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TEDGlobal 2010

Iain Hutchison: Saving faces: A facial surgeon's craft

イアン・ハッチソン:顔面と人生を修復する顔面再建

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顔面外科医のイアン・ハッチソンは顔貌をひどく損傷した人のために働いています。彼は外科技術と患者の人生の向上の手助けをしています。そして患者の肖像画を使い、彼らの人としての質への理解を求めます。注意:この講演には顔面が崩壊していたり、激しく損傷したショッキングな画像が含まれています。ハッチソンは、どうして崩壊した顔面がこんなにも強い衝撃を与えるのかについて、思いやりのある回答を提示してくれます。気分を悪くしやすい方は12分10秒から13分19秒の間は画面を隠して、お聞きください。

- Facial surgeon
Iain Hutchison is a pioneering oral and facial surgeon; his foundation, Saving Faces, explores the nature of our expressions. Full bio

Our face is hugely important
顔はとても重要なものです
00:15
because it's the external, visual part
外部から誰にでも
00:18
that everybody else sees.
見えるものですから
00:20
Let's not forget it's a functional entity.
機能的にも重要なものです
00:22
We have strong skull bones
硬い頭蓋骨は
00:24
that protect the most important organ in our body: the brain.
脳という一番重要な
臓器を守っています
00:26
It's where our senses are located, our special senses --
顔にはあらゆる感覚が集中しています 
特別な感覚―
00:29
our vision, our speech,
視覚 聴覚 嗅覚 味覚
00:32
our hearing, our smell, our taste.
そして言葉を発する口があります
00:34
And this bone
この骨には小さな穴が
00:36
is peppered, as you can see, with the light shining through the skull
あり光が漏れているのがわかりますね
00:38
with cavities, the sinuses,
これは副鼻腔という空洞で
00:41
which warm and moisten the air we breathe.
ここで空気の温度と湿度を調整します
00:43
But also imagine if they were filled with solid bone --
しかし この空洞がないと
どうなるでしょうか
00:46
our head would be dead weight,
頭はすごく重くなり首を真っ直ぐ
00:49
we wouldn't be able to hold it erect,
支えられないし
見回すこともできません
00:51
we wouldn't be able to look at the world around us.
(ショッキングな画像が含まれてますが
警告ではありません)
00:53
This woman is slowly dying
この女性は徐々に
死に近づいています
01:02
because the benign tumors in her facial bones
頭蓋骨の中に良性腫瘍があって
01:04
have completely obliterated her mouth and her nose
口と鼻を完全に閉塞してしまっており
01:07
so she can't breathe and eat.
呼吸も食事もできません
01:10
Attached to the facial bones
顔を構成し形取る骨に
01:12
that define our face's structure
備わっている筋肉は
01:14
are the muscles that deliver our facial expression,
表情を伝える役割を果たします
01:18
our universal language of expression,
表情は世界共通の感情表現方法であり
01:21
our social-signaling system.
社交的な信号でもあります
01:24
And overlying this is the skin drape,
次に筋肉を覆っているのが皮膚です
01:26
which is a hugely complex
皮膚は複雑な
01:29
three-dimensional structure --
三次元構造でできており
01:31
taking right-angled bends here and there,
あちこちに線が入っています
01:33
having thin areas like the eyelids,
まぶたみたいに薄いところもあれば
01:35
thick areas like the cheek, different colors.
頬のような厚いところもあり
色も様々です
01:38
And then we have the sensual factor of the face.
顔には感覚器も
備わっています
01:41
Where do we like to kiss people?
キスは普通どこにしますか?
01:44
On the lips. Nibble the ears maybe.
唇でしょうか 耳かもしれませんね
01:46
It's the face where we're attracted to with that.
キスをしたいと思うのが顔なんです
01:49
But let's not forget the hair.
毛のことも忘れてはいけません
01:52
You're looking at the image on your left-hand side --
左側の画像を見てください
01:54
that's my son with his eyebrows present.
私の息子です 眉毛がありますね
01:56
Look how odd he looks with the eyebrows missing.
眉毛がなかったら違和感を感じますよね
01:58
There's a definite difference.
