Yearning to be another face in the crowd: Girl who shot her face off in a failed suicide attempt is given a second chance at life with the world's most audacious transplant

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When Katie Stubblefield's boyfriend broke up with her, in a moment of madness and despair, the pretty teenager snatched her brother Robert's hunting rifle, locked herself in the bathroom and shot herself in the head.

When Robert kicked down the door, he discovered his sister with her face 'gone'.

The bullet, which was fired upwards as she rested the gun barrel under her chin, had destroyed almost everything in an upwards and inwards triangle, from her chin to between her eyebrows.

Katie Stubblefield, 21, is the youngest person to get a full face transplant (right), three years after she shot herself in the head aged 18 (left)

The 18-year-old's nose and sinuses, her mouth (apart from the corners of her lips), part of her forehead, and most of her jaw and facial bones were destroyed. Her eyes were so badly damaged she was left with limited vision.

Astonishingly, Katie survived. Perhaps even more astonishingly, doctors have been able to give her a new face and the opportunity of a life with some semblance of normality.

Three years and 22 operations later, Katie became, at the age of 21, the youngest person ever to receive a full face transplant.

She is one of 40 people worldwide to have undergone the procedure, but surgeons who treated her believe she had the worst injuries of any patient to date, requiring one of the most extensive transplants yet undertaken.

It culminated in an epic, 31-hour procedure at the world-famous Cleveland Clinic in Ohio, during which a team of doctors effectively replaced 100 per cent of her facial tissue with that of a 31-year-old female donor.

Katie's incredible story, documented by a team from National Geographic magazine, was published this week.

The bullet destroyed almost everything in an upwards and inwards triangle, from her chin to between her eyebrows

Even now, her ordeal is not over. She is, in effect, a human guinea pig in an immensely complicated specialism still in its infancy.

Her progress — indeed, her survival — is fraught with the risk of her body rejecting the transplanted face, so she must remain on high doses of powerful immuno-suppressive drugs and be constantly monitored by doctors.

There is also, sadly, a risk of Katie herself 'rejecting' her new identity. At least one other face transplant recipient has committed suicide.

What emerges from her story is Katie's determination to embrace this second chance she's been given, whatever the challenges.

Raised in a devoutly Christian family in Lakeland, Florida, Katie was 'fearless and a lot of fun' as a child, and shared a sardonic wit with her older brother, Robert, according to their sister, Olivia.

As she matured, she became immensely competitive at school and in sport. But after the family moved to Oxford, Mississippi, she suffered a succession of setbacks, including medical problems and her mother losing her job as a teacher at Katie's school.

Three years and 22 operations later, Katie became, at the age of 21, the youngest person ever to receive a full face transplant

Then, in March 2014, Katie discovered her boyfriend was sending text messages to another girl, and he ended their relationship. Distraught, she went to her brother's home and attempted suicide.

In the aftermath, she was taken to a local hospital and then transferred to another in Memphis, Tennessee, where surgeons managed to keep her alive but failed in their attempt to cover the huge wound in her face with a tissue graft from her abdomen.

Five weeks later, she was moved to the Cleveland Clinic, where surgeons looked at her tiny, 7 st 7 lb frame and wondered whether they could find enough tissue for the reconstructive work she required.

Katie's brain was partially exposed and had suffered traumatic injury. Some on her team of 15 specialists feared she might die, but in a string of operations, they stabilised her condition and patched up her face.

Brian Gastman, a plastic surgeon and one of the team leaders, created a rudimentary nose and upper lip using tissue from her thighs, while a piece of her Achilles tendon was used to rebuild her chin and lower lip.

Using a three-dimensional model made from a scan of Olivia's jaw, the team built a new lower jawbone from titanium and a piece of her calf bone.

It culminated in an epic, 31-hour procedure at the world-famous Cleveland Clinic in Ohio, during which a team of doctors effectively replaced 100 per cent of her facial tissue with that of a 31-year-old female donor

Her eyes had been displaced by the force of the bullet, and so they moved them closer together.

Katie got to know her embryonic new face by touch, but it was a long way from her dream of an appearance that wouldn't automatically make her stand out in a crowd.

Most noticeably, it featured a crooked sausage of flesh in the centre and a bulbous chin below. Katie called it her 'Shrek face', a reference to the pudding-faced film character. A face transplant was the only option.

Her parents, who had left Mississippi to live in a house near the clinic (owned by a charity for parents of hospitalised young patients), hadn't realised such surgery was possible until a doctor in Memphis mentioned it.

Katie's father, Robb, a former church minister, has said: 'There was an older trauma surgeon who told us: 'It's the worst wound I've ever seen of its kind.' 

He added: 'The only thing I can think of that would give her functional life again is a face transplant.'

Adrea Schneider, 31, (left) was the donor face after she died of a cocaine overdose. Her facial tissue and bones were used to construct Katie's new face (right)

Katie said she, too, was dumbfounded when told about the revolutionary procedure. 'I had no clue what a face transplant was. When my parents helped explain everything, I was very excited to get a face again,' she said.

She says she cannot remember anything about the day she shot herself or, indeed, the operations that followed, and that she had never thought of suicide before. She 'felt so guilty that I had put my family through such pain'.

It proved crucial that psychiatrists were persuaded her suicide attempt was, as her family insisted, an impulsive act that wasn't reflective of her normal personality.

One of the earliest transplant patients, a man who had also shot himself, was given a new face by doctors in Paris. It was judged a success, but he killed himself three years later. 

The team who had worked so hard to repair him were devastated, and their leader urged others in the field not to operate on other 'survivors' of suicide.

