TEDGlobal 2010
Iain Hutchison: Saving faces: A facial surgeon's craft
Iain Hutchison 談拯救臉部
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臉部手術師Iain Hutchison的工作幫助對象是臉部極度變形的病患。他改進了臉部手術的技術，進而來改善這些病患的生活。他藉由使用他們的肖像來慶祝他們作為人類的存在。註：此演講包含極度變形及嚴重受傷的恐怖臉部圖像--為何極度變形的臉蛋可以讓我們如此恐懼？Hutchison提供了對此問題的發人深省的解釋。感覺想吐？在12:10-13:19中間停止觀看螢幕但繼續聽演講。
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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我們的臉部非常重要
00:18
because it's the external, visual part
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因為我們的臉部裸露在外
00:20
that everybody else sees.
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大家都會看到
00:22
Let's not forget it's a functional entity.
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但我們不要忘記，臉部也是有實際功用的。
00:24
We have strong skull bones
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我們有強壯的頭顱骨，
00:26
that protect the most important organ in our body: the brain.
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用來保護我們身上最重要的器官：腦。
00:29
It's where our senses are located, our special senses --
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這是我們感官的所在，我們特別的感官 ——
00:32
our vision, our speech,
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視覺、說話能力、
00:34
our hearing, our smell, our taste.
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聽覺、嗅覺、味覺。
00:36
And this bone
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這塊骨頭上
00:38
is peppered, as you can see, with the light shining through the skull
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分散着一些別的東西，你可以透過光看到，上面有
00:41
with cavities, the sinuses,
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一些孔洞，這是鼻竇
00:43
which warm and moisten the air we breathe.
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可以將我們吸入的空氣加溫加溼。
00:46
But also imagine if they were filled with solid bone --
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但想想看，如果這是塊實心的骨頭，
00:49
our head would be dead weight,
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我們的頭會非常重，
00:51
we wouldn't be able to hold it erect,
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重到我們無法將之豎直。
00:53
we wouldn't be able to look at the world around us.
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我們也就沒有辦法看我們周遭的世界。
01:02
This woman is slowly dying
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這位女性正在步入死亡，
01:04
because the benign tumors in her facial bones
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因為他她臉部骨頭上的良性腫瘤
01:07
have completely obliterated her mouth and her nose
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已經封住了她的口鼻，
01:10
so she can't breathe and eat.
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導致她無法呼吸和進食。
01:12
Attached to the facial bones
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臉骨上連著
01:14
that define our face's structure
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的肌肉構成了臉部的結構
01:18
are the muscles that deliver our facial expression,
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這些肌肉也讓我們可以有臉部表情，
01:21
our universal language of expression,
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一個人類中共通的語言
01:24
our social-signaling system.
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一個人與人交往的信號系統
01:26
And overlying this is the skin drape,
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在這外面是皮質層，
01:29
which is a hugely complex
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是一個很複雜、
01:31
three-dimensional structure --
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立體的結構：
01:33
taking right-angled bends here and there,
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在恰當的地方凹折
01:35
having thin areas like the eyelids,
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有像眼皮這樣很薄的部份、
01:38
thick areas like the cheek, different colors.
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也有像臉頰般厚、不同顏色的部份。
01:41
And then we have the sensual factor of the face.
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然後臉部還有負責感官的部份。
01:44
Where do we like to kiss people?
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我們最喜歡親吻的哪裡？
01:46
On the lips. Nibble the ears maybe.
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嘴唇，或是輕咬耳朵。
01:49
It's the face where we're attracted to with that.
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我們被臉部所吸引，想要親吻
01:52
But let's not forget the hair.
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但我們也別忘記了毛髮
01:54
You're looking at the image on your left-hand side --
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你們現在看看左邊的這張照片。
01:56
that's my son with his eyebrows present.
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那是我兒子有眉毛的樣子
01:58
Look how odd he looks with the eyebrows missing.
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看看他沒有眉毛時有多奇怪。
02:01
There's a definite difference.
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這裡有一個很明顯的差別。
02:03
And imagine if he had hair sprouting from the middle of his nose,
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想像一下他鼻子中間冒出毛髮
02:05
he'd look even odder still.