全然違いますよね
02:01
And imagine if he had hair sprouting from the middle of his nose,
もし鼻の真ん中から毛が生えていたら
02:03
he'd look even odder still.
違和感は増すでしょう
02:05
Dysmorphophobia
醜形恐怖症とは
02:07
is an extreme version
これの極端な形態で
02:09
of the fact that we don't see ourselves
他人の目線と同じように自分を
02:11
as others see us.
見れなくなる症状です
02:13
It's a shocking truth
私達は左右反対の自分しか
02:15
that we only see mirror images of ourselves,
見ることはできないし
それも人生のほんの一部を
02:17
and we only see ourselves
捉えただけの
画像や映像の
02:20
in freeze-frame photographic images
中でだけなんです
02:22
that capture a mere fraction of the time that we live.
これはショッキングな
事実ですよね
02:24
Dysmorphophobia
醜形恐怖症とは
02:27
is a perversion of this
この事実をねじ曲げたもので
02:29
where people who may be very good looking
容姿端麗な人達が
02:31
regard themselves as hideously ugly
自分をひどく醜いと思い込んで
02:33
and are constantly seeking surgery
理想の顔立ちに近づくために
02:35
to correct their facial appearance.
常に整形手術を求めてしまうんです
02:37
They don't need this. They need psychiatric help.
必要なのは手術ではなく
精神科医の助けです
02:40
Max has kindly donated his photograph to me.
親切にも彼は
画像を提供してくれました
02:43
He doesn't have dysmorphophobia, but I'm using his photograph
彼は醜形恐怖症ではないですが
ここに写る彼は
02:45
to illustrate the fact that he looks exactly like a dysmorphophobic.
醜形恐怖症患者と
同じ顔立ちをしています
02:48
In other words, he looks entirely normal.
つまり彼もいたって普通なんです
02:50
Age is another thing
見た目に対する態度が変われば
02:53
when our attitude toward our appearance changes.
年齢もまた問題となります
02:56
So children judge themselves, learn to judge themselves,
子供たちは自分で判断を下します
周りの大人達を見て
02:58
by the behavior of adults around them.
判断の仕方を学ぶんです
03:01
Here's a classic example: Rebecca has a benign blood vessel tumor
例としてレベッカを紹介します 
彼女には頭蓋骨を脱出した
03:04
that's growing out through her skull, has obliterated her nose,
良性の血管種があり
鼻は閉塞しています
03:07
and she's having difficulty seeing.
ご覧の通り腫瘍が視界に被り
03:10
As you can see, it's blocking her vision.
視界が一部遮られています
03:12
She's also in danger, when she damages this,
この腫瘍に傷が付けば
03:14
of bleeding profusely.
大量出血の危険もあります
03:16
Our research has shown
私達の研究結果では
03:18
that the parents and close loved ones of these children
両親や親しい人達はレベッカのような
03:20
adore them.
患者に多大な愛を注ぎます
03:23
They've grown used to their face; they think they're special.
彼らはこの顔に慣れてしまったので
自分は特別だと思っています
03:25
Actually, sometimes the parents argue
事実 両親が病変の
03:28
about whether these children should have the lesion removed.
摘出をするか否かで
言い争うこともあります
03:30
And occasionally they suffer intense grief reactions
時に悲嘆にくれることもあります
03:33
because the child they've grown to love
愛するわが子の病状の悪化により
03:35
has changed so dramatically and they don't recognize them.
わが子と分からなくなる程
容姿が激変するからです
03:37
But other adults
しかし他人は時に
03:40
say incredibly painful things.
とてもひどいことを言うものです
03:42
They say, "How dare you take this child out of the house
「よく この子を外に連れて行けるね
03:44
and terrify other people.
皆が怖がるじゃないか
03:46
Shouldn't you be doing something about this? Why haven't you had it removed?"
することはないの?
なんで取らないんだ?」
03:48
And other children in curiosity come up and poke the lesion,
他の子供達は好奇心から
近づいては腫瘍を突きます
03:51
because -- a natural curiosity.
悪気はないんです
03:54
And that obviously alerts the child
しかし こんなことをされれば
03:56
to their unusual nature.
自分は変なんだと思います
03:58
After surgery, everything normalizes.
