What is it like to look in the mirror and see a face that is not the one you have always had?

That's the question developmental psychologist Carla Bluhm, PhD, of the College of Coastal Georgia, has been asking since beginning research on the psychological effects of face transplants in 2006. Several months before beginning her research, surgeons in France had performed the world's first partial face transplant on a 38-year-old woman who was disfigured by a dog attack, Bluhm says.

"Two years after her transplant, [this patient] was saying things like, ‘I'm not sure who I am,' and ‘Old photographs are highly disturbing because I can never be that person again,'" says Bluhm, co-author with Columbia University Teachers College doctoral student Nathan Clendenin of "Someone Else's Face in the Mirror: Identity and the New Science of Face Transplants" (Praeger, 2009).

In addition to the medical concerns faced by all transplant recipients, including a lifetime of immunosuppressant drugs and the possibility of organ rejection, face transplant recipients must also deal with the surgery's psychological effects on — and potential threat to — their identity, Bluhm says.

"With internal organ transplants, issues of ethnicity are moot — a liver is a liver," Bluhm says. "But a nose carries with it meaning; it acts as a signifier of family heritage and belonging. These issues are completely unique."

Bluhm notes that how well face transplant recipients are able to "find themselves" in the mirror after a face transplant may depend on how much they feel their identity is tied to appearance. With so many disfigurements occurring among soldiers in Iraq and Afghanistan, experimental face transplants may soon become more common for injured military personnel, Bluhm says. Face transplants for civilians also continue to increase. In March, for example, a Texas construction worker badly disfigured in a power line accident received the nation's first full face transplant at Brigham and Women's Hospital in Boston.

Psychologists have an important role to play both in evaluating potential transplant candidates and in working with them post-transplant to manage the psychological issues they may face.

"A face transplant will only be helpful for its recipient insofar as it offers the possibility of enriching the narrative of one's life through putting a new face to one's identity," Bluhm says. "Psychologists can help face transplant recipients do this."

—A. Novotney