Almost six months after a rare face and hands transplant, Joe DiMeo is relearning how to smile, blink, pinch and squeeze.
The 22-year-old New Jersey resident had the operation last August, two years after being badly burned in a car crash.
"I knew it would be baby steps all the way," DiMeo said.
"You've got to have a lot of motivation, a lot of patience. And you've got to stay strong through everything."
Experts say it appears the surgery at NYU Langone Health was a success, but warn it will take some time to say for sure.
Worldwide, surgeons have completed at least 18 face transplants and 35 hand transplants, according to the United Network for Organ Sharing (UNOS) which oversees the US transplant system.
But simultaneous face and double hand transplants are extremely rare and have only been tried twice before.
The first attempt was in 2009 on a patient in Paris who died about a month later from complications.
Two years later, Boston doctors tried it again on a woman who was mauled by a chimpanzee, but ultimately had to remove the transplanted hands days later.
"The fact they could pull it off is phenomenal," Dr Bohdan Pomahac, a surgeon at Boston's Brigham and Women's Hospital who led the second attempt, said.
"It's incredibly complicated. It's a tremendous success."
DiMeo will be on lifelong medications to avoid rejecting the transplants, as well as continued rehabilitation to gain sensation and function in his new face and hands.
In 2018, DiMeo fell asleep at the wheel. His car hit a curb and utility pole, flipped over, and burst into flames.
Afterward, he spent months in a medically induced coma and underwent 20 reconstructive surgeries and multiple skin grafts to treat his extensive third-degree burns.
Once it became clear conventional surgeries could not help him regain full vision or use of his hands, DiMeo's medical team began preparing for the risky transplant in early 2019.
"Within the world of transplantation, they're probably the most unusual," Dr David Klassen, UNOS chief medical officer, said.
In early August, the team finally identified a donor in Delaware and completed the 23-hour procedure a few days later.
They amputated both of DiMeo's hands, replacing them mid-forearm and connecting nerves, blood vessels and 21 tendons with hair-thin sutures.
They also transplanted a full face, including the forehead, eyebrows, nose, eyelids, lips, both ears and underlying facial bones.
"The possibility of us being successful based on the track record looked slim," Dr Eduardo Rodriguez, who led the medical team of more than 140 people, said.
Since leaving the hospital in November, DiMeo has been in intensive rehabilitation, devoting hours daily to physical, occupational and speech therapy.
"Rehab was pretty intense," DiMeo said, and involves a lot of "retraining yourself to do stuff on your own again".
"You got a new chance at life. You really can't give up," he said.