A New Face, a New Life: A Medical First for France

Her name is Isabelle Dinoire.  She is French, blonde, 38 years old and mother of two daughters.     She is also a worldwide medical phenomenon roughly on a par with the first patient to receive a heart transplant at the hands of Dr. Christiaan Bernard in South Africa in 1967.     She is the first ever to have been given an almost total face transplant to replace a visage savagely disfigured in May 2005 by her Labrador dog while she lay unconscious from an overdose of sleeping pills.     When she awoke, she found her lips gone, along with her chin and the better part of her nose. The bones remained but the skin and flesh were gone.     She could scarcely open her mouth, less than an inch. She couldn’t chew, could barely talk, could only be nourished with pureed food.     Rapidly hospitalized in Amiens, in the north of France, she spent six months wearing a face mask to protect her from the inevitably shocked reactions she received from others. During this time she waited while her doctors sought a donor who could provide her with a new face. In addition, the French medical ethics authorities had to be convinced that such an operation would be medically ethical and that Ms. Dinoire would be able to survive the shock of seeing someone else’s face every time she looked in the mirror. .     Finally it was decided that a different face was better than no face at all. The authorities gave their approval and the donor was located in November 2005 when the family of a woman who had just died near Amiens agreed to let her facial tissue be used for a transplant.     The 15-hour-long operation by two teams of French specialists, 80-strong in all, one in Amiens for the skin graft and another from Lyon for the post-operative recovery treatment, took place on November 27, 2005. Another two months of physical, emotional and psychological recovery time were required, however, before the lady generally referred to previously only as “the woman with the face transplant” was deemed ready to have her identity revealed, to appear in public and face the press.      When she finally did so on February 6, the world discovered a woman of remarkable aplomb, relatively calm, straightforward in her responses and profuse in her thanks not only to her doctors but also to the family of her donor.  Despite their own sorrows, she said, they had accepted “to give a second life to people in distress.”  She said she now had only one desire: to continue and complete her recovery, to return to her family, to resume work and lead a normal life.     Ms. Dinoire’s problems are far from over, however. While she probably could now pass relatively if perhaps not totally unnoticed in a crowd, the lower part of her mouth still hangs a bit agape and hardly moves at all when she talks. Her speech, although understandable, is still a bit slurred. The stitch lines around the graft are not striking but still noticeable. At least three and perhaps more months will be required before these difficulties are overcome.  Meanwhile her doctors continue to monitor her carefully for any signs that her body is rejecting its new additions. Some minor signs have been noticed but have been quickly treated.     She remains for the moment in the hospital in Amiens to continue the supervision and the exercises needed to give her face muscles more mobility and her speaking ability more fluency but also to shield her a bit from the emotional burden of the press scrutiny that surrounds her.     Between the revelation of the operation in the press last December 1st and her first public appearance in February, the national and international press had debated and editorialized endlessly about whether it was ethically or morally correct to impose someone else’s image upon her. Would she be able to live with that? What if she decided she couldn’t?     All that was blown away by Ms. Dinoire’s positive attitude during her first confrontation with the some 300 reporters, photographers and cameramen.  She said, in effect, that she was getting used to and even getting to like her new face.  So there.     In retrospect, Ms. Dinoire, who lived in the north of France in the village of Marly, was extremely lucky that her accident happened within reach of the University Hospital Center in Amiens where Professor Bernard Devauchelle, the chief surgeon for her operation and a nationally renowned skin-graft specialist, practices.    Devauchelle’s preparations were painstaking. A first major problem was to convince the French medical authorities that doing the operation with skin taken from elsewhere on Ms. Dinoire’s own body, while ethically more acceptable, would, in fact, have been medically more complicated and dangerous.   He produced studies showing that such a procedure would have required seven or eight successive operations which would have left his patient, after all that, still with a deformed face and practically no nose, a much worse result.     With a team of eight plastic surgery specialists from his hospital he exercised similar care for the skin donor. Her identity remains a secret but, to honor her dignity, they carefully ensured that, after the lifting of her skin tissue, her face was restored to look as it had before.    Professor Devauchelle remains prudent.  “It’s not sufficient to give life again to a mutilated visage,”…
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