A 30-year-old Michigan man can smell, swallow, blink and smile for the first time in a decade thanks to a face transplant at Mayo Clinic.

In the last 20 years, just a little more than 50 face transplants have been performed worldwide. This is the second face transplant completed at Mayo Clinic.

For Derek Pfaff, the transformational surgery has been life-changing.

Watch: Derek Pfaff's story

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On the shore of Lake Huron in a small town with just one traffic light, everybody knows everybody in Harbor Beach, Michigan. A decade ago, the face of Derek Pfaff was well-known in this tight-knit community.

"He was kind of that hometown hero," says Lisa Pfaff, Derek's mother.

The son of Jerry and Lisa Pfaff, Derek was a straight-A student and captain and star running back on the school's only state championship football team.

On the night of March 5, 2014, Derek, then 19, was home from college on spring break when he decided to take his own life.

"I looked across, and the gun cabinet was open … I just … my heart dropped," says Jerry Pfaff, Derek's father.

"He does not remember getting the gun. He does not remember going outside. He does not remember shooting himself," says Lisa. "We met with the doctors, and they told us that there was no way Derek was going to make it."

But Derek did survive. "It's a miracle he lived," Lisa says.

However, most of his face was gone.

"I should have died that night. I'm thankful to be alive," Derek says.

Thankful to be alive, but after 10 years and 58 reconstructive surgeries, what remains of Derek's face is unrecognizable. He has only one eye and is unable to blink. He struggles with speaking and breathing normally, and no longer has a sense of smell. He can't chew or swallow food, and uses a feeding tube to eat.

"After my last surgery, the doctor told my parents that there's nothing more he could do except refer us to a place to get a face transplant," Derek says.

Ultimately, that place would be Mayo Clinic in Rochester, Minnesota.

"The thought of this surgery is our ray of hope," Lisa says.

"Life-changing for him," Jerry says.

It's a second chance at life for Derek.

"The heart is a lifesaving operation. The kidney, for the most part, is a lifesaving operation. With facial transplantation, it's a life-giving operation. You can live without it, but you're missing out on life," says Dr. Samir Mardini, surgical director of Mayo Clinic's Reconstructive Transplant Program. "Face transplant is a rare surgery. There are only a few teams around the world that are doing them."

Derek's surgery is Mayo Clinic's second face transplant and its most complex and extensive procedure to date. A face transplant replaces all or part of the face with donor tissue. Dr. Mardini estimates 85% of Derek's face needed to be replaced.

"In Derek's case, the donor tissue included part of the forehead, the upper and lower eyelids on the right side, the nose, the mouth, the upper and lower jaws — including the teeth — as well as all of the skin, muscles and nerves of the entire face and neck," says Dr. Mardini.

The most meticulous part of this complex surgery is reconnecting the many small nerves between Derek and the donor to ensure function, like eating, blinking and even smiling, is restored.

In extensive preparation for Derek's surgery, the face transplant team spent nearly nine months, including many weekends, rehearsing the procedure. Detailed scans of the face allowed the team to practice the surgery virtually. The latest technology in medical modeling and 3D printing also played a vital role in the planning and execution of the surgery.

"The restorative nature of the facial transplant makes it very complex," says Dr. Mardini.

In February 2024, a donor becomes available. Six surgeons and a multidisciplinary medical staff numbering more than 80 complete a surgical marathon lasting nearly two and a half days.

"We're trying to give Derek back functions he was missing for 10 years," says Dr. Mardini.

Still healing nearly a month after surgery — and 10 years to the day of his suicide attempt — Derek gets the first glimpse of his new face. In the months to follow, Derek has additional surgeries to refine his appearance, improve his tongue and eyelid function, and ensure the connection of nerves is working properly.

"This is not an aesthetic operation, although the side benefits of it are hugely beneficial for the aesthetics of the patient," says Dr. Mardini. "Derek is looking to be normal. He's looking to walk on the street and not have anyone notice anything on him."

As he approaches a new year in 2025, Derek is just another face in the crowd now — with a new smile.

"It makes my heart so full to see him smile and happy and just be a normal person again," Lisa says.

"It's been 10 years since you've seen a nose, lips and teeth on your son — just totally amazing, a miracle," Jerry says.

"It wasn't just Derek's face that was given. It was his other organs as well. So there were multiple recipients tied to that one donor, and that is the greatest gift that someone can make the courage and the decision to do," Lisa says.

