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TED Talks, Iain Hutchison: Saving faces

Iain Hutchison: Saving faces

Our face is hugely important because it's the external visual part that everybody else sees.

Let's not forget it's a functional entity. We have strong skull bones that protect the most important organ in our body: the brain. It's where our senses are located, our special senses -- our vision, our speech, our hearing, our smell, our taste. And this bone is peppered, as you can see, with the light shining through the skull with cavities, the sinuses, which warm and moisten the air we breathe. But also imagine, if they were filled with solid bone, our head would be dead weight, we wouldn't be able to hold it erect, we wouldn't be able to look at the world around us. This woman is slowly dying because the benign tumors in her facial bones have completely obliterated her mouth and her nose, so she can't breathe and eat. Attached to the facial bones that define our face's structure are the muscles that deliver our facial expression, our universal language of expression, our social signaling system.

And overlying this is the skin drape, which is a hugely complex three-dimensional structure -- taking right angled bends here and there, having thin areas like the eyelids, thick areas like the cheek, different colors. And then we have the sensual factor of the face. Where do we like to kiss people? On the lips. Nibble the ears maybe. It's the face where we're attracted to with that. But let's not forget the hair.

You're looking at the image on your left-hand side -- that's my son with his eyebrows present. Look how odd he looks with the eyebrows missing. There's a definite difference. And imagine if he had hair sprouting from the middle of his nose, he'd look even odder still. Dismorphophobia is an extreme version of the fact that we don't see ourselves as others see us.

It's a shocking truth that we only see mirror images of ourselves, and we only see ourselves in freeze-frame photographic images that capture a mere fraction of the time that we live. Dismorphophobia is a perversion of this where people who may be very good looking regard themselves as hideously ugly and are constantly seeking surgery to correct their facial appearance. They don't need this, they need psychiatric help. Max has kindly donated his photograph to me. He doesn't have dismorphophobia, but I'm using his photograph to illustrate the fact that he looks exactly like a dismorphophobic. In other words, he looks entirely normal. Age is another thing when our attitude toward our appearance changes.

So children judge themselves, learn to judge themselves, by the behavior of adults around them. Here's a classic example: Rebbecca has a benign blood vessel tumor that's growing out through her skull, has obliterated her nose, and she's having difficulty seeing. As you can see, it's blocking her vision. She's also in danger, when she damages this, of bleeding profusely. Our research has shown that the parents and close loved ones of these children adore them. They've grown used to their face; they think they're special. Actually, sometimes the parents argue about whether these children should have the lesion removed. And occasionally they suffer intense grief reactions because the child they've grown to love has changed so dramatically and they don't recognize them. But other adults say incredibly painful things. They say, "How dare you take this child out of the house and terrify other people. Shouldn't you be doing something about this? Why haven't you had it removed?" And other children in curiosity come up and poke the lesion, because -- a natural curiosity. And that obviously alerts the child to their unusual nature. After surgery, everything normalizes. The adults behave more naturally, and the children play more readily with other children. As teenagers -- just think back to your teenage years -- we're going through a dramatic and often disproportionate change in our facial appearance.

We're trying to struggle to find our identity. We crave the approval of our peers. So our facial appearance is vital to us as we're trying to project ourselves to the world. Just remember that single acne spot that crippled you for several days. How long did you spend looking in the mirror every day, practicing your sardonic look, practicing your serious look, trying to look like Sean Connery, as I did, trying to raise one eyebrow. It's a crippling time. I've chosen to show this profile view of Sue, because what it shows is her lower jaw jutting forward and her lower lip jutting forward.

I'd like you all in the audience now to push your lower jaw forward, turn to the person next to you, push your lower jaws forward, turn to the person next to you and look at them -- they look miserable. That's exactly what people used to say to Sue. She wasn't miserable at all. But people used to say to her, "Why are you so miserable?" People were making misjudgments all the time on her mood. Teachers and peers were underestimating her, she was teased at school. So she chose to have facial surgery. After the facial surgery, she said, "My face now reflects my personality. People know now that I'm enthusiastic, that I'm a happy person." And that's the change that can be achieved for teenagers. Is this change though a real change, or is it a figment of the imagination of the patient themselves.

Well we studied teenagers attitudes to photographs of patients having this corrective facial surgery. And what we found was -- we jumbled up the photographs so they couldn't recognize the before and after -- what we found was that the patients were regarded as being more attractive after the surgery. Well that's not surprising, but we also asked them to judge them on honesty, intelligence, friendliness, violence. They were all perceived as being less than normal in all those characteristics -- more violent, etc. -- before the surgery. After the surgery, they were perceived as being more intelligent, more friendly, more honest, less violent -- and yet we hadn't operated on their intellect or their character. When people get older, they don't necessarily choose to follow this kind of surgery.

