Narrator: Twenty-three-year-old Nelson Castillo has made a life for himself in southern California as a cable installer, loving husband, and young father. A native of Guatemala , Nelson was born with a small red skin blotch on his face known as a port wine stain.
[Nelson Castillo Speaks Spanish]
Interpreter: When I went to school at age 12, it became difficult, because they began giving me nicknames and ugly looks and laughed at me. So it was hard in Guatemala .
Narrator: As he grew, the stains continued to spread, and eventually formed hook-shaped polyps at the end of his nose. Today, Nelson spends most of his time at home in order to avoid public reaction.
Interpreter: Well, I feel bad when the children ask their parents what I have on my face, or when they point at me. Sometimes I feel ugly or bad that doesn't feel good.
Narrator: Two years ago, Nelson's life took an unexpected turn while installing cable for entrepreneur Eric Hanes .
Eric Hanes: When I opened the door, I was just struck instantly because of his condition. And I had no idea, even, what I was looking at.
Narrator: Eric worked up the courage to ask Nelson about his face.
Eric Hanes: He explained to me that, you know, he had had it all his life, but it had been getting progressively worse. And that he had seen a doctor on a couple of occasions about it, but they couldn't help him because he didn't have insurance. And I said, Give me your phone number, and I'm gonna call you in a week, but I'm gonna see what I can do.
Narrator: For over a year, Eric searched for plastic surgeons to help Nelson improve his appearance. He asked for, and received, financial backing for Nelson's operation through his parish, the Bellaire Presbyterian Church.
Eric Hanes: Seeing any person who could be helped is an opportunity for we, as fellow human beings, to try and help one another.
Interpreter: I think he's a nice person. He likes to help people, and that's why he helped me.
Narrator: The quest finally ended in Beverly Hills with Drs. Paul Nassif and David Amron , who agreed to operate free of charge.
Dr. Amron: __________, good to see you again.
Dr. Nassif: Eric.
Eric Hanes: How's it going?
Dr. Amron: So the two of us have a nice plan for you.
Dr. Nassif: The first part of what we're gonna do is the surgical part.
What these little round things are they're called venular malformations. And what they are, are you're feeding some of the blood into this little area right here from the port wine stains. We're gonna remove this lesion right here, and take some skin from behind your ear, and cover that area after I remove that.
And then I'm gonna do something called a septoplasty . I'm gonna fix the little partition inside your nose that divides your nostrils. Because it's blocked up, and it's blocking your left side of your nose for you.
And then Dr. Amron is gonna continue with what he's gonna do.
Dr. Amron: Well, like I told you, this is called a port wine stain made up of veins under the skin. And most of the time, it's flat like in these areas. In this case, you have this growth here, which Dr. Nassif is gonna remove, but we have to do something for the flat areas. And I'm gonna use a laser called a veebing laser. It's really a very wonderful laser for treating blood vessel growths.
Nelson Castillo: I had a question. Do you know how long it will take to clear this part?
Dr. Amron: It's gonna be numerous treatments somewhere between 10 to 15 treatments. And each one will take about 20 minutes to do. And each time we should notice it lighten a little bit.
Okay now, since that's the game plan, we're gonna get things scheduled. We're gonna schedule Dr. Nassif's surgery, and __________ surgeries after.
Nelson Castillo: All right.
Narrator: Nelson looks forward to the day when his face is no longer the focal point.
Interpreter: After the operation, I'll feel happier and new. When I look in the mirror, I'll look different. I'll be able to go anyplace I want and feel comfortable with my family.
Narrator: Nelson and Eric check in bright and early for his rhinoplasty surgery. Dr. Nassif plans to remove the lesions from Nelson's face, correct his deviated septum, and use a skin graft from his ear to cover the unhealed areas. In three weeks, Nelson will begin a series of laser treatments over a four-month period to reduce his port wine stains.
Dr. Nassif: Okay.
Narrator: First, Dr. Nassif excises the smaller malformations from his chin and lower eye. He then turns his attention to the large polyp extending from Nelson's nostril.
Dr. Nassif: Okay, so now we're gonna gently start to remove this lesion.
