But last month, Tarleton, a 52-year-old former nurse, chose to do it again, making her the first American and the only second person to undergo the procedure twice.
The surgery, which took place at Brigham and Women’s Hospital in Boston in July, involved more than 45 clinics over the space of nearly 20 hours, according to a hospital announcement.
“This 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 face transplant gives me the comfort and function I want and need on a daily basis – that I will live a better life with a face transplant.”;
Now, she said, “all the pain I had on my failed face is gone.” Since the surgery, she said she is only experiencing “cutting and swelling” pain.
Her doctors agreed that the recovery is going smoothly.
“Carmen is progressing and recovering very nicely with this second transplant – she is one of the most resilient patients I have had the opportunity to care for,” said Dr. Bohdan Pomahac, Brigham’s director of Plastic Surgery Transplant who led the effort, said in the release. “We call this the life procedure and we are excited to offer her the opportunity to get back to the kind of life she so deserves.”
The burns caused complications in the first operation, the hospital says
Tarleton’s first face transplant was ultimately unsuccessful because her body had begun to reject donor tissue, causing pain, tightness, swelling and pain, she and the hospital said.
Because she was sensitized by blood rescue products and tissue grafts to treat her burns, Tarleton became more immunologically predisposed to refuse the first transplant, the hospital said.
“Entering her second facial transplant, Carmen was not very sensitized, not at high risk of rejection, as she had lost almost all the HLA antibodies in her blood that had made her previously highly sensitized – “Probably because of the immunosuppression he had received during the first transplant,” said Dr. Anil Chandraker, member of the transplant team, in a news release.
This time around, Tarleton had an “unusual tight tissue match” from the donor, the hospital said.
India was so narrow that it was a “better match than it would find in your sister,” said Dr. Pomahac for CNN.
A new approach to a complicated operation
The latest surgery could also be a new approach to future face transplants, according to Dr. Pomahac.
The surgical team decided to stop the transplant for approximately 15 hours in the procedure in order to manage blood loss, which could make blood clotting more difficult, the hospital said.
Dr Pomahac said the choice to stop the operation, which was unplanned, had also allowed a fresh team to do the most important and complex part of the operation – the inscription – when the blood vessels are reunited and the tissues around the nose, eyelids and the lips are realized.
The team finished the cover the next day.
“It was difficult,” said Dr. Pomahac, when asked how difficult the decision was to move forward with the second face transplant.
Although he had weighed on whether to do a conventional facial reconstruction, Dr. Pomahac said they decided to go ahead after Tarleton had pointed out how much the first face transplant had improved her quality of life.
The pandemic also complicated the situation, he said.
All elective surgeries were held pending, not to mention all transplant surgeries as donor tissues were not routinely tested for Covid-19 at the time. There were also issues involving team members from overseas who could have come from other viral points, Dr. said. Pomahac.
So far, so good
“One can hope for a transplant to extend the life of a patient, but realistically speaking, any type of transplant has a limited lifespan,” said Dr. Pomahac in a statement to the press release.
While Tarleton is recovering well, the long-term survival of the transplant remains to be seen, he said.
The main point, the recovery of facial function, usually lasts three to six months and continues to progress after that, he added.
“This facial transplant is lighter, smaller and fits better on my scalp,” she continued. “My blindness makes me see great detail, but when I look in the mirror I can see that I have a different face. It looks nicer than my first face.”
Tarleton said she remains good friends with the family of her original donor.
Because of the pandemic, she has remained socially distant – so she has been FaceTiming with loved ones who are still accustomed to the new Carmen.
“My sister says, ‘I’re just looking at you, so my brain knows it’s you,'” Tarleton said.
CNN’s Stephanie Becker contributed to this report.