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About Face Season 1 Episode 3
#AboutFace
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#AboutFace
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Short filmTranscript
00:00This program examines medical conditions and the procedures involved with treating them.
00:04Due to their graphic nature, viewer discretion is advised.
00:09I was born a normal baby, but over time the tumor started to grow.
00:14Every single interaction is a reminder that I'm different.
00:20This is a very widespread infiltrative type of tumor. It's kind of large. Is it kind of heavy?
00:26Oh yeah. It's got some weight to it. Yeah, I can feel the weight.
00:28You don't know where the normal begins or the tumor ends.
00:32Treating it is not as straightforward as it may look.
00:36We have to be pretty precise about how you remove it.
00:40If we don't get these muscles on the right tension in the right direction, it can't function as a mouth.
00:46Looks like this is a bleeder.
00:48It's basically racing against blood loss.
00:50Move, move, move.
00:51Trying to remove more tumor is just going to be life-threatening.
00:54If we can't get control of it, then we've got to stop.
00:58Trey Matlock
01:04Hello. Oh, hey.
01:07Hey, Andre.
01:08How's it going?
01:09What's happening?
01:09How's it going, buddy?
01:10I'm good.
01:11What you got?
01:12Okay, so I have a patient coming in.
01:15His name is Trey Matlock, and he's got tumors, and these tumors can be massive.
01:22Trey's case is a condition called neurofibromatosis, and you know, I deal with this condition a lot.
01:28I specialize in it, and when it happens on your face, it's pretty noticeable.
01:32It's almost impossible to hide.
01:35It sort of distorts the half of his face.
01:38It goes across the scalp area, and it actually dives down along his hairline in the back.
01:45It's almost like it gives you the impression that it's hanging.
01:47Yeah, it's literally pulling his eye down.
01:50The weight of it looks like it's pulling the corner of the eye down.
01:54It just looks swollen. It almost looks like a boxing match to me.
01:57I mean, yeah.
01:58His ear's actually a little bit lower and almost even tilted back.
02:02We want like, what, a 20-degree tilt, and this is like close to the 90.
02:05Exactly. So the idea is to get him some sort of relief from the tumor, but one of the things that
02:11I always worry about, these things bleed. They bleed a lot, and they bleed fast. I'm talking about
02:17life-threatening bleeding. I mean, it's already a very vascular area. I mean, people can literally
02:22bleed to death from the scalp if you don't get it closed. I can tell you that a lot of people try,
02:27and they aborted the surgery because it was too much bleeding, and they didn't account for that when
02:33they went in. Yeah, I mean, I think it's gonna be challenging, but, um, I think it's worth a shot.
02:37It's definitely worth a shot, and he's in great hands with you, so. All right, we'll do it.
02:46I want to be able to go out and not have kids scared of me or wonder what's wrong with me.
02:53It's a genetic disease. One in 3,000 people, I believe, have it.
02:59I got it from my mother who got it from her mother,
03:01and I'm the only one from my generation who has it.
03:13Every day, I get a sharp pain on the side of my head.
03:20I was born a normal baby, but over time, the tumor started to grow.
03:24I first noticed I was different in elementary school because I tried to play sports like football,
03:32and when I tried to put a helmet on, it didn't really fit me like the other kids.
03:38It was hard for me because I just wanted to be a normal kid and play sports with my friends,
03:43but I really couldn't play because of my condition.
03:49I have a tumor on the back of my neck that hangs down.
03:53I have a tumor here, a tumor here, and also my ears, uh, it causes it to deform,
03:59and it sits lower than my other ear. When I look in the mirror, my biggest fear is that the tumor
04:05will get bigger and eventually just grow and grow.
04:12I don't want to hide who I am.
04:18What's up, man?
04:19What up, brother man? How you doing?
04:20How you feeling?
04:21Good, good.
04:22It's good to see you, bro.
04:23Always, always.
04:26So what they talking about, man? What you got going on?
04:28Elijah is my best friend. We knew each other about nine years, going on ten. We met in college
04:34in southern Colorado. I feel more comfortable with him than anybody else. He really brings me out of
04:40my shell. Like, he doesn't let me get inside of my own head. He keeps me going.
04:45You ready for some football?
04:47Yeah, while we're out there, we got to catch, like, a Rams game or something like that.
04:49Let me see if we can get some tickets out here, man.
04:52Probably going to be gouging us for the tickets, though.
04:54For sure, bro. Like, I'm trying to keep my mind occupied, not really, like,
04:58thinking about going, like, going out there, but at the same time, like,
05:01my mind's been racing about going out there.
05:03Right.
05:04The plan is to fly to Los Angeles and meet with Dr. Pernozian.
05:07And Elijah is coming with me because he's been there for me since the beginning,
05:11and I really want him to be there to support me now.
