TEDGlobal 2010
Iain Hutchison: Saving faces: A facial surgeon's craft
伊恩·哈奇森Iain Hutchison：整容面部
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面部手术医生伊恩·哈奇森为那些严重毁容的人们动手术。他通过努力提高手术方法来改善他们的生活；依托他们的肖像，他复原了他们的人性。注意：这个演讲会有毁容和面部被严重毁坏的图片可能会引起不适--哈奇森告诉我们为什么被毁容的面部会让我们不安，这些答案发人深省。 如果您容易对此产生不适,请在12：10 - 13：19之间不要看屏幕，但请您继续听期间的演讲。
Iain Hutchison - Facial surgeon
Iain Hutchison is a pioneering oral and facial surgeon; his foundation, Saving Faces, explores the nature of our expressions. Full bio
Iain Hutchison is a pioneering oral and facial surgeon; his foundation, Saving Faces, explores the nature of our expressions. Full bio
Double-click the English transcript below to play the video.
00:15
Our face is hugely important
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我们的面部十分重要
00:18
because it's the external, visual part
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因为它是身体外部可视的部分
00:20
that everybody else sees.
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所有人都可以看见。
00:22
Let's not forget it's a functional entity.
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我们别忘了它也是一个功能实体。
00:24
We have strong skull bones
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我们有坚固的头盖骨
00:26
that protect the most important organ in our body: the brain.
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用来保护我们身体中最重要的器官:大脑。
00:29
It's where our senses are located, our special senses --
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我们感官也位于面部,我们的一些特殊感官 --
00:32
our vision, our speech,
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我们的视觉,我们的言语,
00:34
our hearing, our smell, our taste.
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我们的听力,我们的嗅觉,我们的味觉。
00:36
And this bone
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这块骨头
00:38
is peppered, as you can see, with the light shining through the skull
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布满了 正如你看到的 穿透过头盖骨的光线
00:41
with cavities, the sinuses,
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还有空腔, 鼻窦,
00:43
which warm and moisten the air we breathe.
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使我们吸入的空气变的温暖和湿润。
00:46
But also imagine if they were filled with solid bone --
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但想象一下,如果这全是实心的骨头,
00:49
our head would be dead weight,
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我们的头会变得非常重,
00:51
we wouldn't be able to hold it erect,
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我们将不能抬起头,
00:53
we wouldn't be able to look at the world around us.
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我们也不能看到我们四周的世界。
01:02
This woman is slowly dying
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这个女人正在慢慢的死去
01:04
because the benign tumors in her facial bones
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因为她面颅骨里的良性肿瘤
01:07
have completely obliterated her mouth and her nose
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已经彻底毁坏了她的嘴巴和鼻子,
01:10
so she can't breathe and eat.
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所以她不能呼吸也不能吃东西。
01:12
Attached to the facial bones
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依附于面颅骨
01:14
that define our face's structure
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用来勾画我们面部结构的
01:18
are the muscles that deliver our facial expression,
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是传递我们面部表情的肌肉,
01:21
our universal language of expression,
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我们通用的表情语言
01:24
our social-signaling system.
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我们的社会信号体系。
01:26
And overlying this is the skin drape,
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覆盖其上的是皮肤褶皱，
01:29
which is a hugely complex
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它是个极其复杂的
01:31
three-dimensional structure --
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三维结构 --
01:33
taking right-angled bends here and there,
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在这里那里会有各种角度的弯折
01:35
having thin areas like the eyelids,
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有薄如眼睑的区域，
01:38
thick areas like the cheek, different colors.
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有厚如脸颊的区域和不同的颜色组成。
01:41
And then we have the sensual factor of the face.
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我们的脸上也有官能要素。
01:44
Where do we like to kiss people?
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我们喜欢亲吻别人什么地方?
01:46
On the lips. Nibble the ears maybe.
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嘴唇上。也许在耳边轻咬。
01:49
It's the face where we're attracted to with that.
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这正是因为我们被面部所吸引。
01:52
But let's not forget the hair.
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不过我们也不要忘记头发。
01:54
You're looking at the image on your left-hand side --
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你现在看一下你左手边的图片 --
01:56
that's my son with his eyebrows present.
