Three who suffered disfiguring injuries learn to live with their new looks and the shocked reaction of others
July 25, 2010 8:00 AM
Doug Surowiec's surgeon, Steven Bonawitz, examines his face during an appointment last week at UPMC Presbyterian.
By Mark Roth Pittsburgh Post-Gazette
On Oct. 5, 1992, at 5:30 p.m., Louise Ashby was driving up Doheny Drive in Los Angeles. Newly arrived in Hollywood from Great Britain, the young actress was ready to seek her chance at stardom.
On April 5, 2003, at about 1 p.m., JR Martinez had been in Iraq for just a month when he was asked to drive the next stretch of road in his Army unit's Humvee.
And four months ago, on March 7, Doug Surowiec was bicycling home at 6:30 p.m. from a long Sunday trip into Ohio and back to Beaver County, enjoying the weather and the feeling of well-being from his strenuous exercise.
Within seconds of those moments, Ms. Ashby would go from a young beauty to a woman with a shattered face; Mr. Martinez would run over a land mine and be trapped in his burning vehicle; Mr. Surowiec would fly off his bicycle into a metal guardrail that would slice off his nose and lips.
In those horrible instants, the faces they had known disappeared forever.
JR Martinez before and after suffering burns to his face and body.
Their new faces would be shaped by surgery. But only they would be able to shape how they faced the world.
Ms. Ashby was 21 on that warm fall day 18 years ago in Los Angeles. She was driving a convertible when a driver coming the opposite direction crossed the center line and slammed into her.
The impact hurled her head-first into the driver's side window post.
"One of my emergency doctors told me it was like dropping an egg; my skull just smashed like an eggshell. My brain was resting on my left eyeball," she said in a recent interview in Santa Monica, Calif.
The impact destroyed part of the left frontal lobe of her brain. It severed her optic nerve, leaving her blind in her left eye. From scalp to cheek, the left side of her face was shattered.
An estimated 500,000 people a year suffer facial disfigurement in the United States from accidents, fires, cancer and other causes. Another 100,000 children are born each year with facial abnormalities, often because of rare genetic conditions.
While new plastic surgery techniques and other treatments are being developed, medicine has its limits, says Anna Pileggi, executive director of AboutFace International, a Toronto-based group that educates people about facial differences.
"For many people, surgery is not an option," she says. "Many others have had 40 or 50 procedures done, and they still have noticeable facial differences."
Human beings are exquisitely attuned to facial features, and for those whose faces fall outside normal boundaries, the public is not always kind.
For the person with a facial anomaly, Ms. Pileggi says, "at a certain point you have to decide 'this is who I am, and I have to accept this.' "
Today and tomorrow, in the second installment of our continuing series on the human face, we tell the stories of six people who have been on that journey.
She underwent 11 hours of brain surgery and 22 hours of reconstructive facial surgery.
And while surgeons at Cedars-Sinai Hospital put her face back together as well as they could, the left eye bone and cheekbone were slightly misaligned, said her eventual plastic surgeon, Henry Kawamoto.
"When they put her together at Cedars," Dr. Kawamoto said in an interview in his Santa Monica office, "she was pretty bruised and bloody and they did the best they could. But they were off a little bit, and with the face when you're off a little bit, it dominoes down."
Today, Mr. Martinez is a soap opera actor, portraying police officer Brot Monroe on ABC's "All My Children."
But on that broiling day in 2003 near Karbala, Iraq, he was a 19-year-old infantryman in the U.S. Army's 101st Airborne Division.
He had enlisted straight out of high school in Dalton, Ga., where he had played strong safety on a football team that went to the state championship. He wanted to serve his country, but he also saw the Army as a way to pursue his dream of going to college and possibly becoming a pro football player.
He had been in Iraq about a month when he was asked to drive his Humvee as the lead vehicle in a protective escort, he said during a recent phone interview.
"I still had that 19-year-old mentality," he said. "I was driving along with one hand on the wheel like I was in southern California, and someone in the vehicle brought up the Purple Heart and everyone started talking about how neat it would be to have a Purple Heart and how if you went to a restaurant you'd get to go to the front of the line -- I mean, joking was how we kept our spirits up -- and I remembered looking back to the dirt road, and about three seconds later, I ran over a land mine."
The other three soldiers in the Humvee were thrown out of the vehicle, but he was trapped inside as it caught fire and began to set off the ammunition and fuel it was carrying.
