They say that eyes are like mirrors.
Whether they stare or look away,
Jérôme senses the strange feelings of those looking at his face.
A mixture of astonishment
and fear.
I've always been like this.
I've always lived like this.
- It is your face. - It is.
But it's difficult to cope with how people look at me.
It's because of, or thanks to, the way they look at me,
that I feel like improving things,
to become anonymous,
to be like everybody else.
- To be unobtrusive? - To blend in.
To blend into the crowd.
- That'd be ideal. - It would be.
Jérôme is 33 but his face is ageless.
A disease has made his skin heavy since he was small.
It has eaten up his forehead, his cheeks, his eyes.
It has frozen his facial expressions
between folds.
On the Champs-Élysées, Abdel-Rahman's mind is elsewhere.
His parents have been visiting children's hospitals for years,
in the quest to get their child a new face.
From Kuwait City to Paris,
the breadth of their travel equals the magnitude of their hopes.
What would be left of our faces,
were it not for our eyes or our expressions?
What can be read from these pictures?
It's ugly.
It's ugly, so...
It isn't normal.
- Does it scare you? - It does.
A face like this is frightening, indeed.
It's not normal,
so you run away.
Like thousands of people each year,
Mrs Lemaguère wishes to erase
the consequences of a disease or an accident.
Let's pull back the hair.
- My camouflage. - It's a good one.
We agreed to reposition
the external part,
and try and fill this hole, here.
- With an implant. - Yes.
Exactly what do you rebuild when you rebuild a face?
Do you need to risk your life for a new look?
What challenges and limits
do surgeons set for themselves, behind these faces?
BEHIND THE MIRROR
8:00am, Henri Mondor Hospital, in Créteil.
This is Prof. Lantieri's first operation of the day,
the first day of her long-awaited new face
for Mrs Lemaguère, already under anaesthetic.
There's a nerve here.
It's the frontal nerve.
It accounts for movement of the forehead.
If we start here and I get in deep,
too deep, I'll cut the nerve.
Her forehead won't move again.
In order to get deep in there,
we have to start at the back of the head,
and scalp it all, to reach the bone.
Then we can insert the implant, deep in there,
close to the bone.
Surprisingly,
modifying a face
isn't only about skin.
In this small, stratified world, going deep is the key.
A face is defined by its bone structure?
It's really
what gives a face its identity.
The depth determines the personality.
The surface determines expressions, movements and functions.
If I peeled this young woman's face off completely,
I'm not going do it,
and attached it to this young man's bone structure,
his bone structure would shape his expressions,
much more than her face.
Indeed.
Now we're making dough,
to fill the area where there's a hole.
Well-placed, this small cement implant is going to change
the whole morphology of the face.
Once inside, it's going to heat up a lot.
So we need to spray it constantly.
The implant is visible here.
We have molded it in situ to fill this hole, here.
It's very impressive.
It is impressive surgery.
We're really scalping the patient.
It's like we're really peeling the face off,
the facade of the bone structure,
to work on the bone structure.
It's impressive to you because what you view as the person,
we analyze as a mere anatomical structure,
an organ that we're treating.
In a few hours, Mrs Lemaguère will discover
the face she's been expecting.
Such patients don't wish to look prettier or to be perfect.
They just want to look normal.
What is a normal face?
It isn't about beauty, aesthetics or nose size.
From face to mask, from one culture to another,
it's all about symmetry and harmony.
Exactly what surgery aims for.
Back to the hospital,
an ordinary day of consultation,
at the Maxillofacial unit in Amiens.
Each face has a story,
but these faces have no mystery: cancer, dog bites
accidents, gunshot wounds.
Reconstruction,
everyday.
Very often, a new face will change one's character.
- What did you want to fix next? - The nose.
Three years ago, Jérôme tried to shoot himself.
He's had 25 surgeries to be able to smile again,
but his face isn't finished yet.
- You don't like the tip. - Nor the width.
- Maybe finer.
A nose should be in the middle.
- It bothers you? - I can see people.
That's what they notice first.
So we should work on the width.
Here at the base?
- A bit higher? - Yes.
OK.
For 3 years, this face project has kept him going.
Is it like being reborn?
It is. It will be like a revival.
It's the same person,
but some things will have changed,
and they will come back...
I can't explain it.
It makes you want to go on.