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这是我儿子有眉毛的照片，
01:58
Look how odd he looks with the eyebrows missing.
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而他没有眉毛的照片看起来是不是很奇怪。
02:01
There's a definite difference.
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这有着决定性的差异。
02:03
And imagine if he had hair sprouting from the middle of his nose,
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想象一下他如果从鼻子中间有毛发
02:05
he'd look even odder still.
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他会看起来更加奇怪。
02:07
Dysmorphophobia
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曲影症
02:09
is an extreme version
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是一个事实的极端特例
02:11
of the fact that we don't see ourselves
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我们看我们自己
02:13
as others see us.
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和别人看我们是不同的。
02:15
It's a shocking truth
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这是个让人震惊的事实
02:17
that we only see mirror images of ourselves,
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我们只能看到我们的镜像，
02:20
and we only see ourselves
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我们只能看到我们自己
02:22
in freeze-frame photographic images
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在定格的照片中
02:24
that capture a mere fraction of the time that we live.
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这些照片只能捕获我们生活中的短暂瞬间。
02:27
Dysmorphophobia
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曲影症
02:29
is a perversion of this
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是这一事实的反常行为
02:31
where people who may be very good looking
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有些相貌很好看的人
02:33
regard themselves as hideously ugly
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认为自己面目狰狞
02:35
and are constantly seeking surgery
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并且不断寻求通过手术
02:37
to correct their facial appearance.
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来矫正他们的容貌。
02:40
They don't need this. They need psychiatric help.
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他们并不需要手术, 他们需要心理辅导。
02:43
Max has kindly donated his photograph to me.
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马克斯好心的把他的照片捐赠给我。
02:45
He doesn't have dysmorphophobia, but I'm using his photograph
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他没有曲影症，但我用他的照片
02:48
to illustrate the fact that he looks exactly like a dysmorphophobic.
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来说明他看起来跟一个曲影症患者一样。
02:50
In other words, he looks entirely normal.
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换句话说，他看起来完全正常。
02:53
Age is another thing
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年龄是另外一个因素
02:56
when our attitude toward our appearance changes.
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在我们对待自己容貌态度的改变之中。
02:58
So children judge themselves, learn to judge themselves,
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所以孩子们自我衡量，学习自我衡量
03:01
by the behavior of adults around them.
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是通过他们身边成年人的行为。
03:04
Here's a classic example: Rebecca has a benign blood vessel tumor
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这是个经典案例:丽贝卡的良性血管瘤
03:07
that's growing out through her skull, has obliterated her nose,
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从她的头骨中长出来，并且毁坏了她的鼻子，
03:10
and she's having difficulty seeing.
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她看东西已经成问题。
03:12
As you can see, it's blocking her vision.
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你可以看到，肿瘤阻挡了她的视线。
03:14
She's also in danger, when she damages this,
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如果她弄破了肿瘤她的生命也会
03:16
of bleeding profusely.
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因为大出血而有危险。
03:18
Our research has shown
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我们的研究表明
03:20
that the parents and close loved ones of these children
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这些孩子们的父母和亲近的人们
03:23
adore them.
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极其喜欢他们。
03:25
They've grown used to their face; they think they're special.
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他们已经习惯了这些孩子们的脸；他们觉得这些孩子很特殊。
03:28
Actually, sometimes the parents argue
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其实，有的时候父母们会讨论
03:30
about whether these children should have the lesion removed.
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是不是要把这些孩子的病变除去。
03:33
And occasionally they suffer intense grief reactions
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偶尔的，他们会难过
03:35
because the child they've grown to love
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因为他们心爱的孩子
03:37
has changed so dramatically and they don't recognize them.
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会有如此大的变化以至于都不能认出他们来了。
03:40
But other adults
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但另外的成年人
03:42
say incredibly painful things.
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会说一些让人难以置信的心痛的话。
03:44
They say, "How dare you take this child out of the house
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他们会说，“你们怎么敢把这个孩子带出家门
03:46
and terrify other people.
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这会吓到其他人的。
03:48
Shouldn't you be doing something about this? Why haven't you had it removed?"
