• 9/11/2006
  • Philadelphia, PA
  • Susan Boni
  • Philadelphia Inquirer (www.philly.com)

Before-and-after portraits show the saving grace of surgery.

A native of a small town in northern England, she longed to look normal and would do anything she could to distract people from her face.

“I’d dye my hair all different colors,” she said. “I’d go over the top with eye makeup to take the view away from my lower face.” She has only a few pictures of herself before the age of 29.

Today, 11 years later, Morgan-Elphick’s face is a case study of what surgery can do. Her new smile has been enshrined in a six-foot oil painting in the “Saving Faces” exhibit that originated at London’s National Portrait Gallery. Twenty-six paintings from the original exhibit went on display Friday at the Esther M. Klein Art Gallery, 3600 Market St. The show is in collaboration with the College of Physicians of Philadelphia, which is mounting a smaller version of the exhibit.

“Saving Faces” was conceived by Iain Hutchison, an Oral and Maxillofacial surgeon at St. Bartholomew’s and the Royal London Hospital.

Hutchison, 58, who operated on Morgan-Elphick in 1995, believes that the public needs to know what is possible with modern facial surgery – and what isn’t. The exhibit follows some of his patients as they are treated for severe deformities from facial injuries, cancer and congenital impairments.

His collaborator, portrait painter Mark Gilbert, 37, has been a regular exhibitor at the National Portrait Gallery since 1993.

At Hutchison’s urging, Gilbert immersed himself in hospital life to chronicle 35 patients in various stages of facial repair.

The portraits are arguably more personal than photography. They interpret the patients’ faces in warm and vibrant colors, capturing the struggles and successes.

The subjects include a 21/2-year-old girl who had a tumor the size of a baseball removed from her cheek. Another patient, a lawyer, had endured 15 operations in 13 years, losing an eye and all the bones on the left side of his face and head.

Gilbert was amazed that patients, who normally would decline to look in the mirror, would sit for portraits and like the results. Many felt the painting process helped them heal emotionally, he said.

Several revolutions have occurred in modern facial surgery in the last 20 years, said Hutchison, founder of England’s Facial Surgery Research Foundation.

Surgeons can now take a tiny artery or vein from elsewhere in the body and place it in the neck. The block of tissue or flap attached to the blood vessel can then be harvested, carved into the right shape, and used to replace the lost tissue in the head and neck.

This means that surgeons are no longer limited in what they can transplant by the distance between the face and other parts of the body, Hutchison said.

Another advance has been the use of titanium metal plates, much lighter than stainless steel, to hold together bones that have been fractured or moved around in a new way.

Surgeons can now lengthen bones by stimulating new growth through a technique discovered by Russian innovator G.A. Ilizarov. A bone is cut and a screw is inserted on each side of the cuts. The patient turns the screw each day, opening the bone by a fraction of a millimeter. New bone then forms across the opening, eliminating the need for bone grafts from another part of the body.

Surgeons have also found new ways of gaining access to the face without leaving visible scars. For Morgan-Elphick, Hutchison did the whole operation from inside her mouth. After working with an orthodontist for 14 months before surgery, he fractured her cheekbone, pushed it out, and inserted a rib, fixing it in place with a titanium metal plate. She has no external scars.

Besides showing what modern facial surgery can do, “Saving Faces” shows its limitations. Not all patients are free of scars or have perfect faces.

“The general public sometimes thinks that we surgeons are supermen and women who can achieve the impossible,” Hutchison said.

Still, he hopes the exhibit will help show that “people with disfigurement can lead normal, active, full lives.”