By Maggie Fox, Health and Science Editor

WASHINGTON, Dec 17 (Reuters) - Surgeons have replaced 80 percent of a woman's face, transplanting bone, teeth, muscle and nerve in the first such operation in the United States.

They said the woman suffered severe trauma that cost her an eye, much of her nose and her upper jaw and left her unable to breathe, smell, taste or smile properly.

"You need a face to face the world," Dr. Maria Siemionow, director of plastic surgery research at the Cleveland Clinic in Ohio, where the operation was performed, told a news conference on Wednesday.

The clinic gave no details about the woman, how she was injured, or who the donor was.

The operation is the fourth done globally. French surgeons replaced much of the face of a woman in 2005 after she was disfigured in an attack by her dog. Last year, her doctors reported that she recovered slowly and steadily, overcoming two episodes of rejection.

In 2006, Chinese doctors performed a face transplant on a 30-year-old mauled by a bear, and a French team did a transplant in 2007 on a 29-year-old man who suffered from von Recklinghausen disease, which deforms the face.

The U.S. operation, which was performed two weeks ago, took 22 hours. A team of eight specialists transplanted bone, muscle, blood vessels and nerves.

"We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, the facial nerve," said Francis Papay, chair of dermatology and plastic surgery at the clinic.

"Our hopes are ... that she will be able to smile again."

Some controversy has surrounded the issue of face transplants, in part because face injuries are not seen as life-threatening. In this case, the doctors said, the patient had virtually no life because of her injury.

"We know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go the the street," Siemionow said. "Our patient was called names and was humiliated."

"We very much hope that for this very special group of patients there is a hope that someday they will be able to go comfortably from their houses and enjoy the things we take for granted."

Dr. Eric Kodish, a bioethicist, said a team of experts, called an institutional review board, approved the operation.

"This is not a cosmetic surgery in any ... sense. The face is the embodiment of personal identity," Kodish told the news conference.

"A person who has sustained trauma or other devastation to the face is generally isolated and suffers tremendously," Kodish added. "We have hope that our patient will begin to smile again, will be able to smell again."

The patient will take immune-suppressing drugs and may have to fight rejection, the doctors noted, like any other transplant patient.

(Reporting by Maggie Fox)

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