Derek Pfaff's life changed forever on March 5, 2014, when a tragic incident during his college years left his face severely damaged by a gunshot.
"I was under a lot of pressure at college. I don't remember making the decision to take my own life. When I woke up in the hospital, I originally thought I had been in a car accident," he says.
Despite undergoing 58 reconstructive facial surgeries in 10 years before going to Mayo Clinic in Rochester, he was still unable to eat solid food or speak casually with friends and family. Wearing glasses proved impossible without a nose. This transformational face transplant at Mayo Clinic means the now 30-year-old from Harbor Beach, Michigan, will once again be able to do all those things he has missed. He has also become a passionate advocate for suicide prevention and plans to share his story to encourage others who are struggling to get help.
"I lived for a reason. I want to help others," Pfaff says. "I am so grateful to my donor, his family and my care team at Mayo Clinic for giving me this second chance."
"Mayo Clinic Transplant Center is the largest integrated transplant center in the world. We were the first transplant center in the country to make face transplant part of its clinical practice. That has allowed us to focus exclusively on the needs of each individual patient," says Hatem Amer, M.D., medical director of Mayo Clinic's Reconstructive Transplant Program.
In the 19 years since the first face transplant was performed, more than 50 have been done around the world. Survival outcomes for these transplants are encouraging, according to a recent JAMA Surgery study. Mayo Clinic performed its first face transplant in 2016.
How the surgery was done
Mayo Clinic surgeons performed Pfaff's face transplant in February 2024 in a procedure that lasted more than 50 hours and involved a medical team comprised of at least 80 healthcare professionals, including surgeons, anesthesiologists, nurses, technicians, assistants and other specialists.
This multidisciplinary team was led by Samir Mardini, M.D., a facial reconstructive and facial reanimation surgeon and surgical director of Mayo Clinic's Reconstructive Transplant Program. Dr. Mardini estimates that 85% of Pfaff's face, including the mandible and maxilla, was reconstructed and replaced with donor tissue.
Surgeons meticulously planned this complex operation over several months. To ensure precision and accuracy, a digital surgical plan was created relying on detailed scans of both the donor's and recipient's faces, allowing the team to perform the surgery digitally first. Facial nerve mapping also was performed of both the donor and recipient's nerve system to understand the function of each nerve. While the digital aspect ensured preparation, customized 3D-printed cutting guides translated these plans into tangible tools to be used in the surgical suite.
The intricate transplant required replacing virtually everything below Pfaff's eyebrows and part of his forehead, including his upper and lower eyelids and intraorbital fat, upper and lower jaws, teeth, nose, cheek structure, neck skin, hard palate and parts of his soft palate. Relying on the preoperative facial nerve mapping, one of the most critical aspects of the face transplant surgery was ensuring the donor and recipient's delicate facial nerves - 18 branches between the two sides - were properly connected to restore function. A new microsurgery technique also was employed to transplant the donor's tear drainage system, which allows Pfaff's tears to drain normally into his new nose. Pfaff can now express happiness, sadness, joy and disappointment through his transplanted facial muscles and nerves.
"Most organ transplants are lifesaving. With facial transplantation, it's a life-giving operation. You can live without it, but you are missing out on life," Dr. Mardini says.
The medical team included specialists from Plastic and Reconstructive Surgery, Transplant, Nephrology, Neurology, Ophthalmology, Dermatology, Pathology, Radiology, Critical Care, Anesthesia, Psychiatry, Infectious Diseases, Histocompatibility, Pharmacy, Nursing, Social Work, Rehabilitation, and Speech and Language Pathology.
"This successful transplant would not have been possible without the donor and his family's generous gift and the care team's collaboration and dedication," Dr. Mardini adds.
LifeSource, the federally designated organ procurement organization for the Upper Midwest, also played a pivotal role in the transplant, working closely with the family of the donor and Mayo Clinic care teams. Thanks to his face transplant, Pfaff says he is focused on making plans for his future.
"This surgery has transformed my life. I feel so much more confident. I am hoping to one day meet someone, settle down and have a family," he says. "I'm also going to keep sharing my story with others to help as many people as I can."
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