SURGEONS announced the world’s first face transplant yesterday. A French woman who had been disfigured in a dog attack received a new nose, lips and chin from a donor.

The operation reopened a debate on the ethics of facial transplants, which can be psychologically difficult for the patient.

Professor Jean-Michel Dubernard, regarded as the most eminent surgeon in France, led the operation on Sunday and Monday and was said to be delighted at the outcome.

The 38-year-old patient is expected to stay in hospital for several weeks in case of infection or rejection of the donor tissue. The partial face transplant included muscles and blood vessels from the donor, who had died at a hospital in the northern French city of Lille. Scarring of the recipient was minimised by running grafts along the edges of the nose and “naso-labial groove” between the lips and nose.

Both lips and part of the nose of the patient, from Valenciennes, in northern France, had been torn off in the dog attack, said to have taken place in her home after a fall. It was difficult for her to eat or speak and in August the French Organ Procurement Agency authorised a transplant. Until then the French ethical authorities, like those in Britain and the US, had blocked facial transplants on the ground that the risks, especially of psychological damage, were too great.

Philippe Domy, directorgeneral of Amiens University Hospital, said: “This operation is a breakthrough for surgical techniques. Until now the French National Consultative Committee on Ethics has had reservations about face grafts and said they could be undertaken only when there was not only an aesthetic injury but also difficulty in swallowing, eating or talking.

“This was the case here, and it is important to understand that it was an exceptional response to an exceptional situation.”

Professor Dubernard, head of the Department of Transplantation Surgery at Lyons University Hospital, and Professor Bernard Devauchelle, the head of the Department of Maxillofacial Surgery at Amiens University Hospital, carried out the operation in Amiens.

Professor Dubernard’s reputation and experience are believed to have been instrumental in obtaining the authorisation. He carried out Europe’s first pancreas transplant in 1976, the world’s first hand transplant in 1998 and double hand and wrist transplant two years later.

The Royal College of Surgeons advised in 2003 that it would be unwise for British doctors to attempt face transplants yet. Its views are not binding but would be taken seriously by hospital ethics committees.

The chief medical risk comes from the immuno-suppressant drugs that the patient has to take to prevent rejection.

Scientists had thought that high doses would be needed for transplants involving skin, but experience of hand transplants suggests not. Of 24 hand transplants worldwide, involving 18 patients, only two failed. If the face transplant is rejected, it should be possible to remove it and try again. Many ethicists are anxious about the psychological impact of a failed transplant, and there are concerns about how a patient would cope with a new appearance.

Contrary to the impression given in the movie Face/Off, in which the stars, John Travolta and Nicolas Cage, swap appearances, the recipient of a face transplant would not bear a close resemblance to the donor.

In Britain, word that the first partial transplant had taken place received a mixed reception. It was widely hailed as a medical breakthrough. However, serious concerns about the implications were raised.

Peter Butler, a surgeon who is planning full-face transplants at the Royal Free Hospital in London, said: “The patient appears to be an excellent candidate and I have no doubts about Professor Dubernard’s technical abilities. The prognosis should be pretty good.”

A consultant facial surgeon, Iain Hutchison, chief executive of Saving Faces — the Facial Surgery Research Foundation, said: “All medical advances are to be celebrated, but this operation throws up many moral and ethical issues. The recipient chose to take the risk of the operation failing. She could be back to square one without a face, needing further reconstruction operations.”

Brendan Eley, the chief executive of The Healing Foundation, described facial transplantation as “exciting and fast developing” but called for further research before it is allowed in Britain.

Stephen J. Wigmore, the chair of ethics at the British Transplantation Society, said: “Facial appearance is closely associated with an individual’s sense of personal identity. The recipient of a face must adapt to this new identity as well as to other people’s responses to it.”

ABOUT-FACE

2002 French National Consultative Committee on Ethics rules that face transplants should be conducted only in exceptional cases

2003 Royal College of Surgeons tells doctors not to attempt face transplants until the procedure and its impact are better understood

July 2005 Hospital in Ohio, gives permission for full-face transplant

November 24-25 First partial face transplant operation at Amiens is deemed successful

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