2 years after face transplant, doing well

WASHINGTON - A French woman who two years ago became the first person to receive a face transplant has recovered with remarkably good aesthetic results and has gradually regained normal skin sensation and control of her facial muscles, doctors reported yesterday.

Isabelle Dinoire, who at age 38 lost her lips, cheeks, chin, and most of her nose when she was mauled by her dog, now blends into crowds and attends parties comfortably with the face she got from a 46-year-old brain-dead donor, which was attached like a mask in a landmark 15-hour surgery.

Her recovery has at times been harrowing. Twice her immune system has mounted violent reactions against the new tissue, one of several anticipated risks that had led some to question the wisdom of the surgery. The immune-suppressing drugs she must take for the rest of her life have also wreaked havoc, causing infections and, at one point, kidney failure.

But Dinoire is "very satisfied" with the outcome, the medical team reports in today's New England Journal of Medicine. And although some experts remain uncomfortable with the experiment, some early critics say they are impressed.

"They proved me wrong," said Peter Butler of the Royal Free Hospital in London, who is organizing a slower paced effort to transplant faces in England.

The full circumstances of her injury remain mysterious, but the result was devastating. Lacking lips and key muscles, she was fed through a tube.

At the time, teams in several countries were developing plans to transplant faces, raising concerns among ethicists and others that a race-to-be-first was underway. Critics said the risks - including the possibility of total rejection, leaving the person worse off than before - were not justified to fix a non-life-threatening injury.

Others wondered about the psychological impact of wearing another's visage, given the import of the face as a core element of identity.

But with Dinoire's consent, much of the donor's face - a triangular swatch of skin, including lips, muscles, nerves and blood vessels - was microsurgically attached.

She has learned to make expressions, eat, drink and enunciate. A video shows her progress; photos show that with makeup there is virtually no evidence of the trauma.

"It is a success," her surgeon, Jean-Michel Dubernard, said in France. "It gives hope to patients with total disfigurement."

Several experts said they still had concerns - about Dinoire's immune-system response and about the lack of a formal psychological evaluation that would shed light on whether she has truly accepted her new face.