LYON, France - As she held the mirror up to her new face, the woman looked at her reflection. She paused for a moment. Unable to speak because of the breathing tube in her throat, she wrote a note, "Merci." Thank you.
Then, she cried. Dr. Sylvie Testelin, one of her surgeons, cried too.
The results of the daring nose, lips and chin transplant - the first ever attempted - were beyond what the doctors had hoped for. The new face bore an uncanny resemblance to her former face, one doctor said.
At their first news conference since Sunday's surgery in northern France, doctors on Friday described the 15-hour operation and the woman's reaction to her new face.
The 38-year-old divorced mother, who doesn't want her identity known, had been mauled in June by her dog, a Labrador retriever mix adopted from a rescue shelter. The lower half of her face had been ripped off.
Before the operation, the woman couldn't chew her food. She had trouble speaking. Whenever she tried to drink something, most of the liquid dribbled from her mouth. She would only go out in public wearing a surgical mask to protect her from stares.
Conventional reconstructive surgery may have been possible, but it would have been very difficult, if not impossible, to restore not only her appearance, but also basic functions, her doctors said Friday.
Several expert advisers agreed that traditional surgery involving skin and muscle grafts from elsewhere on the woman's own body was not a viable solution, the doctors said.
Leading transplant surgeon Dr. Jean-Michel Dubernard acknowledged that he initially had reservations. But he added that when he saw the extent of the woman's disfigurement, "I no longer hesitated for a second."
"If we didn't perform this operation, her outcome would have been quite poor. She would have had to undergo four, maybe five conventional surgeries over a long period of time, with uncertain results," said another of her surgeons Dr. Benoit Lengele, of the Saint-Luc University Clinic in Brussels, Belgium. "We wanted to try to restore her as best as possible and as quickly as possible. We truly believe from the human standpoint and the scientific point of view that the solution we took was the best one."
Dubernard said the cost of the operation hasn't been calculated. It will be paid for by the French government's tax-funded health system, as is most French health care.
The groundbreaking and risky operation began at 12:30 a.m. Sunday at a hospital in Amiens. One team of doctors traveled to Lille, another northern town about 60 miles away, to collect the lips, nose and chin from the donor. The brain-dead woman's family donated her facial tissue to the doctors and the rest of her organs to other recipients.
Engineers designed a silicone prosthetic mask that was fitted to the donor's face after the tissue was removed to try to restore the body to a more normal appearance. The prosthetic had the same stiffness, color and shape as the donor's face, the doctors said.
Another team of surgeons prepared the disfigured patient. They cut away the fibrous tissue that had formed on her face since her accident.
When the transplant team arrived in Amiens, eight surgeons led by Dr. Bernard Devauchelle sewed the blood vessels in the woman's face to those of the donor tissue. They then connected the nerves and muscles, then sewed in the lining of the mouth and the skin from the nose to the chin.
Four hours into the 15-hour operation, the blood was circulating normally between the graft and the rest of the woman's face.
"When it was finished and we were washing the skin and applying the dressings, there was a big silence in the operating room. We were all surprised because the immediate result was completely outside our expectations - it looked marvelous," Lengele said.
"There is simply a small scar around the outside of the graft. All the other scars are inside, in the mouth, in the nose. A small scar in the neck," he said.
Devauchelle said the team was "totally stupefied" by how perfectly the transplant was integrated into her face in terms of the color and the thickness of the skin.
The woman already has some mobility in the new tissue. She can eat, drink and speak clearly, Devauchelle said. But it will be another six months before the nerves start to regenerate. It's too early to tell how natural the transplant will look, but the doctors said they were optimistic.
The biggest hurdle now is the body's acceptance of the transplant. The woman must take drugs for the rest of her life to prevent her immune system from rejecting the tissue. It's still possible that the surgery will fail, that the new tissue on her face might die and turn black, even months later. In that case, reconstructive surgery or a new transplant would be needed.
In an effort to keep her body from rejecting the new tissue, the doctors infused the woman with stem cells taken from the bone marrow of the donor. They hope that might make it possible to lower the dosage of anti-rejection drugs.
The woman is getting her main food pureed, but she has eaten chocolate and strawberries, Testelin said. For now, she can only show her gratitude by smiling with her eyes.
As for the dog that maimed her, the woman holds no grudge, Testelin said, as the circumstances surrounding the injury remained cloudy Friday.
"She doesn't blame the dog," the doctor said. "The dog liked her. He tried to wake her up, or whatever. I was not there. It was no more than an accident, and she thinks like that."
Dubernard denied a French media report that the woman was attacked by the dog after she had passed out from taking pills in a suicide attempt. Instead, he said, the woman had taken a pill to try to sleep after a confrontation with one of her two teenage daughters and was bitten by the dog during the night.
The dog was euthanized, but since then, the patient has acquired a new dog, Testelin said.