於其上,把它放入,所以我們知道這是一個準確位置,然後我們從後方放入骨頭和組織,你可以看到金屬板將其固定住,你可以看到植入物正被放入。因此,在一次手術中,我們達成這個目標,還有這個,因此,病人的生命得以保住,這是個好消息,不過下巴的皮膚看起來跟之前不一樣,這是來自他背部的皮膚,較厚、較黑、較粗糙,沒有下巴的輪廓,這是我們失敗的地方,這正是我們需要進行臉部移植的地方。

 

臉部移植手術大多用於取代燒傷病人的皮膚,我們可以取代下層的骨骼結構,但仍不擅長臉部皮膚的取代,所以,讓我們的醫療擁有這種技術非常寶貴,但患者仍得服用藥物,在餘生抑制他們的免疫系統,這是什麼意思?他們感染的風險增加、罹患惡性腫瘤的風險增加,這不是挽救生命的移植,像心臟、肝臟或肺臟移植,這是一種生活品質的移植。結果是,患者會說,如果他們10或15年後會罹患惡性腫瘤,「我希望能接受傳統重建技術,而不是這個。因為,我現在就會逐漸死於惡性腫瘤嗎?」我們還不知道,我們也不知道他們關於識別和認知的感覺。Bernard Devauchelle 和Sylvie Testelin做了第一次手術,正研究著這一點,捐贈者極少,因為,有多少人會希望自己心愛者的臉在死亡時被移除?因此,這也將成為臉部移植的問題。

 

較好的消息是,未來幾乎觸手可及,即未來的組織工程。試想,我可以製造生物降解模板,我可以把它放在應放置的位置,我可以灑下一些細胞,來自患者本身臀部的幹細胞,一點點基因工程蛋白質。瞧,等待四個月,臉部長成,這有點像Julia Child食譜。

 

但我們仍有些問題,我們得解決口腔癌問題,我們仍未治癒足夠的病患-這是最容易毀容的癌症,我們仍未完善的將他們重建。在英國有一種流行病,即年輕人的臉部受傷,我們仍然無法去除疤痕,我們需要做研究。最好的消息是,外科醫生知道我們需要做研究,我們已經成立慈善機構,這將有助於我們募集臨床研究基金,確定目前最佳的治療方法,以及未來更佳的治療方法。我們不能只是故步自封,說,「好吧,我們做的還不錯,目前這樣就行了。」

 

非常感謝。

 

(掌聲)

 

以下為系統擷取之英文原文

About this talk

Facial surgeon Iain Hutchison works with people whose faces have been severely disfigured. By pushing to improve surgical techniques, he helps to improve their lives; and by commissioning their portraits, he celebrates their humanity. NOTE: This talk contains images of disfigured and badly injured faces that may be disturbing -- and Hutchison provides thoughtful answers as to why a disfigured face can shock us so deeply. Squeamish? Hide your screen from 12:10 - 13:19, but do keep listening. Portraits shown in this talk come from Mark Gilbert.

About Iain Hutchison

Iain Hutchison is a pioneering oral and facial surgeon; his foundation, Saving Faces, explores the nature of our expressions. Full bio and more links

Transcript

Our face is hugely important because it's the external visual part that everybody else sees. Let's not forget it's a functional entity. We have strong skull bones that protect the most important organ in our body: the brain. It's where our senses are located, our special senses -- our vision, our speech, our hearing, our smell, our taste. And this bone is peppered, as you can see, with the light shining through the skull with cavities, the sinuses, which warm and moisten the air we breathe. But also imagine, if they were filled with solid bone, our head would be dead weight, we wouldn't be able to hold it erect, we wouldn't be able to look at the world around us. This woman is slowly dying because the benign tumors in her facial bones have completely obliterated her mouth and her nose, so she can't breathe and eat.

Attached to the facial bones that define our face's structure are the muscles that deliver our facial expression, our universal language of expression, our social signaling system. And overlying this is the skin drape, which is a hugely complex three-dimensional structure -- taking right angled bends here and there, having thin areas like the eyelids, thick areas like the cheek, different colors. And then we have the sensual factor of the face. Where do we like to kiss people? On the lips. Nibble the ears maybe. It's the face where we're attracted to with that.

But let's not forget the hair. You're looking at the image on your left-hand side -- that's my son with his eyebrows present. Look how odd he looks with the eyebrows missing. There's a definite difference. And imagine if he had hair sprouting from the middle of his nose, he'd look even odder still.

Dismorphophobia is an extreme version of the fact that we don't see ourselves as others see us. It's a shocking truth that we only see mirror images of ourselves, and we only see ourselves in freeze-frame photographic images that capture a mere fraction of the time that we live. Dismorphophobia is a perversion of this where people who may be very good looking regard themselves as hideously ugly and are constantly seeking surgery to correct their facial appearance. They don't need this, they need psychiatric help. Max has kindly donated his photograph to me. He doesn't have dismorphophobia, but I'm using his photograph to illustrate the fact that he looks exactly like a dismorphophobic. In other words, he looks entirely normal.