05:14Hoping they can just do as much as they can and just
05:17make me feel more confident.
05:20Yeah.
05:20Like, when I walk around in public, it feels like everybody's eyes on me.
05:24It's, like, the spotlight. Like, I want to be able to just walk around and...
05:28Yeah, and I see that, too.
05:29Yeah.
05:30Obviously, I would be lying if I didn't say that I saw a physical difference,
05:33but because I was able to start building a friendship with him immediately,
05:37it was more of who he was as a person.
05:39His strong will and his ability to push through something that not many people have to deal with.
05:45And when you get past that shy exterior, he's always wanting to have fun.
05:49I want other people to be able to see that also.
05:51It's the hardest thing for me, like, to not notice back.
05:56Yeah.
05:56And it hurts sometimes because I want to feel how I feel on the inside, on the outside.
06:01The inside of me loves to go out, loves to have fun, play sports with his friends.
06:09But the person on the outside wants to isolate itself.
06:13Just hang out inside and not be around people.
06:18Just never be seen again.
06:20Growing up to L.A. soon, man, I'm really excited to do this.
06:23You feeling nervous since it's new doctors, new experience, new environment type of thing?
06:27Yeah, yeah. Like, I've had, like, a lot of people, like, tell me no or, like,
06:34we're too scared to do it. And this is not, this is, like, a great opportunity to see what can be, you know?
06:39So I've seen many doctors who told me they can't do the surgery.
06:43They don't want to take the risk because it's a very bloody surgery.
06:46Like, I felt like I was helpless and no one could help me change, like, my condition.
06:51You got some of the best doctors in the world working on it, too.
06:53So that's another bonus.
06:54Oh, yeah, it's exciting.
06:56I am very nervous to meet Dr. Pranozian because I've heard no so many times.
07:00I don't want to get my hopes up and just have another letdown.
07:12Hello. Hi.
07:13Want to see Dr. Pranozian?
07:14Perfect. If you could sign in.
07:16My emotions are on a roller coaster right now.
07:18I'm hoping you can help me. Just excited, nervous, anxious, scared.
07:25Everything is all going to one right now.
07:31All right, we're here.
07:32I know, man. It's exciting.
07:34I got a little nervous just now.
07:35Yeah. Bro, hospital rooms always get me. I don't know why.
07:44Looking at trace photos, I'm seeing a giant tumor. This is definitely on the extreme side.
07:50This is a very widespread infiltrative type of tumor.
07:55I'm always worried about bleeding. These tumors are fast bleeders.
07:59They don't clot normally. In a matter of seconds, you can lose hundreds of cc's of blood.
08:05There's a ton that can go wrong with this.
08:07He's just going to come in here straight, sedate you and start surgery right away?
08:09That's all I want, bro. Come here with this.
08:12Hello. How are you doing, sir?
08:13Hey, how's it going?
08:14Good, how are you?
08:15Great. I'm Dr. Pranozian. Good to meet you.
08:17Good to meet you.
08:17Nice to meet you, Elijah.
08:19And how are you guys related?
08:20Basically, my brother, my best friend. I knew him since college.
08:23Your buddy's getting surgery. You're going to come out.
08:25Absolutely. I got to be there for moral support, right?
08:27Yeah. So let's talk a little bit about why you're here today.
08:31I was born with neurofibromatosis. Pretty sure you know it's like a genetic disease.
08:35And it's going to pass down for me from my mother, who got it from her grandmother.
08:38And just trying to figure out the next step of having surgery with it.
08:41Neurofibromatosis is a genetic condition. You're born with it.
08:45And it involves the formation of nerve-related tumors throughout the body.
08:50Sometimes they can be these smaller, very discrete masses. And other times, such as in
08:54trite, it's this big continuous mass. And they pose a big reconstructive challenge.
08:59Let's take the glasses off for a second. Let's take a look here a little bit.
09:08I'm going to just sort of look at everything starting from the back here. And it looks like
09:11you've got a nice large piece still back here in the back of the scalp.
09:15Yes. It's kind of large. Is it kind of heavy?
09:17Oh, yeah. It's got some weight to it.
09:18Yeah, I can feel the weight. So like I can like lift it up and just feel like
09:21a difference when I lift up rather than when it's down.
09:24It's probably adding somewhere around a pound or two to his head weight.
09:28Now, it doesn't sound like much, but if he turns his head, if he moves, it sort of swings.
09:34So you're adding that mass, that momentum mass there and slowly growing. It's a lot.
09:41He can develop some spinal issues as time goes. And we're going to have a serious problem.
09:48This is the most critical part of the surgery.
09:50Ambie could be left with a huge hole in her cheek.
09:56Shoot. It's a lot of bleeding.
09:58These dark pools of what looked like squidding kind of scored out.
