About Face Season 1 Episode 1
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Five Minute Recap brings you quick 5-minute summaries of the latest news, movies, tech, and trends. Stay informed and entertained in minutes with clear, engaging recap perfect for busy people who want to learn fast and keep up with the world.
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00:00This program examines medical conditions and the procedures involved with treating them.
00:04Due to their graphic nature, viewer discretion is advised.
00:15I've been called a human dog toy, a Frankenstein.
00:21When I look in the mirror, I'm like, this isn't me.
00:26Every single interaction is a reminder that I'm different.
00:33What we're looking at here is really complicated.
00:36I agree.
00:37We're a group of doctors in Los Angeles, and we take on some of the most difficult cases in the
00:42world.
00:42Her nose and her jaw was torn out.
00:45Gosh.
00:46I was hit by a underage drunk driver.
00:48When she decided to drive off, my jaw shot in the car.
00:52There's a solid chance he doesn't have an entire jawbone.
00:55Okay, incision.
00:57Incision.
00:57Incision.
00:58From the moment you make the incision, looks like this is a bleeder, everything is difficult.
01:07My name is Dr. Andre Panosian, and I'm a board-certified plastic surgeon.
01:10This is obviously a critical step.
01:12This is, this has to work.
01:14My name is Dr. Jason Rustayan.
01:16I'm a board-certified plastic surgeon.
01:18It kind of looks like a bomb went off in here.
01:20My name is Dr. Millicent Rovello.
01:22I am a board-certified plastic and reconstructive surgeon.
01:26We treat people that are missing major portions of the face, missing jaws, missing ears.
01:32The list goes on.
01:33We can help people to open and close their eyes.
01:36We can give them a nose, or maybe they never had one before.
01:39Let's see if the results here...
01:42Yes!
01:43You know?
01:44You have to go through a lot, but we definitely have some options.
01:48I love what I do because our work can change a person's life.
01:53Yes!
01:57The idea is basically to give you that smile back.
02:00I like you so much.
02:02Yeah, we can give somebody their smile back.
02:05You can't underestimate how important that really is.
02:21My name is Dr. Jason Rustayan.
02:23I'm a plastic surgeon.
02:25I specialize in aesthetic surgery and also reconstructive surgery.
02:28In my career, I've performed thousands of surgeries.
02:31Everything from really complex rhinoplasty to rebuilding entire faces.
02:35I went into plastic surgery because the work we do is life-saving and life-altering.
02:41I like the high pressure, the challenge.
02:45It's what puts me at my best.
02:47Hey!
02:47Hey, how are you doing?
02:48I'm good, how are you?
02:49Excellent.
02:50My name is Dr. Millicent Rovello.
02:52I am a plastic and reconstructive surgeon.
02:54We all know what the stereotype of plastic surgery is, right?
02:57It's big boobs, it's big butts, it's facelifts, it's Beverly Hills.
03:01But there's another side of plastic surgery that many people have no idea exists.
03:07Surgeries to address traumas, rebuilding a nose, making a jaw that wasn't there before.
03:13I have the guy that got ran over by a drunk driver and was stuck under a muffler and had
03:19fourth-degree burns to the whole side of his face.
03:22I mean, that was a major reconstruction, no doubt about it.
03:27My name is Dr. Andre Panosian, and I'm a plastic surgeon.
03:30I specialize in peripheral nerve reconstruction.
03:32And for people with facial paralysis, I specialize in facial reanimation.
03:37We will hit problems during surgery where there's no manual to it.
03:41There's no phone-a-friend.
03:43It's all on you, using every trick in the book to make things work.
03:49We are a team of surgeons in Los Angeles, California.
03:52We take the most complex and challenging cases nationwide.
03:57The idea of being able to change that person's life forever, it's awe-inspiring.
04:02Okay, so I have a patient coming in.
04:04His name is Ron Sigler, very nice gentleman from Iowa.
04:08And he's got a big tumor on his face.
04:11I mean, this is massive.
04:14He has one that occurs on sort of half his face.
04:18And you see the pictures, and I'll show them to you.
04:21But you're going to be struck with the size of the tumor.
04:24I'll sort of bring that up.
04:26And there is Ron Sigler.
04:28So as you can see, the tumor is massive.
04:33That's impressive.
04:35It's been going on for over four years now.
04:37When it first showed up, it was simply a bump on the nose.
04:41He was concerned about it, went to the doctor's office,
04:44which did reveal this diagnosis of a cancerous tumor.
04:48So is he having any pain associated with this?
04:51It looks like it would be painful.
04:53Yeah.
04:53It's sort of a generalized pain or an ache that these things can cause.
04:57You know, it's not our everyday to see something this large.
05:00You know, obviously it doesn't look good.
05:02But, you know, from a life-saving standpoint,
05:04clearly you can benefit from an excision.
05:07For sure.
05:07And this is not going to be a small one.
05:10For sure.
05:11Yeah.
05:11In looking at Ron's case,
05:13I'm struck by the size and extent of his tumor.
05:17This is definitely super dangerous.
05:19It can lead to imminent death.
05:21We have to always sort of be honest with our patients in that regard
05:24and figure out, okay, does he get it?
05:26Does he know what the risks are, what the stakes are here?
