Should Our Faces Define Who We Are?

To date, there have been over 30 face transplants performed worldwide, dating back to 2005. Public opinion has shifted dramatically, from initial responses of horror, disgust, fear, and deep concern to admiration for the transformative power of medicine and a recognition of the fundamental quality of life advantages this surgery bestows.

While the technicalities of the operation itself can be quite complicated, the bottom line is straightforward: people who do have lost their faces get new ones. The transplanted faces come from end-of-life donors who may well be donating several organs for lifesaving properties.

But faces are a bit different from traditional organs used for donations like hearts and lungs that save the lives of their recipients. Face transplant recipients do not have the same kind of immediate risk; they can, and often have, lived without faces. And indeed, like traditional organ transplant recipients, those who get new faces need to be on a lifetime anti-rejection medication regime that itself poses serious health risks.

These immunosuppressants make the recipient more vulnerable to illness and are themselves carcinogenic. Many bioethicists originally argued that face transplants actually make well people sicker.

“Well” is a complicated term. In this case, it doesn’t take into account the very real challenges of living life without a face. Face transplant surgery insisted on a more expansive view of health and wellness, prioritizing quality of life and mental health on the one hand, and unsettling traditional notions of the relationship between face, body, and character on the other.

At the heart of the initial resistance to the surgery was, for some, a fundamental concern about what identity means when faces can be shared. In that concern lies, I believe, great possibility to challenge our own biases around race, gender, and ability: if we know that faces can be changed, we must recognize that they ought not to determine who we are, or, more importantly, who we imagine others to be based on how they look.

That is, of course, a fantasy. It is not one that has yet been realized; there have been very few of these surgeries, and they are needed partly because of the tremendous pressure we place on how people look. It is due to a broader social disgust with disfigurement and a physical difference that the lack of a face is so fundamentally debilitating for some people.

But there is no contradiction here between a more expansive vision of how we express our humanity and individuality and a fundamental call to be more inclusive of people with a broad range of facial differences. Both of these approaches ask us to reexamine the assumptions we make about what faces mean and what they tell us about others. They also both ask us to develop new and more meaningful modes of interaction than those determined by the face. In this fantasy, people may well change their faces and bodies, but they would not feel like they have to.

That’s a fantasy worth dwelling on. Amongst the many possibilities raised by the face transplant surgery, this is amongst the most valuable and would grant recognition both to those who wish to undergo this procedure and the very many who, despite looking very different from those around them, very much would choose not to.