Isabelle Dinoire: Saturday, 10 December 2005: Woman with a new face tells the story of a miracle. Her daughter couldn't look at her and she had to wear a mask to go out. But pioneering surgery may have changed all that. By Andrew Johnson
Isabelle Dinoire, the world's first face transplant patient, spoke for the first time yesterday of her joy and hope for the future after a pioneering new procedure that has opened a Pandora's Box of ethical and moral concerns. Amid increasing controversy in France, where the operation took place, Ms Dinoire said she had no regrets and would "do it again".
Ms Dinoire, 38, whose lips, chin and nose were destroyed by her pet Labrador, said from her hospital bed in Lyon: "It's simply amazing to see a nose and mouth on my face again. When I looked at my new face I knew straight away that it was me. I didn't have a boyfriend when I had the accident. Now, with my new face, I am more relaxed about the future. I won't need to worry. I am pleased with the way I look and how the operation has gone."
Ms Dinoire could be the heroine of a fairy-tale. Others would place her in a Victorian Gothic-horror novel. Her facial disfigurement was so terrible she couldn't bear to look at herself, or for others to see her - she removed the mirrors from her house and wore a mask in the street.
Two weeks ago, she woke up with her features restored, thanks to the pioneering surgery of a brilliant doctor, Professor Jean-Michel Dubernard, who gave her the face of a dead person. When Ms Dinoire's new lips changed their pallor from a lifeless wan to pink as her blood flowed into the alien vessels - bringing life to a dead face - there was applause in the operating theatre.
Last week, the French magazine Paris Match published pictures of the historic moment when Ms Dinoire, a divorced mother of two, received her new face - the first operation of its kind and one that could herald a brave new medical world, offering hope to thousands of disfigured people.
But there is growing unease in France over the ethics of the procedure. Critics point out that Ms Dinoire's new face is someone else's old face - and that it had to be removed while blood was kept flowing through the dead donor's body. The donor, anonymous under French law, is thought to be a suicide victim whose heart was kept pumping with a ventilator. There is concern for Ms Dinoire's psychological well-being in the future.
However, there is no doubt that Ms Dinoire, recuperating in the Edouard Herriot Hospital in Lyon, is currently happy. Her eldest daughter, Lucie, 17, told how her mother was teased and stared at when she walked in the streets of her home town - Valenciennes in northern France - after the accident.
Accounts of how or why her pet Labrador mauled her in May differ - further fuelling the controversy. At first her doctor said she had tripped over the dog, triggering its attack in which Ms Dinoire's chin, lips and part of her nose were destroyed. Another story is that she took a sleeping tablet after a row with Lucie, and the dog caused the damage to her face by pawing her while she was asleep.
Lucie said her mother took an overdose in a suicide attempt, and that the dog, which has been destroyed, mauled her in an attempt to wake her. This has led to further questions about Ms Dinoire's psychological state, and whether she is emotionally equipped to deal with the aftermath of such an operation.
"You would have to be pretty desperate to have this sort of surgery, which carries so many risks," said Dr Eileen Bradbury, a British consultant psychologist, who pioneered the psychological aspects of plastic surgery. "Should someone that desperate be submitted to it?"
Professor Dubernard, 64, fulfils the popular Victorian image of the driven, brilliant but egotistical professor who dabbles too much with nature. Three years ago, he performed the world's first hand transplant. That ended with the recipient asking for the foreign limb to be amputated.
Critics have accused him of being more concerned with winning the "face race" than with Ms Dinoire's welfare. He denies this, as well as accusations that he stole the procedure. He said he followed all ethical guidelines, was satisfied with his patient's psychological state, and planned to carry out five more operations. He dismissed criticism of a deal for the operation to be filmed, insisting all profits will go to the patient. "This was not about pulling off a stunt," he said.
Ms Dinoire's injuries were horrible. "My eldest daughter, Lucie, didn't want to see me," she said. "I had to wear a mask. If I didn't, she refused to see me. At the shops people would recoil in horror. The way people acted filled me with disgust."
It took a team of 50 doctors working for 15 hours to carry out the operation, which included the delicate sewing together of 3mm-wide blood vessels with thread as fine as hair.
First, two teams worked in parallel, one cutting away the scar tissue on Ms Dinoire's face while the other "harvested" the face from the donor - removing in one piece skin, muscles, nerves, blood vessels, lips and the inner lining of the mouth. Then the blood vessels were stitched together, beginning with the facial artery, which pumped Ms Dinoire's blood into the new face. This procedure has to be carried out within six hours or the face will die.
Next, the inner lining of the new mouth and nose were joined to Ms Dinoire's tissues. Then her muscles that move the face and the nerves, which give it sensation, were sewn together and attached to the skull using bone anchors. The final procedure involved fitting the skin over the bones and stitching it to her face.
Ms Dinoire will not look like her donor due to her different bone structure. But she faces a lifetime on drugs to prevent her body's immune system from rejecting the face - a 50 per cent likelihood within five to 10 years. This will leave her susceptible to other diseases, such as cancer. She has also received bone marrow from the donor in an effort to prevent rejection.
"It is too early to think about the future," Ms Dinoire says. "I don't want to walk alone in the street, I'm scared that people will recognise me as the woman who had a face transplant. But I regret nothing. I would do it again."