I was so low that it can't get any worse than it was.
I'm moving on now,
I'm focused on that.
So, building your new face,
enables you to build a new life?
Exactly. And a better one, at that.
I feel way better now.
- It's given you purpose? - Yes.
That's what you need in life. Purpose.
A young man's hopes rest in his surgeon's hands.
Alright.
Always give them hope.
Never tell them
that we can't improve the reconstruction.
Never tell them it's over.
It makes them feel like we're letting them down,
like it's over and done with for them,
they won't see any surgeon anymore and all hope is lost.
It's bound to depress them, surely.
Give them hope.
Wait until the patient says: "It's good enough."
Jérôme has two lovely reasons to get back on track.
His daughters, Célia and Marie.
Who's the best?
Well, it's me!
It's you? Alright!
He plays football with the Beauvais Reds in Picardy.
On the field, no one judges him.
He's a player like the others.
Go, Daddy, go!
He has just a few more supporters on his side.
It's the story of a great victory, even when his team loses.
Back to the hospital.
Mrs Brémaud
is not in for a good night.
Tomorrow, surgeons will break half of her jaw,
remove a tumor and rebuild her face,
all during a single operation.
If I make an incision...
The surgery will last about 10 hours.
- Way on the outside. - Yes, compared to...
We'll cut at the top here,
preserve this area, accurately,
and rebuild this part at once.
We'll take your left iliac crest.
- OK? - Is it up here?
Right
here, this portion of the bone.
The good thing with the iliac crest
is that the shape of the crest, of the front part here,
corresponds well,
even though we'll need to adjust it during surgery,
it matches quite well the angle of the jaw.
It will recreate your contours.
It's more...
Did you know that hipbones were used to fix jaws
before you needed it?
I had no idea.
It's hard to conceive
that one bone can replace another.
That's true.
But you knew about bone grafting, didn't you?
I did, but I thought a graft
came from someone else's bones in 90 % of the cases.
I see.
Well, you see, an iliac crest...
Time for a surgery lesson
to reassure Mrs Brémaud.
That's all. Any questions?
Let me think. Any risk of failure?
There is, as with any surgery.
5 to 8 % in your particular case.
Extra challenge:
for the operation to succeed, Mrs Brémaud's face
has to stay the same as today.
Nowadays, that's a requirement for surgeons,
as we're concerned about aesthetics.
We want surgery to be as unobtrusive as possible,
to keep the procedure from producing
something of an additional defect
or an additional disability.
Our priority is to remove the tumor,
then reconstruct the face,
then keep surgery from producing,
visible additional scars.
We want discretion.
The next morning,
surgery begins.
Take it out, careful. Let's not mess up.
Can someone hold this?
Bipolar forceps, please.
Move the lip aside.
Gently,
and lovingly, as always.
Feels like a forceps delivery, though.
Here we go. Alright.
You can see that the problem here... It's not very long, is it?
And the problem is hidden inside.
- It's quite big! - It's... Yeah.
- That was her jaw? - Part of her lower jaw, yes.
6 hours into the operation, the surgeons are extracting
the hip bone meant to replace the lower jaw.
If we, surgeons, found ourselves in this situation,
what would we accept?
Would we accept this for ourselves? That's the...
To use a trendy word,
the ethics.
Would you accept it, then?
Above all, I'd choose my surgeon.
For the bone to live in the jaw,
it is extracted with a vein and an artery
that will be reconnected.
It also has to be sculpted.
A microscope is used to finish the operation
and suture the vein.
This is still pretty thick.
The technical limit of what we can do,
is to connect two vessels
of about 0.8 mm in diameter, approximately.
Anything smaller can't be done by hand.
Last suture. The bone comes back to life in the jaw.
Surgery is finished, Madam. It's all good.
The operation is over.
A few years ago,
Mrs Brémaud's face would have been lost,
forever scarred.
Nowadays, facial reconstruction is planned in 3D.
Software designed for aeronautics
is used to anticipate the future of faces.
Long gone are the days
of the Great War's broken faces, for which surgeons of the time
had to invent the first reconstruction techniques.
All of today's pioneers
are their heirs.
Back to Henri Mondor Hospital, in Créteil,
where a new face awakens.
- OK? - It's great!
I have my symmetry back.
It'll be great once the swelling's gone.
In this hospital, there are faces to discover,
but others are already well known, like Pascal's.
Pascal is here.
- How are you? - Good.
Pascal has had a face transplant.
Only 3 people in the world live in someone else's skin.
It'll be one year on the 21st.
Right, it'll be one year on the 21st!
Is Prof. Lantieri going to celebrate it?
I don't know. I think so.
You are going to celebrate, right?
Pascal wants to say hi.
- How are you? - Happy New Year!
Same to you!
Along with a new face,
his whole life has changed,
undreamed-of one year ago.
A disease had completely disfigured him.
- Take care. - Alright.
- Bye. - See you, Pascal, bye!
This touches you.
It does, yes. It happens with some patients.
When you see their evolution,
and that it's all going well,
it touches us a lot more.
Each story is different.
This one is beautiful.
A beautiful story and a gamble for Pascal and his surgeon.
The benefits are great, but so are the risks.
From surgery
to life treatment, Pascal's future will always be hazy.
His disease isn't fatal, but trying something
to get rid of it is life-threatening.
What good is it to add years to your life
if you can't add life to your years?
What good is it to tell someone: "You can live with this",
if they can't experience a normal human life?
Communicating with others,
marrying and having children,
working, going out, traveling.
- There are risks of cancer. - There are.
There are risks of infection, yes.
We're aware of that. We're taking that risk.
Pascal knew it very well, too. We've informed him of everything.
On the other hand, he's improved. He has a good life now.
His treatment is light enough,
to not interfere with his quality of life.
Even though the transplant has shortened his life span?
- It's still positive for him? - Yes.
Yes.
We may have cut a few years from his life,
but we have given life to the years he has left.
Who would risk their life
for a new face?
How do you decide to operate
when risks are so high?
- Hello. - Hello.
- How are you? - Hello.
Come in.
Pascal's transplant has given Jérôme high hopes.
They have the same disease: neurofibromatosis.
Close your eyes, tightly.
Release.
The skin of people
with neurofibromatosis
is different.
Normal skin is elastic.
When you pull on it, it comes back.
Studies we've conducted show that skin with neurofibromatosis
reacts like chewing gum.
When you pull on it, it stays.
If we apply traction here, it will go down after a few months.
We need to remove tissues where they're damaged the most.
What kind of face can Jérôme hope for?
The question is: "What can we hope for?"
We hope to give him a face
that allows him to blend in a crowd.
What about you, Jérôme?
Just like Prof. Lantieri said.
I don't expect
miracles,
to look like Alain Delon or Georges Clooney.
I just want an ordinary face
to blend in a crowd.
For months, the dermatologist and the surgeon have been speculating,
researching, hesitating, consulting neurosurgeons.
Jérôme's disease is very invasive,
and surgery is risky.
Last time, we talked about a possible operation.
How many surgeries have you had?
- About 15. - 15.
I'm not here today to ask you
for a transplant at all costs.
If it can be avoided, that's fine.
I don't want a transplant at all costs.
It's up to the medical team to make the decision.
- My goal isn't the transplant. - The decision is up to you.
We explain the risks
and the benefits to bear
if you decide to go through with this operation.
The transplant isn't our primary goal either.
Our goal is improvement
with as few risks as possible.
There's something
we haven't discussed yet.
You haven't asked us about the risk of death during surgery.
I don't ask myself that question,
I suppose I shy away from it on purpose.
It's a bit paradoxical.
I wonder a lot about risks,
but it's scary,
so perhaps I don't dare ask questions.
It's risky surgery, for sure.
Plexiform neurofibroma such as yours
is prone to heavy bleeding during surgery.
It's the greatest risk for us.
Most of the teams doing this or at least trying to do this,
stop after the first gesture
because they quickly feel overwhelmed by the hemorrhaging.
Our experience allows us to move forward,
but the risk is still here.
See you for your hospitalization.
No decision has been made, except for a medical checkup.
They're all taking time to think about it.
Of course, we're scared.
Our responsibility is not only forensic or legal.
The problem is, our purpose is to heal people.
So we're scared to take risks.
We take them because at one point,
our conscience tells us we can improve the patient,
and because the patient accepts this improvement,
knowing there's this potential risk.
We're not reckless, though.
If we go through with it, it means that we can manage the risk,
and that it won't lead the patient
to death.
