‘Just another face’: Mayo Clinic performs its first face transplant

Transplant following twin tragedies gives suicide survivor new look, new life

posted Feb. 18, 2017 12:00 a.m. (CDT)
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by / Sharon Cohen Associated Press

  • Andys New Face
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    - Face transplant recipient Andy Sandness looks Jan. 25 at Mayo Clinic Hospital, St. Marys Campus, in Rochester, Minn. Sandness, the first to receive a face transplant at the medical center, has the nose, cheeks, mouth, lips, jaw and chin of his donor.
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    Eric M. Sheahan | Enlarge
    - In this June 10, 2016 photo provided by the Mayo Clinic, Andy Sandness, right, talks with his father, Reed Sandness, and Dr. Samir Mardini, left, before Andy's face transplant procedure at the Mayo Clinic in Rochester, Minn. In the process leading up to the surgery, Mardini tried to temper his patient's enthusiasm. "Think very hard about this," he said. Only a few dozen transplants have been done around the world, and he wanted Andy to understand the risks and the aftermath: a lifelong regimen of anti-rejection drugs. But Sandness could hardly contain himself. "How long until I can do this?" he asked. (Eric M. Sheahan/Mayo Clinic via AP)
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    - Sandness waits for his face transplant procedure last June 10 at Mayo Clinic.
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    Eric M. Sheahan | Enlarge
    - In this June 10, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini shows Andy Sandness photos of his children on his smartphone before Sandness' face transplant surgery in Rochester, Minn. Over the years, the two say they've become as close as brothers. (Eric M. Sheahan/Mayo Clinic via AP)
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    - In this June 10, 2016 photo provided by the Mayo Clinic, a medical team of about 60 doctors, nurses, anesthesiologists and others at Mayo Clinic gather before performing the first face transplant surgery at their hospital in Rochester, Minn. Mardini and his team devoted more than 50 Saturdays over 3 1/2 years to rehearsing the procedure, using sets of cadaver heads to transplant the face of one to another. They used 3D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on Andy Sandness. (Michael Cleary/Mayo Clinic via AP)
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    Eric M. Sheahan | Enlarge
    - In this June 11, 2016 photo provided by the Mayo Clinic, a medical team performs a face transplant surgery at the medical center in Rochester, Minn. The surgery that started shortly before midnight Friday was over early Monday morning. (Eric M. Sheahan/Mayo Clinic via AP)
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    - A Mayo Clinic medical team performs the face transplant surgery last June 13 on Andy Sandness in Rochester, Minn. It took about 24 hours to procure the donor's face, which involved taking bone, muscle, skin and nerves, and almost the same time to prepare the recipient. His entire face was rebuilt below his eyes, taking an additional 32 hours. The medical team rotated, taking four-hour breaks through the weekend.
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    Eric M. Sheahan | Enlarge
    - In this June 18, 2016 photo provided by the Mayo Clinic, Dr. Samir Mardini checks on his patient, Andy Sandness, days after leading a team that performed the first face transplant surgery at the medical center. Sandness, who was sedated for several days, wasn't allowed to see himself immediately. His room mirror and cell phone were removed. (Eric M. Sheahan/Mayo Clinic via AP)
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    - Dr. Samir Mardini shaves the face of his patient Andy Sandness last July 3, days after leading a team that performed the first face transplant surgery at the hospital. The two say they’ve become as close as brothers.
