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Face to face

Nine years after the first face transplant and after 28 such surgeries in between, Lancet report says procedure is safe

By: New York Times | Published: May 11, 2014 2:01:52 am

When the world’s first face transplant was performed in France in 2005, it pushed medical boundaries. Yet the procedure’s future was much in doubt.

The surgeons, operating on a 38-year-old Frenchwoman whose face had been mauled by her pet Labrador, had to surmount the opposition of medical societies, which declared the procedure unethical. Critics said the pioneering team did not follow ethical and legal guidelines.

But the first comprehensive review of every face transplant reported since then — 28 in seven countries, counting the French case but not two done in Turkey since the review was completed — has removed many of those early doubts.

The report, published online by The Lancet, says the procedure is generally safe and feasible. The endorsement is cautious: The researchers note that the operation is still experimental, risky and expensive, and that patients must be carefully selected. After the transplant, recipients face continual risks of infection and reactions to toxic anti-rejection drugs.

But the paper adds that for victims of genetic disorders, gunshots, animal bites, burns and other accidents, transplants can ease or erase the deformities that leave them subject to discrimination, isolation and depression.

Face transplants have transformed the lives of nearly all surviving recipients. They have regained their ability to eat, drink, speak more intelligibly, smell, smile and blink; many have emerged from ostracism and depression. Four recipients are back to work or school. Three have died.

The idea of one individual wearing another’s face initially frightened some critics. But contrary to such fears, no recipient physically resembles the stranger who gave it. New faces initially feel numb, as if the recipient had come from a dentist’s office. The numbness lasts for months.

But recipients regained facial sensations — feeling a kiss or a fresh breeze, smelling freshly mowed grass — as early as three months after the transplant. Although restoration of motor function was slower, some patients could bring their new lips together by six months and close their mouths by eight months. By three months, some were able to swallow and produce intelligible speech. Smiling began after two years, and continued to improve after eight years.

The overriding reason for success was a rigorous pre-transplant effort to identify candidates who would be motivated to stick to an anti-rejection regimen and who had a strong social support system.

But the costs of surgery and anti-rejection therapy require lifelong financial support. Many recipients need post-transplant surgical revision for such problems as bone and dental realignment, which increases the risk of infection and poor wound healing.

Of the three recipients who died, one disliked the side effects of immunosuppressant drugs and resorted to other remedies that led to multiple rejection episodes and death. A second, who had simultaneous transplants of both hands, developed an infected graft at 12 days and died two months after the combined surgery. The third death resulted from a recurrence of cancer in an HIV-positive patient who had undergone cancer surgery before the face transplant.

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