Otherwise we'd be mad to suggest surgery.
It must be mind-blowing.
It is.
It's true. And it's the reason we work as a team.
If I was alone with a patient,
deciding what to do, without knowing all the facts,
without a whole team, it would be impossible.
It keeps us up at night.
It does, at times.
It isn't mind-blowing.
It's just the thick of life and death issues.
There's nothing subtle about it. We're right in the...
It's about scary decisions.
It's beyond mind-blowing.
Medical research
is likely to deny them more sleep.
That day,
one of their young patients has been rushed in.
When was the accident again?
November 2004.
When did the eyes get worse?
- Fifteen days ago? - Yes.
He was badly burnt and completely disfigured.
Surgeons shut his eyelids to protect his eyes.
I'm going to reopen the right eye
which we had closed gradually over time,
so we can examine it correctly
and treat it properly.
What can you do for him?
What can medicine do for him? What can we do?
We can try to help him for now.
Sadly, there's no solution for this kind of lesion.
He's had a lot of surgery already.
A transplant would be the only solution.
The problem is, so far no surgeon has found
how to graft fully functional eyelids.
It's all about working and designing solutions.
It's about research.
It has been shown
that there are solutions for the lower part.
It means we can find solutions for the upper part,
but it's a lot harder.
Until a potential transplant...
Monocryl, please.
...this young man is doomed to a life with no face and no vision.
He is 27.
- You got candy? - In my house.
So you didn't bring any candy at all with you?
- What did you bring with you? - Nothing.
Nothing?
Miles away from the concerns of medical research,
at Armand-Trousseau, Paris,
other questions puzzle younger patients.
- Billy? - No.
- Frank? Harry? - No.
Rémy? Jacques?
Is your name
- Paul-Émile? - Yes.
Found it! Awesome!
I'm so happy, I'm so smart.
Whether because of a malformation, accident or dog bite,
reconstructing faces
starts very early.
Here, surgeons challenge ill-fortune
and change children's future.
Going back to school, making friends,
stopping the taunts.
Reconstructing their face
to help them build a full life.
It was a week ago.
Then you look like this.
Tomorrow we'll remove all that,
inside the nose and on the nose.
In the operating room, 5-month-old Loa
is about to get a new face.
She was born
with a cleft lip that impairs her smile.
Farther, time is of the essence for David.
He's 3 and his tracheotomy ostracizes him.
He can't breathe or talk like other children.
Surgeons are going to try and free him from his cannula.
To do so,
they have to redesign his face
and extend his entire lower jaw.
During the operation,
the surgeons will cut the bone on both sides
and spread the fracture
by 1 mm a day with custom-made devices,
called distractors.
Within that space, new bone
will grow naturally.
You're using the natural workings of the human body.
We are. It's regenerative surgery.
We call on the person's healing abilities.
The child, thanks to his natural healing abilities,
is conditioned to grow a new bone
where we choose.
Two weeks later,
David's jaw bones
will have grown by about 2 cm.
In the next room,
reconstructing Loa's face is precision work.
The surgical site is less than 10 mm².
We're suturing the lip's muscles.
They're used in facial expressions, smiles,
for the lip function.
Despite appearances, all elements of the face
are there from the birth:
the nose, lips and palate.
The surgeon assembles them,
just like they would have in the womb.
But there's an additional issue:
any error will grow
with the child.
If the outline of the lip is flawed,
by, let's say, 0.2 mm,
when the child is 4, it will amount to 1 or 2 mm.
It'll be much more visible.
Flaws aren't always visible in infants.
They show when the child grows.
Self-image starts from the birth.
If Loa hadn't been operated on,
this difference
could have been hard to live with,
as early as kindergarten.
We know that around 4 or 5,
the child can point out his disgrace.
As a consequence,
there can be a permanent negative impact on his self-image.
That's why now, in pediatric plastic surgery,
we tend to operate earlier and earlier,
especially before first grade,
to avoid these self-image issues
that would persist as time goes by.
In the recovery room,
the children's new faces awaken.
The road ahead is long.
Loa will be monitored until she is 18.
She'll have more surgery.
This is just the beginning for David's
facial reconstruction.
Children's surgery is very different from adults'.
Modifying a face can take 18 years.
The surgeons meet that evening.
