Imagine not being able to go out into public for fear of embarrassment. Imagine not being able to smile or eat unable to perform the simplest of functions such as display facial expressions. And then imagine being able to breathe, smell and taste properly.

For a time, that was the constant reality of a patient who suffered from severe facial disfigurement, until surgeons at Cleveland Clinic gave her the first near-total facial transplant in the U.S. and the fourth in the world.

"This was definitely a triumph," Francis Papay, MD, chairman of dermatology and plastic surgery at the clinic, and a member of the team that performed the procedure, told Medical Device Daily. "She was shunned by society, she was afraid to go out into the public. Now she has a sense of smell, and she will be able to eat without the aid of a device. [This procedure] gave her, her life back."

The operation involved the patient (who wishes not to be identified) and a deceased donor. Surgeons took a nose, most of the sinuses around the nose, the upper jaw and even some teeth from the donor.

The transplant is said not to give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different.

"She looks normal, but has a mask-like feature," Papay said. "She lacks animation nerves, but those will come within six to eight months. Overall, it's going to take about a year for her to recover."

During the process, doctors paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures they recovered from the donor's facial tissue.

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 in the 22-hour procedure.

Typically after these procedures are completed, the patient must take immunosuppressive drugs to suppress their own immune system and prevent rejection. There are some risks including the risk of developing life-threatening infections, kidney damage and cancer.

This also brings into question the ethics surrounding the procedure, since the patients can be more susceptible to diseases and face death as a result of the medicines they take to prevent tissue rejection.

But the Cleveland Clinic surgeons said that this is not just a cosmetic surgery and the risks far outweigh the benefits.

The transplant team was led by Maria Siemionow, MD, PhD, head of plastic surgery research, who received worldwide attention in November 2004 when the clinic's Institutional Review Board said that face transplantation is both ethical and possible by approving the first protocol for the surgery.

During a press conference last week, Siemionow said she was "proud" and "emotional" to be able to report that the procedure was a success.

"The surgery took 22 hours," she said. "The preparation to the surgery took over 20 years of work in the field of composite tissue transplantation."

A patient by the name of Isabelle Dinoire received the first facial transplant in France in 2005, after she had been mauled by a dog. Dinoire received a new nose, chin and lips from a brain-dead donor. Since then two others have received partial face transplantations a Chinese farmer who had been attacked by a bear and a European man suffering from a genetic disease.

Even though this is the fourth such transplant, Papay said he thinks it will lead to more procedures down the line.

"I think as science progresses and the type of immunotherapy that causes tissue to be more compatible becomes more widespread, we'll see more of these procedures," Papay told MDD. "I think in the future you'll find this type of procedure replacing lower extremities such as legs and feet. I think we'll also see amputated limbs replaced."