(CNN) — Seven years ago, Carmen Tarleton received a face transplant, a decision she made after her ex-husband attacked her in 2007 with a bottle of bleach, disfiguring her face beyond recognition. The transplant was a complex and exhausting surgical procedure, which was ultimately unsuccessful.
But last month, Tarleton, a 52-year-old ex-nurse, decided to do it again, making her the first American and the second person to undergo the procedure twice.
The surgery, which took place at Boston’s Brigham and Women’s Hospital in July, involved more than 45 doctors in a span of about 20 hours, according to a hospital news release.
“That 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 knew from experience that a face transplant gives me the comfort and function that I want and need on a daily basis, that I am going to live a better life with a face transplant.”
Now, he said, “all the pain I had on my weakened face is gone.” Since the operation, she said she only experiences pain related to the “incision and swelling.”
His doctors agreed that the recovery is progressing smoothly.
“Carmen is progressing and recovering very well with this second transplant; she is one of the most resilient patients I have ever had the opportunity to care for, ”said Dr. Bohdan Pomahac, Brigham’s director of plastic surgery transplants, who led the effort, in the statement. “We call this procedure bringing life to life and we are delighted to offer you the opportunity to return to the kind of life you so highly deserve.”
Burns caused complications in first surgery, says hospital
Tarleton’s first face transplant ultimately proved unsuccessful because her body had begun to reject donor tissue, causing scarring, tension, swelling and pain, she and the hospital said.
In 2007, her husband – from whom she had separated – attacked her with a bottle of bleach, severely burned 85% of her body and disfigured her face.
Because she became sensitive to blood products and tissue grafts to treat her burns, Tarleton became more immunologically prone to reject the first transplant, the hospital said.
«Going into her second face transplant, Carmen was not very sensitized, she was not at high risk of rejection, as she had lost almost all the HLA antibodies in her blood that had previously sensitized her, probably due to the immunosuppression she had received during the first transplant, “said Dr. Anil Chandraker, a member of the transplant team, in a press 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 brother,” Dr. Pomahac told CNN.
A new approach to a complicated operation
The latest operation may also be a new approach for future face transplants, according to Dr. Pomahac.
The surgical team chose to pause the transplant about 15 hours after the procedure to control blood loss, which can make it difficult for blood to clot, the hospital said.
Dr. Pomahac said that the choice to pause the operation, something that was not planned, had also allowed a new team to do the most important and complex part of the operation, the graft, when the blood vessels are reconnected and the tissue around the nose, eyelids and lips are realigned.
The team finished the graft the next day.
“It was difficult,” said Dr. Pomahac, when asked how difficult the decision to go ahead with the second face transplant was.
Although they had considered having a conventional facial reconstruction done, Dr. Pomahac said they decided to move on after Tarleton emphasized how much their quality of life had improved with the first face transplant.
The pandemic also complicated the situation, he said.
All elective surgeries were discontinued, 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 out of state who could have come from other viral hotspots, Dr. Pomahac said.
Brigham and Women’s Hospital has performed 10 of the 16 face transplants in the country. Doctors in Paris, France, performed Jérôme Hamon’s first face transplant twice in 2018.
So far so good
“One can expect a transplant to last the life of the patient, but realistically speaking, each type of transplant has a finite lifespan,” Dr. Pomahac said in a statement in the news release.
While Tarleton is recovering well, long-term transplant survival remains to be seen, he said.
The next milestone, recovery of facial function, typically takes three to six months and continues to progress thereafter, he added.
Tarleton, who became a public 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 in three weeks.
“This face transplant is lighter, smaller and better suited to my head,” he continued. “My blindness prevents me from seeing great details, but when I look in the mirror I can see that I have a different face. It looks paler than my first face.
Tarleton said she remains a good friend to her original donor’s family.
Due to the pandemic, he has remained socially distant, which is why he has been FaceTiming his loved ones who are still getting used to the new Carmen.
“My sister says, ‘I’m just looking at you so my brain knows it’s you,'” Tarleton said. “I look more like I looked before they burned me.”
CNN’s Stephanie Becker contributed to this report.