10:01Keep them coming. Keep them coming.
10:02Now it's a race against time before we get into a life-threatening situation.
10:06Move, move, move.
10:11Now, the most obvious thing that I'm seeing here is the position of the ear has changed.
10:24So it's a little bit further back and it's sort of dropped down and it's also kicked out a little bit.
10:28It looks like you have what we call a plexiform neurofibroma, basically ill-defined tumors.
10:36There's no perfect border to it.
10:38When people think of tumors in general, they may think of something like a little marble popping right
10:44out or a little golf ball or something like that. Some people even talk about a big softball.
10:48But what Trey has is completely different. They're sort of what we call diffuse.
10:51They enter the tissues. You don't know where the normal begins or the tumor ends.
10:56Now, we've got that mass here and it sort of continues and obviously goes all the way to the back of your scalp.
11:01But the good news is that we do have a surgical option here.
11:06Like this is like really exciting for me to like actually have the opportunity to get a surgery.
11:10My plan for you is remove the tumor as much as possible in one surgery.
11:17Okay.
11:17The bigger it gets, the harder it is to remove. If we don't get to him now, this is going to
11:23potentially grow and give him spine problems, maybe sit on the facial nerve and give him some
11:27facial nerve paralysis. So we do need to address that.
11:30So once that tumor is removed and much of it's gone, I'm going to reposition the ear, anchor it back
11:35down against the skull. Then we can really kind of look at that symmetry and just nail it down.
11:40Okay.
11:41At this point, I want to take some photos of you, 3D photos to be exact.
11:44What that allows me to do is sort of figure out what we might expect out of the surgery.
11:48Okay.
11:49Look at a point over in the distance in front of you.
11:52Okay.
11:52And these will just be a few quick little pictures here.
11:57It's really helpful when we have this technology because we can then in real time show the different
12:02problems from different perspectives, which helps people understand not only the severity of
12:08their problem, but what we are going to do to help correct it. So this is you.
12:13Oh, wow.
12:14And we'll outline that bulge area and sort of pull it in.
12:19Wow. That already makes a huge difference.
12:20Isn't that great?
12:21Yeah, it's crazy.
12:22Oh, wow. It's a big difference.
12:23This is your post image to show what our goal is to move that cheek volume back in.
12:29Looking at those pictures gave me a lot of like hope.
12:33This is what we might see afterwards, the tumors removed from this location.
12:38What do you think?
12:39Seeing this gave me like the utmost like excitement for this.
12:44Great. That's our goal. And I think we can get pretty close to that.
12:49Now, with that said, one of the challenges is going to be these tumors have a risk of bleeding
12:56quite a bit. And if it bleeds way too much, we have to stop.
12:59Okay.
13:00The scariest part is if the doctor can't do anything for me, the tumor will get bigger and
13:05eventually this grow makes me feel this anxious all over again.
13:11So this part way back here in the scalp, I think that would be a good starting point.
13:15Okay.
13:15Because that will give me an idea, does this tumor bleed while staying safe in an area that's going to heal
13:20fine. Okay.
13:21So we can move forward with doing the surgery.
13:24I'm really excited for that.
13:26All right.
13:27I'm happy, like really.
13:28Terrific.
13:29I really hope that Dr. Pronosian can help me because I want to be able to start my life
13:34with dating, going out, hanging out with my friends and everything.
13:38Going into this type of surgery, we've got a lot of questions.
13:42For big, giant neurofibromas like this, I'm hoping we get all of it out if possible.
13:48But the worst case scenario is if we just make our opening incision and it just bleeds way too
13:52much and we have to stop.
13:53Excellent.
13:54Boss, any questions?
13:55Nothing for me.
13:56I'm excited for him.
13:57I just told him, as long as he doesn't look prettier than me after, then we're good to go.
14:02We're ready for surgery.
14:03All right, let's do it.
14:04Okay.
14:04Excellent.
14:05Thank you, sir.
14:06Much appreciated.
14:06Excited for it.
14:07Great to meet you guys.
14:08See you soon.
14:11So I have a patient coming in today.
14:21Her name is Ambie, and Ambie was born with a vascular birthmark or a vascular malformation
14:27of the corner of her mouth.
14:28My biggest concern regarding Ambie's birthmark is really how big it is internally.
14:35There's a component that I can see on the outside, but there is a strong chance that there could be
14:41a more extensive involvement inside the mouth as well.
14:44I may not be able to take the whole thing out because it would just leave a giant hole
14:48at the corner of her mouth and on her cheek.
14:50That would end up causing way more problems than she currently has.
14:56Growing up, kids would call me fishhook face.
14:59Being bullied and called names.
15:05Every single interaction is a reminder that I'm different.
15:09I can remember all the way back to kindergarten and wanting to kiss a boy and the boy saying,
15:25I'm not going to kiss you until you take care of that thing on your face.
