- 20 hours ago
The Bad Skin Clinic S08E03 I Want My Normal Face
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00:00I use my hair to kind of like cover my
00:14keloids. It doesn't cover it completely but it's definitely a lot better. It helps
00:23like with the staring. People are like disgusted by it and have told me oh if I looked like
00:34you I wouldn't leave my house. There's certain days I've just cried myself to sleep. You just
00:44keep thinking this is it. I'll have to live with it for the rest of my life.
00:53I just want to have my normal face. It's so cold. It is so cold. Look this rain.
01:15It always takes me so long when it rains. That is why I check the weather forecast. I never do.
01:25Did you make Pilates this morning? Yeah. Can you tell when I stood up? Yeah. It's actually
01:37the legs there sewer.
01:39Oh my god. Okay. I think I took too many. I'm going to put that one back. Okay.
01:53Oh look at that. That photo is nice. Yeah. Very nice.
02:09Look. Yeah. This is at the shop. Yeah. I'm really in the shop. You let me put it up in the shop.
02:28Yeah. Oh you're smiling. Your face everywhere. It's lit up. When I was younger I was more
02:41like confident and like happier in general. Wow. Time fly fast. Yeah. Stopped taking photos.
02:55Really at the start of my early teenage years. Due to the keloids growing. It makes me angry because
03:04it affects you mentally. It's socially. Everything you do is there. Just don't like it and just feel ugly.
03:15I have a skin condition called keloids where it's a growth of scar tissue. So over time it's slowly
03:24keep growing and keep growing. It feels quite like thick and tough. Sometimes it can give like a really like
03:33sharp pain. I'm packing to go to London for an appointment to see Dr. Emma. I'm nervous for the
03:46appointment. Just wondering what Dr. Emma will say whether she can treat the keloids.
03:58So Emma has two surgeries. One this morning and then one this afternoon. Okay. And then in between
04:03we have Zoe and it looks like she's quite an interesting case. Okay so I will book a double slow then. Perfect. Thank you. Thank you. See you.
04:11I'm excited about seeing Dr. Emma. I am. Yeah. Especially now that it's going to this extent.
04:24The train was parked. Can you get a taxi up there? It's quite busy. These are some of the things
04:39that make you paranoid isn't it? Yeah. I do get anxious. Just because I constantly think people are staring.
04:49Someone told me. Someone told me, oh it's leprosy. Just keep your stupid comments to yourself.
04:56Yeah, the tattoo's here.
05:04Emma. Mm-hmm. We've got 20 minutes before Zoe comes. Do you want me to get you anything?
05:08No, no. I am finished. So I'm going to go and make us both a coffee. Okay.
05:11I mean there could be a possibility Dr. Emma may not be able to treat you.
05:17Oh Zoe, most people who go there, she finds a solution to their problem. Just keep her positive mind.
05:27Thank you. Let's get you sorted.
05:31Hello. My name's Zoe. I'm here to see Dr. Emma. Fantastic. If you just take a seat, I'll let her know you're here.
05:46Oh yeah. That's how, when it started. That's right, when it started.
05:50When I had it like this then, it bothered me. So it wasn't even that many. But now it's obvious.
05:57And because it's on your face, it's the first thing that people see.
06:02Yeah.
06:12Hi Zoe. Hello.
06:13Hi, nice to meet you. I'm Dr. Emma.
06:15Hello.
06:16Come with me.
06:18Did you have to come from far today?
06:19Yeah, from Barnsley.
06:21From Barnsley.
06:22Yeah.
06:23So how long does that take?
06:25Over two hours.
06:27Over two hours.
06:28Yeah.
06:29Sometimes it takes two hours just to get across London.
06:31Yeah.
06:34Come on, have a seat.
06:36This is Moti, he's our nurse.
06:37Hello.
06:38Hello.
06:39Nice to meet you.
06:40This is Zoe.
06:41And Mum.
06:42So Zoe, I can see why you've come to see me in the clinic today.
06:46Yeah.
06:47Tell me a little bit about these scars on the face.
06:49So I had acne during my early teenage years and then that developed into keloids.
06:55And does anyone else in the family have problems with developing keloids?
06:59Her dad's side of the family.
07:01Yeah.
07:02OK.
07:03But it's very, like, very, very mild.
07:05I seem to be, like, affected really severely.
07:07Yeah.
07:08Yeah.