Because of that donor's gift, Derek, now 30 years old, is ready to start the next chapter in his life.

"One day, meet someone, start a family," Derek says.

And he has found purpose as a public speaker for suicide prevention.

"Talk to someone. Tell them how you're feeling," Derek says.

"He's received so many letters that it's kind of like his calling now to continue to impact people and share," Lisa says.

"Hearing their stories and how I helped them, makes me feel pretty good," Derek says. "I lived for a reason. I want to help others anyway I can."

Related content:

• Mayo Clinic performs successful face transplant, restoring vital functions for Michigan man
• Transforming a life: Mayo Clinic announces its first face transplant
• Mayo’s first face transplant patient meets donor’s family

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ROCHESTER, Minn. — A Michigan man can blink, swallow, smile and breathe through his nose for the first time in a decade thanks to a face transplant performed at Mayo Clinic. This transformative and complex procedure underscores Mayo Clinic's skilled multidisciplinary surgical team who provide hope to patients with complex medical needs.

Derek Pfaff's life changed forever on March 5, 2014, when a tragic incident during his college years left his face severely damaged by a gunshot. 

"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 says. 

Despite undergoing 58 reconstructive facial surgeries in 10 years before going to Mayo Clinic in Rochester, he was still unable to eat solid food or speak casually with friends and family. Wearing glasses proved impossible without a nose. This transformational face transplant at Mayo Clinic means the now 30-year-old from Harbor Beach, Michigan, will once again be able to do all those things he has missed. He has also become a passionate advocate for suicide prevention and plans to share his story to encourage others who are struggling to get help.

"I lived for a reason. I want to help others," Pfaff says. "I am so grateful to my donor, his family and my care team at Mayo Clinic for giving me this second chance."

"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," says Hatem Amer, M.D., medical director of Mayo Clinic's Reconstructive Transplant Program.

In the 19 years since the first face transplant was performed, more than 50 have been done around the world. Survival outcomes for these transplants are encouraging, according to a recent JAMA Surgery study. Mayo Clinic performed its first face transplant in 2016.

Derek's story: Just another face in the crowd

How the surgery was done 

Mayo Clinic surgeons performed Pfaff's face transplant in February 2024 in a procedure that lasted more than 50 hours and involved a medical team comprised of at least 80 healthcare professionals, including surgeons, anesthesiologists, nurses, technicians, assistants and other specialists. 

This multidisciplinary team was led by Samir Mardini, M.D., a facial reconstructive and facial reanimation surgeon and surgical director of Mayo Clinic's Reconstructive Transplant Program. Dr. Mardini estimates that 85% of Pfaff's face, including the mandible and maxilla, was reconstructed and replaced with donor tissue.  

Surgeons meticulously planned this complex operation over several months. To ensure precision and accuracy, a digital surgical plan was created relying on detailed scans of both the donor's and recipient's faces, allowing the team to perform the surgery digitally first. Facial nerve mapping also was performed of both the donor and recipient's nerve system to understand the function of each nerve. While the digital aspect ensured preparation, customized 3D-printed cutting guides translated these plans into tangible tools to be used in the surgical suite.

The intricate transplant required replacing virtually everything below Pfaff's eyebrows and part of his forehead, including his upper and lower eyelids and intraorbital fat, upper and lower jaws, teeth, nose, cheek structure, neck skin, hard palate and parts of his soft palate. 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. A new microsurgery technique also was employed 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," Dr. Mardini says.

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.

"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.

LifeSource, the federally designated organ procurement organization for the Upper Midwest, also played a pivotal role in the transplant, working closely with the family of the donor and Mayo Clinic care teams. Thanks to his face transplant, Pfaff says he is focused on making plans for his future.

"This surgery has transformed my life. I feel so much more confident. I am hoping to one day meet someone, settle down and have a family," he says. "I'm also going to keep sharing my story with others to help as many people as I can."

If you or someone you know is experiencing a mental health crisis, you can call the National Suicide Prevention Lifeline at 988. 

Journalists: Press kit, including b-roll, photos, interviews and animation available here. Derek Pfaff, his mother Lisa Pfaff and Dr. Samir Mardini are available for interviews. Please contact newsbureau@mayo.edu to schedule.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

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• Heather Carlson Kehren, Mayo Clinic Communications, newsbureau@mayo.edu

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Everything about his life changed that day. And at breakfast on a December morning in Rochester, Sandness says he is finally living the life he hoped for.