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你们难道不应该做些什么么? 为什么不把这些病变除去？”
03:51
And other children in curiosity come up and poke the lesion,
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其他的孩子们会好奇的上来戳一戳，
03:54
because -- a natural curiosity.
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因为一种自然的好奇心。
03:56
And that obviously alerts the child
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这当然会让这个孩子意识到
03:58
to their unusual nature.
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他不寻常的特质。
04:00
After surgery, everything normalizes.
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手术之后，一切归于正常。
04:03
The adults behave more naturally,
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大人们的举动更自然，
04:05
and the children play more readily with other children.
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这些孩子和其他孩子也更玩的来。
04:08
As teenagers --
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作为青少年--
04:11
just think back to your teenage years --
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回想一下你们的青少年时期--
04:13
we're going through a dramatic
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我们经历着戏剧性的
04:15
and often disproportionate change
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时常是不成比例的
04:17
in our facial appearance.
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面部变化。
04:19
We're trying to struggle to find our identity.
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我们努力的寻找自己的身份
04:21
We crave the approval of our peers.
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我们渴望得到同龄人的认可。
04:23
So our facial appearance is vital to us
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所以我们的面容对我们来说极其重要
04:26
as we're trying to project ourselves to the world.
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当我们努力的向世界展现自己。
04:28
Just remember that single acne spot
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还记得吗？一个青春痘
04:30
that crippled you for several days.
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就可以让你好几天都精神萎靡。
04:34
How long did you spend looking in the mirror every day,
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你每天花多长时间盯着镜子，
04:37
practicing your sardonic look, practicing your serious look,
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练习讽刺的表情，严肃的表情，
04:40
trying to look like Sean Connery, as I did,
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尝试看起来更像肖恩·康纳利，像我小时候一样。
04:42
trying to raise one eyebrow?
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尝试着扬起一只眉毛。
04:44
It's a crippling time.
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那是个让人束手无策的时期。
04:46
I've chosen to show this profile view of Sue
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我选择给你们看苏的侧面像，
04:50
because what it shows is her lower jaw jutting forward
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因为这样可以看出来她的下颚向前凸出
04:53
and her lower lip jutting forward.
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她的下唇也向前凸出。
04:55
I'd like you all in the audience now to push your lower jaw forward.
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我想让你们在座的每一位现在把你们的下颚推向前，
04:58
Turn to the person next to you,
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然后转向旁边的人，
05:00
push your lower jaws forward. Turn to the person next to you
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把你们的下颚推向前，然后转向你旁边的人
05:02
and look at them -- they look miserable.
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看着他们 -- 他们看起来很忧愁。
05:04
That's exactly what people used to say to Sue.
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正如所有人告诉苏的一样。
05:07
She wasn't miserable at all.
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她一点也不忧愁。
05:09
But people used to say to her, "Why are you so miserable?"
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但是大家以前都会问她：“为什么你那么难过？”
05:13
People were making misjudgments all the time
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人们总是错误的判断
05:16
on her mood.
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她的情绪。
05:18
Teachers and peers were underestimating her; she was teased at school.
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她被老师和同学低估，在学校被取笑。
05:21
So she chose to have facial surgery.
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所以她选择了面部手术。
05:23
After the facial surgery,
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手术之后，
05:25
she said, "My face now reflects my personality.
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她说：“现在我的脸是我的个性的写照。
05:28
People know now that I'm enthusiastic,
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人们现在知道我很积极，
05:31
that I'm a happy person."
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我是个很幸福的人。”
05:33
And that's the change that can be achieved for teenagers.
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青少年们可以实现这样的改变。
05:37
Is this change, though, a real change,
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这样的改变到底是真实的改变，
05:39
or is it a figment of the imagination
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还是只是虚构的
05:42
of the patient themselves?
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病人自己的想象？
05:44
Well we studied teenagers' attitudes
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我们考察青少年们
05:46
to photographs of patients having this corrective facial surgery.
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对矫正面部手术患者照片的态度。
05:48
And what we found was --
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我们发现 --
05:51
we jumbled up the photographs
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我们把这些照片混杂在一起
05:53
so they couldn't recognize the before and after --
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所以他们不能识别哪些是手术前那些是手术之后 --
05:55
what we found was that the patients were regarded
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我们发现这些病人们
05:57
as being more attractive after the surgery.