05:29And they're high.
05:31Yeah.
05:39When I go out in public, people stare all the time.
05:42I mean, you're seeing something that's kind of shocking.
05:46It has been a stress, and I am embarrassed.
05:50One woman, she looked at me and she was scared.
05:52I was like, wow, I guess I do look like a monster.
06:03Every day when you wake up with this on your face,
06:05I feel my left side.
06:07I'm like, it's still there.
06:09Oh.
06:10When I look in the mirror, I'm like, this isn't me.
06:13This growth is not me.
06:14I don't want it.
06:18I'm terrified because, you know,
06:20is this going to keep on growing?
06:22Is it going to kill me?
06:27It's about the size, I would say, an orange.
06:29When I grab it, it's just a little bit hard,
06:33like you would squeeze a piece of fruit.
06:37It's got some firmness.
06:39The weight is a problem.
06:41It's hard to smile, hard to eat,
06:43and it makes it hard to speak,
06:46hard to give another person a kiss even.
06:50You know, you've got to kind of move your head
06:52in, like, the right way.
06:54The cheek kind of looks like it's, you know,
06:56inflated like a balloon,
06:57and I think it's ready to be popped.
07:02Hey, how's it going?
07:04Good.
07:04Good.
07:05Good.
07:08When it first started,
07:09I went to start seeing doctors,
07:11and they just wanted to do a massive surgery
07:15and leave a big hole in my face.
07:17I was terrified because it wasn't a very good outcome.
07:21I didn't go through with what they proposed.
07:26It was hard news for me to take,
07:29and so conditions weren't really that great at home.
07:35It was crushing.
07:36I felt like I wasn't a man.
07:37I wasn't a father.
07:39I wasn't myself.
07:41Everything's coming together right now.
07:43I want to be free of it.
07:46I've been worried about you for a long time,
07:48about it,
07:49because it's like anything that was ever moving forward is on it.
07:52You know, doctors would fall through,
07:55and I know my mom and my brother,
07:58they're worried about it,
08:00and it's just going to be a huge relief
08:02for the whole family when it's gone.
08:03It has to come off, period.
08:07There's no two ways about it.
08:09I hate watching it,
08:11and it's kind of hard to be next to you.
08:14You know,
08:17I'd be very glad to see it coming.
08:19Levi, my son,
08:20he wants the best for his dad,
08:23which is really
08:25has taken me back,
08:27you know?
08:29You know,
08:31the plan is
08:32to leave
08:33for Los Angeles,
08:34and I'd like you to come,
08:35of course.
08:36Yeah.
08:37And if there's any...
08:38I'm going to fly to Los Angeles
08:41to meet Dr. Panozian.
08:43This has got to work,
08:44you know?
08:45I don't see another option out there,
08:47and so my life does depend on
08:49having everything work out.
09:01This is definitely
09:03not a common tumor.
09:04It's incredibly rare
09:06to have this particular tumor
09:07and diagnosis
09:08at the size it is.
09:10The diagnosis given to him
09:11was by way of a biopsy,
09:12so they took a little piece
09:13of the one on the nose,
09:15and they sent it to a pathologist.
09:16They look at it under a microscope,
09:18and they give you a diagnosis.
09:19His diagnosis is
09:22dermatofibrosarcoma protuberans.
09:24It's a big, long mouthful of a word,
09:26but it basically
09:27is a type of cancer.
09:29What this type of cancer does
09:31is that it sort of occupies
09:33a space somewhere on the body,
09:34and it sort of expands
09:35from that space
09:36into neighboring tissues.
09:38So when that happens,
09:39it can erode into
09:40things like muscles
09:42or bones
09:43or cartilage
09:43or teeth sometimes.
09:45So this is a serious tumor.
09:47This needs to be removed.
09:51Hello.
09:52Hey, how are you?
09:54Great, how are you?
09:55Great.
09:56Dr. Panosian,
09:56good to meet you.
09:57Good to meet you.
09:58Levi.
09:59Levi, good to meet you.
10:00All right.
10:01Meeting Ron,
10:02I wanted to really
10:03kind of drill down
10:04into why he hasn't
10:05had this removed before.
10:07All right.
10:08So, Ron,
10:10tell me about the tumor.
10:12Tell me about it.
10:13When was the first time
10:14you noticed something
10:15was not quite right?
10:17That was in 2014.
10:192014.
10:20And tell me,
10:21what was it?
10:21It was obviously
10:22not this big lump.
10:23It was something different.
10:24No, it was just the nose.
10:26And so I went to the doctor
10:27and he looked it over
10:28and we just took a chunk off
10:30and took it in for a test.
10:32And what did they say it was?
10:34They just said
10:34it was a benign tumor
10:36and that was basically it.
10:38So what was the next time
10:39that you went to the doctor?
10:41The next time
10:42was in 2016.
10:43Uh-huh.
10:44Um, I really wanted
10:45to get it removed.
10:46He said,
10:46well, our team feels
10:48it's, uh, rare cancer.
10:50And, you know,
10:51that word cancer.
10:52You got cancer.
10:53Right.
10:54Oh, it was very difficult
10:55taking that news
10:56and they gave me
10:57all this info
10:57about five years to live.
10:59You know?
