Butler, the Irish surgeon who is championing British efforts to win the international race to carry out the world’s first full face transplant, has a lot on his mind. He’s back in Dublin to present a lecture but instead of finalising his notes he’s concentrating on a much more urgent matter.
There are just hours to go to England’s second World Cup match and Butler is worried about whether Wayne Rooney will make an appearance. He refers to Roo as “the little elephant,” a moniker attached to the player by the Chinese, apparently.
It’s an opportunity for the surgeon to show that there is more to him than the pursuit of a goal that some perceive to be a self-indulgent dream.
For more than a decade, Butler has been frustrated in his attempts to carry out a procedure that until now has been confined to the realms of science fiction. But all that might change on Wednesday when the consultant plastic surgeon and his 30-strong team of doctors at the Royal Free Hospital in London will discover if they have received the ethical approval required to turn that dream into reality.
If he gets the go-ahead, Butler will pick four candidates for operation. Already, 29 people with facial disfigurements have presented themselves to him. About £40,000 (€58,000) has been raised to finance two operations. The chances of a successful outcome appear to have improved following the recent success of partial face transplants in France and China.
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“It’s made my job easier,” Butler admits. “We’ve seen a woman in France with severe facial deformity change to what looks like a perfectly normal face, a women who says the procedure has changed her life. So it’s now inevitable. It’s no longer a matter of how, but when.”
The issues involved in changing faces are an ethical minefield. Butler’s lecture — Face Transplant: Science Fiction to Science Fact — generates plenty of interest from curious members of the public as well as peers from the medical profession.
“Everyone has a face, so everyone has a view on facial transplantation,” he says. “The interesting thing is that public opinion is changing. People are now quite accepting of the idea, but I still want to explore the reasons why some people have reservations.”
Some of the confusion surrounding the operation can be blamed on Hollywood. Face/Off, the 1997 blockbuster starring John Travolta and Nicolas Cage, conjured up the spectacle of transplantees adopting the facial features and likeness of donors. It made for a good movie but Butler points out that even though such an outcome is impossible, convincing people that this is the case has been a tough task and one of the reasons why there are so few donors.
“For most people this is still the biggest misconception. If I say I’m going to take the skin off your face and put it on someone else’s face, some people think it’s basically identity transfer. That’s not the case. Bone features and face structure will still come through on the person who received the face transplant. What you would get is a hybrid of the two, not the face of your loved one on someone else.”
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Butler has been battling his own profession too. Viewed by some as cavalier in his approach, he has been forced to defend himself on a regular basis.
“Selecting the right patient is very important. It has to be someone who can handle the psychological impact and has the coping mechanisms to deal with the procedure. If they don’t have these, then I can damage them and the process itself,” he admits.
When an Irish teenager who was badly disfigured in a fire was identified in 2003 as a likely candidate to undergo the operation under Butler’s supervision, many members of the medical profession were horrified. Around the same time, two other Irish volunteers approached Butler.
The public unease that followed forced the Royal Free to rethink its stance on the pioneering project and permission to carry out the operation was refused. Butler’s frustration increased when, last July, a hospital in Ohio gave permission for a procedure. The team, led by Dr Maria Siemionow, a Polish-born plastic surgeon at the Cleveland Clinic, immediately launched its search for a volunteer but, to date, has not found one.
The Royal Free decided that a full public debate should precede any attempt to carry out the risky surgery. Butler has obliged by taking on a rigorous roadshow of public lectures to convince doubters.
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“It’s interesting how perceptions have changed since the French case. Debate is important. It’s good that there are opposing views, but some are based on gut instinct, without any thought. But where people in other clinics have been against it in the past, now they are offering me patients.”
Butler works five 12-hour days in a week that frequently “blends” into the weekend. Despite the workload he still manages to look younger than his 43 years. His time is split between his National Health Service practice, his private practice and research. “Oh, and family,” he remembers, not quite in the nick of time.