"I don't get the looks like I used to," he says. "I mean, I can just sit down, eat normally, drink normally."

He enjoys the little things in life.

"I mean, I can smell pretty good," he says. "I mean, my taste is better than my smell, for sure."

He enjoys the little things most others take for granted.

"What I like is just being able to smile and being able to have the lip movement and being able to kiss," he says.

Little things that a few years ago he didn't know would ever be possible for him to enjoy.

"I made a huge list of all my goals of what I wanted," Sandness says. "I wanted function more than anything with the aesthetic looks."

Watch: 2 years after face transplant, Andy Sandness' smile shows his progress

Journalists: Broadcast-quality video pkg (3:37) is in the downloads at the end of the post.
Please 'Courtesy: Mayo Clinic News Network.' Read the script.

They were ambitious goals considering the results of face transplants have been so variable and unpredictable.

"He says, 'Well, we're gonna connect all the nerves,'" Sandness says. "... I think where some of these [other] doctors have slipped is not connecting every nerve. So that's why my surgery took 56 hours."

The "he" Sandness refers to is Dr. Samir Mardini, the Mayo Clinic surgeon who led a team of dozens that performed Andy's face transplant. They spent more than 50 Saturdays over a three-year period planning and practicing every step of the surgery with the team of surgeons, nurses, surgical technicians and anesthesiologists.

They practiced the nerve surgery every time.

"We identified on the donor all the facial nerve branches supplying the area of the face that was transplanted," Dr. Mardini says. "We took pictures. We videotaped. We studied what every little branch of those nerves did for the face. And we did the same thing on our patient, on Andy."

Connecting all of them was a tedious process.

"So when we came to connect the nerves together, we had to make sure that every nerve branch matched the perfect nerve branch from the donor and the recipient, so that the function is exactly what Andy will try to do when he's doing his daily life," Dr. Mardini says. So if he wants to smile, he thinks about smiling. It goes from his nerve for the smile to the donor nerve for smile, and it creates a smile."

For Sandness, it was that tedious work connecting the nerves that he thinks made all the difference.

"I was in line one day at the grocery store and the guy says, 'Oh man, what happened,'" Sandness says.

It was soon after his surgery when his scars were more noticeable and the nerves were still regenerating.

"He's like, 'Did you get in a car wreck?' Like, no, man, it's a little bigger than that."

It was a significant moment for Sandness, though, because he could tell that it never occurred to the man that the face he was asking about didn't always belong to Sandness.

"That was our goal," Dr. Mardini says. "So success for us was measured in multiple fronts, but, ultimately, success is Andy walking into a store, not being noticed as someone abnormal in any way, talking to the person at the counter. They talk to him back. They don't think twice about him, and he moves on with his day. That's a success to us, and that's what we were able to achieve in Andy's case."

It's what Sandness always wanted: to be just another face in the crowd.

"Just going into a restaurant or stores, I mean, I feel normal," he says. "And nobody stares like they used to. I mean, I just sit down. I can talk. I can speak fairly clear."

"It's part of me. It's, like, my face."

The payoff from those extra hours in the operating room continues to grow 2½ years later.

"The nerves, they're still growing," Sandness says.

His smile serves as proof that the success of his face transplant surgery is still growing, too.

No longer does his face frighten kids. In fact, kids don't even notice him.

"There's no part of me that's uncomfortable anymore," Sandness says. "Like when I walk into a restaurant, I'm not uncomfortable or go into a store or see kids or anybody that used to scare me — like those situations where you try to avoid those situations. There's no situation that I don't want to be in anymore."

Watch: Transforming a life - Mayo Clinic announces its first face transplant

Watch: Mayo's first face transplant patient meets donor's family

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Reporter Dennis Douda and videographer Andy Shilts were there for the Mayo Clinic News Network.

Watch: Mayo's first face transplant patient meets donor's family

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Sandness has started a trust fund in honor of his donor to benefit Rudy and Lilly Ross' son, Leonard. He and Lilly also hope to help raise awareness about two causes that are important to them: organ donation and suicide prevention.