11:00It just hit me like
11:01maybe I was scared.
11:03The next step was
11:04how do I remove it?
11:05What are we going to do?
11:06And so he said,
11:07well,
11:08you have to see
11:09other specialists now.
11:10I was transferred
11:11to another doctor
11:14who was a dermatologist
11:16and, uh,
11:17she tried to do
11:18a biopsy.
11:20Wow.
11:21And then
11:21when was the first time
11:23that you noticed
11:23this tumor
11:24just start to expand?
11:26On the cheek,
11:27it was 2018.
11:29When it started growing.
11:31Okay.
11:31And at that point,
11:32did you visit anybody
11:33to say,
11:34hey, this is brand new.
11:35This wasn't there before.
11:37Well,
11:37they said that
11:38after all their tests
11:40and so forth
11:41looking into the case,
11:42it would be
11:43a radical surgery.
11:44We have never done this before.
11:45You could lose an eye.
11:47You could lose
11:48some teeth.
11:50And, uh,
11:51we may not be able
11:53to reconstruct your nose.
11:55It looked like
11:55Frankenstein to me,
11:57uh,
11:57the process,
11:58and I don't know
11:59if I would have
12:00a better life
12:00after the surgery.
12:02So I just left it.
12:04I don't blame you.
12:05I think that's a,
12:06that's a scary proposition.
12:07It is intense
12:09to see such a tumor
12:11of this magnitude,
12:12um,
12:13on a person's face.
12:14This tumor needs
12:16to come out right now
12:17because these types
12:18of tumors
12:19can be a death sentence.
12:22I have a patient,
12:23her lower lip
12:24is very enlarged.
12:26It's a pretty severe case.
12:28I don't know
12:29if I can remove
12:30a whole lot.
12:31If you start
12:31cutting away muscle,
12:32it could paralyze
12:34her mouth.
12:35Incision.
12:37It's not great
12:38that the nerves
12:38and the muscles
12:39are sort of
12:40entangled with this tumor
12:41with the flick of a blade.
12:42You can paralyze his face
12:43and that's it.
12:45It's the end of it.
12:59It's an unusual diagnosis.
13:01You have a large mass
13:03on the cheek
13:04that once you remove it,
13:06you've got to be able
13:06to reconstruct it.
13:07But I totally get
13:09where you're coming from
13:09with this.
13:10So let's take a look
13:12a little bit more closely.
13:13I just want to kind of
13:14come in a little bit closer
13:15and just take a good look
13:17at everything here.
13:17And let's just get a sense
13:19for the weight of it.
13:19And it's pretty heavy.
13:20I mean,
13:21this is not
13:22a light object whatsoever.
13:25It's almost like
13:25I can pick it up
13:26off your face completely.
13:27Yeah.
13:28In fact,
13:28let's just see
13:29if you give me a smile
13:31and you can see
13:32it kind of rise up.
13:33So to some degree,
13:34it is sort of sitting
13:35on the muscles
13:36of facial expression,
13:37which is,
13:38in this case,
13:38is the smiling muscle.
13:39Here,
13:40let me have you do a pucker.
13:42Good.
13:42And relax.
13:43Can you try to sneer?
13:45Mm-hmm.
13:46Can you blow up your cheeks?
13:49And relax.
13:49Is that really heavy
13:50and a lot of force?
13:51It is heavy, yeah.
13:52Yeah.
13:53And in fact,
13:53let me have you open your mouth.
13:55And it's really amazing
13:56because it's completely clear.
13:58It doesn't even intrude
13:59into the mucus lining.
14:00It's probably all the way
14:01through the cheek
14:02to some degree.
14:03This is a pretty impressive mass,
14:06to be honest.
14:07I mean,
14:07this is something
14:08that most people would rush
14:10to getting removed.
14:11So we have your MRI here.
14:13I want to pull it up.
14:14And here we go.
14:15This is sort of looking at you
14:17from the feet up.
14:19And as you can see,
14:20here's this big mass here.
14:23But you can see
14:23that there's a pretty good
14:25rind to it almost.
14:26There's a little bit of a space,
14:27a little tiny shadow
14:29between the skin
14:30and the tumor itself.
14:32It's got a pretty dense structure
14:34to it overall.
14:35It's almost like a softball,
14:36basically.
14:37It's got this density to it.
14:39Let's talk about
14:40what we want to do.
14:42In a nutshell,
14:43we want to just remove the mass,
14:45okay?
14:45So what we're going to do
14:46is basically make an incision
14:47on top.
14:48Remove the big bulk
14:49that we see there.
14:50And then continue over
14:52towards the nose
14:52and remove that piece as well.
14:54We're going to tuck
14:55all the scars in very nicely,
14:57do a nice job of it.
14:58And that's basically it,
14:59okay?
15:00Let's get it removed.
15:01Let's get it removed.
15:02Levi, you're on board?
15:03Yeah.
15:05Good stuff.
15:06The stakes are kind of high
15:07for this type of tumor removal.
15:08This is going to be
15:09a lot of work,
15:10trying to remove this
15:11without creating extra damage.
15:12We have our work
15:13cut out for us.
15:14Okay.
15:14All right, well, thank you.
15:15Let's do it.