15:29No way.
15:34Yes!
15:34Did it go in?
15:36It went in.
15:37Yeah, it did.
15:38You want to sit down?
15:39Mm-hmm.
15:39When I was born, it was just a tiny little purple speck in the corner of my mouth,
15:45but it just continued to grow as I grew.
15:48I had surgery when I was five where they took out a good portion of it.
15:53And then between then, through my teenage years, we tried a laser treatment.
16:00We did a couple saline injections to try and shrink it.
16:04And at that point, they had told me there really wasn't much more that could be done.
16:08I had kind of reserved myself to believing, like, this is, this is it.
16:13Oh, my goodness.
16:16Did you have fun?
16:16Yeah, it was awesome.
16:17Yeah.
16:18So are you ready?
16:19How's it going to feel having surgery now?
16:25I think I felt very discouraged after that last consult.
16:29He was just very adamant, like, there's really nothing more we can do.
16:34I think there was, like, a part of me that was, like, scared to inquire for the fear that
16:40the answer would still be no.
16:41Yeah.
16:42A big reason for wanting surgery was just so I didn't have to, like, worry about, you know,
16:49having it bleed.
16:50It can bleed very easily.
16:53If I eat something sharp, if my dog nips at me in the wrong spot, it bleeds and it doesn't stop
16:59until the skin is healed. And the skin can't heal so long as I'm talking or moving my mouth.
17:05It's just very exposed and vulnerable.
17:08So how's it going to feel not to have to worry about people staring in public?
17:14It's like, it's something that's been my reality my whole life. I think it'll be a burden off.
17:20You know, I think I'll start to kind of, like, open up a little bit.
17:24So the plan is I'm going to go to L.A. and meet with Dr. Ravello and she's going to let me know if
17:30there's anything she can do for me. I'm excited. I'm excited. I'm nervous.
17:36I'm going to miss my little buddy.
17:37Yeah. You little weirdo.
17:47Hi.
17:48Hi. Welcome.
17:49Are you here to see Dr. Ravello?
17:51Great.
17:55I get people saying, what is that on her face?
17:58Why doesn't she get that taken care of?
18:01Go ahead and take a seat. My doctor will be with you shortly.
18:05It's exhausting and it does hurt when it's pointed out to you your whole life that it's different.
18:12Oh my goodness.
18:15Hello, hello. Hi.
18:18How are you?
18:18I'm good. How are you?
18:19Very good. Good to see you.
18:21Yeah, good to see you too.
18:23Andi, Josh.
18:24Hi.
18:24Josh. Josh is...
18:26Partner.
18:27Partner. You know, I always ask, I have to clarify because I've made some mistakes.
18:30I'm like, oh, you brought your mom with you.
18:32Oh my God.
18:33Oh, that's my wife.
18:35Well, how are you feeling today?
18:37I feel good. I feel excited.
18:38Good, good, good.
18:39Yeah, yeah.
18:40If you don't mind, let's take the mask off.
18:42Let's do it.
18:42And let's talk a little bit about why you're here.
18:55What's going on?
18:56So I have a vascular malformation that I had surgery on when I was little 20 years ago.
19:05They said there wasn't much else that could be done.
19:08I've kind of just accepted that reality and lived my life.
19:13So how old were you when you first had a surgery for this?
19:17I was five.
19:18You were five years old.
19:19I was five, yeah.
19:19Okay.
19:20And after they did the first surgery, was that malformation completely gone or did you still have
19:27some left behind?
19:28There was definitely some left behind.
19:30That small part that was left continued to grow as I grew.
19:34Got it.
19:35This is going to definitely keep growing and could become a huge problem.
19:40We have to address this.
19:41Well, with that in mind, may I take a look?
19:44Let's do it.
19:45Okay.
19:46Does any of this hurt?
19:47Does it hurt when it's touched?
19:48Not at all, no.
19:49Okay.
19:51Close your mouth here.
19:52So what I can see here, you have this scar from your previous resection that comes down vertically
20:00this way.
20:00Then open a little bit.
20:02And then on the outside, you have this kind of conglomeration of abnormal blood vessels
20:09coming out the corner of the mouth.
20:11And then open again.
20:13It continues around to the inside for a couple centimeters.
20:17And so it's really almost kind of like this wrapping around the corner.
20:22Right.
20:22Of your mouth.
20:23Okay.
20:23And then open all the way.
20:26Okay.
20:26Ambie's malformation is in a very tricky area.
20:30The external part involves the corner of the lip.
20:33And then on the inside, it's pretty large.
20:35I mean, it's definitely a couple of inches at least.
20:39That means that I can't remove the whole thing.
20:41I can't take out this entire malformation because it would be half of her cheek.
