When Richard Lee Norris opened his eyes after a marathon 36-hour surgery to give him a new face, he immediately wanted a mirror.
A natural reaction for a man who had been practically living as a recluse since a 1997 gun accident took off his nose, chin, lips and teeth, said doctors from the University of Maryland who had just performed the world's most extensive face transplant on the 37-year-old from Hillsville, Va.
Norris is relearning to talk and couldn't convey his wonder in words — but his doctors could.
"'This is so cool'" one of the surgeons kept repeating, said Dr. Thomas M. Scalea, director of the University of Maryland School of Medicine trauma program and physician-in-chief of the Maryland Shock Trauma Center, where the transplant was performed last week.
Scalea oversees care of the state's most horrific injuries at the center but called these results "the most remarkable thing I've ever seen."
He counted up to 150 doctors, nurses and other professionals from the Maryland medical system who had a direct hand in caring for Norris. Just six days after his surgery, Norris was saying some words, shaving and brushing his teeth. He's also beginning to get some feeling back in his face.
Norris received donor skin from his scalp to his neck, as well as a new jaw, teeth, tongue and the underlying muscle and tissue. In addition to matching his blood type, doctors had to match his skin color and bone structure to a donor.
Unemployed and living with his parents before he came to Maryland in 2005, Norris had undergone a dozen surgeries, but none that could restore him to functioning membership in society, said Dr. Eduardo D. Rodriguez, associate professor of surgery at Maryland's school of medicine and chief of plastic, reconstructive and maxillofacial surgery at Maryland Shock Trauma Center.
Maryland had been working for the past decade on face transplant methods, improving the way tissue, muscle, skin and bone are woven onto a recipient and increasing the odds of acceptance by a recipient.
The Department of Defense's Office of Naval Research funded the work with eight grants totaling $13 million. It supports research that could aid returning service members injured by explosives. At some point, injured veterans could undergo transplants at Maryland.
"Our goal is to restore function as well as have aesthetically pleasing results," said Rodriguez, who led the surgery.
The hospital provided no details about the gun accident, but during Tuesday's news conference at Maryland, doctors and university officials recounted Norris' transformation through a series of photos.
Doctors showed before and after pictures that included a photo from Norris' high school prom; a post-injury photo where Norris appeared to have no chin and a mangled nose; and a post-surgery photo that made him appear close to normal, if swollen, after surgery.
Norris' facial features appear to be a blend of his own and those of his donor, whose family he has not met, Rodriguez said. The donor was not named by the Living Legacy Foundation of Maryland, which works in the state to supply recipients with needed organs. The same donor provided five life-saving organs to five other recipients, four of whom also had surgeries at Maryland.
Drivers who check "organ donor "on their licenses do not consent to face transplants. A family must give special permission, said Charlie Alexander, the foundation's president and CEO.
Around the world, 22 people have received face transplants since the first was performed in France seven years ago. While Maryland is a large transplant center, this was its first face transplant.
Doctors there have been working to perfect the protocol to prevent rejection of any transplant, said Dr. Stephen T. Bartlett, chair of the medical school surgery department and surgeon-in-chief at the University of Maryland Medical Center. Normally, patients are given a daily three-drug cocktail for the rest of their lives to keep them from rejecting their transplants.
Starting five years ago, the center's doctors began using two drugs for many kidney and pancreas transplant patients and they're trying them on Norris, the first time for a face-transplant patient, surgeons said. The drugs suppress the immune system and make a patient more vulnerable to infection, so a smaller amount can reduce that side effect. Eventually, doctors hope to reduce the dosage of the two drugs.
Doctors felt confident using the new drug regimen on Norris after years of lab work at Maryland, Bartlett said. The research supported the change as long as they also transplanted high amounts of "vascularized" bone marrow, which came inside the jaw transplanted into Norris' face. The bones and attached vessels give the marrow a ready place to live and steady supply of blood, and that seems to offer some continuous protection from rejection, Bartlett said, though researchers aren't entirely sure why.