Narrator: Making slow and precise incisions, he dissects the venular mass.
Dr. Nassif: There's a chance that in the future, one of these growths can start to come back slowly. But as long as we treat it early, he shouldn't have a problem like this.
Narrator: Up next, the septoplasty to open the nasal airway.
Dr. Nassif: He can't breathe because the mass is pushing and collapsing his left nostril.
Narrator: Dr. Nassif takes out excess cartilage and bone to clear the blocked passage.
Dr. Nassif: The cosmetic aspect it will make his nose appear more straight.
Narrator: He performs Nelson's most challenging procedure the skin graft last.
Dr. Nassif: The problem with this is it's kind of a large area. So our challenges are gonna be how much of that skin graft will live. We don't know until we have to wait through the healing process.
Narrator: If the skin graft dies, the incision may reopen and cause an infection within the nose. Dr. Nassif outlines a circular template matching Nelson's exposed nose tissue.
Dr. Nassif: This will give us the exact size of the amount of skin tissue I'll take from behind the ear.
Narrator: He then takes skin from behind Nelson's ear and covers the opening. He attaches and sutures the skin graft. After a total of three hours, the first step in Nelson's transformation draws to an end.
Dr. Nassif: Everything went fantastic, I mean, he's gonna be extremely happy with this. This is gonna be a significant improvement on what he had before.
Narrator: Nelson returns three weeks later, pleased with his rhinoplasty results and ready for his first laser treatment.
Nelson Castillo: I'm very happy, because my nose looks great it looks good.
Dr. Amron: Hi, Nelson, how are you doing?
Nelson Castillo: Fine, thank you.
Narrator: Dr. David Amron recommends 12 sessions over a four-month period to reduce the dark purple pigmentation.
Dr. Amron: Ultimately we should get about 75% or 80% of this to improve in color.
Dr. Adams: Port wine stains occur as a result of dilated blood vessels. Possible causes include artery vein malformations, tumors, or an increased pressure caused by infection. The point is, they can be deforming and unsightly. A CO 2 laser reduces the redness by using heat to cauterize or burn the vessel. However, because the stains on Nelson Castillo's face are so deeply imbedded, it is unlikely the doctor will be able to completely clear up his skin tone.
Narrator: Both Nelson and the doctor don protective eyewear to avoid the electromagnetic light that can impair vision.
Dr. Amron: This laser uses a wavelength that's very specific for the blood vessels.
Narrator: Normally an anesthetic isn't used because it reduces the effect of the laser by constricting the blood vessels. Because Nelson's case is so severe, he may experience more discomfort than other patients with smaller areas of impact.
Dr. Amron: It's a little more uncomfortable for Nelson because he has so much target, that the laser's energy is getting absorbed by the blood vessels. They're so deep that, certainly, one treatment is not gonna get rid of it all.
Narrator: Dr. Amron injects Nelson with a numbing medicine that may require him to undergo additional treatments.
Dr. Amron: I want you to hold some ice on here for a few minutes, okay?
Narrator: Thirty minutes later, the first of Nelson's dozen treatments is complete.
Dr. Amron: I'll see you in two weeks, and we'll do another treatment on you, okay?
Nelson Castillo: All right.
Narrator: Up next, can Nelson's rhinoplasty and laser treatments coax him out of his shell?
Interpreter: I stay home watching TV that's what I do on my days off.
Narrator: And a teenage girl across town confronts her own self-esteem.
Emma Stewart : The thing I don't like most about my nose, I'd have to say, is the fact that it's crooked.
Narrator: Since birth, Nelson Castillo suffered from embarrassing skin blotches and disfiguring nasal polyps.
Nelson Castillo: I feel bad because I don't like people to see me and say, What happened to your face?
Narrator: After a chance encounter led to plastic surgery, Nelson's confidence and appearance are at an all-time high.
Nelson Castillo: I'm very happy. My birthmark looks better now. The growth is gone, so that's what is the best.
Nelson's Mother: He's so happy now, because before, he didn't want to go anywhere to the mall, or to the parks or something, because everybody is looking at him and saying, What happened? But now he's more happy, and he goes everywhere.