Related posts:
Mayo Clinic announces successful face transplant on Wyoming man
Transforming a life: Mayo Clinic announces its first face transplant

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"There are no words to express just how grateful I am for this gift,” says Andy Sandness. The 32-year old Wyoming man received the first-ever face transplant performed at Mayo Clinic. “This is an extraordinary example of the teamwork, collaboration and compassion that we provide,” says Samir Mardini, M.D., Ph.D., medical director of Mayo Clinic's Essam and Dalal Obaid Center for Reconstructive Transplant Surgery. In announcing details of the procedure, Dr. Mardini added, “I couldn’t be more proud of this team.”

CLICK HERE TO VIEW VIDEOS ABOUT THE PATIENT AND THE SURGERY.

Journalists: Broadcast-quality video packages with split-channel audio, animations and extra b-roll are in the downloads.

View photo gallery on Flickr.

Read news release: Mayo Clinic announces successful face transplant on Wyoming man.

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“I am absolutely amazed at the outcome so far,” says Sandness. “I am now able to chew and eat normal food, and the nerve sensation is slowly improving, too. My confidence has improved, and I’m feeling great ― and grateful. I am so thankful to my donor and the donor’s family, and to all of the people who have supported me throughout this process.”

The care team led by Samir Mardini, M.D., and Hatem Amer, M.D., the surgical director and medical director, respectively, for Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery. The team includes specialists from Plastic and Reconstructive Surgery, Transplant Medicine, Neurology, Ophthalmology, Dermatology, Radiology, Critical Care, Anesthesia, Psychiatry, Infectious Diseases, Immunology, Pharmacy, Regenerative Medicine, Nursing, Social Work, Rehabilitation, and Speech and Language Pathology. The team also includes staff from LifeSource, the federally-designated nonprofit organization dedicated to saving and healing lives through organ, eye and tissue donation in the Upper Midwest.

CLICK HERE TO VIEW VIDEOS ABOUT THE PATIENT AND THE SURGERY.

Journalists: Broadcast-quality video packages with split-channel audio, animations and extra b-roll are in the downloads.

MEDIA CONTACT: Ginger Plumbo, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

“Mayo Clinic has a long history of specialized teams of experts providing complex care to patients who need hope and healing,” says Dr. Mardini. “This is an extraordinary example of the teamwork, collaboration and compassion that we provide at Mayo Clinic, and I couldn’t be more proud of this team. Andy has been our patient for 10 years. He has worked so hard to prepare for this, and during his entire recovery period, he has been strong, gracious and determined. Andy is an amazing person and so well-deserving of this gift.”

The surgery, which spanned more than 50 hours, occurred in the summer 2016 and involved restoring Sandness’ nose, upper and lower jaw, palate, teeth, cheeks, facial muscles, oral mucosa, some of the salivary glands and the skin of the face (from below the eyelids to the neck and from ear to ear). The surgical team used virtual surgical planning technology and 3-D printing to optimize the aesthetic and functional outcomes of the surgery. Sandness has been recovering in Rochester and likely will return home to eastern Wyoming this month.

View photo gallery on Flickr.

“We are grateful that the guiding principles of the Mayo Brothers have endured and shepherded the development of the Reconstructive Transplant program, and for Andy’s dedication to his medical care,” says Dr. Amer. “Throughout the entire journey, we have shared Andy’s concern and sympathy for the donor family who have made this amazing gift possible. Their selfless gift gives hope to so many other people who are living reclusively, have limited function, and are socially isolated due to facial deformities.”

The multidisciplinary team leaders for this project ― all from Mayo Clinic ― are:
• Samir Mardini, M.D., surgical director
• Hatem Amer, M.D., medical director
• Charles Rosen, M.D., director, Mayo Clinic Transplant Center
• Brooks Edwards, M.D., immediate past director, Mayo Clinic Transplant Center
• Sheila Jowsey-Gregoire, M.D., Transplant Psychiatry
• Kevin Reid, D.M.D., Bioethics
• Daniel Brown, M.D., Ph.D., Anesthesia/Critical Care
• Sharon Prinsen, M.S.N., R.N., N.E.A.-B.C., nursing administrator, Transplant
• Cheryl Weisbrod, R.N., N.E.-B.C., nursing administrator, Surgery
• Lori Ewoldt, M.A., administrator, Transplant Center
• Mark Dahl, CPP, Security
• Christopher Arendt, Pharm.D.

