In a medical first, a French surgeon says he has performed a second face transplant on the same patient — who is now doing well and even spent a recent weekend in Brittany.
In this undated combination handout photo provided on Tuesday, April 17, 2018 by HEGP AP-HP, Jerome Hamon before and after two transplants. (HEGP AP-HP via AP)
Dr. Laurent Lantieri of the Georges Pompidou Hospital in Paris first transplanted a new face onto Jerome Hamon in 2010, when Hamon was in his mid-30s. But after getting ill in 2015, Hamon was given drugs that interfered with the anti-rejection medicines he was taking for his face transplant.
Last November, the tissue in his transplanted face began to die, leading Lantieri to remove it.
That left Hamon without a face, a condition that Lantieri described as "the walking dead." Hamon had no eyelids, no ears, no skin and could not speak or eat. He had limited hearing and could express himself only by turning his head slightly, in addition to writing a little.
"If you have no skin, you have infections," Lantieri told The Associated Press in an interview Tuesday. "We were very concerned about the possibility of a new rejection."
In January, when a second face donor for Hamon became available, Lantieri and his team performed a second face transplant. But before undergoing the second transplant, doctors had to replace all of the blood in his body in a monthlong procedure, to eliminate some potentially worrisome antibodies from previous treatments.
In this undated combination handout photo provided on Tuesday, April 17, 2018 by HEGP AP-HP, surgeons perform a face transplant on Jerome Hamon. (HEGP AP-HP via AP)
"For a man who went through all this, which is like going through a nuclear war, he's doing fine," Lantieri said. He added that Hamon is now being monitored like any other face transplant patient.
Hamon's first face was donated by a 60-year-old. With his second transplanted face, Hamon said he managed to drop a few decades.
"I'm 43. The donor was 22. So I've become 20 years younger," Hamon joked on French television Tuesday.
Other doctors applauded the French team's efforts and said the techniques could be used to help critically ill patients with few options.
"The fact that Professor Lantieri was able to save this patient gives us hope that other patients can have a backup surgery if necessary," said Dr. Frank Papay, of the Cleveland Clinic, who performed the first face transplant in the U.S.
He said the techniques being developed by Lantieri and others could help doctors achieve what he called "the holy grail" of transplant medicine: allowing patients to tolerate tissue transplants from others.
Dr. Bohdan Pomahac of Harvard University, who has done face transplants in the U.S., said similar procedures would ultimately become more common, with rising numbers of patients.
"The more we see what's happening with (face transplant) patients, the more we have to accept that chronic rejection is a reality," Pomahac said. "Face transplants will become essentially non-functional, distorted and that may be a good time to consider re-transplanting."
He said it's still unknown how long face transplants might last, but guessed they might be similar to kidneys, which generally last about 10 to 15 years.
"Maybe some patients will get lucky and their faces will last longer. But it will probably be more common that some will have to be replaced," he said, noting there are still many unknowns about when chronic rejection might occur.
Lantieri said he and his team would soon publish their findings in a medical journal but he hoped cases like Hamon would remain the exception.
"The other patients I'm following, some have had some alteration of their transplant over time, but they are doing fine," he said. "I hope not to do any future transplants like this."
Americans have been having a love affair with avocados in recent years. Especially in guacamole.
According to the California Avocado Commission, some 81 million pounds of avocados are consumed in the U.S. during Cinco de Mayo, the annual celebration of Mexican American culture that falls on May 5.
But some guacamoles are disappointing — bland, or watery, or lacking in creaminess. So, what makes the difference between meh guacamole and great guacamole?
“The conversation has to begin with the avocados themselves," says Julian Rodarte, a chef and co-owner of Beto and Son in Dallas, and a guacamole aficionado.
There are hundreds of varieties of avocados, though only a few are commonly available in the U.S. Rodarte says that Mexican Hass avocados (specifically from the Michaocan region of Mexico) are the best avocados for guac, with the highest oil content.
Ivy Stark, chef/owner of the restaurants Mexology and BKLYNwild in New York City, also recommends Hass avocados for guacamole. In general, Hass avocados, which can also come from California and other locales, are denser than the larger varieties, creamier and richer in flavor. Avocados with more water in the flesh will break down more quickly, especially when blended with the other ingredients.
To check the ripeness of the fruit (we all know avocado is a fruit, yes?), Rodarte suggests looking for two indicators. First, touch. Gently press the skin and "it will tell you right away if it’s soft.” Second, break off the little piece of stem at the top of the avocado and look at the little navel-like circle underneath. If it’s bright green, the avocado should be ripe. White is under-ripe, and brown is past its prime.