15:16Good to meet you guys.
15:17Okay.
15:20Take care, guys.
15:27I have a patient coming in.
15:28Her name is Danielle,
15:30and she was born
15:31with a port-weinstein.
15:32A port-weinstein
15:34is a vascular birthmark.
15:37It's mainly composed
15:38of blood vessels.
15:39Danielle's looks very severe.
15:41Her birthmark is taking over
15:43almost half of one side
15:45of her face.
15:46In addition,
15:47her lower lip
15:48is very enlarged.
15:51It's a pretty severe case.
15:53When these birthmarks
15:55affect the lip,
15:56the lip can actually
15:57keep growing over time
15:59because abnormal blood vessels
16:01continue to grow.
16:02Hopefully, I can help her.
16:07When I was younger,
16:08I'd have to deal with people
16:08like looking at me,
16:09asking questions.
16:12And it was like,
16:13I feel like I have to hide this
16:15just to like live my life.
16:18People just ask,
16:20did you get punched?
16:22Were you in a fight?
16:24Did someone hit you?
16:26Are you allergic to something?
16:30Those are the kind of questions
16:32that I get.
16:32They don't really care.
16:34They're trying to be rude.
16:37I like this.
16:38This is more you.
16:40Put a little plant in there.
16:42Mm-hmm.
16:42Cool.
16:50I have a port wine stain birthmark.
16:53It's congenital.
16:54Everyone has blood vessels
16:55and capillaries in their skin.
16:56I just have way more than normal
16:58and they're close to the surface
17:00of my skin,
17:00so that's what gives it that look.
17:02And it goes from this side of my face
17:04all the way over,
17:05down my ear,
17:06behind my ear,
17:08down my neck,
17:08and down my throat.
17:10I don't feel anything.
17:11It feels like normal skin,
17:12but it has affected my lip.
17:14There's just so much blood flow
17:15that my lower lip
17:16has just slowly grown over time.
17:17Because my lip is so big,
17:19I often end up biting my lip
17:21like while I'm eating
17:22or sometimes I have a hard time,
17:24like I'll stumble over my words.
17:26My biggest worry
17:27if I didn't have surgery
17:28on my lower lip
17:29is that my lip would just keep growing
17:31and growing over the years
17:32and it wouldn't stop.
17:33Some days I feel like
17:34I want to just go out
17:35and not have to worry
17:37about people looking at me
17:38or asking questions
17:39or whatever.
17:42That makes sense.
17:43Yeah.
17:43In college,
17:44my first year,
17:45social media was like
17:46just getting going
17:47and very popular
17:47to post pictures of yourself online.
17:49and I posted a picture of myself.
17:52I'd only had one lip surgery
17:53at that point.
17:54So my lower lip was still very big
17:56and some random person
17:57commented DSLs
17:59just as a comment.
18:01And I was like,
18:01I have no idea what that means.
18:03So I had to look it up
18:04and it stands for
18:06lips.
18:09That made me feel like terrible
18:12because someone really said that to me
18:14on the internet.
18:15And I just like deleted that comment
18:18and I wasn't on social media
18:20for a while.
18:28I'm excited to go to L.A.
18:30I bet you are.
18:31Yeah.
18:32Like.
18:33I'm so happy for you.
18:34I know.
18:34It's really,
18:35I don't know.
18:35I've never,
18:36I've never been.
18:37My plan is to fly to L.A.
18:39to meet with Dr. Rubello.
18:40I would like to have a laser surgery
18:42on my birthmark
18:43and on my lip.
18:44This is my last attempt
18:46to have one lip surgery
18:48that will be like the last,
18:51the last one.
18:52Are you nervous at all?
18:54I am nervous
18:55that she'll look
18:56and just kind of be like,
18:57hmm,
18:58can't really do that much,
19:00which would really be a bummer.
19:02If Dr. Rubello
19:03couldn't do surgery
19:04on my lower lip,
19:06I don't know what I would do.
19:18This program examines
19:19medical conditions
19:20and the procedures
19:20involved with treating them.
19:22Due to their graphic nature,
19:23viewer discretion is advised.
19:45Okay,
19:46today's Ron's surgery day.
19:47We are taking off
19:49his big facial tumor.
19:50So that's going to be
19:52incredibly satisfying
19:53for everyone in the room,
19:54I'm sure,
19:54but especially for Ron.
19:56Excited?
19:56Are you excited?
19:57Yeah.
19:58Yeah.
19:59Yeah, I'm a little nervous,
20:01but I know
20:02it's all going to work out.
20:03Yeah.
20:05This has been
20:06a long journey for me.
20:07I have been through
20:08a lot,
20:10having cancer,
20:12having no really
20:13good solution
20:14for having it removed
20:16and out of my life.
20:17The excitement
20:18is overwhelming
20:19to take this step
20:21to get the tumor
20:23off my face.
20:24Good morning.
20:24How are you doing?
20:26Great.
20:26Today's the day, huh?
20:27Yeah.
20:27Okay.
20:28So how do you feel?
20:30I feel great.
20:31Excited.
20:31Yeah, absolutely.
20:32Now, one of the things
20:33I'd like to do
20:34is mark out
20:35sort of the extent
20:35of what we see
20:36while you're awake.
20:37Okay.
20:38So you want my glasses on?
20:39If you don't mind,
20:40that'll be great.
20:42Excellent.
20:44As we sort of
20:45shift things over...
20:47When we mark
20:48patients out
20:49preoperatively,
20:50I'm always trying
20:50to figure out
20:51how is gravity
20:52impacting what I'm seeing?
20:53So this is where
20:54the mass sort of
20:56almost like hangs
20:57from this spot.
20:58I want to know
20:59where the borders are
21:01exactly before
21:02any incision is made.
21:03I want to know
21:04planning out
21:05where I'm going
21:05to put my incision.
21:06They serve as
21:07a reference point
21:08that we're not going
21:09to lose our
21:10anatomic bearings.
21:11I think that's
21:12looking good
21:13from my standpoint
21:14as far as
21:14incisions go.
21:15Anything else?
21:16Levi, you good?
21:17Yeah.
21:17What are you going
21:18to do today?
21:20Wait for the news?
21:22All right, guys.
21:23I'm going to go
21:24get ready, okay?
21:25Okay.
21:26And I'll see you inside.
21:27Sounds good.
21:27All right.
21:28I'll take it easy.
21:33Woo, it's cold.
21:36Heavy.
21:39Okay.
21:48Okay.
21:49Incision.
22:03So it's sort of
22:04confirming what we're
22:05seeing on the MRI right
22:06now, this big mass
22:08right here has this
22:09shell around it.
22:11Sort of it's this
22:12capsule that's
22:13containing it.
22:14So it's almost like
22:15you can stick a finger
22:16in there.
22:16In fact, let's just
22:17see if we can push
22:18through all the way.
22:20And we can.
22:22Hopefully it just
22:23pops out.
22:24So as I'm cutting
22:25into it, I want to
22:26get that skin lifted up
22:27over the tumor so that
22:29we can get to the
22:29nitty-gritty of the
22:30muscles that it may be
22:32attached to.
22:47We're at the point
22:48where we've got this
22:49tumor exposed and, you
22:51know, it's different
22:51from what we thought.
22:52The hope was that this
22:54tumor was sitting on top
22:56of the muscles.
22:56As we got in there, it's
22:57very much insinuated into
22:59the muscle layer.
23:00So a lot of the muscle
23:01fibers are going into it.
23:02Now we've got to figure
23:03out how we're going to
23:03separate those muscle
23:04fibers, keep them intact,
23:06keep them functioning
23:07while we get this deeper
23:09tumor removed.
23:10This is actually going to
23:11make the surgery way more
23:12complicated.
23:30I just flew out from New York
23:33to meet with Dr. Ravello in
23:34L.A., and I'm just worried
23:36that my lower lip could just
23:37continue to grow and grow and
23:39grow, so I'm really hoping
23:40that this works out with
23:41Dr. Ravello.
23:42Hello.
23:43Hi.
23:44Hi.
23:44Danielle.
23:45Nice to meet you in
23:46person.
23:46Me too.
23:47How's everything going?
23:48Good.
23:48Hi, Joe Capelli,
23:50Danielle's dad.
23:50Joe, nice to meet you.
23:51Where are you guys coming
23:52from?
23:53New York.
23:54New York.
23:54Well, welcome.
23:55I'm so glad you guys
23:55made it.
23:56Yeah.
23:56If you could just sort
23:57of go over your history
23:59and where you are now.
24:00So from the beginning,
24:02born with a port wine stain,
24:03so we started having laser
24:05surgery starting at like
24:06two years old to lighten it.
24:09So I've had like 15 to 20
24:12laser surgeries on my port
24:14wine stain.
24:15There is one mainstay of
24:17treatment for port wine
24:19stains, and that's laser
24:20therapy.
24:21Laser therapy actually zaps
24:23the blood vessels and sort
24:24of causes them to die or
24:26close off, and that in turn
24:28allows the appearance of
24:30the birthmark to decrease.
24:31So when you have the laser
24:34treatment, do you notice a
24:36difference afterwards?
24:37In other words, like each
24:38time you do get better?
24:39I've always seen improvement,
24:41especially the more
24:42intense the laser is.
24:43Yeah, of course.
24:44Of course.
24:44Of course.
24:45And then let's talk a little
24:46bit about the lip surgeries
24:47that you've had.
24:48My lip started growing over
24:50time, so I've had two
24:51surgeries to debulk my lower
24:53lip and make it a little
24:54smaller.
24:55And each time you saw a
24:56difference, right?
24:57Yeah, my lip was
24:58definitely smaller.
24:59I have noticed that since my
25:01last surgery, which was in
25:022016, that there's some
25:05volume slowly coming back.
25:07The challenge of doing lip
25:08surgery is that you are
25:09working with an extremely
25:11functional area.
25:13It's not just pieces of skin
25:15that we can remove and
25:16close together.
25:17There's very important
25:18muscles of the lip.
25:20They allow us to close our
25:21mouth completely.
25:22They allow us to form facial
25:24expressions.
25:25They allow us to smile.
25:27And if you cut away muscle,
25:28now you've actually lost the
25:30function of the lip.
25:31All right, let's do a quick
25:33exam here.
25:34Okay.
25:35Let's see.
