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

Face Transplants Increasingly Possible Despite Psychological Hurdles

November 05, 2008 07:00 AM
by Shannon Firth
As more hospitals move toward full facial transplants, critics and transplant patients warn that results are bittersweet.

Facial Transplant Patient Copes With Identity Issues

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. 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.”

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.

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

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.”

Background: The first partial and first full facial transplants

In November 2005, French doctors Jean-Michel Deubernard and Bernard Devauchelle performed the world’s first partial facial transplant after Dinoire’s pet Labrador ripped off a portion of her nose, mouth and chin while she was sedated on sleeping pills. Dinoire, a mother of two, had had a difficult week and “took some drugs to forget,” the Associated Press quoted her as saying. After she woke up, Dinoire said, “I tried to light a cigarette, and I didn't understand why I couldn't hold it between my lips.”

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.

Related Topic: Recipients of transplants may inherit donor traits

Jaime Sherman, a 28-year-old psychology student at Arizona State University, told the Arizona Daily Star how she acquired a taste for Mexican food and an interest in sports after receiving a heart transplant. “I'm a psychology major, and my professors will tell you it's all in your mind," she said. "But the scientists, the psychologists—they don't have someone else's heart beating inside them. I do.”

In April 2008, Sonny Graham, a Georgia heart transplant recipient who married his donor’s widow, committed suicide in the same manner as the donor had—by shooting himself in the neck.

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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