After struggling with depression since adolescence, California native Cameron Underwood spent much of a June 2016 day drinking, placed a shotgun under his chin and pulled the trigger.

The blast destroyed much of his face — and began a journey that led to the most advanced face transplant surgery ever performed.

More than two years later, Underwood’s priorities are to return to work and start a family of his own someday.

“Thank you for not giving up on me,” the 26-year-old Yuba City man said to loved ones and family Thursday during a news conference at New York University.

The suicide attempt and conventional surgical repairs left him disfigured and required five months of skin grafts just to make reconstructive plastic surgery a possibility. Underwood underwent a successful face transplant at the start of 2018. On Thursday, almost 11 months later, Underwood made his first public appearance, speaking at NYU Langone Health center.

Addressing media and dozens of surgeons, therapists, nurses and other medical staffers whom he called “incredible,” Underwood smiled and told them they’d given him a second chance at life.

“It hasn’t been easy but it has been worth it,” he said in the news conference, which was streamed live to Facebook.

The procedure took 25 hours, from the morning of Jan. 5 into Jan. 6. Two teams of surgeons worked concurrently in adjacent operating rooms, lead surgeon Dr. Eduardo Rodriguez explained: one for the donor and one for the recipient.

Less than a year later, Underwood can speak intelligibly. He is lovingly restoring an old truck. He’s golfing. And, as Rodriguez showed in a slide show presentation, the outdoorsy Underwood has even gone skydiving. (No, he did not ask his doctor’s permission first.)

“There have been so many amazing advances in surgery. I’m living proof of that,” Underwood said. “But it only happens because of special people like [donor] Will and his family.”

On Jan. 4, New York City writer Will Fisher died at age 23 after a lengthy battle with mental illness. An organ donor, Fisher was Underwood’s perfect match.

The two were connected by LiveOnNY, New York City’s federally designated organ procurement organization, ahead of Fisher’s death. LiveOnNY is a nonprofit that provides eye, organ and tissue donation; it has connected 20,000 donors to recipients, according to its website.

“It’s like finding a needle in a haystack,” Helen Irving, LiveOnNY’s chief executive since 2011, said at Thursday’s news conference. “We want the perfect patient for Cameron.”

The first successful, complete face transplant involving a living recipient happened in 2010 in Spain. Fewer than 50 have been performed worldwide, and fewer than 10 total or near-total operations have been performed in the U.S.

A significant portion of the surgery’s cost was covered under Underwood’s insurance through his employer, according to a news release by NYU Langone Health. Rodriguez said this was the first U.S. case in which third-party insurance covered any part of the procedure. Face transplant surgeries are usually funded by research grants, often from the Department of Defense, according to the release.

With just 18 months between the initial injury and the surgery, Underwood’s procedure represented the shortest wait time for a face transplant in the U.S.

“We’re often asked about identity crisis following a face transplant,” Rodriguez said. “As Cam defined it, his life was in pause” while he lived with a disfigured face.

The circumstances of Fisher’s death have not been publicly disclosed, but Irving said that Will’s mother, Sally Fisher, first met with LiveOnNY on New Year’s Eve.

“While the world was celebrating, a family was being consoled, and a mother was facing the loss of her only child,” Irving said.

Underwood — whom Irving, Rodriguez and others call Cam — was “waiting and waiting, as all our families do,” for word of a donor match, Irving said.

On Jan. 4, the same day Will Fisher died, Sally Fisher asked to meet and thank Underwood.

Rodriguez called this type of meeting between a donor’s parent and a face transplant recipient prior to the surgery “unprecedented.”

“Welcome to New York,” Sally told Cam during a hugging embrace. “Thank God for you.”

Underwood’s procedure was monumental in terms of its use of advanced technology and novel in other facets.

The two-room operation required a team of more than 100 total surgeons, nurses and other staff, according to NYU Langone Health. It used techniques that had never been used before.

Underwood’s road is still long. Rodriguez estimated three to five years until his face is “pristine.”

Now 11 months later, Rodriguez said Underwood’s body has shown no signs of rejecting the transplanted face, a path that his team believes was his only road back to a normal life.