Seven years ago, Carmen Tarleton received a facial transplant, a decision she made after her estranged husband attacked her in 2007 with a bottle of lye and distorted her face without acknowledgment. The transplant was an exhausting, complex, surgical procedure – one that ultimately failed.
But last month, Tarleton, a 52-year-old former nurse, chose to do it again, making her the first American and only the second person to ever undergo the procedure twice.
The operation, which took place at Boston’s Brigham and Women’s Hospital in July, involved more than 45 clinics over a period of about 20 hours, according to a news release at the hospital.
“The first face transplant served me very well,” Tarleton, who is recovering from his home in New Hampshire, told CNN. “And when it started to fail, I only knew from experience that a face transplant gives me the comfort and function I want and need on a daily level – that I will live a better life with a face transplant.”
Now she said, “All the pain I had in my failed face is gone.” After the operation, she said she only experienced “oblique and swelling-related pain.
Her doctor agreed that recovery is smooth.
“Carmen is progressing and recovering very well with the second transplant – she is one of the most resilient patients I have had the opportunity to take care of,” says Dr. Bohdan Pomahac, Brigham’s head of plastic surgery transplantation who led the effort, in the issue. “We call this procedure living-giving, and we are happy to offer her the opportunity to return to the kind of life she so richly deserves.”
Burns caused complications during the first operation, the hospital says
Tarleton’s first facial transplantation ultimately failed because her body had begun to reject the donor tissue, causing scarring, tightness, swelling and pain, she and the hospital said.
In 2007, her estranged husband attacked her with a bottle of lye, severely burning 85% of her body and disfiguring her face.
As she became sensitized by the life-saving blood products and tissue grafts to treat her burns, Tarleton became more immunologically likely to reject the first transplant, the hospital said.
“In her second face transplant, Carmen was not very sensitized, not at high risk of rejection, as she had lost almost all the HLA antibodies in her blood that had made her very sensitized in the past – probably due to the immunosuppression she had received during the first the transplant, said Dr. Anil Chandraker, a member of the transplant team in a news release.
This time, Tarleton had an “unusually close tissue match” from the donor, the hospital said.
The tissue was so remarkably close that it was a “better match than you would find in your sibling,” said Dr. Pomahac to CNN.
A well-founded strategy for a complicated operation
The latest surgery may also be a new method for future face transplants, according to Dr. Pomahac.
The surgical team chose to pause the transplant about 15 hours into the procedure to deal with blood loss, which can make blood clots more difficult, the hospital said.
Dr. Pomahac said the unplanned operation to pause the operation had also allowed a new team to perform the most important and complex part of the operation – the operation – when the blood vessels reconnect and the tissue around the nose, eyelids and lips are aligned.
The team finished the effort the next day.
“It was tough,” said Dr. Pomahac, when asked how difficult the decision was to proceed with the second face transplant.
Although he had weighed if they would do a conventional facial reconstruction, Dr. Pomahac that they decided to move on after Tarleton had emphasized how much the first face transplant had improved her quality of life.
The pandemic also complicated the situation, he said.
All optional surgeries were put on hold, not to mention all transplant surgeries, as donor tissue was not routinely tested for Covid-19 at that time. There were also issues related to having team members from outsiders who could have come from other viral hotspots, says Dr. Pomahac.
Brigham and Women’s Hospital has performed 10 of the 16 face transplants in the country. Doctors in Paris, France, performed the first two-part facial transplant at Jérôme Hamon 2018.
So far, so good
“One can hope that a transplant will last a patient’s lifetime, but realistically, each type of transplant has a finite lifespan,” said Dr. Pomahac in a statement in the news release.
While Tarleton is recovering, the long-term survival time of the transplant remains to be seen, he says.
The next milestone, recovery of facial function, usually takes three to six months and continues to continue thereafter, he added.
Tarleton, who became a speaker after her transplant, said she has “no regrets” about the first face transplant and hopes to reach her goal of working six hours a day within three weeks.
“This face transplant is lighter, smaller and fits my head better,” she continued. “My blindness prevents me from seeing big details, but when I look in the mirror I can see that I have a different face. It looks brighter than my first face.”
Tarleton said she remains good friends with her original donor’s family.
Due to the pandemic, she remained socially distant – so she has been FaceTiming with loved ones who are still getting used to the new Carmen.
“My sister says, ‘I’m just staring at you so my brain knows it’s you,” Tarleton said. “I look more like I did before I was burned.”
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