Eighteen months after receiving a new nose, chin and lips, the world's first face transplant recipient has recovered enough use of her facial muscles to close her lips and draw her face into a slight smile, doctors in France reported Wednesday.
The patient, Isabelle Dinoire, who was 38 when the transplant was performed in 2005, has overcome two tissue-rejection episodes and two cases of kidney failure -- a side effect of the powerful drugs she must take to prevent her immune system from rejecting the facial graft.
Dinoire, who bears thin scars where her new face was attached, is satisfied with her appearance and says she is not afraid of walking in the street or meeting people, her doctors reported in the New England Journal of Medicine.
Her case shows that a face transplant is technically feasible and may one day become an option for badly disfigured patients willing to assume related health risks, said Dr. David M. Young, assistant professor of plastic surgery at UC San Francisco, who has been drawing up plans for a face transplant.
"Everyone in the world said this should not be done because the world was not ready and the risks were too high," Young said. The French medical team "has beaten the odds."
Dinoire, who has two daughters, became badly disfigured when her pet Labrador chewed off the lower part of her face while she was unconscious after taking sleeping pills. Her nose and lips were missing, and the attack left her teeth and lower jawbone exposed.
Before Dinoire received the transplant from a brain-dead donor, food dripped from her mouth and she wore a surgical mask in public.
The procedure brought criticism from some in the medical community because the health risks associated with the transplant were high and Dinoire's injuries were not life-threatening. She faces lifelong treatment with immunosuppressant drugs and the persistent worry that her immune system may reject the graft. The drugs bring the added risk of kidney failure and increase the chance of infection and cancer.
Lead author Dr. Jean-Michel Dubernard, a member of Dinoire's transplant team in Lyon, France, said plastic surgery was not an alternative for his patient because it would have been "nearly impossible" to sculpt a new nose and lips.
"She now has a human face," he said. "If she wanted to kiss someone, she could."
Six months after the transplant, Dinoire could detect heat, cold and touch in the grafted skin, her doctors noted in their report. By 10 months, she could completely close her mouth. A video released with the report showed Dinoire producing a partial smile and pronouncing words that contain the letters B and P, which required her lips to touch.
Compared with Dinoire's appearance before the accident, her face looks round and puffy -- a possible side effect of her anti-rejection medicines -- and slightly asymmetrical.
Besides the two cases of kidney failure, her anti-rejection drugs caused anemia, high blood pressure and low platelet counts. Dinoire's condition slowly improved after treatment and a change in her medication, her doctors said in their article, which details the first 18 months of her recovery after her November 2005 surgery.
Dr. Maria Siemionow, director of plastic surgery research at the Cleveland Clinic, said the report underscored a need for less toxic anti-rejection drugs.
Dinoire suffered more complications than are typically seen in patients who get abdominal skin grafts after cancer surgery or in the few patients who have received hand transplants, she noted, an outcome "that may be specific to facial grafts."
A lingering question hanging over the procedure is whether the patient has psychologically adjusted to her new face, Siemionow said.
Dinoire received regular psychological support during the first four months after her surgery but has not been given a formal psychiatric evaluation, the report said.
"They are telling us she is happy, but she has not undergone testing," Siemionow said. "They are giving us the functional results, but it would be very good for us to know the psychological outcome."