Experts have played down fears that people who have face transplants would look like their dead donor.
Doctors in the United States have carried out face transplants on dead bodies donated for medical research.
Now doctors at the University of Louisville hope to carry out the procedure on living patients.
They have requested formal approval from the university's institutional review board, which vets new research proposals, New Scientist magazine says.
If approved, the procedure is likely to be offered to people with severe facial injuries or disfigurement.
The move comes just six months after the Royal College of Surgeons of England urged doctors not to carry out face transplants.
In a report, the college acknowledged that the technology to carry out such a procedure existed.
However, it warned that too little is known about the possible risks, including the physical and psychological effects.
It also voiced concerns over the impact of such a procedure on the family of the donor, particularly if the patient looked like their deceased relative.
But this latest research suggests that those fears are groundless.
"More often than not you don't recognise the person," said Dr John Barker, who is leading the research at Louisville University.
New Scientist magazine recently teamed up with British TV company Mentorn to test the theory further. They commissioned Darkside Animation to carry out a virtual face transplant.
The firm scanned the face of a living woman and placed this face on a standard 3D model of a human skull.
They then developed a virtual donor, with different facial features. The team then carried out a transplant, placing the face of the virtual donor onto the woman's skull.
The recipient shared some of the features of the donor, such as the shape of her mouth. However, by and large she had her own distinct identity.
The project will feature in a documentary to be screened on the Discovery Health channel in the United States on 28 May and on Channel 4 in the UK at a later date.
Peter Butler, a surgeon at London's Royal Free Hospital, has also been carrying out research in this area.
He has said in the past that he would not carry out a face transplant until the psychological, immunological, moral and ethical questions are resolved.
Mr Butler has also expressed concerns about the drugs that patients who have face transplants would have to take.
"These drugs have significant complications and they don't always work," he said. "Is it really worth it for the patient?"
The UK charity Changing Faces, which helps people with facial disfigurements, said it was concerned about plans to carry out face transplants.
"Changing Faces is extremely concerned about the news that surgeons in Louisville, USA, are seeking an application to proceed with the world's first face transplant," said its chief executive James Partridge.
"There a great many questions to which answers are needed before this extremely risky and experimental surgery could be considered a viable option for patients with severe facial disfigurements."
PITTSBURGH (AP) -- Researchers are studying antirejection drugs as a recent interest in hand transplants increases the possibility that a face transplant could be conducted soon.
Dr. W.P. Andrew Lee, the University of Pittsburgh Medical Center's chief of plastic surgery, said it's a matter of when, not if, face transplants will be performed on humans. But since powerful anti-rejection drugs could hurt someone's chances of survival, Lee and others are studying how to wean transplant recipients from the drugs, or at least lower the doses of them.
"As many as 88 percent of organ transplant recipients receive some type of opportunistic infection," Lee told the Pittsburgh Tribune-Review.
Face transplants are getting attention across the world. At the University of Louisville, officials are likely to seek permission soon from its Institutional Review Board to transplant a face from a cadaver to a living recipient. The University of Louisville had done cadaver-to-cadaver face transplants, university spokeswoman Kathy Keadle said.
And researchers in England and France are also discussing the possibility of performing the complicated surgeries, which involve transplanting skin, muscles, fat, blood vessels and nerves.
Lee said face transplants make sense because surgeons can't adequately rebuild the face's of people who have been disfigured. Many times, tissue and other things are transplanted from elsewhere on someone's body, but the results are usually not perfect.
Lee said researchers have transplanted limbs on rats and pigs, and the animals have successfully lived without anti-rejection drugs for as long as a year.
Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania Medical School, said face transplants have raise many serious ethical questions.
"It's one thing to say your heart is rejecting and you're going to die within seconds. If your face is sloughing off your body - can you imagine? It's a nightmare," Caplan said.
Caplan and Lee agree that more animal studies are needed before face transplants become a reality. In particular, Caplan said there needs to be a national policy on them, and the psychological and social ramifications need to be thought through.
LOUISVILLE, Kentucky -- A team of doctors from Louisville and the Netherlands says in a new medical journal article that it is ready to perform a face transplant, a procedure considered controversial by some medical ethicists.
