First Partial Face Transplant – 2 Year Follow-Up

In November 2005, Isabelle Dinoire, a 38-year-old woman whose face was mauled by her dog, received an historic face transplant at the Centre Hospitalier Universitaire d’Amiens in France. Two years later, her doctors have published a follow-up study of her case in the New England Journal of Medicine.

According to the NEJM article, Mlle. Dinoire “the patient is very satisfied with the results of the transplant”. She is able to eat, drink, and speak normally; it is said that, with make-up, her surgical scars are no longer evident. The results do appear to be remarkable:

The picture on the left is NOT a post-transplant image; it’s from 2001, four years before the face transplant, when Mlle. Dinoire was 34 years old. The middle picture is from November, 2006, one year post-transplant. The right picture is of Mlle. Dinoire in June, 2007, eighteen months post-transplant, showing her natural face, without make-up.

The post-surgical journey has been difficult. Mlle. Dinoire has suffered several bouts of rejection and one of kidney failure. She has battled infections; she must, of course, take immune-suppresents for the rest of her life. The return of functional abilities has exceeded expectations, though. This chart (left), from the New England Journal of Medicine, tracks the changes throughout the first six months; her abilities now far exceed those noted here.

Mlle. Dinoire’s case is controversial for many reasons. One of her doctors initially reported that she had attempted suicide; Mlle. Dinoire herself confirmed this in an interview with a London newspaper. Her injuries occurred when her dog was trying to rouse her from unconsciousness following the drug overdose. (Her donor did commit suicide, adding another layer of emotional complexity to the case.)

Mlle. Dinoire, a single mother, has a history of depression, and had been unemployed for a year prior to the incident. Criticism has been leveled at her doctors, who, some feel, may have chosen a particularly vulnerable patient for this historic operation.

Long-term, the physical problems alone may prove overwhelming. Notes The Washington Post:

Maria Siemionow, director of plastic surgery research and training at the Cleveland Clinic, which has been planning to do face transplants, expressed concern about Dinoire’s “unexpectedly aggressive immune response.” Scientists need better ways to prevent rejection of large, complex tissues such as faces, she said.

Siemionow, along with others, also expresses concern about the psychological implications; no psychological study has been published in connection with Mlle. Dinoire’s treatment.

British filmmaker Michael Hughes has made a documentary of the surgery; Mlle. Dinoire allegedly signed a deal for movie rights to her story earlier this year, netting (according to one account) over $400,000 (USD). The Hughes documentary is reviewed here (in French).

Whether Mlle. Dinoire’s pioneering venture will prove worthwhile over time remains to be seen. The potential scope of this experiment is breathtaking, yet it cannot help but recall the innocence and irony of Miranda’s words in Shakespeare’s Tempest: