The Scar Free Foundation and Health and Care Research Wales launch world-leading 3-year programme of facial reconstruction research

Above Professor Iain Whitaker, Tom Jovic and Cynthia Decourcey in the lab

A world-leading £2.5 million plus research programme that aims to revolutionise surgeons’ ability to reconstruct nose and ear cartilage in patients affected by facial difference has been launched today, 21^st July, by The Scar Free Foundation, the only medical research charity which focuses solely on scarring, and Health and Care Research Wales. 

The three-year programme at Swansea University will have a global impact – advancing 3D bioprinting of cartilage for facial reconstruction and examining how facial scarring affects mental health by analysing data from the world’s largest cohort of people living with this visible difference.

One in 100 people in the UK have a significant facial difference, and this can have a profound effect on the mental health of patients. The Scar Free Foundation/ Health and Care Research Wales Programme of Facial Reconstruction and Regeneration Research at Swansea University will advance the development of 3D bioprinted facial cartilage (ears and noses), using human cells and plant based materials for future treatment of people in the UK and across the world who are either born without body parts or live with facial scarring as a result of burns, trauma or cancer. 

It will be combined with the world’s largest study of people living with facial scars to assess the psychosocial impacts on patients - in terms of experiences of anxiety or depression - so that effective healthcare strategies can be developed and appropriately targeted.

Patients living with loss of ear/nose have told researchers that existing plastic prostheses don’t feel ‘part of them’ and would prefer that their own tissue is used for reconstruction.  The research programme will address this problem by creating a custom ‘cartilage’ scaffold which the patient’s own stem cells then grow onto, for facial reconstruction, to avoid the need to take cartilage from elsewhere in the body (which would lead to further scarring and can cause other complications). 

Cartilage is the main type of connective tissue seen throughout the body. It serves a variety of structural and functional purposes and exists in different types throughout our joints, bones, spine, lungs, ears and nose. 

The research will be led by Professor Iain Whitaker - the only professor of plastic surgery in Wales - Chair of Plastic Surgery at Swansea University Medical School and Surgical Specialty Lead for Health and Care Research Wales.

The pioneering programme will take the world class 3D BIO-FACE research to the next stage – developing 3D bioprinted facial cartilage using human cartilage specific stem/progenitor cells and nanocellulose (derived from plants) as a ‘bioink’ for facial reconstruction.

This new programme builds on an initial study (supported by the Royal College of Surgeons) based on the Medical Research Council-funded PhD work of Ms Zita Jessop, now a Senior Lecturer in the team, and other previous post doctoral researchers. Subsequent PhD work was carried out by Mr Tom Jovic, funded by Action Medical Research and Microtia UK.

The project will include scientific studies to determine the ideal combination of cells to grow new cartilage, optimise nanocellulose bioinks for 3D bioprinting patient-specific cartilage constructs and show that they are safe, non-toxic and well tolerated by the immune system.  This will lead to human clinical trials for facial reconstruction.

Professor Iain Whitaker (see right) said: “I am grateful for this significant investment and support from The Scar Free Foundation and Health and Care Research Wales which will accelerate our ongoing research efforts to offer pioneering treatment options to patients and recruit further world class researchers into Wales. 

"The ability to successfully 3D print living tissue has been highlighted by the Royal College of Surgeons as one of the futures of surgery and the UK Government selected regenerative medicine as one of the ‘Eight great technologies’ to propel the UK to future growth.

"Successful translation of this research programme will transform the future of surgery, removing the need to transfer tissue from one part of the body to another and avoid the associated pain and scarring. Although we are currently focused on cartilage, the scientific concepts and platform technologies our work is based on can be applied to tissue types such as blood vessel, nerve, bone, skin and fat which will enhance the impact significantly.”

Professor Ann John, Professor in Public Health and Psychiatry at the Swansea University Medical School said: “We live in a society that seems increasingly pre-occupied by appearance so there is a real need to understand the mental health consequences of facial scarring and their underlying causes. This ranges from societal responses, body image, gender, pre-existing mental health problems to what caused the scar.

"We know there is a risk of anxiety and depression in those with facial scarring but much of the evidence is based on short term studies. It’s vital we look at what might explain who, when and why people might be more strongly affected so we can do something about it early and develop new ways of managing and preventing these mental health issues. While not as visible as the facial scar these mental health problems can have long term far reaching impacts on people’s lives and relationships.

"It is great to see this pioneering programme of research address these issues in tandem with surgical innovation.”

Brendan Eley, Chief Executive of the Scar Free Foundation, said: “Giving surgeons the ability in the future to reconstruct people’s faces using their own cells without the need for further scarring is revolutionary. 

"We’re delighted to work with Health and Care Research Wales to launch such a ground-breaking programme at Swansea University.  We know that scarring can have a long term emotional and physical impact on people and this study will also help us understand how facial scarring in particular affects mental health, leading to new treatments. 

"This life changing research is part of our commitment to achieve scar free healing within a generation for the millions of people living with scarring in the UK and across the world.”

Michael Bowdery, Head of Programmes at Health and Care Research Wales, said: “This pioneering programme has the potential to change the lives of people around the world. We’re pleased to be working in partnership with The Scar Free Foundation to fund world-leading research, which under the leadership of Professor Whitaker could make such a difference.”

The Scar Free Foundation and Health & Care Research Wales research team outside Swansea University Institute of Life Sciences. (Left to right, Octavian Parkes, Professor Iain Whitaker, Tom Jovic, Em Combellack, Cynthia Decourcey.)

The world-leading, pioneering programme is funded in partnership by The Scar Free Foundation and Health and Care Research Wales.  The programme also includes a Health and Care Research Wales funded project that will establish a comprehensive national overview of the nature and state of treatments and services currently provided to skin cancer patients across Wales, where group members Mr Tom Dobbs and Mr John Gibson will be working alongside Professor Whitaker to make recommendations for service redesign based on patient need.