"There arrives a point in time when the procedure should simply be done. We submit that that time is now," the researchers wrote in an article scheduled for publication Friday in The American Journal of Bioethics. The procedure attaches the face of a dead donor to someone with a severely disfigured face, such as a burn or accident victim.
The doctors said they don't have a prime candidate for the procedure, and they are not actively screening for candidates.
They have submitted an application to an institutional review board in the Netherlands and are nearly ready to submit one to an independent board in the United States.
The Louisville doctors said they would not perform the transplant without approval from one of the boards, which are designed to protect medical research subjects' rights.
"The people we're considering are people who have no other options," Dr. John H. Barker, director of plastic surgery research at the University of Louisville, told The Courier-Journal newspaper.
Nichola Rumsey of the University of the West of England, an expert in psychosocial issues in medicine, said the ethical issues of the procedure have yet to be fully explored. She wrote one of 14 essays written in reaction to the article and published in the bioethics journal.
"Previous research and current understanding indicate that the psychological risks are more complex and extensive than the Louisville team suggest," she wrote. "I have no wish to minimize the distress experienced by many people with severe disfigurements, but to my mind, the current risk/benefit ratio ... is dubious at best."
Besides Louisville, such transplants are being considered by teams in Cleveland, England and France.
I am also an only child, and believe me when I tell you that I have a lot of problems. Maybe you are pretty lucky, and I am happy for you.
And back on topic, before getting to work I was thinking about this thread and a local society that helps burned children. I am convinced that having the chance to be able to walk around people without being stared at is worth the risks and problems related to taking inmunosupressants and other medication. Children deserve to live their lives to the fullest (and I am not quoting Anton La Vey, by the way).
Not exactly a face transplant but an article in New Scientist about a single skin graft being used to rebuild a mans face rather than lots of little patches. It also mentions face transplants. I should warn squeamish people the "before" picture is not too pleasant.
For the first time, plastic surgeons have reconstructed a burn victim’s entire face using a single sheet of thick skin harvested from his back. Unlike after conventional multiple grafts, the patient’s lips and eyes opened and closed properly and his skin looked smoother and more natural.
Hiroyuki Sakurai and colleagues from the Tokyo Women’s Medical University in Japan used a new technique, avoiding the traditional method of patching together a series of thin flaps which often disrupts facial function and appearance.
“It’s like having a fresh canvas on which to paint rather than one that’s been cut up and sewn back together,” explains Thomas Stevenson, a plastic surgeon at the University of California, Davis.
Sakurai presents the work on Wednesday at the annual meeting of the American Society for Plastic Surgeons in Philadelphia, Pennsylvania. His team used a method of “tissue expansion” to harvest a single sheet of skin from the back, rather than relying on a series of patches.
In conventional skin grafts, surgeons scrape off small scraps of skin just a few millimetres thick from the legs or back of the patient and place them over the existing facial veins and arteries. Because the skin is thin, the blood vessels embed themselves in the new tissue. But the vessels do not always connect, leading to multiple painful operations.
Another problem with thin skin grafts – which consist of just the outer epidermis and a portion of the dermis – is that they tend to shrivel up shortly after grafting. This can mean patients cannot shut their eyes, which dries them out, or cannot close their mouths, which can result in drooling.
To avoid these problems, Sakurai used a single square of skin 2 centimetres thick and 28 centimetres to a side. This included the full dermis, epidermis and subcutaneous fat. But because the sheet was so thick, he could not rely on the facial blood supply embedding itself.
To avoid this problem, Sakurai sewed six of the arteries and veins that normally pump blood through the face to blood vessels on the underside of the grafted skin, using tiny stitches narrower than the width of a human hair. This microsurgery technique is often used to reconnect blood vessels when a severed hand or finger is sewn back on, but has never been used for a skin graft before, says Stevenson.
No further skin grafts were necessary, except to add the eyelids, which were built from thinner arm skin so that they could open and close.
Sakurai was able to harvest such a large sheet of skin because, six months prior to the operation, his team had inserted a deflated plastic balloon into the 56-year old burn victim’s back, which was gradually pumped up with saline.
Once it had fully expanded to 1.5 litres, the balloon was removed, leaving behind an extra flap of skin that was then harvested, leaving a relatively small scar. Such “tissue expanders” are commonly used to prepare a woman’s skin before a breast implant.
