By Emma Cott, Abby Goodnough and Leslye Davis
A Face in Progress: Carmen Tarleton is adjusting to her new face since undergoing transplant surgery in February.
THETFORD, Vt. — At 1:30 a.m. on Valentine's Day this year, Carmen Tarleton left her rural home here and drove through the frigid dark to Brigham and Women's Hospital in Boston. Her doctor had called hours earlier with the news she had been waiting for: a suitable donor had been found. She would get a new face.
Almost six years had passed since her estranged husband broke into her house one spring night, beat her with a baseball bat and soaked her with industrial lye that he squirted from a dish-soap bottle. The attack nearly blinded Ms. Tarleton, a nurse and mother of two, and burned her beyond recognition. She lost her eyelids, upper lip and left ear. What remained of her face and much of her body was a knobby patchwork of scar tissue and skin grafts, painful to look at and far more painful to live with.
Now, after overcoming some initial fears, she was ready to receive someone else's features. After 15 hours of transplant surgery, Ms. Tarleton, 45, emerged from the operating room with what looked to her mother, Joan VanNorden, like a puffy, surreal mask. At first she wanted to faint as she stared at the new face, smooth and freckled, stitched to her daughter's pale scalp. But when Ms. Tarleton started talking in her old familiar voice — "Can't you just get in here?" — Mrs. VanNorden relaxed.
"I said, 'This is who Carmen is now,' and it really looked beautiful," she recalled. "Although it didn't look anything like her, it was her face."
Face transplants are still an experimental procedure, the first having taken place just eight years ago in France. Some two dozen full or partial transplants have been completed worldwide, including five at Brigham and Women's, which used nearly $4 million in research grants from the Department of Defense to do four of the surgeries. Arteries, veins, nerves and muscles from the donor face must be painstakingly connected to the recipient's, in what Dr. Bohdan Pomahac, Ms. Tarleton's chief transplant surgeon, called "by far the most complicated operation that I do."
Yet the psychological impact of a face transplant is perhaps as far-reaching as the surgical one. Unlike a kidney or liver or heart, a donated face is visible to all, challenging recipients and their loved ones to incorporate an entirely new countenance into long-held perceptions of a person's identity.
Ms. Tarleton's appearance is still evolving: her scalp was so badly burned that hair will never return to parts of her head, but her donor's hair, the same shade of brown as her own, is growing around her forehead and temples. Her right eye remains closed, and her left droops. Her face is sometimes masklike, betraying little emotion, because the muscles are still reconnecting and she cannot yet move them well. And that mask, oddly enough, looks like neither her nor the woman who donated it.
But eight months after the operation, there is evidence that Ms. Tarleton's new face is more than just donated tissue, and is becoming part of who she is.
When her family thinks, or even dreams, about her, they imagine her new visage. "When someone at work asks me, 'How's Carmen?' the picture that comes up in my mind more and more is that face," said Ms. Tarleton's sister, Kesstan Blandin.
Yet for Ms. Tarleton herself, the process of acceptance has been trickier. For one thing, her poor vision keeps her from seeing herself clearly unless she holds a mirror up close. "I don't yet feel it is 'my face,' " she wrote in a recent blog post. "I feel like I am still borrowing it."
Ms. Tarleton's former husband, Herbert Rodgers, 58, pleaded guilty to a charge of maiming and is serving a prison sentence of at least 30 years. Mr. Rodgers told the police that he had been angry at Ms. Tarleton, believing she was seeing another man after they separated.
Ms. Tarleton underwent a number of reconstructive surgeries, but with little success. When Dr. Pomahac called in May 2011 to propose a face transplant, Ms. Tarleton's mind first leapt to a "Twilight Zone" episode that had jarred her as a child, about a man who could change his appearance to look like other people.
"Initially I felt that it was very sci-fi," she said in a recent interview while curled on the couch in the modest home she shares with her two daughters. But she and her family started researching, and after a few weeks of weighing the pros and cons — for one thing, she is likely to be on immunosuppressant drugs for the rest of her life, raising her risk of infection and cancer — Ms. Tarleton decided to forge ahead.
After a number of trips to Boston for physical and psychological screening to determine if she was a good candidate, she got on the donor list that fall. "It was like a big surprise, a big gift," she said. "I'd already accepted my disfigurement, fine. But I accepted it believing there wasn't an alternative."
The things Ms. Tarleton wanted from a new face were more pragmatic than aesthetic. Tight bands of scars ringed her neck, causing debilitating pain. She drooled constantly and could not blink, jeopardizing a synthetic cornea in her left eye. And with her face frozen from scarring, it was hard for others to read her emotions.
For a time, she was devastated that she could not see "the old me," as she put it. But she moved on, writing a book about her physical and emotional recovery from the attack and speaking publicly about the experience. She seemed mostly unconcerned about her appearance.
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