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在手术之后被认为更加有吸引力。
05:59
Well that's not surprising, but we also asked them to judge them
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这并不让人惊讶, 但我们继续让这些青少年们对
06:02
on honesty, intelligence,
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诚信度，聪明程度,
06:04
friendliness, violence.
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友善度,暴力程度进行评判。
06:07
They were all perceived as being
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在手术之前的病人们都被认为
06:09
less than normal in all those characteristics --
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在这些品质上不够正常
06:11
more violent, etc. -- before the surgery.
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比如更暴力,等等。
06:14
After the surgery,
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手术之后，
06:16
they were perceived as being more intelligent,
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病人们被认为更聪明,
06:18
more friendly, more honest, less violent --
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更友好,更诚实,更平和 --
06:21
and yet we hadn't operated on their intellect
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可是我们并没有对他们的智力
06:23
or their character.
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或者性格动手术。
06:25
When people get older,
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当人们的年龄增长,
06:27
they don't necessarily choose to follow this kind of surgery.
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他们不一定选择这类手术。
06:30
Their presence in the consultation suite
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他们对咨询室的光顾
06:32
is a result of the slings and arrows of outrageous fortune.
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是被厄运打击的结果。
06:35
What happens to them
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他们正在经历的
06:37
is that they may have suffered cancer or trauma.
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可能是癌症或者创伤的折磨。
06:39
So this is a photograph of Henry,
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这是亨利的一张照片
06:41
two weeks after he had a malignant cancer removed
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在他把恶性肿瘤
06:44
from the left side of his face -- his cheekbone,
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从他左侧的脸上 - 他的颧骨,
06:47
his upper jaw, his eye-socket.
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他的上颚和眼窝上切除几周之后照得。
06:49
He looks pretty good at this stage.
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他这个时期看起来还不错。
06:51
But over the course of the next 15 years he had 14 more operations,
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但是接下来的15年,他接受了14次手术,
06:54
as the disease ravaged his face
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因为疾病毁了他的脸
06:56
and destroyed my reconstruction regularly.
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也毁了我定期对他面部的整容。
06:58
I learned a huge amount from Henry.
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我从亨利那里学到了很多东西。
07:00
Henry taught me
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亨利告诉了我
07:02
that you can carry on working.
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我还可以继续工作。
07:04
He worked as an advocate. He continued to play cricket.
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他是个辩护律师。他还在继续打板球。
07:07
He enjoyed life to the full,
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他全心全意地享受生命。
07:09
and this was probably because he had a successful, fulfilling job
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这可能因为他有一份成功的令他满意的工作
07:11
and a caring family
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一个充满关爱的家庭
07:13
and was able to participate socially.
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他也可以参与社会活动。
07:15
He maintained a calm insouciance.
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他依旧镇定自若。
07:18
I don't say he overcame this; he didn't overcome it.
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我并不是说他战胜了肿瘤;他没有。
07:21
This was something more than that. He ignored it.
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但重要的是:他忽略了它。
07:24
He ignored the disfigurement that was happening in his life
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他忽略发生在他脸上的毁容
07:27
and carried on oblivious to it.
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他忘却疾病, 继续生活。
07:30
And that's what these people can do.
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这是这些人可以做到的。
07:32
Henriapi illustrates this phenomenon as well.
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亨利阿皮也阐述了这个现象。
07:34
This is a man in his 20s
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这是个二十多岁的年轻尼日利亚男子
07:36
whose first visit out of Nigeria was with this malignant cancer
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他第一次出国是因为他的恶性肿瘤
07:39
that he came to the United Kingdom to have operated on.
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他需要到英国做手术。
07:41
It was my longest operation.
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这是我最长的一次手术。
07:43
It took 23 hours. I did it with my neurosurgeon.
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历时23个小时。我跟我的神经外科医生一起。
07:46
We removed all the bones at the right side of his face --
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我们把他右脸的所有骨头都除去 --
07:48
his eye, his nose,
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他的眼睛,鼻子,
07:50
the skull bones, the facial skin --
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头骨,面部皮肤 --
07:52
and reconstructed him with tissue from the back.
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用他背部的组织给他整容。
07:55
He continued to work as a psychiatric nurse.
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亨利阿皮继续着他精神科护士的工作。
07:57
He got married. He had a son called Jeremiah.
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他结了婚,他的儿子叫耶利米。
08:00
And again, he said,
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他说,
08:02
"This painting of me with my son Jeremiah
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“这幅我跟我儿子耶利米的画像
08:05
shows me as the successful man that I feel that I am."
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告诉我我觉得到我是个成功的人。”
08:08
His facial disfigurement
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他的面部畸形
08:10
did not affect him
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没有影响到他
08:12
because he had the support of a family;
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因为他有他家人的支持，
08:14
he had a successful, fulfilling job.
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他有一份成功的令他满足的工作。
08:16
So we've seen that we can change people's faces.
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所以我们看到我们可以改变这些人的面部。
08:19
But when we change people's faces,
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但当我们改变人们的面部时，
08:21
are we changing their identity --
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我们同时也改变了他们的身份，
08:23
for better or for worse?
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这到底是好还是不好?
08:26
For instance,
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比如说,
08:28
there are two different types of facial surgery.
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有两种不同的面部手术。
08:30
We can categorize it like that.
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我们可以这样归类。
08:32
We can say there are patients who choose to have facial surgery --
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我们可以说一种是病人选择进行面部手术 --
08:34
like Sue.
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正如苏.
08:36
When they have facial surgery,
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他们进行面部手术之后,
08:38
they feel their lives have changed
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感觉到他们的生活改变了,
08:40
because other people perceive them
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因为其他人认为他们
08:43
as better people.
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是更好的人。
08:45
They don't feel different.
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他们本身并没感觉有什么不一样。
08:47
They feel that they've actually gained
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但他们觉得他们获得了一些
08:49
what they never had,
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他们曾经没有的东西,
08:51
that their face now reflects their personality.
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他们的面部现在反映了他们的个性。
08:53
And actually that's probably the difference between cosmetic surgery
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这可能是整容手术
08:56
and this kind of surgery.
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和这些手术的不同之处。
08:58
Because you might say, "Well, this type of surgery
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因为你可能会说，“这种手术
09:01
might be regarded as cosmetic."
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也可以被认为是整容性质的。”
09:03
If you do cosmetic surgery, patients are often less happy.
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如果你进行整容手术，病人们通常不会那么满意。
09:06
They're trying to achieve difference in their lives.
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整容手术病人想要改变生活。
09:12
Sue wasn't trying to achieve difference in her life.
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苏并没有想改变生活，
09:14
She was just trying to achieve the face
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她只是想让她的面部
09:16
that matched her personality.
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和她的个性相匹配。
09:18
But then we have other people
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也有其他一些人
09:20
who don't choose to have facial surgery.
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他们没有选择面部手术。
09:22
They're people who have their face shot off.
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这些人的面部被严重毁坏。
09:24
I'll move it off, and we'll have a blank slide for those who are squeamish amongst you.
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我还是赶紧把图片移开，为了你们中感觉不舒服的人我们还是看着这张空白的幻灯片吧。
09:27
They have it forced upon them.
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但是他们被迫要做面部手术。
09:29
And again, as I told you,
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正如我告诉你的，
09:31
if they have a caring family
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如果他们有个关心他们的家庭
09:33
and good work life,
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好的工作和生活，
09:36
then they can lead normal and fulfilled lives.
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他们可以过正常和满意的生活。
09:39
Their identity doesn't change.
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他们的身份并没有变化。
09:41
Is this business
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这样的
09:43
about appearance and preoccupation with it
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关于外表和对其专注的行业
09:45
a Western phenomenon?
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是一种西方的现象么？
09:47
Muzetta's family give the lie to this.
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Muzetta一家的经历说明并不是这样的。
09:50
This is a little Bangladeshi girl from the east end of London
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这个住在伦敦东部的孟加拉国小女孩
09:53
who's got a huge malignant tumor on the right side of her face,
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她右脸上巨大的恶性肿瘤，
09:56
which has already made her blind
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已经使她看不见东西，
09:58
and which is rapidly growing and is going to kill her shortly.
