first face transplant
Amiens Hospital/AP
A surgical team operate on an unidentified woman.

America’s First Face Transplant Performed in Cleveland

December 16, 2008 02:03 PM
by findingDulcinea Staff
Eighty percent of an unnamed woman’s face was replaced with that of a donor in the nation’s first near-total face transplant.

Unnamed Woman Becomes Latest Face Transplant Recipient

The Cleveland Clinic announced on Tuesday that Dr. Maria Siemionow performed the procedure a few weeks ago on a patient, whose name and age have not been released.

"There are patients who can benefit tremendously from this," said Dr. Bohdan Pomahac, a surgeon at Brigham and Women's Hospital in Boston, to the Associated Press. "It's great that it happened. It is a major move forward. Hopefully it will open the door both to the public and to other centers" wanting to offer such transplants, Pomahac said.

But the procedure has remained controversial, ever since the first partial face transplant was performed by doctors in France three years ago on a woman who had been attacked by her dog. Because the operation's aim is to improve quality of life, its ethics are less clear than procedures that can save a patient's life. It also carries medical risks, as it requires that the recipient take immune-suppressing drugs to prevent the body from rejecting the transplant, but also increase the risk of infection.

Background: Face transplants increasingly possible despite psychological hurdles

As more hospitals move toward full facial transplants, critics and transplant patients warn that results are bittersweet.

Three years after undergoing the world’s first partial face transplant, French woman Isabelle Dinoire is still coping with the psychological aftermath of her surgery. In November 2005, French doctors performed the transplant after Dinoire’s pet Labrador ripped off a portion of her nose, mouth and chin while she was sedated on sleeping pills. Dinoire told The Daily Telegraph, “Before the operation, I expected my new face would look like me but it turned out after the operation that it was half me and half her.”

Dinoire conceded, “I have the feeling of looking at something beautiful … but it wasn't easy at the beginning."

Her statement may cause concern among the doctors of the Royal Free Hospital in London who were recently granted permission from England’s National Health System’s ethics board to complete the world’s first full facial transplant.

In a press release following a 2006 lecture at the Royal College of Surgeons in England, Nichola Rumsey, professor in appearance and health psychology, explained that the psychological effects of facial transplants had yet to be discovered. Rumsey added, “The significance of ‘wearing’ someone else’s face may present particular challenges, including issues of identity, or feeling toward the donor.” In addition, critical anti-rejection drugs, required post-surgery, must be taken on a permanent basis and can “significantly lower life expectancy.”

While British doctors say they are preparing for the world’s first full facial transplant, ABC News reported that Dr. Laurent Lantieri has already completed the landmark surgery on Pascal Coler at Henri-Mondor Hospital in France in early 2008. After suffering for 24 years from a condition similar to that of Joseph Merrick, known as “The Elephant Man,” Coler said, "I'd love to find a wife. Settle down and have children."

An August report from The Lancet noted the success of Coler’s facial transplant as well as that of Li Guoxing, a Chinese man who was mauled by a bear and received a partial face transplant.

Video: The world’s first partial facial transplant

A 2006 BBC Horizon documentary of the first partial facial transplant surgery is not for those with a weak stomach. At the University Hospital in Amiens, Dr. Jean-Michel Deubernard and Dr. Bernard DeVauchelle completed Dinoire’s groundbreaking surgery in 15 hours.

Opinion & Analysis: How do people feel about facial transplants?

According to The West Australian, a study from the University of Louisville reported that even after being given a list of 20 immunosuppression-related side effects, 77 percent of respondents with facial deformities said they would still choose to have facial transplants. For healthy individuals who questioned on the basis of being hypothetically disfigured, 86 percent said they would agree to the surgery.

Reference: How a face transplant is performed

According to The Daily Telegraph, after arteries, veins and nerves have been reconnected during a facial transplant, it can take between six months and a year before transplanted facial muscles will function normally. After surgery, the recipient then begins a difficult lifetime regiment of immunosuppressant drugs. The alternative to face transplants is to use thick and thin skin grafts taken from areas such as the back. In these surgeries, the patient may only have slits in place of eyes and a mouth.

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