Shot in the Face Part 3: Reconstructing Hope with Dr. Eric Dierks & Dr. Larry Over

An extraordinary medical journey unfolds as devastating trauma—a 17-year-old girl's shotgun blast to the face—is transformed into renewed hope through groundbreaking facial reconstruction.

Dr. Long welcomes special guests Dr. Eric Dierks, an oral maxillofacial and ENT surgeon, and Dr. Larry Over, a prosthodontist specializing in maxillofacial prosthetics. Together, they unravel the remarkable case of a patient, whose face was catastrophically damaged by a shotgun injury that destroyed her nose, eyes, and significant portions of her facial structure.

The conversation takes us through the progressive stages of reconstruction, beginning with the initial life-saving surgeries performed by Dr. Bryce Potter and team, who created a new structural foundation using bone from the patient's leg. Two years later, when the patient was still facing profound disfigurement that caused public whispers and stares, Dr. Dierks stepped in to prepare her for a prosthetic solution.

What follows is a fascinating deep dive into both the surgical and artistic elements of facial prosthetics. Dr. Dierks describes creating a nasal airway that allowed her to breathe normally for the first time in years, while Dr. Over reveals the meticulous process of crafting a silicone facial prosthesis—from creating impressions and wax prototypes to custom-matching skin tones and placing artificial eyes with perfect symmetry.

Perhaps most compelling is hearing how this medical intervention transformed not just the patient's appearance but her entire life. The magnetically-retained prosthesis allowed her to blend into society as simply a blind person rather than someone with a visible disfigurement. She later established a long-term relationship and built a fulfilling life that would have seemed impossible in the aftermath of her injury. 

This episode exemplifies the podcast's core mission: showcasing how collaborative expertise, innovative thinking, and patient-centered care can create outcomes that once seemed impossible. Listen now to discover how saving time saves lives, and how dedicated medical professionals can transform a flatline situation into a lifeline of hope. 

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.  

Follow us on X @DrLongPodcast 

Producer: Esther McDonald 

Technical Director: Lindsey Kealey, of PAWsitive Choices

Editing and Post Production: Adam Scott of Atamu Media Productions

© Flatline to Lifeline 2025

Transcript

Introduction to Facial Reconstruction

SPEAKER_02 0:00

Welcome to Flatline to Lifeline with Dr. Bill Long. For three seasons, this podcast has explored unexpected survival outcomes and how Dr. Long and his team of trailblazing nurses and staff of doctors began to replicate these unexpected outcomes by applying available technology and simple principles in new and profound ways. Pursuit of these unexpected survival outcomes became a mission for Dr. Long's team over his almost 50-year career. We hope to educate those listening from any walk of life and just inspire those within the medical community to consider and adopt these life-saving techniques and approaches to trauma care. Because when the need is greatest for the patient, saving time saves lives. Welcome back to Flatline the Lifeline with Dr. Bill Long, another continuing episode of a case study that we've been looking at for a couple of episodes now. Dr. Long, how are you this morning? That's fine.

SPEAKER_03 0:58

Thank you. Perfect.

SPEAKER_02 1:00

And you have some guests here with you. Bring in more fame and talent as we speak every week. So would you like to introduce them or would you like me to?

SPEAKER_03 1:10

Well, I'll start. The first one was Dr. Eric Dirgs, a person with trained at two illustrious trauma centers, one in Kentucky and the other one in basically Dallas at Parkland. And he is also an MD medical drug degree and has a dental degree and trained in oral surgery and irritation state. And so he could tell you his story of why he left Dallas to come to Portland, Oregon, and worked with the unforementioned. Fair enough.

SPEAKER_04 1:57

Yeah. He said, and you're trained in both oral maxillofacial surgery and PMT, head and neck surgery. I said, Yeah. I said, who are you? He said, he said, I have a unique situation where I am doing all of the maxillofacial trauma at a level one trauma center, and I also do cancer surgery. And he said, Yeah, we do a lot of that. And he said, I too am trained as you are, which is a fairly uncommon combination to do ENT and oromaxillofacial. So anyway, I came out and looked at the manual hospital, met Dr. Bill Long, gave a little talk for them. And I had a job, and it was a much better position than I had at the University of Texas Southwestern. In the sense I was able to do what I wanted instead of being, well, you know, today you're an urinosis drug doctor, you got to do that. And tomorrow you're going to do oral maxillofacial surgery. So I just did private practice.

