Seven years ago, Carmen Tarleton received a facial transplant, a decision she made after her foreign husband attacked her in 2007 with a bottle of lye, causing her face to be damaged without recognition. The transplant was a gruesome, complex, surgical procedure – one that ultimately failed.
© J. Kiely Jr./Lightchaser Photography / Brigham and Women’s Hospital via AP
In this July 2020 photo, members of the anesthesiology team at Brigham and Women’s Hospital, Drs. Kamen V. Vlassakov in front, and Lindsay Wahl, led Carmen Blandin Tarleton to the operating room for her second facial transplant at Brigham and Women’s Hospital in Boston.
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 undergo the procedure twice.
The operation, which took place at Boston’s Brigham and Women’s Hospital in July, involved more than 45 clinicians over the span of about 20 hours, according to a news release from the hospital.
“That first face transplant served me very well,” Tarleton, who is recovering from her home in New Hampshire, told CNN. “And when it started to fail, I just knew from experience that a facial transplant would give me the comfort and function I needed on a daily level – that I would live a better life with a facial transplant.”
Now, she said, “all the pain I had in my failed face is gone.” Since the operation, she said she has only experienced related pain to “incidental and swelling”.
Her doctors agreed that the recovery was going smoothly.
“Carmen is making progress and is coming back very nicely with this second transplant – she is one of the most amazing patients I have had the opportunity to care for,” said Dr Bohdan Pomahac, Brigham’s Director of Plastic Surgery Transplant who the effort led, said in the release. “We call this procedure live-giving, and we are excited to offer her the opportunity to return to the kind of life she so richly deserves.”
Burns caused complications at first surgery, hospital says
Tarleton’s initial face transplant turned out to be unsuccessful, as her body began to shed 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, burning 85% of her body and freezing her face.
Because she was sensitized by the life-saving blood products and tissue transplants to treat her burns, Tarleton became more likely immunologically to reject the first transplant, the hospital said.
“In her second facial transplant, Carmen was not highly sensitized, not at high risk of rejection, because she had lost almost all of the HLA antibodies in her blood that had previously sensitized her strongly – probably because of the immunosuppression she received during the first 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 brother,” Drs. Pomahac to CNN.
A new approach to a complex operation
The latest surgery could also be a new approach for future face transplants, according to Drs. Pomahac.
The surgical team decided to pause the transplant for about 15 hours in the procedure to control blood loss, which can make blood clotting more difficult, the hospital said.
Dr Pomahac said the choice to pause the operation, which was not planned, also allowed a fresh team to do the most important and complex part of the operation – the deployment – as blood vessels are connected and the tissue around it nose, eyelids and lips are adjusted.
The team completed the commitment the next day.
“It was difficult,” said Dr. Pomahac, when asked how difficult the decision was to proceed with the second facial transplant.
Although he, that they were waiting, whether they would do a conventional facial reconstruction, said Dr. Pomahac that they decided to move forward after Tarleton had emphasized how much the first face transplant had improved her liveability.
The pandemic also complicated the situation, he said.
All elective surgeons were put on guard, and not to mention all transplants, because donor tissue was not regularly tested for Covid-19 at the time. There were also issues related to having team members from the state who could come from other viral hotspots, Drs. 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-way facial transplant in 2018 on Jérôme Hamon.
So far, so good
“One can hope for a transplant to last a patient’s life, but realistically, each type of transplant has a finite lifespan,” said Drs. Pomahac in a statement in the news release.
While Tarleton is recovering well, the long-term survival of the transplant remains to be seen, he said.
The next milestone, recovery of facial function, typically lasts three to six months and then stays ahead, he added.
Tarleton, who became a public speaker after her transplant, said she “has no regrets” about the initial face transplant and hopes to achieve her goal of working six hours a day within three weeks.
“This facial transplant is lighter, smaller, and fits my head better,” she 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 good friends with the family of her original donor.
Because of the pandemic, she remained socially distant – so she has been FaceTiming with lovers still accustomed 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 it looked before I was burned.”
© Carmen Tarleton
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