“This represents promising work, but it is not yet a miracle,” says Stevenson. “But if studies of more people show improvement, then the technology could be a real breakthrough.” He also notes that although the face looks smooth, it still does not move like a normal face.
In future, an alternative surgical procedure could be a face transplant, where the entire face of a deceased organ donor is removed and placed over the facial bone structure of a patient. Aesthetically, this would be more natural than Sakurai’s graft because the skin is from a face rather than the back, so would have the appropriate topography.
But aside from raising ethical questions, it is much harder to achieve, says Stevenson, as the new face would normally be rejected by the recipient's immune system.
Surgeons have carried out what is believed to be the first full face reconstruction using a single flap of skin.
A piece of skin from the burn patient's back was used, the American Society of Plastic Surgery conference heard.
Standard practice is to use several skin grafts, but this is not always successful, especially if the burn has caused severe damage to the face.
UK experts said the finding offered hope for other burns patients.
A 54-year old man was treated by the team at Tokyo's Metropolitan Hiroo Hospital after sustaining severe burns from gasoline which affected his face, neck, chest and arms.
He was initially given skin grafts to close the wound and a tracheotomy to help him breathe. However he was left with a partial loss of his nose and severe damage to his ears.
In the study, doctors "stretched" skin on the patient's back using a tissue expander - where a silicone balloon expander is inserted under the skin and filled with salt water, causing the skin to stretch and grow - for six months.
The patch of skin had its own unique blood supply.
'Ability to smile'
Surgeons removed the scarred facial skin, removed the skin flap, measuring 28 by 27cm from the back, and transferred it to the face.
It was large enough to cover the face completely. Uniquely, it had extra tissue to create a nose.
In the past, burns patients have required separate surgery to create a nose, increasing trauma for the patient, and the risk they will experience physical damage such as scarring and infection around the site that the skin is taken from.
The arteries and veins supplying the skin flap were connected to those of the neck and face.
The team closed the donor site on the back and, because the skin had been expanded, they were able to do so without having to take skin grafts from the leg to close the wound, eliminating huge scars that accompanied previous techniques.
The team, led by Dr Hiroyki Sakurai, said: "To our knowledge, this is the first case of a successful total face reconstruction, including the nose, with one flap."
Dr Thomas Stevenson, president of the Plastic Surgery Educational Foundation and a member of the American Society of Plastic Surgeons, said: "The difficulty with previous techniques was harvesting a thick, uniform piece of skin and closing the wound where the incision was made, to minimise scarring.
"Through this combination of surgical techniques, a burn patient has only one operation rather than multiple procedures, reducing pain and recovery time."
He added: "Many burn patients who successfully complete facial reconstruction can close their eyes again, relieving the dryness around their eyes.
"They stop drooling because their lips have been rebuilt, and they can finally smile."
Dr Stevenson said: "By rebuilding the face, they can feel better about themselves and are more accepted socially once their abnormality is less dramatic.
"This procedure is an important step to help burn patients overcome their trauma."
Mr Peter Butler, a consultant plastic and reconstructive surgeon at the Royal Free Hospital in London, told BBC News Online: "This shows that it is a viable option for patients with severe facial injuries.
"Often people are very sick after suffering acute burns, they may be in the intensive care unit, and be on a ventilator."
Mr Butler said UK surgeons had the technology and expertise to carry out the procedure.
He added: "It may not be something that is appropriate for all patients, but it is certainly something that could be considered."
Iain Hutchison, head of the Facial Surgery Research Foundation's clinical research centre in London, said the team had used existing techniques, such as tissue expanding, to achieve their success.
"They have achieved something which could be very useful indeed.
"The good thing about it is that is has obviated the need for face transplants, where the face is taken to someone else. It takes away the inherent problems with transplants such as the need for immunosuppressant drugs."
Surgeons in France have carried out the first face transplant, it has been reported.
The woman had lost her nose, lips and chin after being savaged by a dog.
In the controversial operation, tissues, muscles, arteries and veins were taken from a brain-dead donor and attached to the patient's lower face.
Doctors stress the woman will not look like her donor, but nor will she look like she did before the attack - instead she will have a "hybrid" face.