07:09OK.
07:10And did these keloids come up just in, like, little bumps initially?
07:13Yeah.
07:14But that's when I started to seek treatment.
07:17And what treatment were you given?
07:19So I was given surgery.
07:22I've had three.
07:23And do you have any photographs of these?
07:25Just so I can get an idea of what it was like before each of the surgeries?
07:29Yeah.
07:31First one was only to remove one.
07:32OK.
07:33So they've removed this one.
07:35That was after the surgery.
07:36And it just got bigger after the surgery.
07:38Yeah.
07:39The second surgery, where was that?
07:41The bottom here.
07:42OK.
07:43They decided to just remove one.
07:45The last one.
07:46They removed all the keloids.
07:48And how long ago did they do that?
07:50Five years.
07:51That's really helpful to see and see, you know, how much they've grown.
07:55A lot.
07:56Yeah.
07:57A lot.
07:58So the surgery has actually made things much worse for you.
08:01And did they do any radiotherapy or any steroid injections?
08:05No.
08:08Are these painful?
08:10Yeah.
08:11Like a sharp, like, shooting pain.
08:13It must be difficult to have something that's painful and so visible for everyone to see.
08:19How does it affect you?
08:20Confidence.
08:21When she was more, she's loud, you know, giggly, playful, and then suddenly, because of things that people say, she started, you know, retreating a bit.
08:33It's hard to see as a mummy, isn't it?
08:34Yeah, it is.
08:35OK.
08:36Do you mind if I come and have a close-up look at all of these?
08:39Is that OK?
08:40Yeah, that's OK.
08:43OK.
08:44Let's have a wee look at this.
08:47So this is actually really all merged into be one giant keloid, isn't it?
08:53Yeah.
08:54It's got a real overhang of where it's just dangling down.
08:59It's on a stalk.
09:00I can get my fingers right underneath that.
09:04And then it's attached all the way on the cheek area.
09:07And actually, that's one active little spot there.
09:11Yeah.
09:12And if we move round to this side, these are still distinct separate ones.
09:16So you've got one, two, three, four, and then the one underneath the chin, five.
09:26And actually, just noticing the little hairs.
09:32Undoubtedly, these are keloids.
09:34So when we think about what a keloid is, usually there has to be an injury to the skin to begin with.
09:39So sometimes it's an acne spot.
09:41Sometimes it's a cut.
09:43Sometimes it's even as simple a thing as a hair being trapped.
09:48And normally, whenever we have a wound, our fibroblasts, which are our cells repair wounds, kick in, repair it.
09:56And then they go, OK, we're done, we're repaired, we can stop.
09:58But when somebody has a tendency to keloids, those fibroblasts just keep on making more and more scar tissue.
10:07You probably carry one of these genes that have got a tendency to develop keloids from your father's side of the family.
10:14What's caused the keloids that you have now has really been these surgical interventions.
10:21Because whenever you do surgery on a keloid, you're essentially making an even bigger wound that can result in another keloid.
10:29Not having anything afterwards has then undoubtedly meant that the recurrence risk was going to be higher.
10:37And here we are now.
10:39Another factor, I think, of what's potentially driving it for you is a hormonal factor.
10:45Has anybody ever looked at your ovaries to see if you've had any cysts on the ovaries, something called polycystic ovarian syndrome?
10:52No one's ever, like, tested me for that, or even said you have it all.
10:57OK.
10:58Yeah.
10:59Because we know for people, well, women who have keloid scars, they are worse whenever the hormones are a bit out of balance with something like PCOS,
11:09polycystic ovarian syndrome, that drives acne.
11:13And it also is the driver for why people often have hair in areas that they don't necessarily want to have hair.
11:21So I think with this condition of PCOS, which I think you do have, a really important step will be to get the hormones exactly in balance.
11:30It's an injection to reduce the acne, to reduce the bits of hair growth.
11:35So that is step one.
11:36And then step two, this is a big job, and this will require quite a bit of planning.
11:44So I would like you to see my colleague, who's a specialist in facial plastic surgery, to see, you know, how is this possible?
11:53And then there is no way you can have any surgery on your skin unless you have something like post-operative radiotherapy to try and stop these from coming back.
12:02Yeah.
12:03And that's the thing that's associated with the best cure rate. Does that make sense to you?
12:08Yeah.
12:09No one has ever thought about all the problems within me.
12:14I feel like before, just get surgery and then that's it.
12:18Yeah. Surgery alone is absolutely never the answer, ever. And it just makes things worse.
12:26Zoe is just 20 years old and she has one of the worst cases of facial keloids I have ever seen.
12:35The thing is, our face is really our identity. It's how we think of ourselves and it's how others view us and interact with us.
12:43And so no wonder this has had such a devastating impact on her. I really want to be able to help her.
12:48What a dream to catch.
12:51But she's already had three failed surgeries and each time the keloids have come back and they've come back bigger than before.
13:00And now virtually both of her cheeks are just scar tissue.
13:04OK, I need to get a taxi.
13:07Removing these keloids is going to be a complicated surgery.
13:10And the big challenge is going to be closing up those wounds and leaving as little scarring as possible.
13:18And I think it's going to take a lot out of her emotionally and physically.
13:21Can I take a message?
13:36Zoe suffered with keloids for pretty much her entire teenage years.
13:44And previous attempts to try and remove these have just resulted in them growing back even bigger.
13:49So she needs a very specialised and complicated surgery.
13:55And I'm referring her to the brilliant and very experienced plastic surgeon, Mr. Simon Withey.
14:01Dear Simon, I'm most grateful for you seeing my patient, Zoe, who has attended the clinics with keloids on both aspects of her cheeks.
14:07They're having a significant impact on how she's viewing herself.
14:10And I think we need to make a plan of how to treat these definitively.
14:14With counter-guard your sincerely.
14:15Zoe's really quite reserved, isn't she? Very, very self-contained.
14:21I think that's quite common after teenagers have experienced that kind of trauma.
14:27Almost like, I don't know, keeping everything inside.
14:31Yeah, I've noticed that. Like a protective kind of layer.
14:34Yeah, that's exactly what it's like.
14:35When she came to see me, I diagnosed Zoe with a condition called polycystic ovarian syndrome.
14:53And it's this hormonal imbalance that's causing her to develop acne on her face and hairs on her face which are becoming ingrown.
15:02And that is what the trigger is for the keloids.
15:05It's vital to get this under control before her surgery.
15:09So I'm starting her on some treatment to balance the hormones and reduce the risk of her developing new keloids.
15:14So it comes in a pen, press my stomach and then inject.
15:19Yeah.
15:23I have an appointment with my dad to go and see Mr. Withoo.
15:32Mr. Withoo.
15:36Hello. My name's Zoe.
15:39I'm really hoping that he's going to agree that further surgery and the right aftercare is going to be the best option for Zoe.
15:47Nice to see you Zoe. How was your journey?
15:50It was good.
15:51Good. Can I ask you to come over to the couch?
15:53The bit which is attaching the scar to the skin is fortunately a little bit smaller.
16:04Which is quite helpful when it comes to deciding whether we can take these out.
16:12Thank you so much. Come and have a seat.
16:17I think surgery is a solution for removing these keloids.
16:21Yeah.
16:22I think there are areas which worry me.
16:24One is the widest bit of the scar on the left side.
16:29The base that it's growing from is really very significant size.
16:34Thank God.
16:36And it is quite possible that we wouldn't be able to close the wounds at the time of your first operation.
16:43What I propose having seen you today is to talk to Dr. Emma.
16:48Yeah.
16:49And then I think we'll meet together where we discuss whether we do the operation as one stage or two stages.
16:56Alright?
16:57Yeah.
16:59Alright. It's a pleasure.
17:01The thought of two different surgeries makes me feel nervous.
17:06You let your mum know about it.
17:08But just happy now knowing that it is possible to now get surgery.
17:15Erm, yeah.
17:19So what did he say?
17:21He said that he can do it, so it's brilliant news.
17:24I'll speak to you soon.
17:26Bye.
17:27Mottie, can I leave you to set up for the meeting with Mr Withey downstairs?
17:44Yeah.
17:45Is that OK?
17:46Perfect.
17:47I'll see you down there.
17:48Yeah.
17:52Simon, this is Mottie.
17:53Hi, Mottie.
17:54Mottie, Simon Withey.
17:55So there's no doubt that this is a really complicated case and I thought we could just get together so we can get it clear in our heads the plan for her treatment.
18:05Part of the problem of why she's been getting these on her face is because of the PCOS and any tiny little hair that's getting coiled up and inflamed is leading to an inflammatory bump that's turning into a keloid.