Facial transplantation is the process of removing part or all of a donor’s face and attaching it onto a patient who has previously suffered facial injury or deformity. Skin, fat, muscles, nerves, tendons, cartilage and bone may be components of the transplant. Attaching nerves and blood vessels from the donor’s face to the recipient’s provides the potential (with extensive rehabilitation) for sensation, function and mobility similar to an uninjured face. In some situations, it may allow the recipient to regain the ability to speak, chew food, avoid ongoing use of feeding tubes, and regain his or her sense of smell.

Mayo Clinic’s primary goal is to restore normal anatomy and improve function as much as possible. A secondary goal is to help patients achieve better social integration by improving their appearance and removing their facial deformity, giving them the confidence to live less reclusively and have a better quality of life. At Mayo Clinic, teams of experts focus on meeting the needs of each patient as a whole person, providing exactly the care he or she needs.

For more than 50 years, thousands of people have received organ, tissue and bone marrow transplants at Mayo Clinic, and Mayo Clinic has been on the forefront of reconstructive facial surgery since the 1930s. Mayo Clinic performs more transplants than any other institution in the nation. The face transplant program combines these long-standing areas of expertise to provide patients with peace of mind that Mayo Clinic has the capabilities and experience they need to have a successful outcome and improved quality of life.

The Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery is supported by a generous gift from Mr. Tarek Obaid and the Essam and Dalal Obaid Foundation in honor of the Obaid family’s values — particularly hope — which they consider the most powerful emotion, providing the fortitude to persevere and the well from which people draw strength.

Related news: Transforming a life: Mayo Clinic announces its first face transplant

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

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ROCHESTER, Minn. — Mayo Clinic announced today a $10 million gift from Tarek Obaid in honor of his parents, Essam and Dalal Obaid, to support reconstructive transplantation at Mayo Clinic. The gift will be used to establish the Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, which includes an honored scholar position named after his grandfather, Ahmad Obaid, an endowed program fund, and an operating fund, also named in honor of the Obaid family.

“We are honored to be able to help Mayo Clinic establish this center,” says Mr. Obaid. “We know it can have a profound impact on patients and it is our pleasure to support these programs.”

Reconstructive transplantation at Mayo Clinic currently includes hand transplantation. In the future, Mayo Clinic plans to expand to include face transplantation, which will complement Mayo Clinic’s existing facial reconstructive surgery program for complex deformities of the face caused by congenital issues, trauma and illness. “Many of these patients will do very well with advanced reconstructive techniques,” says Samir Mardini, M.D., a facial reconstructive surgeon at Mayo Clinic, “and some who might be candidates for a face transplant would be considered for this procedure in the future.”

Mayo opened the first clinical hand transplant program in the U.S., that gives patients a reconstructive transplantation surgery option without needing to enroll in experimental trials. Mayo Clinic is currently screening patients for bilateral and unilateral hand transplantation, which includes all aspects of needed care: microsurgery, rehabilitation, rejection monitoring, social services, and psychiatric support. A physician referral is not required.

Brooks Edwards, M.D., leads the Mayo Clinic Transplant Center, which houses the interdisciplinary reconstructive transplantation team led by surgical co-directors, Steven Moran, M.D., and Dr. Mardini, and medical director, Hatem Amer, M.D. The medical and surgical staff also includes Brian Carlsen, M.D., Sheila Jowsey, M.D., Keith Bengtson, M.D., Mary Jurisson, M.D., and Thomas Schwab, M.D.

Tarek Obaid and Dr. Mardini were childhood friends. Mr. Obaid’s generosity was inspired by his experience as a Mayo patient, his friendship with Dr. Mardini, and his compassion for victims of war and trauma. The gift was made in honor of the Obaid family’s values -- particularly hope -- which they consider the most powerful emotion, providing the fortitude to persevere and the well from which people draw strength.

“Tarek and the Obaid family are dear to my heart, and knowing them and how much they enjoy helping others in need is a tremendous inspiration,” says Dr. Mardini. “Their gift will transform lives and provide hope, even for those who have lost hope. Through their gift, we will advance scientific discoveries and provide clinical care to so many, who now will have the chance to live normal lives.”

Mr. Obaid, 35, lives in Riyadh, Saudi Arabia, and is a co-founder and CEO of PetroSaudi, a privately held oil exploration and production company.

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About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org

MEDIA CONTACT:
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