Gill Hicks: Saturday, 10 December 2005: Wedding joy just five months after losing both legs. On 7 July, on the London Tube, terrorists blew Gill's life apart. Rescue workers barely expected her to make it to hospital, but she fought back. By Tom Anderson
When Gill Hicks entered St Etheldreda's Catholic Church in central London yesterday afternoon for her wedding, the lights dimmed and the 300 guests fell silent.
As Handel's "Eternal Source of Light Divine" struck up, the bride walked carefully down the aisle with her brother Graham by her side, looking resplendent in her white high-collared dress and jewel-encrusted tiara.
For Gill, who lost both her legs in the terrorist bombings of 7 July, her appearance was the fulfilment of a promise to herself as she lay in hospital in the dark hours following the explosion that ripped through a Piccadilly Line Tube train near King's Cross Station and almost killed her.
That she was there, on prosthetic limbs, was a testament to her remarkable resilience - illustrated by the fact that she tied her own tourniquets with a scarf when she realised the extent of her injuries. Her determination saved her life on the day that four suicide bombers killed 52 people on London's transport system.
Her wedding to her fiancé, Joe Kerr, 47, had been booked before the outrage. The medieval church in Holborn, one of the oldest in London, is only a mile or so away from Russell Square Station where the now Mrs Kerr was the last person to be brought to the surface alive. The carnage was described by rescue workers as a "scene from hell".
Planned though it was, some extra names had to be added to the wedding guest list - the rescue and medical staff who saved Mrs Kerr's life. They included the British Transport Police officers Steve Bryan and Aaron Debnam, who carried her up the emergency steps at Russell Square using a blanket as a stretcher, and an off-duty doctor who gave her emergency resuscitation.
Mrs Kerr, who recently met the two officers, said: "They rescued someone who will take life with both hands and the best way I can thank them is to lead a very fulfilled and brilliant life."
An Australian who has lived in London for 12 years, Mrs Kerr had been travelling to work in the same packed carriage as one of the four London bombers, Germaine Lindsay. Twenty-six of her fellow passengers died in the explosion between King's Cross and Russell Square, on one of the deepest sections of the Underground.
In the sudden, disorientating blackness that engulfed the train, Mrs Kerr thought she was dying of a heart attack. After losing consciousness, she awoke to find the carriage had changed into a smoking chaos. At first there was screaming, followed by an eerie quiet as fellow passengers either died or slipped into unconsciousness.
Mrs Kerr called for a nearby passenger to pull her up from the floor of the carriage and put her on an empty seat.
By the emergency lights shining from the tunnel she could see her lower body. She said later: "I looked at my legs and realised it was pretty serious. Both my feet were almost surgically severed. They were dangling. From the knee down, I just had bone, and the skin was flapping. It was like looking at an anatomical drawing of the inside of a leg."
While Mrs Kerr waited for help in the wrecked carriage she used her teeth to rip a scarf in two and fashion a tourniquet for both of her legs. She later recalled: "I realised that I was losing a hell of a lot of blood. I looked at my injuries and said: 'OK, I will bleed to death if I don't do something about this.' So I took off my scarf and applied a tourniquet to each leg. My hand seemed to go right through one leg, so I had to tie the scarf higher. I somehow knew I had to elevate my legs, so I pushed them over the armrest."
Mrs Kerr also sustained a big wound on her back caused by what was thought to be bomb shrapnel, but which turned out to be a piece of someone else's bone.
"Someone shielded Gill and probably died in the process," said Mr Kerr, an architectural historian who lectures at the Royal College of Art.
As she held on to a smashed window waiting for help, Mrs Kerr said, there were conflicting voices struggling inside her.
She recalled: "One was saying: 'Just close your eyes, close your eyes. Let's have a little nap.' The other was saying: 'The nap is not a nap. It will be death. Don't be fooled by that.' One voice was saying: 'If I live, I may not see my legs again.' The other voice: 'Don't get hysterical. It looks far worse than it is.' Then there was one very clear point when I looked round and said: 'I am not going to die down here.' That was the decision."
Her heart stopped twice before she reached hospital that morning and she was not expected to survive. She had lost 75 per cent of her blood. Both her legs were amputated below the knee.
Mrs Kerr spent two-and-a-half months in hospital learning to use prosthetic legs, with the help of Mr Kerr and staff. Even from her bed in intensive care, she expressed her determination to walk down the aisle at her wedding. With time, her singed eyebrows and hair grew back and she began to resemble her former self.
Father Kit Cunningham, who conducted the ceremony, said before the wedding: "Gill is very brave, a very positive girl. The wedding was booked before the disaster and when I went to see her in hospital the first thing she said to me was, 'Father, I shall walk up the aisle'.
"People should look at her story and take something from it," he said. "So many people get very worked up about their in-grown toenails. They should look at this."
Nor does Mrs Kerr, an events manager for the Design Council, hold any grudge against the suicide bomber who caused her injuries, 19-year-old Lindsay.
She said: "I don't feel any anger at all towards the poor guy who was susceptible enough to, I guess, almost be a victim himself. I feel deeply sad for all their families and for the guy who killed himself on my Tube.
"The wedding has been a fantastic date to focus on - and a reason to walk. It's now only part: I want to walk because I want to have some sort of life back."
The couple will honeymoon in Mrs Kerr's native Australia before returning to their home in north London.