Filmmakers have been persistently fascinated by plastic surgery because, as the art historian Juergen Mueller has written, "It is used to dramatize or reflect on the essence of identity." In his essay Plastic Surgery in Movies, published in Aesthe-tic Surgery (Taschen, 2005), Mueller, chairman of the art history department at Dresden University, argues that in films like Seconds or Face/Off, the face is both the "proof and the expression of personality."
"In this context, a look in the mirror brings with it the question of identity, of whether inside and outside still correspond," he writes.
In real life, some argue, a medical procedure that necessarily tampers with identity might take an unacceptable psychic toll. "The implications are shudder-worthy," said the writer Daphne Merkin. "Can you borrow someone else's features and still be you?"
Noting that Botox and plastic surgery have already eroded the idea of character by erasing laugh and frown lines, she asserted that such a face transplant might eliminate the concept of character. "Are we equipped to deal with this aesthetic fungibility?" she said.
In the case of the French transplant patient, Isabelle Dinoire, critics have raised questions about the psychological impact of having another person's features -- in this case, a donor who may have committed suicide, it was revealed this week.
Medical experts point out that a transplant recipient would never acquire exactly the features of another person, because the recipient's underlying bone structure would affect the way the skin appears.
Face transplants are difficult and controversial in large part because of the risk that the recipient's immune system will reject the borrowed tissue. The patients must take strong immune-suppressing drugs for the rest of their lives and these may cause cancer or be toxic to the heart, doctors say.
The day of routine practical transplants, even of a part of the face, is "very, very far off," said Dr. Peter Cordeiro, the chief of plastic and reconstructive surgery at Memorial Sloan-Kettering Cancer Center in New York.
And why bother with a transplant at all, some ask, when conventional surgery will do the job?
"Many people walking around, especially celebrities, already have had so many procedures that they no longer look like themselves," said Dr. Frederic Brandt, a dermatologist in New York and Miami who has a large celebrity following.
That notion is not lost on Janice Dickinson, a onetime supermodel and the author of Everything About Me Is Fake and I'm Perfect (Regan Books, 2004). Dickinson, who acknowledged in an interview having had a number of cosmetic procedures, including a face-lift, confided only half in jest that she would not mind trading in her features for a classier set. "I've been dying to look like Iman Bowie," she said referring to the model and cosmetics entrepreneur.
Nor is the concept of a transplant as a mark of privilege utterly alien to Suzanne Yalof Schwartz, the executive fashion director at Glamour magazine.
"If I had to have a face transplant, why not upgrade?" Schwartz asked. "I've lived long enough as a jalopy. I want to be a Jaguar."
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