Their presence in the consultation suite is a result of the slings and arrows of outrageous fortune. What happens to them is that they may have suffered cancer or trauma. So this is a photograph of Henry to weeks after he had a malignant cancer removed from the left side of his face -- his cheekbone, his upper jaw, his eye-socket. He looks pretty good at this stage. But over the course of the next 15 years he had 14 more operations, as the disease ravaged his face and destroyed my reconstruction regularly. I learned a huge amount from Henry. Henry taught me that you can carry on working. He worked as an advocate. He continued to play cricket. He enjoyed life to the full. And this was probably because he had a successful, fulfilling job and a caring family and was able to participate socially. He maintained a calm insouciance. I don't say he overcame this; he didn't overcome it. This was something more than that. He ignored it. He ignored the disfigurement that was happening in his life and carried on oblivious to it. And that's what these people can do. Henriapi illustrates this phenomenon as well.

This is a man in his 20s whose first visit out of Nigeria was with this malignant cancer that he came to the United Kingdom to have operated on. It was my longest operation. It took 23 hours. I did it with my neurosurgeon. We removed all the bones at the right side of his face -- his eye, his nose, the skull bones, the facial skin -- and reconstructed him with tissue from the back. He continued to work as a psychiatric nurse. He got married. He had a son called Jeremiah. And again, he said, "This painting of me with my son Jeremiah shows me as the successful man that I feel that I am." His facial disfigurement did not affect him because he had the support of a family, he had a successful, fulfilling job. So we've seen that we can change people's faces.

But when we change people's faces, are we changing their identity, for better or for worse? For instance, there are two different types of facial surgery. We can categorize it like that. We can say there are patients who choose to have facial surgery -- like Sue. When they have facial surgery, they feel their lives have changed, because other people perceive them as better people. They don't feel different. They feel that they've actually gained what they never had, that their face now reflects their personality. And actually that's probably the difference between cosmetic surgery and this kind of surgery. Because you might say, "Well, this type of surgery might be regarded as cosmetic." If you do cosmetic surgery, patients are often less happy. They're trying to achieve difference in their lives. Sue wasn't trying to achieve difference in her life, she was just trying to achieve the face that matched her personality. But then we have other people who don't choose to have facial surgery.

They're people who have their face shot off. I'll move it off, and we'll have a blank slide for those who are squeamish amongst you. They have it forced upon them. And again, as I told you, if they have a caring family and good work life, then they can lead normal and fulfilled lives. Their identity doesn't change. Is this business about appearance and preoccupation with it a Western phenomenon?

Muzetta's family give the lie to this. This is a little Bangladeshi girl from the east end of London who's got a huge malignant tumor on the right side of her face, which has already made her blind, and which is rapidly growing and is going to kill her shortly. After she had surgery to remove the tumor, her parents dressed her in this beautiful green velvet dress, a pink ribbon in her hair, and they wanted the painting to be shown around the world, despite the fact that they were orthodox Muslims and the mother wore a full burqa. So it's not simply a Western phenomenon. We make judgments on people's faces all the time.

It's been going on since we can think of Lombrosso and the way he would define criminal faces. He said you could see criminal faces, judging them just on the photographs that were showed. Good-looking people are always judged as being more friendly. We look at O.J. -- he's a good looking guy. We'd like to spend time with him. He looks friendly. Now we know that he's a convicted wife batterer, and actually he's not the good guy. And beauty doesn't equate to goodness, and certainly doesn't equate to contentment. So we've talked about the static face and judging the static face, but actually, we're more comfortable with judging the moving face.

We think we can judge people on their expressions. U.K. jurors in the U.K. justice system like to see a live witness to see whether they can pick up the telltale signs of mendacity -- the blink, the hesitation. And so they want to see live witnesses. Todorov tells us that, in a tenth of a second, we can make a judgment on somebody's face. Are we uncomfortable with this image? Yes we are. Would we be happy if our doctor's face, our lawyer's face, our financial adviser's face was covered? We'd be pretty uncomfortable. But are we good at making the judgments on facial appearance and movement? The truth is that there's a five minute rule -- not the tenth of a second rule like Todorov, but a five minute rule. If you spend five minutes with somebody, you start looking beyond their facial appearance, and the people who you're initially attracted to may seem boring and you lose interest in them, and the people who you didn't immediately seek out, because you didn't find them particularly attractive, become attractive people because of their personality. So we've talked a lot about facial appearance.

I now want to share a little bit of the surgery that we do -- where we're at and where we're going. This is an image of Ann who's had her right jaw removed and the base of her skull removed. And you can see in the images afterward, we've managed to reconstruct her successfully. But that's not good enough. This is what Ann wants. She wants to be out kayaking, she wants to be out climbing mountains. And that's what she achieved, and that's what we have to get to. This is a horrific image, so I'm putting my hand up now.