Nelson Castillo: My comfort is better now, and my self-esteem is better too. I think this improvement has helped me to do a better job.
I want to thank Eric and the church, because these guys, you know, helped me and everything. And God bless you guys.
Narrator: In Los Angeles , California , a normal day for 13-year-old Emma Stewart includes tap dancing, playing piano, and hanging out with her friends.
Emma Stewart: You know, we just do stuff like paint each other's nails, watch TV, and we go to the __________ place down the street.
Narrator: Now that summer has arrived, Emma is preparing for her first year of high school.
Emma Stewart: I'm gonna be a freshman next year. I'm excited about that.
Narrator: As she faces her freshman year, Emma dreads starting school for one reason: her lopsided nose.
Emma Stewart: It's crooked. When I turn my nose this way, there's more of a bump. And when I turn it this way, it's more straight.
Narrator: During junior high school, Emma endured teasing from other classmates.
Emma Stewart: Like this one guy, he would say, Oh, your nose, it makes you look like a man. It kind of hurts when someone says that to you, so you always kinda have it in the back of your mind.
Emma's Mother: I think that it has made her feel self-conscious about the way that her nose looks.
Narrator: Emma's misshapen nose is a result of a deviated septum. The condition develops when the nasal cavity is blocked with cartilage. The buildup pushed Emma's nose to the far right.
Emma Stewart: Since it's crooked, I can't breathe very well out of one side of it.
Narrator: She needs a septoplasty to repair the condition. The reconstructive procedure will open the airway and alleviate her breathing difficulties by removing excess cartilage and tissue.
Emma's Mother: Emma has suffered from allergies and asthma since she was a baby.
Emma's Father: I think her whole health issue will be better if she gets more oxygen through her nose.
Narrator: Emma also wants a rhinoplasty to reduce the bulk and straighten the tip.
Emma Stewart: I'm not asking for a little tiny nose, but I just want a nose that fits my face better, and it's not crooked, and I can breathe out of it and everything.
Narrator: The same surgeon who operated on Nelson Castillo, Dr. Paul Nassif, will perform Emma's surgery.
Dr. Nassif: So I think we're gonna talk about your nose today, huh?
Emma Stewart: Yeah.
Dr. Nassif: Okay. What I wanna do is give you a mirror. All right, so why don't you go ahead and point to me, and tell me what you don't like about your nose.
Emma Stewart: There's a bump right there, and then another bump right there. And I just kinda want it to be like smooth.
Dr. Nassif: Any problems breathing?
Emma Stewart: Yeah, I can't really breathe out of the right side very well because it's crooked.
Dr. Nassif: All right, let me take a look inside your nose. Yeah, your nose is a little crooked. Instead of being straight, it's deviated to the right. So let's talk about what we can do. You're about 5'3 or 5'4?
Emma Stewart: Yeah.
Dr. Nassif: So you probably have some growing to do still.
Emma Stewart: Yeah.
Dr. Nassif: But you're not going through any growth spurts, so you're just at that age when we start thinking about doing a rhinoplasty. And what we'll do is we'll actually take care of these issues and take care of the inside of the nose with septoplasty, which means basically taking the cartilage and bone that's pushed over, removing it, getting your septum back in the middle, and putting some of that cartilage back in your nose, and that's the septoplasty. The rhinoplasty would be the cosmetic part, you know, getting this in, and working on your tip.
Narrator: The next morning, Emma's focus extends far beyond her surgery.
Emma Stewart: I'm hungry (Laughter) more than nervous.
Emma's Mother: Are you ready?
Emma Stewart: Yeah.
Dr. Nassif: The biggest challenge with Emma's nose is trying to achieve that smoother oblique look. And also, her bones are very, very wide. And so we're gonna probably have to break each bone in two places called double- ostiotomies . And hopefully after we do the septum, her nose will be straight.
Narrator: Dr. Nassif begins with the septoplasty to clear Emma's nasal airway.
Dr. Nassif: Her cartilage is very flimsy, and her septum is very soft because it's still very young.
