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Surgeons Describe 1st U.S. Face Transplant

Transplanted Face 'Lit Up Like Christmas Tree,' Joyful Surgeon Says

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The big risk for any transplant is rejection of the new tissues by the body's immune system. Culp spent 12 days in intensive care, and 45 days in the Cleveland Clinic's post-transplant room. She was able to leave the hospital on Feb. 5 -- 58 days after being wheeled out of the operating room.

She can now eat solid food without restrictions, drink from a cup, breathe through her nose, and smell. Her pain, which she'd described as 8 on a 1 to 10 scale, is down to a 1 -- the lowest level of pain.

The before-and-after pictures are amazing, but for the time being Culp's face is still a work in progress. The surgeons intentionally gave her much more tissue than she needed to provide room for swelling.

"More skin is easy to remove, but if there's not enough it's harder to put back on," Djohan says. "And remember, if we put the face on too tight it will restrict any possible facial expression."

Over time, Djohan says, the nerves in Culp's new face will regenerate. That takes time -- nerves grow about an inch a month. Doctors expect Culp's facial nerve to reach full length in about a year, giving her much more facial movement and function than she now has.

What will she look like? Doctors will remove the excess skin when it's safe to do so, and there will be more procedures to improve the results.

"We will try to get her close to her former appearance -- but this is a reconstruction, not cosmetic surgery," Djohan says. "She will not resemble the donor, and she will not resemble herself, but something in between."

Before undergoing surgery, Culp convinced her doctors that she understood the risks of needing immune-suppressing drugs for the rest of her life. Those risks include life-threatening infections and cancers. And there's always the risk of rejecting the transplant, although those risks diminish over time.

Siemionow says that what Culp has taught her team will be applied to other patients who suffer extreme facial deformities that have destroyed their lives.

"There are so many patients in their houses where they are hiding from the society, because they are afraid to go to the grocery store, afraid to walk the streets," she said. "We hope that this special group of patients will one day be able to go comfortably from their houses."

WebMD Health News Reviewed by Brunilda Nazario, MD on May 06, 2009


Images provided by the Cleveland Clinic, Copyright © Cleveland Clinic 2009


Risal Djohan, MD, program director, plastic surgery residency training program and reconstructive microsurgery fellowship, Cleveland Clinic.

Maria Siemionow, MD, PhD, transplant team leader, Cleveland Clinic.

News releases, Cleveland Clinic.

Cleveland Clinic web site.

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