This is a photograph of Adi, a Nigerian bank manager who had his face shot off in an armed robbery. And he lost his lower jaw, his lip, his chin and his upper jaw and teeth. This is the bar that he set for us. "I want to look like this. This is how I looked before." So with modern technology, we used computers to make models. We made a model of the jaw without bone in it. We then bent a plate up to it. We put it in place so we knew it was an accurate position. We then put bone and tissue from the back. Here you can see the plate holding it, and you can see the implants being put in -- so that in one operation we achieve this and this. So the patient's life is restored. That's the good news. However, his chin skin doesn't look the same as it did before. It's skin from his back. It's thicker, it's darker, it's coarser, it doesn't have the contours. And that's where we're failing. And that's where we need the face transplant. The face transplant has a role probably in burns patients to replace the skin.

We can replace the underlying skeletal structure, but we're still not good at replacing the facial skin. So it's very valuable to have that tool in our armamentarium. But the patients are going to have to take drugs that suppress their immune system for the rest of their lives. What does that mean? They have an increased risk of infection, an increased risk of malignancy. This is not a life-saving transplant -- like a heart, or liver, or lung transplant -- it is a quality of life transplant, and as a result, are the patients going to say, if they get a malignant cancer 10 or 15 years on, "I wish I'd had conventional reconstructive techniques rather than this, because I'm now dying of a malignant cancer?" We don't know yet. We also don't know what they feel about recognition and identity. Bernard Devauchelle and Sylvie Testelin who did the first operation are studying that. Donors are going to be short on the ground, because how many people want to have their loved one's face removed at the point of death. So there are going to be problems with face transplantation. So the better news is the future's almost here -- and the future is tissue engineering.

Just imagine, I can make a biologically degradable template. I can put it in place where it's meant to be. I can sprinkle of few cells, stem cells from the patient's own hip, a little bit of genetically engineered protein, and low and behold, leave it for four months and the face is grown. This is a bit like a Julia Child recipe. But we've still got problems.

We've got mouth cancer to solve. We're still not curing enough patients -- it's the most disfiguring cancer. We're still not reconstructing them well enough. In the U.K. we have an epidemic of facial injuries among young people. We still can't get rid of scars. We need to do research. And the best news of all is that surgeons know that we need to do research. And we've set up charities that will help us fund the clinical research to determine the best treatment practice now and better treatment into the future, so we don't just sit on our laurels and say, "Okay, we're doing okay. Let's leave it as it is. Thank you very much indeed.

(Applause)

Iain Hutchison: Saving faces Iain Hutchison: Ukládání tváří Iain Hutchison: Das Gesicht wahren Iain Hutchison: Hutchison: Σώζοντας πρόσωπα Iain Hutchison: Salvando caras イアン・ハチソン面目を保つ Iainas Hutchisonas: Gelbstint veidus Iain Hutchison: Salvando rostos Иэн Хатчисон: Сохраняя лица Iain Hutchison: Yüzleri kurtarmak Ієн Хатчісон: Рятуючи обличчя 伊恩-哈奇森挽回面子

Our face is hugely important because it’s the external visual part that everybody else sees. Naše tvář je nesmírně důležitá, protože je to vnější vizuální část, kterou vidí všichni ostatní. 私たちの顔は、他の人が見る外部の視覚的な部分であるため、非常に重要です。 Yüzümüz son derece önemlidir çünkü herkesin gördüğü dış görsel kısımdır.

Let’s not forget it’s a functional entity. Nezapomínejme, že je to funkční entita. それが機能的な存在であることを忘れないようにしましょう。 Bunun işlevsel bir varlık olduğunu unutmayalım. 我们不要忘记它是一个功能实体。 We have strong skull bones that protect the most important organ in our body: the brain. Máme silné lebeční kosti, které chrání nejdůležitější orgán v našem těle: mozek. 私たちは体の最も重要な器官である脳を保護する強力な頭骨を持っています。 It’s where our senses are located, our special senses -- our vision, our speech, our hearing, our smell, our taste. それは、私たちの感覚が位置している場所、私たちのビジョン、スピーチ、聴覚、匂い、味などの特別な感覚です。 And this bone is peppered, as you can see, with the light shining through the skull with cavities, the sinuses, which warm and moisten the air we breathe. そして、この骨は、あなたが見ることができるように、頭蓋骨を通って頭蓋骨を照らしている光と、私たちが呼吸する空気を温めて湿らせてくれる副鼻腔とを痛めます。 И эта кость, как видите, приправлена светом, пронизывающим череп с полостями, пазухами, которые согревают и увлажняют воздух, которым мы дышим. But also imagine, if they were filled with solid bone, our head would be dead weight, we wouldn’t be able to hold it erect, we wouldn’t be able to look at the world around us. しかし、彼らがしっかりとした骨で満たされていれば、私たちの頭は重い体重になり、私たちはそれを立てることができなくなり、私たちの周りの世界を見ることができなくなるだろうと想像してください。 Но также представьте, если бы они были заполнены твердой костью, наша голова была бы мертвым грузом, мы не смогли бы держать ее прямо, мы не смогли бы смотреть на мир вокруг нас. This woman is slowly dying because the benign tumors in her facial bones have completely obliterated her mouth and her nose, so she can’t breathe and eat. 这个女人正在慢慢死去,因为她面部骨骼中的良性肿瘤已经完全抹去了她的嘴巴和鼻子,所以她无法呼吸和进食。 Attached to the facial bones that define our face’s structure are the muscles that deliver our facial expression, our universal language of expression, our social signaling system.

