Surgeons in France Perform the World’s First Face Transplant

Dr. Jean-Michel Dubernard, the French surgeon famous for performing the world’s first successful double forearm transplant in 2000, performed another first on Sunday when he operated on a 38-year old woman who had been severely disfigured by a dog bite, resulting in it being difficult for her to speak and chew. The woman, who wishesto remain anonymous, received a nose, lips, and chin from a brain-dead donor whose family gave consent for her to have the body parts grafted onto her face. The operation took place in Amiens, a city in northern France. Dubernard would not discuss the surgery afterward, but he confirmed that it did indeed involve those three parts, and the hospital’s statement said that the patient’s general condition is excellent, and the transplant looks normal.

A complete facial transplant would involve applying one sheet of skin, in one single operation. Such a procedure has never been done, but the partial transplant performed by Dubernard is the closest thing so far. Although the procedure is intricate and lengthy, standard surgical procedures are used. Scientists in China have transplanted ears and scalps successfully, but according to experts, the nose and mouth are the most difficult parts of the face to transplant. All types of facial reconstruction surgeries have been done for years, but facial transplants are a new frontier, and a risky one both medically and ethically.

Specialists around the world have been working for years to perfect techniques involved in transplanting faces. Many medical experts have praised Dubernard’s accomplishment. "For pushing the bounds of science, they are to be applauded, as long as they have got full informed consent from the patient and the donor’s family," said Dr. Iain Hutchison, of the London-based Facial Surgery Research Foundation. If the surgery is successful, the procedure will offer hope to people who have been horribly disfigured by accidents, injuries, or burns. Today’s best reconstructive treatments usually leave people with scars and disfigurement, and scarred skin that doesn’t move like natural skin.

Critics of the surgery say that the procedure is too risky for correcting a condition that is not life-threatening. The main worry, as with most transplants, is organ rejection, which could cause the transplanted skin to slough off. If it becomes infected, the skin could turn black and require a second transplant or reconstruction with skin grafts. Patients would have to take drugs to prevent rejection for the rest of their life, and such drugs increase the risk of kidney damage and cancer. Dubernard performed a hand transplant in 1998 on a patient in New Zealand who later had to have the hand amputated because he failed to take the required medications and his body rejected the new hand. Surgeons around the world have performed partial face transplants using the patient’s own skin, but because such operations do not require anti-rejection drugs, they are usually successful.

Concerns about the potential physical and emotional ramifications of facial transplants have delayed plans by British surgeons to attempt the surgery. Ethics authorities in France blocked an application to attempt a full face transplant last year, although they approved Dubernard’s application to perform the partial procedure. In the United States, the Cleveland Clinic is planning to attempt a full face transplant, and the success or failure of the partial transplant in France doesn’t change their plans. Cleveland surgeon Dr. Maria Siemionow said, "We are really looking for the right candidate," adding that they would consider "severely disfigured patients who have already had the conventional treatment," and for whom a transplant is their last chance at normalcy.

The recipient of Dubernard’s double forearm transplant, whose arms were severed in a model rocket accident, said in 2003 that he had regained normal usage of his hands and was even able to shave himself. The success of the partial face transplant performed Sunday may not be known for months, or even years. The hospital has not said how long the patient will have to recover before being released, but a news conference is planned for Friday.