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他鐵定看起來會更怪。
02:07
Dysmorphophobia
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醜狀恐懼症
02:09
is an extreme version
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是一種極端的例子，
02:11
of the fact that we don't see ourselves
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是一種我們看到的自己
02:13
as others see us.
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與他人看到的我們很不相同的症狀。
02:15
It's a shocking truth
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很驚人的事實是
02:17
that we only see mirror images of ourselves,
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我們只能從鏡子中看到我們自己，
02:20
and we only see ourselves
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或是從
02:22
in freeze-frame photographic images
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不動的照片等圖像中看到自己，
02:24
that capture a mere fraction of the time that we live.
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但這些只是我們生命中的一小部份。
02:27
Dysmorphophobia
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醜狀恐懼症
02:29
is a perversion of this
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是這個現象的一種變態的症狀，
02:31
where people who may be very good looking
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表現是長得還不錯的人
02:33
regard themselves as hideously ugly
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認為自己極度醜陋
02:35
and are constantly seeking surgery
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且不斷地尋求整形手術
02:37
to correct their facial appearance.
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來改正他們的臉部外貌。
02:40
They don't need this. They need psychiatric help.
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他們不需要整形手術，他們需要的是心理幫助
02:43
Max has kindly donated his photograph to me.
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Max很好心的捐了這張照片給我。
02:45
He doesn't have dysmorphophobia, but I'm using his photograph
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他沒有醜狀恐懼症，但我用他的照片
02:48
to illustrate the fact that he looks exactly like a dysmorphophobic.
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來顯示他長得就跟一個醜狀恐懼症病患一樣。
02:50
In other words, he looks entirely normal.
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換句話說，他長得非常正常。
02:53
Age is another thing
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年齡是另一個
02:56
when our attitude toward our appearance changes.
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改變我們對自己的外表的態度的因素。
02:58
So children judge themselves, learn to judge themselves,
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孩童們經由周圍的大人們的行為來
03:01
by the behavior of adults around them.
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評斷、學著評斷他們自己。
03:04
Here's a classic example: Rebecca has a benign blood vessel tumor
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這是個經典的例子：Rebecca有一個良性的血管腫瘤
03:07
that's growing out through her skull, has obliterated her nose,
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從她的頭顱內長出來，已經埋沒了她的鼻子，
03:10
and she's having difficulty seeing.
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並且影響到了她的視力
03:12
As you can see, it's blocking her vision.
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你們可以看到，腫瘤已經擋到她的視線了。
03:14
She's also in danger, when she damages this,
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如果她弄傷這個腫瘤，她也有
03:16
of bleeding profusely.
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大量失血的危險。
03:18
Our research has shown
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我們的研究顯示
03:20
that the parents and close loved ones of these children
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這樣孩子的父母親及關愛他們的人
03:23
adore them.
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非常喜歡他們。
03:25
They've grown used to their face; they think they're special.
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他們已經習慣了他們的臉蛋，他們覺得這很特別。
03:28
Actually, sometimes the parents argue
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事實上，有時候他們的父母親
03:30
about whether these children should have the lesion removed.
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會為了是否要將這些缺陷移除而起爭執。
03:33
And occasionally they suffer intense grief reactions
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偶而他們會感到強烈的悲傷
03:35
because the child they've grown to love
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因為他們已經漸漸愛上的孩子
03:37
has changed so dramatically and they don't recognize them.
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有了非常大的轉變，使他們無法認出孩子。
03:40
But other adults
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但有些其他成年人
03:42
say incredibly painful things.
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會說一些非常傷人的話。
03:44
They say, "How dare you take this child out of the house
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他們說：「你怎麼可以帶這樣的孩子出去
03:46
and terrify other people.
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會嚇到其他人！
03:48
Shouldn't you be doing something about this? Why haven't you had it removed?"
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你不是應該做些甚麼嗎？你不是該把那個東西拿掉嗎？」
03:51
And other children in curiosity come up and poke the lesion,
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然後其他小孩好奇地圍過來戳病變的地方，
03:54
because -- a natural curiosity.
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純粹是因為好奇。
03:56
And that obviously alerts the child
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這樣很顯然地會讓這孩子
03:58
to their unusual nature.
