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Face transplants: Success abroad, but not yet in Britain

Fergus Walsh | 19:07 UK time, Monday, 26 July 2010

OscarIt is five years since Isabelle Dinoire became the first person in the world to have a partial face transplant. That breakthrough inspired teams in the US, Spain and China to perform even more complex surgery. Last year, Connie Culp, left disfigured after being shot by her husband, had 80% of her face replaced by doctors in Ohio.

Then, in April this year, a team in Barcelona announced they had carried out the first full face transplant. That patient has now been named, simply as Oscar, to protect his identity, and he has appeared in public for the first time.

It must have taken great courage to face the world's TV cameras and photographers. Oscar's face is still very swollen and he can't completely close his mouth or eyes. But despite two bouts of acute transplant rejection, doctors say he is ready to be released from hospital.

Oscar's sister said his ambition was to lead a normal life; to be able to walk down the street without anyone looking at him. It is the same thing that Connie Culp and Isabelle Dinoire said after their surgery. Photographs of Dinoire taken just after surgery and then a year later show a significant improvement and suggest that ambition is realistic.

Isabelle DinoireBefore Isabelle Dinoire's operation, many thought face transplantation was a bad idea. There were doubts about the ethics and the practicalities. Recipients have to take immuno-suppressants, which can be life-shortening. But for patients like Dinoire, who lived a life in the shadows, rarely going outside, it was a price they felt was worth paying. There were fears too about the psychological impact of having someone else's face. Interviews with Dinoire suggest she has got used to living with her new face, although she still regards it as not her own.

Some years ago my own features were morphed with those of the leading transplant surgeon Peter Butler. The aim was to give an idea of what I might look like if I received his face in a transplant operation. It was done for a news story, but also to help give potential recipients and donor families an idea of how face transplantation might alter someone's appearance.

The end result was something that looked more like me than the surgeon, which was good news for the team at the Royal Free Hospital. It demonstrated that a person's face shape is largely determined by their underlying bone structure, rather than the skin envelope. Since then, the Royal Free team has used the animation as part of its assessment process in selecting patients.

But as yet no patient in the UK has had a face transplant. This is despite the efforts of Mr Butler, who is now professor of plastic and reconstructive surgery. He has been researching face transplants for 17 years, long before it became a reality elsewhere.

Professor Butler set up a charity, The Face Trust, to look at research into surgical treatments for patients with severe facial injuries. He and his team have ethical approval to carry out a full face transplant for a patient with severe burns.

A spokesman for the Face Trust told me that the team had been looking for donors for more than six months but had yet to find a match for any of their patients.

It seems only a matter of time before this innovative surgery is carried out in Britain. But for the moment, surgeons and patients here must continue to wait.


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