BOSTON It took 18 months for her smile to come back completely, but doctors say the French woman who received the world's first partial face transplant is doing well and is very satisfied with the results.
Isabelle Dinoire, then 38, had her nose, cheeks, mouth, lips and chin replaced by donor tissue on November 27, 2005, after they were torn off by her own dog six months earlier.
The doctors, led by Jean-Michel Dubernard of Lyon University in France, report in Thursday's edition of the New England Journal of Medicine that Dinoire recovered slowly and steadily, overcoming two episodes of rejection.
Her rehabilitation program included daily psychological counseling for the first month, and regularly after that, as well as a regimen of facial exercises.
At first, because her lips did not move properly, she could not always drink neatly, but that problem cleared up after a year. Sensation to heat and cold was normal at the six-month mark, and she could perceive light touch to her new skin.
Dinoire initially had trouble moving her lips properly to pronounce words that contained sounds such as P and B, but that problem also resolved itself over time.
Six months after the transplant, she could completely close her lips when she tried.
"At present, the patient says she is not afraid of walking in the street or meeting people at a party, and she is very satisfied with the aesthetic and functional results," the Dubernard team wrote.
Photographs that accompany the report show scars that are still visible from the bridge of the nose extending outward to make a broad circle around the mouth, but makeup makes them far less visible.
More operations on other patients will need to be done to gauge all the problems that might be associated with the surgery, doctors said.
"Meanwhile, the encouraging 18-month outcomes of face transplantation in our patient suggest that this procedure can offer hope for some patients with severe disfigurement," they said.
Since Dinoire's surgery, two other people are known to have had face transplants.
(Editing by Maggie Fox and Xavier Briand)