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警覺他自己與別人不同的特質。
04:00
After surgery, everything normalizes.
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手術過後，一切都回歸正常。
04:03
The adults behave more naturally,
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成年人表現得更正常，
04:05
and the children play more readily with other children.
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孩子更容易和其他孩子玩耍。
04:08
As teenagers --
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在青少年時期，
04:11
just think back to your teenage years --
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就想想你們的青少年時期，
04:13
we're going through a dramatic
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那時我們都會經歷一些巨大的變化，
04:15
and often disproportionate change
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尤其是我們的臉部
04:17
in our facial appearance.
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會有一些相比而言更加顯著的變化
04:19
We're trying to struggle to find our identity.
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那時的我們為了找到自己的定位而努力
04:21
We crave the approval of our peers.
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我們渴望得到同齡人的肯定。
04:23
So our facial appearance is vital to us
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當我們試圖向世界展示自己的時候
04:26
as we're trying to project ourselves to the world.
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我們的臉部的樣子對我們就至關重要
04:28
Just remember that single acne spot
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想想那個臉上冒出來的一個青春痘
04:30
that crippled you for several days.
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就讓你不開心了好幾天。
04:34
How long did you spend looking in the mirror every day,
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你一天花多少時間站在鏡子前面
04:37
practicing your sardonic look, practicing your serious look,
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練習你的嘲諷表情，練習你的嚴肅表情
04:40
trying to look like Sean Connery, as I did,
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或像我一樣試著看起來像sean connery（蘇格蘭演員）那樣
04:42
trying to raise one eyebrow?
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只揚起一邊的眉毛。
04:44
It's a crippling time.
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那是一段令人不正常的時間
04:46
I've chosen to show this profile view of Sue
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我選了這張Sue的側面照
04:50
because what it shows is her lower jaw jutting forward
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因為可以看出她的下巴突出
04:53
and her lower lip jutting forward.
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且她的下唇也往前突出。
04:55
I'd like you all in the audience now to push your lower jaw forward.
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請在座各位把你們的下巴往前推，
04:58
Turn to the person next to you,
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然後看看你旁邊的人，
05:00
push your lower jaws forward. Turn to the person next to you
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把下巴凸出，轉向你旁邊的人，
05:02
and look at them -- they look miserable.
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看看他們--他們看起來很慘兮兮的
05:04
That's exactly what people used to say to Sue.
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那就是人們一直跟Sue說的。
05:07
She wasn't miserable at all.
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但她一點都不感到悲慘
05:09
But people used to say to her, "Why are you so miserable?"
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但人們一直跟她說：「為什麼你那麼慘兮兮的？」
05:13
People were making misjudgments all the time
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人們總是誤解她的
05:16
on her mood.
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心情。
05:18
Teachers and peers were underestimating her; she was teased at school.
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老師和同儕總是低估她，她在學校被人嘲笑。
05:21
So she chose to have facial surgery.
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所以她選擇了臉部整形。
05:23
After the facial surgery,
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整形過後，
05:25
she said, "My face now reflects my personality.
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她說：「我的臉蛋現在可以反映出我的個性了。
05:28
People know now that I'm enthusiastic,
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人們知道我很熱心，
05:31
that I'm a happy person."
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我是個快樂的人。」
05:33
And that's the change that can be achieved for teenagers.
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而且這是個在青少年身上可以做到的改變。
05:37
Is this change, though, a real change,
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這樣的改變是一個真的改變嗎？
05:39
or is it a figment of the imagination
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還是只是病患自己
05:42
of the patient themselves?
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腦海中的想像？
05:44
Well we studied teenagers' attitudes
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我們研究了青少年
05:46
to photographs of patients having this corrective facial surgery.
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對有過這樣的改正性臉部手術照片的態度。
05:48
And what we found was --
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下面就是我們的研究結果
05:51
we jumbled up the photographs
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我們把照片弄亂
05:53
so they couldn't recognize the before and after --
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讓他們認不出哪些是術前照片哪些是術後照片。
05:55
what we found was that the patients were regarded
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我們發現，術後的病患
05:57
as being more attractive after the surgery.
