Face transplant recipient Isabelle Dinoire faces the world

The recipient of the world's first lip, nose and chin transplant confronted the press yesterday to talk about the operation that restored her features. John Lichfield reports from Amiens

Mme Dinoire, 38, had the lower half of her face replaced two months ago in the first transplant operation of its kind. She put her rebuilt face on public view before the TV cameras in Amiens, in northern France, in an attempt, once and for all, to satisfy the world's (understandable) prurience and curiosity.

What do you look like when you've had someone else's nose, lips and chin sewn on to your own face? Remarkably normal, actually. Mme Dinoire slurred her speech. Her mouth seemed partially frozen open, as if she were under a dentist's local anaesthetic. Her lower lip did not move when she spoke, as if she was a ventriloquist. Faint scars were still visible around the oval of her transplanted features.

Otherwise, you might have passed her in the street and not given her a second look. She was a slight, pretty woman, with rather untidy, dark blonde hair. She could talk reasonably well. She could smile, at least partially. She could drink from a white, plastic cup (provoking another storm of camera shutters).

"I have a face again, like everyone else," she said. "I can open my mouth and I can eat. In the last few days, I have been able truly to feel sensation in my lips, my nose and my mouth."

Asked to compare the way she looked now with her appearance before she was disfigured in an attack by her own dog last May, she said: "There is no comparison between my face now and my face of seven months ago. No comparison."

This was rather a puzzling answer. Half her original face remained after all. She also said she was very happy with her new features and that her two teenage daughters were delighted to have their mother back. She has no plans to change the old photograph on her identity card.

The press conference was also attended by the surgeons who performed the 15-hour operation in Amiens Nord hospital, on the night of 27-28 November, Professor Bernard Devauchelle and Professor Jean-Michel Dubernard.

Professor Dubernard, the man who also presided over the first hand transplant in 1998, revealed that the French team hoped to perform five further face transplants in the near future.

Their ground-breaking surgery - also involving transplanting 20 muscles and reconnecting hundreds of nerve endings - has caused a frenzy of media interest worldwide. The case has also thrown up a number of confusing points, which were cleared up, at least partially.

Had Mme Dinoire been accidentally disfigured by her dog, (a labrador cross breed) when it was frantically trying to revive her after a suicide attempt? This was the version given to the French press by one of her daughters but later rejected as "absurd" by her surgeons.

Yesterday, Mme Dinoire said, in a brief opening statement: "On 27 May, after a very upsetting week, with many personal problems, I took some pills to forget ... I fainted and fell on the ground, hitting a piece of furniture.

"When I came round, I tried to light a cigarette and I could not understand why I couldn't hold it between my lips. Then I saw a pool of blood and the dog beside it. I looked in the mirror and I couldn't believe what I was seeing. It was too horrible."

It seems that the overdose story was not so absurd after all.

The suggestion of attempted suicide has been seized upon by other French surgeons who have accused Professor Dubernard and Professor Devauchelle, of trampling proper procedures to win the worldwide medical race to be the "first" to provide someone with a new face. The critics suggested that Mme Dinoire was not a psychologically suitable candidate for the stresses of a face transplant.

Her calm performance yesterday - and the fact she agreed to the press conference - suggested the medical critics were wrong on this point. Professors Dubernard and Devauchelle said the critics were also wrong on all other points. The transplant team, from the university hospitals of Amiens and Lyons, had followed all ethical and medical guidelines, they said, and done the operation with official knowledge and backing.

"Do you think that in a country like France you can get hold of spare parts for transplant surgery without official permission? Well you can't," Professor Dubernard said.

To answer their medical critics - who are mostly rival surgeons in France, rather than abroad - the two professors showed a horrific photograph of Mme Dinoire after her injuries. They also showed photographs of a boy of about 10 who had had been given "normal" plastic surgery after a similar dog attack. His face was still terribly disfigured and nowhere near as convincing as that of Mme Dinoire.

Asked whether she had started smoking again with her "new" lips (as reported last month), Mme Dinoire gave a wry scowl.

"No I haven't started smoking again because I never stopped. I smoked a few fags when I was disfigured and I still smoke a few now," she said.

Professor Dubernard denied reports that smoking cigarettes could increase the chances of rejection of her new face by Mme Dinoire's body. Smoking has no effect on rejection of transplanted tissue, he said. Given the trauma that she had been through, it was probably best to let her smoke - even though she smoked "fag after fag", he said. The professor gave Mme Dinoire a pointed look. She used her new features to attempt a wry smile.

Mme Dinoire, a divorcee from close to Lille in northern France, agreed to answer a few questions, so long as there was no probing into her private life.

Could she laugh without causing herself pain? "Yes I can ... no pain at all."

Had she found the media interest oppressive?

"If I could change one thing, it would be the pressures that this has put on my family and my neighbours and the family of the donor. I hope that, after today, that will now stop."

Did she accept the new face as her own face?

"Yes."

Why?

"Because I can smile. Because I can grimace. Because I can express myself with my face and so it's now become my face."

Mme Dinoire said that she was undergoing physiotherapy and hoped soon to have even better control over her features. Before the operation, she could only open her mouth by three millimetres, Now she could eat normally.

"I expect to resume a normal life," she said. "I want to go home and be with my daughters again. I hope to find a job and go back to work as soon as possible."

Both she and her doctors made it clear that the press conference had been arranged to exhaust media interest. Professor Dubernard appealed to the media not to pursue Mme Dinoire when she returns home and to cease their attempts to explore her past life, as well as that of her donor.

Although there had been some signs of rejection of the new facial tissue 18 days after the operation, hugely increased dosages of immuno-suppressant drugs had controlled the problem. All the same, this was a "first". It was impossible to say whether the transplant would be permanent or not. "The longest surviving transplant of another kind is 39 years... I am very optimistic," the Professor said. M. Dubernard said that the Amiens-Lille team had asked the French government for permission to perform five similar operations. He said that he knew that similar plans existed in the US and in Britain. The French team believed that it could offer significant, further technical advances.

"We want to give this operation to many many other people in France and in the world."

An American TV journalist asked, with a mumbled apology, what she called the "obvious Hollywood question". Was it now technically possible for a criminal to have his entire face replaced to conceal his identity?

Professor Devauchelle replied: "Yes. It is possible. But the patient would not look like the donor. It is your bone structure which decides what you look like, not the flesh of your features. And in any case I'm not sure that you would easily find a surgeon who would perform such an operation. At least, not in France."