手術後は全てが落ち着きました
04:00
The adults behave more naturally,
大人たちはより自然に接し
04:03
and the children play more readily with other children.
何のためらいもなく
他の子と遊んでいます
04:05
As teenagers --
十代だったらどうでしょう
04:08
just think back to your teenage years --
十代の頃を思い出して下さい
04:11
we're going through a dramatic
大げさに しかもそれは
04:13
and often disproportionate change
しばしば度を超えた方法で
04:15
in our facial appearance.
見た目を変えていました
04:17
We're trying to struggle to find our identity.
アイデンティティーの模索に必死になり
04:19
We crave the approval of our peers.
友人に認められたいと強く思うものです
04:21
So our facial appearance is vital to us
十代にとって 見た目は
世の中に自分を発信する
04:23
as we're trying to project ourselves to the world.
重要な手段なんです
04:26
Just remember that single acne spot
たった一つのにきびのせいで
04:28
that crippled you for several days.
数日間しょんぼり
過ごすこともあるでしょう
04:30
How long did you spend looking in the mirror every day,
毎日 鏡の前で
どれくらい過ごしましたか?
04:34
practicing your sardonic look, practicing your serious look,
澄ました顔をしてみたり
まじめぶったり
04:37
trying to look like Sean Connery, as I did,
ショーン・コネリーの真似をした
04:40
trying to raise one eyebrow?
私みたいに眉毛を挙げてみたり
04:42
It's a crippling time.
こうして時間を浪費するんです
04:44
I've chosen to show this profile view of Sue
スーの写真を
お見せすることにしました
04:46
because what it shows is her lower jaw jutting forward
彼女の下顎と下唇は前へ
04:50
and her lower lip jutting forward.
大きく突き出していますね
04:53
I'd like you all in the audience now to push your lower jaw forward.
皆さん 下顎を前へ
押し出してみて下さい
04:55
Turn to the person next to you,
そのまま横を向いて下さい
04:58
push your lower jaws forward. Turn to the person next to you
下顎を突き出し 隣へ見せて下さい
05:00
and look at them -- they look miserable.
憂鬱そうに見えますよね
05:02
That's exactly what people used to say to Sue.
スーはよくそう言われていましたが
05:04
She wasn't miserable at all.
全然憂鬱ではなかったんです
05:07
But people used to say to her, "Why are you so miserable?"
でもよく聞かれたそうです
「どうしてそんなに悲しいの?」
05:09
People were making misjudgments all the time
人々はいつも彼女の気持ちを
05:13
on her mood.
取り違えていました
05:16
Teachers and peers were underestimating her; she was teased at school.
彼女は先生や同級生に
見くびられ いじめも受けました
05:18
So she chose to have facial surgery.
だから整形手術を決めたんです
05:21
After the facial surgery,
整形手術後に
05:23
she said, "My face now reflects my personality.
彼女は言いました
「今の顔は私の性格を映してるわ
05:25
People know now that I'm enthusiastic,
みんな 私が活発で明るいことを
05:28
that I'm a happy person."
分かってくれてるの」
05:31
And that's the change that can be achieved for teenagers.
十代で整形すれば
こんな違いを獲得できます
05:33
Is this change, though, a real change,
この変化は本物でしょうか?
05:37
or is it a figment of the imagination
それとも患者自身の想像の産物に
05:39
of the patient themselves?
過ぎないのでしょうか?
05:42
Well we studied teenagers' attitudes
さて私達はこうした整形手術を受けた
05:44
to photographs of patients having this corrective facial surgery.
子供達の写真を使って
行動を研究しました
05:46
And what we found was --
この写真をごちゃまぜにして手術前後の
05:48
we jumbled up the photographs
組を分からなくしました
05:51
so they couldn't recognize the before and after --
この研究から術後の
05:53
what we found was that the patients were regarded
患者はより魅力的だと
05:55
as being more attractive after the surgery.
みなされることが分かりました
05:57
Well that's not surprising, but we also asked them to judge them
驚くことではありません
他にも 正直さ 知的さ
05:59
on honesty, intelligence,
親しみやすさ 凶暴さ
06:02
friendliness, violence.
