Patient Stories > Face in the Mirror: The Story Behind Mayo Clinic’s First Face Transplant

Face in the Mirror: The Story Behind Mayo Clinic’s First Face Transplant

By Mayo Clinic Press Photography by Gosha Weivoda

The following is an excerpt from Face in the Mirror by Jack El-Hai — a book that follows the journey of Andy Sandness, who received the first face transplant at Mayo Clinic. Proceeds are invested into furthering medical research and education at Mayo Clinic.

Andy felt calm when he checked into the Rochester hotel where he would spend the night before his face transplant began. He no longer felt scared. Focused on the surgery, he forgot to check on the outcome of the NHL Stanley Cup championship game that day, diehard sports fan though he was. As he prepared for bed, he strove to relax and mentally prepare himself for the momentous event ahead.

The next morning, transplant nurse coordinator Lori Ewoldt walked Andy the short distance from the hotel to Saint Marys. She was relieved to have been able to share some laughs with him the previous night after the ambulance finally made its rendezvous with his taxicab. It was hard not to look at him through a mother’s eyes. He was young enough to be her child. The calmness with which he faced the long surgery ahead impressed her.

After Andy’s admission to the hospital, Mayo Clinic plastic surgeon Samir Mardini, M.D., visited Andy in his room. He and Andy shook hands and started talking. Dr. Mardini explained some technicalities and paperwork they had to get out of the way. He presented Andy with the final consent forms to sign. They had spoken together many times previously about the risks and consequences of the surgery, but discussions just before serious operations often carry a stronger urgency than conversations that happen way in advance, when the surgery seems merely a possibility. Dr. Mardini asked Andy if he was certain he wanted to undergo the transplant.

“Yes, I’m ready,” Andy replied.

“We’re going to do the best we can,” Dr. Mardini said. “Do you have any questions?”

Research fellow Marissa Suchyta, M.D., Ph.D., was present, and Andy’s composure surprised her. “He was so ready for this to happen and had so much trust in the team that he had no hesitation signing those consent forms,” she said.

Hatem Amer, M.D., too evaluated Andy. He once again told Andy about the risks and possible complications of the face transplant. They also discussed Andy’s CMV mismatch with the donor’s tissues and the medications and treatments that could minimize any potential problems. Dr. Amer judged that the risk of Andy undergoing anesthesia was acceptable.

A LOOK INSIDE
FACE IN THE MIRROR

For years, they came in on weekends to plan and practice — nearly 60 surgeons, nurses, and anesthesiologists, preparing to harmonize in a vast medical symphony. For the team at Mayo Clinic, it was their most complex surgery to date: a face transplant.

At the heart of this event was Andy Sandness. He grappled with feelings of isolation and shame after a disfiguring suicide attempt but was determined to reclaim his future, to be seen as ordinary, and to belong again. Alongside him was Dr. Samir Mardini, a surgeon with an intense, unwavering desire to transform medicine and create a new life for his patient.

Their story — told over nearly two decades — is a poignant exploration of resilience, hope, and friendship, as well as an incredible account of medical breakthroughs and scientific discovery that reveals the strength of the human spirit, and the courage to rise above our scars.

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Early on Friday, Dr. Mardini held a team meeting. The group included Katie Weimer, vice president of 3D Corporation, the company that had provided the three-dimensional models the team used in its rehearsals. Weimer had been involved from the start in the virtual surgical planning aspects of the surgery. “The day has come,” Dr. Mardini said at the start of the meeting. “We have all put in so much time and effort and thought into this — we could not be more ready.” He felt no need to review the operation itself after so many rehearsals in the cadaver lab. Instead, Dr. Mardini presented a schedule for breaks to ensure a high-performing team at the transplant’s conclusion, when it would be needed most. He asked team members to take breaks when asked, and not do the courteous thing and offer to keep working.

Knowing the transplant surgery was imminent, ophthalmologist Elizabeth Bradley, M.D., had canceled all her other appointments starting Friday afternoon. After the meeting, Dr. Bradley needed stress relief, so she worked out at the on-site fitness center and returned to duty by late afternoon. Dr. Mardini let her and other members of the surgical team know that he would handle last-minute preparations and that they should take it easy, sleeping if possible, until later. The operation was still some hours off, and Dr. Bradley went home to rest. The call to report in came at 2 a.m. Saturday morning, awakening her. She was back at the hospital at 3 a.m.

Andy had presented himself for the face transplant in excellent physical condition, and he seemed to Dr. Mardini to be at prime readiness. The surgeon estimated that Andy had worked out five or six days per week before the operation in addition to his rigorous outdoor activities on the job. “He was healthy-looking and strong in his mind,” Dr. Mardini said. “He said he knew we were preparing hard, and he wanted to do the same.”

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Andy’s dad, Reed, was able to travel to Rochester on short notice for the operation (he ended up staying in Rochester for three months). After booking a hotel room across the street from the hospital, he got lost trying to find Andy’s hospital room. It took a while for him to find it, but he did. Just before the transplant began, Reed gave Dr. Mardini a handshake and a hug, and Andy told Reed he loved him.

Great care was to be taken with the nerve segments to ensure that Andy’s new facial muscles could accurately respond to signals from his brain. If it was done correctly, then when Andy wanted to smile, impulses from his brain would activate the corresponding transplanted facial nerves to correctly curve the mouth upward rather than close the mouth or perform another unintended movement. The same painstaking process would enable Andy to speak, cry, and perform other facial functions correctly. To ensure that all the nerves matched properly between the donor and Andy, Dr. Mardini asked Mayo resident Waleed Gibreel, M.B.B.S., who would later join Dr. Mardini’s craniofacial team at Mayo, and research fellow Dr. Suchyta to watch and double-check the videos showing the stimulation of the nerves of the donor and patient. Dr. Mardini and the team then knew with certainty which nerves to connect from Andy to the donor.

In Andy’s suite, Mayo’s videographers used an eerily silent overhead video system that they controlled from a console. It had an arm that rose above the surgery and shot straight down. It ran constantly, supplemented by footage from handheld cameras. “We got engaged,” Sheahan said. “We made sure the camera was where it needed to be. We didn’t let somebody stand in the way, and we spoke up when we needed to take a photo, because we were helping Andy [to] have greater success when we spoke up if something was not right.” Sheahan’s aggressive methods in the operating room, shooting in the intense quiet, led him to call himself “the surgeon’s henchman.”

“You weren’t just there to capture images,” said Mayo photographer Kevin Ness. “You engaged yourself in the surgery, so you knew what’s going on and you knew when there was a picture needed. And you were right there, and they didn’t even have to ask you to take a picture. You just did it.”

This photographic diligence was necessary not only to document the face transplant and crucially aid in the surgery but also to preserve what transpired in the surgical suites as a learning aid for surgeons and perhaps face transplants to come. The record of this long weekend for Andy and Dr. Mardini in Saint Marys would teach and inspire caregivers far into the future.

To follow the rest of Andy’s journey, read Face in the Mirror.