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看起來更具吸引力。
05:59
Well that's not surprising, but we also asked them to judge them
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當然這不令人驚訝，但我們也要被試青少年們判斷這些照片人物的
06:02
on honesty, intelligence,
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誠實度、智商、
06:04
friendliness, violence.
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友善度、暴力程度。
06:07
They were all perceived as being
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在術前他們給人的感覺是
06:09
less than normal in all those characteristics --
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在這些特質上不正常的
06:11
more violent, etc. -- before the surgery.
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手術前的形象被認為更暴力
06:14
After the surgery,
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術後
06:16
they were perceived as being more intelligent,
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他們給人的感覺是更聰明、
06:18
more friendly, more honest, less violent --
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更友善、更誠實、較不暴力。
06:21
and yet we hadn't operated on their intellect
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但我們並沒有改變他們的
06:23
or their character.
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智商或者個性
06:25
When people get older,
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隨著年紀增長，
06:27
they don't necessarily choose to follow this kind of surgery.
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他們不一定會選擇這樣的手術。
06:30
Their presence in the consultation suite
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他們在諮商室的原因是
06:32
is a result of the slings and arrows of outrageous fortune.
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一連串厄運的結果。
06:35
What happens to them
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他們是經歷了癌症
06:37
is that they may have suffered cancer or trauma.
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或創傷的病患。
06:39
So this is a photograph of Henry,
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這是一張亨利的照片。
06:41
two weeks after he had a malignant cancer removed
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這是他移除左臉上的惡性腫瘤後
06:44
from the left side of his face -- his cheekbone,
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兩個禮拜的照片，包括左臉臉頰、
06:47
his upper jaw, his eye-socket.
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上顎、眼圈。
06:49
He looks pretty good at this stage.
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他在這個階段看起來很不錯。
06:51
But over the course of the next 15 years he had 14 more operations,
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但在接下來的十五年內他又接受了十四次整形手術，
06:54
as the disease ravaged his face
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因為疾病摧殘著他的臉
06:56
and destroyed my reconstruction regularly.
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且定期地破壞我的整形結果。
06:58
I learned a huge amount from Henry.
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我從亨利身上學到很多。
07:00
Henry taught me
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亨利讓我瞭解
07:02
that you can carry on working.
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一個這樣的病患可以繼續工作。
07:04
He worked as an advocate. He continued to play cricket.
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他的工作是辯護者。他繼續打板球。
07:07
He enjoyed life to the full,
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他很享受著他的生活。
07:09
and this was probably because he had a successful, fulfilling job
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且這很有可能是因為他有一個成功的、有滿足感的工作
07:11
and a caring family
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和一個關懷他的家人
07:13
and was able to participate socially.
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並且他仍然可以進行正常的社交活動。
07:15
He maintained a calm insouciance.
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他一種冷靜而漫不經心的生活態度
07:18
I don't say he overcame this; he didn't overcome it.
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我不是說他克服了自己的問題，他並沒有。
07:21
This was something more than that. He ignored it.
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他做到了比克服更難的：他忽視了它。
07:24
He ignored the disfigurement that was happening in his life
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他忽視他生命中這些扭曲的部份
07:27
and carried on oblivious to it.
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然後繼續過他的生活，無視這些扭曲。
07:30
And that's what these people can do.
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這就是這些人可以做的。
07:32
Henriapi illustrates this phenomenon as well.
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Henriapi也同樣做到了這點。
07:34
This is a man in his 20s
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這是一個二十多歲的男人。
07:36
whose first visit out of Nigeria was with this malignant cancer
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他第一次離開尼日利亞就是為了來英國
07:39
that he came to the United Kingdom to have operated on.
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來移除臉上的這個惡性腫瘤。
07:41
It was my longest operation.
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這是我做過最長的手術。
07:43
It took 23 hours. I did it with my neurosurgeon.
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手術花了23小時。我和一個神經外科醫生一起完成的。
07:46
We removed all the bones at the right side of his face --
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我們把他右半邊的臉的骨頭全部拿出來，
07:48
his eye, his nose,
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包括他的眼睛、他的鼻子、
07:50
the skull bones, the facial skin --
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他的頭顱骨、他的臉部皮膚，
07:52
and reconstructed him with tissue from the back.
