Wednesday, March 11, 2009

Face/Off part 1

Here's the first post for a multiple installment analysis of John Woo's Face/Off.  

For six years FBI agent Sean Archer (John Travolta) has been pursuing terrorist Castor Troy (Nicholas Cage), the murderer of Archer's young son.  Troy is finally captured, albeit in a comatose state.  Archer discovers that Troy and his brother, Pollux (Alessandro Nivola) have planted a bomb containing a nerve gas and a biological payload somewhere in LA.  Archer takes on Troy's identity by borrowing the skin and superficial fascia of his (Troy's) face in a hefty surgical procedure that also transforms his voice and body into a replica of Troy.  He heads off to prison as Troy, to trick Pollux, whose central nervous system is intact, into revealing the location of the bomb.  Troy awakens from his coma faceless, and insists on making use of Archer's face and looks.  He then murders the surgeons and agents who know about this top-secret project.  Now things get complicated.  No one but Troy and Archer knows that they are not themselves. Archer (posing as Troy) escapes from prison, to recover his face and his family. There is a lot of great action.  Archer reveals himself to his wife (Joan Allen) who types the men's blood (O- and AB) to discover the truth.  After more great action, Troy dies and Archer is restored "just the way he was."  He also gets a new adopted son, the offspring of Troy.  Balance is restored.

A friend of mine in med school couldn't stand this film.  She hated it!  It was so idiotic!  That surgery could never happen!  She took the whole thing very personally, which is too bad.  She missed a great film.

The key to the success of this movie is that everyone knows the premise is impossible and nobody cares.  I'd say the film even leans into that impossibility as hard as it can, mixing heavy doses of the preposterous with touches of accuracy and new directions in medical research.  Woo uses special effects and snappy dialogue to ignore or gloss over gargantuan obstacles to the success of a super-secret cosmetic alteration and transplantation project.

Let's look at some of the ideas this film invokes regarding transplantation surgery and healing from this type of operation.

In this scene Troy is comatose, I assume due to head trauma incurred in the great action sequence during his arrest.  Archer visits Troy in the hospital ward where he lies in a stupor, sporting what looks like an oxygen feed up his nose.  Another FBI agent, Dr. Hollis Miller (played by CCH Pounder - lover her!) tells Archer that Troy isn't dead after all.  He's in a coma and "he's a turnip."  She then puts her cigarette out on Troy's arm.  Troy doesn't twitch.  His monitors blink regularly and don't alter tempos in the least.  This moment clearly demonstrates that, "In deep coma primitive avoidance reflexes may be absent"(1).  This means that you could put a giant glowing coal on Troy's arm and, if the damage to his brain were severe enough, he wouldn't respond.  I believe we were meant to understand that Troy was in a coma, not a vegetative state, even though he was called a "turnip"(2).  I'm no doctor, but I watch one on TV, and I suspect someone unresponsive to cigarette burns will core pretty low (below an 8 out of a possible 15) on the Glasgow coma scale(3).  That's not good in terms of prognosis of spontaneous recovery, even though this is a plot point later.

In order to impress Archer, and get him to agree to a risky and preposterous mission, the head surgeon, Dr. Malcolm Walsh (Colm Feore) leads him to a glass wall, behind which we see a team of surgeons building a new ear, from scratech, with red and blue lasers.  the ear is for an agent Loomis, injured during Troy's capture.

In order to build and ear, these lasers would have to be able to organize a number of different types of cells into a super organized arrangement of skin layers, superficial fascia, elastic cartilage, blood vessels, and a number of nervous structures.  the surgeons then attach the ear to Loomis, and seal the tissue with another laser. Later a laser is used as a cutting tool to perform surgery.

In the real world, lasers are being used to perform a number of different tasks from skin tightening to tumor removal(4).  When researching to see what has been done in the area of lasers and tissue regeneration, I found an abstract describing the use of lasers to stimulate cartilage cells to grow(5), and since one's ear is elastic cartilage, that's a big part of the wounded agent's ear graft.  The abstract was a little vague as to whether or not this approach will pan out in terms of its usefulness, or even if it really worked at all.  But, assuming it worked, I suspect that the cartilage cells stimulated by laster activity would grow in one big, undifferentiated lump.  Still, the way the film used lasers to generate and destroy tissues wasn't quite as far-fetched as one might think.  Well, okay.  It's pretty out there but I could find evidence of research (regardless of outcome) in this area, so you have to give the movie a little credit here.

Next time, we look at the "new anti-inflammatories!"

1.  Berkow, Robert.  "The Merck Manual of Diagnosis and Therapy."  Whitehouse Station, NJ: Merck Research Laboratories, 1992 p.1398
2. Wikipedia classifies turnips as true "root vegetables" as opposed to modified stems such as tubers or other root-like structures such as bulbs.
3.  "Merck" p. 1463  Yes, they have a point scale for comas.  you can score between 3 and 15.  The lower the score, the worse the prognosis.  3-5 means you will probably die.  Over 8 and your chances of recovery are good.  Troy must have been somewhere between 5-8 and had the help of a miracle.
4. Galewitz, Phil. "Multi-use Lasers Cast doctors in New Light." USA Today
5. Baumann, Marcus, et al.  "Influence of Wavelength, Power Density and Exposure Time of Laser Radiation on chondrocyte Cultures - an in-Vitro Investigaion."  Medical Laser Application 21.3 (2006): 191-8. Abstract.