And overlying this is the skin drape, which is a hugely complex three-dimensional structure -- taking right angled bends here and there, having thin areas like the eyelids, thick areas like the cheek, different colors. そしてこれを覆うのは、まぶたのような薄い部分、頬のような厚い部分、さまざまな色を持つ、まっすぐに曲がった屈曲をあちこちに取る、非常に複雑な3次元構造であるスキンドレープです。 И поверх этого лежит кожная драпировка, которая представляет собой чрезвычайно сложную трехмерную структуру - изгибы под прямым углом здесь и там, с тонкими областями, такими как веки, толстыми областями, такими как щеки, разных цветов. And then we have the sensual factor of the face. Where do we like to kiss people? On the lips. Nibble the ears maybe. It’s the face where we’re attracted to with that. Нас привлекает именно это лицо. But let’s not forget the hair.

You’re looking at the image on your left-hand side -- that’s my son with his eyebrows present. あなたはあなたの左側のイメージを見ています - それは彼の眉毛のある私の息子です。 Look how odd he looks with the eyebrows missing. 彼の眉毛が見えなくなって見えて奇妙に見えます。 There’s a definite difference. 明確な違いがあります。 And imagine if he had hair sprouting from the middle of his nose, he’d look even odder still. そして、彼が鼻の真ん中から髪の毛が出ていれば、彼はさらに奇妙に見えるだろうと想像してください。 Dismorphophobia is an extreme version of the fact that we don’t see ourselves as others see us. Dismorphophobiaは、他人が私たちを見るのと同じように、私たち自身を見ることができないという事実の極端なバージョンです。 Дисморфофобия — крайняя версия того, что мы не видим себя такими, какими нас видят другие.

It’s a shocking truth that we only see mirror images of ourselves, and we only see ourselves in freeze-frame photographic images that capture a mere fraction of the time that we live. 私たちが自分たちの鏡像だけを見ていることは衝撃的な真実です。私たちは、私たちが生きる時間のほんの一部を捕らえるフリーズフレームの写真の画像に自分自身を見ます。 Это шокирующая правда, что мы видим только зеркальные изображения самих себя, и мы видим себя только в фотографических изображениях с фиксированным кадром, которые захватывают лишь часть времени, которое мы живем. Dismorphophobia is a perversion of this where people who may be very good looking regard themselves as hideously ugly and are constantly seeking surgery to correct their facial appearance. Dismorphophobiaは、非常に良いかもしれない人々が醜く醜いと自分自身を見て、常に彼らの顔の外観を修正するための手術を模索している、これの倒錯です。 Дисморфофобия - это извращение этого, когда люди, которые могут быть очень красивыми, считают себя ужасно уродливыми и постоянно ищут хирургическое вмешательство, чтобы исправить свой внешний вид. They don’t need this, they need psychiatric help. 彼らはこれを必要とせず、精神科の助けが必要です。 Max has kindly donated his photograph to me. マックスは親切に私の写真を寄付しました。 He doesn’t have dismorphophobia, but I’m using his photograph to illustrate the fact that he looks exactly like a dismorphophobic. 彼は変造恐怖症を持っていませんが、私は彼の写真を使って、彼が変態嫌いのように見えるという事実を説明しています。 У него нет дисморфофобии, но я использую его фотографию, чтобы проиллюстрировать тот факт, что он выглядит в точности как дисморфофоб. In other words, he looks entirely normal. つまり、彼は完全に正常に見えます。 Age is another thing when our attitude toward our appearance changes. 年齢は、私たちの外観に対する態度が変わるときの別のものです。 Возраст — другое дело, когда меняется наше отношение к своей внешности.