If you need to help your avocados ripen faster, place them in a brown bag or other container with a banana and let them sit for half a day to a day or two. The natural gases emitted by the banana will accelerate the ripening of the avocados.
As for seasonings, Rodarte says, “I eat guacamole for the flavor of the avocados,” so he recommends using a thoughtful, light hand. Fine sea salt is his preference, as it melts into the guac “without interrupting the creaminess with crunchy bits of salt.”
He also feels that lime or lemon juice alone is too assertive and will overwhelm the delicate flavor of avocado. He always adds in some orange juice, too, and sometimes uses orange juice all on its own, liking the natural balance of sweetness and tartness.
Rodarte recommends mashing the avocados with the seasonings until creamy, and then folding in the other ingredients so they don’t break down and make the guacamole watery.
Both Rodarte and Stark recommend using a mortar and pestle to mash the avocados. Rodarte aims for a “whipped butter consistency” while Stark describes her ideal consistency as “soft and chunky.” For those of us who don’t have a mortar and pestle in the kitchen, Rodarte says a fork is fine, too.
He then stirs in chopped meaty tomatoes, with the juice and seeds removed, and recommends a finely minced white or red onion. He adds finely minced or chiffonaded cilantro, but says “a little goes a long way,” so be judicious when adding this strong herb.
Stark thinks cilantro and jalapeños are essential to good guacamole. Rodarte also like the heat of chile peppers in his guacamole, but prefers fresnos or serranos to jalapeños.
Rodarte says the molcajete, or base of the mortar, is the “cast-iron pan of Mexico,” taking on flavors from different ingredients over the years.
“Nothing will ever taste like a dish made using your abuelita’s mortar and pestle, with years of gradual seasoning," he says.
Rodarte does play with more non-traditional ingredients, too. He’s used chili crunch as a finisher, blended in yuzu ponzu sauce, and added a few drops of toasted sesame oil in some versions of guacamole.
Stark offers many twists on guacamole, playing with tropical fruits and berries. She also likes to make versions with shrimp, crab and lobster, and at Mexology they offer a guac with pomegranate seeds and toasted pepitas.
As for the challenge of storing guacamole without it browning, both chefs recommend pressing plastic wrap right on top of it to minimize oxidation. Rodarte also suggests brushing the top of the guacamole with a bit of oil to seal it from exposure to the air.
Keep the guac in the fridge, and if there is some browning, Stark says to just scrape a thin layer from the top before serving.
If I know I'm making the guacamole to serve later, I hold back on adding the lime juice to the recipe. I blend everything up, then pour the lime juice over the top, using it to “seal” the top of the guac, and then stir it in just before serving. The proportions will still be perfect, and you will have avoided the browning.
Consider serving guacamole in scooped-out avocado shells. They might be a little wobbly, but you can nestle the shells in a bed of tortilla chips for more stability.
The following guacamole recipe is inspired by Rodarte’s tips:
Ingredients:
2 ripe Hass avocados, preferably from Mexico
Fine sea salt and freshly ground black pepper to taste
2 teaspoons fresh lime or lemon juice
2 teaspoons fresh orange juice
⅓ cup minced red or white onion
1 Roma tomato (cored, seeded, and chopped; about 1/2 cup)
½ to 1 teaspoon minced seeded serrano or Fresno pepper
½ to 1 teaspoon minced fresh cilantro
Directions:
Cut the avocados in half, remove the pits, and use a knife to cut the avocado flesh into chunks right in the skin, cutting in one direction and then crosswise in a grid-like fashion. Use a spoon to scoop out all of the flesh into a medium-size bowl. Mash with a fork, or use a mortar and pestle. Blend in the salt, pepper and citrus juices.
Add the onion, tomato, chile pepper and cilantro and gently fold into the avocado until well blended. Taste, then adjust the seasonings.
You can serve the guacamole with tortilla chips or use on tacos, burritos, quesadillas or other dishes.
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Katie Workman writes regularly about food for The Associated Press. She has written two cookbooks focused on family-friendly cooking, “Dinner Solved!” and “The Mom 100 Cookbook.” She blogs at https://themom100.com/. She can be reached at Katie@themom100.com.
For more AP food stories, go to https://apnews.com/hub/recipes
A recipe for guacamole, served in an avocado shell, appears in New York in June 2019. (Carrie Crow via AP)
A recipe for guacamole, served in an avocado shell, appears in New York in June 2019. (Carrie Crow via AP)
A recipe for guacamole, served in an avocado shell, appears in New York in June 2019. (Carrie Crow via AP)
