A dramatic new type of transplant - which would see a donor's face grafted on to a recipient - received a cautious welcome yesterday as a surgeon revealed such an operation could be medically possible within six months.
Experts in medical ethics and a potential recipient applauded the procedure as a means of significantly improving the quality of life of the seriously disfigured patients for whom it is designed.
But a psychologist warned the Brave New World technology - itself the subject of the Hollywood film Face/Off - could be misappropriated for aesthetic reasons, and opened up "unchartered territory" in terms of psychological impact.
The possibility of the first full-face transplants was raised by Peter Butler, a leading plastic surgeon at the Royal Free Hospital in north London, at a conference of the British Association of Plastic Surgeons yesterday. He stressed it was essential that a moral and ethical debate took place before anyone underwent the operation.
"The technical part is complex but I don't think that's the thing that's going to be the very great difficulty. It's the ethical and moral debate that's going to have to take place before the transplant takes place.
"It is like any other organ transplant because you can actually do it and achieve it with modern immuno-suppression. But it is different because it is visible and it is part of our expression. It's emotional and functional," he told BBC Radio 4's Today programme.
The microsurgical procedure - already used to transplant skin from one hand to another - would involve the patient's face, facial muscles, skin and subcutaneous fat being removed, and replaced with that of someone who had recently died. Donated blood vessels, arteries and veins would also have to be connected to the patient's vessels with microscopic stitches, along with the nerves.
This method - creating a so-called "skin envelope" - would see the patient gaining the skin tone and texture, eye brow colour and eyelids of their donor, but retaining his or her own bone structure and still looking more like themselves than their donor.
The consultant predicted that the techniques could be in place in six to nine months and said that there were likely to be just 10 to 15 severely disfigured people in Britain who might benefit.
However, a Department of Health spokeswoman stressed that, before this could occur, the procedure would have to be examined by an advisory committee of the National Institute for Clinical Excellence.
After this, the Department of Health might launch a consultation process, which was welcomed by the BMA.
Dr Vivienne Nathanson, chairwoman of its ethics committee, said: "There are obviously issues concerning the family of the deceased person: how will they feel concerning someone who looks like their loved one? And how will the recipient feel? How we look is very much part of our identity."
Dr Aric Sigman, a psychologist who has conducted research into facial recognition, predicted the development would come about because it would ultimately be seen as curative, but warned it could be abused. "Inevitably there will always be people who look over the precipice and want to appropriate medical technology for aesthetic reasons, but that shouldn't mean this shouldn't go ahead," he said.
He added that it was difficult to assess the psychological impact - but those who sought to misappropriate it would only further damage themselves. "This really is unchartered territory. It's about a profound identity change."