So children judge themselves, learn to judge themselves, by the behavior of adults around them. だから、子供たちは自分自身を判断し、彼らの周りの大人の行動によって自分自身を判断することを学びます。 Так дети судят о себе, учатся судить о себе по поведению взрослых вокруг них. Here’s a classic example: Rebbecca has a benign blood vessel tumor that’s growing out through her skull, has obliterated her nose, and she’s having difficulty seeing. 古典的な例があります:レベベカには良性の血管腫瘍があり、頭蓋骨を通って成長し、鼻を塞いでいて、見るのが難しいです。 Вот классический пример: у Ребекки доброкачественная опухоль кровеносного сосуда, которая прорастает через ее череп, стерла ее нос, и она плохо видит. As you can see, it’s blocking her vision. She’s also in danger, when she damages this, of bleeding profusely. 彼女はまた、危険にさらされているときに、これを傷つけ、豊かに出血する。 Ей также грозит обильное кровотечение, если она его повредит. Our research has shown that the parents and close loved ones of these children adore them. 私たちの研究は、これらの子どもの両親と親しい人たちが崇拝することを示しています。 Наше исследование показало, что родители и близкие из этих детей обожают их. They’ve grown used to their face; they think they’re special. 彼らは彼らの顔に慣れてきた。彼らは彼らが特別だと思う。 Они привыкли к своему лицу; они думают, что они особенные. Actually, sometimes the parents argue about whether these children should have the lesion removed. 実際には、時に両親は、これらの子供が病変を取り除かなければならないかどうかについて主張する場合があります。 На самом деле, иногда родители спорят о том, должны ли эти дети удалять поражение. And occasionally they suffer intense grief reactions because the child they’ve grown to love has changed so dramatically and they don’t recognize them. そして、時には彼らは愛に成長した子供が非常に劇的に変化し、彼らはそれらを認識しないため、激しい悲嘆の反応に苦しんでいます。 И иногда они испытывают сильную реакцию горя, потому что ребенок, которого они полюбили, так сильно изменился, и они не узнают его. But other adults say incredibly painful things. しかし、他の大人は信じられないほど苦痛なことを言う。 They say, "How dare you take this child out of the house and terrify other people. 彼らは、「あなたはこの子供を家の外に連れ出して、他の人々を恐れているのですか? Они говорят: «Как вы смеете выносить этого ребенка из дома и пугать других людей. Shouldn’t you be doing something about this? これについて何かしてはいけないのですか? Why haven’t you had it removed?" なぜあなたはそれを削除していないのですか? " And other children in curiosity come up and poke the lesion, because -- a natural curiosity. 好奇心を抱いている他の子供たちも、自然の好奇心を持っているので、病気を突きつけます。 And that obviously alerts the child to their unusual nature. そしてそれは明らかに子供に彼らの珍しい性質を警告します。 After surgery, everything normalizes. 手術後、すべて正常化する。 The adults behave more naturally, and the children play more readily with other children. 大人はより自然に行動し、子供たちは他の子供たちとより簡単に遊びます。 As teenagers -- just think back to your teenage years -- we’re going through a dramatic and often disproportionate change in our facial appearance. ティーンエイジャーは10代の年齢に戻って考えると、私たちは劇的で、しばしば不自然な顔の変化を経験しています。

We’re trying to struggle to find our identity. We crave the approval of our peers. 私たちは、同僚の承認を切望しています。 So our facial appearance is vital to us as we’re trying to project ourselves to the world. 私たちが世界に自分自身を投影しようとしているように私たちの顔の外観は私たちに不可欠です。 Just remember that single acne spot that crippled you for several days. 数日間あなたを苦しめていた1つの座瘡部位を覚えておいてください。 How long did you spend looking in the mirror every day, practicing your sardonic look, practicing your serious look, trying to look like Sean Connery, as I did, trying to raise one eyebrow. あなたは毎日鏡を見るのにどれくらいの時間を費やしましたか?あなたの空想的な表情を練習し、あなたの深刻な表情を練習し、ショーン・コネリーのように見せて、眉をあげようとしました。 It’s a crippling time. それは壊滅的な時間です。 I’ve chosen to show this profile view of Sue, because what it shows is her lower jaw jutting forward and her lower lip jutting forward. 私はSueのこのプロフィールを見ることにしました。なぜなら、彼女の下顎が前方に突き出ていて、下唇が前方に突き出ているからです。 Я решил показать этот профиль Сью, потому что он показывает ее нижнюю челюсть, выступающую вперед, и ее нижнюю губу, выступающую вперед.

