Rebuilding people's faces and lives

Kay Brennan meets Mr Iain Hutchison, oro-maxillofacial surgeon

  In 1973, Mr Iain Hutchison qualified as a dentist. He became disillusioned by a lack of stimulation and desired more variety and excitement in his job. He also had the understandable fear of being synonymous with pain, and an interest in becoming a face saving surgeon. He is currently one of the country's leading consultants in oro-maxillofacial surgery at Barts and the London Hospital. I arranged to meet him to delve deeper into his history.

My appointment with Mr Hutchison is at 4 pm in his office on the third floor of the hospital. This is not the image of Calvin Klein lab coat and coffee table I had imagined for an eminent surgeon, but a cramped chaos complete with "bang head here" sign on the door. Just after 5 pm a chunk of a man with hectic hair and ruffled suit gusts in - I later find out his square stature is the result of playing water polo for England in his earlier years.

Mr Hutchinson was seduced by treating patients with facial lacerations
(BRUCE AYRES/TONY STONE IMAGES)

"I want to do that nose this week, Elaine," he says to his secretary, hidden behind the paperwork pillars. "You know, the doctor's son who had his nose bitten off by a dog." His lateness now seems very trivial.

Mr Hutchison, who is aged 51 years, specialises in oral cancer and facial reconstruction after trauma, deformity, or tumour removal. He is the facial injury expert for London's premier league football teams, including Arsenal and Tottenham Hotspur, where he treats the likes of Jürgen Klinsmann, who suffered a fractured mandible two seasons ago. He is currently working at rugby's Six Nations Championship at Twickenham, endeavouring to return the players to the pitch as soon as possible after injury.

I am picked up in his tailwind and whirled down to the basement of the hospital to be confronted with a Tomorrow's World type machine that has yet to be tested. Mr Hutchison shows his excitement for the new toy by lapping up a lid full of azure dye and thrusting a probe into his mouth. Seconds later red blood cells whizz across the computer screen. "This," he splutters, now complete with blue lipstick, "should help identify oral cancers at an earlier stage." Studies show that at present only 30-40% of patients survive five years after diagnosis because of the late presentation of many cases.

The blustering pace calms as we head to his town house in Chalk Farm, north London, to continue the interview. I am seated in a stately drawing room, complete with last year's Christmas card from Britain's current prime minister, Tony Blair, and his wife, a framed picture of government minister Peter Mandelson, and an ornate invitation to a royal wedding. The room secretes success.

On questioning, Mr Hutchison explains that his mother had forced dentistry upon him. A general practitioner herself, she had believed that he was too lazy to be a doctor. But after his dentistry course he took the important step of returning to school to study medicine at the Royal Free Hospital in London, "I was seduced by treating patients with facial lacerations," he explains. Five years later and with double qualifications, he found oro-maxillofacial surgery to be the right choice. "I loved it from the start, even the simple things such as removing a tooth root."

Mr Hutchison is one of 260 oro-maxillofacial surgeons in the United Kingdom. His highly intricate "jigsaw puzzle" job entails working in an area that is important both functionally and cosmetically. "It's miraculous," he exudes. "You can change a patient's whole psyche with a little care and attention." He adds: "You are achieving something dramatic for people. The results are immensely satisfying."

His enthusiasm is infectious, and he delves into the details of recent trauma. "The work is so varied," he says. "Lately I've had to rebuild a nose bitten off by another human, reconstruct an eyelid after a suicidal man tried to shoot himself, and operate on a dented temple when a gang of baseball wielding thugs shattered a boy's skull." Mr Hutchison has almost 40 different types of operation in his repertoire, many of which are performed together. "I'll remove a tumour, which creates a hole in the oral cavity, and then it is also my job to fill that hole."

Not content with rebuilding faces and lives, Mr Hutchison last year led those 260 specialist surgeons into local schools with the message, "Save your face, drink sensibly." He studied people turning up at casualty departments with facial damage. It was found that many of the victims had been drinking before their injury occurred, and two out of five were aged 16-25 years. "It used to be a bit of stitching up after fist fights. Now we are talking about new scales of violence. We are dealing with injuries caused by baseball bats, scaffolding poles, knives - you name it," he says.

The campaign, aimed at young drinkers as part of "Save Your Face" week in 1998, was backed by a dramatic video depicting the consequences of drunken violence. "It is very rewarding to stop the accidents as well as clear up the mess," Mr Hutchison says.

Mr Hutchison is very satisfied with his current job, and believes the decision to study medicine was the right one. He advises the following personality traits for the job: "Above all you need courage. Courage to move on from your mistakes, which are easy to make in such an intricate area. Courage to try new things, and above all courage to go and see your patients after surgery. Some of the results, especially after trauma, may be difficult to deal with."

All surgical specialties require particular attributes. "It is essential in facial surgery that you view the patient as a whole and understand their aspirations and perceptions of the problem, otherwise they will not be satisfied." "At 40 years of age I was a reasonably energetic consultant, but now, at 51, my brain, especially my memory for names, is starting to wane."

Oro-maxillofacial surgery seems an ideal specialty for those wanting a challenging career with variety and excitement. Mr Hutchison says: "There is no other surgical specialty with the opportunity to be a surgeon and physician as well as participate in research and prevention campaigns." He recently led the second "Oral Cancer Awareness" week - this crusade followed on from the great success of the first campaign in promoting mouth cancer prevention. "Eighty per cent of my patients have not even heard of oral cancer until I tell them that the ulcer in their mouth in not just an innocent irritation," he says.

The route to success in oro-maxillofacial surgery is difficult because of stiff competition. Both medical and dental degrees are needed, but, with exemption for previous training, both courses can be completed in eight years. Great satisfaction can be gained from helping patients after trauma and those with facial deformity or oral cancer. The job also requires an understanding of a patient's psychology and an appreciation of the aesthetic significance of facial injuries.

My inquiries turn to family life. Does a successful surgeon have time for three children and a wife? "I never see enough of my children, I am always frustrated," he says with a sigh.

"But I get up early at weekends to do my paperwork so I can spend time with them." Is the workload very heavy? "I am guilt ridden. I never do enough paperwork, and ideas for research never get past my notebook." But he adds: "I would never consider doing anything else. Patients give me back so much for the little I do."