"I was so happy when I could talk again."
On June 30, 2005, 55-year-old James Maki suffered an injury so devastating that the surgeon who treated him in the Brigham and Women's Hospital (BWH) emergency room that evening, Bohdan Pomahac, MD, said that he had never seen such significant facial burn damage in his entire career. That night, Mr. Maki fell onto the electrified third rail at a Boston subway station, destroying the entire core of his face – including his lips, cheeks, upper teeth, roof of the mouth, and nose – and severely burning his arms and hands.
His condition was eventually stabilized, but for the next few years he continued to suffer from significant physical impairments and from cruel comments received as a result of his appearance. Without some sort of dramatic and innovative surgical intervention, he would spend the rest of his life with hampered breathing, an inability to speak coherently, an inability to eat, and a severe disfigurement that would psychologically hinder him from going out in public and living a normal life. As Jim's daughter, Jessica Maki said, "Life without a face is not a life."
Just a few years later, Jim would experience a glimmer of hope when he saw Dr. Pomahac talking about face transplant surgery on a local television news show. "I remember sitting there and saying, 'Boy, I wish I could be eligible for that.'" As it turns out, Dr. Pomahac already was thinking of Jim.
Jim went through a battery of tests during the course of 2008, and upon determining that Jim would be an ideal candidate for this innovative face transplant procedure, he was immediately placed on a waiting list. Jim and the BWH surgical team did not have to wait for long. "I guess I was just lucky," said Jim. "Because it wasn't long before Dr. Pomahac called and said, 'We've got a donor. We want you to come into the hospital right now.'"
The following day, April 9, 2009, a Brigham and Women's Hospital surgical team, lead by Dr. Pomahac, performed the first partial face transplant in New England – and only the second such procedure to be performed in the United States and the seventh in the world. The multidisciplinary team of more than 35 specialists, including surgeons, nurses, anesthesiologists and residents, worked for 17 hours to replace the entire middle region of Jim's face – including the nasal structure, the nose, hard palette, upper lip, facial skin, facial animation muscles and nerves – with face tissue from a human donor.
A few days after the surgery, Jim and his daughter took a look at his new face. "I can see myself in this picture," said Jim, while looking at his new appearance in a mirror.
"It's amazing," said his daughter, Jessica. "It surprisingly looks more like him than I thought it would. It's still him."
Functionally, significant benefits came very quickly for Jim. The surgery immediately restored much of his ability to breathe, speak and swallow. Instead of getting nutrition from a tube inserted in his stomach, now everything he eats comes on a plate. And, as his nurses can attest, his taste buds are fully operational. "I'm real picky on what I eat," he admitted.
Formerly incoherent speech is now crystal clear. "I was so happy when I could talk again," said Jim. And, as nerves regenerated and muscle function was restored, he also recovered his ability to smile and show other emotions.
Psychologically, the restoration of his facial features has led to a restoration of confidence. Now Jim refuses to live his life indoors. "I go out a lot," he said. But he also understands that the stares won't go away overnight. "It doesn't bother me now," he said. "It used to, but I've gotten past that."
Helping him get through the trials of recovery are the new members of his family, the hospital staff. "They've been excellent," said Jim. "I couldn't have come to a better hospital. I made a lot of good friends through this surgery."
Known affectionately as "Jimmy" around the hospital, both he and the staff look forward to his periodic check-ups, as well as follow-up surgical procedures that help further restore his appearance and improve functionality. In between tests and examinations, he likes to play cards with the nurses and chat with the doctors. "In his case, it's a little like a social event," said Dr. Pomahac. "He likes to come."
Ironically, Jim will tell you that this traumatic injury actually served to change the course of his life for the better. "Having this accident was really a blessing to me," he said.
Following his military service in Vietnam, life had been a continuous struggle. When describing his existence after Vietnam and before the accident, a period of more than 35 years, Jim simply says, "It wasn't good."
However, the surgery has given him an opportunity to rejuvenate his life. "We can begin, as a family, together again," said Jessica. "He can begin again."
Jim is pleased with the results thus far, but he also looks forward to the days to come. "I look at this as a work in progress," he explained. "What you see now – this isn't the final result. These scars are going to clear up. The swelling is going to go down."
"I have a lot of faith in all the people on the surgical team," said Jim. "I think they're fantastic."
"After each surgery, it gets a little better. I'd like to see the final result – I'm sure it'll be quite good."
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