One year later

Brussels, Belgium - A year after receiving a partial face transplant, Frenchwoman Isabelle Dinoire has recovered to an "incredible" degree, one of her surgeons tells Dermatology Times. However, he says long-term risks - including graft rejection and the possible development of cancer as a result of her heavy immunosuppressive drug regimen - persist.

Ms. Dinoire was severely disfigured by her pet Labrador in May 2005. In November 2005, surgeons gave her the nasal tip, lips and chin of a deceased donor during a 15-hour operation.

As of early December 2006, she had regained complete sensation - including thermalgesic and two-point discriminative sensitivity - in her facial graft, says Benoit Lengele, M.D., Ph.D., professor of anatomy and reconstructive microsurgery at Catholic University of Louvain in Brussels, Belgium, and co-leader of the surgical team with Jean-Michelle Dubernard, M.D., and Bernard Devauchelle, M.D.

Regarding motor function, Dr. Lengele says Ms. Dinoire now can smile symmetrically and has complete active and passive lip closure. Since a February 2006 press conference, during which participants could see sagging of her lower lip due to the effects of gravity and lingering muscle paralysis, "A dramatic improvement has occurred," he says.

Ms. Dinoire's scars are "nearly invisible," partly due to several months of Endermologie (LPG Systems) treatment, Dr. Lengele says.

"The single part of the scar which remains somewhat visible is located in the submental area, where there is a very slight skin excess that perhaps we will try to improve if necessary," though the patient already is satisfied with her results, he says.

In fact, Dr. Lengele says, "She can go outside and no one recognizes her as the face transplant patient." Conversely, he says people who knew her before her disfigurement can recognize her, although Ms. Dinoire jokes that her nose now looks better than ever.

Rejection episodes

However, her recovery hasn't progressed entirely smoothly. In particular, Dr. Lengele says Ms. Dinoire suffered two rejection episodes - one in December 2005, another in July 2006. But he says physicians controlled these events - which occur commonly with transplants - with corticosteroids and increased immunosuppressant doses.

Postsurgery, he adds, "There was a period of excessive motor renervation, with an imbalance between the upper and lower lip, between months six and eight." Additionally, Dr. Lengele says it took time to restore symmetrical function to the left and right sides of Ms. Dinoire's face.

Now, however, he says surgeons plan no further surgeries on the patient. Whereas a Chinese patient who received a partial face transplant in April required a revision surgery, "We planned the operation very cautiously," he says. "We knew exactly what we needed, and everything in the flap was tailored to match exactly the defect."

Overall, Dr. Lengele says, "The results are incredible. Even we don't believe it when we see and speak to her."

Had someone told surgeons at the time of the operation that Ms. Dinoire would be doing this well, he says, "I would have said it's impossible. We would have been happy to reach 40 to 60 percent of the result we have now."

Risks remain

Nevertheless, a Nov. 28, 2006, Evening Standard article quotes Dr. Devauchelle as saying that despite doctors' vigilance, "Ultimately, her body could totally reject the tissue, meaning her face would simply fall away."