25:37I can definitely see where
25:38the laser helped because I
25:40can see the areas that are
25:41still affected and then areas
25:43that are almost non-pigmented.
25:45My neck seems to respond
25:46really well.
25:47Yeah, that is a really good
25:48response.
25:49Let's see the lip here.
25:50Go ahead and open a little
25:51bit.
25:53So you have an incision here
25:55on the inside that I can see.
25:57And actually where that
25:58incision is, there's definitely
25:59a decent amount of scar tissue.
26:02This side of the lip is pretty
26:03soft, but over here it gets a
26:05little bit harder.
26:06And I see some of that down
26:08here as well from your
26:09previous surgery.
26:10We have laser treatment
26:12options for her port wine
26:13stain, but the lip is going to
26:14be tricky because she's already
26:16had a couple of surgeries and
26:18being able to differentiate
26:19what's muscle, what's related
26:21to the port wine stain, and
26:22what's just scar tissue is going
26:24to be a challenge.
26:25If you go in there and you start
26:27cutting away muscle, it could
26:28paralyze her mouth.
26:35That side's definitely a little
26:36bit firmer on that side.
26:38I'm sure you can feel that.
26:39Mm-hmm.
26:40Danielle's lower lip is much
26:42larger than her upper lip.
26:44This could potentially keep
26:45growing and could become more
26:47of a problem to address that.
26:50I'll remove what's obviously
26:51scar tissue and as much diseased
26:53tissue as I can while preserving
26:55normal anatomy.
26:57I do think that we have some
26:59options.
27:00Mm-hmm.
27:00I think we should start with the
27:02laser you've already had that
27:03you've responded really well to.
27:05I like to go back in and get
27:06those areas that still need to be
27:08addressed on the face and neck.
27:10And then I would like to reduce
27:11the size of the lower lip.
27:12So go in through your same
27:14incision on the bottom and take
27:15out some of that scar tissue to
27:17make it smaller.
27:17And what we don't want to do is be
27:19too aggressive and take out
27:21normal functioning muscle that you
27:23need in the lip.
27:24But I do think we can make it at
27:25least a little bit smaller.
27:27Great.
27:28So part of the reason the lower
27:29lip looks like it's so much
27:30larger is because the upper lip
27:32is smaller.
27:32Yes.
27:33Yeah.
27:33So I'd like to do a little bit
27:34of filler and Botox in the upper
27:36lip to make it a little bit
27:38larger to give it a little bit
27:39more symmetry.
27:40I never really thought about
27:41making the upper lip bigger to
27:43match a little bit like
27:45proportionally.
27:46Right.
27:46I was always trying to make the
27:47lower lip smaller, smaller,
27:48smaller.
27:49So that's a really cool idea.
27:51Okay.
27:51So you want to do this?
27:52I'm so excited.
27:53Okay, she's in.
27:54We really only have laser
27:56treatment options for her port
27:58wine stain.
27:58My concern is that she may have
28:00plateaued in her treatment
28:01response, but I think it's
28:03worth a shot.
28:04For the lip, I don't know if I
28:06can go in and remove a whole
28:08lot more.
28:09So that is the big unknown.
28:10She is a very complex case.
28:12This is not going to be an easy
28:14surgery.
28:24So now we're on the intense part
28:26of this surgery.
28:26We're on the bottom half of the
28:28tumor.
28:28Yeah, this little guy's a monster.
28:31It's not great that the nerves
28:33and the muscles are sort of
28:34entangled with this tumor, and I
28:36got to do my best to separate the
28:38tumor away from these structures
28:39without damaging them.
28:46Yeah, pretty much every cut
28:47counts.
28:48I mean, you can hit a nerve, a
28:49blood vessel.
28:50At this level, anything goes.
28:52These nerves don't always look
28:54big.
28:55They're tiny and inconsequential in
28:57their appearance sometimes.
28:58You could go right through it with
29:00the flick of a blade.
29:01You could paralyze his face, and
29:02that's it.
29:03It's the end of it.
29:04So I'm being super cautious,
29:06super meticulous as I'm approaching
29:08these deeper structures.
29:26Now we're almost ready to take the
29:28big, giant piece off his cheek.
29:29We're on the bottom-most surface.
29:31There's only a little, tiny
29:32connection left.
29:51It's such a relief to have this
29:53thing finally off his face.
29:55There she is.
29:56That's what we pulled out.
29:58That's what he was living with for
29:59four years.
30:00Pretty impressive.
30:01It basically feels kind of like a
30:04mushy softball, so it's almost like
30:06you could squeeze it, but then not
30:08all the way.
30:08But it's pretty fleshy, that's for
30:11sure.
30:12I mean, this thing was like an atom
30:14bomb that went off in his cheeks.
30:16I'll set this back here for now.
30:19It just rolls around.
30:21The next step is going to be to
30:22address the lip and the nose.
30:24We're taking this out in a piecemeal
30:26fashion.
30:26It doesn't want to come out in one
30:28piece.
30:29It just breaks off.
30:30So all these little bits came out from
30:31the upper lip, believe it or not.
30:33The nose is a little bit different.
30:35Took the entirety of that mass from
30:37inside the nostril.
30:42Okay.
30:42That's that.
