Woman gets near-total face transplant in Cleveland

A woman who had suffered severe facial trauma got essentially a whole new face in a first-of-its-kind operation at the Cleveland Clinic, hospital officials said Wednesday.

Only the woman's upper eyelids, forehead, lower lip and chin were left - the other 80 percent of her face was replaced with one donated from a female cadaver during the 22-hour surgery about two weeks ago.

It was the nation's first face transplant and the fourth worldwide, though the others were not as extensive as this one.

The patient's name and age were not released, nor details on how she was injured. Her injuries were so horrific that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe.

After the transplant, "I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw," said the lead surgeon, Dr. Maria Siemionow.

The woman is doing well and showing no signs of rejecting the new face, doctors said.

It is the first facial transplant known to have included bones, along with muscle, skin, blood vessels and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw and even some teeth, said Dr. Frank Papay, the clinic's plastic surgery chief.

"This patient exhausted all conventional means of reconstruction, and is the right patient," Siemionow said at a news conference.

So many disfigured patients are stuck "in their houses who are hiding from society," afraid to go out, she said.

"Our patient was called names and was humiliated," she said. "You need a face to face the world."

The face was donated by a family that was asked specifically to approve the gift - not simply done under general organ donation consent rules, said officials of LifeBanc, the Northeast Ohio organ procurement group that arranged the transplant.

The recipient was not shown a picture of the donor, and in animal experiments, "the recipient never looks like the donor," especially when the injuries are so severe, Siemionow said.

The hospital posted a statement from the woman's sibling on its Web site.

"We never thought for a moment that our sister would ever have a chance at a normal life again, after the trauma she endured," it says. "But thanks to the wonderful person that donated her organs to help another living human being, she has another chance to live a normal life. Our family cannot thank you enough."

The hospital's bioethics chief, Dr. Eric Kodish, said the ethical and psychological issues surrounding the donation and consent were "beyond reproach."

"This is not cosmetic surgery in any conventional sense," Kodish said.

Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life - not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.

Siemionow considered dozens of potential candidates over the past four years, ever since the clinic's internal review board gave permission for her to attempt the operation.

"The surgery took 22 hours. The preparation to the surgery took over 20 years," she said Wednesday.

The world's first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. She has done so astoundingly well that surgeons have become more comfortable with a radical operation considered unthinkable a decade ago.

Two others have received partial face transplants since then - a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition.

Leading plastic surgeons praised the operation. It's an example of a medical advance "that gives patients their lives back," said a statement from Dr. John Canady, president of the American Society of Plastic Surgeons.

The group and others wrote guidelines two years ago to help doctors considering offering such transplants. Still, there are medical and ethical issues that need careful examination as more information on the Cleveland case becomes known, the group said Wednesday.

"The fact that three have been done (worldwide) and there's been a long runway up to this, I would imagine the circumstances are optimum," said Dr. John Barker, director of plastic surgery research at the University of Louisville.

---

On the Net:

Cleveland Clinic: http://www.clevelandclinic.org/face