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并且还在急速生长，在不久的将来会杀死她。
10:00
After she had surgery to remove the tumor,
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在她手术移除肿瘤之后，
10:03
her parents dressed her in this beautiful green velvet dress,
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她的父母给她穿上漂亮的绿色天鹅绒连衣裙，
10:06
a pink ribbon in her hair,
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用粉色丝带装饰她的头发，
10:08
and they wanted the painting to be shown around the world,
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他们希望全世界都可以看到这个画像，
10:10
despite the fact that they were orthodox Muslims
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虽然他们是正统的穆斯林教徒
10:13
and the mother wore a full burqa.
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她的母亲一直穿罩袍。
10:15
So it's not simply a Western phenomenon.
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所以这并不只是一个西方现象。
10:20
We make judgments on people's faces
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我们根据人的面部做判断
10:22
all the time.
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每时每刻。
10:24
It's been going on since we can think of Lombroso
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从Lombrosso
10:27
and the way he would define criminal faces.
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和他定义罪犯脸部方法开始。
10:29
He said you could see criminal faces,
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他说你可以
10:31
judging them just on the photographs that were showed.
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只从照片就看出来哪些是罪犯的面孔。
10:34
Good-looking people
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好看的人们
10:36
are always judged as being more friendly.
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总是会被认为更加友好。
10:38
We look at O.J. --
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当我们看到O.J (O·J·辛普森) --
10:40
he's a good-looking guy.
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他长的不错。
10:42
We'd like to spend time with him. He looks friendly.
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我们愿意花时间和他相处。他看起来挺友善。
10:45
Now we know that he's a convicted wife-batterer,
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我们现在知道他因为殴打他的妻子而判有罪，
10:48
and actually he's not the good guy.
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他其实并不是个好人。
10:50
And beauty doesn't equate to goodness,
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美貌并不等同于善良，
10:54
and certainly doesn't equate to contentment.
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更不等同于满足。
10:57
So we've talked about the static face
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我们谈了静态的面部
10:59
and judging the static face,
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和对静态面部的判断，
11:01
but actually, we're more comfortable
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事实上，我们更习惯于
11:03
with judging the moving face.
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从动态的面部来判断。
11:05
We think we can judge people on their expressions.
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我们觉得我们可以从人们的表情进行判断。
11:08
U.K. jurors in the U.K. justice system
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英国法律体系下的陪审员
11:11
like to see a live witness
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喜欢见到现场目击者
11:13
to see whether they can pick up the telltale signs of mendacity --
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这样他们可以看出来是否有泄露真相的迹象 --
11:16
the blink, the hesitation.
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眨眼，犹豫。
11:19
And so they want to see live witnesses.
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所以他们想见到现场目击人。
11:22
Todorov tells us that, in a tenth of a second,
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托多罗夫告诉我们，只用十分之一秒，
11:25
we can make a judgment on somebody's face.
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我们就可以根据他人的面部来做判断。
11:28
Are we uncomfortable with this image? Yes, we are.
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我们对这个画面感觉的不舒服么？确实是这样。
11:31
Would we be happy if our doctor's face, our lawyer's face,
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如果我们的医生，律师，
11:34
our financial adviser's face was covered?
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金融顾问的脸被遮起来，我们会开心么?
11:36
We'd be pretty uncomfortable.
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我们会挺不舒服的。
11:38
But are we good at making the judgments
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但是我们能够很好的
11:40
on facial appearance and movement?
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根据面部外观和活动做判断么？
11:43
The truth is that there's a five-minute rule,
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真实情况是有一个五分钟准则 --
11:45
not the tenth-of-a-second rule like Todorov, but a five-minute rule.
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并不是托多罗夫所说的十分之一秒，但是是一个五分钟准则。
11:48
If you spend five minutes with somebody,
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如果你和某个人相处五分钟，
11:50
you start looking beyond their facial appearance,
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你会开始注意到他们面部外观之外的地方，
11:52
and the people who you're initially attracted to
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这些一开始吸引你的人
11:54
may seem boring and you lose interest in them,
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可能会让你觉得很无聊，你对他们不再有兴趣，
11:56
and the people who you didn't immediately seek out,
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然后有些并没有立刻就引起你注意的人，
11:58
because you didn't find them particularly attractive,
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因为你一开始并没觉得他们特别有吸引力，
12:00
become attractive people
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变得更加引人瞩目
12:02
because of their personality.