30:44So I'm feeling pretty good.
30:45We got what we wanted out, which was
30:48that big mass on the cheek.
30:50I'm sending this off to pathology.
30:51I won't know definitively what this
30:54thing is until they give me a final
30:56result.
30:56Can it be something worse from the
30:58diagnosis that he's already been
30:59given?
31:00It can be.
31:01Is this one of these cancers that can
31:03spread, for example, go to the lungs,
31:05go to the brain?
31:06We don't know that yet.
31:21So are you ready for this?
31:23Yeah.
31:23Yeah?
31:24Yeah.
31:24I'm a little nervous.
31:25It'll be good.
31:26It'll be fine.
31:26Yeah.
31:28Hi.
31:28Hi, doctor.
31:29How are you?
31:30I'm okay.
31:30How are you guys?
31:31I'm good.
31:31Really good.
31:32Yeah?
31:32Yeah.
31:33You ready?
31:33I am.
31:34Good.
31:34We're going to do the laser procedure
31:35in here.
31:36Okay.
31:36Just trying to blend that
31:38pigmentation.
31:39Once you finish with the laser,
31:40we're going to go back to the
31:41operating room and work on the lip.
31:42Sound good?
31:43Yes.
31:43You ready to get started?
31:44Yes.
31:44Like right now?
31:45Yes.
31:45Okay.
31:46Good.
31:46Me too.
31:47All right.
31:47Good luck, honey.
31:48I'll see you later.
31:48Love you.
31:48Love you.
31:50The first thing we're going to do
31:51is get you numbed up.
31:52Okay.
31:53Put a numbing cream on the skin.
31:54Whatever you do, don't lick your
31:56lips.
31:56No.
31:56Oh, my God.
31:57Your tongue will go numb for
31:59sure.
31:59The first part of Danielle's
32:00treatment is going to be the laser
32:02to reduce her port wine stain.
32:04The laser is designed to target
32:05specifically pigments on the red
32:07spectrum.
32:08The idea is that this laser zaps
32:10that red pigment and sort of blows
32:12it up.
32:22You could see where the skin that
32:24had been treated got this dark,
32:25bruised color, and that's actually
32:27a really good thing.
32:28That's what you want to see,
32:29because it means that those areas
32:30picked up the laser and those blood
32:32vessels were blasted.
32:33We lasered the rest of her face
32:36and neck, and now we've moved on
32:37to doing her lip surgery.
32:49I don't know what I'm going to find
32:50when I go into this lip.
32:52She's already had a couple of
32:53debulking surgeries, but my plan
32:56is to go in and remove a whole lot
32:58more.
32:58My concern is that she's going to
33:01have a lot of scar tissue mixed in
33:03with normal tissue, and I'm not going
33:05to be able to tell what the
33:06difference is between the two.
33:08We have to be pretty precise about
33:10removing scar tissue without
33:12compromising functioning muscle.
33:14So my plan is just to go in here,
33:17excise this old scar, scoop out as
33:20much abnormal tissue and scar that I
33:22can, advance this in, and close it a
33:24little bit more to reduce some of that
33:26mucosal show.
33:27Okay.
33:29Incision.
33:39Normal lip, there's a distinct
33:41separation between each of the layers
33:43of the lip, and usually it's a very
33:44smooth dissection.
33:46You can go sort of layer by layer.
33:48And in her, all of the layers are
33:50sort of fused together.
33:51This is definitely not ideal.
33:54It's scary when you can't find
33:55normal anatomy because you don't
33:58know what you can take, what you
33:59can't.
34:00Maybe there's some normal muscle in
34:01there.
34:02I can't see any.
34:03All I'm looking at is this really
34:04firm, unhealthy, unnatural-looking
34:07tissue.
34:07This was literally the worst outcome I
34:10could have hoped for.
34:19This is definitely not ideal.
34:22So, we've been chiseling away at some
34:24of this hard scar tissue, and we
34:27haven't been able to find any muscle
34:28that actually jumps when we touch it.
34:30Muscles should jump and contract, and
34:32we just haven't seen that so far.
34:34It kind of looks like a bomb went off
34:35in here.
34:36Planes are fused together as a result
34:38of previous surgeries, as well as just
34:40your underlying disease.
34:42It's like when you have a layer cake
34:44and somebody smashed it, and then
34:46you're told to go in and unsmash it
34:48and find out where the layers are.
34:49It's impossible.
34:50And then you find that one jelly
34:52layer, and you're like, ah, I know
34:53where I am.
34:57We have muscle.
34:58We found some muscle.
35:00Found some muscle.
35:01Ah, we've removed some of the scar
35:03tissue that was sitting on top of the
35:04muscle, and for the first time, we
35:07see the jumping muscle.
35:09See that?
35:10Ah, that's good.
35:12Yeah, that's what we were talking
35:13about, looking for.
35:14It's a big win.
35:15Finding the muscle is a huge relief
35:16because now I have a roadmap to this
35:19lip.
35:19So identifying the muscle allows us to
35:22now know, okay, this is the normal
35:24tissue, and everything that we've come
35:25through above it is abnormal, and we
35:28can get rid of it.
35:29So we've debulked to the level that I'm
35:31happy with, that I feel safe debulking,
35:33and now we're going to start closing.