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然後利用他背部的組織來復建。
07:55
He continued to work as a psychiatric nurse.
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他繼續當一個心理護士。
07:57
He got married. He had a son called Jeremiah.
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他後來結婚且生了一個名為Jeremiah的兒子。
08:00
And again, he said,
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再次的他說：「
08:02
"This painting of me with my son Jeremiah
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這幅我和我兒子Jeremiah的圖畫
08:05
shows me as the successful man that I feel that I am."
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顯示出了我是一個成功男人，就像我自己認為的這樣。」
08:08
His facial disfigurement
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他臉部的變形
08:10
did not affect him
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並沒有影響他，
08:12
because he had the support of a family;
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因為他有家人的支持
08:14
he had a successful, fulfilling job.
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和成功、有滿足感的工作。
08:16
So we've seen that we can change people's faces.
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所以我們已經看到我們可以改變人們的臉部。
08:19
But when we change people's faces,
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但當我們改變人們的臉的時候，
08:21
are we changing their identity --
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我們有改變他們的對自己定位嗎？
08:23
for better or for worse?
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不管是變好還是變壞。
08:26
For instance,
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舉例來說，
08:28
there are two different types of facial surgery.
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主要有兩種臉部手術。
08:30
We can categorize it like that.
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我們可以將它分類。
08:32
We can say there are patients who choose to have facial surgery --
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我們可以說有些病患選擇要做臉部手術--
08:34
like Sue.
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像是Sue。
08:36
When they have facial surgery,
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當他們做了臉部手術後
08:38
they feel their lives have changed
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他們感覺他們的人生改變了。
08:40
because other people perceive them
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因為其他人對他們的看法變了
08:43
as better people.
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認為他們是更好的人
08:45
They don't feel different.
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他們不會感覺不同。
08:47
They feel that they've actually gained
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他們感覺他們真的得到了
08:49
what they never had,
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他們之前沒有的東西，
08:51
that their face now reflects their personality.
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那就是他們的臉終於可以反映出他們的個性。
08:53
And actually that's probably the difference between cosmetic surgery
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事實上這就是是美容手術和這樣的手術
08:56
and this kind of surgery.
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的區別
08:58
Because you might say, "Well, this type of surgery
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因為你可能會說：「嗯，這樣的手術
09:01
might be regarded as cosmetic."
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可以被看成是美容整形手術。」
09:03
If you do cosmetic surgery, patients are often less happy.
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如果你做整形手術，病患一般來說比較不開心。
09:06
They're trying to achieve difference in their lives.
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他們想要改變人生。
09:12
Sue wasn't trying to achieve difference in her life.
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Sue不是要改變人生，
09:14
She was just trying to achieve the face
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她只是想要她的臉
09:16
that matched her personality.
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和她的個性相符。
09:18
But then we have other people
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但也有一些其他人
09:20
who don't choose to have facial surgery.
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不會選擇臉部手術。
09:22
They're people who have their face shot off.
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他們是那些臉被槍打毀的人
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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讓我為在座那些較膽小的人把這圖片拿掉，換成一張空白的投影片
09:27
They have it forced upon them.
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他們的臉部是被強加在他們身上的。
09:29
And again, as I told you,
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再次的，讓我提醒你們，
09:31
if they have a caring family
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如果他們有個關懷他們的家庭
09:33
and good work life,
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和好工作，
09:36
then they can lead normal and fulfilled lives.
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那們他們可以有一個正常且滿足的生活。
09:39
Their identity doesn't change.
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他們的身分並沒有被感變。
09:41
Is this business
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這樣在乎外表
09:43
about appearance and preoccupation with it
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的情況
09:45
a Western phenomenon?
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只存在於西方文化嗎？
09:47
Muzetta's family give the lie to this.
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Muzetta的家庭告訴我們不是的。
09:50
This is a little Bangladeshi girl from the east end of London
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這是倫敦東部的一個孟加拉女孩，
09:53
who's got a huge malignant tumor on the right side of her face,
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她右臉上有一個很大的惡性腫瘤。
09:56
which has already made her blind
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這已經讓她變瞎了
09:58
and which is rapidly growing and is going to kill her shortly.
