Isabelle Dinoire, who underwent a face transplant three years ago, has said that it was not easy getting used to life after the operation
The Frenchwoman who underwent the world’s first face transplant has said she is still struggling to come to terms with her looks. (PICS)
Isabelle Dinoire admitted that three years on from the medical breakthrough, she remained uncertain as to whose face she looked at in the mirror every day.
Referring to the dead donor, Miss Dinoire, a 41-year-old divorced mother of two from northern France, said: “It’s not hers, it’s not mine, it’s somebody else’s.
“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.”
She said she had not yet worked out her new identity, adding: “It takes an awful lot of time to get used to someone else’s face. It’s a peculiar type of transplant.”
Such psychological difficulties will concern British medics from the Royal Free Hospital in London who have been given permission by the NHS ethics board to carry out the world’s first full face transplant.
Surgeons have been transplanting livers, kidneys and hearts for many years, but faces have always been different.
They are seen as a sacred, untouchable parts of a person’s identity.
Unlike other organs, face transplants are not life-saving operations. As a result, ethical committees frequently blocked them from going ahead.
But the face transplant surgeon, Jean-Michel Dubernard, said after carrying out the operation: “Once I had seen Isabelle’s disfigured face, no more needed to be said. I was convinced something had to be done for this patient.”
Miss Dinoire, from Valenciennes, northern France, was given a new nose, mouth and chin at the nearby Amiens Hospital in November 2005.
She was rushed to hospital after her pet dog apparently ripped off the vital features.
Miss Dinoire herself had no memory of what happened. After taking sleeping pills, all she could remember was waking up with blood on the ground.
When she tried to light up a cigarette, she realised her facial features were missing.
In spite of some early signs of immune rejection, Miss Dinoire soon regained sensation back in the transplanted face.
Rejection of the new tissue was brought under control by increasing the doses of immunosuppressant drugs, which Miss Dinoire is till taking.
Miss Dinoire made her latest comments in an exclusive interview with the journalist Vanessa Pontet on Reporters, a programme about face transplants broadcast on French channel NT1.
Despite her worries about the identity of the new face, Miss Dinoire admitted that technically at least, “it’s mine”. She added: “It’s part of me. I have the feeling of looking at something beautiful, I accept looking at myself now, but it was wasn’t easy at the beginning.”
She said she had lots of physio to reactivate the muscles and everything was back to normal as far as sensitivity was concerned.
Saying that face transplants should not be a taboo subject, Miss Dinoire said: “It’s important to get people to think about it because it completely changes your life.”
“There is no reason to think these face transplants would not be as common as kidney or liver transplants one day,” said Dr. Laurent Lantieri, one of the French doctors who operated on a man severely disfigured by a genetic disease.
In an issue of the British medical journal Lancet, Lantieri and colleagues reported on their patient’s status one year after the transplant. Chinese doctors also reported on their patient, two years after his surgery.
Last year, the French team operated on a 29-year-old man with tumors that blurred his features in a face that looked almost monstrous. They transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.
The Chinese patient had part of his face ripped off by a bear. Surgeons in Xian gave him a new nose, upper lip and cheek from a donor. After a few months, he could eat, drink and talk normally, and returned home to Yunnan province in southwest China.
The patients were not identified although photos were included in the reports.
As is the case with all transplants, doctors use immune-suppressing drugs to prevent the recipient’s body from attacking the donated tissue. In both face transplants, the patients started rejecting the transplanted tissue more than once. Their doctors solved the problem by juggling their medications.
The French patient now takes three pills a day to prevent rejection.
“That’s less than most people with diabetes,” said Lantieri, a plastic surgeon at the Henri Mondor-Albert Chenevier Hospital in suburban Paris.
Other doctors were reassured by the results.
“To be able to wean down the dosage of the medication in small amounts and relatively quickly, that is encouraging,” said Dr. Bohdan Pomahac, a plastic surgeon at the Brigham and Women’s Hospital in Boston.
Pomahac has permission to do a face transplant in the U.S., as do doctors at the Cleveland Clinic.
Experts have worried that if patients take lifelong anti-rejection drugs after a transplant, their cancer risk will jump. Some also predicted that rejection would destroy the face within a few years. Those fears seem to have been allayed, Pomahac said.
With three successful partial face transplants so far – including the world’s first on a woman whose face was bitten off by a dog in France – doctors say that some of the surgery’s initial uncertainties, like how functional the new face would be, are being answered.
For example, Lantieri’s patient’s face was paralyzed by tumors for more than a decade. The French team wasn’t sure if nerves could grow after the transplant. But they discovered later their patient could blink, proving the brain was able to restore long-forgotten facial nerve connections.
Not everyone is convinced that face transplants are so revolutionary.
Dr. Patrick Warnke, a plastic surgeon at the University of Kiel in Germany, calls them a “dead-end road,” because he doesn’t think the rejection problem can be solved. Instead, he hopes to re-grow tissue from patients’ own stem cells.
Still, the biggest obstacle to more face transplants may not be scientific, but social.
“When kidney transplants first began, people were reluctant to donate because there were a lot of cultural, social and religious issues,” Pomahac said. “This is exactly the same scenario now.”
Doctors plan to do more face transplants, but are having a hard time finding donors.
“Everyone says they would accept a face transplant if they were disfigured,” Lantieri said. “The real question is, would you be a donor, or would you allow your family member to donate their face? That is the answer we need to change.”
Before image of first face transplant
After image of first face transplant
A French team operated on a 29-year-old man with tumors that blurred his features in a face. Doctors transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.
Li Guoxing, a Chinese farmer who was badly disfigured in a bear attack. Guoxing was the world’s second full face transplant patient.