When her husband shot her five years ago, Connie Culp was left without a nose, a palate or lower eyelids, but on Tuesday she revealed her new face.Culp's was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date.
The 46-year-old mother of two underwent a procedure last December that lasted 22 hours at the Cleveland Clinic in the state of Ohio.
Surgeons transplanted about 80 percent of Culp's face using facial tissue from a dead woman that was placed like a mask atop her own. Almost her entire face was replaced, except for the forehead, upper eyelids, lower lip and chin.
The team of 11 surgeons who performed the operation said Culp, who was missing bone support and had been unable to eat or breathe without a tube in her windpipe, could now perform functions normally. But her face was bloated, drooping and her speech was at times difficult to decipher.
"We think this ... procedure has changed her life dramatically," Maria Siemionow, the clinic's director of plastic surgery research, told a news conference.
Culp's identity and the incident that had disfigured were kept under wraps until today.
"Well, I guess I'm the one you came to see today," Culp said after being helped up to the podium.
But, she added, "I think it's more important that you focus on the donor family that made it so I could have this person's face."
When Risal Djohan, a plastic surgeon at the clinic, first looked at Culp's injuries two months after she was shot, "he told me he didn't think, he wasn't sure, if he could fix me, but he'd try," the patient recalled.
"Here I am, five years later. He did what he said -- I got me my nose," she said with a laugh.
Facial transplants are controversial because they carry heavy risks and are performed to improve a patient's quality of life rather than as a life-saving operation.
There are also concerns that the operation could eventually be used for purely cosmetic purposes or as a means of altering someone's identity.
Although the circumstances that led to Culp's injury were not revealed at the news conference, local media reported that her husband, Thomas, had shot her in 2004 at point-blank range before turning the gun on himself. The apparent murder-suicide attempt failed and he was sentenced to seven years in prison.
A thoroughly disfigured Culp went through 30 operations in an attempt to salvage her face before finally undergoing the transplant, which was also the first of its kind known to have included bones, along with muscle, skin, blood vessels and nerves.
Siemionow said the transplant "was the most complex functional restoration in the world today."
"We have transplanted for the first time in the world the largest scheme of the face, which was combined with the bones, with the entire nose and functional units, including lower eyelids, upper lip and including also her palate," she said.
Doctors paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures, as they recovered the donor's facial tissue.
The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves.
Culp, whose sight had made adults cringe and children run away, urged others not to judge people by their looks.
"When somebody has a disfigurement and don't look as pretty as you do, don't judge them, because you never know what happened to them," she said.
"Don't judge people who don't look the same as you do. Because you never know. One day it might be all taken away."
Doctors in France performed the first partial face transplant in 2005 on a 38-year-old woman, Isabelle Dinoire, who was disfigured in a dog attack and had her mouth and nose replaced.
In a world first, French surgeons replaced in a single operation in April the face and both hands of a man horribly disfigured by an accident. The operation lasted 30 hours and required a medical team of more than 40.