The Brigham held a press conference with Del Peterson to announce the successful surgery, and Wiens knew that he would soon be in front of the cameras. Before flying to Boston, he had given interviews; he says that he was not seeking the spotlight, but he did not reject it, either—sensing that telling his story was part of his responsibility as a patient. “It was difficult,” he said. A British media company had acted aggressively, calling him on his cell phone while he was in post-op and insisting that it had exclusive access. The family took the company to court, alleging that it had falsified documents. (The dispute has been settled.) ABC’s “Good Morning America” asked to film Wiens’s first meeting with his daughter, and he agreed.

By May, the swelling had gone down, and the face drooped, an expected phenomenon that would be corrected. Patches of skin tingled as nerves regenerated. In the ABC segment, Wiens wore sunglasses, a leather jacket, and his flat cap. He had grown a goatee. Cameras surrounded him, and his daughter was placed in his arms. His face could register only gross sensations by then—say, a thumb pressed upon it—but, he said, “It is an amazing experience to be able to just feel a kiss again after two and a half years of having no feeling whatsoever.”

A week later, Wiens returned home. As he had been warned, the immunosuppression had severe side effects, including migraines and fatigue. “His hair was falling out—his own hair, not the donor’s hair,” Chrzanowski told me. “I knew that he was heartbroken about it. And then he was having really bad mood swings—not toward anyone or anything directly, but he would go from being happy to being sad to being angry to resentful.”

“I don’t want to be empowered—I want to be sassy.” Facebook

Twitter

Email

Shopping

Back in Fort Worth, Wiens’s grandmother noticed that he was less animated. His voice seemed lower, too. “And yet I think he handled the transplant very well emotionally,” she said. “He immediately laid claim to it as his own. I asked if I could touch it, and he said, ‘It’s me, it’s a part of me.’ So he has done well in that area, but I wondered if putting on somebody’s physical face changes your persona. I don’t know what that other gentleman was like. He could have been the most jovial person in New England. But Dallas is more sombre today. Maybe part of that is the medications. Before, he was on zero medication. I don’t know what it is.”

If a face transplant demonstrates anything about what it means to be human, it may be that we are less superficial than we imagine. When Peter Butler published his article in The Lancet, skeptics argued that recipients of face transplants would likely suffer an identity crisis. The argument reflects the obsessions of popular culture—cosmetic surgery rendered in fun-house exaggeration on TV—and the dark imaginings of serious literature. In 1964, the year the first hand transplant was attempted, Kobo Abe wrote “The Face of Another,” a parable for postwar Japan; its protagonist, whose face is horribly disfigured, manufactures a lifelike mask to hide his injury. The mask, he discovers, has its own identity; his personality becomes macabre, deformed.

Actual face-transplant recipients appear to adapt quickly. Isabelle Dinoire at first had difficulty; she told Noëlle Châtelet, “Having the inside of the mouth of someone else—it didn’t belong to me. It was atrocious.” But it’s hard to know if the face felt foreign because it initially had no feeling—that strangeness of touching your hand after it’s fallen asleep—or because the tissue was not hers. When I met Dinoire, she was so at ease in the face that she questioned whether she had ever made the statement to Châtelet. The transplant appeared to have aged, perhaps hastened by her smoking, but it seemed like an expressive and integral part of her body. Bernard Devauchelle told me, “There is the fourth dimension—time—affecting the texture of the skin, the quality of the movement, and some atrophy of the tissue. I would like to improve what we can do.” Aside from two early episodes of rejection, which were fought off with medication, her body has accepted the tissue.

Dinoire’s doctors were particularly excited by her brain’s plasticity. Just after she came to Amiens, they conducted fMRI scans. “The part of Isabelle’s brain that controlled motor functioning in her face was progressively being used for function in her hands,” Benoît Lengelé, a Belgian surgeon working with the French team, told me. “But we saw that this brain damage was progressively reversed after the face transplant, and the normal functioning of her brain was restored.”

