Dr Benoit Lengelé proved the critics wrong when he performed the world's first partial face transplant. However, he is not actively recruiting more patients. Erin Goldenreports
It's been almost 18 months since Dr Benoit Lengelé made headlines and stirred controversy as part of the French surgical team that completed the world's first partial face transplant. It was a risky, complex procedure that left the patient with a new face - but also with a lifetime of potential complications.
Despite the challenges and criticism, the procedure has since gained credibility. In the months after Lengelé, head of the department of plastic and reconstructive surgery at the Catholic University of Louvain in Brussels, and his team replaced the missing chin, lips and nose of a 38-year-old Frenchwoman with those of a brain-dead female donor, similar surgeries have been performed in Paris and China.
In addition, a team in Britain led by Irish-born surgeon Dr Peter Butler has received permission to perform full face transplants at the Royal Free Hospital in London.
If needed, Lengelé is willing and able to do it again; the French government recently issued his team permission to perform at least five more of the transplant procedures.
"If we have the indication we will do a larger transfer, or perhaps a smaller transfer," he says.
But in a recent visit to Dublin for a speaking engagement at the Craniofacial Society of Great Britain and Ireland's Annual Scientific Conference, Lengelé said unlike other leaders in the field, he was not actively recruiting patients.
The surgery on the first patient, dog bite victim Isabelle Dinoire, required careful consideration and months of co-ordination between specialists.
"We were thinking about the possibility of using several types of composite tissue transfer to refer face defects in severely disfigured patients, working on that topic in our laboratories," he says. "It was a meeting of two teams: a team that had performed a hand transplant and our team in Amiens who had a big retrospective experience of taking care of severely disfigured patients."
The successful completion of the first transplant has generated a great deal of interest in Lengelé and his team.
But he says the procedure requires a specific type of patient with very particular needs.
"Patients come into our centres and we examine them and analyse the situation. Some of them are good candidates, but many of them are not - they are candidates for other kinds of reconstruction, for traditional tissue transplant."
Patients left scarred by cancerous tumours, for example, have to be turned away. The time-consuming follow-up for a face transplant procedure includes ongoing immunosuppressive treatments that would interfere with the treatment of cancer.
According to Lengelé, the first face transplant recipient is doing better than expected but her condition has to be constantly monitored. "She comes weekly to the hospital to show her face graft," Lengelé says.
"And she is doing blood tests and taking immunosuppressive treatments. The treatments have to be altered based on the results of the blood tests. It's simply what she has to do."
Though the red scars of surgery are still visible across her chin and cheeks, Dinoire has now recovered full sensitivity in the transplanted portions of her face and can now speak, eat and even smile, actions that were impossible before the surgery.
"Ms Dinoire is doing fine - she has found a job, working half-time, and that's proof she's integrated into a normal life," Lengelé says. "She's able to go out to a party with family or friends, go to the bar or to the shops."
Before Dinoire's surgery, many in the medical profession and elsewhere called the decision to proceed with the transplant unethical. And although he proved the critics wrong, Lengelé says he understood the concern.
"There was a lot said in the press by so-called experts and doctors, real experts, but they did not know the reality of the procedure," Lengelé says. "They raised questions, but that's normal. They raised questions because they didn't know."
Much of the initial criticism, however, stemmed from concerns about the risk of complications from after-surgery treatment - concerns that Dinoire and her doctors have had to face. But Lengelé says that the risk is far outweighed by a second chance at a normal life.
"There are so many people living with a liver transplant, with a pancreas transplant, and that's not a problem for them. There is a cost-benefit balance between the benefit offered by the face graft and the cost of sustaining the treatment that may generate complications. And for the moment, at least, the balance is very positive for the patient."
And while the next phase of his patient's recovery remains unknown, Lengelé believes strongly in the promise of the transplant technology.
"We will never be sure of the future, as with any transplanted patient," he says. "A heart transplant patient may do very well for more than 10 years and then develop a chronic rejection, but during those 10 years he had a good quality of life. So even if we face a problem, the time that has been gained has been gained."