His wife is Annabel Heseltine — daughter of Michael, the Tory party grandee — who has abandoned her It girl status for a mainly stay-at-home career raising four children — all under four years of age. He is divorced from a South African woman he met during time spent in Harvard.
He and Annabel were keen to start a family together and used IVF treatment to help. Twins Mungo Columbus Montague Heseltine, and Isabella Aurora Gigi Heseltine, were born in August 2002. Two more children followed naturally, Rafferty Gabriel Theodore Heseltine in December 2003, and Montgomery (Monty) Michael Caradoc Heseltine in March. Using Heseltine as a forename for all four children continues a family tradition. Michael Heseltine uses Dibdin, his mother’s maiden name, as a forename. “We took our time naming them,” Butler says of his small army. “We didn’t want just any old names.”
Annabel Heseltine, who formerly worked for The Sunday Times and still freelances, was the first western journalist into Rwanda, Butler says proudly. That’s quite a contrast to her most recent foray into print, an account of Hollywood actor Kevin Costner’s over-fondness for her. Even with four young toddlers, she has just completed a masters in Wildlife Management and Game Conservation.
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Butler originally planned to become a vet until he saw what the job entailed. He swapped animals for humans, and graduated from the Royal College of Surgeons and Physicians of Ireland in 1987. He did his general surgical training in Dublin and became a fellow of the Royal College of Surgeons in Ireland in 1991 and the Royal College of Surgeons of England in 1992.
Ireland was never going to be big enough for his ambitions. After his plastic surgery training in Dublin, he undertook a research fellowship in the field at the Massachusetts General Hospital and Harvard Medical School in Boston. His workmates there included the team who grew a human ear on the back of a mouse.
“I did as much as I could in Ireland, but my research ideas were met with ‘why do you want to do that?’ So I started to look around, the job offer in Boston came up and off I went.”
It was while treating a burns victim during his training in Dublin, that he began thinking about a surgical alternative. The meeting instilled in Butler a recognition of the potential psychological damage that could be caused to patients with facial scarring.
“I discovered plastic surgery can do amazing things,” he says. “I came across a 19-year-old boy who had a facial burn. He came in dribbling, and the skin on his chin and eyes were pulled down. We reconstructed it, got his head up, but found there were other problems there. Despite our efforts, he still had his own problems which were not just physical.
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“It was about getting out there into society. People may question why it is people seek facial surgery but it’s really about them wanting to be normal. They just want to blend into the crowd. They are not looking to be exceptional in any way.”
The controversial face transplant is not for the faint-hearted. It involves the removal of skin, fat, nerves, arteries and veins from a brain-dead donor and then attaching them to the recipient in as short a time as possible, usually between six to 12 hours. A successful operation would give patients back 70% of their functions. Even though they wouldn’t look like the donor, they will not look like their old selves either. They also face a lifetime on immunosuppressant drugs. “Most patients I talk to are happy to take the drugs. They would rather trade it off for a normal life,” says Butler.
He believes not enough is being done to address the needs and issues of isolation and social exclusion of those who, through no fault of their own, suffered burns or scarring through freak accidents.
One such is Jacqui Saburido, a Venezuelan woman who suffered facial deformity in a car fire. She contacted Butler two years ago about a face transplant after more than 60 reconstructive procedures to put some shape back on her face. She is now in touch with the Ohio team.
“The whole reason why we are talking about face transplants is because the reconstruction we can do now, though very good, will not produce a normal face. For Jacqui, she has to weigh up the pros and cons of the procedure.
“At the moment she spends her time at the computer tapping on the keyboard. She has stumps for hands and has to wake up every two or three hours to put artificial tears in her eyelids because they don’t close properly. If she walks down the street, people stare at her and children scream. She lives in social isolation.”
As Butler awaits his opportunity, he is anxious to point out that it’s not about winning the race. “It doesn’t really matter if I am the first because, in the end, all I’ve tried to do is publicise this as much as I can, and I have,” he says.