"I was screaming and yelling at the top of my lungs and there was a point where I could actually see the skin falling off of my hands, and I remember thinking, 'This is where my life is going to end.' "
Eventually, his sergeant pulled him free and threw him onto the sand, where another soldier cradled Mr. Martinez's head in his lap.
"I remember trying to touch my face and he kept knocking my hands down and telling me I was going to be fine, but there was something in his voice that told me I wasn't going to be fine."
Mr. Surowiec had just started to chart a new direction for his life.
After graduating from New Brighton High School in 1984, he had taken classes at Penn State's Beaver Campus with hopes of one day going to a photography institute in California. Those plans were derailed, though, when the Armco Steel plant in Ambridge, where his father worked, was shut down.
He went to work in retail sales for several years, and had been unemployed for awhile when he began taking classes last fall at the Community College of Beaver County, hoping to become a probation officer.
He also had become a dedicated recreational bicyclist, dropping about 45 pounds and ending his smoking habit.
On that first Sunday in March, he was heading home on Route 51 in Darlington when either a vehicle hit him from behind or he lost control of the bicycle.
Passers-by found him sitting against the guard rail, his face mangled and bleeding, his crumpled bike nearby. When paramedics arrived, they found his nose and lips lying on the ground, looking like a Hollywood makeup artist's gruesome prosthetic.
He has no conscious recollection of the accident.
"All I can remember truthfully is the sound of a helicopter" taking him to UPMC Presbyterian.
Damage to the brain's frontal lobes often causes serious problems with judgment or reckless behavior, and Ms. Ashby said she was a living example of that.
"Anybody who'd had the kind of accident I had would not go out a week after going home and get absolutely smash drunk and then spend the night vomiting and call the doctors and say, 'Why was I so sick?' and then have the doctors say 'Are you crazy, why would you do that?' and then a few nights later go out and do the same thing.
"I didn't know that I'd lost [part of] the front of my brain and what that meant. I would think things and just say them. There was no pause button, and everybody would kind of look at me, and I would say, 'I don't know why I just said that.' "
In those early days after the accident, though, Ms. Ashby's top priority was to recapture her face.
"Originally my doctors said it's going to take two years to make you socially acceptable, and I said, 'Two years? You've got to be kidding me.' "
It would take much longer than that. She didn't find out how daunting her case was until her father took her to see a well-known Hollywood plastic surgeon several weeks after the accident.
She was still wearing an eye patch and a wig after her hair had been shaved off for brain surgery when she and her father met the surgeon and his wife in a hotel room.
"The doctor took me into the bathroom and asked me to take my wig and my eye patch off, and then, he just looked at me, and was like, 'Whoa.' And I wasn't expecting that.
"The unimaginable had happened -- I'd lost my identity and my face, and I thought, 'He'll fix it. That's just what he'll do.' He felt around, and he said, 'Louise, I'm really sorry. This is the most severe thing I've seen and I just can't do this.'
"And at that point I just completely broke down and thought, 'Are you kidding me? I've got to look like this the rest of my life?'
"Then I could hear my dad was heartbroken on the other side of the door. And the doctor went out and said, 'John, I'm really sorry, I just can't see how to do this.' And I said, 'I'm not leaving here until you tell me who can do this.' He said, 'Look, if there is anybody who would know how to start with this, it's Dr. Henry Kawamoto.' "
The first time he saw Ms. Ashby, said Dr. Kawamoto, a renowned reconstructive surgeon based at UCLA, she was disfigured and very depressed.
"I told her what needed to be done. The problem was, Louise is a very good-looking woman and was here like many good-looking women to get going in show business, and this just wiped her out," he said. "She thought she looked like a monster."
Over the next decade, she would undergo more than 15 operations. Dr. Kawamoto said he put at least 10 metal plates and 40 screws on the left side of her face to rejoin all the broken pieces. She also had several surgeries to position her left eye properly. The unseeing eye looks normal, except that it doesn't move when she shifts her gaze.
Today, her likeness is remarkably similar to the face she had before her accident. In the long process of rebuilding her appearance, though, Ms. Ashby lost many of the prime years of an actress's career.
After the explosion, Mr. Martinez was flown to Germany for abdominal surgery, and then on to Brooke Army Medical Center in San Antonio, Texas, where many badly injured veterans are sent for care.
He was burned over 40 percent of his body, including his face, scalp and neck, his hands, upper arms and parts of his back and thighs.