This is the first face transplant using skin from another person
Iain Hutchison, Barts and the London Hospital
The 38-year-old French patient from the northern French town of Valenciennes underwent extensive counselling before her operation, which is believed to have lasted at least five hours, and which took place at the weekend at a hospital in Amiens.
The French magazine Le Point reports that the tissues, muscles, arteries and veins needed for the transplant were taken from a donor in the northern city of Lille, who was brain-dead.
The operations were carried out by a team led by Professor Bernard Devauchelle and Professor Jean Michel Dubernard.
In a statement, the hospital said the woman had been gravely disfigured in the attack in May this year.
She has been unable to speak or eat properly since.
It added that the woman - who wishes to remain anonymous - was in "excellent general health" and said the graft looked normal
It is not clear whether an individual could be left worse off in the event that a face transplant failed
Stephen Wigmore, British Transplantation Society
Like any other transplant patient, the woman will have to take immunosuppressant drugs to help her body cope with the donated tissue.
Doctors working in the field say many could benefit from the procedure, including 10,000 burns victims in the UK.
Iain Hutchison, an oral-facial surgeon at Barts and the London Hospital, said: "This is the first face transplant using skin from another person."
But there are medical, and ethical, concerns of facial transplants.
Mr Hutchison, who is chief executive of Saving Faces - the Facial Surgery Research Foundation, said there were three phases where the procedure could fail: "In the short-term, blood vessels in the donated tissue could clot.
"And in the long term, the immunosuppressants fail. The drugs also increase the patient's risk of cancer."
Mr Hutchison added there were ethical and moral issues around donating facial tissue.
"It is unusual that someone was prepared to do it," he said.
"Where donors would come from is one issue that would have to be considered.
"The transplant would have to come from a beating heart donor. So, say your sister was in intensive care, you would have to agree to allow their face to be removed before the ventilator was switched off.
"And there is the possibility that the donor would then carry on breathing."
Stephen Wigmore, chair of British Transplantation Society's ethics committee, said: "The extent of facial expression which will occur in the long term is unknown.
"The skin tends to promote rejection by the immune system very strongly and immunosuppression is likely to need to be kept at high levels for prolonged periods of time.
"It is not clear whether an individual could be left worse off in the event that a face transplant failed."
The first patient to undergo a face transplant thanked her doctors as soon as she came round after the operation.
The woman, who sustained her injuries when her dog mauled her is "doing well" and has been able to eat strawberries and chocolate, doctors say.
The medical team who carried out the operation on Sunday in Amiens, France, say they were justified in undertaking the ground-breaking surgery.
But one expert questioned if such a radical procedure was needed.
Laurent Lantieri, an advisor to the French National Consultative Ethics Committee, said the team who operated on the patient had violated the panel's advice by not attempting conventional reconstructive surgery first.
The team who carried out the pioneering operation - which altogether lasted around 21 hours - have been giving details of what they called an "exceptional case".
Facial tissue from a donor from Lille, who was brain-dead, was used to repair severe damage from the top of the woman's nose to her chin.
The medics denied reports she had been attacked while she was unconscious after a suicide attempt.
Transplant surgeon Dr Jean-Michel Dubernard said the woman had taken a pill to try to sleep after a family argument, and was bitten by her dog during the night.
"There was no suicide".
The pet was later put down, against the family's wishes.
Dr Dubernard said several psychiatrists had assessed the patient before her operation and "all gave the green light".
Dr Bernard Devauchelle, a facial surgeon who took part in the operation, said: "We decided to go ahead with a transplant of part of the face because it restored the anatomy and the aesthetics, but also the function of this face."
Philippe Domy, the director of the hospital in Amiens, northern France, where the transplant was carried out last Sunday said the surgery was required because the patient's case was exceptional.
"We are in an exceptional situation that required an exceptional response," he said.
Dr Devauchelle described how the team painstakingly transplanted skin, muscle tissue - connecting lots of blood vessels and nerve cells.
Connecting the nerves should allow the patient's face to be mobile, he said.
Four hours after the operation, blood was flowing through the transplanted tissue.
The patient regained consciousness 24 hours after the operation.
Caroline Camby, director general of the agency under the French health ministry that co-ordinates organ procurement, said normal surgery had not been possible in this case.