I’d like you all in the audience now to push your lower jaw forward, turn to the person next to you, push your lower jaws forward, turn to the person next to you and look at them -- they look miserable. 私はあなたの下顎を前に押して、隣の人に向かい、下顎を前に押し、隣の人に向かって見て、彼らを見てみましょう - 悲惨に見えます。 That’s exactly what people used to say to Sue. それはまさに人々がスーに言っていたことです。 She wasn’t miserable at all. 彼女は全く悲惨ではなかった。 But people used to say to her, "Why are you so miserable?" しかし、人々は彼女に「なぜあなたはとても悲惨ですか」と言っていました。 People were making misjudgments all the time on her mood. 人々はいつも気分の悪い判断をしていました。 Teachers and peers were underestimating her, she was teased at school. 教師や同僚は彼女を過小評価していた。 So she chose to have facial surgery. After the facial surgery, she said, "My face now reflects my personality. 顔面手術の後、彼女は言った、 "私の顔は今私の人格を反映しています。 People know now that I’m enthusiastic, that I’m a happy person." 人々は今私が熱狂していることを知り、私は幸せな人だ」 And that’s the change that can be achieved for teenagers. そして、それは10代の若者にとって実現可能な変化です。 Is this change though a real change, or is it a figment of the imagination of the patient themselves. この変化は本当の変化だが、それは患者自身の想像力である。

Well we studied teenagers attitudes to photographs of patients having this corrective facial surgery. 私たちは、この矯正顔面手術を受けている患者の写真に対するティーンエイジャーの態度を調べました。 And what we found was -- we jumbled up the photographs so they couldn’t recognize the before and after -- what we found was that the patients were regarded as being more attractive after the surgery. 私たちが見つけたのは、前と後を認識できないように写真を混乱させたことです。手術後に患者がより魅力的であると考えられたことがわかりました。 Well that’s not surprising, but we also asked them to judge them on honesty, intelligence, friendliness, violence. まあそれは驚くべきことではありませんが、正直さ、知性、親しみやすさ、暴力でそれらを判断するように頼んでいます。 Что ж, это не удивительно, но мы также попросили их судить их по честности, уму, дружелюбию и жестокости. They were all perceived as being less than normal in all those characteristics -- more violent, etc. 彼らはすべて、より暴力的であるなどのすべての特徴において、すべて正常であるとみなされていました。 Все они воспринимались как менее нормальные по всем этим характеристикам - более жестокие и т. Д. -- before the surgery. - 手術の前に。 After the surgery, they were perceived as being more intelligent, more friendly, more honest, less violent -- and yet we hadn’t operated on their intellect or their character. 手術後、彼らはよりインテリジェントで、よりフレンドリーで、より正直で、暴力的ではないと認識されましたが、彼らの知性や性格では動いていませんでした。 When people get older, they don’t necessarily choose to follow this kind of surgery. 人々が年を取ると、必ずしもこの種の手術に従うことを選択するとは限りません。

Their presence in the consultation suite is a result of the slings and arrows of outrageous fortune. コンサルテーションスイートでの彼らの存在は、不運な財産の矢と矢の結果です。 Их присутствие в кабинете для консультаций - результат ударов невероятной удачи. What happens to them is that they may have suffered cancer or trauma. 彼らに起こるのは、がんや外傷を患っている可能性があるということです。 So this is a photograph of Henry to weeks after he had a malignant cancer removed from the left side of his face -- his cheekbone, his upper jaw, his eye-socket. これは、彼の顔の左側から悪性のがんを取り除いた数週間後のヘンリーの写真です。彼の頬骨、上顎、アイソケットです。 He looks pretty good at this stage. 彼はこの段階でかなりよく見えます。 But over the course of the next 15 years he had 14 more operations, as the disease ravaged his face and destroyed my reconstruction regularly. しかし、今後15年間に、彼は病気が彼の顔を荒廃させ、私の再建を定期的に破壊したので、14の手術を受けました。 I learned a huge amount from Henry. 私はヘンリーから莫大な金額を学んだ。 Henry taught me that you can carry on working. ヘンリーはあなたが仕事を続けられることを教えてくれました。 He worked as an advocate. 彼は弁護士として働いた。 He continued to play cricket. 彼はクリケットを続けた。 He enjoyed life to the full. 彼は完全に人生を楽しんだ。 And this was probably because he had a successful, fulfilling job and a caring family and was able to participate socially. そして、これはおそらく、彼が成功した、充実した仕事と世話をする家族を有し、社会的に参加することができたからでしょう。 He maintained a calm insouciance. 彼は落ち着いた不器用を維持しました。 I don’t say he overcame this; he didn’t overcome it. 私は彼がこれを克服したとは言わない。彼はそれを克服しなかった。 This was something more than that. これはそれ以上のものでした。 He ignored it. 彼はそれを無視した。 He ignored the disfigurement that was happening in his life and carried on oblivious to it. 彼は彼の人生で起こっていた不自然さを無視し、それに気付かなかった。 And that’s what these people can do. Henriapi illustrates this phenomenon as well. Henriapiもこの現象を説明しています。