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是因为他们的个性。
12:05
So we've talked a lot about facial appearance.
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我们谈了一些面部外观。
12:08
I now want to share
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现在我想和你们分享
12:10
a little bit of the surgery that we do --
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一些我们做的手术 --
12:12
where we're at and where we're going.
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我们现在和未来在做的手术。
12:14
This is an image of Ann
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这是一幅安的图片
12:16
who's had her right jaw removed and the base of her skull removed.
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她的右下颚和头骨底部被移除了。
12:18
And you can see in the images afterward,
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你可以看到手术后的图片，
12:20
we've managed to reconstruct her successfully.
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我们对她整形的很成功。
12:22
But that's not good enough.
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但依旧不够好。
12:24
This is what Ann wants. She wants to be out kayaking,
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安想要到外面去划皮划艇，
12:26
she wants to be out climbing mountains.
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她想去爬山。
12:28
And that's what she achieved, and that's what we have to get to.
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这些她曾经都做过，而这是我们现在需要努力的方向。
12:30
This is a horrific image,
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这是一张恐怖的图片，
12:32
so I'm putting my hand up now.
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所以我把我的手盖在上面。
12:34
This is a photograph of Adi,
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这是阿迪的一张照片，
12:36
a Nigerian bank manager who had his face shot off
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一位尼日利亚的银行经理，他的面部
12:38
in an armed robbery.
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在一起持枪抢劫中被严重毁容。
12:40
And he lost his lower jaw, his lip, his chin
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他失去了下颚，嘴唇，下巴
12:42
and his upper jaw and teeth.
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还有上颚和牙齿。
12:44
This is the bar that he set for us.
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这是他对我们的期望。
12:46
"I want to look like this. This is how I looked before."
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“我想看起来像这样。这是我以前的样子。”
12:49
So with modern technology,
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使用现代技术，
12:51
we used computers to make models.
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我们用电脑做出模型。
12:54
We made a model of the jaw without bone in it.
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我们做了个无骨的的颚部模型。
12:56
We then bent a plate up to it.
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然后我们折弯一块薄板。
12:58
We put it in place
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放入适当的地方
13:00
so we knew it was an accurate position.
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这样我们可以知道一个精确的位置。
13:02
We then put bone and tissue from the back.
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之后我们把骨头和组织放在其后。
13:05
Here you can see the plate holding it,
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你可以看到薄板支撑着它，
13:07
and you can see the implants being put in --
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植入体正在被放进去--
13:10
so that in one operation
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在一次手术之中
13:12
we achieve this
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我们做到了这个
13:15
and this.
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还有这个。
13:17
So the patient's life is restored.
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这位病人恢复了正常生活。
13:19
That's the good news.
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这是好消息。
13:21
However, his chin skin
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虽然如此，他下颚的皮肤
13:23
doesn't look the same as it did before.
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看起来跟以前不一样。
13:25
It's skin from his back.
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这是他背部的皮肤。
13:27
It's thicker, it's darker, it's coarser, it doesn't have the contours.
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所以更厚，颜色更深，更粗糙一些，也没有应有的轮廓。
13:30
And that's where we're failing,
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这些是我们不足的地方。
13:32
and that's where we need the face transplant.
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这时候我们需要面部移植。
13:34
The face transplant has a role
332
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面部移植手术
13:36
probably in burns patients to replace the skin.
333
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可能在更换烧伤病人的皮肤中扮演了一个重要角色。
13:39
We can replace the underlying skeletal structure,
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我们可以替换底层的骨骼结构，
13:41
but we're still not good at replacing the facial skin.
335
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但是我们对面部皮肤的替换还很不足。
13:44
So it's very valuable
336
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所以
13:46
to have that tool in our armamentarium.
337
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在我们医疗设备中有这样的工具是十分重要的。
13:48
But the patients are going to have to take drugs
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可是病人们会终身需要服药
13:50
that suppress their immune system for the rest of their lives.
339
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用来抑制他们的免疫系统。
13:52
What does that mean?
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这说明什么呢?
