“A Face is a Beautiful Thing, Especially if You Don’t Have One!”

Heroes are hard to find these days, but Dr. Elof Eriksson, Brigham & Women’s Hospital’s Chief of Plastic Surgery, is at the top of my list. He’s the soft-spoken B&W leader whose courageous support led to the first full face transplant in America in March 2011 headed by Dr. Bodhan Pomahac. The 15-hour surgery involving 30 specialists replaced Dallas Wiens’ face from midscalp to his neck, including a nose, lips, eyebrows, skin, muscles and nerves to provide sensation.

“This was the chance for me to get my life back. My dream was to kiss my daughter again.” – Dallas Wiens with daughter, Scarlette

This fantastic new B&W procedure, sponsored in part by the Department of Defense to eventually help battlefield-damaged soldiers, is giving disfigured patients new faces and entirely new lives. Now they can interact with their children and venture out in the world without kids screaming and running for safety. (See graphic before and after photos below from the Boston Globe.)

A Dramatic Impact

The impact on Brigham & Women’s image has been dramatic. Talk about the “umbrella” marketing effect.  The hospital’s perceptual image has improved overall, not just in cosmetic surgery.  B&W moved into the Top 10 Best Hospitals for 2012, jumping four rankings to eighth in the U.S. News & World Report Honor Roll. The hospital has also experienced a significant increase in overall business, reflecting the positive media exposure. And, while many cosmetic surgery programs are experiencing declines of up to 40% due to the economy, B&W’s elective cosmetic surgery is doing well. In fact, over 90% of prospective patients who visit the Department of Plastic Surgery for a consultation decide to move forward with the procedure. (If they can replace an entire face, a facelift or liposuction procedure is a walk in the park.) Media experts have valued the public relations exposure at more than 20 million dollars, but it involved many monumental decisions along the way.

Elof Eriksson, MD, PhD

“We must make up our minds quickly during surgery with hundreds of decisions, sometimes with limited data, because if we delay, our patients can die!” – Dr. Elof Eriksson, Chief of Plastic Surgery, Brigham & Women’s Hospital

The Toughest Decision

I asked Dr. Eriksson (a friend and fellow swimmer from Wellesley, Massachusetts whose daughters babysat my boys years ago) what the toughest decision was in the process. His answer was, “Deciding to do full face transplants at all was the first question. Logically the timing was right with our background in cosmetic surgery. We knew it was physically possible, but also we had to decide that it was ethically right. Dr. Joseph Murray, the hospital’s Nobel laureate who conducted the first successful kidney transplant in 1954, told me it’s no different than what he went through. He said we should not be swayed by naysayers. I became convinced that this was the right thing to do so I tried my best to move it forward.” It took two years for the hospital’s ethic board to approve face transplants, starting with a successful partial transplant for James Maki who had fallen face-first onto the electrified third rail at a subway station. The learning curve was skyrocketing, but a new concern was voiced by other surgeons who sought healthy organs for their own patient transplants.

Changing the Pecking Order

Dr. Eriksson and Dr. Pomahac had to convince New England transplant surgeons to change the standard organ removal pecking order, before the heart team. The brain-dead donor was on a ventilator. The face removal would have to go first so the face would get enough blood to keep the facial tissue viable. However, the facial removal took up to 6 hours. What if the donor became unstable and the other organs deteriorated? Dr. Ericksson and Dr. Pomahac agreed to back away from the operating room if the donor became unstable and let the other teams in. Saving lives with organ transplants came before facial transplants.

During the first full facial transplant procedure (Dallas Wiens who had a horrific power lines accident) the “timing” issue came home to roost as reported recently in the New Yorker Magazine. Transplant surgeons from another unnamed hospital needed the donor’s liver for a very sick patient. The life saving procedure took precedent. Under pressure, Dr. Pohamac negotiated three hours from the other surgeons who would then move in to remove the liver. The clock started ticking as Dr. Pohamac and Dr. Ericksson rushed to dissect and remove the face. Dr. Pohamac said the pressure was so great he actually worried about having a heart attack. Somehow they got the job done in time and Dallas Wiens got a new life. The rest is history.

So what kind of a decision maker is Dr. Eriksson? He hasn’t taken our DecisionMODE quiz yet, but I’m sure he’s “off the charts” in both his Commander and Thinker mode scores. Non-surgeon doctors are high in the Thinker mode with their incredible memories, but surgeons (“hands on”) are also high in Commander mode. Dr. Eriksson’s philosophy is , “Do the right thing to care for patients today, but also to care for them even better tomorrow.”

 Is it any wonder that Dr. Elof Eriksson is my hero?

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