Friday, March 13, 2009

Face/Off part 2 - new anti-inflammatories

Walsh and Miller pitch the face transplant idea to Archer.  While trying to convince him that this cosmetic/transplantation procedure will be a snap, Walsh tells Archer, "with the new anti-inflammatories, healing takes days, not weeks."

Inflammation gets a bad reputation, but actually helps to stimulate acute wound healing.  The problem is that inflammatory reactions can get out of hand and secondary tissue death and/or delayed healing can be the result.  I'm curious what "new anti-inflammatory" might make it possible to heal from major surgery in "days, not weeks."  One interesting anti-inflammatory mediator I cam across is called Activated Protein C, or APC for short.  This stuff is great at healing rat skin(1) and seems like a very promising therapeutic agent for the healing of chronic wounds.  Even though the research I found dates from 2005 instead of 1997, kudos to screenwriters Mike Werb and Michael Colleary for hopping on the research train.

Image from

Walsh also tells Archer that they'll use "laser sheers" and micro plugs to alter his head and body hair.  Did you know that about 80% of all transplanted hair falls out within three weeks, then starts growing again(2)?  I love the idea of John Travolta and Nicholas Cage going about this movie with many looking bald patches on their heads and torsos.  Did they transplant leg hair too?  How many hours would that take?  A head can take hours.

Image from Wikipedia

This is a great line: "Your blood types won't match, but Pollux won't know that." But Pollux might get suspicious when Archer's face, which would actually be Troy's face, started turning black and sliding around.  The problem here is that blood typing is really important to transplanting.  Tissue rejection can happen within minutes to hours (acute rejection) from blood coagulation, if the donor and recipient don't have compatible blood types.  Tissue typing would also be a good idea if you were doing a transplant.  More on this in later posts.

Walsh also explains to Archer that abdominoplasty can be performed for his "love handles."  Abdominoplasy is often called a "tummy tuck."  The procedure involves "tightening" the abdominal musculature and fascia with sutures, repositioning the navel, cutting away redundant skin, and a little liposuction to get those extra areas of fat.  Does Troy get Archer's fat squirted into his abdominal fascia when he takes Archer's place?  Ew!  He might need some of that cut away skin to accommodate the extra fat.  Ick!  If he's on prednisone (an immune suppressive drug to prevent tissue refection) for long enough, he may develop a layer of abdominal fat caused by the drug, and not have to get Archer's fat squirted in there after all.

Walsh has been taking Archer around his facility, showing him the great strides he's made in surgery, tissue regeneration, and transplantation.  After talking about anti-inflammatory drugs and love handles, Walsh says "but here's the real science."

To give Archer Troy's face, Walsh is going to use a "state of the art Morphogenetic Template" which looks like a clear hard plastic facemask with blobs of putty inside it.  The inside is modeled on Archer's skull, the outside on Troy's skull, although the external surface is shaped like soft tissue and not bone.  The morpho plate (my nickname for it) doesn't have a separate jaw hinge, which should make speaking difficult, but we don't notice any speech impediments or inability to chew, post operation, so what do I know?

That the template is "morphogenetic" implies all sorts of things, and nothing at all.  Morphogenesis means the formation of an organism.  It can refer to cell formation, tissue formation, and also the organization of cells and tissues in a larger structure or organism.

So if I was the writer trying to justify the science, I might say that the morpho plate was impregnated (by lasers, of course) with some type of, I don't know... polymer?.... enzyme?... protein?... I'm trying to recall substance that previous movies have relied on for this kind of thing.  Ultimately the plate would be impregnated with something that promotes organized cell growth, as dictated by the DNA(3) of the cells in the donor tissue that has been laid over it.
Image from Wikipedia

Now, this part is unclear to me:  The remove Archer's skin, put the mask on him, and put Troy's skin over the mask to "fit the face on top."  Walsh will "simply connect the muscles, tear ducts, and nerve endings" and voila!  My confusion arises because some facial muscle run from bone to bone(4), some run from skin to skin(5), and some from bone to skin(6).  If they want to attach zygomaticus minor, how do they get the muscle from Archer's face through the mask to Troy's mouth-skin?  Or, how do they get Troy's muscle through the mask to the bone below?  Apparently they can do this because both men smile after their transplants.  Of course Archer (as Troy) is smiling ironically at the cruelty of his position, but it's still a smile.

Even with the "new anti-inflammatories," it takes time to build movement skills with parts that have undergone major surgery, or parts that were moved from one area to another, or parts that aren't originally yours.  As an example of the time it takes for this type of recovery, the woman who received the first face transplant in the United States in December of 2008 has a good prognosis.  she should have feeling return to her face in six months, and with physical therapy to retrain her muscles, she should be able to smile and have most function (speaking, eating, expression) return in about a year(7).  Archer has six days to have transplant surgery, recover full function, fool Pollux into revealing the location of the bomb, find it, and neutralize it.  That's a lot of pressure for his physical therapist.

One of my favorite things about this film is that everyone keeps saying, "this procedure is completely reversible."

Next time, the surgery!

1.  Jackson, Christopher J., et al. "Activated Protein C Prevents Inflammation Yet Stimulates Angiogenesis to Promote Cutaneous Wound Healing." Wound Repair & Regeneration 13.3 (2005): 284-94.
2.  "Hair Today, More Hair Tomorrow?" Harvard Health Letter 33.10 (2008): 1-3
3.  Yes, I know DNA is so 90s but this is a 90s film, so it would fit if they'd used it.
4.  E.g., the masseter which closes the jaw, attaches at the cheekbone and onto the jawbone.
5.  Obicularis oculi makes a sphincter around teh eye, just under the skin.  It is a blinker and a squinter.
6.  Zygomaticus minor runs fromt he cheekbone to tissue of the upper lip.  This muscle contributes to smiling and sneering derisively.
7.  Altman, Lawrence K.  "First U.S. Face Transplant Described."  The New York Times, December 18, 2008.  


  1. I'm trying to recall substance that previous movies have relied on for this kind of thing.

    Plasma? That's the word I always remember being floated around -- it's used for body stuff and bomb stuff.

  2. Which type of thing? Plasma is the clear fluid of the blood. Red and white cells float around in it. It contains a number of different types of proteins, cholesterol, antibodies, hormones, and other stuff (including inflammatory mediators). So you couldn't use plasma. You might be able to use "growth factors" which could be anything from a growth hormone to a vitamin. It also sounds technical and you know what it does just from its name.