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Transplant patient says she's ready to face the world

By Alison Daniels for CNN
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LONDON, England -- Talking publicly a year after having the world's first partial face transplant, Isabelle Dinoire declared: "It may be someone else's face, but when I look in the mirror, I see me."

French woman Dinoire says normal feeling has returned to her new face. She is ready to face the world again and even plans return to work.

Five more similar operations are planned in France, and United Kingdom surgeons hope to be given the go-ahead within weeks to carry out four full face transplants.

Nevertheless serious questions remain about whether the procedure is really in a patient's best interests.

Dinoire, 38, found herself in the eye of an ethical storm after she underwent a pioneering operation to replace part of her face that had been savaged by her pet dog.

Instead of reconstructive surgery, French surgeons Dr. Jean-Michel Dubernard and Dr. Bernard Devauchelle decided to carry out an operation to stitch on a nose, chin and mouth from a brain-dead donor.

The operation sparked controversy in France centered on the ethics of transplanting a face before attempting reconstructive surgery.

For most the question was less about surgical protocol but the wider psychological impact of facial transplants.

Since Dinoire was given the lower part of a face taken from a woman who had committed suicide, only one other face transplant has been attempted.

What about the issue of identity transfer? If a loved one donated their face would the recipient look like the dead donor? And conversely, would the recipient be able to cope with looking like someone else?

The outline of Dinoire's transplanted face is clearly visible but she is still recognizable.

Dr. Peter Butler, leading a UK research team into facial transplants told a BBC documentary. "If you take the skin envelope off the face and put it onto facial bones, it will deform around those facial bones and actually give you most of the features of the recipient not the donor."

Surgeons Dubernard and Devauchelle, have declared her recovery a "huge clinical success." They argue that they are not philosophers but men of medicine. The frontiers transplant surgery are continually being stretched. For example surgeons have already predicted that womb transplants for infertile women are only two years away.

But the medical profession is divided over the high risks associated with a procedure which is not ultimately necessary for a patient's survival. It has been predicted that up to half of patients could reject their new face within a year.

If the procedure fails the patients will be considerably worse off than before the operation. It is intended that transplants would be carried out on patients with severe disfigurement. In order to perform the surgery the skin and most of the soft tissue left on the face has to be cut away. If the new face then has to be removed, the patient will be even more disfigured than before.

There is also the risk of cancer caused by the immunosuppressants needed to prevent organ rejection. Is it ethical to give a patient drugs that could cause death in the treatment of a non-life threatening condition?

Dr. Iain Hutchinson, a facial surgeon at Barts Hospital in London told CNN that Dinoire's progress must be monitored closely. "She is doing well and she and the surgeons have been brave. But the risks continue. The risk of malignancy remains and there are still her psychological feelings and those of her family.

"We've been using the drugs for 30 years, we've used the surgical procedures for 20 years. The plunge into the unknown is the psychological factor."

Two years after having a hand transplant New Zealander Clint Hallam asked surgeons to remove it. He said he felt psychologically detached from the hand, which came from a dead motorcyclist, and that the hand felt like a dead man's hand with no feeling in it.

Having said that, when Dr. Christiaan Barnard pioneered heart transplant surgery in South Africa it was described as an "unnatural" development. Heart and lung transplants are now routine.

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Isabelle Dinoire's face transplant has given her the confidence to return to work.

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