"It is precisely because there was no way to restore the functions of this patient by normal plastic surgery that we attempted this transplant.
"She could no longer eat normally, she had great difficulty speaking and there is no possibility with plastic surgery today to repair muscles around the mouth which allow people to articulate when they speak and not spit out food when they eat."
It has been technically possible to carry out such a transplant for some years, with teams in the US, the UK and France researching the procedure.
But the ethical concerns of a face transplant, and the psychological impact to the patient of looking different has held teams back.
There have also been concerns about the consequences of patients having to take to immunosuppressant drugs for the rest of their lives.
Donor for world's first face transplant had hanged herself
By Anthony Barnes and Tom Anderson
Published: 04 December 2005
The donor whose features were used for the world's first face transplant had committed suicide just hours before the operation.
As Isabelle Dinoire, 38, the recipient mauled by her pet labrador, was eating strawberries and chocolate yesterday following the operation, it emerged that the source of her new nose, lips and chin had hanged herself.
The woman, also 38, was brain dead when she arrived at a hospital in Lille last weekend, at which point preparations for the groundbreaking surgery began.
Her family gave consent for the operation.
Ms Dinoire was given her new start in a 15-hour procedure that ended on Monday morning. Speaking yesterday for the first time since the operation, she said: "I am very grateful to this woman. I thank her family for giving their permission for this operation. I thank them from the bottom of my heart."
She had suffered her appalling injuries after she lost consciousness following an overdose of sleeping tablets, which she has now confirmed was an attempt on her own life. Her dog, which has been destroyed, is thought to have been trying to revive her.
Now recovering from the surgery in the Eduard Herriot hospital in Lyons, she has been able to admire the work of the surgeons who had to ensure a match for skin tone and quality.
"I have been looking at my face in the mirror. It is very impressive. They have given me my face back," she told The Sunday Times.
The unmarried woman, who has two children, has some movement in her face, but any sensation could take many months. Doctors have warned that there is still a risk of the new skin not taking, and it will need to be monitored closely for up to six months and treated with anti-rejection drugs.
If rejection does occur, the new skin would have to be removed completely, but the team has said it would perform the procedure again in that situation.
Prior to her surgery, Ms Dinoire had to wear a mask in public because of her shocking appearance, which led to teasing by those who saw her who assumed she was obsessed with germs. The injuries meant that she had trouble eating, breathing and talking with her lips completely absent. She had been on a waiting list for the surgery since August.
Medical teams have revealed that they are already competing to be the first to attempt a full-face transplant. Surgeons are now considering how they could develop the technique to give a patient a completely new face.
Ethical and medical concerns have delayed plans to attempt such an operation. But a team at the Royal Free Hospital in London is planning to attempt a full-facial transplant, as is the Cleveland Clinic in the US.
The French surgeons who performed Ms Dinoire's surgery denied suggestions that they had been rushing to perform the operation to claim a world first.
"As doctors, if we have the possibility to improve [the condition of] our patient, that is what we do," said Dr Jean-Michel Dubernard, the team leader who performed a controversial hand transplant in September 1998. He said he initially had doubts about performing such an operation but when he first saw her face he realised there was no other option.
Face transplant OK with Catholic Church
AS FAR as the Catholic Church is concerned face transplant is okay, especially if the materials used are derived from placenta.
This is according to Malolos Bishop Jose Oliveros, chairman of the Catholic Bishops Conference of the Philippines office on bioethics, during the second day of the International Congress on Bioethics, an event jointly sponsored by Vatican City’s Pontifical Academy for Life and the University of Sto. Tomas.
Oliveros said face transplant is now being practiced in advance countries and the first transplant recipient was a woman in France.
The prelate said bioethics scientists were able to develop a procedure wherein the placenta — an organ in uterus of the pregnant woman where the supply of food and oxygen develop and subsequently supplied to the fetus through the umbilical cord — could be transformed into a skin.
“Experts were able to find ways to use skin taken from placenta as filling materials to the damaged portion of the face. And scientists are still looking for practical uses of placenta,” Oliveros said.
Asked if the use of placenta is morally acceptable to the Church, the prelate answered in affirmative, saying it is being allowed so long as it does not harm another person where the placenta was taken.