13:54
They have an increased risk of infection, an increased risk of malignancy.
341
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他们会更可能被感染，有更大风险使病情恶化。
13:57
This is not a life-saving transplant --
342
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这并不是一个挽救生命的移植 --
13:59
like a heart, or liver, or lung transplant --
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比如心脏,肝脏,肺部移植 --
14:02
it is a quality-of-life transplant,
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这是一种生命质量的移植，
14:05
and as a result,
345
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移植的结果
14:07
are the patients going to say, if they get a malignant cancer 10 or 15 years on,
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是这些病人们是不是会说，如果他们十年或者十五年后会罹患恶性肿瘤，
14:10
"I wish I'd had conventional reconstructive techniques rather than this
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“我还不如当时用常规的整容方法而不是用这个，
14:13
because I'm now dying of a malignant cancer"? We don't know yet.
348
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因为我现在正在死于恶性肿瘤？”我们还不清楚。
14:16
We also don't know what they feel
349
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我们也不知道他们
14:19
about recognition and identity.
350
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对此的认可度和认同有什么感受。
14:21
Bernard Devauchelle and Sylvie Testelin, who did the first operation,
351
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首先尝试此类手术的伯纳德·德沃谢勒和塞尔维·泰斯特兰
14:24
are studying that.
352
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对他们进行了研究。
14:26
Donors are going to be short on the ground,
353
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接受手术的人不会很多，
14:29
because how many people want to have their loved one's face
354
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有多少人愿意自己关爱的人的脸部
14:32
removed at the point of death?
355
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在他/她过世的时候被移除。
14:35
So there are going to be problems
356
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所以会有很多的问题
14:37
with face transplantation.
357
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对于面部移植。
14:39
So the better news is
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所以更好的消息是
14:41
the future's almost here --
359
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未来即将到来--
14:43
and the future is tissue engineering.
360
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这个未来就是组织工程。
14:45
Just imagine,
361
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想象一下，
14:47
I can make a biologically-degradable template.
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我可以做一个生物上可降解的模板。
14:50
I can put it in place where it's meant to be.
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我可以将它放在它应该在的地方。
14:52
I can sprinkle a few cells,
364
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我可以随机分配一些细胞，
14:54
stem cells from the patient's own hip,
365
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从病人髋关节抽取一些干细胞，
14:56
a little bit of genetically engineered protein,
366
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一些转基因的蛋白质，
14:58
and lo and behold, leave it for four months and the face is grown.
367
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然后瞧,四个月后面部就长好了。
15:02
This is a bit like a Julia Child recipe.
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这有些像一份朱莉娅的儿童菜谱。
15:06
But we've still got problems.
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但我们还有很多问题。
15:08
We've got mouth cancer to solve.
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我们需要解决口腔癌。
15:10
We're still not curing enough patients -- it's the most disfiguring cancer.
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我们仍然没有治愈足够多的病人--这是最严重的癌症毁容。
15:13
We're still not reconstructing them well enough.
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我们的整容术还是不够好。
15:16
In the U.K. we have an epidemic
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在英国
15:18
of facial injuries among young people.
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面部创伤在年轻人中很普遍。
15:20
We still can't get rid of scars.
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我们还是不能消除疤痕。
15:22
We need to do research.
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我们需要研究。
15:24
And the best news of all
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最好的消息
15:26
is that surgeons know
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是医生们知道
15:28
that we need to do research.
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我们需要做研究。
15:30
And we've set up charities
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我们已经建立慈善组织
15:32
that will help us fund
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给予我们
15:34
the clinical research
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临床试验资金方面的帮助
15:36
to determine the best treatment practice now
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用来测定目前最好的理疗实践
15:38
and better treatment into the future,
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和将来更好的治疗方法，
15:40
so we don't just sit on our laurels and say, "Okay, we're doing okay.
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所以我们不能安于现状说，“我们做的还不错。
15:42
Let's leave it as it is."
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我们就这样算了吧。”
15:44
Thank you very much indeed.
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十分感谢。
15:46
(Applause)
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(掌声)
ABOUT THE SPEAKER
Iain Hutchison - Facial surgeonIain 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."
Iain Hutchison | Speaker | TED.com