18:18So she's on an injection to get the hormones under better control to stop new keloids from forming.
18:24So now it comes down to your part.
18:28Can we go to the profile pictures?
18:31Keloids lie along the line of the original scar.
18:38So we have to follow that from top by the lobe of the ear down towards the bottom, sort of behind the corner of the mouth, which isn't a great position.
18:48But the idea is that if she responds well, then she'll be left with a fine line.
18:52I don't want to promise anything, but you know, that would be the perfect solution.
18:56Should we have a look at the other cheek?
18:58And this is the big one.
18:59So it's possible that when you take this out, you can sort of get something which might just approximate and close the wound, but it might not.
19:13If we feel it's not going to a close, we will take the majority of this out, leaving a little bit of scar tissue behind before a second operation.
19:22And how long do you think it would be between the first and the second one?
19:26Three or four months minimum, maybe extending to six months.
19:31You do feel the responsibility of making sure that it's as good as it can be, because it's probably the last go surgically.
19:38It's a lot of pressure.
19:39It's a lot of pressure.
19:41On you.
19:42And you.
19:43I'm so pleased Mr. Withy wants to operate on Zoe because this is a really complicated case.
19:53Until he removes the keloids, he's not going to know if there's enough healthy skin underneath to close this over.
20:00In which case, Zoe would require another operation in six months time.
20:05But this would mean delaying one of the radiotherapy treatments, which would increase the risk of the keloids coming back.
20:12Even with just one surgery, we know that there's not going to be enough healthy tissue left for any more attempts after this.
20:19This is her one and only chance, and we have to get this right.
20:39I do love training to be a nurse, but it's really pushing me out of my comfort zone.
20:49Good morning.
20:52Morning.
20:53To the hospital, please.
20:54Yeah, no problem.
20:55I feel like patients expect a nurse to look a certain way.
21:00So when they see me, they think that I'm not going to do as good of a job as maybe another student.
21:12Bye.
21:14So I have one year and then I'll be a qualified nurse.
21:19I do hope that if the keloids are gone, I can just be a bit more confident.
21:25I'm just hoping to just live life a bit more, just be more happier, wanting to like do things that I've been putting off doing.
21:34Thanks, Simon.
21:35That's brilliant.
21:36Yeah.
21:38Bye.
21:39That's Mr. Withy has just called for Zoe and we've got a date for surgery.
21:40That's amazing.
21:41Yay!
21:42That's the lift.
21:43It's the morning.
21:44It's the morning of surgery.
21:45I'm so sorry.
21:46It's your excitement.
21:47It's the morning of surgery.
21:48Thank you, Simon.
21:49It's the morning of surgery.
21:50It's the morning of surgery, and we can't see the surgery.
21:51It's the morning of surgery.
21:52I'm so sorry.
21:53Oh, that's amazing.
21:54Dee!
22:08That's the lift.
22:12It's the morning of surgery.
22:15Going to floor two.
22:17I haven't really slept that much.
22:20Just hope that after today,
22:22the key loads will be gone.
22:25Hello.
22:26Hello.
22:27My name's Zoe.
22:28Nice to meet you, Zoe.
22:29My name's Louise.
22:30I'm going to be your nurse today.
22:31Let me show you to your room.
22:33So make yourself comfortable.
22:36How are you feeling today?
22:38A little nervous.
22:40I'm going to look after you.
22:46How are you?
22:47I'm welcome.
22:48Good.
22:49Any questions?
22:51Are you able to do both sides of my face?
22:54I'm hoping we'll be able to take everything away,
22:57but I really can't make any firm promises.
23:00Okay.
23:01How long do you think the operation will take?
23:04Good question.
23:05I don't know.
23:06It's not going to be shorter than three hours.
23:09It could be as long as sort of five hours.
23:12I think we've got the rest of the day.
23:13All right?
23:14Yeah.
23:15Are you ready to go?
23:16Yeah.
23:17A kiss for good luck?
23:18I'm the best.
23:20We'll look after that.
23:21Yeah.
23:22We'll look after that.
23:23Yeah.
23:24Okay.
23:25This is the largest facial key load I've removed.
23:29If we take it all out but can't close the wound, we've completely messed up.
23:48So we have one patient, Zoe, who is 20 years old, I think?
24:07Yep.
24:08Who is coming in for excision of facial keloids.
