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Half a Brain

The First Face Transplant

Isabelle Dinoire

Partial Face Transplant

A young woman with a horrific face injury, made medical history in November 2005. French doctors took a controversial decision to perform an operation that had been banned in almost every other country in the world. For some, it has redefined the boundaries of transplant surgery.

Isabelle Dinoire, the recipient of the world's first face transplant, lives in Valenciennes, Northern France. Born in 1967, she is divorced with two teenage daughters. Mauled by her pet Labrador in May 2005, she lost her nose, lips and chin.

Astonishingly, she did not seek medical attention immediately. Instead she chose to hide away, too ashamed to out with her disfigured face.

Professor Sylvie Testelin remembers: "This woman turned up on a stretcher, it was three weeks after the accident. She had a loose bandage over her face and a stomach tube feeding her. She couldn't take anything in through her mouth".

Isabelle Dinoire
Isabelle is NOT Grimacing, she has no lips

Several weeks after being admitted to hospital, Isabelle came to the attention of specialist maxilla-facial surgeon Professor Bernard Devauchelle. Using conventional surgery, doctors are limited in what they can do to reconstruct Isabelle's face. Dr. Devauchelle believed there was an alternative: "This type of tissue loss requires this type of treatment, anything else is just a make-shift solution. The best way, the only way, to fix it is with a face transplant".

Bernard Devauchelle
Bernard Devauchelle

At the Royal Free, in London, surgeon Peter Butler has dedicated his career to researching face transplantation: "Facial transplantation is not a new idea. We have known for some time that this is technically possible because we have been looking into it for 14 years experimentally and nearly 6 years clinically. I'm convinced this is a good thing to do and is a therapeutic possibility".

Doctors have been transplanting livers, kidneys and hearts for over forty years, but faces have always been different. They are seen as a sacred, untouchable part of our identity. Unlike other organs, face transplants are not life-saving operations. As a result, ethical committees have always blocked them from going ahead.

However, in France, surgeons Bernard Devauchelle and Sylvie Testelin believed that, in Isabelle, they had a unique case, worthy of ethical approval.

Convinced that they will get approval, Testelin and Devauchelle assembled a team of specialists including world famous transplant surgeon Jean-Michel Dubernard. Dubernard and his team were already medical pioneers having performed the first successful hand transplant.

Jean-Michel Dubernard
Jean-Michel Dubernard

Dubernard said, on joining the team: "Once I had seen Isabelle's disfigured face, no more needed to be said. I was convinced something had t be done for this patient".

While Isabelle waited for permission for her transplant, doctors were worried that her condition was deteriorating. Her muscles had slowly tightened, making it difficult for her to open her mouth more than a few millimetres.

During this time, doctors conducted extensive, scientific, tests to see how her brain might function after the transplant. MRI scans showed that, even though her lips were missing, the part of her brain that controls the lips was still active, which should allow her to control the muscles of a new face.

Peter Butler is frustrated by the limitations of conventional surgery in reconstructing the human face. "The skin of the face is very specialised. If you take a line from the hair-line to the chin, you will go through five or six different thicknesses of epidermis and dermis, with different numbers of hair follicles, sweat glands, and pigment changes. It is very difficult to reproduce using thigh skin or back skin".

Simon Weston was just 20 years old when his troop-ship was struck by an Argentinean missile during the Falklands War. He suffered 49% burns and has undergone extensive reconstructive surgery. He explains Peter Butler's frustration "My nose doesn't look normal, my eyes can never look normal. My eyelids came from my shoulder, my nose came from my backside. It's impossible to make it look normal".

Simon Weston
Simon Weston

After four months of waiting, the surgical team in Amiens have, finally, been given the permission they have been waiting for. The ethical committee agreed that all the medical questions had been answered and Isabelle's operation could proceed. Now, Isabelle will begin the long and difficult wait for a suitable donor. The donor will need to be of a similar age and have the same skin colour and blood-group.

Doctors plan to remove the nose, lips and chin from the donor face. The operation would be a first, but the surgical techniques have been established for decades.

Surgeons have always hit one problem. Whenever they tried to transplant skin from one person to another, it would always be rejected. However, it was proved possible, in 1998, when they gave Clint Hallam a new hand. This was made possible by new anti-rejection drugs which suppress the body's immune system to prevent donated organs being rejected.

Besides the medical risks, their are serious concerns about the long-term psychological consequences of transferring one person's face onto another. Peter Butler tells us: "The popular misconception of the public is 'If I donate the face o my loved one, I will see them walking down the street'. If you take the skin envelope off a face, which is pliable, and put it on the facial bones of the recipient, it will remould over the facial bones to give you most of the features from the bones, but with the skin tone and texture of the transplanted skin. The resultant face is a hybrid of both faces, but will look more like the recipient than the donor".

Hybrid Face
Donor, Hybrid and Recipient Face

Six months after Isabelle's arrival at the hospital in Amiens, the call finally comes. A donor had been found in Lyon.

The team swings into action. Dr Devauchelle collects the donor face while Dr Dubernard prepares Isabelle for the surgery. Using threads finer than a human hair, the major facial arteries are connected. The crucial test will be whether blood will flow through Isabelle's veins to the newly transplanted face, bringing the flesh back to life.

The moment of truth is when they unclamp the arteries and the blood starts to flow. Within minutes, the lips regain their colour, volume and density.

With all the veins and arteries in place, the skin is finally stitched back together. After fifteen hours, the operation is complete.

Isabelle after the Operation
Immediately after the Operation

From now, Isabelle will be closely monitored to see if her body accepts the transplant. She is transferred to Lyon where she will undergo months of tests. Doctors have detected some immunological signs of rejection, but increasing the dose of her medication has brought it under control. After several weeks, Isabelle is showing signs of sensation returning to her face.

Isabelle's New Face

Even though the surgery was a success, she will be in and out of hospital for the rest of her life.

But, she has her life back!

She has the confidence to go out and meet people. She has decorated her house, she can eat and drink normally.

She has even, despite strong protestations from her doctors, started smoking again.

Following the success of Isabelle's partial face transplant, Peter Butler has now redoubled his efforts to have the ethical committee in Britain give approval for the first full face transplant.