Read Excerpt: 'Face to face'

June 4, 2009— -- Dr. Maria Siemionow details the story of her effort to perform the first near-total face transplant in the United States and how to identify a transplant candidate in her new book.

In "Face to Face: My Quest to Perform the First Full Face Transplant," the Polish-born surgeon describes her 30-year journey to the top of American medicine at the Cleveland Clinic, one of the most prestigious medical institutions in the world.

Read an excerpt of the book below.

Look in the mirror. You see your face, sleepy in the morning, tired in the evening, capable of a thousand emotions — one or more for every experience, every encounter. Desire. Weariness. Irritation. Happiness. Sadness. Resignation. Joy. Even thoughts are reflected by a flicker here, a shift there. No other aspect of our anatomy is capable of even a fraction of the complexity of motion and emotion allowed by the muscles and tissues of the face.

The surface of the face has as many as 27 different landmarks on each side that give it character and help identify structures such as nerves and blood vessels that lie underneath. If you placed your fingertip in the middle of your upper lips and traced halfway around your mouth to the skin between your lower lip and chin, you would have crossed ten different muscles in that short trip.

These muscles, which lie directly beneath the skin and control the movements of the mouth, cause everything from smiling to whistling to puckering up for a kiss to spitting out a watermelon seed. The eyes, the nose, the cheeks, and even the ears are controlled by a similar pattern of overlying muscles that pull the flesh in all directions. Thus the face can convey emotion, expression.

Imagine, however, if you looked in the mirror and saw something entirely different. Scars. Skin and tissue distorted by a burn. Lips reduced to a circle. And what if what was reflected back at you did not even register those emotions? What if your face was unable to move — it had been rendered a mask? What if you couldn't recognize yourself in the mirror? If that face — or what was left of it — stared back at you as if it were a stranger, how would you feel?

Most of us take for granted the value of our own face. We don't consciously realize how it reinforces and shapes our identity. When we look into a mirror, we assign an identity to the reflection, and that identity carries a great deal of weight. The reflection says this is a young person or an aging person, a successful person, a person with a goal, a person someone can love. Or perhaps this is someone whose visage is so scarred and distorted that even self-love seems impossible.

IN NOVEMBER 2004, Cleveland Clinic and I attracted worldwide attention when the hospital's institutional review board announced that it considered a face transplant to be both ethical and possible. The Clinic is used to such attention. I wasn't. Calls and requests for interviews came from local and national media everywhere in the world. Whether community weeklies or large metropolitan dailies, all were interested in this story.

Mixed in with the calls from the media were quiet, hesitant inquiries from individuals who wanted to know what the procedure would involve, who would be eligible, and whom they might contact at the Clinic to register as possible candidates for the surgery.Four years later, in December 2008, I lead the team that performed the first face transplant in the United States, making international headlines.

This book is a response to that attention. It's intended for those who may be interested in the evolution of a microsurgeon, those interested in the medicine that will allow a face transplant, those hoping for a new life, and those who contemplate giving hidden sufferers a new life and permission to walk in sunlight once again. I wanted to tell something of my life, not because it's particularly exciting or laden with adventure, but because it shows the path someone would follow en route to conducting a procedure that has never before been attempted.