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Nothing without a face: Surgeon talks about landmark transplant

Famed transplant surgeon Jean-Michel Dubernard is flipping through slides of his celebrated patient, Isabelle Dinoire, the first woman in the world to receive a face transplant. Dinoire, whose face was mauled by a dog, is trying to coax her new muscles into smile, then gazes into the mirror in surprise. "It is not her face but somebody else's," Dubernard says to a small group of Stanford transplant surgeons.

Dubernard flew in from France last night to share his remarkable experience with Stanford faculty and students. He said he initially envisioned three major challenges to the face transplant: technical difficulties, patient psychological issues and the strong likelihood that the new facial tissues would be rejected as foreign. The skin, he notes, is the most immunologically sensitive part of the body. "All of our patients have acute rejection, and after a while, there is no more," he said, as he believes the skin builds up a store of certain T-cells that no longer recognize the donated tissue as strange.

Dubernard also was the first to perform single- and double-hand transplants on patients, a procedure he called more psychologically challenging for patients but less technically difficult. "We know how to replant the hand. For the face, it's much more difficult because it depends on the kind of injury." For instance, an explosion may destroy the underlying bone, which provides the foundation for the facial structure, he said.

Since his landmark face transplant in 2005, there have been at least seven other procedures done: one in China, two in the United States and four others by a separate team in France, said Dubernard, who has established an international registry of face transplant patients. He said he has two other patients waiting for the procedure, but that it is hard to find donors. They have to be matched immunologically, as well as for skin complexion, size and age, he said. "We are just at the beginning of this new experience," he said.

As for Dinoire, she continues to do well, despite episodes of rejection. "They gave me an identity," she says to the camera. "Because when you have no face, you have nothing."

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