Three years after the world’s first partial face transplant, significant progress has been made with two further successful operations.

A 30-year-old man who had part of his face torn off by a bear and another with a disfiguring tumour have had their quality of life transformed after partial transplants using tissue from deceased or comatose donors, surgeons in China and France report.

A French woman, Isabelle Dinoire, received the first partial face transplant in 2005 after she was attacked by a dog.

British surgeons are among those aiming to conduct the world’s first full-face transplant but this procedure would carry significant ethical and psychological risks, experts say.

The surgeons, writing today in The Lancet medical journal, said that partial face transplants can restore sensation, movement and communication for injured or paralysed patients up to two years after surgery.

There are risks, however, and any candidates would have to take powerful drugs for the rest of their lives to stop their immune systems rejecting the new tissue, they said.

In one case an unnamed patient from a remote village in Yunnan province, south China, was attacked by a bear in October 2004 and lost his left eye, nose and much of his upper lip and left cheek. Doctors decided to go ahead with a face transplant after an initial attempt to repair the damage with tissue from the patient’s left forearm failed. The face donor was a 25-year-old man who had died in a road accident. After consent was obtained from his family, the operation was performed in April 2006.

Shuzhong Guo, from Xijing Hospital and Fourth Military Medical University in Xi’an, Shaanxi province, led the team of surgeons. During an 18-hour operation they reconnected blood vessels and nerves, and repaired the nose, lip and sinuses. Four drugs were used to suppress the patient’s immune system and to decrease the chances of tissue rejection. Other drugs were given to prevent infection.

Dr Guo said: “After transplantation, the patient’s facial appearance was greatly improved . . . the patient was able to eat, drink and talk normally.”

Eight months after the operation, the man was able to feel heat and cold on the transplanted side of his face, he added. Dr Guo said that the patient’s body tried to reject the donor tissue three times, at three, five, and seventeen months after transplantation.

While these reactions could be controlled, the required drugs have side-effects that carry an increased risk of cancer and other diseases, the researchers say.

In a second case a French team was able to help a 29-year-old man with a massive tumour known as a neurofibroma that disfigured and paralysed the middle and lower parts of his face.

The donor was a brain-dead patient with a beating heart. The operation, led by Professor Laurent Lantieri, from Henri Mondor University Hospital in Creteil, France, took place in January last year and lasted 15 hours. The patient made a good recovery and began full-time work 13 months later.

Facial transplants have sparked an ethical debate because of the risks when the condition is not life-threaten-ing, problems of tissue rejection and issues for a donor’s family.

Peter Butler, clinical director of surgery at the Royal Free Hospital in Hampstead, North London, is among those hoping to attempt the first full-face transplant. Ethical permission has been obtained from the hospital and he hopes to carry out the operation within 12 months.

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