A French woman who received the world's first partial face transplant has died, 11 years after the surgery that set the stage for dozens of other transplants worldwide.
The Amiens University Hospital in northern France announced Isabelle Dinoire's death on Tuesday.
It said she died aged 49 in April after a long illness, but her family wanted her death kept private.
The hospital went public with the death after Le Figaro reported on it.
The hospital did not release any further details and it was not clear if her illness was related to the transplant.
Dinoire was severely disfigured by her pet Labrador - and was given a new nose, chin and lips in 2005 by doctors Bernard Devauchelle and Jean-Michel Dubernard.
Medications that patients must take to prevent their bodies from rejecting the new organs can cause other illnesses and have severe side effects.
Le Figaro said she had suffered two cancers linked to the transplant and lost partial use of her transplanted lips last year.
The operation changed Dinoire's life and drew international attention. There have been nearly 40 face transplant surgeries around the world since 2005, including one last year in New York that was the first to include a scalp and functioning eyelids.
Dinoire, a divorced mother of two teenage daughters, said she was wrestling with personal problems at the time of the 2005 dog attack and "took some drugs to forget". She said she had passed out when the dog bit her.
Disabled by her disfigurement, she welcomed the opportunity for a transplant from a brain-dead woman. Her doctors said they repeatedly warned her of the risks involved.
Her operation was "an unquestionable surgical success" and the medical community learned from her experience, said Dr Jean-Paul Meningaud, who heads the reconstructive surgery department at the Henri Mondor Hospital south of Paris and was not involved in treating Dinoire.
But Dr Meningaud, who has been involved in seven of France's 10 face transplants, is now arguing for suspending the procedures so that the medical community can take stock of whether the long-term benefits are worth the physical and psychological toll they take on patients.
In Dinoire's case, "the results were very good in the medium term, but the long-term results were not so good," Dr Meningaud said.
He said that face transplant recipients are having more difficulty with anti-rejection medication than doctors initially predicted, and are requiring more follow-up surgery.
"It's a rather high price to pay for the patient. It's time to mark a pause," he said.
Her immune system nearly rejected the transplant twice.
A year later, doctors said she was gaining more and more sensitivity and facial mobility, and she got herself a new dog.
"I can open my mouth and eat. I feel my lips, my nose and my mouth," Dinoire said at a news conference in 2006.
"I have a face like everyone else," she said. "A door to the future is opening."