||Face-transplant patient is smoking
Surgeons worry cigarettes may undo their work
By Carla McClain
The world's first face-transplant patient is using her new lips to smoke cigarettes, alarming the French surgical team that performed the pioneering surgery in November.
The toxins in the cigarette smoke could impair blood circulation vital to the fragile, newly transplanted facial skin, taken from a brain-dead donor, her doctors said Wednesday.
Smoking also could trigger yet another episode of skin rejection for the 38-year-old Frenchwoman, a former smoker who resumed the unhealthful habit within a month of getting her new face.
Traumatically mutilated in a mauling by a dog last June, the woman lost the lower half of her face, leaving her unable to swallow, chew or speak. Those functions are returning now, along with sensation, in the transplanted nose, lips and chin.
But the smoking — a habit much more accepted in France than in the United States — "is a problem," said Dr. Jean-Michel Dubernard, the French surgeon who led the pioneering five-hour transplant, which was performed Nov. 27 in Amiens, France.
Speaking at a Tucson press conference, Dubernard presented his team's first report on the revolutionary surgery at an international meeting of groundbreaking tissue-transplant surgeons and physicians held this week at Loews Ventana Canyon Resort.
Despite the smoking concern, Dubernard described his patient — known only as "Isabelle" — as "doing fine" and "very satisfied" with the transplant results.
In fact, the world will get its first look at Isabelle "within weeks," he said, noting that the "media onslaught" over her new face has been almost as tough a challenge as the extraordinarily complex surgery itself.
"There has been intense pressure at a time of much stress," Dubernard said. "We don't want to traumatize her — we want her to be free, walking the streets.
"But presenting her to the world, it is a necessity. Not next week, but yes, within weeks, the world will get a look at her."
Isabelle actually has taken several public walks in recent weeks without attracting any unusual notice — a "very happy" achievement for a woman so hideously disfigured that she never ventured out without a mask, Dubernard said.
"These are severely, severely disfigured patients who do not go out of their houses," said Dr. Maria Siemionow, a surgeon at the Cleveland Clinic in Ohio, who is now on track to do the first face transplant in the United States.
"We are trying to bring them a normal human look. They are people who would just love to be less visible in the world."
Flooded with calls from traumatically injured or burned victims asking about the chances of undergoing such a transplant, Siemionow has narrowed her list of candidates to 15. But she would not say when the surgery might take place.
"There are many obstacles to doing this, and we are going through a very thorough selection process," she said. "We are looking for patients who have exhausted all options for facial reconstruction, who are psychologically stable, and who can be compliant with a difficult post-transplant regimen."
One of those candidates apparently will not be Jason Schechterle, the Phoenix police detective who lost his ears, eyelids and all but a stump of his nose after his police cruiser erupted into a fireball in a 2001 crash. To save his life, burn surgeons were forced to strip off most of his face.
Contacted a couple of years ago by an unidentified team of U.S. surgeons trying to gauge interest in face transplants, Schechterle never responded to its questionnaire.
"I wouldn't go through the pain, the recovery and hoping that it worked — all the chances that it wouldn't," he told The Associated Press recently.
"What for? Some people whose appearance is not socially acceptable, they've been deeply affected by that. This, to me, is who I am now."
Besieged by media demands for a look at Isabelle, her surgical team so far has refused to release graphic photographs of her grisly injuries and of her new face.
Isabelle herself, however, recently did accept 3,000 euros — about $3,600 in U.S. money — for pictures taken before the dog mauling, Dubernard said.
In trying to describe her new look, her plastic surgeon said she "does not have the identity of her donor, and not exactly the identity she had before her injuries."
"Her identity will depend partly on the mobility of her face, and on her underlying bone structure," said Dr. Bernard Devauchelle, the French plastic surgeon who performed a large share of the transplant operation.
"It's really too early to say what her identity will be."
Although members of the French team have said they are planning to perform five more face transplants in the near future, experts at the conference acknowledged that it is much harder to find face donors than organ donors — one major factor limiting this kind of transplant.
"Tissue donation is more invasive than organ donation, and a lot of families simply draw the line; they stop at organ donation," said Paul O'Flynn, executive director of Kentucky Organ Donor Affiliates, who is working with another U.S. team gearing up for a face transplant at the University of Louisville.
The idea of allowing surgeons to remove a patient's face right after brain death is likely to rattle a family much more than the taking of internal organs.
"We have found that there is a small, select group of potential donors willing to go that far," O'Flynn said. "I never cease to be amazed at the generosity of these people."