Dr. Tessier the Great

TIMES STAFF WRITER

Paris, in the early 1940s: Each night a tall, young surgeon leaves the hospital where he works and travels four hours to a little French town where a friend has acquired--don't ask how--an interesting selection of skulls and skeletons.

The craggily handsome doctor--Paul Tessier--spends his nights hunched over these bones, studying how the human face and head is put together--and how it might be taken apart. Each morning at 4, he takes the train back to Paris, arriving just in time for hospital rounds.

Cut to the San Fernando Valley, 1969. Tom and Mary Brunski are presented with their third child, Nicholas. He is fine in every other respect, but his mother sees that his head is shaped like the letter C. The forehead and chin come forward, but the center of his face is compressed. Plagiocephaly is what they call it. There is nothing to be done, the doctors say.

Now, to a happy home in Westminster, same year. Joan Duclos, mother of eight, gives birth to a girl. The baby's eyes protrude--they are "out of their sockets," doctors tell her. The infant is also missing the bridge of her nose and a cheekbone, among other problems. There is no known cause for Apert's syndrome, they say, and there is no surgical remedy.

That same year in Torrance, Laura Aiello, 10, is attending school. She has already endured 29 major operations to correct her fused jaw and other congenital problems--all of them failures. Doctors have tried everything and can do no more, they tell her anguished parents.

But the doctors were wrong. The Great Tessier had by now arrived on the worldwide surgical scene to change the face of modern surgery. The young man who had spent so many sleepless nights studying cadaver heads in a small French town had perfected what has been called "the Tessier magic."

Last week, the 81-year-old living legend came to Los Angeles, as did dozens of his far-flung patients, former students and fans. They had come for a Tessier fest at UCLA Medical Center, a three-day seminar to honor the elegant French doctor.

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After years of lonely experimental hacking and sawing; of grafting, sculpting and shaping bone; and two decades of successful surgeries performed on children with severe facial anomalies, he understood by the 1970s above-the-neck anatomy better than anyone who had lived before him.

As several doctors at the seminar explained: Before Tessier, there was no cranio-facial surgery. It did not exist. There was only plastic surgery. And that was mere camouflage--mostly unsuccessful attempts to patch up or cover severe problems rather than fix them. Tessier was the first to literally take apart the bones of the head and face, to restructure and reposition all the component parts--without injuring the brain and without leaving visible scars. Patients who had no shot at living normal lives before Tessier now could proceed pretty much as everyone else.

By the 1970s patients were being sent to Tessier from around the world. And he was traveling to five continents, as a guest surgeon in hospitals where children had been on waiting lists to see him for months or years.

"There was no help for these kids before Tessier," says speech pathologist and Tessier admirer Julia Hobbs, who teaches at the UCLA dental school, is on the hospital's cranio-facial team, and who attended the seminar. "He was the first to dare to disconnect everything and move the features around all at once. He took sunken cheekbones and moved them forward. He rebuilt and repositioned the orbits [eye sockets]. Nobody had done this before. And he avoided facial scars by peeling down the facial skin from above the hairline before surgery, and reconnecting it afterwards."

Dr. Henry K. Kawamoto Jr., who studied with Tessier in the 1970s and who founded the cranio-facial clinic at UCLA hospital, hosted the weekend seminar. It was Kawamoto's own students who organized and established this first annual Henry K. Kawamoto Jr. Visiting Professorship at UCLA. Of course, the kick-off guest had to be their mentor's mentor. Tessier's opening remarks were homage to Kawamoto, the former student whom he now calls "one of my sons."

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The auditorium was packed and silent, as doctors bent forward to catch every one of the Frenchman's words.

Tessier greeted patients he had treated as children, as far back as 25 years ago. They appeared one at a time, took a seat facing him on stage and remained silent as the doctor talked about their cases and took questions. Frequently, doctors went on stage to take a closer look.

Laura Aiello Popps, 38, is a USC graduate and occupational therapist who now lives with her husband, John, in Seattle. They flew to L.A. at their own expense, Popps later said, because she "wanted to help Dr. Tessier teach other doctors, so that more children can be helped ultimately."

Popps was the child who underwent 29 failed surgeries before her parents heard of Tessier--and then eight Tessier surgeries between the ages of 16 and 22 to mitigate the damage. She knows what can happen when well-intentioned doctors "try to help even though they don't know how." But her parents never gave up, she says. "I'm eternally grateful, and I came here to try and give some of that back."

Nicholas Brunski, now a 29-year-old graduate of Cal State Northridge with a degree in psychology, also spent time on stage. Afterward, he recalls that "as a child I was so very deformed that my parents sent me to a school for handicapped children. They were afraid kids in a regular school would be too cruel. But they never stopped looking for help until they found Dr. Tessier."

Joan Duclos made the trip to Paris when her ninth child, Amy, was 3. "By that time, we'd been through dozens of doctors. Most were brutal to us, I think mainly because they didn't know what to do." Duclos was not daunted.

"I could see this little kid had great potential," the mother said the other day at the UCLA. "At 3, she had no idea anything was wrong with her. She'd prance in front of a mirror and say how pretty she looked in her new little dress. Actually, she was pretty ugly at that point. We'd get into an elevator, people would take one look at her and get off at the wrong floor. Or I'd sit down next to someone in a doctor's office with Amy, and the person next to me would get up and move away."

Duclos heard of Tessier and went to Paris with Amy. The doctor examined the child and told Duclos to start seeing Kawamoto at UCLA, who would keep records on Amy until she was old enough for Tessier to operate. Amy's first surgery was at 10; the second, at 16.

"He is a miracle worker; look at her face today," says Duclos, who now lives in Central California. "He made an incision across the top of her scalp, took her facial skin down, reshaped her cheekbones, added a bridge to her nose and reshaped the nose itself. He brought the top jaw forward so it was even with the bottom jaw--all in just two surgeries."

Amy graduated from high school in 1989, has worked ever since as a salesperson and got married 2 1/2 years ago.

Dr. David Matthews of Charlotte, N.C., studied in Paris with the doctor.

"The magic of Tessier," he says, "is that he saw clearly through all the problems and was the first to translate the final goal into surgical procedures that would work. He could achieve for these children a normal face, a happy face, which no one had been able to do before."

It helped that his breakthrough coincided with the advent of antibiotics and the specialty of neurology, the doctors note.

"It's rare that you can point to one person who is the actual father of a whole field," says Dr. John F. Reinisch, chief of plastic surgery and director of the cranio-facial team at Childrens Hospital of Los Angeles. "Usually many people arrive at similar solutions in different places at around the same time. That's not so in Tessier's case. He is truly the father of his field of surgery."

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On the personal side, Tessier fans often exchange lore about the doctor's IMAX-like, real-life adventures: He has hunted wild elephants, dived with Jacques Cousteau, trekked the Himalayas, driven race cars--"all these things and much more," says Dr. John Mulliken, director of the cranio-facial program at Children's Hospital, Boston, who calls him "the most charming, articulate and constantly fascinating man I've ever met."

Mulliken adds that Tessier's principles and techniques were so new and useful that they are used in all sorts of cases.

"Every time a tumor is removed and a face has to be reconstructed; every time an auto accident or other trauma ruins the bones in a person's face--it is thanks to this man that the injured people can look normal again," he says. "There are many of us who think he deserves a Nobel prize, based on the number of people in the world he has affected by his superb work. That's why we call him simply Tessier. He is the Michelangelo of surgery."

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