Face/Off part 4 - Troy Emerges From His Coma!

Face/Off

TROY AWAKENS

Troy comes out of his coma without signs of functional or cognitive debility, and unwraps his face. We get some great wet sucking sounds as he pads barefoot through a deserted hospital ward to discover Archer's face-skin floating in a dish.

Face/Off

Troy is initially incoherent and starts screaming when he sees Archer's face, but he's a resilient psychotic terrorist and recovers his wits pretty quickly. Within hours (or less) he's sucking up a cigarette and on the phone to his henchmen.

Troy also talks on the phone pretty well. We see a bit later in a reflection of his faceless face that he's still got a lot of lip and cheek left, which explains why he is so coherent when speaking. It also explains how he can get that smoke out of his cigarette. Yes, smoking without a face, nice touch! It reminds me of the old films like Double Indemnity where Fred Mc Murray has been mortally wounded, is oozing blood everywhere, and wants a cigarette from Edward G. Robinson, which he smokes as he slips into unconsciousness(1).

Face/Off

My colleague Bill reports that the whole smoking without skin on your face thing had been done already. Hellraiser III apparently has a woman, with no skin at all, calmly smoking a cigarette.

We don't see Dr. Walsh and his team perform Troy's surgery as he takes on the face and body of Archer, but one again, the procedure is a success. surgery is performed and Troy is recovered before people come in to work the next morning.

FUN FACTS ABOUT TRANSPLANTATION

An allograft is a tissue graft between genetically dissimilar members of the same species(2). An autograft is a transfer of one's own tissues from one site to another(3). Transplantation is the transfer of living tissues or cells from a donor to a recipient(4).

So when Archer gets Troy's face the first time, it's transplantation/allograft. The question is, is it autograft when he gets his face back at the end of the film? Is there a name for a procedure where one has living tissue removed, and then re-attached to the same place after hanging out on someone else for awhile?

Allografts may be rejected by the recipient's immune system. this is a major danger for most types of transplants.

Image from Dailymail

As a plot point in the film, Troy's AB blood gives him away to Archer's doctor wife, which Archer's O- blood confirms that he is who he claims to be. I assume that both men are Rh negative(5), just for the sake of argument. If we only look at blood typing, people with type AB blood can receive type O, but people with type O blood cannot receive type AB (long story). So Archer's face might go onto Troy's body (assuming tissue compatibility for a moment) without major trouble, but Archer will probably reject Troy's face tissue that minute his blood vessels get his blood into Troy's tissues. CLOT CITY!

Next time: The final episode of Face/Off - Tissue rejection!

1. Chandler, Raymond, Billy Wilder, et al. Double Indemnity. Universal legacy series. Universal City, CA: Universal Studios Home entertainment, 2006. One of the bes love stories about two men in the insurance business.

2, 3, 4. Berkow, Robert. The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 1992 p. 347

5. In the most basic of nutshells, Rh factor is a blood group discovered on the surface of erythrocytes (red blood cells, to you and me) of rhesus monkeys. Some people have this group (RH+) and some do not (Rh-). If you inject an Rh- person with Rh+ factor, their body will become sensitized to it. If injected with it again later on, perhaps via a transfusion, the Rh- person's body will have a transfusion reaction, which is an allergic reaction (cytotoxic hypersensitivity reaction for you trivia buffs). Red blood cell destruction and huge amounts of clotting are the result. Gues what "Rh" stands for...Yup! Rhesus!

Face/Off part 1

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

SYNOPSIS

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.

COMMENTARY

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.

THE "SCIENTIFIC EXPLANATION" SCENE

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.