Dr. Adams: When performing plastic surgery on a young patient, the surgeon must be mindful of the fact that she's still growing. The operation could, in fact, alter the pattern of growth because the patient is not skeletally mature. While it usually benefits younger patients to wait until they've reached maturity, other concerns such as Emma's blocked nasal passages necessitate the procedure.
Take-home message: The decision for early surgery is best left up to patients, their parents, and the doctor.
Narrator: Dr. Nassif uses a scalpel to separate the bone and cartilage from the surrounding tissue.
Dr. Nassif: If you overdo the nose and take too much cartilage, you'll get a pinched look. Plus, you won't be able to breathe.
Narrator: A surgical chisel breaks the nasal bone so dr. Nassif can realign the passage.
Dr. Nassif: So this right here is some of the bone on the floor of the septum which was pushed over into the left airway. And just by removing that, that's gonna help her breathing quite a bit.
Narrator: He measure the cartilage inside Emma's nose to identify the exact amount to extract.
Dr. Nassif: Leaving seven millimeters of cartilage will keep the nasal tip very stable for a long time.
Narrator: Satisfied with the symmetry of Emma's nose
Dr. Nassif: Besides being a little swollen, it looks pretty darn straight to me.
Narrator: Dr. Nassif performs the final procedure, a rhinoplasty.
Dr. Nassif: This is a rasp, and that's gonna remove some of the little knuckles on the side of her nose here.
Narrator: He takes tissue from the end of the nose to reduce the bulbous tip.
Dr. Nassif: I'm gonna lay the skin back down very gently.
Narrator: The doctor shaves down the hump to give Emma's nose a more balanced appearance. Dr. Nassif closes with interior and exterior sutures to her nose.
Dr. Nassif: Everything went absolutely perfect, and I think she'll be very happy with this.
Emma Stewart: __________.
Emma's Mother: It's all right. I know your throat is dry.
Narrator: Coming up, will Emma be bowled over by her results?
Emma Stewart: I want to have the self-confidence that other girls my age do.
Narrator: Next, see if Emma's nasal revision strikes the right chord.
Emma Stewart: I definitely think it's gonna help my self-esteem because, if my nose looks better, then I'll feel better.
Narrator: And will Curt's pec implant pump up his self-esteem?
Curt Meecham: I hope that the surgery will make me look normal, and will allow me to walk on the beach with my shirt off with confidence.
Narrator: A month ago, 13-year-old Emma Stewart had a rhinoplasty to straighten her nose, and a septoplasty to improve her breathing.
Emma Stewart: When I was in grade school, I used to get teased a lot about it.
Narrator: Now she's got a nose that she loves, and more than enough confidence to spare.
Emma Stewart: I feel really good. It's straight, you know. It's not like different when you look at it this way and this way. I can really feel the difference because before, you know, I'd touch my nose like that, and it would just be like this, like, bump right there. And now I feel it, and it's just like smooth, and I'm like, Yay! And I can breathe better now that it's straight. Air can get through, and it's like the first time I went back and he took the packing out, it was like air (Laughter) .
Emma's Mother: I think Emma's nose looks fantastic, and I think she looks beautiful.
Emma Stewart: I was scared that people would be able to tell that I had work done on my nose. But if I don't tell anybody, nobody says anything about it. They say, Oh, you look good, you know, like not, What did you do?
My friends say it looks really good. They're like, Oh, you know, you look really pretty, and it's like it's so straight and perfect. You have the perfect nose now.
Emma's Mother: Since Emma had the surgery, I think her confidence level would just be boosted. In fact, she just went to have her school picture taken. And this time, she didn't have to worry about, Do I have my good side or my bad side?
Emma Stewart: It's good to get it done before high school, so I don't have to miss any school. And you know, if people that I meet in high school see me, then they don't have to know I even did anything. And it makes me feel really good, because now it's just like I don't have to worry about anything. I just feel like I'm happy with it.
Dr. Adams: Did you know that in the last year, 3.1 million plastic surgery procedures were performed worldwide? Whether it's cosmetic or reconstructive, there's no doubt that plastic surgery is on the rise. And we, as doctors, will continue to find ways to improve procedures and provide our patients with the best care possible. I want the patient to be happy. That's the bottom line.
I'm Dr. Jan Adams. Thanks for watching.
