PARIS — He has been called the man with three faces.
Jérôme Hamon of France has earned the title because of pioneering operations that have made him the first person to get not just one, but two full face transplants.
Both surgeries were performed by Dr. Laurent Lantieri of the Georges-Pompidou European Hospital in Paris. Mr. Hamon was said to be recovering in the hospital from the second operation, which he underwent in January.
Mr. Hamon, a French bookseller, has neurofibromatosis, a genetic disease that can lead to facial deformities. In June 2010, Dr. Lantieri removed Mr. Hamon’s entire face, including his eyelids and lachrymal system.
Using material from a 65-year-old donor, the surgeon replaced the bookseller’s face with a full-face skin graft. The operation was a success. The only features of Mr. Hamon that were preserved were his blue eyes.
“I am not the one that people are staring at with terror and cruelty. I am a man among men, simply a happy man,” he wrote in “Have You Seen That Gentleman,” a book describing his experience.
But five years later, his new life took a cruel turn — all because he caught the common cold.
To treat the illness, Mr. Hamon took an antibiotic he had received via a medical prescription. But the pill was incompatible with the immunosuppressive treatment for the transplant. Mr. Hamon’s body quickly started rejecting his face.
Doctors decided to add Mr. Hamon to the national transplant waiting list for a new face. They made clear that while the first transplant sought to give him a better quality of life, the second was to save his life.
Parts of his first transplant began gradually to die. The skin began to get stiff. In November, surgeons had to remove Mr. Hamon’s new face entirely. Dr. Lantieri said Mr. Hamon looked like a “zombie in ‘The Walking Dead’” after the transplant was removed.
“Without skin, the organism is subjected to repeated microbial attacks that can lead to septicemia, and therefore to death,” Dr. Lantieri said.
With no face, Mr. Hamon was confined to a highly sterilized room for about two months. He was unable to move and could not drink, eat or breathe naturally because he did not have lips. He could barely hear because he did not have ears. He could not see because he did not have eyelids (doctors closed his eyes artificially to protect them).
To communicate, Mr. Hamon sometimes typed words on a touch pad. But “while waiting, he never complained — he was even in quite a good mood,” Bernard Cholley, an anesthetist-resuscitator, told French television.
“It’s just an incredible ordeal that no one in the world has ever experienced,” Mr. Cholley added. “He earned the well-deserved admiration of everyone for his stoicism and his capacity to confront the situation”
In mid-January, skin from a new donor became available from a 22-year-old man in western France who had been declared brain-dead. After getting the family’s approval, Dr. Lantieri removed the face of the young man.
“In the U.S., it is necessary to be declared as a donor. But in France, we follow the principle of supposed consent,” Dr. Lantieri said in a phone interview on Wednesday. “It enables us to take organs without authorization. However, we always ask for the family’s agreement for a face.”
A prosthetic mask was made for the donor. “Even though the family does not want to see the deceased, we do it as a matter of respect,” Dr. Lantieri said. The procedure has been used in New York to replace the faces of dead patients. “It’s extremely lifelike,” Dr. Lantieri said.
Before Mr. Hamon underwent the second transplant, doctors replaced all the blood in his body in a monthlong procedure, to eliminate any potentially problematic antibodies from previous treatments.
Then, medical workers began painstakingly putting the new face on Mr. Hamon’s head. The operation lasted almost 24 hours and involved about 30 members of staff.
“It was very difficult because the blood vessels had a much worse quality after the first transplant,” Dr. Lantieri said. “It’s not like a lifting. Everything had to be reconstructed.”
But the work paid off. Mr. Hamon’s face started getting red again at the end of the operation.
“I recognize him; it’s him,” Mr. Hamon’s mother, Arlette Geffroy, said at the hospital when she first saw her son after his second transplant, according to Dr. Lantieri.
Mr. Hamon cannot yet eat, and he speaks with difficulty. His face does not perfectly fit his skull. He lost a lot of weight but remains highly motivated, his doctor said.
“He can’t move his face or have facial expressions yet, but he has sensations on his face,” Dr. Lantieri said. “He is tired but not depressed. His treatment shows that there is no rejection. I am very confident.”
In a news release, the hospital said, “The patient, still hospitalized, was able to enjoy a first outing, with his final discharge expected in the short term.”
“For the first time worldwide, it showed that, when it comes to composite vascularized transplants (face and hand), re-transplantation is possible,” the statement added.
There have been about 40 face transplants globally (about a quarter of them in France) since the world’s first partial face transplant was performed on a Frenchwoman, Isabelle Dinoire, in 2005. Her nose, lips, chin and parts of her cheeks were replaced after she was bitten by her dog. Ms. Dinoire died in 2016 at 49.
In the United States, the first face transplant was performed in Cleveland, in 2008, on an unidentified woman. In 2011, Charla Nash, 62, underwent a full face transplant at Brigham and Women’s Hospital in Boston after she was mauled by a friend’s pet chimpanzee in Stamford, Conn., in 2009.
Mr. Hamon’s surgery meant he was not only the first to get two full face transplants and to live without a face for months, he also became the first to be able to cry with someone else’s tear ducts.
On French television on Tuesday, Mr. Hamon noted that he had gone from the face of a man in his 60s to that of a man in his 20s. “I’m 43,” he said. “The donor was 22. So I’ve become 20 years younger.”
The whole procedure, including the transplant and the medication, cost nearly a quarter of a million euros, about $309,000, which was paid by the French public health care system.
Mr. Hamon’s surgery offers hope for patients with severe facial deformities. But Dr. Lantieri, who has performed eight such operations, said, “It will never be a generalized practice.”
The operations remain very sensitive. Because of the difficulty in finding donors, the cost and the risks of complications, they are not expected to become commonplace. And multiple face transplants are likely to remain even more rare.
“It’s an experience I don’t want to live again,” Dr. Lantieri said. “Neither for him, nor for me.”
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