Face-transplant technology has come a long way in seven years.
Richard Lee Norris, a Virginia man who was severely disfigured after a gun accident in 1997, has made a notable recovery after undergoing the world's fullest face transplant in March.
"People used to stare at me because of my disfigurement," Norris, 37, said in a prepared statement. "Now they can stare at me in amazement and in the transformation I have taken."
To see other face transplants through the years, click here.
"If you would have told me 20 years ago, would this be possible? I would say absolutely not," said Norris' surgeon, Dr. Eduardo Rodriguez of the University of Maryland Medical Center. "It's hard to imagine it's the same person, isn't it?"
The goal for Norris' transplant, Rodriguez said, was to restore both form and function.
"I strongly believe that it is the most aesthetically acceptable result thus far," he said. "I am only hopeful that the functional result will be as good as the aesthetic result."
Compared to the first face transplant case in 2005, which included just the soft tissues of the nose, lips and chin, Rodriguez and his team transplanted the entire face from scalp to neck, complete with teeth, bones, muscles, nerves and skin.
They removed the entire face in one piece and used 3-D modeling software to ensure a perfect fit. Norris was also the first face transplant patient to receive a special anti-rejection drug before his treatment, in order to limit early rejection of his new face.
"Face transplantation is one of the biggest innovative breakthroughs in last decade," said Dr. Maria Siemionow, a plastic surgeon at the Cleveland Clinic who led the country's first near-total face transplant in 2008.
"We are moving forward," Siemionow added. But "it takes time."
Face transplant recipients rely on a cocktail of drugs to prevent their immune systems from attacking the new face, drugs that come with a hefty price tag and serious side effects. Early research suggests it might be possible someday to engineer new faces using the patient's own stem cells seeded on a donor framework, but that's still decades away.
In Norris' case, the transplanted jaw bones contained donor stem cells to help coax his body into accepting the new face. Such an approach was based on a decade of animal research at the University of Maryland transplant team's laboratory.
But face transplant experts have learned tough lessons after some heart-breaking disappointments. One Chinese partial face transplant patient died of unknown causes in 2008. His transplant surgeons reported in Agence-France Press that he had stopped taking his anti-rejection drugs in favor of herbal medications.
"Patient selection is very important," said Dr. Joseph Losee, director of the reconstructive transplantation program at the University of Pittsburgh Medical Center, explaining that the results can be disastrous if patients don't remain committed to their follow-up treatment. "Not everybody should get reconstructive transplant surgery."
One critical factor in Norris' transplant success was his commitment as a patient, surgeon Rodriguez said.
"There's only so much we can do with our hands. The rest is up to the patient," he said, adding that Norris was selected by an expert committee that included psychiatrists, psychologists and social workers. "He has done everything exactly as we've asked him to do."
Rodriguez and other transplant surgeons hope to one day extend the use of face transplants to replace numerous reconstructive surgeries in children with disfiguring facial birthmarks, burn victims and wounded warriors.
"I believe that face transplants will eventually become more common, as there are no alternatives that authentically restore our human facial features," said Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's Hospital in Boston who performed the country's first full-face transplant in 2011.
"Provided that the patients continue to do well, we will likely expand our transplant program to include patients with less severe deformities."
In order to perform more face transplants, however, more people would have to sign up to be donors.
"I imagine that it would be difficult to donate your loved one's face," Rodriguez said, adding that he was amazed at the positive reaction he has encountered so far from donor families.
As a final touching gesture, Norris' donor left the operating room with a silicon replica of his face to cover the defect left after the removal of the face in case the family opted for an open-casket funeral, Rodriguez said.
"We were committed to restoring the integrity of the donor as much as possible," he said.