EDITORIAL Facing Up Is an Act of Dignity: Lessons in Elegance Addressed to the Polemicists of the First Human Face Transplant Benoı ˆt Lengele ´, M.D. Sylvie Testelin, M.D. Sophie Cremades, M.D. Bernard Devauchelle, M.D. Brussels, Belgium; and Amiens, France “The spirit of excellence is to take care more than others think is wise, to risk more than others think is safe, to dream more than others think is real, and to expect more than others think is possible. Elegance is an art of living in the spirit of excellence, seeking to create more passion, grace, and beauty than others think is practical.” Concluding a conference entitled “Microsur- gery and Elegance” some years ago, we asked our- selves whether face transplants, under discussion at the time, constituted the ultimate accomplish- ment in surgical elegance or, on the contrary, a total lack of it. Even today, although we are best placed to answer this question, it is no easy task for us, in all humility, to provide a final conclusion to this issue. One thing, however, is certain: recon- structive surgery cannot exist without some com- ponent of elegance. Likewise, the scientific spirit from which it arises, the gestures it requires, the way in which it carries them through, the pertinent nature of its indications, and the ethics of its ac- complishment with regard to respect of the pa- tient, cannot escape this imperious requirement. Moreover, no exception to these rules of excel- lence should exist when, breaking down the bar- riers of what is allegedly possible, reconstructive surgery continues to explore new fields in an un- known universe with the same desire for elegance. Everyone here should be aware that it was this noble virtue that guided the medical teams who performed the first human face transplant in Amiens, France, on November 27, 2005. In relation to transplants, of whatever type, French law enforces respect for the anonymity not only of the donor–-obviously–-but also of the re- cipient. In a surgical first, it could be surmised that due observance of this regulation can be difficult with regard to the recipient when the media start to become involved. Very quickly indeed, and un- beknown to the medical teams, the name of the patient appeared in mainstream newspapers. This does not, however, mean that the scientific au- thors of surgical firsts depart from observation of the rules and do not respect the anonymity of patients in their scientific communications or pub- lications. This was, in our specific case, a formal duty of obligation that was never transgressed. Revealing the name of a donor and the med- ical circumstances before his or her brain death is a much more serious transgression, strictly forbid- den by law, that is liable to be pursued in court. Even though certain British tabloids, relayed in turn by other newspapers, infringed on this law by publishing such information, also unknown to the medical team at the time of operation, it does not entitle other members of the medical profession to relay this information in an editorial published by a scientific journal, 1 the latter one acting ipso facto illegally too. Therefore, let us first remind everyone concerned of our deontological duty of reserve and call on everyone to have the elegance to be able to respect anonymity. Why should the presumed fragility of patients condemn them to be deprived of the best thera- peutic management, when medical ethics rule that we should care for our fellow human beings in accordance with the rules of good practice, using the most up-to-date tools available to sci- ence? Would “merit” then become an issue in patients’ entitlement to benefit from treatment? An affirmative answer would lock us into the most damnable form of ostracism, diametrically op- posed to our obligations as health care providers. From the Experimental Morphology Unit and Plastic Surgery Department, Universite Catholique de Louvain, and De- partments of Maxillofacial Surgery and Psychiatry, North Hospital. Received for publication December 14, 2006. Copyright ©2007 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000271097.22789.79 www.PRSJournal.com 803