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並且如果這個腫瘤繼續成長的話，很快就會取了她的生命。
10:00
After she had surgery to remove the tumor,
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腫瘤移除手術後，
10:03
her parents dressed her in this beautiful green velvet dress,
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她父母親為她穿上漂亮的綠絲絨洋裝
10:06
a pink ribbon in her hair,
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在她頭髮上系上一個粉紅色的絲帶
10:08
and they wanted the painting to be shown around the world,
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他們希望這幅畫可以在全世界展示，
10:10
despite the fact that they were orthodox Muslims
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雖然他們是保守伊斯蘭教徒
10:13
and the mother wore a full burqa.
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且他母親是穿全身的罩袍的。
10:15
So it's not simply a Western phenomenon.
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所以這不是只是西方的問題。
10:20
We make judgments on people's faces
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我們幾乎隨時都在
10:22
all the time.
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對別人的臉作出評判
10:24
It's been going on since we can think of Lombroso
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這可以追朔到朗柏朔的犯罪學說時代，
10:27
and the way he would define criminal faces.
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包括他如何定義“罪犯臉“
10:29
He said you could see criminal faces,
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他說你可以可以看出哪些是”罪犯臉“
10:31
judging them just on the photographs that were showed.
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僅從照片就可以
10:34
Good-looking people
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長得好看的人
10:36
are always judged as being more friendly.
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會被認為是比較有親和力的。
10:38
We look at O.J. --
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看看O.J.
10:40
he's a good-looking guy.
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他是個長得還不錯的人。
10:42
We'd like to spend time with him. He looks friendly.
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我們會想要跟他在一起。他看起來很好相處。
10:45
Now we know that he's a convicted wife-batterer,
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但現在我們知道他是個家庭暴力者，
10:48
and actually he's not the good guy.
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並且事實上他不是個好人。
10:50
And beauty doesn't equate to goodness,
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而且美貌跟好心是不能劃上等號的，
10:54
and certainly doesn't equate to contentment.
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而且也絕對不能跟滿足感劃上等號。
10:57
So we've talked about the static face
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所以我們已經談了靜態的臉，
10:59
and judging the static face,
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也評斷靜態的臉。
11:01
but actually, we're more comfortable
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但事實上，我們更會評斷
11:03
with judging the moving face.
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動態的臉。
11:05
We think we can judge people on their expressions.
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我們認為我們可以透過人們的表情評斷他們。
11:08
U.K. jurors in the U.K. justice system
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英國法律體制下的陪審團
11:11
like to see a live witness
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喜歡在在現場觀察證人
11:13
to see whether they can pick up the telltale signs of mendacity --
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看是否能看出一些謊言的蛛絲馬跡：
11:16
the blink, the hesitation.
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眨眼、猶豫。
11:19
And so they want to see live witnesses.
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所以他們喜歡到現場的證人
11:22
Todorov tells us that, in a tenth of a second,
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Todorov 告訴我們，在十分之一秒中，
11:25
we can make a judgment on somebody's face.
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我們可以對一個人的臉做出一個評判
11:28
Are we uncomfortable with this image? Yes, we are.
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我們會覺得這張圖片讓人不舒服嗎？是的。
11:31
Would we be happy if our doctor's face, our lawyer's face,
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如果我們的醫生、我們的律師、
11:34
our financial adviser's face was covered?
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我們的理財顧問把臉遮起來，我們會開心嗎？
11:36
We'd be pretty uncomfortable.
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我們會很不舒服。
11:38
But are we good at making the judgments
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但我們真的能夠由臉部外貌和動作
11:40
on facial appearance and movement?
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做出正確的評斷嗎？
11:43
The truth is that there's a five-minute rule,
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事實上有個五分鐘規則，
11:45
not the tenth-of-a-second rule like Todorov, but a five-minute rule.
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不是像Todorov說的十分之一秒，而是五分鐘。
11:48
If you spend five minutes with somebody,
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如果你跟一個人在一起超過五分鐘，
11:50
you start looking beyond their facial appearance,
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你就會開始注意臉部外貌以外的情況
11:52
and the people who you're initially attracted to
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一些一開始吸引你的人
11:54
may seem boring and you lose interest in them,
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可能會讓你覺得無聊然後你對他們就沒有興趣了
11:56
and the people who you didn't immediately seek out,
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然後那些你因為他們沒有長得特別好看
11:58
because you didn't find them particularly attractive,
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而馬上註意到的人
12:00
become attractive people
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可能會用他們的個性
12:02
because of their personality.