SPEAKER_02 3:04

So this gave you the opportunity to literally just act on all of your training as the situation provided. Precisely. Isn't that the beautiful messing of a world in a life where you're just like, I have been put in a place where everything works.

unknown 3:22

Dr.

SPEAKER_02 3:22

Wong, you had something?

SPEAKER_03 3:24

Yeah, I think the other thing that was attractive to Eric, and he made a big point about this to me, is that we realized it took four specialists to do maxfacial trauma before somebody like Bryce came along. And we covered world surgeon, DNT surgeon, plastic surgeon, and somebody do an emergency tracheostomy. And I was the one that did that. Four of us had to be on call to cover what Bryce could do by himself. So in order to stimulate Bryce to get a partner, highly competitive world, we offered him an exclusive franchise if he could put a team together that would do the things that Eric and he could do. And so you can't find exclusive franchise at most university hospitals. They're all broken up into departments, each vying for a right to have an experience of a certain type of facial injury. Have it all wrapped up into one area where you didn't have to compete for that. You just had to have the credentials to do it, is a different story. What do you think, Eric?

SPEAKER_04 4:26

Yeah, I agree completely, Bill. It was a breath of fresh air when we came to Portland and to manual hospital. This was something that I had not experienced before. There was a call schedule, and there was oral maxillofacial surgery took call one night, and the next night there was ENT taking call. And the night after that is plastic surgeries taking call. Some of the people are innocent in trauma that go through any of these three disciplines, and others really don't have so much interest in it, depending on the individual who's on call that night. Well, in the situation built that developed the manual hospital, we had people that were profoundly interested in this every night of call because we took call every night. That was a little bit of a problem, but most of the time it was just a passion.

SPEAKER_02 5:24

Well, we've definitely touched on the fact that when you got that call from Bryce Potter and Dr. Long is assembling his team, and you get dropped into it in the experience of saying, okay, we're with a group that is all doing the same thing. It's funny that you said you're on call every night. I always remember as a young child coming over for holidays, Thanksgiving, Christmas. And I always said that I never knew what my uncle did. I knew he was a doctor, but I never knew what he actually did until we started doing this podcast. And I was like, oh, that's why you were an egg-renter. Okay, you were fixing a person who was missing a face. Got it. So I'll give you a pass for missing dinner. That's incredible that you had all those people who are rock stars in their specific practice or specialty, all with the same goal. Just to save lives and to utilize your training at the optimal level. All right. So let's go on to your next guest, Dr. Long. Can you please introduce Dr. Larry Ober for us?

SPEAKER_03 6:28

Larry Ober, I didn't know. He was down in Eugene, but Eric knew him, as he just said. So when this girl's what you're going to talk about, it's face to be reconstructed, Eric turned to Larry. Larry appeared on the scene. They rendered together, they collaborated with reconstructing this person's face in a way that I didn't think would be possible. They were giving me an education while I was watching. Well, Dr.

SPEAKER_02 6:52

Over, welcome. Can you tell us a little bit about yourself? Can you give your view on how this genesis occurred?

SPEAKER_01 6:59

Yes. So I did my residency in both prosodonics and maxelf prosthetics in Indiana. I'm a native Oregonian in. I wanted to go into private practice. My wife's Reese from Washington, and we had an opportunity to come back to Eugene. I loved Eugene. I was born there. And so I set up a private practice there and was lucky enough to treat the cancer patients and trauma patients that Dr. Dirks would refer to me. We got to know each other and developed a real friendship in treating these patients and a congeniality. And he was not a stranger when Chrissy came on the scene and we connected on Chrissy. I was fortunate that Eric asked me to become involved in the prosthetic reconstruction of Chrissy and involved also in the treatment planning on the implants and revision of the surgery as far as the treatment planning goes, so that we could work together to give Chrissy the best outcome for her final prosthesis. I worked with Eric throughout Chrissy's treatment from the beginning, from the time that Eric took case over until we finished the prosthesis for Chrissy. And that was done. Everything that I did on Chrissy was done in my office in Eugene. Okay.

SPEAKER_02 8:28

So timeline-wise, from the initial onset of the injury, the shotgun blast to the face, and all the work that Dr. Potter and Dr. Long team did. This now is two years post the original bank of surgeries and the original free flap and all of that rehabilitation. Is that correct, timeline-wise, Dr. Long? Yes, it is. I guess, Dr. Dirch, would you like to take over here and really say where this transition to give a historical perspective first? Remember this a 17-year-old girl. She's taken a 12-gig shotgun. It basically canoeed the front of her face from right about the bridge of the nose, you know, scooped out through the front of the like right above where the eyebrow outs are. So I mean it's unbelievably horrific. And you can see the pictures in the show notes after the podcast. The magnitude of this injury is shocking, let alone that it was able to be fixed and that Sheeta still walks the earth today. I'll go back to Dr. Dirks. Do you want to take us like how you kind of entered into this whole scenario?

Dr. Dirks Joins the Case

SPEAKER_04 9:36

I first met Chrissy after her injury. My partner, Bryce Potter, was on call the night she came in, and it was an obvious horrific facial injury, but it was more than the face, it was the anterior cranial fossa, and the wound, the the shotgun blast, carved a swath out of the upper part of her mid face. And this would have been a lethal injury, I think, in most situations. Fortunately for Chrissy, she's young and resilient. Fortunately for Chrissy, she was brought to an excellent level one trauma center, Legacy Emmanuel Hospital. And Bryce and our colleague Mark Bueller, orthopedic microsurgeon, replaced part of her mid-facial body structures with the fibular strut, which formed uh part of the basis for what we did later to give her prosthesis. Chrissy was discharged from the hospital and kind of disappeared from our radar screen. I found out later that she recovered from her injury and went through the educational process that people undergo when they are blinded. So she went to blind school to learn how to function as a blind person in our world. The problem that Chrissy had was that she still had a horrific divot carved out of her face, and she covered that with a mask that but the patent didn't really hide the deformity. I noticed that when Chrissy was in the waiting room, other people in the waiting room would whisper, Oh, I wonder what happened to her. She was visibly deformed. She had no nose, both of her eye sockets were empty, her right eye was present, but it shriveled the left eye had been blown out of her face. If we could make her have the physical appearance of a normal blind person, she could live life to the fullest without dealing with this horrific facial deformity.

SPEAKER_02 12:15

Wow. Well, that's an excellent entrance into the story. I guess the natural progression here would be Dr. Long, where do you where would you like to take this? Where would you like to explain the necessary steps that had to go in in this young girl's recuperation? So at this time, she's 19 years old, she's in the waiting room, Dr. Dirks has seen her, and there's obviously something that needs to be done to improve her quality of life and emotional well-being. It takes a toll when you've had something horrific happen to you, and then you have the lasting marks and you hear people whisper.

SPEAKER_03 12:47

Well, Bryce, as you remember, and Eric were partners. So Bryce passed the baton to Eric because Eric had more facial reconstruction training than Bryce did. When he passed the baton, Eric had to come in and do his own assessment of how he would begin to try to make this patient's face presentable. Remember, she's blind, so she'll never be able to look in the mirror and see how she looks. Right. Basically, it has to be presentable to the public at large if she was going to go shopping, whatever a blind person has to do out in public.

unknown 13:21

Right.

SPEAKER_03 13:22

Eric picked it up and then formed a plan with Larry on how to put her face back together.

SPEAKER_02 13:28

Okay. And we spoke with Dr. Potter about how difficult the fibulograft was because you couldn't anchor it to both sides and you had to leave one side anchored for a bit and then let the other side max really adhere to itself before it was fashioned down. The complications on this are are massive. I mean, even Dr. Potter, you know, talking about having to, you know, having to bring in a microvascular surgeon. It's beyond my understanding. To that end, let us continue forward. I'm just sitting back amazed.

SPEAKER_04 14:02

So explained to Chrissy that it was not going to be possible to reconstruct this horrific midfacial defect that she had with living tissue. You can't make new eyelids and eyelashes that open and close. You can't make that out of thin air. She didn't have eye sockets. They had been blown away. Prosthesis was the proper way to go, the best option for her. But we have to we have to straighten out, take care of the problems and her defect in her face before she would be ready to receive a prosthesis. That began a series of I think it was five operations to prepare her facial defect. Now two years had gone by and everything had healed in really well. Operation that Debry Spotter and Mark Beale did was very successful. So just things needed to be done. I started the sequence with an operation to open her airway because her airway was her mouth. She breathed through her mouth because the reconstructed flap covered over her nose. So she could not breathe through her nose. She did not have a nose. The first operation was to create a hole where her nose would have been. But to surgically create a hole in anything doesn't mean it's going to stay there. So I had to do multiple Z plastys, it's a surgical term, where instead of just cutting a hole and leaving it open, the healing process naturally will close it off. Z plasty means you make incisions shaped like a Z and then transpose flaps, and it's a basic reconstructive surgical procedure. And it worked like a charm for her because the walls at the breathing stoma or opening were intact and were functional and did not well, it was on. She was breathing through her nose, which she hadn't done in several years. She slept a lot better after that because she had a version of sleep after.

SPEAKER_02 16:27

Oh, I can imagine. That's incredible. I mean, that's a humongous gift to the quality of her life just immediately. It was. Okay.

Understanding Chrissy's Facial Injury

SPEAKER_04 16:38

So the next operation, as I recall, was to create a slot in the fibula bone that was transplanted previously to span the missing gap where the mid face was. I had to put a slot in there, which was also the bottom edge of where this new breathing opening was. That had to heal for a while. The orbit, doctor name for the the eye socket, had been blown away, but shotguns don't do a real clean job at removing tissue. It's kind of messy. Shotgun blasts are messy. They're quite messy. All the tissue and everything routinely is removed from an area of the gunshot lens. It's always imperfect. There's always something more left in there. The eyeball and the eye muscles were completely blown out of her head and gone. And on the right side, uh you know Larry. Did I get that right? It was her right side where there was residual presence of an eyeball. That's correct. That required an operation to remove the remaining parts of the eyeball and then put a skin graft which would cover the raw surface to prepare this to be self-cleaning as much as it could be, and something that would be compatible with later creation of a prosthesis. And then everything healed in and then it was done. And I'll give a thanks to the manufacturer, Zimmer, of the dental metal implants, who not only provided complimentary dental implants for Chrissy's case, but also sent their main technician to Portland to be present for this surgery to make sure we got everything right. His input was valuable.

SPEAKER_02 19:07

Excellent. And then Dr. Over, where we where do you come in in this transition?

SPEAKER_01 19:14

Where I came in was after Chrissy had those surgeries and she was stable. Eric had done such a beautiful job in getting a base and her mid-fit base that she didn't have before. Besides the opening of her nose, he had grafted so he had nice smooth tissue. He was able to remove the jagged edges and place a skin in those areas that would bear a prosthesis and withstand the pressure of the prosthesis, even though it was minor with the implants. So what we did is before the implants were placed, Dr. Dirks had a CT scan done on Chrissy's entire skull that generated a very accurate model of her skull. The technology thankfully allowed us to do that, and it made a huge difference. That was sent down to me, and then I marked the location. We had decided to have eight implants placed on Chrissy, two and each to the superior portion of where the orbits were, the eye sockets, and then two in the inferior portions on either side for a total of eight implants.

SPEAKER_02 20:29

So for those of you who can't see, what when we was talking about these locations, uh, Dr. Over was pointing to right above his eyebrows and right about where your cheekbone sits underneath your eyes. And these are eight magnetic implants. Is that correct?

SPEAKER_01 20:45

Well, the implants themselves are not magnetic. They are the normal implants that we would place to replace a tooth or teeth intraorally. The beauty of having to be able to use the CT-generated model is that we knew how much bone we had, and which Dr. Dirk could measure and use these longer intraoral implants, which have a much better prognosis than the older extraoral implants that were only three and four millimeters long. So that was a huge step forward that technology allowed us. Then the next step was that Dr. Dirks placed the model as a guide. He then placed the eight implants at one surgery, and then those healed. And then after those healed three to four months, then I put the magnetic abutments on top of those. They were screwed in on top of those.

SPEAKER_02 21:41

So it's been two years since the onset of the injury, and then Dr. Dirks comes in, and then when the transition happens over to you. And you said all of the actual prestigious work was done in your office in Eugene. Yes. Once you came onto the scene, how long did it take? I mean, because everything you were doing, as I've heard, is based on the work that Dr. Dirks allowed for you to be able to continue. And he passes the baton to you, and you take it. How long is your time frame with this young girl?

SPEAKER_01 22:11

Well, the implants healed about four months, and then it took, I did it with one of my colleagues, and we did the prosthesis really quite quickly in I think 10 days. Oh, wow. Yeah. It was a combined effort, and that really was helpful. There was a lot of news media around, and it helped that we were able to expedite treatment for her. That's fantastic. Dr. Long, you had something in there?

SPEAKER_03 22:38

Yeah. So for those who read National Geographic over the years, there's been a lot of skulls that have been identified of cavemen and Neanderthals, but they're just bony skulls. And there's a whole new art form that has developed on what they actually look like with the soft tissues on top of it. And in some ways, I don't know if it's preceded that technology developed for archaeology, but this was done for help to, because they had pictures of Chrissy's face before it was injured. So they had some idea of what the mask would look like.

SPEAKER_02 23:14

We established in the first time we talked about this. This didn't happen in the dark ages of 1983 when there wasn't 911 universally available in Oregon, but it's not far off. This is like late 80s, pretty much when this happened. Is that about right?

SPEAKER_04 23:31

2000.

SPEAKER_02 23:31

Oh, it was around 2000. I apologize. So when you're talking about these cranial models, Dr. Over mentioned it, you're talking about like a 3D model you can see on the computer, and it kind of spins around, and that gives you the accurate measurements.

SPEAKER_01 23:44

The CT scan generates an entire skull that's then printed out in a plastic material. So you get a real skull, except it's plastic and it's like size and quite accurate. That's what we had available for us to use as a guide for the implant placements. That made all the difference in the world. Dr. Dirks did a beautiful job in the surgeries and placing any implants. The implants were in an ideal position. We had agreed where those eight implants should be placed, and it turned out there was enough bone in those areas, and they were just ideally placed where it also could support the prostheses. All right.

SPEAKER_02 24:28

Are any of you guys Lionel Ritchie fans? This is a very odd break, but you're a Lionel Ritchie fan? Sure. Most people know the song Hello. And that whole time it's the blind art student creating that model of his head. And I that's just all I have in my head is just masses of doctors looking at this clay model of her face. Trying to figure out where things are going to go. I'm sorry, that's the simpleton in me coming out. Dr.

SPEAKER_04 24:55

Older is the artist here. I am the technician.

SPEAKER_02 25:01

I believe that. I mean, don't be bashful. If you're good at something, say it. Transfers over to you four months on the original, and then you turn around the prosthesis in ten days. And it just magnetically flips on, and so she's got her Batman Robin suit, and so she can basically take it off with one hand and then put it right back on. Yes. Unbelievable. Okay, so knowing nothing else, that's incredible, but I totally want to hear more about the intricacies of it. But Dr. Dr Dr. Dirch, you had something.

SPEAKER_04 25:29

I just wanted to ask Dr. Over to elaborate on the fact that prosthesis is much more than duct tape and down to it's built up in layers. It's amazing. I would like to hear more from him about the intricacies of how this is made to have the right modulus of elasticity. There's science in this as well. It's art and science coming together.

SPEAKER_01 26:04

It amazes me. I love it. So where we started was the implants after four months. Dr. Dirk tested those to make sure they had united in the bone. They were solid. I believe of the eight we lost. I think we lost one implant. Ironically, that was one in the mouth. Yeah. So we had great success with those implants. I had to order the magnetic components that screw on top of the implants. There is a magnet that affixes to the top of the implant, and then there's a corresponding magnet in the prosthesis.

SPEAKER_03 26:48

Just chime in. If you got something to say, we're going back. The issue: here's a girl missing her nose. And the nose and a face is one of the most prominent features that we have. How Larry and his team were able to reconstruct a nose that looked normal with plastic, it were strikingly, especially with holes in it, so she can breathe through it to the airway that Derek had created. I mean, this was not a trivial feat.

Surgical Steps to Prepare for Prosthesis

SPEAKER_01 27:17

So it's this cowboy nature of you guys. You're out there just making your own rules. So my specialty, I do a lot of intra-oral work with impression materials. The same impression materials we used for Crown or Bridge, I used on Chrissy to make the impression of her face. Those were syringed around the implants. We had the other half of the magnets put on top. The silicone impression material, silicone impression material is not very different from the silicone that you put around windows, except it's a medical grade and has physical properties suitable for human use with impressions. So once that sets and it takes about four minutes to set around her whole mid-face, it was a large impression of about three-quarters of her face. And we put then a sil a plaster backing on that to give it rigidity. Once the plaster set, we took that off of Chrissy's face and then poured an impression in a special stone. That's an exact replica of her face, but instead of her face, it's in stone. Then we have an exact replica to work with for Chrissy that we know is accurate. The next step involved a special wax to wax up her entire missing midfacial structures, including the nose, the ears, or excuse me, the eyes were we had a we were able to get those from a distributor that had those ready-made. You can get plastic eyes, so we didn't have to generate those ourselves. We fortunately had a photo of Chrissy before this terrible accident occurred. So we knew what her nose looked like. We knew what color her eyes were. And and we talked to Chrissy and asked her about what she wanted as far as the shape of her nose. And she wanted to have a duplicate of what she had before the accident. That one photo was critical to the prosthetic reconstruction of Chrissy. The most typical portion of this is to orient the two eyes properly in that wax of the facial prostheses because the eyes have to look the same way. The gaze has to be correct, the level of the two eyes has to be correct, and in three dimensions. That is the most difficult part of designing and developing this facial prosthesis for Chrissy. Once that's done, we fashion the upper and lower eyelids, the nose, and the subsequent structures of the cheeks. But it's a long, laborious process with the wax to make sure that it's done an accurate and looks like we want it to look like, mimicking that photo of her. That's tried it several times because we have the magnets in that wax up. So we can put that on face and it snaps right onto those magnets on the implants, and we know it's accurate, so it doesn't move around. And then we can assess it, go back to furthering the waxing process, fine-tuning it until we have it finalized. And once that's finalized, we take it off, we open up the airway from behind so that the prosthesis has open airways for her nose. So she can breathe out of this, just like she could her regular nose. And try that again to make sure that she can breathe through her nose. Once that's established, we take it off, put it on the mold, and seal it down on that stone mold so that it doesn't move. We refine the margins so they're very thin. And then we have to pour another half of the mold so that you have two halves of the mold that are together just like an A and a B side. At this point, the wax per face is inside that mold. Once the second half of the mold is poured in stone, the mold is boiled out under very hot water, and the wax is boiled out. The only thing that is not boiled out are the two plastic eyes, the artificial eyes. And those then will go back into the one-half the mold. And so we have two halves of the mold, but now we have no wax. We just have the representation of both halves, the tissue side and the face on the outside of Chrissy's facial prosthesis. At that point, the next thing Can I ask a question real quick?

SPEAKER_02 32:23

Can I ask something real quick? Okay. So when you just said it represents the front and the back side of the stone, are you saying that the mask itself, the prosthesis, has a concave on the sides, so it's going to rest against her existing skin to fill the cavity of space to the front of the mask? So is it's actually hollow in the middle?

SPEAKER_01 32:44

No, it's not hollow, but it's quite light. The silicone is quite light. She has openings in the nose that are hollow.

SPEAKER_02 32:52

But we were able to What I mean is when she puts it on and it connects to the other magnets, is there a cavity behind the prosthesis and the screen, so to speak, and then the area between where the shotgun blast took out her face?

SPEAKER_01 33:08

Or is it just a cover? There is in the nose area behind. So it is hollow off the tissue behind the nose portion.

unknown 33:16

Okay.

The Prosthetic Creation Process

SPEAKER_01 33:20

Got it. Thank you. So the final step in this process is we had these two halves of the mold, the really enjoyable part of this comes, and we have a different type of silicone that's used to make facial prostheses. It's a very specialized silicone. It's clear, and we have different colorants, whether they're pigments or rayon flocking fibers and an opaque medium so that we can get the right opaqueness versus translucency. We don't want it to be just a flat prosthesis for her. And we sit down across from her and measure out a certain amount of the silicone. In her case, I think it was probably 150 grams. And with the colorant in with her sitting across from us and mix the colors until we find the color is very, very close. It's a trial and error, just like you would if you're doing a painting and mixing colors. Dr. Dirk said you're the artist. So we hold that up to the patient until we feel it's where it's supposed to be. The silicone is a 10 to 1 ratio, catalyst to base. Once that's ready, we put in one part of the catalyst, mix it together, and put it poured into the mold, both halves of that mole. And then the mold is closed under some light pressure and held together with the clamps. It's polymerized at 200 degrees Fahrenheit for about two and a half hours. Once the prosthesis is polymerized in the dry heat oven after two and a half hours, we take it out, separate it. And the next step is to try it in on Chrissy. It's in a raw form. We have a one-color silicone. We haven't done any coloration to the top of the prosthesis, the outside surfaces. And as you know, we all have these little nuances of colors with our skin, whether they're moles or freckles or just different colorations. So we take Chrissy and sit her across the table again, but instead of doing the wax up, we try the prosthesis in for her. And it did fit, fortunately. The next step is we put the eyes in, and they are just put in uh the artificial sockets that were formed in the silicone facial prosthases, and they're just uh mechanically held in place. They can be taken out to clean, but her gaze was good. The final step in that is to do a little bit of what's called extrinsic coloration, where we do different colors of the skin in different areas to blend in her face. The forehead has a different color slightly than below her nasal area. That's done with more pigments and more colorants. And then the very last step is to put in artificial eyebrows and eyelashes. And once we are satisfied with that, we seal everything with another silicone sealant so that it's not something that can be torn or distorted or becomes full of dirt because she's going to have to clean this every day. We want it to be durable for her and hold up over time. Once that's finished, that was the last step for her.

SPEAKER_02 36:58

Amazing. Amazing. Anybody else want to chime in? As Dr. Over just casually sits back, taking a rest from explaining this highly complicated issue and making it sound very simple. Unbelievable. Yes, Dr. Long.

SPEAKER_01 37:14

Well, the question is, how long does this mask last? The prostheses typically last if they're implant retained. In other words, the old type of facial prostheses, we used to have to rely on adhesive. Thanks to the beauty of implants and the fact that Dr. Dirgs was able to do implants on Chrissy. We did not have to rely on any type of adhesive to hold the prosthesis in place, which will allow the prosthesis to last much longer. So her lifespan with this prosthesis would be in the neighborhood of five to seven years. I had since colored another one for her. And I'll probably do another one for her in the next couple of years. The implants just make the prostheses last so much longer by not having to use the adhesive.

SPEAKER_02 38:11

I can see that. And these are the titanium implants that are screwed in.

unknown 38:17

Yes.

SPEAKER_02 38:18

I'm looking at the schematic right now, which hopefully will be in the show notes as well, the Stelts' fatal prosthesis. And that's what you've been describing. So I believe this is actually a a picture from the newspaper, The Oregonian, during the media coverage of this specific event. There were another couple of things I was curious about. We talked about the length of the prosthesis and you had to change it over and you're planning on another one. Did she have to do any rehabilitation from the point, Dr. Dirks, that you saw her? Did she have to continue rehabilitation after the prosthesis was attacked?

SPEAKER_04 38:58

Not specifically, but learning to live with the prosthesis was really something Dr. Over might be able to comment later on.

SPEAKER_01 39:08

Another hygiene, you touched on making prosthesis last for yes, there was an issue with smoking, and smoking degrades the silicone very rapidly. So we had to caution Chrissy not to have the prosthesis in place with smoking because it breaks down silicone. And we gave very specific hygiene instructions, which are very easy. You use an antibacterial soap on a small gauze that we give out and lightly dab it every day. And then we have them stored in the refrigerator overnight. They don't wear this at night. They let the tissues breathe. By putting it in the refrigerator, it actually prolongs and increases the lifespan on silica. So then they take it out and warm it up in the morning. It's already been clean and they put it on.

SPEAKER_02 40:05

Dr. Over, you're saying at this point everything is complete. You have finished the job, so to speak, but there is still more work to be done. One of the questions I, or many of the questions I had were going to look like what is the natural progression as she moves forward? What sort of things does she have to watch out for? You know, can she swallow? Can she breathe normally? The quality of life things, and then is there ongoing rehabilitation that's going to have to occur? That those are the things I'm left with. That's beyond just the magnitude of what you did. You said she was a good patient and she diligently showed up. She tried to make the effort to be there. So you guys did a phenomenal job, each working on the great work of somebody who passed the baton to you. Where did the three of you kind of want to leave on this topic? What's the big takeaway for the patient-centric model, for caring for a patient's life, the incredible technical skill? Or do we just go to this case? What speaks to you here that the message that you want to get a message out with? Don't everybody jump in at once.

Life After Facial Reconstruction

SPEAKER_04 41:20

Maybe this would be the time to answer the question: why not do a face transplant? Facial transplantation was not as well documented in the early 2000s as it is today. But still, I had a call from a plastic surgeon in Boston who had a grant to do facial transplantations for the U.S. military. And he was asking, would this patient be interested in a face transplant? And we talked through the whole situation and came to the conclusion that no, for her deformity, which is in a non-mobile part of her face, the eyelids, the eyes are gone, a prosthesis is much easier to live with. A face transplant certainly could have been done, but secure surgery and the anti-rejection medication costs about twelve thousand dollars a year. If you stop taking anti-rejection medication, your transplanted tissue dies and falls off. To saddle her with that need was not worth it. Prosthesis just needs to be reconstructed every five years. Another thing that touched me, and and Dr. Over as well, was the media outpouring from the local newspaper, the Portland Oregonian, did a series of articles culminating in cover on a Sunday edition. Monday morning, yeah, right after Monday morning, my phone started ringing from all over the world. All over Australia, Germany was on the headline of the newspaper. What does that mean? The woman without a face. That's incredible. And other Australia based or senior television personality to Portland to meet Katie Courier, for example. So that was very touching.

SPEAKER_02 43:50

Dr. Long.

SPEAKER_03 43:52

I think it's important for people to know that this girl went on to marry another blind person. They've had a child. She was on national television showing to her with basically with a child on national television. So she's made a very well-adjusted life considering what's happened to her. I think the second thing is that with this mask, I don't know, she's going to get older with time. And with this mask, she'll never get older. She will not show the features. I'm not saying that this is for the age, but it's something to think about. She's got a little Ponce de Leon in her.

SPEAKER_04 44:30

Little correction to I guess she does because I was going to say it was the father of Junior. Junior. But she used to. I don't think she married a guy that she's been with now for a number of years.

SPEAKER_01 44:48

He has normal sight. Yeah, he has normal sight. I've met him several times.

SPEAKER_02 44:52

We're gonna edit this, Lindsay, Esther, whoever's, yeah. Let's be creative on our fact-checking edit on that one. Okay. So she is actually married to someone who has sight.

SPEAKER_04 45:05

She has a long-term relationship.

SPEAKER_02 45:08

Okay. I see. By the way, if any of you guys are interested in a little off-beat program, there's a there's a show called C on Apple TV with Jason Momoa. The whole society is blind. And the outcasts are the people who have the gift of sight. And they try to hide all the people with sight so they don't get killed by the blind people. It's just a very dystopian thing, but a really cool concept to think about how all the characters on screen, with the exception of one or two, are blind. It's very interesting. All right. So, Dr. Dirks, you're saying that the magnitude of this is the human element, how people responded to it, simply in the choice of not to go the facial transplant route to protect her quality of life moving forward and financially as well with the medications. But then the outpouring of media and interest in this from worldwide, just people clung on to it. Now, was it the nature of the shiny object where it's like, man, that's incredible? You know, that they were able to put a prosthesis on someone. Or do you think it was generally people were coming together and saying, look what look what we can do, look what we can survive, look what these men were able to accomplish. Where did it fit? Do you think? Did I muddle that?

SPEAKER_04 46:35

I think it was the constellation of all these parts coming together for a young woman beginning the prime of her life who received what would be a lethal injury. She survived that. And then she underwent this multi-step, multi-staint procedure to reconstruct her face such that instead of wearing a night guard to cover her facial deformity, she was still grotesquely disfigured by her injury. Now she fits into society as any other blind person would. And those, I think, were the value points.

SPEAKER_02 47:26

To be able to just reintegrate and not hear the whispers. That's amazing. Dr. Overton, did you have anything you wanted to add on this?

SPEAKER_01 47:41

She was such a great patient to treat, extremely grateful. And it was really an honor to work with her, Eric, and the other two surgeons. I will tell you that almost without exception, these patients have the greatest deformities, whether it's cancer or trauma like Chrissy, and they're the most grateful. They have lost not only a part of their face, but a lot of their the psychology that affects them and affects them having a normal life. And in some small way, if a prosthesis, whether it's intraoral or in Chrissy's case, this extraoral prostheses helps them regain that, then that's the reward that I feel. And that's what drives me to continue to help these patients.

SPEAKER_02 48:48

Not just a patient. That's amazing. We've talked about this from season one on, and it blows my mind every single time we do one of these episodes, especially when there's a guest doctor on. The unique environment, the kind of the ecosphere that you guys created, was one where the doctors are willing to try, and the patients and the families allow the doctors to try, and the administration allows the doctors to try. And these incredible results can then be replicated or at least tested out. I mean, that that is phenomenal. And since it is your show, Dr. Long, how do you want to put a ribbon on this?

SPEAKER_03 49:35

I think this is a classic example when you don't have the expertise yourselves, but you try to find people to work with and teach you how to bring out their talents and make it helpful for the improvement of patient care. And this was an extreme example, and she was fortunate, and we all were fortunate, especially the team treating her, the nurses, the therapists, all the doctors involved, everybody was inspired by what they saw evolving over time. And just took a lot of time to get this girl into a presentable position.

SPEAKER_02 50:10

Fair enough. With that, I think we come to the natural conclusion of this episode. We hope you enjoyed it. To learn more about this case study, the history of the equipment systems, the techniques that we have discussed, or the strategies for life saving, you can check out the show notes in Dr. Long's upcoming book, Flatline to Lifeline. As we close, we remind you to imagine a world where dead isn't actually dead. That there are places and people, that there are systems who value the patient over the system. Flatline is not the end. A lifeline exists. Saving time saves lives. Thank you for joining us here on Flatline to Lifeline with Dr. Bill Long and special guest, Dr. Dirks and Dr. Over. We'll see you again soon.