について質問をしてみました
06:04
They were all perceived as being
「乱暴そう」など通常よりも
06:07
less than normal in all those characteristics --
ネガティブな印象を与えたのは
06:09
more violent, etc. -- before the surgery.
共通して手術前の写真でした
06:11
After the surgery,
手術後のものは
06:14
they were perceived as being more intelligent,
より利口 友好的 正直
06:16
more friendly, more honest, less violent --
乱暴そうではないという
回答が得られました
06:18
and yet we hadn't operated on their intellect
もちろん 知性や性格を
06:21
or their character.
手術することはできません
06:23
When people get older,
人は歳をとると必ずしも
06:25
they don't necessarily choose to follow this kind of surgery.
整形手術には頼らなくなります
06:27
Their presence in the consultation suite
診察室にいる彼らは
06:30
is a result of the slings and arrows of outrageous fortune.
不運な運命に耐えてきたんです
06:32
What happens to them
彼らは癌やトラウマを
06:35
is that they may have suffered cancer or trauma.
体験してきたのかもしれません
06:37
So this is a photograph of Henry,
こちらはヘンリーです
06:39
two weeks after he had a malignant cancer removed
悪性腫瘍を取り除いて
2週間後の写真です
06:41
from the left side of his face -- his cheekbone,
その腫瘍は顔の
左側にあり 頬骨 上顎
06:44
his upper jaw, his eye-socket.
眼窩に広がっていました
06:47
He looks pretty good at this stage.
一見 手術は完了したようですが
06:49
But over the course of the next 15 years he had 14 more operations,
この後15年間で
14の手術を受けました
06:51
as the disease ravaged his face
腫瘍は彼の顔をむしばみ 何度も
06:54
and destroyed my reconstruction regularly.
再建箇所を破壊しました
06:56
I learned a huge amount from Henry.
私はヘンリーから多くを学びました
06:58
Henry taught me
彼は術後も弁護士として
07:00
that you can carry on working.
仕事を続けていることや
07:02
He worked as an advocate. He continued to play cricket.
クリケットも楽しんでいると
話してくれました
07:04
He enjoyed life to the full,
彼は人生を謳歌していました
07:07
and this was probably because he had a successful, fulfilling job
これもやりがいのある仕事と
07:09
and a caring family
温かな家族 社会への所属が
07:11
and was able to participate socially.
あったおかげでしょう
07:13
He maintained a calm insouciance.
彼は冷静 そして無頓着を貫きました
07:15
I don't say he overcame this; he didn't overcome it.
彼が克服したとは言いません
克服をしなかったんです
07:18
This was something more than that. He ignored it.
克服の問題ではなく
彼は無視したんです
07:21
He ignored the disfigurement that was happening in his life
彼は人生で被った醜い傷を無視して
07:24
and carried on oblivious to it.
無関心を続けたんです
07:27
And that's what these people can do.
これは誰にでもできます
07:30
Henriapi illustrates this phenomenon as well.
ヘンリアピも実証しています
07:32
This is a man in his 20s
この男性は悪性腫瘍を抱え
07:34
whose first visit out of Nigeria was with this malignant cancer
20代の時 手術を受けるために
07:36
that he came to the United Kingdom to have operated on.
ナイジェリアからイギリスに来ました
07:39
It was my longest operation.
私の中では一番長い手術でした
07:41
It took 23 hours. I did it with my neurosurgeon.
脳外科医と23時間もの
手術を行いました
07:43
We removed all the bones at the right side of his face --
顔の右側の骨を全摘出しました
07:46
his eye, his nose,
目も鼻も
07:48
the skull bones, the facial skin --
頭蓋骨 そして皮膚もです
07:50
and reconstructed him with tissue from the back.
背中の皮膚で顔面を再建しました
07:52
He continued to work as a psychiatric nurse.
精神科看護師として
彼は働き続けました
07:55
He got married. He had a son called Jeremiah.
結婚して ジェレマイアという
息子もいます
07:57
And again, he said,
彼はこう言っていました
08:00
"This painting of me with my son Jeremiah
「これは息子が描いた私です
08:02
shows me as the successful man that I feel that I am."
私が思う通りの成功した
人物を描いてくれました」
08:05
His facial disfigurement
彼の顔の傷が
08:08
did not affect him
全く問題にならなかったのは
08:10
because he had the support of a family;
家族のサポートに加えて
08:12
he had a successful, fulfilling job.
