WHAT is spooky about face transplants is the possibility that a person鈥檚 new face will look like the dead donor鈥檚. Now the first full account of the second and third face transplants ever to take place has allayed these fears.
鈥淎t last, we鈥檙e getting over the misconception that we鈥檙e transferring faces,鈥� says Laurent Lantieri, head of the team that completed the third transplant on 21 January 2007 at the Henri Mondor Hospital in Cr茅teil, France. 鈥淚nstead, we鈥檙e reconstructing patients鈥� faces with spare tissue, and people are starting to understand that.鈥�
Surgeons who pioneered the operations are hoping that this will persuade more bereaved families to donate their loved one鈥檚 facial tissue.
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The first face transplant, carried out on Isabelle Dinoire in November 2005, was held up by fears that she might end up looking like her donor, causing psychological distress. The new studies confirm that while recipients have a new appearance, they don鈥檛 look like their donors (The Lancet, vol 372, p 631 and p 639).
One recipient, in China, had been attacked by a bear. The other, in France, had been severely disfigured by a huge tumour from an inherited condition. Both the second and third transplants broke new ground.
The Chinese team, led by Shuzhong Guo of the Fourth Military Medical University in Xi鈥檃n, was the first to transplant bone as well as the nerves, muscle and skin that made up Dinoire鈥檚 transplant. More than two years after the operation on 13 April 2006, the patient has recovered the ability to speak, eat and talk normally.
Lantieri鈥檚 team, meanwhile, came the closest yet to a whole facial transplant, transferring a graft three times the size of the skin flap used to repair Dinoire鈥檚 face. The hardest part, says Lantieri, was removing the tumour, which had left the patient fully paralysed down one side of the face and partially paralysed on the other. 鈥淣ow, he can close his mouth completely, speak and eat, although he has some problems smiling because the way we set the facial muscles was not perfect,鈥� he says.
Jean-Michel Dubernard of the Edouard Herriot Hospital in Lyon, France, who co-pioneered Dinoire鈥檚 transplant, says that the biggest challenge to a complete transplant is transferring functioning eyelids. Lantieri points out that the muscles and nerves controlling eyelids run both within and outside the eye socket itself. 鈥淲e鈥檙e working on it,鈥� he says.
