The nation's first face transplant is a big risk not just for the severely disfigured woman who received it, but also for the surgeon who has made it the highlight of her career.
The Cleveland Clinic's Dr. Maria Siemionow has put her professional reputation on the line by doing a radical operation that some consider unethical but others praise as the only hope for people horribly disfigured by burns, trauma, cancer or violence.
She has spent more than a decade preparing for it, and fame is not her motivation, she said in an interview several years ago.
"I don't feel competition to do anything in life except with myself. I compete with myself," she said.
Which is no small matter for an overachiever fluent in five languages, who has made a reputation on several continents as a skilled hand microsurgeon.
Siemionow, 58, grew up in Poland. As a young girl, she had private classes in English, studied Russian and learned German in high school. She learned Spanish during two summers in Barcelona as an exchange student.
After medical school in Poznan, Poland, she trained in Belgium, Spain and Finland.
Working with Physicians for Peace in Turkey, she operated on many kids with burned hands.
"They looked like one big paddle," she said, and she would separate the fingers and graft skin between them.
Siemionow came to the United States in 1985 for a fellowship in hand surgery at Louisville, Kentucky, where the first hand transplant in the U.S. was done in 1999. She has been at the Cleveland Clinic since 1995.
She has done hundreds, perhaps thousands of operations in 30 years. She knows that good results are only partly under the control of the surgeon.
"Many patients will think you've repaired their tendon and they don't have to exercise hundreds of times a day," and blame the surgeon when they end up with a stiff finger, she said.
These "learning experiences," as she calls them, taught her a lesson: "Be more critical in how you evaluate a patient."
It is why, after the hospital approved her plans, she spent more than three years selecting her first face transplant patient. She put candidates through formal interviews, looking for someone with a severe disformity, "not a little scar."
The person should be "psychologically stable but not happy," where the risks of the operation would clearly be outweighed by its potential benefit, she said in interviews. The person has to be strong enough psychologically, with good family support, to commit to taking anti-rejection drugs for the rest of their life.
Asked how much she wants to know about a patient, she replied: "Everything possible. It's a commitment on both sides."
"She doesn't toot her own horn but she has done her homework," said Dr. Alan Lichtin, vice chairman of the hospital review board that approved the transplant plans.
Temperamentally, Siemionow seems ideal for the task. Her own hands are small and delicate, almost childlike. She dyes her hair blonde, likes to look sharp, and speaks of herself in confident but humble terms.
During surgery, "I like it quiet," she said. "I cannot read when there's music," preferring to give full attention to one task at a time.
In interviews over the last few years, she has talked of the many surgeries disfigured people have endured, and the poor quality of life many of them are left with.
"If you choose to be a surgeon, you are used to results that are not ideal but good," she said.
But with this landmark operation, she is clearly hoping for better.