24:14Given that she has already had surgery, her keloids have come back very aggressively.
24:21There is one attempt at doing this.
24:24So we're just going to do our safety checks.
24:26Okay.
24:27And then put the drip in, a bit of oxygen and off to sleep.
24:30Okay.
24:32So the decision is, can we cut it all out today?
24:35How do I minimize the amount of operations for her?
24:38Do we have to leave a bit behind?
24:40How do we get the bits back together?
24:42So you might be starting to feel a little bit sleepy now.
24:49Pleasant dreams and we'll take good care of you.
24:51Okay.
25:02That's me done.
25:03Good.
25:04I'm going over to another hospital because Mr Withy is operating on Zoe.
25:08Oh yeah?
25:09Yeah.
25:10I'm also doing that mixture of excited and nervous for her because there's no room for anything to go wrong.
25:17Good luck.
25:19I will see you tomorrow.
25:20See you tomorrow.
25:21Good well.
25:23Mayors do the best.
25:33Facial surgery carries especially high stakes
25:34because our face is the most visible and personal part of who we are.
25:36Studies show that, when done well, scars that are placed properly and have healed discreetly, have very little impact on how a person can live their life.
25:46One, two, three.
25:48But poorly placed scars can deeply affect
25:51a person's confidence and wellbeing,
25:53so there really is no room for error.
25:59The plan is to start on the left-hand side.
26:03This is the more challenging one.
26:05Work out how much of the scar I can confidently take
26:09without risking having an open wound,
26:12and then fit the bits back together again.
26:16You can see there are a few little smaller scars on the cheek.
26:21Those are going to have to be left, unfortunately.
26:23Taking them just means that I end up
26:26really struggling to close things.
26:34Inject some local anesthetic and a bit of fluid
26:39to separate the scar from the layers in the cheek.
26:46Oh, goodness.
26:51The scar seems quite...
26:55Oh.
26:56Oh, goodness.
26:58This canyon isn't getting in there.
27:03Normally, the tissue plane will open up
27:06based on the sort of pressure of the fluid being injected.
27:10And here, it's just coming out back through the hole
27:15that I made to put the cannula in.
27:20More scar deeper down than I thought.
27:25It hasn't lifted.
27:26It hasn't done the job.
27:28I thought that might ease the operation for us a bit.
27:31So we'll have to do that surgically.
27:33Just take a bit longer.
27:37Cut through the skin now.
27:40The fact that the fluid didn't go in
27:41means that the tissues are quite tightly adherent
27:43and scarred to one another.
27:45It's certainly not an easy tissue plane to dissect.
27:48Just trying to make sure we lift this up
27:53without getting too deep, effectively.
27:58There's a little branch of the facial nerve at this level.
28:02If we get that,
28:03then it gives her an imbalance of smile,
28:05so very keen to avoid it.
28:07Do I leave a bit behind?
28:17Am I reasonably confident
28:20that we're going to be able to close this?
28:27So we're close to getting this off.
28:31Last little bit.
28:33A little bit here.
28:34There we go.
28:36That's her keloid.
28:44So now I've got to try and close it.
28:50If you can just pull a bit on the cheek.
28:56We have been building up to this day for so many months.
28:59This means so much.
29:01And this is her one shot of this working.
29:04And so that's why I have to be here.
29:07I'm anxious about this because this is so complex.
29:14Hi, Simon.
29:15Hi, Emma.
29:16So how's it all going?
29:17Hi.
29:19Obviously getting the two edges of this together is difficult.
29:23It's amazing when you take all the scar out
29:25how much it then suddenly just opens itself out, isn't it?
29:28Yeah, exactly.
29:31Do you think you'll be able to remove all of these today?
29:35I'm hoping so, yeah.
29:36And I'm just tacking the edges together to see how it best fits.
29:48It looks like we might close it.
29:49Yeah.
29:52I can breathe now.
29:53Yeah.
29:55It's obviously very tight.
29:56You know, if you took another couple of millimeters each side,
29:59you might get a slightly better quality of edge skin.
30:02But I'd rather have this than overdo it
30:05and therefore increase the risk of further scar thickening
30:09as a result of the increased tension.
30:11Yeah, I think that's exactly right.
30:12So I think we'll accept what we have.
30:15I mean, Zoe is going to be so pleased
30:17that this is not there on her face.
30:21One side almost done.
30:24My last stitch.