やりがいのある仕事があったからです
08:14
So we've seen that we can change people's faces.
さて 顔の整形について
お見せしてましたが
08:16
But when we change people's faces,
これと同時に 良くも悪くも
08:19
are we changing their identity --
人々のアイデンティティまでも
08:21
for better or for worse?
変えてしまっているんでしょうか?
08:23
For instance,
例えば 整形手術には
08:26
there are two different types of facial surgery.
2つのタイプがあります
08:28
We can categorize it like that.
こんな風に分類できます
08:30
We can say there are patients who choose to have facial surgery --
1つは整形手術を決めた患者
08:32
like Sue.
スーみたいな人達です
08:34
When they have facial surgery,
彼らは顔の手術を受ければ
08:36
they feel their lives have changed
人生が変ったと感じるでしょう
08:38
because other people perceive them
なぜなら他人からよりいい人だという
08:40
as better people.
印象を受けるからです
08:43
They don't feel different.
彼らは違いを感じません
08:45
They feel that they've actually gained
彼らは 新しい顔が自分の
08:47
what they never had,
性格を表しているという未体験の
08:49
that their face now reflects their personality.
感覚を覚えていくんです
08:51
And actually that's probably the difference between cosmetic surgery
実際 ここが美容整形手術と
彼らのした手術の
08:53
and this kind of surgery.
違いなのではないでしょうか
08:56
Because you might say, "Well, this type of surgery
こうおっしゃる方もいるかもしれません
08:58
might be regarded as cosmetic."
「これも美容整形手術の一種だ」
09:01
If you do cosmetic surgery, patients are often less happy.
整形手術をすると
しばしば幸福度は下がります
09:03
They're trying to achieve difference in their lives.
何か違うものに変りたいと
思っているからです
09:06
Sue wasn't trying to achieve difference in her life.
しかし スーは違いました
09:12
She was just trying to achieve the face
彼女はただ性格とマッチする
09:14
that matched her personality.
顔になりたかったのです
09:16
But then we have other people
しかし これとは違う人もいます
09:18
who don't choose to have facial surgery.
顔の手術を選ばなかった人です
09:20
They're people who have their face shot off.
銃で自らの顔を打ち抜きました
09:22
I'll move it off, and we'll have a blank slide for those who are squeamish amongst you.
気分が悪くなる方もいるでしょうから
白紙のスライドにします
09:24
They have it forced upon them.
顔を気にして打ち抜いたんです
09:27
And again, as I told you,
もう一度言いますが
09:29
if they have a caring family
もし彼らを愛する家族がいたら
09:31
and good work life,
充実した仕事環境があれば
09:33
then they can lead normal and fulfilled lives.
平凡だけど充実した人生を送れるんです
09:36
Their identity doesn't change.
彼らのアイデンティティーは変りません
09:39
Is this business
容姿と容姿への固執は
09:41
about appearance and preoccupation with it
西洋だけに限った
09:43
a Western phenomenon?
現象でしょうか?
09:45
Muzetta's family give the lie to this.
ムゼッタ一家はそれは違うと
教えてくれます
09:47
This is a little Bangladeshi girl from the east end of London
ロンドン東部に住む
バングラデッシュ人の女の子です
09:50
who's got a huge malignant tumor on the right side of her face,
右顔には巨大な悪性腫瘍があり
失明もしましたし
09:53
which has already made her blind
急速に成長を続ける腫瘍に
09:56
and which is rapidly growing and is going to kill her shortly.
彼女の命も危ぶまれていました
09:58
After she had surgery to remove the tumor,
腫瘍を取り除いた後
両親は彼女に
10:00
her parents dressed her in this beautiful green velvet dress,
この美しい緑色の
ベルベットのドレスを着せ
10:03
a pink ribbon in her hair,
髪にはピンクのリボンをつけ
10:06
and they wanted the painting to be shown around the world,
世界中にこの絵を見せたかったんです
10:08
despite the fact that they were orthodox Muslims
保守的なイスラムの一家で
母親はブルカという
10:10
and the mother wore a full burqa.
