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Editor's Note: This story contains a discussion of suicide. If you or someone you know is struggling with suicidal thoughts or mental health issues, help is available. In the US: Call or text the Suicide and Crisis Lifeline 988.
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Derek Faf remembers being under a lot of stress in college. He remembers coming home from school on spring break in March 2014. But he doesn't remember the night that changed his life forever.
“I don't remember anything,” said Pfaff, of Harbor Beach, Michigan. I don't remember holding the gun, going outside, shooting myself or weeks later.
Shortly after 1:30 a.m., his father, Jerry Pfaff, was looking at the family gun. The cabinet was open. He checked the area around the house and found the boy lying in a snow bank near the garage.
Derek Faf was rushed to the hospital. When he finally regained consciousness and found himself in a hospital bed, he thought he had been in a car accident.
In his attempt to kill himself, the gunshot wound caused severe damage to his face. He lost his nose, lips, teeth and parts of his forehead, which could breathe, chew, swallow, smile or blink.
In the years that followed, Pfaff underwent 58 facelift surgeries. They were useful, but still missing the nose, upper and lower jaw, teeth, eyelids and part of the frontal bone. He could neither chew nor speak easily.
“There was still a lot of work to be done, and there was nothing that hospital or facility could do for him,” said his mother, Lisa Pfaff.
At the time, a doctor told her, “The only option for Derek is a face transplant.”
Pfaff, 30, is now one of several dozen people who have successfully received a life-changing face transplant. They are among them Aaron James, who received the world's first full eye and partial face transplantAnd Katie Stubblefield, the youngest person to receive a face transplant In the United States.
Mayo Clinic, where Pfaff's surgery was completed He performed the first face transplant In 2016
“There have been more than 50 face transplant patients in the United States around the world, and every one of these patients is different. There is no identical injury,” says Dr. Samir Mardini, chair of plastic surgery at Mayo Clinic, a facial rejuvenation and facelift surgeon and surgical director of Mayo Clinic's Reconstructive Transplant Program. Mardini directed the Pfaff operation.
“When you look at a deficit, the structure you're missing, the function you're missing — they're never the same,” he said. “So every face transplant that's being done right now is innovative and has something different to it.”
Pfaff's 50-plus-hour transplant surgery in February at the Mayo Clinic in Rochester, Minnesota involved at least 80 health care professionals.
After the team surgically removed the donor's face, donor tissue was surgically transplanted onto Pfaff to restore the structure and function of the face. About 85% of his face was reconstructed and replaced with donor tissue, Mardini said.
Pfaff surgery involves the replacement and reconstruction of most facial structures, including the forehead, nose, cheekbones, upper and lower jaw with teeth, upper and lower eyelids, mouth and all the muscles that make up the facial muscles. Facial expressions, with the skin on the entire face and neck.
The medical team also used a new microsurgical technique to implant the donor's tear drainage system, allowing Pfaff's tears to flow normally into his new nose.
“A face transplant is not a life-saving procedure, but a life-giving procedure,” says Mardini.
“It's a life-changing procedure, and it's something that's very important when we're planning the surgery,” he said. “What's unique about face transplants is the regenerative nature of the process. They are not rebuilding the front parts. You restore it while bringing in fully developed front parts.
To make sure the surgery was accurate and precise, Mardini and his colleagues created a virtual surgical plan that involved taking CT scans of both the donor's and Pfaff's faces. Before performing the actual procedure, the team performed “digital” surgery on a computer with the help of biomedical engineers.
“We decide together where the cuts are going to be on the bone, what angles the cuts should be at,” Mardini said. We do the same on the donor and the recipient, so when we go into surgery, we print the skull models with cutting instructions for the donor and the recipient, which allows us to perform the bone part of the surgery. Exactly how we planned it with the virtual session.
The team published a custom guide for the procedure that used art stencils to guide where to cut and apply all aspects of the 3D-facial bone surgery. And “crucial to the success of the surgery” was identifying branches of the facial nerve in both the donor and the recipient, Mardini said.
“We associate neurons based on function, so when Derek thinks about smiling, it triggers the nerve for smiling — his own nerve with the donor nerve,” Mardini said. The next part is getting the muscles in Derek's face to respond and create that smile.
“You should see the smile on his face,” Mardini said. “And that part of the surgery is really what makes it successful.”
Pfaff He was told to wait about a month after the transplant before he could see his new face, and that's when Mardini said, the patient said. He meets with a psychiatrist to prepare for the big reveal.
“He wasn't allowed to have a camera, his phone, an iPad,” said mother Lisa Pfaff. “The mirror in the bathroom was covered so he couldn't see himself.”
Exactly 10 years later – March 5, 2024 – Pfaff finally gets to see his new face for the first time.
“We turned a very sad and difficult day into a real joy for Derek and it was just a miracle – it was a miracle that he saw himself,” his mother said.
While in the hospital, Pfaff He looked in the mirror. He said he “felt like a man again” and was given a “second chance.”
Pfaff can now express emotions on his face: happiness, laughter, sadness and frustration. He can speak more clearly and simply.
He works out twice a week, trains with a speech therapist and takes immunosuppressants Transplant rejectionThis occurs when the transplant recipient's immune system attacks the donor's organ or tissue. He will continue to take these drugs for the rest of his life.
Overall, Pfaff said, “he's doing great.” He is excited about the future and now wants to “help others” by raising suicide awareness.
“The sun will rise tomorrow,” Pfaff he said. “No matter what the situation is, you have to be positive. Look down.
Worldwide, more than 720,000 people die by suicide every year, and it is the third leading cause of death among young people aged 15 to 29. World Health Organization.
In the United States By 2022, suicide will account for nearly 50,000 deaths. This represents one death every 11 minutes, according to the latest data US Centers for Disease Control and Prevention. The number of people who attempt suicide or have suicidal thoughts is even higher. And Research suggests Most young people who die by suicide in America have never had a mental health diagnosis.
Suicide is a serious mental health issue, but it is preventable and treatable with strategies to reduce risks at the individual, family, and system levels. According to the CDC.
If you have The person you love Asking who is struggling, asking if they are thinking about suicide, trying to listen non-judgmentally, etc 988 crisis lineAnd communicating with them.
In the days before Pfaff tried to kill himself, his parents said, everything felt normal. Pfaff had gone skiing with friends a few days earlier, and on the day of the shooting, the family discussed plans to attend an Ash Wednesday church service the next morning.
Pfaff was a standout in high school and was an all-state football player, Lisa said.
“He had everything going for him, and we didn't see that coming,” she said.
At first, she felt a lot of guilt for missing her son's potential signs. He was in danger of harming himself or taking his life.
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But as Lisa pondered more about their family situation, “I don't think we missed anything,” she said. “Something was triggered and something, and we have to take strength and courage to solve it and keep our family together.”
Pfaff is looking forward to spending the holidays with his parents, four siblings and relatives. They plan to enjoy Thanksgiving dinner at Lisa's mother's house and watch a Detroit Lions football game.
“We are so proud of Derek and everything he has accomplished over the last 10 years with his fighting spirit and positivity,” said Lisa. “Now that Derek is in a position where doors will open for him, we all hope to continue our family's journey and Derek's recovery.