30:25It looks so good.
30:26I'm going to go and update Zoe's mum.
30:30Thank you, everyone.
30:32Emma, thank you so much for joining us.
30:34Bye.
30:39Hi, Agnes.
30:41Hello.
30:42Hello.
30:43How are you?
30:44I'm good, thank you.
30:45It's so good to see you.
30:47So I just thought I'd come and update you.
30:49So the side that was the quite complex side
30:52and Mr. Withy wasn't sure whether he needed to do two operations on it.
30:58He's actually able to get all of it gone.
31:02That's exactly what I thought.
31:04Yeah.
31:05And he's done a closure of it as the scar
31:08and it sits quite neatly.
31:10Oh, God, that is so terrible.
31:13Because as I sat here, all I've been thinking is,
31:16where would the scar be?
31:18But, oh, thank you.
31:21So what's on the other side?
31:22So he's just starting that one now.
31:24Bye.
31:25Right.
31:33So now, obviously, starting on the other side.
31:37So here, the keloids are a bit smaller
31:40and they're not located quite as favourably
31:45in terms of being able to preserve tissue.
31:47But equally, it's not quite as deep as the other one.
31:52Taking one at a time, really, and seeing how we go.
31:57The scarring is quite wide.
32:12Some of the tissue between them you can't leave
32:15because it's very narrow-based and so we won't have a good blood supply
32:19and so it won't be viable.
32:21We'll just die off and then you're in real trouble.
32:25If she gets another keloid scar because she gets an area of tissue loss,
32:33that's it.
32:34There is no way back.
32:35You get a keloid you couldn't really deal with.
32:40This is why we've said all along, this is a chance.
32:47OK.
33:01The base was probably a bit wider than I had anticipated.
33:05The difficulty is to be working out,
33:07you're going to put this back together again.
33:15Anyway, we're committed now.
33:16We've got to do it.
33:19We have no choice.
33:20The surgery on the left side, the surrounding tissues moved together in a reasonable fashion.
33:34You can see it's quite complicated.
33:37It's a little, sort of, bit more of a jigsaw puzzle this side,
33:40which is why I'm sort of going to be tacking a little bit back
33:45before I fully close anything just to make sure it does work.
33:50You don't see it anymore.
33:51You don't know?
33:55You don't know it.
33:56Is it full length?
33:57It's full length, yes.
34:20It's too tight, quite tight in the middle, I'm trying to see how else I might address
34:45that.
34:46I'm just not convinced that's the healthiest bit of tissue, so I'm just taking out corneas
34:56please.
34:57I'm going to advance this flap across this bit of tissue, which will take the tension
35:12off.
35:16A bit of dead tissue would be catastrophic for her.
35:22I'm happy with the tension now.
35:26This is the best alignment we can get of these tissues and so I'm going to formally close
35:33this wound.
35:37It's been a very long surgery, I'm so desperate to see her, I'm anxious.
35:50Putting the last layer of sutures in now.
35:54It's been a bit fiddly, particularly this side, so I'm quite relieved it has come together.
36:00I had a moment of doubt, I had a moment of doubt, full stop.
36:05Well then, the operation's over, okay, we're just going to go to the recovery area.
36:17I was with Zoe last night having her operation.
36:29It went so well and in fact she's probably, yeah, she's on her way to radiotherapy right
36:48now.
36:49That's really good news.
36:50She'll be so thrilled.
36:51So good.
36:52It's good to see you.
36:53Oh, Zoe, you look so good.
36:54Have you seen your face?
36:55Not yet.
36:56Yeah, I have a mirror here.
36:57Look.
36:59Oh, wow.
37:00So nice.
37:01You look amazing.
37:02Yeah, it looks so different.
37:05It's like it's not my own face.
37:19Things are beautiful.
37:22It's like it wasn't bad.
37:26Really happy.
37:31And it's gone.
37:33Yeah, really happy.
37:42If we just did this surgery with no radiotherapy, there's about a 95% chance that this would
37:49just all come back.
37:51However, with the radiotherapy, it lowers that risk to about 13%.
37:57Radiotherapy is a very superficial form of x-ray radiation.
38:02Now, she didn't have this after any of her other previous surgeries.
38:07Take a seat on our couch and we'll get you into position.
38:10This works by penetrating into the skin and targets those cells that are responsible for
38:16making the keloid.
38:17And it kind of stops them in their tracks.
