American man unveils his new smile after the most advanced facial transplant ever

GRAPHIC CONTENT: After struggling with depression since adolescence, American Cameron Underwood spent a day drinking in June 2016, when he attempted to commit suicide.

The attempt destroyed much of his face – and began a journey that led to the most advanced facial graft ever performed.

More than two years later, Underwood's priority is to get back to work and start a family one day.

"Thank you for not giving me up," said a 26-year-old California man on Thursday at a press conference at the University of New York.

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After his suicide attempt and his classic surgical repairs, he was disfigured and required five months of skin grafting to allow reconstructive plastic surgery. Underwood underwent a successful facial transplant in early 2018. On Thursday (Friday NZ), nearly 11 months later, Underwood made his first public appearance in front of the NYU Langone Health Center.

Addressing the media and dozens of surgeons, therapists, nurses, and other medical staff that he described as "incredible," Underwood said smiled and told them that they had given him a second chance in life.

"It was not easy but it was worth it," he told the press conference broadcast live on Facebook.

The procedure lasted 25 hours, from the 5th to the 6th of January in the morning. Two teams of surgeons were working simultaneously in the adjacent operating rooms, said Dr. Eduardo Rodriguez, chief surgeon: one for the donor and one for the recipient.

Less than a year later, Underwood can speak intelligibly. He is in the process of restoring an old truck that he recently bought. He plays golf. And, as Rodriguez showed in a slideshow, Underwood, in the open air, even skydived. (No, he did not first ask for his doctor's permission).

"There has been so much incredible progress in surgery, and I'm living proof of it," said Underwood. "But it only happens through special people like Will and his family."

On January 4, New York writer Will Fisher died at age 23 after a long battle with mental illness. An organ donor, Fisher was the perfect partner of Underwood.

Both were connected by LiveOnNY, the organ procurement organization appointed by the federal government in New York, prior to Fisher's death. LiveOnNY is a non-profit organization that provides a gift for the eyes, organs and tissues. According to its website, 20,000 donors have been connected to beneficiaries.

"It's like finding a needle in a haystack," said Helen Irving, general manager of LiveOnNY since 2011, at Thursday's press conference. "We want the ideal patient for Cameron."

The first full facial transplant involving a live catcher took place in 2010 in Spain. Fewer than 50 face transplants have been performed worldwide and fewer than 10 total or near-total operations have been performed in the United States.

A significant portion of the cost of the surgery was covered by Underwood's insurance through his employer, according to a press release issued by NYU Langone Health. Rodriguez said that it was the first US case in which liability insurance covered part of the proceedings. According to the statement, face transplant surgeries are usually funded by research grants, often from the Department of Defense.

With only 18 months between initial injury and surgery, the Underwood procedure represents the shortest wait time for a US facial transplant.

"We are often asked questions about the identity crisis following a facial transplant," Rodriguez said. "As Cam set it, his life was paused" while he was living with a disfigured face.

Here is a more in-depth look at what happened.

Prior to 2016, Underwood was working as a welder and mechanical worker in Yuba City, California, as he told family members in an exclusive story earlier this month to People magazine.

His suicide attempt followed a day of drinking. His mother, Bev Bailey-Potter, told People that she knew that her son was unhappy, but did not believe him to be suicidal.

Underwood was flown to the Davis Medical Center of the University of California for his injury that had disintegrated the bottom of his face.

A doctor in the emergency room told Bailey-Potter that his son would not survive, that his face was covered with dust, but that he still had eyes and forehead.

But he survived. Underwood remained under intense sedation for more than a month, requiring a feeding tube.

A few months after the initial medical treatment, Bailey-Potter read an article in a December 2016 issue of People on the Langone Center in NYU and its revolutionary face transplant program.

She made an appointment with Rodriguez almost immediately.

The distance was not dissuasive. According to a press release issued by the NYU, Underwood has traveled more than 4500 kilometers.

The curriculum vitae of the plastic surgeon is impressive to say the least. With a total of one-digit successful face transplants taking place in the United States prior to Underwood, Rodriguez has been chief surgeon for two of them – one with NYU Langone in 2015 and one with the Medical Center of the United States. 39, University of Maryland in 2012.

At the March 2012 transplant, Rodriguez and his team gave a new face to a 37-year-old man, Richard Norris, who suffered a ballistic injury in 1997.