This is a man in his 20s whose first visit out of Nigeria was with this malignant cancer that he came to the United Kingdom to have operated on. これは20代の男性で、ナイジェリアからの初めての訪問は、この悪性癌であり、彼は英国で手術を受けました。 It was my longest operation. それは私の最長の操作でした。 It took 23 hours. I did it with my neurosurgeon. 私は神経外科医と一緒にやった。 We removed all the bones at the right side of his face -- his eye, his nose, the skull bones, the facial skin -- and reconstructed him with tissue from the back. He continued to work as a psychiatric nurse. 彼は精神科の看護師として働き続けました。 He got married. 彼は結婚しました。 He had a son called Jeremiah. 彼にはエレミヤと呼ばれる息子がいました。 And again, he said, "This painting of me with my son Jeremiah shows me as the successful man that I feel that I am." そして、再び彼は言った、 "私の息子エレミヤと私のこの絵は、私が私が感じている成功した男として私を示している。 И снова он сказал: «Эта картина, изображающая меня с моим сыном Иеремией, показывает меня успешным человеком, каким я себя чувствую». His facial disfigurement did not affect him because he had the support of a family, he had a successful, fulfilling job. So we’ve seen that we can change people’s faces.

But when we change people’s faces, are we changing their identity, for better or for worse? For instance, there are two different types of facial surgery. We can categorize it like that. そのように分類することができます。 We can say there are patients who choose to have facial surgery -- like Sue. 私たちは、スーのような顔の手術を受けることを選択した患者がいると言うことができます。 When they have facial surgery, they feel their lives have changed, because other people perceive them as better people. 彼らは顔面の手術を受けて、彼らの人生が変わったと感じます。なぜなら、他の人は彼らをより良い人間として認識しているからです。 They don’t feel different. 彼らは違う気がしません。 They feel that they’ve actually gained what they never had, that their face now reflects their personality. 彼らは、彼らが実際に自分が持っていなかったことを得て、彼らの顔が彼らの人格を反映していると感じています。 And actually that’s probably the difference between cosmetic surgery and this kind of surgery. Because you might say, "Well, this type of surgery might be regarded as cosmetic." If you do cosmetic surgery, patients are often less happy. 美容整形手術を行う場合、患者さんはしばしば幸せではありません。 They’re trying to achieve difference in their lives. 彼らは人生の違いを達成しようとしています。 Sue wasn’t trying to achieve difference in her life, she was just trying to achieve the face that matched her personality. スーは彼女の人生の違いを達成しようとしていない、彼女は彼女の人格に合った顔を達成しようとしていた。 But then we have other people who don’t choose to have facial surgery. しかし、その後、私たちは顔の手術を受けることを選択しない他の人がいる。

They’re people who have their face shot off. 彼らは顔を撃った人です。 I’ll move it off, and we’ll have a blank slide for those who are squeamish amongst you. 私はそれを動かすでしょう、そして、あなたの中に魅力的な人たちのための空白のスライドがあります。 Я уберу его, и у нас будет чистый слайд для тех, кто из вас брезглив. They have it forced upon them. 彼らはそれを強制した。 And again, as I told you, if they have a caring family and good work life, then they can lead normal and fulfilled lives. そしてまた、私があなたに言ったように、彼らが世話をする家族と良い仕事の人生を持っているなら、彼らは正常で充実した生活を送ることができます。 Their identity doesn’t change. Is this business about appearance and preoccupation with it a Western phenomenon? Является ли эта забота о внешности и забота о ней западным явлением?

Muzetta’s family give the lie to this. Семья Музетты лжет об этом. This is a little Bangladeshi girl from the east end of London who’s got a huge malignant tumor on the right side of her face, which has already made her blind, and which is rapidly growing and is going to kill her shortly. After she had surgery to remove the tumor, her parents dressed her in this beautiful green velvet dress, a pink ribbon in her hair, and they wanted the painting to be shown around the world, despite the fact that they were orthodox Muslims and the mother wore a full burqa. После того, как ей сделали операцию по удалению опухоли, родители одели ее в это красивое зеленое бархатное платье, с розовой лентой в волосах, и хотели, чтобы картину показывали всему миру, несмотря на то, что они были правоверными мусульманами, а мать носил полную паранджу. So it’s not simply a Western phenomenon. We make judgments on people’s faces all the time.

