Face transplant for Virginia man is lauded as most extensive in history

March 27, 2012

Richard Norris was 22 when a gun accident took his lips, his nose and the front portion of his tongue. The damage to his jaw left him with limited mouth mobility and gave the appearance that his face had sunken into itself, doctors at the University of Maryland Medical Center said.

For 15 years, Norris, of Hillsville, Va., hid behind a surgical mask. He avoided eating in public and shopped for groceries at night. He lived as a “recluse,” according to doctors, “not a functioning member of society.”

Last week, Norris, 37, underwent a 36-hour surgery lauded as the most extensive face transplant in history. Three days later, he looked in the mirror. He had a nose. He could move his tongue. He would no longer need a mask.

And doctors said he couldn’t stop repeating, over and over, “This is so cool.”

The operation, which took place March 19 and 20 at Maryland Shock Trauma Center, was the Baltimore hospital’s first full face transplant. It included replacing the tongue, teeth, and upper and lower jaws, all from one anonymous donor.

Five other patients received a heart, both lungs, a liver and a kidney from the same donor.

Officials said the operation was the culmination of a decade’s worth of research funded by the Office of Naval Research as part of an effort to expand facial reconstruction possibilities for troops injured by makeshift bombs.

Norris, a civilian, was chosen as the first transplant candidate after meeting Eduardo Rodriguez, a dentist and surgeon at UMMC, in 2005. Norris had numerous operations in the years after his accident, first to save his life and then to make his face somewhat functional. But he wanted more. His research led him to Rodriguez, known for his experience with facial reconstruction.

“I remember he drove up here from Virginia one Saturday, and I could see there were some things we could improve with conventional surgery. Functional things, like putting food in his mouth,” Rodriguez said in an interview Tuesday.

“But there were certain parts of his body that we could never re-create,” he said. “For example, his lips.”

Norris had 12 more surgeries to regain additional mobility in his face and mouth and to reconstruct some of his features. But Rodriguez and his team hit a wall.

“The next logical step was facial transplantation,” Rodriguez said.

Norris consented to the clinical trial and began a rigorous evaluation that included physical and psychological exams. Then he had to wait for the right donor. “The perfect donor,” according to Rodriguez.

On March 17, Rodriguez received a call telling him about a potential match. By 7 p.m. that Sunday, the match was confirmed. Norris was rolled into the operating room Monday morning.

“You have every emotion going through your body at that moment,” Rodriguez said. “But the thing that tempered it all was ensuring that everything would go smoothly for Richard.”

The results of countless team meetings, conference calls and practice on cadavers were put to the test during the marathon surgery.

“Everything went off without a hitch,” Rodriguez said of the procedure, which involved more than 150 doctors, nurses and UMMC staff members. “It was just a beautiful event.”

Norris was kept on a ventilator overnight. Doctors lightened sedation after 24 hours. By day three, Norris asked for a mirror. He is one of the few victims of ballistic injury to the face who retained vision, and he wanted to see himself.

One week later, doctors said, he is able to shave his face and brush his teeth.

Despite what doctors have characterized as remarkable progress, recovery will take Norris, who was not made available for an interview, several months. As with any organ transplant, there is a risk of rejection.

Norris is expected to remain in the hospital for one month and stay in Baltimore under observation for three months.

“A lot of people may think this is all cosmetic,” Rodriguez said. “But for someone who has lived behind a mask, if you call it living, he has his life back. He’s a strong man again.”

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