Key figures: Bernard Devauchelle (Centre Hospitalier Universitaire d’Amiens), Benoît Lengelé (Université catholique de Louvain), Jean-Michel Dubernard (Hôpital Édouard Herriot, Lyon), Isabelle Dinoire (patient)
Summary
On November 27, 2005, a surgical team in Amiens, France, performed the world’s first partial human face transplant, grafting a triangle of central and lower facial tissue — the nose, lips, and chin — from a brain-dead donor onto Isabelle Dinoire, a 38-year-old woman whose own face had been severely disfigured earlier that year. The roughly fifteen-hour operation was led by maxillofacial surgeon Bernard Devauchelle and reconstructive surgeon Benoît Lengelé, with Jean-Michel Dubernard — who had led the first human hand transplant in 1998 — contributing the transplantation-immunology expertise. The case marked the first time vascularized composite facial tissue from one person had been transplanted to another, and it opened a new branch of reconstructive surgery while provoking sustained ethical debate.
Background
In May 2005, Dinoire lost the distal part of her nose, both lips, her chin, and adjacent parts of her cheeks after being mauled by her dog while unconscious. The injuries left her unable to speak clearly or eat normally, and conventional reconstruction using the patient’s own tissue (autologous grafting) was considered incapable of restoring an acceptable appearance and function for an injury of that extent. Face transplantation had been discussed in the surgical literature for several years — notably in a 2002 proposal by the British surgeon Peter Butler — but no team had yet attempted it on a human, in part because of the ethical and immunological risks involved.
The Operation
The transplant was carried out at the Centre Hospitalier Universitaire (Amiens-Picardie University Hospital) in Amiens. Surgeons recovered a triangular segment of central and lower face from a brain-dead female donor and reconnected it to the recipient: the right and left facial arteries and veins were re-anastomosed to restore blood flow, the oral and nasal linings were repaired, sensory nerves were joined to give the graft feeling, and the facial muscles were reconnected to a motor branch of the facial nerve to allow movement. The donor tissue had an ischemic time of roughly four hours before revascularization. Because composite tissue grafts of skin are highly prone to immune rejection, Dinoire also received infusions of donor bone-marrow cells alongside a regimen of lifelong immunosuppressive drugs.
Outcome
Within the first year Dinoire regained sensation in the grafted region and the ability to eat, speak, and smile, and the early clinical results were published in The Lancet in July 2006. She experienced two acute rejection episodes — one about a month after surgery and another roughly a year later — both controlled with adjusted immunosuppression. The lifelong drug regimen carried serious side effects, including kidney impairment and an elevated cancer risk. A chronic rejection beginning around 2015 progressively reduced the function of her lips. Dinoire died on April 22, 2016, at the age of 49, from cancer linked to her long-term immunosuppression; the death was announced publicly in September 2016.
Significance
The Amiens operation established face transplantation as a clinically feasible procedure and demonstrated that vascularized composite allotransplantation could restore both appearance and function where autologous reconstruction could not. It also intensified an ethical debate that had preceded it: critics questioned whether the lifelong risks of immunosuppression were justified for a non-life-saving, quality-of-life procedure, and whether a severely injured patient could give adequate informed consent. The case nonetheless became the reference point for the field, and over the following two decades roughly fifty face transplants were performed worldwide, with programs in France, the United States, Spain, and elsewhere refining patient selection, surgical technique, and long-term immunological management.