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吸引上你
12:05
So we've talked a lot about facial appearance.
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所以我們已經談了很多關於臉部外貌的東西。
12:08
I now want to share
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我現在想要分享一些
12:10
a little bit of the surgery that we do --
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關於我們做的手術：
12:12
where we're at and where we're going.
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現狀和未來的走向
12:14
This is an image of Ann
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這是一張Ann的圖片。
12:16
who's had her right jaw removed and the base of her skull removed.
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她的右顎和頭顱骨基底被移除了。
12:18
And you can see in the images afterward,
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在後面的圖像中
12:20
we've managed to reconstruct her successfully.
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你可以看到我們成功地重建了她的臉
12:22
But that's not good enough.
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但那還不夠好。
12:24
This is what Ann wants. She wants to be out kayaking,
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那不是Ann要的。她想要能夠出去划船，
12:26
she wants to be out climbing mountains.
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她要能夠出去爬山。
12:28
And that's what she achieved, and that's what we have to get to.
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且那是她做到的，也是我們必須讓她能夠做到的。
12:30
This is a horrific image,
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這是個恐怖的圖像，
12:32
so I'm putting my hand up now.
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所以我也把我的手舉起來了。
12:34
This is a photograph of Adi,
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這是一張Adi的照片。
12:36
a Nigerian bank manager who had his face shot off
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他是一個尼日利亞的銀行主管
12:38
in an armed robbery.
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他的臉在一個武裝搶劫中被打毀
12:40
And he lost his lower jaw, his lip, his chin
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他失去了下顎、嘴唇、下巴、
12:42
and his upper jaw and teeth.
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上顎和牙齒
12:44
This is the bar that he set for us.
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這是他給我們的標準。
12:46
"I want to look like this. This is how I looked before."
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「我想要看起來像這樣。這是我之前的長相。」
12:49
So with modern technology,
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以現在的科技，
12:51
we used computers to make models.
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我們利用電腦來作模型。
12:54
We made a model of the jaw without bone in it.
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我們做了一個沒有骨頭的顎模型。
12:56
We then bent a plate up to it.
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然後我們做了一個金屬板。
12:58
We put it in place
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我們把它放在該在的位置，
13:00
so we knew it was an accurate position.
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讓我們知道正確的位置。
13:02
We then put bone and tissue from the back.
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然後我們從背部提取骨頭和組織。
13:05
Here you can see the plate holding it,
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這裡我們可以看到金屬板固定，
13:07
and you can see the implants being put in --
320
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你也可以看到移植組織置入--
13:10
so that in one operation
321
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所以一個手術後
13:12
we achieve this
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我們做到
13:15
and this.
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這樣。
13:17
So the patient's life is restored.
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這樣病患的生活就重歸正軌了
13:19
That's the good news.
325
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那是好消息。
13:21
However, his chin skin
326
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但是他的下巴皮膚
13:23
doesn't look the same as it did before.
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跟以前看起來不大一樣。
13:25
It's skin from his back.
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因為是背部的皮膚。
13:27
It's thicker, it's darker, it's coarser, it doesn't have the contours.
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是更厚、更深、跟粗糙且沒有輪廓。
13:30
And that's where we're failing,
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這就是我們做不到的。
13:32
and that's where we need the face transplant.
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也是為什麼我們需要臉部移殖。
13:34
The face transplant has a role
332
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臉部移殖在
13:36
probably in burns patients to replace the skin.
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被火燒傷的病患的植皮過程中有很重要的角色。
13:39
We can replace the underlying skeletal structure,
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我們可以重建底層的骨骼結構，
13:41
but we're still not good at replacing the facial skin.
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但我們仍然不大會重建臉部皮膚。
13:44
So it's very valuable
336
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所以如果可以在我們的醫療設備中
13:46
to have that tool in our armamentarium.
337
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有這樣一個工具，那會是很有價值的
13:48
But the patients are going to have to take drugs
338
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但這些病患會接下來的一輩子都需要吃一些藥
13:50
that suppress their immune system for the rest of their lives.
