Partial face transplant exceeds doctors’ hopes

LYON, France – As she held the mirror up to her new face, the woman looked at her reflection. She paused for a moment. Unable to speak because of the breathing tube in her throat, she wrote a note, “Merci.” Thank you.

Then, she cried. Dr. Sylvie Testelin, one of her surgeons, cried too.

The results of the daring nose, lips and chin transplant – the first ever attempted – were beyond what the doctors had hoped for. The new face bore an uncanny resemblance to her former face, one doctor said.

At their first news conference since Sunday’s surgery in northern France, doctors on Friday described the 15-hour operation and the woman’s reaction to her new face.

The 38-year-old divorced mother, who doesn’t want her identity known, had been mauled in June by her dog, a Labrador Retriever mix adopted from a rescue shelter. The lower half of her face had been ripped off.

Before the operation, the woman couldn’t chew her food. She had trouble speaking. Whenever she tried to drink something, most of the liquid dribbled from her mouth. She would only go out in public wearing a surgical mask to protect her from stares.

Conventional reconstructive surgery may have been possible, but it would have been very difficult, if not impossible, to restore her appearance and basic functions, her doctors said Friday.

Several expert advisers agreed that traditional surgery involving skin and muscle grafts from elsewhere on the woman’s own body was not a viable solution, the doctors said.

Leading transplant surgeon Dr. Jean-Michel Dubernard acknowledged that he initially had reservations. But he added that when he saw the extent of the woman’s disfigurement, “I no longer hesitated for a second.”

“If we didn’t perform this operation, her outcome would have been quite poor. She would have had to undergo four, maybe five conventional surgeries over a long period of time, with uncertain results,” said another of her surgeons Dr. Benoit Lengele, of the Saint-Luc University Clinic in Brussels, Belgium. “We wanted to try to restore her as best as possible and as quickly as possible. We truly believe from the human standpoint and the scientific point of view that the solution we took was the best one.”

The groundbreaking and risky operation began at 12:30 a.m. Sunday at a hospital in Amiens. One team of doctors traveled to Lille, another northern town about 60 miles away, to collect the lips, nose and chin from the donor. The brain-dead woman’s family donated her facial tissue to the doctors and the rest of her organs to other recipients. Engineers designed a silicone prosthetic mask that was fitted to the donor’s face after the tissue was removed.

Another team of surgeons prepared the disfigured patient. They cut away the fibrous tissue that had formed on her face since her accident.

When the transplant team arrived in Amiens, eight surgeons sewed the blood vessels in the woman’s face to those of the donor tissue. They then connected the nerves and muscles, then sewed in the lining of the mouth and the skin from the nose to the chin.

Four hours into the 15-hour operation, the blood was circulating normally between the graft and the rest of the woman’s face.

“When it was finished and we were washing the skin and applying the dressings, there was a big silence in the operating room. We were all surprised because the immediate result was completely outside our expectations – it looked marvelous,” Lengele said.

The woman already has some mobility in the new tissue. She can eat, drink and speak clearly. But it will be another six months before the nerves start to regenerate. It’s too early to tell how natural the transplant will look, but the doctors said they were optimistic.

The biggest hurdle now is the body’s acceptance of the transplant. The woman must take drugs for the rest of her life to prevent her immune system from rejecting the tissue. It’s still possible that the surgery will fail, that the new tissue on her face might die and turn black, even months later. In that case, reconstructive surgery or a new transplant would be needed.