“It is morally acceptable because the procedure does not destroy the fetus in the process. In fact, the placenta is touched days after it was released by the mother,” he said.
Hospitals and maternity clinics usually keep in freezer the placenta released by mothers after they gave birth. Philippine barrio folk in practice usually bury the placenta in their backyards.
However, the first reported face transplant did not use placenta but tissue taken from a brain-dead person.
The first face transplant, a woman recipient, lost her nose, lips and chin after being savaged by a dog.
In the controversial operation, tissues, muscles, arteries and veins were taken from a brain-dead donor and attached to the patient’s lower face.
Doctors said the woman will not look like her donor, but nor will she look like she did before the attack — instead she will have a “hybrid” face.
Apparently, the brain-dead donor was alive when the tissue was taken, which is just plain creepy, not to mention ethically challenging. That may explain why it occurred in France.
Doctors said they would have to wait to evaluate whether she would be able to look down her new nose at others as well as other French people do.
Bioethics is a science, which drew serious attention of the Catholic Church. It tackles issues like suicide, euthanasia, cloning and medical-based stem-cell treatment, among others.
No less than the late Pope John Paul II became cautious that these new scientific breakthrough would intervene in the creation process of God — a thinking that pose questions on morality and ethics, thereby making it a subject with religious implications.
In fact, JP II founded the Pontifical Academy for Life, an office in Vatican tasked to guide bioethics researchers, in 1964. The following year, the Polish Pontiff released his landmark Evangelium Vitae (Gospel of Life) with one singular aim to remind the faithful that human life is a gift of God, redeemed by Christ and can either enter eternal bliss or eternal damnation. Jaime Pilapil
Can someone kindly explain to me what the "ethical" concerns are in face transplants?
I could see a profound philosophical problem if the purpose of such transplants was to change wealthy but plain-featured Joe McPugg into Clark Gable or George Clooney.
But as I understand it full face transplants would be used to restore Joe McPugg to an as-close-as-possible version of his NORMAL visage if his face were to be destroyed by fire, acid burns, the explosion of a bomb, and so on.
The ideal method would be to have a supply of donated faces, from which the closest match to McPugg would be selected. Then plastic surgeons would "carve" and shape McPugg's new face until it as nearly as possible matched his original appearance.
So what IS the "ethical" problem here? It strikes me that the unethical thing would be to leave Joe with a destroyed face.
I haven't understood the negative reaction to this either--it's not "face-ripping." The only reasonable objection that I've heard is from other reconstruction specialists who noted that the patient could end up worse off if the new face was rejected. This was because of the preparation they had to do to her surface skin to make it connect to the blood vessels and such in the new face (I'm not sure how to express this in correct technological terms). If the new face had to be removed it would leave her extremely vulnerable to infections.
But the negative, almost judgemental tone taken by the European press completely baffles me.
As Isabelle Dinoire, 38, the recipient mauled by her pet labrador, was eating strawberries and chocolate yesterday following the operation, it emerged that the source of her new nose, lips and chin had hanged herself.
Back following the First World War the best the French could manage for its most terribly facially-disfigured war veterans whose lips, cheeks, noses and so on had been blasted away and/or gouged out in battlefield explosions was to supply them with waxen face masks modelled upon old photographs of themselves. (This is NOT intended as any criticism of the French.)
So there we have it - turning badly disfigured individuals into Erik the Phantom is ethical. Giving these same people NEW faces is unethical.
Medical ethics seems to be not only stranger than we believe, but stranger than we CAN believe.
Does anybody here remember the name of the fairly attractive young London socialite [though I believe an American by birth and a member of the lesser nobility by marriage], who in the 1920s or perhaps very early 1930s had herself made "more beautiful" (to look at at any rate, if not to touch or kiss) by having her face built up through subcutaneous injections of beeswax?
The problem was that the wax soon melted and shifted, making her look like a movie monster. Heavy black veils, please.
This condition was obviously corrected by surgery, because the only photograph I've ever seen of this woman, taken in her seventies, shows a reasonably handsome older lady.
Face transplant woman ‘does not draw stares’
The surgeon responsible for the world's first face transplant has said the recipient can walk down the street without drawing stares from the public.