It appears that gaining a new face is less psychologically straining than gaining a new hand—and that a double hand transplant is less straining than a single one. This might be because the face regains sensation more rapidly than the hands. It took only six months before Dinoire could feel temperature and less than a year before she could close her lips. Max Dubernard told me that he also suspects that being able to see your hands is significant; unless a face-transplant recipient spends all her time before a mirror, the donor tissue is largely out of sight. New hands can’t be so easily ignored. And, unlike a double transplant, a single one raises the question of symmetry, of constantly comparing the appendages. This was Dubernard’s theory, anyway. “I might be wrong,” he said, but he now refuses to do single hand transplants.

In late summer, I visited Wiens at his grandparents’ modest cream-colored brick house, in Fort Worth. When I arrived, a photographer from a Christian publication was there to shoot Wiens and Scarlette having a tea party in the back yard. Wiens seemed tired, but he had shaved (with an electric razor), and he sat at a folding table while his daughter played around him. After the photographer left, Wiens pointed below his right eye and said, “I have sensation around here.” Then he pointed to the left side of his face. “The fact that I am getting anything in this area is incredible.” The sun was out, and he told me he could feel it. Using a cane, he went inside; the immunosuppression raises his risk of melanoma. “I no longer have any reaction to the medication,” he said. “I haven’t had any migraines.” He walked to a table by his bed, turned on his computer, got a Dr Pepper from a fridge, and sat down.

I sat on the bed, and we talked. When I asked about the event that caused him to turn cold at fourteen, he said, “There are only two people who know, and it will probably stay that way—just two of my dearest friends. It’s just not one of the things you want to talk about. I have seen so much death and carnage and pain.” He told me that he had lived in an area of Texas called the Four Corners. “It’s nothing but gangs and cholos, and the best you can do is lock your door and hope you don’t get shot,” he said. “I carried two nines”—9-millimetre handguns—“on me all the time.”

Wiens has cut off friendships with many people he knew before his injury. “They’re just like I was—not what I need,” he told me. Scarlette dashed in to present him with a drawing from preschool, and after she left he turned to his computer. He uses a text-reading program to navigate the Internet, and he showed me his favorite multiplayer game for the blind. He is forming relationships with other players; sometimes, when he is feeling down, he retreats into virtual reality. But he also sees the computer as an opportunity. He has been trying to develop his own game; he told me that he has already started coding it.

When Wiens is in good spirits, he is pursuing new interests: meditation, Japanese, Braille. He speaks at churches. He hopes to form a relationship with the donor’s family, which has chosen to remain anonymous. A local Lions Club has raised money for a guide dog, and recently he took his first trip on his own, to Michigan, for a workshop for the blind on using a cane. “I had no childhood,” he had told me, but the transplant has given him a chance to experience again a child’s firsts: his first sneeze, his first kiss, his first tears.

Still, the more Wiens improves, the more his dependence will be a challenge. His immunosuppressants are covered by insurance—the Brigham has managed to obtain coverage for all its face-transplant recipients—but finding work will be hard. “Dallas is not from some old-money, Texas-oil-tycoon type of family,” his brother David told me. “He just went through a crippling divorce. He lives with retired grandparents who nearly bankrupted themselves attempting to care for him, and he has no means in sight to take care of himself or support his daughter after their death. Charla Nash stands to not receive any money for what she went through. Jim Maki is living in a group home. Yes, they all have a vast network of people who love and care for them. However, every one of them is in some state of financial hardship.” Wiens has set up a personal Web site, with a page for donations, but he is uncomfortable asking for help, and the contributions have been scarce.

In mid-September, Wiens flew back to the Brigham for a checkup, and learned that he was going to get prosthetic eyes. Until then, his eye sockets were fitted with scalloped plastic shells, called spacers, and his eyelids remained shut. A specialist, Matthew Jackson, arrived with the prosthetics. Wiens’s eyes had been hazel, but he decided to switch to blue. “The complexion of the donor is what you have to go by now,” Jackson explained. “Complexion does play a major factor, even with teeth.”

