26-year-old's incredible face transplant journey: 'I see me'

Underwood, the son of a California pastor, told ABC News’ Amy Robach in an interview for “20/20” that he still has the face he was born with from the cheekbones up, but almost everything below that belongs to the donor — a 23-year-old aspiring New York filmmaker and writer named Will Fisher.

But when he looks at himself now, “I see me,” he said.

Watch the full story on “20/20” this Friday, Nov. 16 at 10 p.m. ET

Underwood grew up in a close-knit family, grounded in its faith. His grandfather founded the United Pentecostal Church in the Northern California agricultural community of Yuba City.

“Faith is the essence of everything in our family,” Underwood’s older sister Julie Jones said. “Without that foundation, I think this journey would’ve been a lot more difficult.”

26-year-old's incredible face transplant journey: 'I see me'

The Underwood FamilyCam Underwood is seen here in this 2008 family photo.

Underwood’s mother, Bev Bailey-Potter said her greatest joy is her children – Julie, Aaron, Brad and her youngest, Cam.

“They were just so close and I always took pride in that.” Bailey-Potter said, and Cam “was just easy. He was always quiet, a little on the shy side… but just a wonderful spirit about him… easy going.”

She said he was “just a handsome boy,” and “His smile would light up his face and it was so evident in his eyes.”

26-year-old's incredible face transplant journey: 'I see me'

The Underwood FamilyCam Underwood is seen here at his high school graduation in 2010.

Underwood had just started his career working in his stepfather’s business of heavy equipment repair. With that money, he was able to buy his own house at the age of 19. Hunting was also a family pastime.

“We’re really an outdoors family,” his father Randy Underwood said. “He [Cam] grew up on the lake… He was just a natural athlete, he was good, he enjoyed it.”

Even with everything going for him, his mom said the bright light that always shone in his eyes began to fade.

“You know, I have a clear memory in my mind,” Bailey-Potter said. “I saw him walk across the parking lot… and he just looked so sad and empty. I just thought… what is he going through? Is he unhappy?”

The family says Underwood became a workaholic and was pushing himself too hard. He began struggling with depression, they said, but kept this to himself, rarely expressing his emotions. After Underwood went through a breakup, his brother Aaron Underwood remembered, “He started going out more… and you know, partying a little more at that time.”

26-year-old's incredible face transplant journey: 'I see me'

The Underwood FamilyCam Underwood, seen here as a young adult, opened up to “20/20” about his story.

Over the next few years, Underwood’s family said he and his closest friend and brothers drifted apart – the friend started a family and his older brothers started new jobs and moved out-of-state. His struggle with alcohol was apparent, but less obvious to his family, they said, was Underwood’s underlying depression. It was a shock to them when Underwood not-so-subtly hinted one day that he was thinking of taking his own life.

“I thought well, you know, he’s just going through a rough time… we all do,” his mother said.

His family decided to remove all of the guns in his home. But there was one they couldn’t get to: Underwood had put a shotgun in his safe.

(MORE: Youngest US face transplant recipient shares story of suicide survival and hope: ‘Life is an amazing gift’)

On a Sunday night in June 2016, Underwood’s uncle Lonnie said he received a text from his nephew asking him to come over and stay the night.

“I got to his house and all the lights were on, which I expected,” Lonnie said. “Door was unlocked, I walked in… nobody in the living room.”

Lonnie walked into the bedroom and into a nightmare. He saw blood everywhere, and Underwood staggering against the wall.

“I think that is probably the point where I went into shock,” Lonnie said.

Underwood had placed the shotgun under his chin and fired, in an attempt to take his own life. He was immediately rushed to a nearby hospital.

At the hospital, “They told us he had … no teeth, no chin, no cheekbones, no facial structure… nothing,” Randy Underwood said.

“It really wasn’t a face… it was pretty horrific,” Aaron Underwood added.

Underwood was transferred to University of California-Davis Medical Center, where renowned plastic surgeon Dr Lee L.Q. Pu implanted 12 titanium plates to keep what was left of his shattered skull intact.

Underwood survived the ordeal but underwent eight surgeries to restore the bare minimum function to his face. To cover his face, doctors used skin from his thigh and tissue from his shoulder. His nose was lost in the blast and he only had a tiny hole to breathe through. Even then, the results from his surgeries were difficult to endure.

“What kind of quality of life would he have?” Bailey-Potter wondered. “If he didn’t want to live with all that he had going for him, then why would he want to continue on now?”

“I cried every day for a year… every single day,” she continued.

Randy Underwood said, “I would’ve changed places with him any day. I would’ve taken his pain any day, but I couldn’t.”

It was six months before Underwood could leave the hospital – even then, he wore a mask wherever he went.

“I would see people stare at him and he would notice that,” Randy Underwood said. “The worst part was the little kids… stare at him and hang onto mom and dad because he looked so pitiful.”

But then Dr. Pu suggested that a face transplant might be possible and could give him a chance at a better life.

Coincidentally, Bailey-Potter found herself at the checkout counter of her local grocery, thumbing through a magazine that highlighted the story of firefighter Patrick Hardison.

Hardison was a fireman in Mississippi who was horribly burned trying to rescue a woman from her burning home. His face was so badly burned that his fellow firemen didn’t know it was him at first when they got to him.

Hardison survived — but his scalp, ears, nose, eyelids and lips were gone.

Hardison underwent multiple surgeries to try to repair his face. He suffered years in isolation, hiding himself as much as possible from the outside world. Then he met Dr. Eduardo Rodriguez, a renown reconstructive surgeon who is the chair of NYU Langone Health’s Hansjörg Wyss Department of Plastic Surgery in New York.

In 2015, Dr. Rodriguez agreed to perform what was at the time the most extensive face transplant ever done.

The operation took 26 hours and replaced Hardison’s entire face and scalp with skin, tissue and nerves of a donor. Since his surgery, Hardison, whose story was also profiled by ABC News’ “Nightline,” has had a better quality of life.

(MORE: Face transplant surgery gives 41-year-old former firefighter a new 26-year-old face)

So Underwood’s mother thought Dr. Rodriguez might be able to help