As she waited for her pedicure at Just Calm Down, a day spa in New York, Vicki Murray, a 30-year-old homemaker, found herself engaged in a heated debate about extreme plastic surgery.
"Sure, if my face were injured or disfigured, I would think about a transplant," Murray said, adding matter-of-factly that under such radical conditions she would trade in her face for a comelier model, one with, say, the vulcanized features of Angelina Jolie.
Why not? Murray mused. "If celebrities put up their faces for auction after they died, people would be bidding on her features all the time."
Debbie Greengrass, a friend, pondered that assertion. "I have nothing against plastic surgery," said Greengrass, 30, a nurse practitioner at a New Jersey fertility clinic, "but accepting a skin transplant from an organ donor just to look like Angelina Jolie somehow doesn't set right with me."
The women's conversation, bizarre and of a sort customarily relegated to science fiction, was occasioned by the groundbreaking partial face transplant two and a half weeks ago in Amiens, France. A 38-year-old woman whose features had been gnawed away by her Labrador retriever received lips, a chin and a nose from a brain-dead donor. The procedure is considered by medical experts to be too experimental, and medically and ethically controversial, to have cosmetic applications.
Nonetheless the prospect of being able to one day swap one's features for a prettier, more idealized configuration seems to have sent the imaginations of people into overdrive, fueling discussion and over-the-top fantasies at the proverbial water cooler.
Among doctors and nonprofessionals alike, the medical and scientific advances that made possible the first face transplant raise issues both practical and moral, and touch on matters pertaining to class, wealth and the more profound question of human identity. The idea that a face might one day be as interchangeable as a watchband, a concept long popularized in futuristic novels and films, engenders reactions of mingled revulsion and awe.
"Replacing your features with those of a donor just to make yourself prettier -- that idea is abhorrent," said Sally Cook, an author of children's books who lives in New York. But Cook, 51, added she was deeply impressed to learn that the procedure was available and would favor such an operation for patients who were disfigured from birth or as the result of an injury.
Others, however, were more willing to entertain the possibility of a future in which a face transplant becomes a means by which one can trade in a shopworn mug as readily as exchanging an outmoded iPod for the newer, trimmer Nano model.
"We're standing on the edge of a new frontier," said Dr. Anthony Griffin, a plastic surgeon in Beverly Hills, who appears on Extreme Makeover, the ABC reality show. Griffin speculated that if a face transplant should become common practice, it would be easier to obtain abroad than in the US.
"We're too puritanical in America to ever allow face transplants for cosmetic reasons," he said, "but I can see someone like Michael Jackson flying to Paris for a nose transplant, although not in my lifetime."
To many people, living at a time when plastic surgery has lost much of its stigma -- total cosmetic medical treatments rose 24 percent over the past four years, says the American Society of Plastic Surgeons -- the idea of a new face requires no great leap of imagination, despite the medical hurdles. Sam Shahid, an advertising art director who once created a magazine cover in which the model's face was a pastiche of the features of other models, predicted that although the notion is bound to seem horrific at first, "once people get over the shock," it would become "acceptable, perhaps desirable."
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