Mayo Clinic performs its second — and most complicated — face transplant

ROCHESTER — After receiving a face transplant at Mayo Clinic earlier this year, a Michigan man can now smile and breathe through his nose for the first time in a decade. It is Mayo Clinic's second face transplant and its most complex and extensive one to date.

The surgery was performed in February and lasted for more than 50 hours and involved a medical team of at least 80 health care professionals, including surgeons, anesthesiologists, nurses, technicians, assistants and other specialists, Mayo Clinic said in its announcement.

Derek Pfaff’s life changed forever on March 5, 2014, when a gunshot wound severely damaged his face.

"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 said.

Before going to Mayo Clinic in Rochester, Pfaff underwent 58 reconstructive facial surgeries over 10 years, but he still couldn’t eat solid food or speak casually with friends and family.

The surgery “transformed my life,” Pfaff said.

Mayo Clinic performed its first face transplant in 2016. The world’s first face transplant was performed 19 years ago and since then, more than 50 have been done.

"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," Dr. Hatem Amer, medical director of Mayo Clinic's Reconstructive Transplant Program, said in the announcement.

The surgery team was led by Dr. Samir Mardini, a facial reconstructive and facial reanimation surgeon and surgical director of Mayo Clinic's Reconstructive Transplant Program. It is estimated that 85% of Pfaff's face, including the mandible and maxilla, was reconstructed and replaced with donor tissue, Mayo Clinic said in the announcement.

LifeSource, the federally designated organ procurement organization for the Upper Midwest, worked closely with the family of the donor and Mayo Clinic care teams, the announcement added.

"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.

The complex surgery took months of intricate planning, including facial nerve mapping of both the donor and recipient's nerve system to understand the function of each nerve.

Virtually everything below Pfaff's eyebrows and part of his forehead was replaced.

"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," the announcement said.

Mayo Clinic doctors also used a new “microsurgery” 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," Mardini said.

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.