'When I look in the mirror I see myself': Incredible transformation of shotgun victim who had most extensive face transplant surgeons have ever performed

Horribly disfigured after a shotgun accident blew off half his face in 1997, Richard Norris has lived a hermit's life for 16 years - hiding behind a mask and only ever shopping at night.
Each day became a living nightmare as he faced cruelty from strangers whenever he ventured outdoors, fought addiction and contemplated suicide.
But doctors have turned the 37-year-old's life around after performing one of the most complex face transplants in history, giving him new features, teeth, a tongue and a jaw.
And as these latest pictures show, Norris barely turns a single head when he goes out after the ground-breaking surgery at the University of Maryland Medical Center.

As good as new: Richard Norris lost almost his whole face in a gun accident 15 years ago

'When I look in the mirror, I see Richard Norris,' he said remembering the immediate connection he felt with his new face.
'When I was disfigured, just walking the sidewalk, I was surprised that more people didn't walk into telephone poles or break their necks to stare at me.
'Now ... there's no one paying attention. Unless they know me personally, they don't know I am a face transplant patient. That right there is the goal we had.'
He hopes his story sends a message of hope to people in similar situations and encourages empathy in others.

Grateful: Norris sits in the office of Dr. Eduardo Rodriguez, who led the surgical team that performed the face transplant

Care: Dr. Eduardo Rodriguez inspects Norris' skin. In the 15 years a shotgun half of Norris' face he faced cruelty from strangers, fought addiction and contemplated suicide

'I've heard all kinds of remarks,' he said. 'A lot of them were really horrible.'
'Those 10 years of hell I lived through, it has given me such a wealth of knowledge,' Norris recently told The Associated Press. 'It's unreal. It has put some of the best people in my life.'
Now, at 38, he's starting a new life: taking online classes in pursuit of a degree in information systems and contemplating a foundation to help defray future transplant patients' everyday expenses during treatment. 
He also has been working with a photojournalist who just completed a book about his journey, titled 'The Two Faces of Richard.'
After the 1997 accident at his home, Norris had no teeth, no nose and only part of his tongue. He was still able to taste but could not smell. When he went out in public, usually at night, he hid behind a hat and mask.
Norris had dozens of surgeries to repair his face, but eventually reached the limits of what conventional surgery could do for him, said Dr. Eduardo Rodriguez, who performed some of those operations and later led the surgical team that performed Norris' face transplant.
Some parts of the anatomy, such as eyelids and lips, are just too complex to recreate, he noted.
'You can create a semblance of something, but I can guarantee you it's not normal by any means.'

Disfigured: When he shot himself in the face in 1997 he lost his nose, lips and most movement in his mouth

Life saving: He has had multiple life-saving, reconstructive surgeries but none as successful as this

Just weeks after Norris was told by another doctor that there was little else that could be done for him, Rodriguez presented him with another option: a transplant.
The doctor, who is head of plastic surgery at the University of Maryland Medical Center's R Adams Cowley Shock Trauma Center, had been following advancements in the face transplant field for years.
An Office of Naval Research grant for the purpose of helping wounded warriors made it possible for him and his team to attempt their first face transplant, an operation that previously had been performed by only two other centers in the United States.
The world's first partial face transplant was performed in France in 2005 on a woman who was mauled by her dog. Of the 27 other transplants that have followed, four recipients have died, and the survivors face a lifetime of immunosuppressant drugs, which can take a toll on their health.

Finally me: For the first time in 15 years, Richard recognizes himself when he looks in the mirror

Good friends: Norris, right, shows friend Andrew Kahle, left, how to load line into a fly fishing rod at Norris' home in Hillsville, Virginia

'Humbled': Norris said he is humbled by the gift he received from the family of 21-year-old donor Joshua Aversano, who died after being struck by a minivan while crossing the street

Now, at 38, he's starting a new life: taking online classes in pursuit of a degree in information systems and contemplating a foundation to help defray future transplant patients' everyday expenses during treatment

Unlike most organ transplant recipients, who need their surgeries to live, face transplant patients are risking death to eliminate a non-life-threatening condition, noted Dr. Mark Ehrenreich, the psychiatric consultant to Norris' transplant team.
Rodriguez says patients are well aware of the situation.
'If you talk to these patients, they will tell you it is worth the risk,' he said.
The team carefully lays out all of the dangers for patients: Norris' mother, Sandra, remembers Rodriguez saying there was a 50-50 chance her son would survive the surgery.
'We looked at Richard and we told him we loved him the way he was and it didn't matter to us, but it was his life,' she said. 'That was what he wanted to do and we supported him.'
Norris said he is humbled by the gift he received from the family of 21-year-old Joshua Aversano, who died after being struck by a minivan while crossing the street. The Maryland family, which agreed to donate his organs, declined to be interviewed by the AP.

