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May 5th, 2009
11:51 PM ET

Facing forward

By Stephanie Smith
CNN Medical Producer

I felt the air catch in my throat when I first saw her. She was tinier than I thought she would be. I don't know why, but I thought the first nearly full face transplant recipient in the United States might be taller. 

Connie Culp walked up to the lectern, with some assistance, to address the news media five months after undergoing a face transplant. She was here to show us her new face, 80 percent of which once belonged to another person. [cnn-photo-caption image= http://i2.cdn.turner.com/cnn/2009/HEALTH/05/04/face.transplant.patient/art.face.transplant.cnn.jpg caption="Connie Culp, 46, was identified as the first recipient of a face transplant in the United States."]

"I got me my nose," she exclaimed. I could see a hint of a smile. Her new face has not healed enough yet for her to fully express that emotion.

What Culp looks like today is a far cry from what she looked like at this time last year. Her face used to be concave, a crib for scar tissue and not much else. She had no nose, no palate, no cheeks, she could barely breathe on her own.

The first thing that struck me was the skin on Culp's face. I was astounded by how smooth it was. Where was the scarring? I came to find out about the painstaking process doctors used to erase those scars from Culp's face.

One of the first steps in the December surgery took nine hours. Doctors grafted skin from the donor face to eventually lie onto Culp's face. The eight-person surgical team was meticulous, carefully preserving arteries veins and nerves from the donor's face that would eventually be married to Culp's.

Before they could do that, they had to clear out the scars and damage to Culp's own face, making it hospitable for the new one. One surgeon described the next step to me as "cookie cutter." They lay the donor's intact face onto Culp's, making sure the vessels and arteries were of similar size, making sure that the donor's nasal passages and cheekbones set at just the right spot on Culp's face.

Then the moment of truth.

After using powerful microscopes to help join Culp's tiny veins with the donor's, a hush fell over the operating room. For five minutes, surgeons waited for the now-opaque veins and arteries that connected Culp's face to her donor's to begin coursing with blood.

Eventually, they did. Success.

Before her history-making face transplant last December, Culp had been through about 30 reconstructive surgeries to try to fix her face.

She didn't talk about it much, but Culp was shot in an attempted murder-suicide by her husband in 2004. She often remarks to hospital staff that she's moved on from the shooting. She prefers to look forward.

I think that makes sense. New face, new life.

The worst thing about her past, says Culp, wasn't feeling the stares from adults, but the jeering from children. Something about innocents regarding her as a monster was more unsettling than being judged by her peers.

What will stay with me about today is not just the stunning revelation of Culp's new face, but her sage words about the uncertainty of life.

"You never know what might happen to you," she said. "You might get in a car wreck and think you're beautiful one day. So don't judge people who don't look the same as you do. You never know. One day it might all be taken away."

For Culp, a new face means taking back something that was so savagely taken away

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.