Prof Bernard Devauchelle made history last month when he carried out a partial face transplant on a woman named Isabelle, who received a new nose, chin and mouth.
In an interview with a French regional newspaper Prof Devauchelle said Isabelle was doing well and was focussed on the future. He said she was looking forward to returning home and leading a normal life.
The 38-year-old divorced mother of two received her new features from a brain-dead donor on November 27. She sustained the horrific facial injuries after being mauled a dog.
Prof Devauchelle told newspaper Le Courier Picard that she is now taking walks, riding a bike, chatting and eating - all actions she found difficult before her groundbreaking surgery.
"Every day, with her face uncovered, she passes by people who don't necessarily recognize her," the surgeon was quoted as saying.
"She went walking to buy magazines without anyone noticing her. That's perhaps the best proof of real integration, even if when you look [at her], you realize that there is not something totally normal about her face's mobility.
"But there is a certain expressiveness that is slowly coming back."
My strange life with someone else's face
By DAN NEWLING and FIONA BARTON, in London
SHE is house-hunting, planning a new career and her once-broken heart is filled with hope.
Isabelle Dinoire knows that rebuilding her life will be a slow process.
But, even though her scars are still livid, she can now look at the world with optimism.
Barely two months ago, the 38-year-old French divorcee received the world's first face transplant and this exclusive photograph reveals the full extent of her remarkable transformation.
Last May, she had a wide, tilted nose, a prominent chin and thin lips. Today, the donated face of suicide Maryline Saint-Aubert has given her a straight and narrow nose, a neater chin and a fuller mouth.
Despite the prominent surgical scars, Miss Dinoire and her doctors say they are delighted by the results.
The operation has left her new mouth looking somewhat loose, but surgeons are confident she will regain control over her partially paralysed face.
Her recovery, they point out, is still in its early stages. Only last month, she appeared to be rejecting the precious new tissue, but a course of steroids has put her recuperation on track.
The transplant was performed by a team of 50 surgeons in Lyon, led by Jean-Michel Dubernard.
Five months earlier, Miss Dinoire's features were destroyed when her labrador savaged her while she was unconscious after a drug overdose. Her face was left a patchwork of torn flesh and exposed bone – so shocking that one of her two teenage daughters refused to look at her.
Miss Dinoire could not venture out of her home on the outskirts of Valenciennes, northern France, without wearing a dental mask. And the stares of strangers and their insensitive comments left her depressed.
But things are improving. She admits that the weeks spent in hospital in Amiens, hundreds of kilometres from her family, have been gruelling.
She said: "I spent Christmas in hospital, which was pretty awful really. The doctors cannot yet give me a date to go home.
"Lots has been said about how happy I am, but this has not always been the case. I spend almost all my time in my hospital room.
"Here, I have radio and television and there is also an exercise bike in the corner. I haven't started using it yet, but that may change."
This week, she left hospital to go home for the first time – a huge psychological step towards normality – to see her daughters Lucie, 17, and Laure, 15.
Miss Dinoire remains reluctant to visit shopping centres and other busy places. But under the close supervision of a team of psychiatrists, she is gaining the confidence to return to society.
In preparation for that important moment, she met housing officials in Valenciennes on Thursday.
It is thought she is considering moving to a neighbouring town with her daughters.
She says she is in a positive mood – though she is chain-smoking again – and is making plans to study computers and accounting at college, with a view to opening a baby-clothes shop.
She now has some feeling in her new face, a huge improvement from the early days after the operation when she felt nothing as she splashed water on her face or pressed her skin.
Her voice then was muffled by the paralysis and she found it hard to chew. Now, she can eat and is relishing food and drink. They are small pleasures, but to her they are miracles.
"I am eating as much as I can," she said in an interview with People magazine. "I love fresh strawberries, but have also eaten omelets, chocolate cake and all kinds of other food, including the odd glass of red wine."
Her new diet is helping her regain some of the weight she lost after the attack. But she still looks gaunt, with her fashionable jeans hanging off her slight frame.
Another of her surgeons, Bernard Devauchelle, said: "Her facial expressiveness is slowly returning and she is talking quite clearly, but has some problems with the letters P and B, which require the lips.
"She certainly does not look like the living dead. She's eating and drinking without dribbling.
"Psychologically, she has totally accepted her new face. Her return to smoking is not the best thing. But that's what she wants to do – we can't stop her."
Dr Devauchelle and his colleagues faced ethical questions about the transplant. The fact that Miss Dinoire had attempted to commit suicide led critics to ask if she was psychologically robust enough to adapt to life with someone else's face.
As a single parent, she had struggled to cope with her daughters and, according to friends, spent most of her time chain-smoking in front of a TV.
Then it emerged that the 46-year-old donor had committed suicide.
There is still a risk that Miss Dinoire's body will reject the new face and for the rest of her life she will have to take preventative drugs, which cause an increased risk of cancer and kidney disease.
The French woman who received the world's first partial face transplant has appeared before the cameras of the world's media for the first time.
Isabelle Dinoire, a 38-year-old mother of two, received the transplant on 27 November after being mauled by her dog.
She told a news conference in the French city of Amiens, where she underwent treatment, the surgery had helped her regain a normal life.
She said being able to go out in the streets had given her courage.
Mrs Dinoire lost her nose, both lips and her chin after she was mauled by her pet Labrador while she slept in June last year. The dog was later put down, against the family's wishes.
At the news conference on Monday, she spoke with difficulty. Fine scar lines ran from her nose over her cheekbones down to her jaw and she seemed to have difficulty closing her mouth.
Mrs Dinoire said that she was left badly disfigured by the incident in June, which caused her "psychological and physical pain".
She said that she was stared at when she went out with her children and realised that a transplant operation could help change that.
Mrs Dinoire said that three days after the transplant surgery she was able to go out into the streets of Lyon.
"That has given me great courage," she said.
"At the moment I can open my mouth and eat and use my lips and nose as well. However, I have to continue my exercises and take medication to use my facial muscles."
She thanked the medical team who treated her and the family of the transplant donor.
Facial tissue from a donor from Lille, who was brain-dead, was used in the operation to repair the severe damage to Mrs Dinoire's face.
The world's first full face transplant could be performed in Britain if the ethical committee at a top London hospital gives the go-ahead.
If the revolutionary procedure is allowed the process to identify a suitable candidate will get underway.
Prof Peter Butler, top plastic surgeon at Royal Free Hospital, has spent 14 years researching the procedure and has spoken to 30 possible patients.
The Royal Free ethical committee meets on Wednesday to make its decision.
Hospital spokesman, Neil Hubands, stressed that even if permission is granted it would not mean a transplant was imminent - the selection process could take a year.
"There is a meeting of the ethical committee that will consider the next stage in the process," he said.
"What they will be discussing is the form of the operation and whether that operation is right to go ahead.
"After that we have still got to find a patient, bring them forward and then get permission for that person to be operated on."
Falklands veteran Simon Weston, who suffered horrific burns in the 1982 conflict, is due to accompany the medical team to the meeting to explain why he thinks doctors should be allowed to perform face transplants.
He used to oppose the procedure but has since changed his mind.
For the past five years Mr Butler has been researching tissue rejection and psychological issues as well as concerns surrounding identity.
Last year he was given permission to identify a patient who meets the selection criteria by a hospital ethics committee.
Hospital spokesman Mr Husbands stressed: "No one has been chosen. The final selection process has not yet begun."
"There is no possibility of a face transplant in this country for some considerable time. There is an awful lot of work to be done still. There are no patients lined up to be operated on."
Last November a French woman received a section of nose, lips and chin in a partial face transplant carried out by a team of surgeons led by Professor Jean-Michel Dubernard.
Isabelle Dinoire, 38, underwent the procedure after being mauled by the family labrador.
A 50-strong team of medics in Amiens, northern France, worked around the clock to perform the transplant.
The organs were taken from a donor who was brain dead, with the family's consent.
In 2003 the Royal College of Surgeons voiced concerns about face transplants concluding in a report that more research was needed into the psychological impact on recipients and the donor family.
They also said greater understanding was needed about the drugs the patient would have to take for the rest of their life to stop their new face from being rejected.
The surgery would require the removal of eight different blood vessels, four arteries and four veins from the donor and attaching them to the patient's face by reconnecting the tissue.
"We are still at a very early stage. It could be more than a year before something happens," Mr Hubands said.