20:46This definitely makes things much more challenging.
20:52This program examines medical conditions and the procedures involved with treating them.
20:57Due to their graphic nature, viewer discretion is advised.
21:01And then close your mouth and do like a whistle blowing move.
21:04Yeah.
21:05And then go like this.
21:07Yeah.
21:07So you have really good muscle.
21:09That's good.
21:09The muscle is retained and strong.
21:12You have a strong mouth.
21:14So when I was examining Ambie, I noticed that the external part of this
21:20malformation actually curves around and then extends into the inside of the cheek.
21:26This may not be the largest malformation, but its location makes it very tricky and complicated to treat.
21:34So I'm sure you know or you've been told before that this is a hemangioma.
21:37Mm-hmm.
21:38Hemangioma is a collection of abnormal blood vessels.
21:42You're born with it.
21:43The problem with yours specifically is the location.
21:46That corner of the lip has a very vital function to the lip.
21:51It controls a lot of the movements of it.
21:53The other concern is that it goes all the way around and is through and through.
21:58Yeah.
21:58So it's going through all the layers of the lip.
22:01That's the inner lining, which is the mucosa, the muscle, as well as the skin on the outside.
22:06Okay.
22:06That side of the lip is already a little bit shorter than the other side.
22:10Yeah.
22:11And further surgery to remove that area could shorten it a little bit more as well.
22:16Yeah.
22:17So treating it is not as straightforward as it may look.
22:21You can't just cut it out and sew it back together and call it a day.
22:24Right.
22:25And that's because it involves so much of that critical part of the mouth.
22:28Mm-hmm.
22:29I do think it is possible, though, to remove it or perhaps only one part of it.
22:34Since the outside is the part that we can see, I think we can definitely start by addressing the outside part first.
22:41Yeah.
22:42Does it sound like something you might want to do?
22:44Yeah.
22:45Yeah.
22:45Let's do it.
22:46Yeah.
22:46Okay.
22:47Good.
22:47All right.
22:48Let's do it.
22:49All right.
22:51My concern about this surgery is how much of a normal lip I'm going to be left with
22:57once we remove this vascular malformation.
23:00We have to be pretty precise about how you remove it.
23:03If you go in there and you start cutting away muscle, now you've actually lost the function of the lip.
23:14It's finally here.
23:29The day is here.
23:29I'm a little nervous, to be honest with you.
23:31I'm, like, a little nervous for you and I can only imagine what you're going through.
23:34But yeah, man, just going with the punches, going with the flow.
23:38Hello.
23:39Hey, how are you guys?
23:40How are you doing?
23:41You ready?
23:41Yes.
23:42Awesome.
23:42Good to see you, sir.
23:43All right.
23:43This is it.
23:44Oh, yeah.
23:44I'm ready.
23:45For me, this is a challenge, but it's also fun.
23:47So I like seeing the changes and, and, you know, you get the benefit from that, too.
23:52Oh, yeah.
23:52I'm hoping for the best.
23:54Yeah.
23:54And I got anything you can do for me is amazing.
23:56What are you going to do in the meantime?
23:58Sunday football, man.
23:59I'm going to watch some football.
24:00I'll wait around.
24:01Let's get in there and get this done, okay?
24:03Thanks, sir.
24:04All right, good.
24:06That made me feel a lot better, too.
24:07Yeah.
24:08Like, just him being relaxed, joking around.
24:11It's like, I'm more relaxed, more ready now.
24:13Yeah.
24:13It's game time.
24:15I'm ready.
24:18Today is Trey's surgery, and neurofibromatosis is one of my specialty areas surgically.
24:23So I, I deal with this a lot.
24:26And they are challenging.
24:29Okay.
24:30You can knock out the nerve.
24:31You can create some life-threatening bleeding.
24:33So we always have to think about how to approach the problem.
24:36All right.
24:37So we got our patient here, Trey.
24:39I think we can just kind of dive in, scoop out as much of that as possible.
24:42Today, I'm helping out Dr. Panossian with Trey Matlock.
24:45This is a very impressive tumor.
24:47He has entire areas of his scalp that don't grow hair because it's completely covered and involved by the tumor.
24:54I'd like to get rid of all this stuff, too.
24:56For sure.
24:56This stuff is...
24:56That'll make a big difference.
24:57Yeah.
24:58My plan for Trey today is to start with the tumor on the back.
25:02The nerves are not that important in that area.
25:05And it gives me a sense for how much bleeding I'm going to encounter.
25:08Incision.
25:10Start with a little something like this.
25:13And you can kind of tell it's already looking kind of amorphous.
25:21That's what these things look like right here.
25:23It's kind of little forms of grapes and worms.
25:26That's kind of what it looks like.
25:28Look at that.
25:28It's like gray in there.
25:29It's definitely not normal.
25:30Yeah.
25:31See that?
25:31Look at that.
25:32That's the grayish junky tissue.
25:34That's a tumor.
25:34It's crazy looking.
25:36Look at that.
25:36It's like ink.
25:37It's like octopus ink.
25:38I was going to say it looks like squid ink.
25:39Yeah.
25:40These tumors got multiple colors and tones to it.
25:43Texture is different.
25:45It's almost gelatinous in terms of what you're touching.
25:47It's like jelly almost.
25:49And some of it is the tumor.
25:50Some of it is the effect of the tumor on the normal tissues.
25:53So I got in my hand about a size of a softball of the tumor.
25:57And that's going to end up coming out.
25:59And then we're going to see if we can take out some more after that.
26:02We have a big giant piece.
26:04Quickly go through the stuff here.
26:05I'm going to just take out more tumor from underneath it.
26:09It's a big old deal.
26:14We just got rid of a lot of this tumor, but it's huge.
26:17There's still a lot of tumor left that I got to go after.
26:20Give me a knife again, please.
26:23Shoot.
26:26So, yeah, we're getting a bunch of bleeding right now.
26:28And I think that that's sort of characteristic of these tumors.
26:31And this is what scares a lot of people to approach this from the surgical side.
26:35But I think it looks like this is a bleeder.
26:38That's a high flow.
26:39That's a high flow.
26:40Now this tumor is going.
26:41It's bleeding.
26:42And there's no way to stop it other than just put a hand on it.
26:45It's kind of crazy.
26:46I'm just trying to hold pressure here.
26:48Are you able to hold pressure on that spot while I do this?
26:52I mean, these tumors are kind of ass .
26:54Like, they just, they bleed.
26:55They're not predictable.
26:57And when you cut through them with a knife, they kind of squirt out.
27:00So at some point, we see these dark squirts of what look like squid ink coming out.
27:05And that's just old pools of collected blood that have accumulated in the tumor.
27:09Let's get a fresh one of these guys.
27:11Just keep them coming.
27:12Some of this we can't even keep up with.
27:14It dribbles onto the drapes and dribbles onto the floor.
27:16Give some fresh slaps.
27:18Keep them coming, keep them coming.
27:20We're soaking up rags, basically.
27:23There's an element of how much blood have we lost?
27:26Should we stop?
27:27It's constantly on my mind when we're doing that.
27:29Do you want me to hold that?
27:30Maybe you work this way or up that way?
27:32No, this is not going to be that easy.
27:34I'm really trying to get as much of the tumor out.
27:36It's basically racing against blood loss.
27:38This is a challenge.
27:39If we can't get control of it, then we've got to stop.
27:41That's it.
27:53It's a nice bleeder there.
27:54Let me just have you put pressure down here.
27:56And let me work up top.
27:57That's sort of the best way to do it.
27:58Trey's tumor basically starts in the front of his face,
28:02extending onto the scalp and towards the back of the head.
28:05And we're getting rid of a lot of this tumor.
28:07But this level of bleeding is obviously not a good sign.
28:10What else are you trying to take out?
28:11I'm going to just sort of do a back cut across here.
28:13Give me a knife, please.
28:14Yep.
28:14I like to operate fast when I see this,
28:16so that we get enough of it out and get this all closed up quickly.
28:21Now it's a race against time.
28:22At the rate that this tumor is bleeding,
28:24we're going to take out as much as we can and close him
28:27before we get into a life-threatening situation.
28:29It's going to go fast.
28:31That's what you got to do.
28:32Doesn't make sense, but hey, move, move, move.
28:36I'm waiting for Trey.
28:41Not exactly sure what's going on in there, but a little worried.
28:45Obviously, anytime someone's getting cut open,
28:47it's a little bit of a scary thing to go through.
28:49This one's coming out.
28:53Trey deserves this more than anybody I know,
28:56just simply because of the type of effort he puts into other people.
28:59Yep, keep grabbing that flap on your side.
29:01For once in his life, he's getting something done for him
29:04that is just going to change everything for him,
29:07where his confidence is consistent all the way through his days,
29:10and he doesn't have to wake up feeling certain types of emotions
29:13because of something he can't control.
29:16Okay, let's get this out of here.
29:18Another piece coming out of here.
29:20This will be the last part of this area here.
29:22Another piece.
29:24It's a lot of bleeding.
29:25So chances are we don't do the front.
29:30It's just going to keep bleeding.
29:31Now I'm reaching the top of the ear,
29:32and we've already lost a lot of blood.
29:35And trying to remove more tumor
29:36is just going to be life-threatening at that point.
29:38It's already got a good chunk of it out.
29:41So at that point, I'm going to stop.
29:44We are definitely not going to be able to get all of this out today.
29:47Now, let's get ready with them stitching.
29:49We still got a lot out, for sure.
29:55Yeah.
29:56Go ahead and weigh that out and see how it looks.
29:59327 grand.
30:02I mean, it's almost a pound.
30:03Oh, yeah.
30:03That's not nothing.
30:05I'm feeling really good about it.
30:06We were able to remove a lot of tumor.
30:09Just got a neck now.
30:12So what we have left to do
30:13is taking out the rest of the tumor in front
30:15and correct the position of the ear
30:17with the next stage of surgery,
30:19moving forward in the next several months.
30:20Well, it was a journey.
30:22Not bad.
30:24All right.
30:24All right.
30:25Very good.
30:41I'm nervous.
30:41Yeah.
30:42Yeah.
30:44Are you nervous?
30:45No.
30:45I feel like I'm the only one that's nervous.
30:47It's like I don't know what I'm going to see when I wake up.
30:52I'm pretty nervous about surgery.
30:54I mean, I haven't had a major surgery since I was a kid.
30:58And it's scary going into a second surgery
31:02as a fully aware adult, you know,
31:05knowing there's always going to be risk.
31:07I'm really putting my life in the hands of Dr. Ravello.
31:15Glad you're here.
31:17I'm ready.
31:20I'm ready.
31:21I'm ready.
31:22I'm ready.
31:23I'm ready.
31:24I'm ready.
31:24I'm ready.
31:25I'm ready.
31:26I'm ready.
31:27I'm ready.
31:28I'm ready.
31:28I'm ready.
31:29All right, good.
31:30We're going to really focus on that outer part of the lip.
31:34If we can get some more from inside the mouth, then we will.
31:37That sounds great.
31:38Yeah.
31:38Are you ready to be gone?
31:39I'm ready.
31:40Yeah.
31:40Yeah.
31:41Yeah.
31:41All right.
31:42Well, I'm excited.
31:42Me too.
31:43Good.
31:43All right.
31:44All right.
31:44Let's do it.
31:45We'll see you back there shortly.
31:46Okay.
31:46Okay.
31:46I trust Dr. Ravello 100%.
31:47I just feel really safe and comfortable with her.
31:52I feel like I'm in good hands.
32:06The surgical plan today for Ambie is removal of her vascular malformation on the side of her mouth.
32:13The hardest part is going to be reconstructing the corner of her mouth.
32:17The corner of the mouth plays a huge functional role in how the mouth works.
32:21If it's not working properly, you can have liquids drip down.
32:25You can have fluids escape.
32:26It might be hard to chew really well.
32:28That corner of the mouth is super critical in how the whole mouth functions.
32:38Look at that.
32:39When you push into it, it's like a sponge.
32:42You go like that.
32:43Watch it fill up.
32:44Okay.
32:44It comes back.
32:45Isn't that cool?
32:46That is very cool.
32:48That's classic root of malformation.
32:50Dr. Panossian is going to be assisting me today.
32:52And having an extra surgeon in the OR with you, someone that can bring a different eye
32:57or a different opinion to the table, is incredibly helpful.
33:00Incision.
33:01My concern is how much of this I can remove while still leaving her with a functional corner
33:15of the mouth.
33:16The deeper this goes and the more involved it is, the closer we're getting to those more critical
33:22aspects of the face, like the nerves.
33:24Right there.
33:27You're definitely looking more spongy there.
33:29Yeah.
33:30It's like little pockets of normal in between.
33:32Yeah.
33:33You don't have any wiggle room to keep cutting out on the face, because you're going to start
33:39just figuring vital parts of the face.
33:41You could probably do something like...
33:43Yeah.
33:49After getting through the initial layers of the malformation, I'm able to remove the superficial
33:55part of it.
34:03That's a big goomba right there.
34:07Removing this vascular malformation was not easy, but it was the simplest part of this whole procedure.
34:13Now what we have to look at is how are we going to reconstruct this corner now that we do have
34:18this large defect.
34:20Yeah.
34:20Right there.
34:22So the next step is putting the muscles back into approximation.
34:26That's the critical part of closing the corner of her mouth.
34:28That's just begging to come over.
34:31It's not just stitching one edge of skin to the other. We actually have to orient the muscles
34:36underneath in such a way that it creates a sharp corner.
34:40If we don't get these muscles on the right tension, in the right direction, in the right amount of
34:46closure, then the corner of the mouth might not look good, or it might not function well.
34:50This is the most critical part of the surgery, so we have to proceed very carefully.
34:56Otherwise, Ambie could be left with a huge hole in her cheek.
35:00We do have some good uninvolved muscle here, which is really helpful.
35:15That's not bad. I would probably use it as a handle.
35:18This is the most critical part of the surgery because the muscle that goes around the lips
35:23goes all the way around it. And when it functions, it contracts down, it opens up,
35:28and allows the mouth to open and to move. If you have a break or a scar or some kind of trauma to
35:35one area, well, now it can't do anything because it's not in continuity.
35:39We have two options. The first one is to just close it and leave behind the majority of the
35:44malformation. The other option is to take more of that malformation, but I need to really sort of
35:51play with how much movement I have and how short her lip's going to be if I take out all of that tissue.
35:58I'm pretty happy with how much we've removed. I mean, yeah, that's it. That's because that'll,
36:05this'll be the new corner. So if this is the new corner, you can kind of guide the muscle.
36:15We've made a decision on how to reconstruct this corner. The next step is to get a suture,
36:21and then we're going to put this lip back together. We have to be precise about how we put the corner of
36:25the mouth back together so that we maintain as normal function as possible.
36:32Middleson is doing a beautiful job on this lip. It was a big relief when we saw it all come together
36:38and the symmetry was good. We didn't shorten the mouth too much. And so it was a big win.
36:44We are all done. Case went beautifully. So the external portion of that malformation is now gone.
36:50She just had a nice scar, which is going to heal really well. This incision here,
36:55that's where the external malformation used to be. So that's what was removed. Underneath that,
37:00there's another layer of sutures that put her muscle back together. And then below that is
37:05another row of sutures. But you don't see those. The only ones that you see is his nice row on the top.
37:10And I'm really excited. I think this is going to be really good for her.
37:12Good job. High five. High five.
37:26I'm following up with Ambie today. She sent in some photos for us to review.
37:31When Ambie came in, she had a residual vascular malformation on the corner of her right lip.
37:36I'm really looking forward to seeing how she's healing up.
37:42When I'm looking at her photos, I can tell immediately that that very obvious vascular
37:47malformation is gone. The corner of the mouth looks great. The scar that's in that area has healed
37:53really well. I'm also looking to make sure that she's able to open and close her mouth,
37:58that we didn't make it too small, and that she can still open wide, eat, do all the things that she was
38:03doing before. I'm very happy with the final result. I think we were able to keep Ambie looking just
38:09like Ambie, but without this vascular malformation that was causing her problems. The malformation
38:14should not come back. These usually tend to grow in their early childhood years and then stop.
38:19Ambie's done with surgery. She should not need anything more after this.
38:33Trey's coming in for his follow-up today. We had a lot of bleeding with Trey's first surgery,
38:48so we had to stop. For Trey's second surgery, we tackled the second part of that tumor, which
38:53extended onto his face, and we got the majority of that out. So what I hope to see today is better
38:58symmetry of the face, a better positioned ear, and I'm really anxious to see how he's doing.
39:05Hey! How you doing? How are you? You look great!
39:09Yeah, no, I feel great. Do you? Yeah. Awesome!
39:12And I can, I can see, like, a lot better. If I look up to the left, I can see better and all that.
39:16Like, there's no, like, hooding over my, my eye. Yeah.
39:19Going back to work, everybody's like, you look different. I was like, yeah.
39:21I'm looking at your ear position. It's much better. That's, like, that's, like, the biggest
39:28difference. Like, I've noticed, like, my ears are actually, like, symmetrical. Like, when I put,
39:31like, glasses on, they feel like they're actually lining up with my ear. They're sitting in the right
39:35spot. That's great. And this contour is really neat back here. It's really smoothed out. It's showing the
39:40back of the head a little bit nicer. Yeah, that's, that's the biggest thing for me. Um, over time,
39:44like, like, it used to be down here. I couldn't feel anything. But now it's just like, I'm slowly
39:48getting sensation back throughout here. Yeah. Yeah. No, that's fantastic. I'm ecstatic to have
39:54the majority of that tumor removed. Is there any chance that it will grow back and how fast it will
39:58go back? There is still a chance that this grows. Will it grow back to, like, the extent it was before?
40:03No, that's the nice thing. So if it were to grow back, it never comes back in that previous form.
40:09You're doing great from what I can tell so far. Overall, I'm just very happy with the results,
40:13and I'm truly thankful for you. Well, I appreciate that. I appreciate it. I'm so happy for you.
40:27All right, guys. Our patient Trey Matlock sent us a video. I want to show it to you. And, uh,
40:32this is what he sent us. What's going on, Dr. Pete? I just want to give you a quick update on how
40:39everything's going. Recovery's going well. I'm back at work. Look at this guy.
40:44Family. Healing is amazing. Oh, my gosh. Oh, wow. I'm a logistic truck driver. Wow.
40:50I deliver all over the state of the Colorado. Before having surgery, I really didn't like
40:55interacting with people. Now, the best thing about my job is I can actually enjoy conversations.
41:01The worst part, I'm always in traffic. I'm on the go. I just want to thank you for helping me through this
41:08journey, and I came home.
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