35:35We get this lip all closed up.
35:36You really can't tell at all that we've
35:38done anything because it's so swollen,
35:40but I know we took out a lot of scar
35:42tissue, so I'm confident that it's
35:44going to make a difference.
35:45And now we're going to do a little
35:46bit of Botox, and then we're going
35:47to put a little bit of filler
35:48throughout the entire upper lip just
35:50to give it a little bit more volume
35:51to match the lower lip.
35:54All right, we're done.
35:56We're all finished.
35:57The hard part is now on Danielle.
35:59The tissue of the lip is paper thin.
36:01It heals fast, but until it heals,
36:04it is very fragile.
36:06I'm pretty happy.
36:07I never tempt fate.
36:09I never leave the room being like,
36:10yes, nailed it.
36:11No.
36:12It's usually the dudes that are high-fiving
36:14each other and patting themselves on the back,
36:16and so good.
36:17Once we're healed, once everything's done,
36:20then I will allow myself to say, good job.
36:24So I am pretty happy, which is actually
36:27pretty good for me.
36:43Danielle's coming in today for her follow-up,
36:45and I'm really, really excited to see
36:47how she's coming along.
36:48I'm really looking to see how much we were able
36:50to decrease the size of the lower lip,
36:52and I want to see how much we were able
36:55to take some of the pigment out of that birthmark.
36:57The concern is always that the lip
36:59is going to grow more.
37:00So maybe we did the surgery and shrunk it,
37:02but in the interim, it's continued to grow.
37:05So that is definitely a concern.
37:11Hello, hello.
37:13Hi.
37:13Hey, how are you?
37:14I'm good. How are you?
37:15I'm doing okay.
37:16You look great.
37:19There used to be so much volume
37:21that it really seemed lopsided,
37:22and now it just is, like, really even.
37:26My neck was always kind of blotchy before,
37:28so the neck was, like, amazingly light,
37:30and then the rest of my face
37:31did lighten up quite a bit.
37:33It just feels good.
37:34Yeah.
37:34Oh, it looks good.
37:35Yeah.
37:35And I know that it's only going to get better
37:37as the swelling continues to come down and soften up.
37:40I'm really excited, too.
37:41I just know it's going to get even better
37:42and better and better,
37:43even though it looks fantastic right now.
37:45All right.
37:45You're going to have a good one.
37:46You too.
37:47I just thank her so much
37:49from the bottom of my heart
37:50because I think it's changed my life
37:51in a bunch of different ways.
37:53I feel like myself.
37:54I feel good on the inside,
37:55and now I feel good on the outside.
37:58I feel more confident,
38:01and I feel like the way that I look belongs now,
38:05and I feel like it just is the way it's supposed to be.
38:25Ron's coming in for his follow-up.
38:27What I hope to see today,
38:29we want to see the normal anatomy return.
38:31We want to see how things are moving in the face.
38:36The surgery was basically a big biopsy.
38:38We sent that specimen to the lab,
38:40and now we have the report.
38:41We're going to go over that with Ron.
38:45Hey.
38:46Hello.
38:46Hey, there's the man.
38:47How are you?
38:48I'm doing great.
38:48How are you?
38:49You look awesome.
38:51This is great.
38:52Are you glad you did it?
38:54I am very glad.
38:55Good, good, good.
38:56I'm very happy.
38:57I mean, this is a big win so far,
38:59as far as I can tell,
39:00but let me sort of come in a little bit closer
39:02and just see how these scars and everything are looking.
39:04And look at that.
39:05It's looking really good.
39:06The scars are healing nice.
39:08You got a good contour to the cheek.
39:10The symmetry is quite good as well,
39:12and this is great right now.
39:14So one of the things that I wanted to talk to you about
39:17was the actual diagnosis.
39:21We got the pathology report back,
39:23and it is dermatofibrosarcoma protuberance.
39:29What that means is essentially
39:30that it is still considered a malignancy
39:32or a cancer, if you will.
39:35I do have concerns about reoccurrence.
39:38It is still something to kind of keep in the back of your mind.
39:42It is cancer.
39:44It's not the best news, having cancer,
39:48cancer, but it's going to cause me to be more vigilant,
39:52to look after the small growths that I might get,
39:55and to take care of them right away.
39:56I think we have a little bit of a follow-up plan in place.
39:59We still got to be vigilant about this,
40:01but I think you've got a bright future ahead.
40:03Well, you know, I want to thank you for the work that you do.
40:07It's changed my life.
40:09It is an absolute pleasure.
40:11Okay, thank you very much.
40:12Of course.
40:14Really grateful for Dr. Fernosian.
40:17He's given me hope, my family hope,
40:19and he's got a great gift.
40:31All right, so you guys remember our guy, Ron?
40:35Oh, yeah.
40:35Oh, yeah.
40:35He sent us a video.
40:37Let's just check it out.
40:38Yeah.
40:39Hi, doctors.
40:40It's Ron, and I'm in Iowa.
40:43As you can see, I don't have a tumor on my face anymore,
40:45and, you know, it's really changed my life.
40:48I sell insurance now,
40:49which I never would have been able to do before.
40:52Every once in a while, we'll do a spinning wheel.
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