Face transplant frees man from life as a recluse

Richard Norris, who was injured in a gun accident, underwent the most extensive face transplant in history in March 2012 and says he is finally coming out of hiding after 15 years of living as a recluse. Photos, from left, show Norris in high school, soon after his accident, six days after his face transplant and seven months after the surgery.
University of Maryland Medical Center | The Washington Post
Richard Norris, who was injured in a gun accident, underwent the most extensive face transplant in history in March 2012 and says he is finally coming out of hiding after 15 years of living as a recluse. Photos, from left, show Norris in high school, soon after his accident, six days after his face transplant and seven months after the surgery.
By Maggie Fazeli Fard, The Washington Post
Posted Dec. 05, 2012, at 9:27 a.m.

After a gun accident took off half his face, Richard Lee Norris spent 15 years living as a recluse in Hillsville, Va. Horribly disfigured, he hid indoors. When he ventured out, it was behind a baseball cap and surgical mask. He didn’t pursue a career and never married.

Now, seven months after undergoing the most extensive face transplant in history, 37-year-old Norris is finally coming out of hiding.

Thanks to a combination of potent medications and dogged determination, Norris is healing faster than anyone expected, according to his doctors at the University of Maryland Medical Center in Baltimore, Md., where his transplant was performed.

“We as doctors do the operation, but the rest is up to you as the patient,” said Eduardo Rodriguez, a dentist and surgeon at UMMC. “You have to carry the ball.” Norris, Rodriguez says, took the ball and ran with it.

By the time Norris was selected as a transplant candidate in 2005, he had already undergone more than a dozen operations attempting to give him functional use of his mouth. Despite the numerous surgeries, certain facial features — such as his lips, nose and the front of his tongue — were beyond repair.

“After several attempts at reconstruction, it became apparent it wasn’t going to work,” Norris, who declined to be interviewed in person, said in a written statement to The Post. “The face transplant was one of my very few options left.”

The 36-hour operation was completed in March and involved more than 150 doctors, nurses and UMMC staff members.

“Everything from the scalp to the midline of my neck was replaced, including the jaw bones, teeth, part of my tongue, muscles, and nerves,” said Norris, who has retained his eyesight through the gun accident and the subsequent surgeries.

The days immediately following the transplant were promising. Norris was taken off his postoperative ventilator, and within the first week he was able to shave his face and brush his teeth.

When Norris saw his new face in a mirror for the first time, he wrote, “the only thing I could do was hug Dr. Rodriguez.”

Still, he spent the first two months following the surgery in the hospital. The goal at that time, Rodriguez said, was to reduce inflammation and stymie the risk of rejection through high doses of immunosuppressing drugs.

In May, Norris was discharged but instructed to remain in the Baltimore area, where he could meet with his transplant team as well as a psychologist, a social worker, and speech and physical therapists multiple times each week.

Finally, Norris was allowed to return home to Hillsville, in southwest Virginia, where he does his speech therapy “homework” and meets with his local physician. He returns to Baltimore once or twice a month for checkups with Rodriguez and other doctors.

“I have been doing very well regaining my speech back,” Norris said. “Each day it improves a little more.”

There was, however, one hiccup in the recovery process: the much-feared rejection.

As with any transplant, there was a possibility that Norris’s body would reject his new face. In this case, the rejection was mild and treatable, Rodriguez said.

“When people hear ‘rejection,’ they think, ‘Oh, my God, the face is going to melt off,’ ” Rodriguez said. “That’s not the case at all. The skin got a little bit swollen and there was a little bit of redness. On a scale of 1 to 10,” with 10 being the worst-case scenario, “this was a Grade 1 rejection.”

Still, Norris is not in the clear. He continues to run the risk of rejection and he will have to take medications for the rest of his life.

Rodriguez said that one of the most common questions he is asked is “How is Richard dealing with having a new face?”

“We always think that there is going to be a facial identity crisis. That’s the worry of people with normal faces. We think how we’d feel if this happened to us,” Rodriguez said. “But for people with disfigurements — these people have lived lives concealed from society. That’s a very different and difficult recovery.”

Before the transplant, Norris rarely left his home. In addition to wearing a surgical mask and baseball cap on his infrequent trips out in public, he did his shopping at night so he wouldn’t have to face the stares of as many people.

“I am now able to walk past people and no one even gives me a second look,” he wrote.

After years of going out of his way to avoid people, Norris is surprisingly comfortable socializing now, Rodriguez said. “Everybody [at the hospital] knows him. He’s such an animated guy.”

While Norris’s results are “extraordinary,” Rodriguez said the full recovery will take more time.

There’s the challenge of teaching Norris, who has not eaten or spoken properly for 15 years, to use his fully functional face. “The teeth plus the tongue is a lot to get used to” when someone has gone so long without them, Rodriguez said. Additionally, minor surgery is planned for the soft tissue of his face, such as the eyelids where there is extra skin.

But more than anything else, there is a looming question. Even with immunosuppressing drugs, doctors say they have no idea how long the transplant will last. There is an expectation that they will have to repair or replace the transplant eventually, Rodriguez said.

Rodriguez looks with hope to earlier face transplants. The world’s first full face transplant took place in Spain in 2010 and is aging well two years later. The first partial transplant was done in France in 2005, and Rodriguez said its longevity is promising.

“I’d like to hit that 10-year mark with Richard,” he said. “Of course, we can’t promise anything, but 10 years would be great.”

In the meantime, Norris said he is excited to fish, golf and spend time with his family and friends.

“My friends have moved on with their lives, starting families and careers,” he said. “I can now start working on the life given back to me.”

http://bangordailynews.com/2012/12/05/health/face-transplant-frees-man-from-life-as-a-recluse/ printed on September 30, 2014