Katie underwent an extensive psychological evaluation before the operation to ensure she was mentally stable, aware of the risks, and could be trusted to stick to an exacting medical regimen.

Katie with her parents, who live with her near the clinic, after the operation

She learned that she would be a beneficiary of some 14 years of experience in the field, with much of the expertise developed at the Cleveland Clinic. 

Until 2004, the best a patient in her position could have hoped for was a 'Shrek face'.

Then, in 2005, French surgeons performed the world's first partial facial transplant. The first full face transplant was carried out in Spain in 2010 on a man injured in a shooting accident.

Maria Siemionow, a scientist at the Cleveland Clinic, radically advanced what was possible after working with animals. But it wasn't until last year that a suitable donor was found for Katie.

In May 2017, Sandra Bennington agreed to donate her granddaughter Adrea Schneider's face, after she died from a cocaine overdose.

Katie's surgery was financed through the U.S. Armed Forces Institute of Regenerative Medicine, which researches the treatment of injured servicemen. Her age and injuries provided the institute with a close equivalent of a typical battlefield victim.

The 31-hour operation began on May 4 — three days after Adrea had died. It involved 11 surgeons and several other specialists who had been practising for months on cadavers, one team removing the face of the donor and the other attaching it to the recipient.

The new face was transferred to the adjacent theatre where surgeons placed it on Katie and immediately started to connect up arteries and veins

Adrea's body — on a ventilator to keep her organs and tissues supplied with oxygen and blood — was in an adjoining operating room. (Her liver, kidneys, lungs and heart were also being donated.)

Dr Gastman made the first incision on the donor's face and, over the course of 16 hours, three to four surgeons bent close over Adrea for their painstaking work.

After removing her eyes so the corneas could be donated to another recipient, the surgeons delicately dissected the main nerves controlling the muscles governing facial expression, and the sensory fibres that provide taste to the tongue and to glands allowing salivation and tears. 

Next, they cut into bone — the upper and lower jaw, most of the cheekbones and bones near the eye sockets. All of these would be transferred to Katie.

The blood vessels were removed last, to reduce the time the face was without a blood supply, and 'tagged' so they could be matched to what remained of Katie's vessels.

Shortly after midnight on the second day of the operation, Adrea's face was finally removed and placed on a surgical tray, floating in preserving solution.

Its eye sockets empty, mouth open and the skin turning pale as it was deprived of blood, it resembled a rubber Halloween mask.

Katie walks down the hospital hallway days after the surgery as she endures a long recovery

It was transferred to the adjacent theatre where surgeons placed it on Katie and immediately started to connect up arteries and veins.

As soon as they unclamped Katie's veins and arteries, the blood rushed in and the face 'blushed'.

'There was a very large internal sigh of relief by almost all of us surgeons,' said Dr Gastman.

The team reversed the steps they had taken to remove the face, working from the neck up. Its bones were connected to Katie's bones with special plates.

Some nerves were left to regenerate, others were connected by micro- surgeons with stitches no thicker than a strand of hair. The eyes were sewn shut to protect them.

Then, the team encountered a problem. The original plan had been to do only a partial face transplant, replacing the missing central triangle of Katie's face. 

They would leave alone the surrounding areas — cheeks, forehead, eyelids and the sides of her face — to preserve the features that made her recognisably Katie, and reduce the risk of her body rejecting the transplanted skin.

The team reversed the steps they had taken to remove the face, working from the neck up. Its bones were connected to Katie's bones with special plates

However, they discovered the donor's face was too big and its skin tone noticeably darker than Katie's. A full transplant would look much better, but was riskier.

After recalling how Katie just wanted to be 'a face in the crowd that no one looks at', her parents made the agonising decision for the surgery to continue.

Katie was discharged from hospital in August 2017 to continue convalescence and therapy. 

She takes 'a two-and-a-half-page list' of drugs each day, works with a speech therapist because her tongue isn't functioning properly, studies Braille because of her limited vision and has physical and occupational therapy.

She's had three major 'clean-up' operations since the transplant to fine-tune the transformation, including one to help her speak more clearly.

There will be more operations to come, and Katie and her parents are still living near the clinic. One possibility is 'whole eye' transplants — which scientists say will be possible within a decade — to improve her sight.

The psychological adjustments for all concerned have proved a challenge. Katie's mother says she saw nothing of her daughter in her new face, and even wonders if she might have inherited a new personality.

There will be more operations to come, and Katie and her parents are still living near the clinic. One possibility is 'whole eye' transplants — which scientists say will be possible within a decade — to improve her sight

For the surgeons who gave her that second chance, she remains a testament to many things — to the terrible consequences of a single, rash decision, to strength in adversity and, above all, to the indomitable human spirit to live

Katie's future is uncertain; her body could reject the transplanted face and the immunosuppressant drugs she must take to reduce the risk make her vulnerable to infection and cancer.

However, her doctors deem the surgery a success, not least because her body hasn't rejected her transplant so far. But they had hoped her vision would be better.

Katie herself describes her rehabilitation process as 'many, many daily steps', adding: 'I am able to touch my face now, and it feels amazing.'

She is busy planning for the future and hopes to take an online university course and become a counsellor and motivational speaker, steering teenagers away from suicide.

'Life is an amazing gift and I am thankful to have a second chance to live my life,' she says. 'So many people have helped me; now I want to help other people.'

For the surgeons who gave her that second chance, she remains a testament to many things — to the terrible consequences of a single, rash decision, to strength in adversity and, above all, to the indomitable human spirit to live.