A year after Dallas Wiens received a face from an anonymous donor to replace the one he had lost in a horrific power line accident, his new face feels like his own, down to the smallest details.
Since his transplant surgery last March at Brigham and Women’s Hospital, Wiens has steadily gained movement in his cheeks, mouth, nose, and forehead. He turns up the corners of his lips into a smile. He smells food and can eat and drink normally. And, except on a small patch above his left eye, he can feel the sun, a breeze, and the kisses of his 4-year-old daughter, Scarlette.
Before the transplant, Wiens most looked forward to feeling Scarlette’s embrace, he said, and now her kisses often make him “cry tears of joy.’’ But he is most surprised by how normal his new face is. Not only has he grown a beard and eyebrows, but eyelashes, too.
“The minute details are incredible to me,’’ he said in an interview Monday at the hospital. “The way my face has thrived has taken me off guard.’’
Wiens, who lives in Texas with his grandparents and daughter, and his doctors talked to the news media about his progress. He sat at a table, wearing sunglasses - the accident left him blind - and a dark suit. His face was fuller than immediately after the transplant - he has gained about 25 pounds - and the scar that extends from ear to ear under his chin was visible only when he turned his head sharply. Red splotches on his face resembled a rash, but doctors said they were simply the result of “aggressive shaving.’’
Wiens, 26, is the first US recipient of a full face transplant, and the only face transplant patient in the world who has not had an episode of his immune system rejecting the new tissue. More than 20 patients worldwide have received face transplants.
Wiens was deeply burned in 2008 when a cherry picker he was standing in to paint a church brushed against a power line. Doctors had to remove most of his facial muscle, tissue, and nerves, essentially leaving just his skull in front, which surgeons in Texas covered with muscle and skin from his back.
But Wiens had lost all of his facial features, except for a small portion of his chin, as well as his teeth and eyes.
At first Dr. Bohdan Pomahac, director of plastic surgery transplantation at the Brigham, thought Wiens’s injuries were too extensive for a transplant. “He was, quite literally, a man without any remnant that would resemble a face,’’ Pomahac said at the news conference.
But after further examination, Pomahac discovered there were enough underlying nerves left in Wiens’s face to go ahead with the surgery.
Because Wiens had dozens of blood transfusions and skin grafts using donor tissue before the transplant, his immune system was so sensitized that the chances of his rejecting a donor face were extremely high - about 80 percent - making locating a match more laborious.
A woman now on the hospital’s waiting list for a face transplant, Carmen Blandin Tarleton of Vermont, has even longer odds. Doctors estimate her body will accept only about 2 percent of donors, and they are working to develop techniques that will make her immune cells less sensitive, Pomahac said.
Dr. Jeffrey Janis, chief of plastic surgery at Parkland Health and Hospital System in Texas, who is now caring for Wiens, said that the “sensitization’’ experienced by Wiens has raised questions about how aggressively doctors should reconstruct the faces of severely disfigured patients who might be headed for a transplant.
“Do you need to go through an extensive and complicated reconstruction to get to the point to be a transplant candidate, or is less more, so that we don’t sabotage some of the potential procedures that could be performed down the way?’’ Janis said.
Three other patients have received face transplants at the Brigham, and all are progressing well, Pohamac said.
James Maki, who lives in a veterans’ home in Fitchburg, has been going out to restaurants and stores since his transplant in 2009. He can smell, talk, eat, and move his face. He is on a very low dose of anti-rejection drugs and does not have side effects.
Mitch Hunter of Indiana, who had his transplant around the same time as Wiens, has had the best results so far, probably because most of his nerves were intact after his power line injury, Pomahac said. He recently landed a job in maintenance and has such good fine-motor movement that he can whistle.
Charla Nash, who was attacked by a chimpanzee that ripped off her face, had a full face transplant in May. She now lives in a rehabilitation facility in the Boston area. While she can smell, eat, and feel her face, doctors are puzzled because she has less movement on the right side than on the left.
Doctors also plan to repair a gap in her palate that makes her speech unclear at times. But Pomahac said she is physically and psychologically stronger and is asking for a second hand transplant to replace the hands she lost in the attack. The first attempt by the Brigham’s doctors, done at the time of her face transplant, failed.
Wiens is continuing rehabilitation therapy in Texas and is starting a foundation to help other victims of burns and traumatic injuries. In the past year, he underwent minor surgery to tighten the skin on his face and received two prosthetic eyes.
“It’s amazing to be given a life that you weren’t sure for quite awhile that you were ever going to have again,’’ Wiens said during the news conference.
He said there are days when he is tired; he is still rebuilding his stamina after about 30 operations since the accident. And while he said he misses his eyes, he accepts the other differences in his new face. His beard grows in thicker now, his nose is smaller, and his lips are not as full.
“It’s who I am today,’’ he said.
One of his greatest pleasures is drinking coffee in a cafe or sitting in the botanical gardens near his home without “really being noticed.’’
He describes going out before the transplant as “an act of will,’’ because even though he is blind, he could feel people gaping at him “like when someone stares at you from behind.’’
“Now I don’t think about it at all,’’ he said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.