Age is another thing when our attitude toward our appearance changes. So children judge themselves, learn to judge themselves, by the behavior of adults around them. Here's a classic example: Rebbecca has a benign blood vessel tumor that's growing out through her skull, has obliterated her nose, and she's having difficulty seeing. As you can see, it's blocking her vision. She's also in danger, when she damages this, of bleeding profusely. Our research has shown that the parents and close loved ones of these children adore them. They've grown used to their face; they think they're special. Actually, sometimes the parents argue about whether these children should have the lesion removed. And occasionally they suffer intense grief reactions because the child they've grown to love has changed so dramatically and they don't recognize them. But other adults say incredibly painful things. They say, "How dare you take this child out of the house and terrify other people. Shouldn't you be doing something about this? Why haven't you had it removed?" And other children in curiosity come up and poke the lesion, because -- a natural curiosity. And that obviously alerts the child to their unusual nature. After surgery, everything normalizes. The adults behave more naturally, and the children play more readily with other children.

As teenagers -- just think back to your teenage years -- we're going through a dramatic and often disproportionate change in our facial appearance. We're trying to struggle to find our identity. We crave the approval of our peers. So our facial appearance is vital to us as we're trying to project ourselves to the world. Just remember that single acne spot that crippled you for several days. How long did you spend looking in the mirror every day, practicing your sardonic look, practicing your serious look, trying to look like Sean Connery, as I did, trying to raise one eyebrow. It's a crippling time.

I've chosen to show this profile view of Sue, because what it shows is her lower jaw jutting forward and her lower lip jutting forward. I'd like you all in the audience now to push your lower jaw forward, turn to the person next to you, push your lower jaws forward, turn to the person next to you and look at them -- they look miserable. That's exactly what people used to say to Sue. She wasn't miserable at all. But people used to say to her, "Why are you so miserable?" People were making misjudgments all the time on her mood. Teachers and peers were underestimating her, she was teased at school. So she chose to have facial surgery. After the facial surgery, she said, "My face now reflects my personality. People know now that I'm enthusiastic, that I'm a happy person." And that's the change that can be achieved for teenagers.

Is this change though a real change, or is it a figment of the imagination of the patient themselves. Well we studied teenagers attitudes to photographs of patients having this corrective facial surgery. And what we found was -- we jumbled up the photographs so they couldn't recognize the before and after -- what we found was that the patients were regarded as being more attractive after the surgery. Well that's not surprising, but we also asked them to judge them on honesty, intelligence, friendliness, violence. They were all perceived as being less than normal in all those characteristics -- more violent, etc. -- before the surgery. After the surgery, they were perceived as being more intelligent, more friendly, more honest, less violent -- and yet we hadn't operated on their intellect or their character.

When people get older, they don't necessarily choose to follow this kind of surgery. Their presence in the consultation suite is a result of the slings and arrows of outrageous fortune. What happens to them is that they may have suffered cancer or trauma. So this is a photograph of Henry to weeks after he had a malignant cancer removed from the left side of his face -- his cheekbone, his upper jaw, his eye-socket. He looks pretty good at this stage. But over the course of the next 15 years he had 14 more operations, as the disease ravaged his face and destroyed my reconstruction regularly. I learned a huge amount from Henry. Henry taught me that you can carry on working. He worked as an advocate. He continued to play cricket. He enjoyed life to the full. And this was probably because he had a successful, fulfilling job and a caring family and was able to participate socially. He maintained a calm insouciance. I don't say he overcame this; he didn't overcome it. This was something more than that. He ignored it. He ignored the disfigurement that was happening in his life and carried on oblivious to it. And that's what these people can do.

Henriapi illustrates this phenomenon as well. This is a man in his 20s whose first visit out of Nigeria was with this malignant cancer that he came to the United Kingdom to have operated on. It was my longest operation. It took 23 hours. I did it with my neurosurgeon. We removed all the bones at the right side of his face -- his eye, his nose, the skull bones, the facial skin -- and reconstructed him with tissue from the back. He continued to work as a psychiatric nurse. He got married. He had a son called Jeremiah. And again, he said, "This painting of me with my son Jeremiah shows me as the successful man that I feel that I am." His facial disfigurement did not affect him because he had the support of a family, he had a successful, fulfilling job.

So we've seen that we can change people's faces. But when we change people's faces, are we changing their identity, for better or for worse? For instance, there are two different types of facial surgery. We can categorize it like that. We can say there are patients who choose to have facial surgery -- like Sue. When they have facial surgery, they feel their lives have changed, because other people perceive them as better people. They don't feel different. They feel that they've actually gained what they never had, that their face now reflects their personality. And actually that's probably the difference between cosmetic surgery and this kind of surgery. Because you might say, "Well, this type of surgery might be regarded as cosmetic." If you do cosmetic surgery, patients are often less happy. They're trying to achieve difference in their lives. Sue wasn't trying to achieve difference in her life, she was just trying to achieve the face that matched her personality.

But then we have other people who don't choose to have facial surgery. They're people who have their face shot off. I'll move it off, and we'll have a blank slide for those who are squeamish amongst you. They have it forced upon them. And again, as I told you, if they have a caring family and good work life, then they can lead normal and fulfilled lives. Their identity doesn't change.