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    - This undated photo provided by his wife, Lilly, shows Calen "Rudy" Ross. In June 2016, he died of a self-inflicted gun shot. He had designated he wanted to be an organ donor, but when the idea was brought to Lilly about a donation for a face transplant, she says, "I was skeptical at first. ... I didn't want to walk around and all of a sudden see Calen." She was reassured the donor had his own eyes and forehead and would not be recognizable as her husband. After consulting with her husband’s best friend, she gave her consent. (Courtesy Lilly Ross via AP)
  • Andys New Face-10
    Associated Press | Enlarge
    - Calen “Rudy” Ross died last June of a self-inflicted gunshot. When agreeing to a donation for a face transplant, his devastated 19-year-old widow, Lilly, thought of their baby son. “The reason that I decided to ... go through with it was so that I can later down the road show Leonard what his dad had done to help somebody,” she said in a video produced by LifeSource, a nonprofit group that works with families in the Upper Midwest to facilitate organ and tissue donation.
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    - Sandness is pictured before his 2006 injuries.
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    - Sandness attends a speech therapy appointment Jan. 24 at the clinic.
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    Charlie Neibergall | Enlarge
    - In this Jan. 24, 2017, photo, face transplant recipient Andy Sandness looks in a mirror during an appointment with physical therapist Helga Smars, right, at Mayo Clinic in Rochester, Minn. He wasn't allowed to see himself immediately after the surgery. His room mirror and cell phone were removed. When he finally did see his face after three weeks, he was overwhelmed. "Once you lose something that you've had forever, you know what it's like not to have it. ... And once you get a second chance to have it back, you never forget it." Just having a nose and mouth are blessings, Sandness says. "The looks are a bonus." (AP Photo/Charlie Neibergall)
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    Charlie Neibergall | Enlarge
    - In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness has his face checked during an appointment with physical therapist Helga Smars at Mayo Clinic in Rochester, Minn. Sandness, the first to receive a face transplant at the medical center, has the nose, cheeks, mouth, lips, jaw and chin of his donor. (AP Photo/Charlie Neibergall)
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    - FILE - In this Tuesday, Jan. 24, 2017 photo, face transplant recipient Andy Sandness wears a LifeSource bracelet at the Mayo Clinic in Rochester, Minn. LifeSource, a nonprofit group, works with families in the upper Midwest to facilitate organ and tissue donation. (AP Photo/Charlie Neibergall)
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    Charlie Neibergall | Enlarge
    - In this Jan. 24, 2017 photo, face transplant recipient Andy Sandness talks with physical therapist Helga Smars, right, during an appointment at the Mayo Clinic in Rochester, Minn. His facial muscles are growing stronger. He received speech therapy to learn to use his tongue in a new mouth and jaw and enunciate clearly. He's thrilled to smell again, breathe normally and be eating foods that were off-limits for a decade: apples, steak and pizza that he shared with his doctors. (AP Photo/Charlie Neibergall)
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    Charlie Neibergall | Enlarge
    - In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness is hugged by Dr. Samir Mardini, foreground, during a visit to the Saint Marys Hospital campus at the Mayo Clinic in Rochester, Minn. Mardini led a medical team to perform Sandness' face transplant surgery, the first performed at the medical center. (AP Photo/Charlie Neibergall)
  • Andys New Face-18
    Charlie Neibergall | Enlarge
    - In this Jan. 25, 2017, photo, face transplant recipient Andy Sandness walks to the Saint Marys Hospital campus at Mayo Clinic in Rochester, Min. Sandness can pinpoint the day he looked normal. About three months after the procedure, he was in an elevator with a little boy who glanced at him, then turned to his mother without appearing scared or saying anything. "I knew then," he says, "that the surgery was a success." (AP Photo/Charlie Neibergall)

