Surgeons with the Cleveland Clinic performing a full face transplant. (Cleveland Clinic)

A gunshot wound to the face left a teenager with so much damage that for years doctors knew plastic surgery could only help so much to give her back a regular life.

In May, the now-21-year-old woman joined the small but growing ranks of face transplant recipients, doctors announced Tuesday.

For the woman, now the youngest to receive the surgery, it was “an incredible gift.”

“To reach this point of recovery has oftentimes been a difficult road to travel, but I’m thankful there’s been a road,” the woman said in a statement on the hospital's website. The hospital did not release her identity or the name of the donor.

The hospital didn't make the woman or her doctors available for interviews. Little was publicly known about the patient's life, injury or what led her to the operating room at the Cleveland Clinic.

Doctors determined early on that she might be a viable candidate for a face transplant because of the extent of her injuries. So in other surgeries, they tried to safeguard as many blood vessels as they could, which would be crucial for a successful transplant.

Doctors transplanted 100 percent of a donor's facial tissue, including eyelids, facial nerves and muscles, the Cleveland Clinic announced in a news release.

In all, 11 doctors were involved in the 31-hour procedure. Doctors hope their efforts restore more than facial tissue.

“With a new nose, lips, palate, eyelids and jaw, she now has the full opportunity to reintegrate into society and have a future just like any other young adult,” said Brian Gastman, who was part of the surgical team. “This surgery can give her back the self-esteem and confidence she lost.”

It was the clinic's third face transplant since the procedure was first performed more than a decade ago, and the first full face transplant by doctors in Cleveland, another step forward for one of the world's rarest surgeries.

“We felt the risk was well worth it to give this patient better function, better social form and, ultimately, a better life,” said Frank Papay, who co-directed the surgical team.

To prepare, the surgeons rehearsed on 3D-printed replicas and used virtual reality simulations.

The first face transplant was performed by Spanish doctors in 2005 on Isabelle Dinoire, a French woman who had been mauled by a dog, according to CNN. Anti-rejection drugs contributed to the occurrence of two cancers. She died of cancer in April 2016, according to the Telegraph.

In 2008, the Cleveland Clinic performed its first near-total face transplant, which was the most complex such transplant in the world at the time. Doctors transferred about 80 percent of a donor's face.

The world's first full face transplant also took place in Spain in 2010. The risky procedures have been controversial, setting off an ethical debate about whether such surgeries should be undertaken to improve quality of life.

The surgery is part of a bevy of transplants in recent years, including penis transplants for wounded soldiers, a young boy's double hand transplant and a uterus transplant in a woman who was unable to bear children.

More than three dozen patients have had face transplants across the globe. They all face a high risk of complications or even death.

As The Washington Post's Ariana Eunjung Cha reported, “even if the initial surgery, which is enormously complicated and dangerous, goes well, face transplant patients — like those receiving donor organs like a heart or kidney — face the significant risk that their body will reject the foreign part. As a result, many doctors believe these patients will have to take immunosuppressant drugs their whole lives.”

Now, six U.S. hospitals perform face transplants, according to the Cleveland Clinic.

In February, the Mayo clinic announced that doctors there had performed a successful face transplant on Andrew Sandness, a 32-year old man who had been shot in the face when he was 21.

After the surgery, he said he had fresh hope of being normal again.

“I am now able to chew and eat normal food, and the nerve sensation is slowly improving, too. My confidence has improved, and I’m feeling great ― and grateful.”

The woman in Cleveland also faces years of relearning to do everyday tasks. In rehabilitation now, she is walking and talking, and learning to swallow again. She said the road after the surgery was difficult, but she was grateful.

“To call my surgeons, physicians, nurses and caregivers ‘world class’ would be an understatement. And to my donor and her family — words cannot express the appreciation I have for this incredible gift.”

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