339
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來壓制他們的免疫系統。
13:52
What does that mean?
340
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這是什麼意思？
13:54
They have an increased risk of infection, an increased risk of malignancy.
341
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他們有更高的風險會被感染、也更有可能會有惡性腫瘤。
13:57
This is not a life-saving transplant --
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這不是保住生命的移殖，
13:59
like a heart, or liver, or lung transplant --
343
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不是像移殖心臟或是肝臟或是肺臟，
14:02
it is a quality-of-life transplant,
344
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而是一個改善生命質量的移殖。
14:05
and as a result,
345
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最後，
14:07
are the patients going to say, if they get a malignant cancer 10 or 15 years on,
346
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如果病患在十或十五年後得了惡性腫瘤，他會不會說：
14:10
"I wish I'd had conventional reconstructive techniques rather than this
347
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「我希望我做了常規的重建手術而不是這個手術，
14:13
because I'm now dying of a malignant cancer"? We don't know yet.
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因為我現在垂死於惡性腫瘤？」我們還不知道。
14:16
We also don't know what they feel
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我們也不知道他們對於
14:19
about recognition and identity.
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識別和身分的感受。
14:21
Bernard Devauchelle and Sylvie Testelin, who did the first operation,
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Bernard Devauchelle和Sylvie Testelin，第一次做了這樣的手術
14:24
are studying that.
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他們正在研究這個
14:26
Donors are going to be short on the ground,
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捐贈者也非常少，
14:29
because how many people want to have their loved one's face
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因為有多少人願意他們深愛的人
14:32
removed at the point of death?
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在死亡的時候將臉部移去。
14:35
So there are going to be problems
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所以在臉部移殖上
14:37
with face transplantation.
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會有一些問題的。
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 --
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未來已經快到了——
14:43
and the future is tissue engineering.
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這個未來就是生物組織建造
14:45
Just imagine,
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想想看，
14:47
I can make a biologically-degradable template.
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我可以做一個可以生物化降解的模板。
14:50
I can put it in place where it's meant to be.
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我可以將這個模板放在該放的地方。
14:52
I can sprinkle a few cells,
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我可以撒上一些細胞，
14:54
stem cells from the patient's own hip,
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一些從病患自己胯上取得的幹細胞，
14:56
a little bit of genetically engineered protein,
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加上一些基因工程製造出的蛋白質，
14:58
and lo and behold, leave it for four months and the face is grown.
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然後靜候四個月，臉部就可以長出來。
15:02
This is a bit like a Julia Child recipe.
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這有點像是童話故事中的食譜。
15:06
But we've still got problems.
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但我們仍然有一些問題。
15:08
We've got mouth cancer to solve.
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我們仍然有口腔癌要解決。
15:10
We're still not curing enough patients -- it's the most disfiguring cancer.
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我們仍然沒有辦法救足夠病患--但它是最容易毀容的癌症。
15:13
We're still not reconstructing them well enough.
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我們仍然沒有辦法足夠好的重建這部分
15:16
In the U.K. we have an epidemic
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在英國，年輕的族群臉部受傷
15:18
of facial injuries among young people.
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有擴大的趨勢。
15:20
We still can't get rid of scars.
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我們仍然沒有辦法不留下疤痕。
15:22
We need to do research.
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我們仍然需要作研究。
15:24
And the best news of all
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但最好的消息是
15:26
is that surgeons know
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外科醫生們知道
15:28
that we need to do research.
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我們需要進一步研究。
15:30
And we've set up charities
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所以我們已經建立起慈善基金
15:32
that will help us fund
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幫助我們
15:34
the clinical research
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作臨床研究
15:36
to determine the best treatment practice now
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來決定目前最好的手術方式
15:38
and better treatment into the future,
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以及未來更好的處理方法。
15:40
so we don't just sit on our laurels and say, "Okay, we're doing okay.
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所以我們不是坐在那說：「好，我們已經做地夠好了。
15:42
Let's leave it as it is."
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就這樣吧。」
15:44
Thank you very much indeed.
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非常謝謝你們。
15:46
(Applause)
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（掌聲）
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