"It is difficult to conceive that the same degree of success ... would have been possible with existing techniques" and no transplant, Dr. Patrick Warnke, a facial surgeon from the University of Kiel in Germany, wrote in a commentary published online by the Lancet, a British medical journal.

In the same journal, Dr. Bernard Devauchelle at Amiens University details how he and other surgeons kept the donor face on iced sponges during Dinoire's surgery as they carefully prepped it and the patient for the procedure.

During surgery, doctors discovered that the donated face lacked a key nerve that would have helped to animate the lower portion of Dinoire's face.

The operation not only restored her appearance, but also her self-confidence, so that she now is willing to go out in public again, doctors said.

Before the operation, three psychiatrists agreed with a fourth independent expert that she was able to psychologically cope with the procedure, Devauchelle wrote.

Since Dinoire's transplant, the Cleveland Clinic has inched forward with plans to do a full face transplant, Chinese doctors have done a partial transplant, and a panel in England is considering a doctor's request to do one there.

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