38:21Got the lead shielding positioned on her jaw.
38:28Cut out blocks are made from lead to protect the rest of the skin so that it's only the scar tissue that's being targeted.
38:35We know that this is tough.
38:37Yeah, do you want to sit up for a minute?
38:39There's quite a lot to go through after you've just been, you know, through a seven-hour operation.
38:45So, we're going to do this cheat now.
38:54OK, so we are all finished, OK?
38:58Well done.
39:00How was it?
39:02It was a bit painful, but I'm happy I've got it done.
39:07So, tomorrow I'm going to come back to do the last radiotherapy.
39:12I'm looking forward to seeing my face without the bondages.
39:16Yeah, it would be nice to see.
39:30Good morning, Dr. Creighton's office.
39:35Good morning, Dr. Creighton's office.
39:37I'm very pleased at how it looks now.
40:02Hello, I'm here to see Dr. Temer.
40:04It's been three months since Zoe's surgery.
40:07I can't wait to see how she's getting on.
40:12Hi, Zoe.
40:13Hello.
40:14Hi.
40:15Nice to see you.
40:16My gosh, you look so different.
40:18Come this way.
40:22Look at you.
40:24I mean, what a difference.
40:26I think the smile kind of says it all.
40:29Yeah.
40:30Yeah.
40:31How have things been for you since the operation?
40:34I'm not used to how it looks like, but I am happy how it looks.
40:38I don't feel any, like, pain or anything.
40:41It's a big difference.
40:43So, this is only three months since the operation?
40:47Yeah.
40:48Gosh, it's no wonder you haven't got used to it.
40:50Yeah.
40:51Is it OK if I have a look?
40:52Yeah.
40:54Wow.
40:55Wow.
40:56Wow.
40:57Wow.
41:02It's quite hard to believe that is such a big area to have it all excised and just so neat.
41:13And you've got these areas where it's a lot paler in colour.
41:17That will all just pigment back up and will match in with the rest of the skin.
41:22And that darkness is from the radiotherapy.
41:24That will fade down.
41:27But this looks absolutely fantastic.
41:31There's no sign of any recurrence at all.
41:34The skin quality itself is much better now, isn't it?
41:36Whereas before you had the little bits of acne bubbling that had me worried that any of those could become a keloid.
41:41We know now that you have this diagnosis of polycystic ovarian syndrome.
41:46And the medicines that we have you on to control the hormones is also controlling these.
41:54It's absolutely perfect.
42:01Well, this has all gone really well.
42:04It is so different to what it was before.
42:07I keep looking at her all the time.
42:10And I say, oh, you look different.
42:11You look beautiful, Zoe.
42:14You really do look beautiful, Zoe.
42:16What are the kind of goals you've set for yourself?
42:19What kind of nursing would you like to do?
42:21I would like to do dermatology nursing, yeah.
42:24Brilliant.
42:25Yeah.
42:26I think you would be amazing at that.
42:28I do have a lot of confidence that these are hopefully not going to come back.
42:32I can't say 100%, but it's certainly much more likely to stay away than to come back.
42:40You don't know how much it's mean what you've done for us.
42:44Just walking in here the first time when we didn't have any hope and you putting a smile on Zoe's face.
42:55We want to say thank you.
42:58You're going to let me cry.
43:01Oh, thank you, Mum. Can I give you a hug?
43:08I am so glad you got in touch.
43:10And I'm just looking forward to seeing what's going to happen to you now over the rest of your life, really.
43:16Yeah.
43:17And the difference that that's going to make.
43:20Thank you so much.
43:26She has actually missed out on a lot of what we would think of as normal teenage experiences.
43:32And so she's got all of those things to do now.
43:36She would take us off.
43:38And I feel excited for her to do those things.
43:40I wouldn't forget this, yeah. It's our last appointment.
43:46Now that I don't have the keloids, life will be better.
43:50Let's get into a taxi.
43:51Taxi.
44:21Pizza center.
44:21You, you, you.
44:22Fix your house.
44:24Now that we are seeing the family of the new houses before I end up like they came down with you.
44:27Are that true?
44:28The whole house.
44:29The king.
44:30Is that true?
44:31niin.
44:37On?
44:39You and the king.
44:40I'm such a bad girl.
44:45Nose of this table really gets cut out ofayım so you can not go let me in�andi.
44:46I'm not going to be here.
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