BRITISH surgeons have been given permission to carry out the world’s first full-face transplant.

A team led by Peter Butler of the Royal Free Hospital, in London, will start to select patients for the pioneering operation now that the hospital’s research and ethics committee has given its approval.

The operation could take place in the next six months, but Mr Butler said that there would be no needless haste.

“This is a new and important way of helping people with terrible facial injuries and we will continue to take infinite care to ensure the best results,” he said.

The patient chosen will be no stranger to surgery. “It will be somebody who has had 50 to 70 reconstructive operations but has been left with a face that is covered with scar tissue and doesn’t function well,” Mr Butler said.

“They have reached the end of the reconstructive ladder and there’s nothing more it can offer them. They have the problem of being able to walk down the street without anybody staring at them. That’s all these people want — to be normal.”

Psychological factors would be more important in selecting recipients than surgical ones, he said. “We will be looking for a patient who is psychologically robust and able to handle the process and the issues that arise afterwards.”

The operation will involve two teams of surgeons, one removing the face from the donor and the other preparing the recipient. It is expected to take 12 hours and will involve the transplantation of skin, fat, and supporting blood vessels.

Since Mr Butler first suggested the possibility of a face transplant in Britain four years ago he has been approached by 34 potential patients. He expects those who are still interested to get in touch again. He will not be contacting them as he believes that this would put undue pressure on them to take part in a procedure that remains risky.

The patient chosen is likely to have suffered facial damage as a result of a burn, an accident, or necrotising fasciitis, the “flesh-eating bug” that eats away at tissue. Mr Butler thinks that a patient damaged by cancer is less suitable, and he will not consider children.

“We won’t be looking at children because they still have a lot of growing to do,” he said The recipient will not acquire the appearance of the donor because most of the facial characteristics are those of their underlying bone. “There will be a transfer of skin colour and hair colour, but you would not be able to tell it is the donor’s face,” Mr Butler said.

Two partial face transplants have already taken place, in France and China. Isabelle Dinoire, who was 38, had her nose, lips and chin replaced in an operation last year. And in April this year a hospital in China conducted a partial face transplant on Li Guoxing, 30.

The Royal Free Hospital’s operation will be different as it involves the entire face. Mr Butler and his team will remove the skin from the donor and use it to replace the skin of the recipient. As far as possible he will avoid transplanting nerves and muscles, but the detail of the operation will depend on the characteristics of the recipient.

Facial function will return because the damaged skin and scar tissue that restrict movement will be removed and the patient’s muscle will then be free to move.

After the operation, the patient will have to take immunosuppressive drugs to prevent rejection of the new tissue. “One of the key factors in choosing a recipient will be to judge compliance,” Mr Butler said. “Will they take the drugs long term? The group we are looking at have already had a lot of experience of medical treatment, so we’ll be able to assess this.”

To begin with, four patients will be selected. When a donor becomes available — probably in the Oxford, Cambridge or North London area — the tissue will be matched by tissue type, skin tone and texture, and age to potential recipients.

Discussing the issue with the donor’s next of kin will be a tricky issue, but Mr Butler says that focus groups carried out with people on the organ donor register have been encouraging. “It’s surprising how supportive they were,” he said.

Changing Faces, the national charity for people with facial disfigurement, said it would have preferred the Royal Free ethics committee to have waited for the recommendations of a review by the Royal College of Surgeons, to be published next month.

The Royal College of Surgeons said that it still had “grave concerns” about face transplantation and advocated a cautious approach.

But Andrew Way, chief executive of the Royal Free, said: “Once again a team from the Royal Free is involved in pioneering medicine. Groundbreaking research is always difficult and there will always be doubters and detractors.”

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