ベールを纏っていたのにです
10:13
So it's not simply a Western phenomenon.
つまり これは西欧だけの
現象ではないんです
10:15
We make judgments on people's faces
人の印象は常に
10:20
all the time.
顔で決まります
10:22
It's been going on since we can think of Lombroso
これはロンブローソが犯罪者顔を
10:24
and the way he would define criminal faces.
定義した時から続いています
10:27
He said you could see criminal faces,
犯罪者かどうかは写真を
10:29
judging them just on the photographs that were showed.
見るだけでわかるものだと
彼は言いました
10:31
Good-looking people
容姿のいい人は常に
10:34
are always judged as being more friendly.
友好的だと思われます
10:36
We look at O.J. --
O.J を見てみましょう
10:38
he's a good-looking guy.
かっこいいですね
10:40
We'd like to spend time with him. He looks friendly.
一緒にいたいと思うし
友好的にも見えます
10:42
Now we know that he's a convicted wife-batterer,
でも妻への暴行で
有罪判決を受けていました
10:45
and actually he's not the good guy.
実はいい人ではないんです
10:48
And beauty doesn't equate to goodness,
美しさは善良と同じではありませんし
10:50
and certainly doesn't equate to contentment.
もちろん美しさは幸福とも違います
10:54
So we've talked about the static face
今までは静止している顔と
10:57
and judging the static face,
その判断の話をしてきましたが
10:59
but actually, we're more comfortable
実は動いている顔に
11:01
with judging the moving face.
判断を下すのは
11:03
We think we can judge people on their expressions.
もっと簡単なんですね
11:05
U.K. jurors in the U.K. justice system
イギリス法制度では陪審員は
11:08
like to see a live witness
証人を自身の目で見たがります
11:11
to see whether they can pick up the telltale signs of mendacity --
それは瞬きや口ごもりといった
11:13
the blink, the hesitation.
虚偽のサインを見つけられるからです
11:16
And so they want to see live witnesses.
ですから証人を自身の目で
直接見たいんです
11:19
Todorov tells us that, in a tenth of a second,
人はコンマ一秒の間に人の顔を見て
11:22
we can make a judgment on somebody's face.
判断を下すとトドロフは言っています
11:25
Are we uncomfortable with this image? Yes, we are.
この画像に違和感はありますか?
そうですよね
11:28
Would we be happy if our doctor's face, our lawyer's face,
あなたの担当医 弁護士
財務顧問がこんな風に
11:31
our financial adviser's face was covered?
顔を隠してたらどうですか?
11:34
We'd be pretty uncomfortable.
とても居心地が悪いでしょうね
11:36
But are we good at making the judgments
しかし 人の顔や動きから
11:38
on facial appearance and movement?
判断を上手にできているでしょうか?
11:40
The truth is that there's a five-minute rule,
真実は5分ルールにあります
11:43
not the tenth-of-a-second rule like Todorov, but a five-minute rule.
トドロフが言ったように
一瞬ではだめです
11:45
If you spend five minutes with somebody,
5分間 誰かと過ごせば
11:48
you start looking beyond their facial appearance,
容貌の向こう側が見えてきます
11:50
and the people who you're initially attracted to
最初は惹かれた人でも
11:52
may seem boring and you lose interest in them,
退屈で興味を失うかもしれないし
11:54
and the people who you didn't immediately seek out,
逆に 最初は特に魅力を感じず
11:56
because you didn't find them particularly attractive,
すぐに惹かれなかった人の
11:58
become attractive people
性格を知り その魅力に
12:00
because of their personality.
気づくこともあるでしょう
12:02
So we've talked a lot about facial appearance.
ここまで 見た目について
たくさん話してきました
12:05
I now want to share
ここで皆さんに私達が
12:08
a little bit of the surgery that we do --
行っている手術と
12:10
where we're at and where we're going.
今後の展開をご紹介します
12:12
This is an image of Ann
これはアンの写真です
12:14
who's had her right jaw removed and the base of her skull removed.
右の顎関節と頭蓋底を摘出しました
12:16
And you can see in the images afterward,
これが手術後の写真ですが
12:18
we've managed to reconstruct her successfully.
再建手術は成功しました
12:20
But that's not good enough.
