It was weeks into treatment when a physician first told a Yuba City man, after a suicide attempt disintegrated the bottom half of his face, that a transplant might even be possible for him.
Now, 26-year-old Cameron Underwood has new hope and a new face following the most technologically advanced partial transplant surgery ever performed. Under the leadership of one of the world’s top plastic surgeons, Underwood says the procedure also helped bring him a closer bond with his family.
Underwood’s new appearance was publicly unveiled Thursday, in a press conference at NYU.
On Friday, Underwood and his surgeon, Dr. Eduardo Rodriguez, spoke with The Sacramento Bee via phone to provide more insight on life before and after the procedure, as well as the ongoing recovery process.
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The surgery was performed at NYU’s Langone Health center in early January by a team of more than 100 surgeons, doctors, nurses and other medical staff. Fewer than 10 full or near-total transplants had been performed in the U.S. before Underwood’s procedure. Rodriguez had been the lead surgeon on two of them, both successful.
“We had no idea what it was and that you could achieve this kind of success with it,” Underwood said Friday. “The more we learn, the more we believe that we could have a great success with this.”
In 2016, Underwood shot himself in the chin with a shotgun on a June evening after a day of drinking. He had spent years struggling with depression.
Only 18 months later – the shortest time a patient has ever waited for such a procedure, Langone Health noted in a press release – Underwood on Jan. 5 began a 25-hour reconstructive plastic surgery procedure, made possible by donor Will Fisher, a 23-year-old New Yorker who had died a day earlier.
The road to recovery has been much longer than those 25 hours – in which two teams worked in adjacent rooms to graft the face of Fisher onto Underwood. Rodriguez has called Underwood a “remarkable patient.”
“He did everything that we asked him to do,” Rodriguez said. “He’s healthy, he’s fit, he’s nutritionally optimized. We have a great surgical team ... but beyond the surgery, what comes afterward is also incredibly demanding.”
How demanding? Underwood spent two full months in the hospital and intensive care unit, with rigorous physical therapy and speech therapy routines. Rodriguez said Underwood has been “compliant and responsible” with all of this.
“Whenever the ladies would come in to do the therapy, I knew it was that time and I wasn’t looking forward to it, I can tell you that,” Underwood said. “But we stuck together and did it. It was rigorous though. It was many hours a day swallowing and learning how to speak again. It was endless.”
In total, Underwood spent 67 days on these regimens – the first 37 days in the hospital, then 23 in the ICU and finally a week in a rehab facility.
Rodriguez said separate speech therapy and swallowing therapy routines proceeded two or three times daily over those two-plus months. Underwood also participated in physical therapy once or twice a day to keep him in shape, including the gym, endurance and resistance training, the surgeon said.
Underwood continues to live in Yuba City, where his dad’s side of the family also resides, and where he ate Thanksgiving dinner this year at his grandparents’ house.
His mom’s side lives in Arkansas, Underwood said. He believes that following tragic circumstances, the surgery and recovery period have helped him grow closer with family, especially his mom, who first booked the appointment with Rodriguez after reading about NYU Langone Health in a December 2016 issue of People magazine.
“A whole family, not just me as this individual family member. But as a family, whole,” Cameron explained it. “We were a close family before, but we’re a lot closer now.”
Underwood also said during Thursday’s press conference that he’s hopeful to start a family of his own in the near future.
He currently lives alone, and says he must make the 5,600-mile round-trip journey to New York City almost monthly for check-ins with Rodriguez and others.
Day to day, though, Underwood says life is basically normal.
“I do my physical therapy. I go out and go grocery shopping,” he said. “Go out and walk my dog. I work on my car, I play sports, I play golf and basketball. I can do pretty much anything I could do before.”
Underwood said the pain was severe throughout his face and jaw at the start.
“There’s all kinds of pain where they connect bone to bone,” Underwood said. “Regrowth of bone. Breaking sinus bones to realign them. Just all kinds of reconfiguring. Anytime you mess with the bone, it hurts.”
Now, he says, the only discomfort he feels is pain near his jaw hinges when he talks or eats a lot.
Underwood is outdoorsy to say the least. A photo of him skydiving after the surgery elicited a few small gasps and some nervous laughter as Rodriguez showed it during Thursday’s press conference.
Before the incident, he worked as a welder and machinist. Most of his work involved tractors or mining equipment, he said.
“I’m hoping next year, after the new year I’ll be able to go back to work. After we’ve gotten a year under our belt with the surgery and we’re past the relief and I think we’ll be able to go back to work then.”
He added that it was tough to be cooped up in a hospital for more than two months during the first phase of recovery.
“You can probably ask any one of my doctors and they’ll tell you how much I like the hospital,” he said, causing Rodriguez to bust out in a chuckle. “It was difficult being in the hospital, but I knew it was for the right reason.”
Rodriguez clarifies that Underwood’s surgery is considered partial rather than total or near-total transplant because the incised area starts below his eyes. But, as photos and video show, the transplanted area covers most of the area of Underwood’s face, his jaw and some of his neck.
The surgeon said that despite the procedure’s advanced nature and length of more than 24 hours, he did not consider “dangerous” to be the right word. Still, there is risk before and after the surgery.
“The biggest concern that we have is that once we remove Cameron’s existing face, we’re basically looking at a crater,” said the surgeon, who took the helm of NYU Langone’s face transplantation program in November 2013. “We’re looking at the back of his throat. And we’re at a point now where we want the new transplant to survive. There are certain unpredictables, and we try to manage those.”
The primary risk remaining during Underwood’s recovery is rejection, which is a possibility following any transplant surgery.
“Your body wants to fight it, always,” Rodriguez explained. “The way we deal with that is anti-rejection medication. Cameron will be on maintenance anti-rejection medication for life.”
The dosage, however, will be tapered down in an effort to avoid complications and side effects, which can include skin cancer originating in the face, as well as liver or kidney damage.
Underwood takes pain meds as well, which Rodriguez said is “basically codeine,” and noted the dosage has been drastically reduced since the January procedure.
Rodriguez said the first face transplant on a living patient was in 2005. He was recruited in 2013 by NYU Langone Health CEO Bob Grossman to “create the best face transplant program in the world,” Rodriguez said.
Fisher, Underwood’s donor, was a 23-year-old aspiring artist and writer. Underwood said he was also a talented chess player. The two were connected by LiveOnNY, a major nonprofit with a current list of 9,000 patients awaiting organs, eye and tissue donations, CEO Helen Irving said Thursday.
Underwood has met Fisher’s mom, aunt and a few of his cousins, he said.
“They’re all very happy for me and they’re all very excited to see Will live on through me.”
The details of Fisher’s death have not been publicly disclosed, but he died Jan. 4 following a struggle with mental illness.
Underwood said he would prefer not to talk about the 2016 suicide attempt, which he referred to at one point as “the incident.”
But he gave his advice for anyone struggling with depression or mental illness:
“If there’s a problem, it can be fixed, but it can only be fixed if somebody else knows about it. If people out there are going through a tough time and they’re feeling down on themselves, just talk to somebody. That first step is always difficult, but it’s well worth it.”