It’s been going on since we can think of Lombrosso and the way he would define criminal faces. He said you could see criminal faces, judging them just on the photographs that were showed. Good-looking people are always judged as being more friendly. We look at O.J. -- he’s a good looking guy. We’d like to spend time with him. He looks friendly. Now we know that he’s a convicted wife batterer, and actually he’s not the good guy. And beauty doesn’t equate to goodness, and certainly doesn’t equate to contentment. So we’ve talked about the static face and judging the static face, but actually, we’re more comfortable with judging the moving face.

We think we can judge people on their expressions. U.K. jurors in the U.K. justice system like to see a live witness to see whether they can pick up the telltale signs of mendacity -- the blink, the hesitation. Система правосудия любит видеть живого свидетеля, чтобы увидеть, могут ли они уловить явные признаки лжи - моргание, колебание. And so they want to see live witnesses. Todorov tells us that, in a tenth of a second, we can make a judgment on somebody’s face. Are we uncomfortable with this image? Yes we are. Would we be happy if our doctor’s face, our lawyer’s face, our financial adviser’s face was covered? We’d be pretty uncomfortable. But are we good at making the judgments on facial appearance and movement? The truth is that there’s a five minute rule -- not the tenth of a second rule like Todorov, but a five minute rule. If you spend five minutes with somebody, you start looking beyond their facial appearance, and the people who you’re initially attracted to may seem boring and you lose interest in them, and the people who you didn’t immediately seek out, because you didn’t find them particularly attractive, become attractive people because of their personality. So we’ve talked a lot about facial appearance.

I now want to share a little bit of the surgery that we do -- where we’re at and where we’re going. This is an image of Ann who’s had her right jaw removed and the base of her skull removed. And you can see in the images afterward, we’ve managed to reconstruct her successfully. But that’s not good enough. This is what Ann wants. She wants to be out kayaking, she wants to be out climbing mountains. And that’s what she achieved, and that’s what we have to get to. This is a horrific image, so I’m putting my hand up now.

This is a photograph of Adi, a Nigerian bank manager who had his face shot off in an armed robbery. And he lost his lower jaw, his lip, his chin and his upper jaw and teeth. This is the bar that he set for us. "I want to look like this. This is how I looked before." So with modern technology, we used computers to make models. We made a model of the jaw without bone in it. We then bent a plate up to it. Затем мы подогнули к нему пластину. We put it in place so we knew it was an accurate position. We then put bone and tissue from the back. Here you can see the plate holding it, and you can see the implants being put in -- so that in one operation we achieve this and this. So the patient’s life is restored. That’s the good news. However, his chin skin doesn’t look the same as it did before. It’s skin from his back. It’s thicker, it’s darker, it’s coarser, it doesn’t have the contours. And that’s where we’re failing. And that’s where we need the face transplant. The face transplant has a role probably in burns patients to replace the skin.

We can replace the underlying skeletal structure, but we’re still not good at replacing the facial skin. So it’s very valuable to have that tool in our armamentarium. But the patients are going to have to take drugs that suppress their immune system for the rest of their lives. What does that mean? They have an increased risk of infection, an increased risk of malignancy. This is not a life-saving transplant -- like a heart, or liver, or lung transplant -- it is a quality of life transplant, and as a result, are the patients going to say, if they get a malignant cancer 10 or 15 years on, "I wish I’d had conventional reconstructive techniques rather than this, because I’m now dying of a malignant cancer?" We don’t know yet. We also don’t know what they feel about recognition and identity. Bernard Devauchelle and Sylvie Testelin who did the first operation are studying that. Donors are going to be short on the ground, because how many people want to have their loved one’s face removed at the point of death. Доноров будет мало, потому что сколько людей хотят, чтобы их близкому удалили лицо в момент смерти. So there are going to be problems with face transplantation. So the better news is the future’s almost here -- and the future is tissue engineering.

Just imagine, I can make a biologically degradable template. I can put it in place where it’s meant to be. I can sprinkle of few cells, stem cells from the patient’s own hip, a little bit of genetically engineered protein, and low and behold, leave it for four months and the face is grown. Я могу посыпать несколько клеток, стволовые клетки из собственного бедра пациента, немного генно-инженерного белка, и, о чудо, оставить на четыре месяца, и лицо вырастет. This is a bit like a Julia Child recipe. But we’ve still got problems.

We’ve got mouth cancer to solve. We’re still not curing enough patients -- it’s the most disfiguring cancer. We’re still not reconstructing them well enough. In the U.K. we have an epidemic of facial injuries among young people. We still can’t get rid of scars. We need to do research. And the best news of all is that surgeons know that we need to do research. And we’ve set up charities that will help us fund the clinical research to determine the best treatment practice now and better treatment into the future, so we don’t just sit on our laurels and say, "Okay, we’re doing okay. Let’s leave it as it is. Thank you very much indeed.

(Applause) (Cheering)