“No two people are the same,” adds Dr. Mardini. “But every journey begins the same way. We put the person at the center of a team of doctors from different disciplines—plastic surgery, neurology, oculoplastics, ophthalmology, physical medicine, physical rehabilitation—and we all come together at the end of the visits to discuss the needs and desires of each patient. Then we plan a course of treatment tailored specifically for them,” he says. “We often see people who come to us as their last resort. And it’s exceedingly rare that we cannot offer anything for them.”
Dr. Mardini is also a world leader in cleft lip and palate and craniofacial surgery, often traveling the world to perform his innovative procedures to those who need his expertise, but may not have access to specialty care. In other places, the expertise may be there, but certain resources are lacking. In those situations, Dr. Mardini and his team share experience and specialized knowledge with other surgeons in those locations, while offering resources to care for patients. While a cleft lip or palate is not life-threatening—without surgery—the deformity will limit a child’s ability to interact with others in a normal way. In addition, basic functions such as speech and eating will suffer and severely limit future potential. “We can change the course of a child’s life in just two hours,” says Dr. Mardini.
After completing his residency in Plastic Surgery at Georgetown University, Dr. Mardini accepted a fellowship at one of the most recognized centers in the world for reconstructive microsurgery and cleft and craniofacial surgery, Chang Gung Microsurgery Center in Taiwan. Working alongside the legendary Fu-Chan Wei, M.D., Dr. Mardini’s grasp of facial reanimation and reconstructive microsurgery grew exponentially. He immersed himself in craniofacial microsurgery, focusing on reconstruction of the head and neck. That intensive training led Dr. Mardini to co-author, along with Dr. Wei, one of the preeminent reference books on plastic surgery, Flaps and Reconstructive Surgery of which two editions have been published so far.
The only way this would work is to have an institution that was keenly aware of the potential complications, and still be supportive. Only then is an undertaking of this magnitude possible.”
Dr. Mardini then joined Mayo Clinic in Rochester where, in 2016, his years of training and perfecting his craft culminated in one of the greatest medical feats performed to date: the first face transplant at Mayo Clinic. “Most procedures, we’ve done in the thousands ” says Dr. Mardini. “With face transplantation, only a few dozen have been performed around the world. And this was our first.” Andy Sandness, Dr. Mardini’s first face transplantation patient, had already undergone multiple reconstructive, craniofacial, and facial nerve surgeries over many years to rebuild his facial structure and function. But his appearance could only be restored so far. A face transplant was the only way to give Andy a normal looking and functioning face. The surgery of transplanting a face is a restorative surgery, which brings in new, transplanted parts, rather than creating parts of the affected face. The hope was to give Andy a chance at a normal life, one where a smile from a child could be reciprocated.
Practicing over fifty Saturdays, Dr. Mardini assembled an elite team of Mayo Clinic surgeons from different specialties: plastic surgery, transplant, microsurgery, craniofacial, and physicians from anesthesiology, dermatology, immunology, radiology, psychology, dentistry as well as a world-class support team. Every weekend they exchanged ideas and explored new techniques. They mastered every move in preparation for the transplant. Dr. Mardini even had a 3D modeling and printing company fly in every weekend to assist. “We looked at anatomy from aspects we never dreamed of,” he says. “Our understanding of the face grew exponentially. Knowledge that we now use in our day-to-day surgeries.”
During the demanding 56-hour operation, Dr. Mardini and the team did their best to create an atmosphere like other surgeries. One nurse who assisted during the face transplant said, “I thought I’d walk in and find it crazy, but it was a day like any other.” Dr. Mardini adds, “Music was playing just like always. People were performing at such a high caliber; as if they’d done it a hundred times before. They had essentially done the surgery on the fifty Saturdays they spent together; studying the anatomy, dwelling over every detail, and meticulously rehearsing the surgery like a symphony. “Those fifty Saturdays were key.”
“The ability to form teams is what sets Mayo Clinic apart,” says Dr. Mardini. “Mayo Clinic has an incredible solid organ transplant program, comprised of world class surgeons, physicians, and many others who care for those needing a transplant, so the infrastructure and support was established. We have a renowned team of facial reconstructive surgeons who were able to create both facial function and aesthetics for Andy. Beyond the surgery, we were fortunate to build the team to care for Andy across many different specialties,” he says. “But the only way this could work was to have an institution that was keenly aware of the potential complications, while continuing to support our efforts. Only then is an undertaking of this magnitude possible.” He credits Mayo Clinic with being behind him and his team every step of the way.
I think enjoying other people is the key to happiness in life.”
As one of the world’s leading surgeons in plastic and reconstructive surgery, Dr. Mardini makes it a point to lean on colleagues. “One of the things that I enjoy most about Mayo Clinic is being around brilliant people and tapping into their brains, their thought processes, and experiences. I want to bring the latest technology, the latest innovations to each and every patient we care for. And with Andy, facial transplantation was the pinnacle of achieving this goal. This unique approach takes patient outcomes to another level,” he says. Dr. Mardini is also one of the world’s leading perfectionists, “Every decision we make, every stitch we put in must be perfect. If it’s not, we redo it. The surgery may take a few hours, but a person will be living with the results for the rest of their lives. We take that very seriously.”
Because of the normal post-operative swelling, Dr. Mardini waited a month before giving Andy an opportunity to look in the mirror. “Once he saw himself, he couldn’t believe it,” says Dr. Mardini. Dr. Mardini asked Andy to share how he was feeling the moment he first saw himself in the mirror. Andy still had a tracheostomy and was not able to speak, so he jotted his thoughts on a notepad: Far exceeded my expectations. “For us,” says Dr. Mardini, welling up, “…that was everything.”
The procedure was not without risk, and Dr. Mardini is grateful for the trust Andy placed in him and his team. “Andy has since married and started a family. He’s become a close friend,” Dr. Mardini says. “He’s brave, he’s thoughtful, he’s kind. He’s gracious. He is truly one of my heroes.”
The future of face transplantation is driven by innovations in facial nerve surgery, microsurgery. Facial reconstruction and immunotherapy and immune modulation. “We’re learning so much about the facial nerve and nerve regeneration that growth in this area will be enormous,” he says. “And bringing new technology to facial reconstruction is critical. We’re working on a device, for example, to create eyelid blink. Implantable devices that create blink rather than doing multiple major surgeries to create facial nerve function. And we’re working towards creating a panfacial smile, where the mouth, lower lip and eyes are all involved. But the true key to the field of facial transplantation is being able to modulate the immune system to prevent rejection of the organ. When this is finally achieved, surgeons will be able to transplant parts of the face such as a nose or eyelids, even eyebrows.
When asked what inspires him, his answer is simple, “I think enjoying helping other people is the key to happiness in life. Children make me laugh, children bring me joy, bring me happiness. Their innocence, their inability to filter things, their passion and excitement for everything, is just truly marvelous and spectacular and enjoyable.”
What brings him hope? “Technology brings me hope. Science brings me hope. But the collaboration we have here at Mayo Clinic makes me believe that anything is possible.” Dr. Mardini is then still for a moment. Before adding one last thought, “Breakthroughs are what we’re about, here at Mayo Clinic. But the sheer joy that we get out of taking care of people…it’s a privilege.”