Richard says: 'When I was disfigured, just walking the sidewalk, I was surprised that more people didn't walk into telephone poles or break their necks to stare at me'

Message: He hopes his story sends a message of hope to people in similar situations and encourages empathy in others

In a statement, the family said, 'We are grateful Joshua's legacy continues through the lives of the individuals he was able to save with gifts of organ and tissue donation.'
Norris said he speaks to the family regularly and keeps them updated on his life and health.
Norris' 36-hour transplant operation is still considered the most extensive ever conducted because it included transplantation of the teeth, upper and lower jaw, a portion of the tongue and all of the tissue from the scalp to the base of the neck, Rodriguez said.
'The real main limitation ... is that patients are dependent on medication for life,' he said. The immunosuppressant medications carry risks for the patients, who don't know how long the transplant will last. Rodriguez said if all goes well, a transplanted face could last 20 to 30 years.
For Norris, who makes daily visual checks, the risk of rejection is never far from his mind.
'Every day I wake up with that fear: Is this the day? The day I'm going to go into a state of rejection that is going to be so bad that the doctors can't change it?'

Hero: Dr. Eduardo Rodriguez, speaks with Norris at the University of Maryland Medical Center in Baltimore

New life: Norris completes homework for an online art history college course that he has enrolled in since the operation

When Norris saw his new face in a mirror for the first time, he wrote: 'The only thing I could do was hug Dr. Rodriguez'

But he said he can't let himself worry about it too much, and he knows that he's in good hands.
Norris has come far in the past 15 months, learning how to eat and talk again and adjusting each time his face gains more feeling. He continues with therapy, travels to Baltimore from his home in Hillsville, Va., regularly to see doctors, and still takes pain and immunosuppressant medications. He says his faith in God has carried him through it all; that he has maintained a sense of humor and remained the same person inside.
And he agrees with doctors, who dismiss a commonly held belief that face transplant patients are likely to experience an identity crisis.
The bigger issue for Norris is being able to appear in public again. Facial disfigurement tends not to engender sympathy, leaving patients feeling shunned, Ehrenreich noted.
'Unfortunately, with severe facial disfigurement, people recoil and make comments they would never make to someone in a wheelchair,' he said.

'I have been doing very well regaining my speech back,' Norris said. 'Each day it improves a little more.'
There was, however, one hiccup in the recovery process: the much-feared rejection.
As with any transplant, there was a possibility that Norris’s body would reject his new face. In this case, the rejection was mild and treatable, Rodriguez said.
'When people hear ''rejection,'' they think, ''Oh, my God, the face is going to melt off,''' Rodriguez said.

'That’s not the case at all. The skin got a little bit swollen and there was a little bit of redness. On a scale of 1 to 10,” with 10 being the worst-case scenario, “this was a Grade 1 rejection.'
Still, Norris is not in the clear. He continues to run the risk of rejection and he will have to take medications for the rest of his life.

Rebuilding process: Mr Norris's skull after his accident (left) and as surgeons began to piece it back together (right)

Remarkable: After a 36-hour operation, doctors had reconstructed the lower half of Mr Norris's face

Rodriguez said that one of the most common questions he is asked is: 'How is Richard dealing with having a new face?'
Dr Rodriguez said: 'We always think that there is going to be a facial identity crisis. That’s the worry of people with normal faces. We think how we’d feel if this happened to us.

'But for people with disfigurements — these people have lived lives concealed from society. That’s a very different and difficult recovery.'
Before the transplant, Norris rarely left his home. In addition to wearing a surgical mask and baseball cap on his infrequent trips out in public, he did his shopping at night so he wouldn’t have to face the stares of as many people.
'I am now able to walk past people and no one even gives me a second look,' he wrote.
After years of going out of his way to avoid people, Norris is surprisingly comfortable socializing now, Rodriguez said. 'Everybody (at the hospital) knows him. He’s such an animated guy.'
While Norris’s results are 'extraordinary,' Rodriguez said the full recovery will take more time.
There’s the challenge of teaching Norris, who has not eaten or spoken properly for 15 years, to use his fully functional face.

The teeth plus the tongue is a lot to get used to when someone has gone so long without them, Rodriguez said. Additionally, minor surgery is planned for the soft tissue of his face, such as the eyelids where there is extra skin.
But more than anything else, there is a looming question. Even with immuno-suppressing drugs, doctors say they have no idea how long the transplant will last. There is an expectation that they will have to repair or replace the transplant eventually.
Dr Rodriguez looks with hope to earlier face transplants. The world’s first full face transplant took place in Spain in 2010 and is aging well two years later. The first partial transplant was done in France in 2005, and Rodriguez said its longevity is promising.
'I’d like to hit that 10-year mark with Richard,' he said. 'Of course, we can’t promise anything, but 10 years would be great.'
In the meantime, Norris said he is excited to fish, golf and spend time with his family and friends.
'My friends have moved on with their lives, starting families and careers,' he said. 'I can now start working on the life given back to me.'

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