“Still on your left.” Facebook

Twitter

Email

Shopping

Jackson had made the eyes himself. They were beautiful little objects: the hand-painted irises looked natural, with veins of yellow and green, and they were laminated with clear acrylic. Wiens’s eyelids are not functional, so Jackson created a ridge over the irises to keep them propped open. The result is an unwavering stare. When Jackson put one of the eyes in, he noticed some twitching near an eyebrow. “Squeeze your face,” he said. Wiens stretched his lips into a wide smile—something he could not do before. “Look at that,” Jackson said. “Now he is able to move part of the seventh nerve.”

By late autumn, there were more improvements. Wiens was speaking more clearly. “I can actually form letters that I couldn’t before, like ‘B’ and ‘P,’ ” he told me. “I’ve been doing less therapy than I should be doing, but yesterday I was out with my grandmother and Scarlette, and I had an unsweetened iced tea from this fast-food place. I was drinking it the same way I usually do, holding the straw in my mouth with my tongue. Just sitting in the car, randomly, I drew from the straw without doing that, just using my lips. I didn’t even notice it the first time, but then the second time I was like, ‘Wow, did I just do that?’ ”

No one knows how long a facial graft can survive; the oldest is only six years old. There have been nineteen face transplants of various kinds, and two of the recipients have died, one from abandoning the immunosuppressant drugs and the other from complications of infection. Almost a year after his surgery, Wiens is the only recipient who has not had an episode of acute rejection. This winter, his grandmother noticed redness on his forehead, and rushed him to the hospital. Soon afterward, he went to Boston. The graft was fine—the problem was acne—but while he was at the Brigham the surgeons removed excess skin beneath his chin, to make the transplant fit him better. “Dallas got a little bit of a face-lift,” Pomahac said.

Just before the surgery, E. J. Caterson stopped by. He had met the resident at Parkland who had proved that Wiens was not brain-dead, and, as a surprise, he called him and handed the phone to Wiens.

“Dallas started to talk about how happy he was to hear from him, and how he was doing, and basically he was saying, ‘I want to thank you for saving my life,’ ” Caterson recalled. “He spoke softly into the phone, and I saw an expression on his face that was deep and meaningful. The next day, I ran into Dallas’s grandfather, and he said, ‘You know, talking to that doctor really made him want to cry.’ Then it dawned on me: I was witness to an involuntary expression of emotion—the kind we have all the time. It was truly a demonstration of cortical integration with something that is not his. Just conceptually, that is mind-blowing. It’s one thing to say, you know, ‘The blood flow is great,’ and ‘We put the bones in the right spot.’ But we’re now talking about a guy who is using his face as an emotional vehicle.”

Pomahac wonders whether Wiens will ever have more than seventy per cent functioning on the left side of his face, but Wiens is more hopeful. He is convinced that one day his remaining eye, the one the surgeons at Parkland preserved, will be restored. In the meantime, he is looking forward to his tooth implants. The rebuilding can seem continuous. He is working on a fantasy novel inspired by his experience, which he titled “Neverending.” For inspiration, he has been listening to fantasy books on his computer. Sometimes, during moments of insomnia, he occupies himself that way.

Wiens dreams occasionally of the injury, of being sucked into the hellish abyss. “I am watching myself in the third person in that darkness crying out,” he told me. “I could still be there, but I am not.” In November, I called him, and he told me that the night before he had had an unusual dream: he saw himself as he had been after Janis reconstructed him, the smooth, featureless skin in place of a face; the experience was nostalgic, as if he had peered into childhood, or into a past that he had long ago left behind. These days, the face that he encounters in his dreams is more often a version of the transplant. He does not know what it looks like, but his unconscious has been struggling to visualize it. “I have never seen it clearly—more as a profile,” he told me, his voice slow and soft over the phone. “It is kind of clouded, so it is difficult to tell, and even if I see it clearly I don’t remember it clearly when I wake up. But it’s pleasant.” He paused, and added, “Mostly because my attitude about life is pleasant.” ♦