In August 2015, Rodriguez repaired the face of Patrick Hardison, a retired firefighter who had been severely burned.

The exact circumstances of Fisher's death have not been revealed publicly, but Irving explained that Will's mother, Sally Fisher, had first met LiveOnNY on New Year's Eve.

"While the world was celebrating, a family was consoling itself and a mother was facing the loss of her only child," said Irving.

Underwood – who Irving, Rodriguez and others call Cam – "waited and waited, as do all of our families," to hear from the compatible donor, said Irving.

As Rodriguez has pointed out, bad weather has done little to prevent it from proceeding as planned.

A devastating "cyclone bomb" hit the northeast in January. Intense storms hit the area, including New York.

Air travel was chaotic during Underwood's scheduled surgery week, but it did so on time with advance planning between the NYU and the air ambulance teams.

"Thanks to the generosity of the pilots, they managed to bring Cameron in as soon as possible," Rodriguez said.

A team of photographers from the NYU Langone Communications Department has been following the process for months, leading up to the operation and during its recovery phases.

On January 4th, the day of Will Fisher's death, Sally Fisher asked to meet and thank Underwood.

Rodriguez has described this type of meeting between the parent of a donor and a receiver of a facial transplant as "unprecedented" before the operation.

"Welcome to New York," Sally told Cam during a hug in her arms. "Thank you God for you."

Underwood's procedure was monumental in terms of using advanced and innovative technology in other areas.

The operation in two halls required a team of more than 100 surgeons, nurses and other staff members, according to a press release issued by NYU Langone Health.

He used techniques that had never been used before, Rodriguez said.

"We are able to take advantage of the most advanced technological procedures that exist and we can do a lot of computer planning before proceeding with the operation," Rodriguez said during Thursday's press conference. "Not everything is perfect and it will require some inter-operative manipulation."

The three-dimensional printing was part of the new technologies used. The guiding frames that helped the surgical tools in place were printed in 3D, said Rodriguez. And for the first time in a face transplant, a 3D printed mask was grafted onto the donor's face after the extraction, performed out of respect for the Fisher family.

The surgery itself required the removal of midface structures, soft tissues and facial nerves from the donor's faces, as well as Fisher's teeth and jaw. Donors and recipients included an incision around the face, eye level in the middle of the neck.

Advanced computer systems helped the Rodriguez team navigate through what he called "interoperable" maneuvers to best adapt the transplant.

Titanium plates were inserted in the middle of Underwood's face. Screws were used to put his new jaw in place.

Underwood took advantage of the proximity of the game and the strong traits of Will Fisher.

"Willie had nice teeth," Rodriguez said.

A world-class orthodontist helped straighten his teeth, said Rodriguez. Underwood wore a splint for several months after the procedure, but her teeth remained naked at Thursday's press conference.

Although 25 hours may seem long, the procedure was reduced by nine hours compared to the previous facial transplant undertaken by Rodriguez's team, although this also required a reconstruction of the forehead.

The moment when Underwood saw his new face for the first time was also filmed. Rodriguez gave him a mirror and the patient froze for a moment before turning him over.

"It had been a few weeks," until he could see it, "but we had the impression that it was almost overnight," Underwood said at the time. the press conference on Thursday. "It was still a rough sketch, but we could see it over there, it was upsetting, with excitement."

Healing is a progressive process in many stages. As Rodriguez said at Thursday's press conference, it's not instantaneous, as it appears in some action movies, such as "Face / Off".

Nerves and blood vessels need time to regain their normal function. Bruising and swelling are immediate and last for weeks or months.

But the monthly photos taken on Underwood's face show a noticeable reduction in swelling and an appearance that gradually improves over time.

Underwood took five months to regain his facial movements. Until then, the outdoorsman had to breathe through a tube in the throat. Seven months after the operation, he could eat again.

The road to Underwood is still long. Rodriguez felt that it would take about three to five years before his face was "virgin".

Today, 11 months later, Rodriguez said that Underwood's body had shown no signs of rejection of the transplanted face.

"It was impossible for us to bring him back to a normal life without a facial graft," said the surgeon.

Underwood still lives in California but must continue to visit New York every month to see the surgeon.

LiveOnNY President and CEO Irving said there are currently about 9,000 suspicious donors of organs, tissues and eye donors on the New York City waiting list.

She asked residents of all states to take the life-saving step of becoming an organ donor. Will Fisher is registered as an organ donor when he was a teenager.

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