(CNN)Seven years ago, Carmen Tarleton received a face transplant, a decision she made after her estranged husband attacked her in 2007 with a bottle of lye, disfiguring her face beyond recognition. The transplant was a grueling, complex, surgical procedure -- one that ultimately proved unsuccessful.
She is the first American to get a new face twice
But last month, Tarleton, a 52-year-old former nurse, chose to do it again, making her the first American and only the second person ever to undergo the procedure twice.
The surgery, which took place at Boston's Brigham and Women's Hospital in July, involved more than 45 clinicians over the span of approximately 20 hours, according to a hospital news release.
"That first face transplant served me very well," Tarleton, who is recovering from her home in New Hampshire, told CNN. "And when it started to fail I just knew from experience that a face transplant gives me the comfort and function I want and need on a daily level -- that I'm going to live a better life with a face transplant."
Now, she said, "all the pain I had in my failing face is gone." Since the operation, she said she's experiencing only "incisional and swelling" related pain.
Her doctors agreed that the recovery is going smoothly.
"Carmen is progressing and recovering very nicely with this second transplant -- she is one of the most resilient patients that I have had the opportunity to care for," Dr. Bohdan Pomahac, Brigham's director of Plastic Surgery Transplantation who led the effort, said in the release. "We call this procedure live-giving, and we are thrilled to offer her the opportunity to return to the type of life that she so richly deserves."
Tarleton's first face transplant proved ultimately unsuccessful because her body had started to reject the donor tissue, causing scarring, tightness, swelling, and pain, she and the hospital said.
In 2007, her estranged husband attacked her with a bottle of lye, severely burning 85% of her body and disfiguring her face.
Because she became sensitized by the lifesaving blood products and tissue grafts to treat her burns, Tarleton became more immunologically likely to reject the first transplant, the hospital said.
"Going into her second face transplant, Carmen was not highly sensitized, not at high risk of rejection, as she had lost nearly all of the HLA antibodies in her blood that had made her previously highly sensitized — likely due to the immunosuppression she had received during the first transplant," Dr. Anil Chandraker, a member of the transplant team, said in a news release.
This time around, Tarleton had an "unusually close tissue match" from the donor, the hospital said.
The tissue was so remarkably close that it was a "better match than you would find in your sibling," Dr. Pomahac told CNN.
The latest operation also may be a new approach for future face transplants, according to Dr. Pomahac.
The surgical team opted to pause the transplant roughly 15 hours into the procedure in order to manage blood loss, which can make blood clotting more difficult, the hospital said.
Dr. Pomahac said that the choice to pause the operation, which was not planned, had also allowed a fresh team to do the most important and complex part of the operation -- the inset -- when blood vessels are reconnected and the tissue around the nose, eyelids, and lips are realigned.
The team finished the inset the next day.
"It was tough," said Dr. Pomahac, when asked how difficult the decision was to go forward with the second face transplant.
Though he they had weighed whether to do a conventional facial reconstruction, Dr. Pomahac said they decided to go ahead after Tarleton had emphasized how much the first face transplant had improved her quality of life.
The pandemic also complicated the situation too, he said.
All elective surgeries were put on hold, not to mention all transplant surgeries since donor tissue was not routinely tested for Covid-19 at the time. There were also issues related to having team-members from out of state who could have been coming from other viral hotspots, said Dr. Pomahac.
Brigham and Women's Hospital has performed of 10 of the 16 face transplants in the country. Doctors in Paris, France performed the first two-time face transplant on Jérôme Hamon in 2018.
"One can hope for a transplant to last a patient's lifetime, but realistically speaking, every type of transplant has a finite lifespan," Dr. Pomahac said in a statement in the news release.
While Tarleton is recovering well, the long term survivability of the transplant remains to be seen, he said.
The next milestone, recovery of facial function, takes typically three to six months and continues to progress thereafter, he added.
Tarleton, who became a public speaker after her transplant, said she has "no regrets" about the first face transplant and hopes to reach her goal of working six hours a day within three weeks.
"This face transplant is lighter, smaller, and fits my head better," she continued. "My blindness keeps me from seeing big details, but when I look in the mirror I can see that I have a different face. It looks paler than my first face."
Tarleton said she remains good friends with the family of her original donor.
Due to the pandemic, she's remained socially distant -- so she's been FaceTiming with loved ones who are still getting used to the new Carmen.
"My sister says, 'I'm just staring at you so my brain knows that it's you,'" said Tarleton. "I look more like I looked before I was burned."