A young Kuwaiti has just arrived in France.
His parents will do anything for him to have a normal face.
The child, Abdel-Rahman,
is 10 and suffers from Goldenhar syndrome.
He is from Kuwait.
He's had many operations,
most notably in Australia,
and in London.
We have, at the same time,
a cleft up to the orbit,
and bones missing from this side
of the face.
What's more, they're coming from Kuwait.
This kind of patient only comes once.
A second trip is difficult for them.
We need to plan the whole procedure now,
even if we don't do it all at once.
What does "all" mean for them?
- They want him... - To bring the jaw forward.
- They want a symmetrical face. - Almost.
He's quite precise about it. His parents want the same as him.
He points to his withdrawn lip
and his eyelid.
He wants that.
All at once?
It's unreasonable and unfeasible.
How do you address expectant or desperate parents?
The surgeons don't want to rush surgery. It could worsen the situation.
We could bring the left upper maxillary forward,
"the good side", as you said.
We can do it in three weeks, then we can graft.
After that, you can
draw the lower eyelid up.
This way, we can at least fulfill the child's requests,
within 4 to 5 months.
We need a minimum of 6 months.
If we lay out a surgical planning,
I'm sure the parents will accept it, even if they need to come back.
A few days later,
the family meets the medical team.
An interpreter accompanies them.
Can they understand and accept
that the surgeons can't fully meet their request?
The way we see it, the priority
is to rebuild bone areas, in several steps.
We're going to try and shorten intervals between steps
as you live far away.
And move forward...
The first operation could happen 3 weeks later.
The parents seem to understand that it's going to take time.
... the upper jaw.
How many millimetres will you bring the jaw forward?
In my opinion, we can easily bring it forward
by 1.5 cm.
- More. - 1.5 cm is a minimum.
The little boy wants to ask something.
Will he be able to play football?
That's a tricky one.
It's a bit dangerous, you know?
Football is a no.
It's best not to play for at least one or two months.
Best to avoid contact sports,
sports where collisions can happen.
By the end of the appointment,
the family agrees to step-by-step surgery:
4 to 5 major interventions within a year.
My parents agree.
What about you? Do you agree with it?
Sure, I do.
I want to look more beautiful
because my friends always stare at me.
I don't like it.
Will you do anything for your son to have a normal face?
Yes, of course.
I have 2 daughters and only one son.
I'll do anything to fix what can be fixed.
Even if it means a lot of surgery?
Yes, but I don't think of it as a sacrifice.
He's hurting, not me.
He's suffering.
Of course, I'll do anything.
It's okay if it takes time. It's up to the doctor.
He knows better than we do.
A month, a year, two or three years, I'm ready to wait.
All that matters is that my son gets a normal face.
The Embassy of Kuwait is going to pay for the child's stay in hospital.
But his father won't be able to work during that time.
Two weeks after his consultation, we went to see Jérôme,
Professor Lantieri's patient.
His mother and aunt have just arrived in Paris.
For the first time, they've come to support him
and discuss his decision
about the surgery.
Are we going to toast or not?
Last time I saw him, we talked about surgical risks,
such as hemorrhages.
Prof. Wolkenstein talked about
death, actually.
He asked if I've ever thought about it.
When you hear the doctor talking about that,
you realise that indeed, there's a risk.
The difficult thing is,
- the final decision is up to me only. - Sure!
Some people say:
"You're right to do it."
It's important to know what others think of it.
Now, I'm facing this and wondering:
"Shall I do it or not?"
For years, Jérôme's face was taboo.
Nobody around him talked about it for fear of hurting him,
but he's always accepted his own story,
and the silence that surrounded it.
It was very painful.
It was very painful to talk about it.
I think there was some sort of guilt.
Some sort of guilt.
You ask yourself: "Why?"
I used to wonder: "Why?"
Are you ready for your son to take risks to have a new face?
Yes. For him to have a better life.
I've seen him go through such depression,
calling me five times a day.
I live 500 km away, so I imagine things.
I want him to be happy.
I know he won't be as long as he lives with this.
That evening,
Jérôme seemed determined to have surgery.
Will he find the life he longs for behind his face?
People giving him other looks? Other mirrors?
The proof, in his appearance, that he's just like everybody else?
Subtitles: T. Close-Koenig, E. Fuchs & N. Guechi