On January 6th, Cameron Underwood was wheeled out of the operating room at NYU Langone Health at the end of a 25-hour surgery to replace his damaged lower face with the skin, tissue, bone, and teeth of a donor.

Now, just 11 months later, 26-year-old Underwood has healed remarkably and is in excellent health. Like all transplant patients, he will need to remain on anti-rejection medication for the rest of his life, but his team of specialist doctors are encouraged by his body’s acceptance of the new face thus far.

“We are thrilled that Cameron is responding so well to the transplant,” Dr Bruce Gelb, MD, one of the hospital’s transplant surgeons, said in a statement. “Our team has established a successful, novel, patient-donor matching protocol and immune suppression regimen that we believe provides the best outcomes for our patients because the risk of rejection and toxicity is greatly minimized.”

Underwood’s extensive facial injury was the result of a self-inflicted gunshot that occurred in June 2016. Soon after, the Yuba, California, native underwent a series of reconstructive surgeries, yet despite the best efforts of plastic surgeons, he was left with a deformed lower face that lacked a nose, most of the lower jaw, and all but one tooth.  

Clearing the approval process in record time, Underwood’s case was accepted by the NYU face transplant program – led by Dr Eduardo Rodriguez – and added to the nationwide organ donation waitlist in July 2017. In another stroke of expedient good fortune, a matching donor face was found a mere six months after Underwood joined the waitlist. Many recipients wait years for a suitable match.

The new face was donated from William Fisher, a 23-year-old who was living in Manhattan and studying at Johns Hopkins University. He has been registered as an organ donor since his teenage years, according to the press release. After Fisher’s mother gave her consent for the transplant, Fisher’s lower face was transported to Langone and Underwood and his family trekked to the East Coast – in the face of the oncoming "bomb cyclone" snowstorm – with the help of air ambulance services.

On the medical team’s end, Dr Gelb and his colleagues rushed into operation planning, aided by advanced technologies including a three-dimensional computer modeled surgery run-through and 3D-printed customized cutting guides. During the complex procedure, the team relied on intraoperative CAT scans and assisted tool navigation systems to achieve ideal alignment between the patient and donor’s bones and correct placement of implanted plates and anchoring screws.

In total, Underwood received Fisher's upper and lower jaw bones, including his 32 teeth, palate (roof of the mouth), floor of the mouth, lower eyelids, cheeks, nose, and nasal passage sections. Underwood's own tongue remained, but underwent reconstruction. 

Several weeks of in-hospital recovery followed, but Underwood surprised his care team by qualifying for discharge to a nearby apartment weeks ahead of schedule, on February 16. After more than a month of additional physical and occupational rehabilitation and speech therapy, Underwood and his family finally returned home to Yuba on March 29.

Currently, he travels to New York once a month for follow-up with his physicians.

“Will and his family made an incredible sacrifice to give back to me what had been lost,” he stated. “I will never forget that. I’m also eternally grateful to Dr. Rodriguez and his face transplant team. My family and I could not have made this journey without them. We hope my experience inspires others who have severe facial injuries to have hope, as I was inspired by others who came before me. The journey hasn’t been easy, but it’s been well worth it.”