Is this business about appearance and preoccupation with it a Western phenomenon? Muzetta's family give the lie to this. This is a little Bangladeshi girl from the east end of London who's got a huge malignant tumor on the right side of her face, which has already made her blind, and which is rapidly growing and is going to kill her shortly. After she had surgery to remove the tumor, her parents dressed her in this beautiful green velvet dress, a pink ribbon in her hair, and they wanted the painting to be shown around the world, despite the fact that they were orthodox Muslims and the mother wore a full burqa. So it's not simply a Western phenomenon.

We make judgments on people's faces all the time. It's been going on since we can think of Lombrosso and the way he would define criminal faces. He said you could see criminal faces, judging them just on the photographs that were showed. Good-looking people are always judged as being more friendly. We look at O.J. -- he's a good looking guy. We'd like to spend time with him. He looks friendly. Now we know that he's a convicted wife batterer, and actually he's not the good guy. And beauty doesn't equate to goodness, and certainly doesn't equate to contentment.

So we've talked about the static face and judging the static face, but actually, we're more comfortable with judging the moving face. We think we can judge people on their expressions. U.K. jurors in the U.K. justice system like to see a live witness to see whether they can pick up the telltale signs of mendacity -- the blink, the hesitation. And so they want to see live witnesses. Todorov tells us that, in a tenth of a second, we can make a judgment on somebody's face. Are we uncomfortable with this image? Yes we are. Would we be happy if our doctor's face, our lawyer's face, our financial adviser's face was covered? We'd be pretty uncomfortable. But are we good at making the judgments on facial appearance and movement? The truth is that there's a five minute rule -- not the tenth of a second rule like Todorov, but a five minute rule. If you spend five minutes with somebody, you start looking beyond their facial appearance, and the people who you're initially attracted to may seem boring and you lose interest in them, and the people who you didn't immediately seek out, because you didn't find them particularly attractive, become attractive people because of their personality.

So we've talked a lot about facial appearance. I now want to share a little bit of the surgery that we do -- where we're at and where we're going. This is an image of Ann who's had her right jaw removed and the base of her skull removed. And you can see in the images afterward, we've managed to reconstruct her successfully. But that's not good enough. This is what Ann wants. She wants to be out kayaking, she wants to be out climbing mountains. And that's what she achieved, and that's what we have to get to.

This is a horrific image, so I'm putting my hand up now. This is a photograph of Adi, a Nigerian bank manager who had his face shot off in an armed robbery. And he lost his lower jaw, his lip, his chin and his upper jaw and teeth. This is the bar that he set for us. "I want to look like this. This is how I looked before." So with modern technology, we used computers to make models. We made a model of the jaw without bone in it. We then bent a plate up to it. We put it in place so we knew it was an accurate position. We then put bone and tissue from the back. Here you can see the plate holding it, and you can see the implants being put in -- so that in one operation we achieve this and this. So the patient's life is restored. That's the good news. However, his chin skin doesn't look the same as it did before. It's skin from his back. It's thicker, it's darker, it's coarser, it doesn't have the contours. And that's where we're failing. And that's where we need the face transplant.

The face transplant has a role probably in burns patients to replace the skin. We can replace the underlying skeletal structure, but we're still not good at replacing the facial skin. So it's very valuable to have that tool in our armamentarium. But the patients are going to have to take drugs that suppress their immune system for the rest of their lives. What does that mean? They have an increased risk of infection, an increased risk of malignancy. This is not a life-saving transplant -- like a heart, or liver, or lung transplant -- it is a quality of life transplant, and as a result, are the patients going to say, if they get a malignant cancer 10 or 15 years on, "I wish I'd had conventional reconstructive techniques rather than this, because I'm now dying of a malignant cancer?" We don't know yet. We also don't know what they feel about recognition and identity. Bernard Devauchelle and Sylvie Testelin who did the first operation are studying that. Donors are going to be short on the ground, because how many people want to have their loved one's face removed at the point of death. So there are going to be problems with face transplantation.

So the better news is the future's almost here -- and the future is tissue engineering. Just imagine, I can make a biologically degradable template. I can put it in place where it's meant to be. I can sprinkle of few cells, stem cells from the patient's own hip, a little bit of genetically engineered protein, and low and behold, leave it for four months and the face is grown. This is a bit like a Julia Child recipe.

But we've still got problems. We've got mouth cancer to solve. We're still not curing enough patients -- it's the most disfiguring cancer. We're still not reconstructing them well enough. In the U.K. we have an epidemic of facial injuries among young people. We still can't get rid of scars. We need to do research. And the best news of all is that surgeons know that we need to do research. And we've set up charities that will help us fund the clinical research to determine the best treatment practice now and better treatment into the future, so we don't just sit on our laurels and say, "Okay, we're doing okay. Let's leave it as it is."

Thank you very much indeed.

(Applause)
 


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我覺得本文中的 identity 一詞, 或許可以翻譯為 "定位".

jerry1129, 2011-04-26 23:13:28

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