In this undated photo, Dr. Risal Djohan, left, Dr. Maria Siemionow, centre, and Dr. Daniel Alam perform a near-total face transplant at the Cleveland Clinic. Reconstructive surgeon Siemionow replaced 80 per cent of the woman's face with that of a deceased female donor. (Cleveland Clinic/Associated Press)

A woman who had suffered severe facial trauma got essentially a whole new face — including bones, muscle and nerves — in a first-of-its-kind operation at the Cleveland Clinic in Ohio, hospital officials said Wednesday.

Only the woman's upper eyelids, forehead, lower lip and chin were left — the other 80 per cent of her face was replaced with one donated from a female cadaver during the 22-hour surgery.

It was the first face transplant in the U.S. and the fourth worldwide.

The patient's name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential.

Dr. Maria Siemionow answers questions during a news conference at the Cleveland Clinic on Wednesday. Siemionow participated in the first near-total face transplant in the U.S. (Tony Dejak/Associated Press)

The woman's injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe.

"I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw," said the lead surgeon, Dr. Maria Siemionow. of the woman's reaction after the transplant.

She said the woman is "doing well" and the surgery went according to plan. The transplant was done within the past two weeks.

It is the first facial transplant known to have included bones, along with muscle, skin, blood vessels and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw and even some teeth, said Dr. Frank Papay, the clinic's plastic surgery chief.

"This patient exhausted all conventional means of reconstruction and is the right patient," Siemionow said at a news conference.

So many disfigured patients are stuck "in their houses who are hiding from society," afraid to go out, she said.

"Our patient was called names and was humiliated," she said. "You need a face to face the world."

The face was donated by a family that was asked specifically to approve the gift and was not done under general organ donation consent rules, said officials of LifeBanc, the Northeast Ohio organ procurement group that arranged the transplant.

'Chance to live a normal life'

The hospital posted a statement from the woman's sibling on its website.

"We never thought for a moment that our sister would ever have a chance at a normal life again, after the trauma she endured," it says. "But thanks to the wonderful person that donated her organs to help another living human being, she has another chance to live a normal life. Our family cannot thank you enough."

Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life — not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.

Siemionow considered dozens of potential candidates over the past four years, ever since the clinic's internal review board gave permission for her to attempt the operation.

"The surgery took 22 hours. The preparation to the surgery took over 20 years," she said Wednesday.

The world's first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. She has done so astoundingly well that surgeons have become more comfortable with a radical operation considered unthinkable a decade ago.

Two others have received partial face transplants since then: a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition.