- 2 days ago
Category
📺
TVTranscript
00:00Why isn't he getting that fixed?
00:02What's he doing here?
00:04I can't close my eyes.
00:06Go all the way up.
00:08The hardest is, like, just dealing with the pain.
00:10I don't want to cry.
00:12People with this type of syndrome have lumps,
00:15and sometimes when they get really large,
00:17they cause real havoc.
00:19These eyelids are extremely complicated.
00:22Muscles that are a millimeter or two thick.
00:25There's really no room for error to make this thing work.
00:27You're gonna be awake during this,
00:29and it's a little bit drowsy but awake.
00:31Are you waking up for me?
00:32Yes.
00:33There you go.
00:34She better not twitch or move or flinch.
00:36When I got this scalpel near her eyeball,
00:38it's kind of a massive crater.
00:40And what I'm worried about is that the facial nerve
00:42that controls all your motor function to your face,
00:45this is right in the area of the divot for him,
00:47and if I cut the facial nerve, I could paralyze his face.
00:50So I have a patient coming in from Chicago.
01:00His name's Patrick Gannon.
01:01It's a neurofibromatosis case.
01:03We do get these a lot.
01:04They're tough.
01:05They're tough.
01:06And he had a tumor, and it really went deep into the face.
01:10Mm-hmm.
01:11So he had a couple surgeries not too long ago
01:15to remove and to bulk this tumor,
01:17and now he's left with a pretty significant deficiency
01:21in the left side of the face.
01:23Look how much it really divots in there.
01:25You can see it's centimeters deep, you know?
01:27Yeah.
01:28Where his divot is, it's only accentuated
01:30because the rest of that tumor is larger.
01:33Sitting here, yeah.
01:34But what a stark difference from the operated side
01:37to the unoperated side.
01:38Oh, my God, yeah.
01:39It's just two different people.
01:40Right.
01:41And the area where we want to treat
01:43is right where the facial nerve is.
01:45Yeah.
01:46The facial nerve controls all your motor function to your face,
01:48so your ability to blink, to raise your forehead,
01:50to smile, to purse your lips.
01:52And if I damage one of these nerves,
01:54I could paralyze his face.
01:55I cannot, I do not want to injure that in this process.
01:59Right.
02:00Especially in light of having had previous surgery.
02:03I mean, things could have been moved.
02:05It's very easy to kind of move a branch of a nerve
02:07up or down a few millimeters
02:08from where you think it should be.
02:10Yeah.
02:11That is definitely going to make this
02:12more challenging and more risky.
02:14But if he's willing to take that risk with me,
02:17I think it's a reasonable thing to try to help him.
02:19Absolutely.
02:20I agree.
02:30I don't like being a hermit.
02:32I like being out and about, and I like socializing.
02:35But with the facial deformity, it makes it hard.
02:46How are you doing?
02:47What can I do?
02:48Two coffees, please.
02:49Turn it up.
02:50When I look in the mirror,
02:51the first thing I see is the crater on my face.
02:53The ear is sticking out too much.
02:55You got the droopy big old ball on the bottom.
02:58And it's very painful.
03:00So how are you doing today?
03:02Not as bad as it was yesterday.
03:03I was having a bad pain day yesterday.
03:05I saw you were having trouble eating.
03:07Yeah.
03:08I just got to be careful and maybe eat smaller meals.
03:14Or, you know, eat things that are softer.
03:16You know, I can't always go eating steak.
03:17No, I know.
03:18I have neurofibromatosis type 1, or NF1 for short.
03:22It causes tumors to grow on the nerves anywhere throughout the body.
03:43This one started to grow, I want to say I was about eight, nine years old, maybe 10.
03:50My parents were always told, it's not cancerous.
03:53We're not going to touch it.
03:55But as an adult, it got to the point where the doctors were like,
03:58okay, this has to come out now because it did so much damage
04:02and took out this entire side of my jaw.
04:05I remember when you had teeth, how much it hurt and how much pain you used to have.
04:14Yeah, never knew how much pain I was truly in until they were gone.
04:17I've technically had three full surgeries.
04:20The first surgery was for my teeth.
04:21I had to get all my teeth pulled because the tumor had fingers that came across
04:26and just started destroying all my teeth.
04:28I don't know how you managed your day-to-day.
04:30Looking back, I don't know how I did it either.
04:33I really don't.
04:34The second one was the first major debulking of this big tumor that I had here,
04:39and it was the size of a grapefruit.
04:41Probably where a lot of that pain came from was just that tumor just putting pressure on everything.
04:46And then the last surgery, he helped with your ear.
04:49The tumor crawled up and was crushing your ear canal.
04:52Which is kind of scary.
04:54I thought I almost lost hearing on that side.
04:58They say, God doesn't give you anything that you can't handle.
05:03But he must think I'm a superhero sometimes.
05:08I've had a lot of tough things happen to me, and I'm still standing.
05:13When you take our son out places and people stare at you...
05:18It hurts.
05:19I see the looks.
05:20I feel them.
05:21I've seen them.
05:22And I get angry.
05:23I get angry.
05:24I try to ignore it, but on the inside, it always stings a little.
05:29Because I was picked on at school.
05:31I was tormented and tortured for years.
05:34I never wanted to go to school because I knew that I was going to get picked on on a daily basis
05:41from almost everybody.
05:43I mean, just constantly picking on me and throwing things at me and pushing me around.
05:48It was bad.
05:51I wanted the indent in my face to go away.
05:54I mean, a crater was left because the tumor is now mostly gone.
05:58And maybe to get my ear pinned back a little, kind of make it look a little more normal.
06:02I thought it would kind of look like Dumbo.
06:04I don't see it.
06:08In my eyes, you're perfect.
06:10But I know that a surgery would make you so happy on the inside.
06:16Yeah.
06:17I'm getting ready to fly out to California and meet with Dr. Rustine.
06:20If he gets my ear back and he gets rid of the crater on my face, I think it'll just make me a happier person inside and out.
06:28We're hoping for good news.
06:30Yeah.
06:31Hope and pray for the best that these doctors can do.
06:34Hello.
06:35Hi.
06:36I'm here to see Dr. Rustine.
06:37Perfect.
06:38If you could sign in.
06:39My wife and I just flew out to LA.
06:40And we are getting ready to go meet the doctor.
06:41All right, if you'd like to follow me back.
06:43I am anxious because I'm not too sure what he is going to be able to do for me.
06:47I'm very anxious and very scared, but my hopes are very high at the same time.
07:04So we'll see what he says, you know?
07:05We're almost there.
07:06Mm-hmm.
07:07And whatever he says, we'll figure it out.
07:08Mm-hmm.
07:09You got this.
07:10It's all right.
07:11Yeah.
07:12Hi, Patrick.
07:13How's it going?
07:14Good.
07:15Hi, Doug.
07:16Good to meet you in person.
07:17Nice to finally meet you.
07:18How are you doing?
07:19It's your lovely wife, I assume.
07:20My lovely wife.
07:21What's your name?
07:22Vanessa.
07:23Vanessa.
07:24Nice to meet you as well.
07:25Nice to meet you.
07:26So, um...
07:27Nice to meet you.
07:28Nice to meet you.
07:29Nice to meet you.
07:30Nice to meet you.
07:31Nice to meet you as well.
07:32Nice to meet you.
07:33So, um...
07:34Tell me more about your medical history now, if you don't mind.
07:37I have neurofibromatosis type 1.
07:39Right.
07:40Um...
07:41The tumor on the side of my face, I had to have started...
07:449, 10.
07:45I was really, really, really young.
07:47Mm-hmm.
07:48As it got bigger, it pulled the skin down and then it was like,
07:51just this lump just kind of hanging there.
07:54And over the years, it just got bigger and bigger.
07:57Do you remember roughly the size of it?
07:59You know, the size of a baseball or...
08:01Uh, the size of the tumor was probably roughly the size of a small grapefruit.
08:04Okay.
08:05It went up into his ear, crushed the ear canal, and went onto his eardrum.
08:11And it actually started rotting the teeth out from underneath.
08:14Okay.
08:15So, the first surgery, I got rid of my teeth.
08:17And then the second surgery was to debulk most of the tumor.
08:21Mm-hmm.
08:22The third surgery, we built my ear canal.
08:24And now we're here.
08:25Okay.
08:26Let's pretend I was the genie in the bottle.
08:28You get all your wishes, all right?
08:29We got three, at least.
08:30Okay.
08:31Okay.
08:32What's number one on that list?
08:33Um...
08:34Number one, I would say if you can't take out the indent that I have over here,
08:38and then get rid of whatever bulge is here.
08:41You know, try to normalize the left side to the right side.
08:44Okay.
08:45I'm glad that is your number one because I think that is, you know, an important goal.
08:49Um, what's number two?
08:51How the ear sticks out.
08:52I was always told I had big ears as a kid.
08:54Uh-huh.
08:55And I grew into them.
08:56Yeah.
08:57This one's sticking out again, and...
08:58Yeah, I agree.
08:59The left side has some room for improvement.
09:01So, again, try to give that fold back more and get it in back a little bit more for you
09:06so it sticks out less.
09:07I think that's a valid goal.
09:08Mm-hmm.
09:09Should we do a quick exam now?
09:10Yeah.
09:11All right.
09:12People with this type of syndrome have lumps all over their body and faces.
09:15And sometimes when they get really large, they get really distorting and invade into nearby structures
09:20and cause real havoc.
09:22And this is exactly what happened for Patrick, and I just hope we can help him with that.
09:26Okay, so you can kind of see this in the area that's excess, and then it's very deficient
09:34here.
09:35Go ahead and open and close your mouth for me.
09:38Bite down for me.
09:40Relax.
09:41Now, when you first did this surgery, was this tissue all the way up there and now it's
09:46kind of fallen down, or what do you think?
09:48Um, no, it's kind of always, always been...
09:51Kind of bulky there?
09:52Yeah.
09:53Okay.
09:54It's a pretty noticeable difference where it really dips in.
10:00It's kind of a massive crater.
10:02And what I'm worried about is that the facial nerve that controls all your motor function
10:06to your face.
10:07This is right in the area of the divot for him.
10:09And if I cut the facial nerve, I could paralyze his face.
10:13Incision.
10:14This is a danger zone.
10:16There is a very real potential that the branches of Patrick's facial nerve are sitting right
10:22under the skin.
10:23And that's terrifying.
10:24Shoot.
10:25It's uneven.
10:26If we get the adjustment wrong, your symmetry's ruined.
10:31Uh...
10:32All right, let's take a look here.
10:48I have a patient, his name's Patrick Gannon, and he has an F1.
10:52He's most bothered by the left side of his face where he has a large divot and an area
10:56where the neurofibroma is still pretty prominent.
10:58Patrick's ear is something else that really bothers him.
11:01You can see his left ear stuck out a lot more compared to his right.
11:04I don't know if this was from the prior surgery or something he's always been born with.
11:08What I do know is that he's missing some of the normal architecture of the ear itself.
11:12If you notice, this ear is missing that normal fold.
11:16You know, you can see it in my ear.
11:18You see this fold?
11:19We call that the anti-helical fold.
11:21And it sits right here.
11:22And that's why this is more prominent, because this doesn't bend back normally.
11:25You see how that gets rid of all that bend?
11:27You see?
11:28I see.
11:29Yeah.
11:30So, and his other ear has it perfectly.
11:31If you look and compare his right ear compared to the left right now,
11:34you can see a perfect anti-helical fold.
11:36And that's why this ear is perfect.
11:38With the prior surgeries and all the ear surgeries he's had,
11:40it is possible that it kind of pulled things forward a little bit.
11:42So we want to set back this part of the ear as well.
11:45This is your helix.
11:46This is the anti-helix.
11:47He's missing this fold.
11:48And when this fold is flatter, it makes the ear stick out more.
11:51So I know I have to recreate that fold.
11:53But, you know, it's more complicated than just setting the ear back.
11:56You have to also change the architecture of the ear itself.
11:59And this is the beauty of the 3D camera.
12:00We're able to appreciate things in a different way with, you know, high definition.
12:04Wow, look at that.
12:05But you see that?
12:06You can see how the fold is the most important part right through here.
12:09It's missing there.
12:11And then obviously this is your main thing we're here for.
12:14Yeah, right.
12:15That's our number one, right?
12:16The creator.
12:17Yeah.
12:18So let's take some other, let's look at some other angles of that.
12:20You know, you can see this is kind of where the tumor ends and that's our divot, right?
12:24Yeah.
12:25We're not even sure if this is really a tumor.
12:27I bet you in the last surgery, they took out the bulk of the tumor.
12:31They took out the grapefruit.
12:32Because it's probably just a mix of tissues and scar and, you know, these are benign.
12:37I know we're calling them tumors and people associate the word tumor with, oh, you got
12:41to cut it out.
12:42That's not true necessarily.
12:43Now, is this something we're going to know when you open him up?
12:46Yeah.
12:47If I see anything that looks abnormal, worrisome, you know, any question of cancer, we're going
12:51to send that off for pathology.
12:52But the chance of any residual problem cancer is exceedingly low and not where my focus is.
12:57My focus is on let's make this look as good as possible.
13:00Okay.
13:01I want to take as much of the tumor, bring it up to fill that divot.
13:05It's going to help us in this case.
13:07If I just cut it out, it's going to create more of a divot there.
13:09Okay.
13:10Any of it that I can use that has this bulk, I want to not just throw it away.
13:14I want to use it to our benefit and fill in that big divot because that's our main problem child.
13:18That makes sense.
13:19So my plan is to do two main things.
13:21One, recruit from the area that's too excess below it, bring it up, right?
13:26And fill in the divot as much as I can with that.
13:28If it's not enough, we may need to add some fat back to that area.
13:31I also want it to be a nice smooth contour as much as possible to match the right side.
13:35So I may cut away some excess tumor down low or anywhere that it's excessive after I moved it up.
13:41Are you going to try to use the same scar that they used last time?
13:44Absolutely.
13:45Yeah, because you already have that scar.
13:47It healed well.
13:48It's in a favorable position.
13:49So we'll go through the same scar and do all our work through that.
13:54Okay.
13:55And then last step, we're going to do the ear, right?
13:58We're going to recreate the fold here and that should help make the ear less prominent.
14:01Um, risks.
14:03Great question.
14:04This is why you bring her?
14:05Yes.
14:06That's why I have my beautiful wife.
14:07She understands all the medical knowledge.
14:09Yeah, yeah.
14:10They tell her, she explains it to me.
14:11Yeah.
14:12So the main risk here is that right here is a really important nerve called the facial nerve that controls all your facial muscles.
14:19You had prior surgery.
14:21It is no doubt a little riskier because of that, because I don't know if scar tissue has pulled it up in an unusual location or were you born with it in an unusual location?
14:30I will look for it every step of the way.
14:32Um, and you know, that is to me, you know, one of the major risks that we have to be mindful of.
14:38A major focus on my end is going to be to avoid that.
14:41Trust is critical and it's a two-way street.
14:44We're taking a major commitment together.
14:46And the last thing I want to do is make them any worse off.
14:49So I've got to be very, like, laser focused and do my most meticulous work to make sure I don't injure one of the facial nerves.
14:56All right, well, I think we have a great plan.
14:58Um, look forward to doing this for you and hopefully this is it.
15:01You know?
15:02I'm feeling really, really good about this.
15:03I'm excited.
15:04I'm nervous, but I'm excited.
15:05Good.
15:06And Vanessa?
15:07100%.
15:08Okay.
15:09Love it.
15:10All right.
15:11Bye, guys.
15:12Good to meet you.
15:14I think it was very worth it.
15:15I just got to keep my fingers crossed and pray for the best.
15:36Hello.
15:37I'm here to check in with Dr. Panossi.
15:39Perfect, thanks.
15:40The hardest is, like, just dealing with the pain.
15:43I've had this since I was little, and as I age, it's just gotten worse.
15:50I can't close my eyes.
15:53Even with blinking, it blinks, like, a lot slower than my right.
15:56I have to, like, brace myself, having to explain that all the time.
16:02My left eyelid doesn't work like a normal eyelid.
16:07I have a muscle deficiency.
16:09It's like a droopy eye.
16:11I'd rather not, like, go out and meet people.
16:13They're going to be looking at me and asking, what's wrong with your eye?
16:17I just thought I was, like, done with everything that I wanted to do with my eye.
16:21Because there wasn't really no change from the other surgeries.
16:24I've had two other procedures done before with little to no results.
16:27And I was trying to, like, mentally be okay with that and just trying to live with it.
16:32And even, like, with the pain.
16:34So I am just looking for a solution to ease the pain of that eyelid.
16:38What pain are you feeling right now?
16:40Like, on my eyelid, like, when my muscles, like, strained.
16:43Mm-hmm.
16:44Because, you know, like, I get that pain in my eyelid, like, when it's, like, strained too much.
16:47Mm-hmm.
16:48And, you know, I stare at a screen before work all the time.
16:51Aw.
16:52So I am an accountant, so it causes me a lot of pain just staring at a screen.
16:57My left eye gets so strained.
16:59I have, like, a bad headache coming from it.
17:02You know, I don't think I've ever pictured my eyes looking the same.
17:07And, like, getting, like, a somewhat symmetrical face.
17:09And I feel like it would mean a lot.
17:11Yeah.
17:12Just I feel I would feel more confident.
17:14I've noticed you always tend to cover it up.
17:17Yeah, with my hair.
17:18Yeah.
17:19Because my face is not symmetrical.
17:21Mm-hmm.
17:22And then you can see it more.
17:23I try to hide.
17:24I hide behind my glasses, behind my hair.
17:26Or, like, when I look at people, like, I try to, like, turn my head or, like, you know,
17:30like, be at an angle where they probably won't see it as much.
17:33I can't even imagine.
17:34I don't even know what it would look like if it did look, um, at least kind of the same.
17:41Yeah.
17:42Yeah.
17:43I really hope that for you.
17:44Thanks.
17:45I didn't want to cry.
17:46I know.
17:47I'm glad you're here.
17:48I know.
17:49I'm really glad to be here.
17:51I know.
17:52I'm really glad to be here.
17:53I know.
17:54Thinking about just living with the pain with, like, the rest of my life is definitely,
17:59um, it sucks.
18:01I'm really excited for you.
18:02I feel really hopeful that, you know, he'll be able to do something about it.
18:16Yeah.
18:17With age, it's getting worse.
18:18I'm taking pain meds just, like, to get by and where, like, I can't really see from one
18:23eye.
18:24I guess just, like, thinking or, like, knowing that there might be something that somebody
18:32can't do.
18:33Mm-hmm.
18:34It makes me emotional.
18:35I know.
18:36So I have a patient coming in, her name is Neris, and she has congenital eyelid ptosis.
18:48Basically, when she was born, for whatever reason, the muscles that are responsible for
18:52lifting and opening your eyelid didn't develop.
18:55When I look at her photos, I notice the immediate asymmetry of her eyes.
19:01Droopy eyelids can be common, but Neris has a severe version of it.
19:06And that's often the case when people are born with droopy eyelids.
19:10But these eyelids are extremely complicating.
19:13The delicate, finesse nature of eyelid surgery makes it incredibly difficult to treat.
19:19We're talking about muscles that are a millimeter or two thick.
19:23We've got to be able to navigate through these areas, and there's really no room for error.
19:35This program examines medical conditions and the procedures involved with treating them.
19:39Due to their graphic nature, viewer discretion is advised.
19:43The
19:490000000
19:53Hello, hi!
19:54How are you guys?
19:55Good, how are you?
19:56Good, how are you?
19:57Great, I'm Dr. Penosian, nice to meet you.
19:59Good to meet you.
20:00All right, so...
20:02Tell me a little bit about what brings you in today.
20:04So my left eyelid looks lower than the other eye, and also the pain that I get just like
20:09trying to keep my eyes open, and I had to close my eyes, and it's like just a pain.
20:12just the pain that I get like on my eyelid that's like um my biggest issue okay when you cannot
20:19properly open up your eyes comfortably your eye is constantly sore what happens is that your forehead
20:25muscle is overactive you're trying to raise your eyebrow enough to pull the skin of your eyelid up
20:30because the natural lifting mechanism is not working it's almost like you've gone to the gym
20:35and you just can't stop working out because that eye is constantly trying to open up but it's
20:39magnified in nurse's case what sort of things does this interfere with are you able to drive okay
20:46i do like have to turn my head with the driving just because like my vision is limited because
20:51my eyelid doesn't open all the way i don't even think about driving honestly but it makes so much
20:56sense so there's a real functional need to get this fixed too right when i close my eyes sometimes
21:02it's like a little gap where it's open now but like i can't like when i look up like it doesn't
21:07like move up either for like my vision the inability to close the eyelids can dry out your eye you can
21:13get debris flying in and scratching your cornea which can ultimately lead to irreversible scarring
21:18and blindness this is really severe stuff so let's do a little exam i'm gonna just grab my ruler real
21:24quick and i'm gonna come right around again go i like to measure out the degree of the drooping let me
21:33have you take your glasses off
21:42and first things first i'm just gonna have you keep looking at my nose and then sort of look up
21:48and relax good now i'm going to put a little ruler it's going to be a little weird to kind of get a
21:56sense for how much lifting we are seeing or not look all the way down good and now go all the way up to
22:04the sky good excellent when examining naris i'm basically going to see how well her eyelid works
22:11so i'm measuring how much movement she's going to gain out of just simply looking up to the sky
22:16and uh in naris's case it's not much so there's a bit of a gap too between how much this rises up
22:24and what it looks like at rest even when you're trying to look all the way down it's this eyelid
22:29doesn't even come down all the way as well so there's a few muscles in your eyelid currently there's
22:34one that is responsible for lifting the eyelid up and that's the one that's not really working in
22:39your case we call that congenital eyelid ptosis which is a fancy word for a droopy eye so the fix
22:46for that is going to come by way of reconstructing this eyelid ptosis or droopy eyelid that you've had
22:53since birth what's been done for this over the past i've had two surgeries on my left eyelid by
22:59two different doctors but um with the other surgeries there was like no results really yeah so
23:07doing the same things that we've done before is not going to be a smart idea here and so what we
23:12need to do is sort of think a little bit outside the box when it comes to this stuff because we have
23:17to kind of recruit a different muscle to pick up the slack of the muscles that aren't working
23:22so we're going to use this forehead lifting muscle right here that raises your eyebrows we just take a
23:28little strip of it we release it so that it travels down to the edge of the eyelid and then we sew it
23:33there at the right height when you're trying to really kind of open your eyes really widely you're
23:38going to end up activating those forehead muscles anyway and in ariza's case she's gotten used to
23:43that so it's sort of intuitive i didn't even know we had a muscle on our forehead i mean i don't know
23:53um a lot of times we like to do this under local anesthetic with a little bit of sedation just to kind
24:00of calm nerves um so like oh awake during the time yeah um it does sound a little bit nutty trying to
24:12work on someone's eyelid while they're awake and having all the instruments come at you seeing
24:16everything but i think uh if you if you look at the big picture it's the way to go we do it so that
24:23we can sort of ask you to open your eyes and close your eyes and see how we did on the adjustment a
24:27little bit more fine-tuned adjustment when she's awake during surgery she can sort of follow
24:32instructions she can look up to the sky look down look to the sides so that i can see the other eye
24:38simultaneously i want to get that symmetry just right when people are asleep i have to guess
24:43and i don't like guessing um i am very nervous i totally get where you're coming from sometimes some
24:54people have a little bit of anxiety with it and then we can kind of go to a more sleepy state at
24:58that point okay all right i think we can do that all today that's our plan that sounds good that sounds
25:05great so you're ready to get this done yes let's do it there's really no room for error to make this
25:12thing work the eyelid's very thin there's not much space or tolerance for bad surgery literally the opening
25:18incision is going to be our toughest thing okay what's happening jen all right excellent we'll get
25:24you into the operating room thank you thank you all right nervous
25:45yeah you got this today's the day of my surgery i'm nervous i'm scared i'm excited all kinds of
25:54emotions going on at the moment which i think is to be expected you're in good hands he knows what he's
26:01doing hey good morning patrick how are you doing how are you guys doing we're doing okay yeah yeah
26:10nervous yeah it's totally normal i'm gonna get a marking pen and actually so we could kind of mark
26:16things out yeah okay patrick gannon has neurofibromatosis type one he had prior surgeries that
26:22caused a large divot in his face my plan today for patrick is to fill the divot move that tissue up
26:29where it kind of sticks out in an unusual way and get rid of any excess skin then i'm going to move
26:33on to the ear give them the fold get rid of the prominence that's causing it to stick out
26:38all right ready to go back yeah yeah and i'll come talk to you as soon as we're done with the
26:43surgery okay all right it's gonna be take some time of course but uh we'll take great care of
26:47this is a tough case dr rivello is going to come out and it's going to give me a second pair of hands
26:52and i think we can make a big difference but by far the most critical portion of this surgery is to
26:57make sure i don't injure one of the facial nerves because that could be a devastating injury
27:00it's game over at that point wow room with the view look at that oh yeah
27:12we do a lot of neurofibromas and each one's a little bit different in terms of where it is and
27:16what it involves this case is unique because it's in a very tricky area incision this is the old
27:29incision i'm going to go ahead and use that first step is lifting up the skin flat and this is a danger
27:38zone i don't know how much depth i have and i have to be really careful if i cut the facial nerve i
27:43could paralyze his face well he doesn't have much soft tissue does he no because of patrick's previous
28:00surgeries the gland that usually covers the facial nerve is gone so there is a very real potential
28:07that the branches of the facial nerve are sitting right under the skin and that's terrifying i'm
28:13trying to stay above it so that we can make sure if we got close to the nerve we'd see it jump nice
28:28i think we're good i think so so far so good and um i don't think we've had any issues with the facial
28:34nerves i'm really happy about that so the next step is i move that tissue from below that was too
28:38prominent up into the upper face and fill that that area of the divot it's a mix of normal tissue
28:45with some neurofibroma it doesn't look cancerous so i'm really happy about that kind of see like
28:50move all that up like that because it's a good secure point i think that looks like a good start
28:55point for me that looks great i was worried it was going to be hard to get it to all the way
28:59smooth and look good but i think it came together pretty nicely it's looking really good
29:05more reasonable yeah it looks good great next up i want to tackle the ear
29:17like that first thing is to figure out where to place the sutures to give them a more natural fold
29:23this is what i'm trying to create something like this you see when i create this bend
29:27it causes this part of the ear not to stick out that much so i made an incision behind the ear
29:33so i can get access to the cartilage and put some needles in there to kind of hold the shape
29:38that i want and then i secure it with sutures once i know it's it's in the right shape
29:44that's good huh yeah that's really good yeah that's really good
29:48the ear looks great it looks so much more flush against his face i think he's gonna be really happy with
29:52that part we're closing and i just hope this heals as you know smooth and perfectly as possible for him
30:03hi vanessa okay so we're all done i think it went very well goal number one which was the face i was
30:09able to move some of that excess tissue he had below and got it all the way up to fill the valley right i
30:15didn't injure any of the facial nerves so i'm really happy about that and then the ear it's less
30:21prominent and kind of nice and flush against his head so it doesn't stick out and honestly it's almost
30:26a little better than the other side so he made me jealous um there want this one to get a little
30:30better awesome i'm excited to see you yeah yeah absolutely it should be any minute yeah all right
30:34all right i appreciate it yeah of course same time all right thanks
30:47i can't believe this is happening i know don't leave
30:52has it hit you yet no i feel a little hopeful but i don't want to be too hopeful
30:57just because i've been disappointed from the other two surgeries
31:03but i am excited just because it won't be the same procedure i've had so i feel like there will
31:08be a difference this time can you eat right after or no um i don't know hello hi all right how are you
31:16doing the moment of truth is here yes okay once again you're gonna be awake during this a little bit
31:23drowsy but awake so we're gonna lift up that eyelid to about the level that it is on the other side
31:28okay okay and then when i'm ready to actually adjust that muscle i'm gonna have you open and close
31:33for me okay thank you well i'm gonna get back in there and get things ready and i'll see you inside
31:38okay see you there give me a hug jen can i hug you and your scrubs yes you can hug why i don't know
31:45if it's like contaminating you you're already contaminating from being in here
31:54nurse my name is carlos i want to be your nurse today hi carlos nice to meet you so dr ravella was
31:59helping me out in surgery today the value of having another doctor is on the spot on the fly collaboration
32:05we're making sure we're getting the best result at the end of the case so what we're going to start out
32:09doing is get you numbed up after that you're gonna feel maybe a little tugging now and then but
32:14you're not gonna feel any pain if you do feel pain just let me know okay so we're gonna just draw a
32:21little bit of a line here that's sort of where the flap will come down so it goes like this more or
32:27less at about the level of the eyebrow let me just get going then all right incision
32:33nurse are you waking up for me yes there you go neris is completely awake during the surgery
32:42you wonder oh my gosh we should better not twitch or move or flinch or do something where when i got
32:48this scalpel near her eyeball so we got to take our time go slow and increase attention and focus
32:54we're definitely above and into the forehead now so i'm gonna pull the muscle down now what we're gonna
33:00do is essentially take her forehead muscle and tunnel it underneath the eyebrow and attach it to
33:04the edge of the eyelid there's just this little strip of tissue right through here you can see the
33:10instrument going through and then as we reach up in here we'll be able to grab the muscle edge and we
33:16can pull it through boom like that and then we're gonna stitch it in to the eyelid like that we're
33:24getting to the point where we're gonna actually attach this muscle to the eyelid now we got to get
33:28nurse involved hey nurse can you open your eyes for me good excellent and then can you see that
33:36little keyhole up on the sky you're just gonna stare at that spot for me okay it's like in a big
33:41square right yeah just kind of keep looking at that i just want to see where we're going to lift
33:45this up to it's going to be roughly about there this is a moment where we have to anchor the muscle
33:50on the eyelid it's a very important step to make sure that those stitches are placed as accurately as
33:56possible if you over tighten that eyelid and then she can't close it afterwards we got ourselves a
34:02problem okay so let us start setting this muscle in can you try to close your eyes good excellent and
34:10open good having an awake patient during surgery that means she can open or close her eyes so i can
34:15set that adjustment on that eyelid level accurately oh you okay i felt that bad you fell okay a little
34:24bit more local coming thank you doctor you're welcome you're a very polite patient doctor i don't
34:30want to be too needy you don't want to be too needy you're not being needy don't you worry you're doing
34:36great she's doing a great job so much so like she was joking during during the surgery which is always
34:42fine okay so open your eyes on no i'm just gonna do that one again i'll tuck that up a little bit more
34:49like that i think it's just enough tension i don't want to overdo it now can you try to look all the way
34:57at me there you go shoot it's a it's uneven it doesn't match i don't like it uh if we get the adjustment
35:13wrong then your symmetry is ruined and that's the problem that i'm i'm worried about something something
35:20over here i'm looking at the eyelid levels and it doesn't match this stitch may be a little too
35:39aggressive right there scissor please it's going to require a great deal of finesse to get the eyelid
35:45levels dead on so what i want to do is sort of take a look at how those lashes go and sort of
35:52re-approximate it i'm going to sort of tighten it down we'll see the difference here as this sort of
35:57secures down this should allow the lid to right up there so let's put a few more of these guys in
36:08now let me have you open your eyes and look at that spot at the ceiling there okay all the way up all
36:12the way up and then really use your forehead to kind of make it go there it is it's pretty even
36:21so you're looking so we're just going to start stitching this thing closed i feel great yeah
36:27everything went well we had a lot of length of muscle to use and we got her eye open mission accomplished
36:32so now that she's got a functioning upper eyelid she shouldn't have any more pain moving forward
36:37all right all done okay all right thank you doctor okay you did it you did it you made it through
36:56i will be seeing naris today she's coming in for her follow-up we did a droopy eyelid repair and uh
37:02i'm excited to see how the results have panned out this is actually an incredibly difficult surgery
37:08but what i'm hoping to see is both eyelids are on the same level the second thing i'm hoping is that
37:14that pain with that area she was complaining of will forever be gone for naris
37:20so that's definitely a plus because just getting that paint was just like a lot i mean i'd love to
37:26hear you to hear that i'm going to go in for the real thing here we go we've already got real
37:31personal i know so fill me in i mean you look awesome so fill me in what's been going on um well
37:39i feel like it's definitely a lot more open and i haven't gotten that soreness at all actually so that's
37:46definitely a plus because just getting that paint was just like a lot i mean i love to hear this this
37:50is exactly why we're doing this stuff so let's do a little exam do you mind taking off your glasses
37:57here we go excellent i'm looking at how the bottom eyelid lines up how the top eyelid lines up i'm
38:04looking at is pretty darn even up top then you're able to close completely i mean i am very happy for
38:11this is as great a result as i could hope for and i think it's just going to get better with time
38:16thank you i really appreciate what you've done for me it's definitely made a big change in my life
38:22i am very very grateful of dr panossian i never in a million years would have thought that
38:30i would have had an opportunity like this and here i am
38:51i had the follow-up for patrick gannon today um and i'm hoping to see that the contour is much
38:56better in the left side of the face and then i just want to see that the ear doesn't stick out as
39:00far as it did before patrick hey doc how you doing how's it going all right well thanks for making it
39:09again yes thank you for having me out again yes of course so you look great thank you i feel good
39:14you feel good yes awesome and the face just feels great it looks great awesome yeah the contour on the
39:21face so much better it's so much smoother than before and let's take a look at the ear
39:28the fold is definitely better than before you look really good yeah yeah it feels better awesome
39:34it looks better i lots of people tell me that and it's really good to hear yeah all good things all
39:40right all right well if you need anything else please let me know and don't hesitate to reach out
39:44thank you so much yeah absolutely all right we'll see you next time all right this experience has just
39:50been amazing and wonderful on so many different levels i'm so grateful to dr brewstein for being
39:57able to do do this for me and help me out all right i have nervous martinez and she sent us this video
40:12just take a look let's take a look i see you hi doctors it's me nerd i'm here in my home in south
40:19colina with my cat and my dog leah it's a whole new world she looks great before the surgery i was always
40:26trying to hide my eyes behind my glasses because i didn't like how i looked but now contacts
40:33my contacts love it now i'm on dating apps and i'm trying to get out there a little more
40:42and not trying to hide and it's just been a great journey oh the dog in the back i don't think i've
40:49ever imagined to be where i am now and i'm very very grateful for this opportunity and i'm just excited
40:57to see where i go from here with my babies i mean she got upstaged by the dog but i mean wow i mean
41:06she looks great she looks fantastic how huge it is to be on dating apps i mean that's really putting
41:11yourself out there she's great it's like hard can't glasses off and now she's super one so right
Be the first to comment