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Virginia man gets extensive face transplant after gun accident

For the past 15 years Richard Lee Norris has lived as a recluse, his face covered by a mask after being shattered in a gun accident. By day he hid from the public, shopping only at night to avoid the curious stares of children and adults.

In a groundbreaking, 36-hour surgery that began in the early morning of March 19, a team of surgeons from the University of Maryland gave 37-year-old Norris a new visage: a transplant that included not just the facial tissue from the hairline to the neck, but also the upper and lower jaws, teeth and a portion of tongue. Doctors called it the most extensive full face transplant yet completed.

A week later, Norris is further along than his doctors had ever hoped. Just three days after the surgery he asked for a mirror to see his new face. He is now able to move his jaws and open and close his mouth.

Norris has even started to shave and brush his teeth again, said the leader of the surgical team, Dr. Edwardo D. Rodriguez, chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center.

“This individual has not lived for the past 15 years as you and I know it,” Rodriguez said. “He’s been living behind a mask. This is clearly a transforming event.”

Norris came to the University of Maryland five years ago looking for help. Doctors wouldn't discuss details, but said that Norris' face had been ravaged by a gunshot. The 12 plastic surgeries helped, but not enough. Norris still lived behind a mask, hiding from the rest of humanity. Rodriguez realized that the only way to give Norris back his life was a full face transplant.

When the team was ready to embark on its first face transplant they picked Norris as the patient who most needed help. The hope was to give him back a face that would be as close to normal as possible – right down to the teeth and the tip of the tongue.

“Richard always said he wanted to have teeth again,” Rodriguez said, pointing to a photo showing the puffy faced, but normal looking, Norris six days after the procedure.

Norris may also benefit from more than a decade of research on immunosuppressing drugs. University of Maryland scientists discovered that by transplanting the jaw as well as the face, they would need lower levels of the medications to keep the body from rejecting the new tissue and bone, said Dr. Steven Bartlett, chair of the Department of Surgery at the University of Maryland Medical Center.

Animal research showed that marrow from the jawbone could make all the difference.

“We realized that there was a massive amount of bone marrow in the jawbone that was vascularized with its own unique blood supply,” Bartlett said. “In that scenario you required much lower than expected long term immunosuppression.

The surgery itself took place at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and involved a multi-disciplinary team of faculty physicians from the University of Maryland School of Medicine and a team of over 150 nurses and professional staff.

Ultimately, Norris’s appearance may seem like a combination of both his and his donor’s faces since his new tissue will drape over his cheekbones and his donor’s jawbones.

Including Norris, there have been 23 face transplant procedures around the world since the first surgery was performed seven years ago in France on a woman who had been mauled by her dog. In the U.S., 25-year-old Dallas Wiens was the first person to receive a full-face transplant.

While Norris was getting his face transplant five other patients were receiving organs from the same donor. “This patient was able to donate five organs to five other recipients,” said Charles Alexander of the Living Legacy Foundation of Maryland.

As for Norris, Alexander said, “it gives this man back more than aesthetics. It gives him back his life.”

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