THE case that Mr Butler is said to have in mind for Britain’s first face transplant is not comparable to that carried out on Isabelle Diniore. She had a partial face transplant: her eyes may have suffered from the mauling from her dog but they were not part of the operation.

When you look at another person you concentrate on changes of expression in the triangle of the face that extends from the line across the eyebrows, with the other two sides encompassing the eyes before meeting at the mouth.

Mr Butler is thought to be intending to carry out a total, or pan-facial, transplant. The bony infrastructure of the face will be left much as it is but the skin and the layer of connective tissue and fat beneath it will be transplanted, possibly also with muscle and a nerve supply. Establishing the blood supply to the grafted tissue is relatively simple. It is the development of the nerve supply to the transplanted area that is problematical.

As with any transplant, rejection and infection are the initial fears. Because the patient is having high doses of immuno-suppressive therapy they are at immediate risk of bacterial and viral infections. Both infection and rejection will be hovering in the wings for the rest of the patient’s life.

The two cancers that transplant patients are most likely to contract are non-Hodgkin’s lymphoma and skin cancers. Fifty per cent of those who have a transplant suffer skin cancer within 20 years, but most of these can be dealt with as they occur. The nonHodgkin’s lymphomas, usually beta-cell, affect 1 per cent of those who survive the transplant each year. This can prove more difficult to treat than beta-cell lymphoma in other patients with a normal immune system.

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