A Face Transplant Gave This 26-Year-Old a ‘Second Chance at Life’ — And Points to a Promising Future for Patients

Cameron Underwood is back to golfing, restoring cars and even sky-diving, less than three years after sustaining a self-inflicted gunshot wound that severely damaged his face and nearly claimed his life.

Underwood, now 26, was left without the majority of his lower jaw, teeth and nose, and with significantly impaired eyesight, speech and mouth function, after his June 2016 injury. But just 18 months later, the California resident became NYU Langone Health’s second-ever face transplant recipient and one of about 40 worldwide — a remarkably brief journey that he says gave him “a second chance at life.”

“Two years ago, I don’t think we had any idea about face transplants, that it was even possible,” Underwood tells TIME. “I absolutely feel like myself [now]. Every time I look in the mirror, I see me. I see my eyes and my face. It’s all growing on me, so to speak.”

The implications of Underwood’s case go beyond his own story. NYU believes that Underwood’s was the first U.S. face transplant to be covered by commercial insurance — a milestone that could mean more patients have access to the life-changing surgery in the future, says G. Leslie Bernstein, administrator for NYU’s face transplant program.

“Any time an insurance company signs on to accept a new, successful type of event, we hope, and we have seen in the past, that it does open doors for more patients, like Cameron, to seek care where they otherwise might think that they have no options,” Bernstein says. About a third of Underwood’s roughly $1.5 million in medical costs were covered by insurance; the gaps were filled in by philanthropic and grant funding, Bernstein says.

Between advances in insurance and medical technology, Dr. Eduardo Rodriguez, the NYU plastic surgeon who oversaw Underwood’s care, says the hope is that face transplantation soon becomes “a mundane operation.”

Progress is well underway. NYU was able to significantly reduce Underwood’s recovery time — he only spent 37 days in the hospital, compared to a 62-day stay for NYU’s first patient — and used 3D surgical planning and printing to make his operation among the most seamless and technologically advanced yet, exceeding even Rodriguez’ expectations. “I only think it’s going to continue to improve, and Cam’s a testament to that,” he says.

Underwood’s journey began after his mother saw a People magazine story about the other face transplant performed at NYU, and contacted the hospital. Shortly thereafter, Rodriguez and his team began conducting extensive physical and psychological evaluations to ensure that Underwood was a good fit for the operation, especially given his prior struggles with depression.

“His life was in complete pause, complete paralysis, [without a face],” Rodriguez says. “The goal was to get him out of that free-fall as soon a we possibly can.”

They succeeded. Just six months after Underwood joined the transplant waiting list, NYU heard from donor network LiveOnNY that William Fisher, a 23-year-old Manhattan resident who died suddenly, might be a match. He was. Just days later, Underwood flew to New York City, in the middle of a snowstorm, to get the surgery that would change his life.

Over the course of 25 hours, Rodriguez and his team removed large portions of Fisher’s skull and face, then, with the help of 3D-printed cutting guides and surgical plans, used them to reconstruct Underwood’s jaw, teeth, gums, mouth, lower eyelids, cheeks, nose and nasal passages. NYU also created and attached a 3D-printed replica of Fisher’s face, so that his family could say their goodbyes and have the option of holding an open-casket funeral.

Rodriguez says that achievement points to an exciting future in facial reconstruction: the prospect of bioengineering a functional face, complete with hair follicles, sweat glands and blood vessels, rather than relying on donor tissue.

“The goal would be that we could bioengineer a face with CT scan technology. Everything can be printed to be so precise,” Rodriguez says. “That is the ultimate goal. I want to see it within my lifetime. I’m giving myself a 10-year timeline.”

Until then, however, Rodriguez says he’s committed to improving facial transplantation for the benefit of patients like Underwood — who has wasted no time enjoying his new visage, even going sky-diving less than a year after surgery.

“A face transplant can tolerate 15,000 feet in the air. It all held together,” Rodriguez laughs. “Cam is living and he’s doing the things that he enjoys. This is the greatest thanks that they could ever provide.”

For his part, Underwood says he’s looking forward to returning to normal life. His goals, he says, aren’t all that different than anybody’s.

“Go back to work, start a family,” he says, “and go from there.”