しかし それだけではありません
12:22
This is what Ann wants. She wants to be out kayaking,
アンが望んだのはカヤックや
12:24
she wants to be out climbing mountains.
山登りをすることでした
12:26
And that's what she achieved, and that's what we have to get to.
彼女の望みを叶えられました
12:28
This is a horrific image,
次のはゾッとする画像ですから
12:30
so I'm putting my hand up now.
手をあげて注意しておきます
12:32
This is a photograph of Adi,
これはナイジェリアの銀行支店長の
12:34
a Nigerian bank manager who had his face shot off
アディです 銀行強盗に
12:36
in an armed robbery.
顔を銃で打たれてしまいました
12:38
And he lost his lower jaw, his lip, his chin
そのため下顎 唇 あご
12:40
and his upper jaw and teeth.
上顎の関節に歯も失いました
12:42
This is the bar that he set for us.
彼は私達に目標を提示しました
12:44
"I want to look like this. This is how I looked before."
「以前の私のように
こうなりたいんです」
12:46
So with modern technology,
現代の技術では
12:49
we used computers to make models.
コンピューターを使ってモデルを作ります
12:51
We made a model of the jaw without bone in it.
骨なしの顎関節のモデルを作って
12:54
We then bent a plate up to it.
金属製のプレートを沿わせました
12:56
We put it in place
正確な場所を知るために
12:58
so we knew it was an accurate position.
プレートを顎の位置に置きました
13:00
We then put bone and tissue from the back.
そして背中の骨と組織を移植しました
13:02
Here you can see the plate holding it,
それを支えているプレートに
13:05
and you can see the implants being put in --
埋め込まれたインプラントが見えますね
13:07
so that in one operation
この1回の手術で
13:10
we achieve this
口はこのようになり
13:12
and this.
顔はこうなりました
13:15
So the patient's life is restored.
彼は人生を取り戻しました
13:17
That's the good news.
それは良いことなんですが
13:19
However, his chin skin
顎の皮膚は以前とは
13:21
doesn't look the same as it did before.
違って見えます
13:23
It's skin from his back.
この皮膚は背中のもので
13:25
It's thicker, it's darker, it's coarser, it doesn't have the contours.
厚く 色も濃いうえ
キメも粗く丸みはありません
13:27
And that's where we're failing,
これは私達の及ばなかった点です
13:30
and that's where we need the face transplant.
ですから顔面移植が必要です
13:32
The face transplant has a role
顔面移植はやけをど負った
13:34
probably in burns patients to replace the skin.
患者の植皮に使われるでしょう
13:36
We can replace the underlying skeletal structure,
骨格構造は作れますが
13:39
but we're still not good at replacing the facial skin.
顔の皮膚移植には改善の余地があります
13:41
So it's very valuable
顔面移植という選択肢は
13:44
to have that tool in our armamentarium.
大きな価値を持ちます
13:46
But the patients are going to have to take drugs
しかし術後はずっと免疫抑制剤を
13:48
that suppress their immune system for the rest of their lives.
飲み続けなければいけません
13:50
What does that mean?
ということは
13:52
They have an increased risk of infection, an increased risk of malignancy.
感染症だけでなく悪性腫瘍の
リスクも上がるのです
13:54
This is not a life-saving transplant --
顔は心臓 肝臓 肺と違って
13:57
like a heart, or liver, or lung transplant --
生命を維持するものではありません
13:59
it is a quality-of-life transplant,
人生の質を向上させるための
移植なのです
14:02
and as a result,
結果的に
14:05
are the patients going to say, if they get a malignant cancer 10 or 15 years on,
10~15年後に悪性腫瘍ができたら
こう言うかもしれません
14:07
"I wish I'd had conventional reconstructive techniques rather than this
「あの時 従来の
再建手術を受けていたら...
14:10
because I'm now dying of a malignant cancer"? We don't know yet.
私は悪性腫瘍で死ぬんでしょ?」
まだわかりません
14:13
We also don't know what they feel
彼らが認識と
アイデンティティーに対して
14:16
about recognition and identity.
どう思っているかもわかりません
14:19
Bernard Devauchelle and Sylvie Testelin, who did the first operation,
初めてこの手術をした
バーナードとシルビィは
14:21
are studying that.
