The Neurocognitive Plasticity of Self-Processing following Facial Transplantation
Ruben T. Azevedo3, J. Rodrigo Diaz-Siso*1, Allyson Alfonso1, Elie P. Ramly1, Rami S. Kantar1, Zoe P. Berman1, Gustave Diep1, William Rifkin1, Eduardo D. Rodriguez1, Manos Tsakiris2
1Wyss Department of Plastic Surgery, New York University, New York, NY; 2Department of Psychology, Royal Holloway, University of London, London, United Kingdom; 3School of Psychology, University of Kent, Kent, United Kingdom
The face is a defining feature of our individuality, crucial for our social interactions. However, we have little understanding of what happens when the face connected to the self is radically altered or replaced. We address the plasticity of self-face recognition in the context of facial transplantation.
The patient sustained ballistic facial injury in June 2016, and underwent autologous reconstruction prior to facial transplantation in January 2018. The patient took part in five experimental sessions, two before and three after transplantation. We quantified self-recognition performance using behavioral and functional magnetic resonance neuroimaging measures, and contrasted the relative strength of the pre-injury, post-injury, and post facial transplantation self-face representations, with the ultimate aim of providing a comparison of these different self-representations before and after facial transplantation.
Neurobehavioral evidence documents a strong representation of the pre-injury appearance pre-operatively, while following the transplantation, the recipient incorporates the new face into his self-identity. The acquisition of this new facial identity is supported by neural activity in medial frontal regions that are considered to integrate psychological and perceptual aspects of the self.
Recognition of one's own face is a hallmark of self-awareness. Our face changes as we age, but these transformations do not necessarily alter our self-identity. What happens when the face is altered or replaced through transplantation has not been studied. We present the first longitudinal investigation of changes in self-face recognition throughout a patient's journey after a life-changing injury, and after facial transplantation. Neurobehavioral measures show how he preserves a strong mental and neural representation of his pre-injury appearance, and gradually incorporates the new post-transplant appearance into his self-identity. These changes and underlying neural processes highlight how the malleable representations of our face ensure the self's continuity over time.
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