Army veteran Joseph Jones looked in the mirror at his swollen face and the patches that would eventually become his eyebrows and beard.
Still numb, he gently patted the tiny hair follicles that had been planted in arcs above his eyes and along his jawline. He looked side to side in the mirror, taking in all the rows, as the first hint of smile began to form. It looked to him like the beginnings of a pine tree forest sprouting from his face. But soon enough, he hoped , he would look like the Jones he knew well before the explosion.
For the first time in more than a decade, Jones — 35 years old, married, former soldier, war survivor — would have his eyebrows and beard back, their absence the collateral damage of a roadside bomb during the Iraq war. For the first time in more than a decade, Jones could recognize traces of his old self.
“After the IED blast, my hair would not grow on my face. I don’t have eyebrows, eyelashes or a beard. I looked odd and sometimes people would stare at me,” says Jones, who lives in Youngstown, Florida, near Tallahassee, with his wife and daughter. “I feel like I lost a part of my identity when I lost my hair.”
Earlier this month, a Miami-Dade plastic surgeon worked to restore what Jones had lost. Dr. Jeffrey Epstein performed hair-transplant surgery on Jones, harvesting about 3,000 hair follicles from a donor site on the back of his head and replanting them on his face. The eight-hour procedure in Epstein’s South Miami office, donated by the doctor, was performed as part of the Faces of Honor program, a national initiative by the American Academy of Facial Plastic and Reconstructive Surgery and its foundation to help Iraq and Afghanistan veterans injured in the line of duty. Jones’ procedure would ordinarily cost about $16,000.
“We are trying to make these veterans look whole. There is a difference between healed and whole,” said Dr. Charlie Finn, the humanitarian chair of the plastic surgery academy.
The program, launched in 2009, coordinates the academy’s plastic surgeons, who donate their services. Only a handful of procedures have been performed so far, including treatment for burns and scar revisions, because the program is not well-known. Two years ago, Finn repaired the nose of a soldier injured in a Taliban attack in Afghanistan.
Considered elective and mostly aesthetic, the services often complement the care already provided by the Veterans Affairs healthcare system. To qualify, veterans must have a combat injury in Operation Iraqi Freedom or Operation Enduring Freedom and an honorable discharge.
The surgical procedures are as much about psychological healing as looks or function.
“The facial hair loss for Jones raises the memories of what was a trauma,” said Epstein, a surgeon with offices in Miami and New York who has specialized in hair restoration since 1994. “The beard and facial hair will put him in harmony with how he feels. It’s going to make a difference.”
For Jones, military service was his chosen career path since age 8, when he was awed by the movies Top Gun and Iron Eagle. His grandfather, father and an uncle had been Army men. He enlisted in his hometown near Jackson, Mississippi.
“When I saw those movies, I knew that was my course in life,” he said. “I knew I wanted to serve my country.”
Jones deployed to Iraq in 2004, early in the U.S-led invasion. In March of that year, Jones and four others were in a Humvee delivering food to fellow soldiers in a convoy traveling through southern Iraq. Then, a small blast.
No one was seriously injured. Jones’ injuries were superficial, relatively painless and, it turned out, deceptive. What Jones didn’t know at the time: The heat of the flames probably deadened the hair follicles on his face and damaged the pigment of his skin.
“It was almost like a grease fire like you see in the kitchen, but it took off my eyebrows and eyelashes. When I was receiving treatment, the doctors told me everything would grow back. But it never did,” he said. “I can grow a goatee, but only because it was covered during the blast by my chinstrap.”
Eight months later, Jones was in a second roadside explosion just outside Najaf, Iraq, wrecking his left knee and right ankle when the truck he was riding in rolled over onto him. Jones returned to the the States with a limp, no eyebrows, eyelashes or beard — and post-traumatic stress disorder.
He left the service, eventually settling in a tiny, unincorporated corner of northern Bay County in the Panhandle near Panama City. He took medication to calm the memories of war, but he still struggled at times. He had a brush with the law. He and his first wife, with whom he has three children, divorced. In 2007, Jones remarried and now sports a tattoo of his second wife’s lips on the side of his neck.
Jones says he hasn’t been able to find steady work because of his PTSD. But it is the hairless face, the eyes without cover, that bother him most. A couple of times, insensitive people had even called him “Powder,” an albino character in the 1995 movie of the same name. It’s about Jeremy “Powder” Reed, who has supernatural powers — and lacks the ability to grow hair.
Jones had resigned himself to living without facial hair until earlier this year, when he heard about the Faces of Honor program through a veterans’ organization.
On Aug. 6, Jones made the eight-hour drive to Epstein’s office on Sunset Drive, the first step toward becoming whole. Jones was the doctor’s first patient in the program, though he has performed similar pro bono procedures for victims of domestic violence.
During the consultation, Jones envisioned the 5 o’clock shadow worn by actor Jason Statham, or, if he were really lucky, a thick hipster beard like that of Jason “Jase” Robertson of the Duck Dynasty reality show. For the eyebrows, he was less specific, simply strips of hair that would help to reframe his face and, he hoped, stop the probing questions.
“The hair is a way for me to feel better about yourself,” he said.
To prepare for the transplant procedure, a technician shaved the bottom third of Jones’ hair on the back of his head, an area called the donor site. That area is used for transplants because it grows hair genetically resistant to balding, the reason balding men often retain a “wreath” of hair on the sides and back.
Before the operation , Epstein drew the outline of eyebrows and a beard on Jones’ face with a blue marker, drawing the beard thinner than Jones originally wanted to make sure enough follicles on the donor site were available. Once grafts are removed, the hairs in the donor site would not grow back, so Epstein made sure to spread out the harvested area. For the eyebrows, he drew arcs that were symmetrical but not perfect.
Jones would go from a small goatee to a “full beard,” Epstein explained as he drew. “Of course, the sideburns are a key for him. For the eyebrows, I am just filling in, which will make a big difference.”
He has performed more than 9,000 hair procedures over two decades: “For eyebrows, women want nice, sculpted looks. Guys generally just want hair.”
Jones was injected with a local anesthetic where the grafts would be harvested from the scalp and transplanted, a modern technique called follicular unit extraction.
Using a microscopic drill, Epstein made micro-punches in the donor tissue, then plucked the grafts — naturally-occurring groupings of one to four hairs called follicular units. Each graft is placed in a petri dish and separated into the units. Epstein uses varying unit sizes.
The doctor then used a surgical jeweler’s forceps to punch holes into the bare eyebrow and beard area, called the recipient site. For the beard, the punches were set in an irregular pattern but at varying angles so the hair would look natural. For the eyebrows, he placed the holes in a cross-hatch pattern.
For the next five hours, Epstein carefully placed the units into the incisions, one by one.
When it was over, Jones was swollen, bruised, bloodied — but pleased. The newly planted hairs looked like stubble after shaving. He said it felt like the sting of a sunburn. The technicians began to explain how to care for his face during the first 24 hours — do not touch, do not get wet. Jones listened, but rarely looked away from the mirror.
After 10 years and eight hours on a Wednesday, the promise of facial hair was real.
The newly implanted hairs began to fall out within two weeks. They will regenerate in about four months, growing into full eyebrows and a beard. For now, he is hairless again.
“Some people might look at me and say I don’t need hair,” he said. “But this is important to me. I want to look normal.”
For more information about the Faces of Honor program, visit www.facesofhonor.org or call 703-299-9291.