When Andy Sandness woke up following his face transplant, what struck him wasn’t merely the new appearance or the unfamiliar sensation of skin that belonged to someone else. It was the sheer length of the surgery—56 hours, longer than anyone had anticipated.
“We discussed 36 hours,” he remembers, “so it was a shock.” The complexities during the procedure were unimaginable; surgeons raced against time to address his disfigurements and attach a new face.
Sandness had prepared rigorously for this moment, working out for years to ensure his body was robust enough for such a major operation. Nonetheless, it would take him months to regain the ability to converse without fatigue and years to feel comfortable in his own skin. Complications during the surgery were nerve-wracking. Dr. Samir Mardini, the lead surgeon, struggled to take breaks during the marathon operation, overwhelmed with adrenaline and urgency.
Now in his late thirties, Sandness stands as one of a handful of individuals globally to have undergone a full face transplant. Back in 2006, at just 21, he attempted suicide by shooting himself in the face. He survived, but the consequences were dire. For a decade, he lived with a piecemeal reconstruction of his face—functional yet far from normal. Children would stare, while adults often looked away in shock.
His was not the first face transplant; that distinction belongs to Isabelle Dinoire, who was mauled by a dog in 2005. However, Sandness’s surgery, performed in 2016 at Mayo Clinic in Minnesota, symbolized a pivotal shift in facial transplantation—from the realm of possibility to reality. It was a test of surgical skill, ethics, and, quite importantly, time.
Dr. Mardini mentioned the team trained for over three years before finding a recipient. They dedicated numerous weekends to practicing on cadavers, developing the intricate technique of transferring faces.
Given the complexity of the human face—its unique muscles, nerves, and blood vessels—finding a matching donor is daunting. Sizes of features, skin tones, and hairlines all have to align closely.
Meanwhile, in rural Minnesota, 21-year-old Rudy Ross took his life following a domestic dispute, leaving behind a pregnant wife. His death was profoundly tragic yet made him an ideal organ donor due to his youth and health.
A Race Against Two Clocks
When Rudy’s body reached Mayo Clinic, the clock was already ticking. Patients across the nation, in desperate need of organs, were poised to receive what they required. When it comes to face transplants, things become tricky. While the need for internal organs is apparent, the face donation requires careful consideration and permission from grieving families.
The families often know if their loved one wished to donate organs. “We might ask them if they’d consider a face donation if their relative had agreed to other organ donations,” explains Dr. Mardini, provided a match is evident. Seeing Rudy’s face, he felt a connection as if they could be related. After deep contemplation, Lilly, Rudy’s widow, consented to the transplant.
Two operating rooms were prepared; one for Rudy and another for Andy. Dr. Mardini managed both, swiftly removing Rudy’s face to attach it to Andy, who was undergoing anesthesia in the next room.
The meticulous process involved removing the surrounding tissue and preparing Andy to accept the new face—a daunting task, both physically and mentally for the surgical team.
“Andy’s surgery included the complete upper and lower jaws, cheekbones, and facial structures,” Mardini elaborated. “You’re left looking at vital components; the entire face had to be removed to accommodate the transplant. It’s not something anyone is accustomed to witnessing—a living human without a face.”
Time was essential; there was no going back. Failure could mean dire consequences.
Jack El Hai, an author who shadowed Sandness and his medical team through the surgery, recalls tense moments when a crucial blood vessel started narrowing during the face placement. There was a palpable shift in the room as Andy’s newly-reconstructed face began to lose blood supply, demanding immediate intervention.
Painful Priorities
The logistics of taking a face from a donor with healthy organs waiting for procurement complicates matters. “We prioritize face donations first,” Dr. Mardini noted. “But this creates a dilemma between life-saving and life-giving procedures.”
Globally, only about 50 face transplants have been completed—not due to a lack of need but because of the challenges involved. Patients with severe facial injuries face immense barriers; a functioning face is crucial for basic activities like talking and eating. Traditional reconstruction may require numerous surgeries and still fall short.
The hurdles are high, requiring remarkable precision in the surgical process. The immunosuppressive drugs necessary to prevent organ rejection entail significant side effects, including potential kidney damage and cancer risk. Isabelle Dinoire succumbed to immunological complications 11 years post-transplant.
Mayo’s team needed to prove to the organ procurement organizations that this was a valid reconstructive procedure—not merely cosmetic. They also had to assure themselves and the hospital that Andy, a man who had previously attempted suicide, would follow through with the necessary medical guidance.
While the time frame for keeping organs viable after death is strict—hearts and lungs typically need to be taken within hours—removing Rudy’s face took longer than anticipated. Coordination among the surgical teams became urgent.
Ultimately, the surgery was successful. Rudy’s organs saved several lives, an aspect dear to Lilly. It was reported that all organs remained healthy, a miraculous feat.
What’s Left Behind
Success in medicine arises from commitment and rigorous training. Sandness’s new life began with Rudy’s face; however, Rudy’s story needed a respectful conclusion. A specialized team trained to create realistic silicone masks had already practiced crafting lifelike prosthetics, ensuring Rudy’s body would look presentable for his funeral.
Lilly Ross had initially planned a closed-casket service, but upon receiving Rudy’s body, the funeral director suggested she might want to rethink that arrangement, leading to an open-casket service instead.
Looking Like Yourself, As Someone Else
While Andy now has Rudy’s face, he doesn’t resemble him due to individual bone structures. This brought solace to Lilly, who met Andy periodically before losing contact as they both moved on with their lives. “Andy is one of the rare people who’s had three faces,” Jack El Hai reflects, emphasizing the emotional ramifications of such profound changes.
Understanding how to adapt to such a transformation is complex. To assist Andy, social workers guided him through a process called “gradual reveal,” letting him acclimate to his new appearance bit by bit.
In El Hai’s view, Andy, once shy and reserved, now appears vibrant and lively, and he humorously notes a resemblance to Matt Damon.
Despite this, Sandness remains private, opting for email communication over direct interviews. Eight years post-surgery, he describes himself as fitting well with his new functionality while acknowledging he’s legally blind in one eye. “My nerves and sensation improve daily,” he reveals. “But there’s always more I can do in terms of improving these areas.”
The journey has been laborious, not just physically but mentally. Reflecting on what’s overlooked about his experience, he shares it’s multifaceted; the dedication of everyone involved in a face transplant is enormous. “But I also think about the shame I felt after my suicide attempt,” he adds, recalling how he woke to embarrassment and depression. He acknowledges the support he’s received from a network of professionals and loved ones, holding it dear to his heart.
Stubbornness is part of his character; he helps others but rarely asks for assistance himself. This trait contributed to struggles earlier in life but also fueled his perseverance. “Of course I’m an organ donor,” he confirms simply.
Dr. Mardini never anticipated such intricate operations. However, the transformation in Andy’s life is significant; he enjoys everyday activities once taken for granted. Recently, Andy described a simple moment that proved to Dr. Mardini their goals had been met: a child glanced at him in an elevator, then continued conversing with their mother, signaling normalcy.
Jack El Hai’s The Face in The Mirror is released on May 20th.
If you are in the U.S. and need mental health support, call the National Suicide Prevention Helpline at 1-800-273-TALK (8255). For other countries, visit www.befrienders.org for local support services.
If you’re feeling distressed or having trouble coping, reach out to the Samaritans at 116 123 (UK and ROI), email jo@samaritans.org, or explore their website for nearby branches.
