Unsettled futures: Unresolved questions of face transplants, 20 years on

• When he saw the headlines in 2002, James Partridge was furious. Severely burned in a fire at 18, he had spent his life advocating for people with “visible difference” through charities like Changing Faces and Face Equality International. Yet he found himself used as tabloid fodder in debates about face transplants: how much better might James look with one?

The question surfaced during a wave of publicity surrounding the UK’s bid to attempt the world’s first face transplant. Plastic surgeon Peter Butler and his team at the Royal Free Hospital argued they were ready, claiming no other procedure could restore appearance and function after severe injury.

The debate had been building for decades. Since the first successful kidney transplant in 1954, surgeons had moved on to hearts, lungs and hands. Some saw the face as the next logical step: “a face is just like a hand”. But not everyone agreed.

Partridge described the idea as ethically fraught and potentially harmful. As he argued in his commentary on the UK proposals, the operation risked promoting the idea that disfigurement must be “fixed” at any cost.

The dangers were already clear. Early reviews warned of graft rejection, life-threatening infections, cancers and other complications linked to lifelong immunosuppressants. Yet the UK media were enthralled, especially after reports that a 14-year-old burns survivor had been identified as a potential first recipient.

Partridge intervened. He persuaded Sir Peter Morris, then President of the Royal College of Surgeons (RCS), to convene an expert working group. Its report advised against proceeding: the psychological implications of giving someone a new face were unknown, making fully informed consent impossible. And what message would the surgery send to others living with facial difference?

Everything changed on November 27 2005, when a French team led by Bernard Devauchelle and Jean-Michel Dubernard carried out the world’s first partial face transplant. The recipient was Isabelle Dinoire, a 38-year-old woman mauled by her dog after taking an overdose. When she woke and tried to smoke, she couldn’t; in the mirror, she saw that part of her face was gone.

At a press conference months later, Dinoire drank from a cup with new lips, spoke quietly, and thanked her surgeons and the donor. Her story became a global media spectacle.

In 2006, the RCS shifted position. Recognising that face transplants were a surgical reality, it suggested they could proceed – cautiously. But by then the UK programme had stalled, while centres in China, the US and elsewhere moved ahead.

Two decades on, only around 50 face transplants have been performed worldwide. Some patients have required re-transplantation, but long-term survival data remain limited. A face, it turns out, is not like a hand: failed hand grafts can be removed, but a rejected face leaves few good options. Immunosuppressants still carry significant risks.

Dinoire’s experience also highlights the psychological toll. She struggled with depression and intense media scrutiny, describing herself as feeling like a “circus animal”. These are not issues kidney or liver recipients typically face. A face is visible, social and symbolic. It shapes identity, relationships and self-recognition.

Partridge understood this. In 2015, he praised Dinoire for taking what he called “a leap into the dark”, while warning that innovation must not outpace psychological support or a deeper understanding of what faces mean to people with visible difference.

Understanding how faces ground identity and social life is more complex than any operation. Twenty years after Dinoire’s transplant, the world is still learning what it means to give someone a stranger’s face. The surgery is possible. The long-term consequences remain uncertain.

The Conversation