A team of doctors from the Mayo Clinic in Rochester, Minnesota, US, has succeeded in making a man smell, swallow, blink and smile for the first time in a decade. This was done through a marathon face transplant that took more than 50 hours, and a multidisciplinary team of at least 80 healthcare professionals participated.
Derek Pfaff (30 years old), from Harbor Beach in the United States of America, has previously undergone 58 facial plastic surgeries, but he still struggles to speak and breathe normally. His nose was also missing, he was unable to chew or swallow food, and had to use a feeding tube. In addition, he only had one eye, and was unable to blink.
“After my last surgery, the doctor told my parents there was nothing else he could do but refer us somewhere for a face transplant,” Pfaff said in an announcement on the Mayo Clinic website. “This surgery has changed my life. I feel so much more confident.”
Alive again
The first face transplant was performed nearly 20 years ago, according to the American magazine Newsweek, and since then more than 50 such operations have been performed around the world. The latest procedure is the second face transplant performed by Mayo Clinic, the first being performed in 2016.
Pfaff attempted suicide on March 5, 2014 at the age of 19 while returning from college on spring break.
“I looked through the door, and the gun safe was open… my heart dropped,” his father, Jerry Pfaff, said.
“He doesn’t remember getting the gun. He doesn’t remember going out. He doesn’t remember shooting himself. We met with doctors, and they told us there was no way Derek would have survived. It’s a miracle he lived,” his mother, Lisa, said.
The then 19-year-old survived the incident, but his face was severely damaged by the gunshot.
“I should have died that night. I’m grateful to be alive,” he said.
Complex surgery
In February 2024, they found a face donor, and the decision was made to perform a transplant. It was performed by a multidisciplinary team led by Dr. Samir Mardini, facial reconstruction surgeon and surgical director of the Reconstructive Transplantation Program at Mayo Clinic.
An estimated 85% of Pfaff’s face was successfully reconstructed and replaced with donor tissue, Mardini noted. This included the upper and lower eyelids, upper and lower jaws, teeth, nose, cheek structure, neck skin, hard palate, and parts of the soft palate.
The surgery was meticulously planned over several months, and the team even created a digital surgical plan based on detailed scans of the donor and recipient’s faces, which enabled them to perform the surgery digitally first.
One of the most challenging aspects of the surgery was reconnecting the many small nerves between Pfaff’s face and the donor tissue to ensure that functions such as eating, blinking and even smiling were restored.
The team mapped the tiny facial nerves of both the donor and recipient to aid in this effort.
“We’re trying to bring back the functions that Derek missed for 10 years. Most organ transplants are life-saving. With a face transplant, it’s a life-giving operation. You can live without it, but you miss out on a life,” Mardini said.
After the initial procedure, Pfaff underwent additional surgery to improve his appearance, improve the function of his tongue and eyelids, and ensure that the newly connected nerves were working properly.
“This is not a cosmetic procedure, although the side benefits are very beneficial to the patient’s aesthetics,” Mardini said. “Derek seems normal. He looks forward to walking down the street without anyone noticing anything on him.”
The 30-year-old is now a passionate advocate for suicide prevention and plans to share his story to encourage people struggling to seek help.
“I live for a reason, I want to help others. I am so grateful to the donor, his family, and my care team at Mayo Clinic for giving me this second chance,” Pfaff said.