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A face in the crowd: A year after most extensive face transplant in history

For 15 years, Richard Lee Norris hid his gun-shot-shattered face from the public, wearing a mask when he left the house and shopping late at night to avoid the curious stares of children and adults. For all intents and purposes, the once sociable Norris had become a recluse.Then, in 2012, Norris received the face transplant that would forever change his life and break new ground for researchers ho

For 15 years, Richard Lee Norris hid his gun-shot-shattered face from the public, wearing a mask when he left the house and shopping late at night to avoid the curious stares of children and adults. For all intents and purposes, the once sociable Norris had become a recluse.

Then, in 2012, Norris received the face transplant that would forever change his life and break new ground for researchers hoping to heal soldiers disfigured by wounds from the Iraq and Afghanistan wars.

The landmark 36-hour-surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland included not just facial tissue from the hairline to the base of the neck, but also the upper and lower jaws, the teeth and also a portion of the tongue.

“It’s the most comprehensive face transplant in medical history,” Dr. Eduardo Rodriguez, chief of plastic, reconstructive and maxillofacial surgery at the center, told NBC’s Ann Curry.

That surgery gave Norris a second chancem and over the past year he’s been on a journey out of darkness and despair and into the light.

A sensitive boy with a mischievous side, Norris grew up in Fieldale, a modest town in rural south Virginia. He loved to hunt and fish with his dad and hoped, friends said, to one day become a policeman or fireman, driven by a desire to help people.

But in 1997, Norris, then 22, became the one who needed to be rescued by first responders.

He’d been at home with his mom when she noticed one of the family’s shotguns leaning precariously against the glass door of the gun cabinet. When Norris stepped over to the cabinet to stand the gun back up, the unthinkable happened. The loaded shotgun went off, blasting upward and through his jaw and nose. He fell to the floor, moaning “Oh mom.”

Rushed to the hospital where surgeons worked frantically to save his life, he was put in a medically induced coma for two weeks. Though his life was saved, Norris was left severely disfigured: his jaws, teeth, lips, tongue and nose were nearly erased and he was in constant pain.

Even after his wounds healed, Norris wouldn’t venture out of the house without covering his face with a black surgical mask, and then often only at night. He began to avoid contact with everyone, even his closest friends. Depressed and disheartened, sometimes Norris wondered if suicide was his only choice.

Costly and painful follow-up surgeries to improve Norris’s situation failed miserably.

“I got fed up with these Band-Aid surgeries on him and giving him false hope,” Norris’s mom, Sandra, told Curry.

Then, in 2005, eight years after the accident, Norris and his family finally found the doctor who would change their lives, Rodriguez, a bold plastic surgeon who believed that Norris could be helped with new breakthrough medical techniques.

Norris’s mom, Sandra, remembered their first meeting: “He put his arm around me, and said, ‘Mrs. Norris we’re going to fix this and I’m going to be with you all the way through it,’” she told Curry. The very first partial face transplant had been performed in France and Rodriguez was inspired to try his hand at this new kind of surgery. Besides, the Department of Defense was now offering funding for research into treatments to help severely injured soldiers returning from the wars. The funding could help pay for experimental procedures, like face transplants.

The possibilities weren’t lost on Norris.

“He began to talk about facial transplantation,” Rodriguez told Curry. “And I remember telling him, ‘We’re not ready yet. It’s still too early in the game. And I just don’t know how we want to do this. We need to figure out some things.’ But he was always inquiring about it.”

Rodriguez started to make a plan – and to hone his skills. By 2011, he was ready to contemplate a surgery in which he would transplant all the bone structure below Norris’s eye sockets as well as the teeth, tongue and an entire new face from the collarbone to above the hairline.

The surgeon knew how risky the operation would be, but he also knew how desperate Norris was and how futile the other options were.

“When you’re missing the upper and lower lip, it’s a very difficult area to recreate,” Rodriguez told Curry. “We can give you some sense of normalcy, but it will never move normally. It won’t have normal sensation. You can’t drink and eat normally. You drool. We could have done surgery on him forever, but he never would have looked normal, functioned normally.”

All that stood in the way of the face transplant was finding a donor who had the right blood type and immune system, among other technical criteria.

In 2012, another family’s tragedy offered Norris the chance to once again lead a normal life.

Joshua Aversano, a young man from White Hall, Md., who had joined the Marines and was soon to head off to boot camp, had gone out on the town with a friend. As Aversano walked across the street he was hit by a fast-moving van.

The 21-year-old Aversano was airlifted to Shock Trauma, the very hospital where Norris was a patient.

When his parents, Randy and Gwen Aversano, arrived at the hospital, they learned that even though there was barely a mark on their son’s body, his brain had been damaged too severely for him to survive.

Asked to donate their son’s organs, the Aversanos didn’t hesitate.

But then the doctors asked something the Aversanos couldn’t have expected: would they be willing to donate their son’s face to a man who had also experienced a tragic accident?

Though it was an unimaginably difficult request, the Aversanos were touched by Norris’s case. “He was our son’s age, maybe a year older, when he went through this devastating accident,” Gwen Aversano said. “And living as a recluse for all those years had to be horrible for him.”

Norris was summoned back to Shock Trauma and asked if he was sure he wanted to take the risk of a surgery that might not only make things worse, but could also kill him. Norris was adamant that he wanted to go forward and told doctors: “If I do die, I want to donate everything, everything, to help other people.”

Although the surgery took longer than anticipated because of the heavily scarred tissue on Norris’s face, Rodriguez and his team of 150 eventually managed to transplant all the bones and tissue, connecting up nerves and blood vessels.

Ultimately the complex surgery may have come with an added bonus – a lower risk of rejection because the transplanted jawbone contained large amounts of marrow, which produces immune cells called lymphocytes.

The hope is that these cells “will interact with the recipient’s immune system,” said Dr. Rolf Barth, a member of Norris’s transplant team who has been managing his immune suppression. “Research has suggested that these cells might decrease the chances of rejection or even help develop a state of immune tolerance in which the body doesn’t reject the graft at all.”

And so far, it looks like that’s what’s happening in Norris’s body.

“In 100 percent of face transplants there has been a significant rejection episode,” said Barth, an associate professor of surgery and director of liver transplantation at the University of Maryland. “Those are almost always reversible as long as they are treated. Richard had a very mild episode of rejection that was easily reversed with an adjustment of his medication.”

The experience doctors have gained through Norris’s case may ultimately help service men and women coming back from the wars, Rodriguez told Curry.

“That was the same type of injury that our soldiers were experiencing in Iraq,” he explained. “They would see these injuries as a result of an IED blast coming from the ground up. So, if we could treat this problem in a civilian patient, then it would be ideal to treat the military patients. So that was our first goal.”

What really mattered to Norris, though, was what he saw when Rodriguez handed him a mirror three days after the surgery.

“I saw a miracle that was performed,” Norris said a year later.