この研究をしています
14:24
Donors are going to be short on the ground,
顔面移植のドナーは
見つからないでしょう
14:26
because how many people want to have their loved one's face
愛する人が死に行く時に顔の提供を
14:29
removed at the point of death?
こころよく思う遺族は
そう多くないでしょう
14:32
So there are going to be problems
つまり顔面移植には
14:35
with face transplantation.
問題がついて回ります
14:37
So the better news is
さて 朗報はというと
14:39
the future's almost here --
再生医療という明るい未来が
14:41
and the future is tissue engineering.
すぐそこまで来ていることです
14:43
Just imagine,
想像してみてください
14:45
I can make a biologically-degradable template.
生物分解性テンプレートを作成して
14:47
I can put it in place where it's meant to be.
然るべき場所に取り付けて
14:50
I can sprinkle a few cells,
少し細胞を振りかけるんです
14:52
stem cells from the patient's own hip,
患者自身の腰骨の幹細胞や
14:54
a little bit of genetically engineered protein,
遺伝子組替タンパク質をかけて
14:56
and lo and behold, leave it for four months and the face is grown.
様子を見ます 4ヶ月経てば
成長して顔になるんです
14:58
This is a bit like a Julia Child recipe.
ジュリア・チャイルドの
レシピみたいですね
15:02
But we've still got problems.
それでもまだ問題はあります
15:06
We've got mouth cancer to solve.
それは口腔癌です
15:08
We're still not curing enough patients -- it's the most disfiguring cancer.
口腔癌は顔面の損傷が最も激しく
完治はまだ不可能です
15:10
We're still not reconstructing them well enough.
口腔癌患者の再建手術は
まだ不完全なんです
15:13
In the U.K. we have an epidemic
イギリスでは若者の間で
15:16
of facial injuries among young people.
顔面損傷が数多く見られます
15:18
We still can't get rid of scars.
傷跡を消すことは未だにできません
15:20
We need to do research.
更なる研究が必要です
15:22
And the best news of all
ですから彼らの未来のためにも
15:24
is that surgeons know
外科医に研究の必要性を
15:26
that we need to do research.
知らせることが重要になります
15:28
And we've set up charities
そこで私達は慈善団体を設立し
15:30
that will help us fund
募金を通じて臨床研究の
15:32
the clinical research
支援活動を行っています
15:34
to determine the best treatment practice now
現行の最善の治療法を決定し
15:36
and better treatment into the future,
将来のより良い治療を決定するんです
15:38
so we don't just sit on our laurels and say, "Okay, we're doing okay.
「順調順調 このままでOK」などと
15:40
Let's leave it as it is."
現状に満足している訳ではないんです
15:42
Thank you very much indeed.
本当にありがとうございました
15:44
(Applause)
(拍手)
15:46
Translated by Amane Dunne
Reviewed by Takahiro Shimpo

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About the speaker:

Iain Hutchison - Facial surgeon
Iain Hutchison is a pioneering oral and facial surgeon; his foundation, Saving Faces, explores the nature of our expressions.

Why you should listen

Iain Hutchison thinks deeply about our faces. In his practice at St. Bartholomew’s, Royal London and University College London Hospitals, he has seen faces that lack the basic ability to function, to communicate emotion, to serve as a window to the world. His work involves repairing individual faces that have been impaired through cancer, birth defect or accidents—and asking all of us to look beyond first impressions.

One way he’s seeding the conversation is through the Facial Surgery Research Foundation/Saving Faces, which supports facial surgery research and education as well as a groundbreaking artistic residency by painter Mark Gilbert. Right in Hutchison’s office, patients sat for Gilbert before and after facial surgery, resulting in searching, honest portraits that show the humanity even of someone whose face we might be unwilling to look at. The “Saving Faces” exhibit has been seen by more than two million gallery visitors. Hutchison is also an active advocate of running clinical trials for facial surgery, and he funds and co-supervises two psychology PhD students to study ways to improve emotional and functional outcomes.

As he says: "Facial surgery is challenging not only because of its intricacy but because it has a profound effect on the patient’s psyche."

More profile about the speaker
Iain Hutchison | Speaker | TED.com