ROCHESTER, Minn. — He’d been waiting for this day, and when his doctor handed him the mirror, Andy Sandness stared at his image and absorbed the enormity of the moment: He had a new face, one that had belonged to another man.

His father and his brother, joined by doctors and nurses at Mayo Clinic, watched him examine his swollen features. He was just starting to heal from one of the rarest surgeries — a face transplant, the first at the medical center. He had the nose, cheeks, mouth, lips, jaw, chin, even the teeth of his donor. Resting in his hospital bed, he couldn’t speak clearly, but he had something to say.

“Far exceeded my expectations,” he scrawled in a notebook.

“You don’t know how happy that makes us feel,” Dr. Samir Mardin replied as he read the message aloud, addressing the man who’d become his friend over the past decade.

The exchange came near the end of an extraordinary medical journey that revolved around two outdoorsmen, both just 21 when they decided to kill themselves: Sandness survived but with a face almost destroyed by a gunshot; the other man died.

Their paths wouldn’t converge for years, but when they did — in side-by-side operating rooms — one man’s tragedy offered hope the other would have a second chance at a normal life.

Terrible mistake

Two days before Christmas in 2006, a deeply depressed Andy Sandness put a rifle beneath his chin and pulled the trigger.

Instantly, he knew he’d made a terrible mistake. When police arrived, he begged: “Please, please don’t let me die!!”

He was rushed from his home in eastern Wyoming, treated at two hospitals, and then transferred to Mayo Clinic, where he met Mardini, a plastic surgeon whose specialty is facial reconstruction.

Sandness had no nose or jaw. His mouth was shattered; just two teeth remained. He’d lost some vision in his left eye.

Mardini and his team reconstructed his upper and lower jaw with bone, muscle and skin from the hip and a leg. They reconnected facial bones with titanium plates and screws.

After about eight surgeries over 4½ months, Sandness returned to tiny Newcastle, Wyo., where friends and family embraced him. He worked at a lodge, in the oil fields and as an electrician’s apprentice.

No social life

But his world had shrunk. When he went grocery shopping, he avoided eye contact with children so he wouldn’t scare them. He had almost no social life. He retreated to the hills to hunt and fish.

Sandness adapted. His mouth was too small for a spoon so he tore food into bits. He wore a prosthetic nose, but it constantly fell off outdoors.

“You never fully accept it,” he said. “You eventually say, ‘OK, is there something else we can do?’ ”

The prospect of 15 more surgeries Mardini had mapped out scared him. For several years, Sandness made annual visits to Mayo.

Then in 2012, Mardini called. It looked like Mayo was going to launch a face transplant program; Sandness might be an ideal patient.

Mardini urged him to “think very hard” about the transplant. Only about two dozen had been done worldwide. He wanted Sandness to understand the risks and lifelong regimen of anti-rejection drugs. After researching the surgery, Sandness has some concern about side effects of the drugs but was undeterred.

“When you look like I looked and you function like I functioned, every little bit of hope that you have, you just jump on it,” he said, “and this was the surgery that was going to take me back to normal.”

Sandness had to undergo a rigorous psychiatric and social work evaluation to address, among other things: Should this surgery be done on someone who’d attempted suicide?

Several factors weighed in his favor: His resilience and motivation, strong family support, his rapport with Mardini and the length of time since the shooting.

Donor available

Last June, five months after his name was added to the waiting list of the United Network for Organ Sharing, he got word: A donor was available.

Calen “Rudy” Ross had fatally shot himself. His devastated 19-year-old widow, Lilly, was eight months pregnant. Despite her grief, she carried out her husband’s wishes to be an organ donor. She met with a coordinator from LifeSource, a nonprofit group that helps families in the Upper Midwest facilitate organ and tissue donation.

Ross’ heart, lungs, liver and kidneys were donated. Additional screening determined he was a good match for a man awaiting a face transplant.

In a second conversation, LifeSource broached the idea.

“I was skeptical at first,” Lilly said. “I didn’t want to walk around and all of a sudden see Calen.” She was reassured because the donor had his own eyes and forehead and wouldn’t be recognizable as her husband.

Mayo’s medical team, which had rehearsed the surgery for 3½ years with cadaver heads, gathered one June night to start a 56-hour marathon. It took about 24 hours to procure the donor’s face, which involved taking bone, muscle, skin and nerves — and almost the same time to prepare Sandness. His face was rebuilt below his eyes, taking an additional 32 hours.

Having a nose and mouth are blessings, he said. “The looks are a bonus.”

Face in crowd

He and Lilly Ross have been in contact. She wanted him to know about her husband. Last fall, she wrote to Sandness and the five other organ recipients, describing Ross as a “giving person” who loved hunting and trapping. Sandness replied with a note of appreciation.

When Lilly later saw photos of Sandness she learned the two men shared a passion for the outdoors; they even stood the same way in photos.

Sandness, now 31, is thrilled to eat steak and pizza again.

He also savors his anonymity. Recently, he attended a Minnesota Wild hockey game where, he said, he was “just another face in the crowd.”

Just thinking about that makes him smile.