IN 2005 a French woman called Isabelle Dinoire, who had been mauled by a dog, made history when she became the first patient in the world to have a partial face transplant.

Since then surgeons in a number of countries have carried out full face transplants, with US medics announcing the most extensive yet on injured firefighter Patrick Hardison last year.

For many of those who have undergone surgery, the drastic operation has been about more than appearance. It has been a way to restore fundamental functions like blinking and swallowing.

But the surgery comes at a price, with patients facing a life on anti-rejection drugs which themselves can take their toll on health. A small number have died.

The maxillofacial surgery team in NHS Greater Glasgow and Clyde did not apply to offer the procedure to patients from across Scotland, and indeed the UK, lightly.

But as a large regional centre with significant experience in facial surgery in part because of the violence on their doorstep, in part because incidence of head and neck cancer is high in Scotland, they felt well placed to develop this additional expertise.

David Koppel, maxillofacial surgeon for NHS Greater Glasgow and Clyde as well as an honorary professor for Glasgow University, said: "The thing about facial transplants is it builds on existing skills we use every day."

Located on the Queen Elizabeth University Hospital site, the department performs 150 head and neck reconstructions a year. They take tissue from other parts of patients' bodies and transfer it to the face, connecting up blood vessels using stitches smaller than hairs - a technique known as microvascular surgery. They also repair nerves in the face as well as bones around the eyes and jaw.

Nevertheless it has taken years of training and planning for the team to make face transplantation a possibility.

Funding from the military allowed one of the leading surgeons, Colin MacIver, to spend a year with the transplant team in France and medical technology company Stryker has provided equipment required at no charge. All the necessary regulatory approvals to offer the surgery are now said to be in place, but some investment to take a patient would be required. It is estimated each case would cost around £100,000 - comparable to other transplant operations.

After visits from successive public health ministers and an investigation led by NHS National Services Scotland (NSS), which oversees the provision of highly specialised healthcare north of the border, staff have been left unable to establish the service. NSS said small patient numbers made it unsustainable.

Mr Koppel said: "I am slightly at a loss as to why the government has not seen this as worthwhile."

Much of the ground work for face transplantation was carried out by Professor Peter Butler who is based at the Royal Free Hospital in London but, ironically, the procedure has never been performed in the UK. The Royal Free Hospital is licensed to do the surgery but has no cases planned.