Besides getting skin grafts, he also went through tissue expansion. In that technique, doctors put a balloon under his chest and filled it with saline until it created a bulging bubble covered with new skin, which they then used to replace scarred tissue on his chin and neck.
The blast had left him bald except for one patch of hair over an ear. He decided to try the tissue expansion there, too, hoping doctors could stretch the hair-producing tissue over his entire scalp. After several weeks of painful expansions, though, "I finally decided, I'm fine with being bald. It's my new look, and if you look at my head now, I think it looks like a map of the United States."
Mr. Martinez was told at Brooke that he would still get his Army pay, but "your job from now on is to recover."
"I said to myself, 'I've got it made. I can watch Sports Center from when I wake up until noon,' But as you know, there's only so much Sports Center you can watch, and there's only so much Jerry Springer and Oprah you can watch, and eventually I thought, 'There's got to be something else I can do.' "
He began to hang out in the burn ward, the place he knew best, and soon, the nurses were sending him on errands. Then a nurse asked him to look in on a veteran who had just come in for burn treatment.
"As soon as I walked into this guy's room, it had a negative setting. The lights were off and the blinds were closed. All I did was sit down and start to talk to this guy, just simple talk, saying 'I'm doing it and you can too.'
"About 40 minutes later, when I was getting ready to leave the ward, I looked into his room, and he had the blinds open, and something in me said, 'I just turned on the light for this young man; I gave him hope.'
"I called my mother, and told her, 'I think I was kept in this world to use my experience to help other people.' My mother laughed, and said 'I think you're right, son.' "
When Mr. Surowiec arrived at UPMC, plastic surgeon Steven Bonawitz faced a big challenge.
The good news, Dr. Bonawitz said in an interview, was that paramedics had recovered Mr. Surowiec's nose and lips. The bad news was that if he couldn't reattach them successfully, Mr. Surowiec would be left with a devastating injury.
"Had we failed, he would have been on the face transplant list," Dr. Bonawitz said. "That's how severe his injuries were."
Mr. Surowiec went into surgery about 9 that night. It would take 36 hours and more than one trip into the operating room for surgeons to complete the work. Doctors also performed a tracheotomy to help him breathe.
After carefully reattaching the blood vessels between his face and the nose-and-lip segment, Dr. Bonawitz noticed that the implanted tissue was turning purple. It meant the veins were clotting, and he had to take more snippets of veins from Mr. Surowiec's foot to make new connections.
Once that problem was cleared up, doctors noticed the implant was too pale. That meant the arteries were clogging up. They administered blood thinner and prayed for the best.
The procedure worked, but Mr. Surowiec knows there is still much work to be done.
Scar tissue is pulling up one corner of his mouth, and much of his upper lip is still numb. More scar tissue is pulling down the inner corner of his left eye. Most important, his nose is collapsing and needs to be rebuilt, probably by using some of his rib cartilage.
On Monday, Dr. Bonawitz told Mr. Surowiec the corrective work could start this fall, but that it might take a year and at least three surgeries to rebuild his nose and correct the scarring.
"It's probably the central structural work that's going to be the toughest part," the surgeon said. "We need to rebuild the scaffolding on which the tip of the nose sits, and then lay the skin back over it."
Over the past 18 years, Ms. Ashby has become intimately familiar with her face and the way the world reacts to it.
"My view of my face has changed over the years as I've aged. In my 20s, I saw how judgmental people were toward me. I was asked to leave public places. I was sat in the back at tables. People said the most unbelievable things to me. I remember once in Kmart, a woman in front of me started screaming and waving her arms and called me a monster.
"I was with a girlfriend, thank goodness, because I was about to tell this woman where to go, and my friend who was with me, said, 'Do not respond. This is not about you; this is about her.'
"At that point I realized that since I was disfigured, I had nothing to hide behind, so I had to work on my insides so they sort of shone through."
Now that she is no longer disfigured, she is actually more critical of her appearance.
"I'm going to be 40 this year, and I've got lines and things are dropping on my face. I remember a few years ago going to Dr. Kawamoto and saying, 'Oh my God, my eyelids, they've dropped again and we need to fix them.' And he just started laughing and said, 'Louise, that's age.' "
Ms. Ashby kept working as an actor over the years, and also set up a charity with Dr. Kawamoto to help children who needed reconstructive surgery.
She is now writing an autobiography, due to come out next year, and she is trying to use all her experiences -- including her impulse control problems, taking care of her dying mother and having to reshape her own goals -- to establish a life coaching business.
"I didn't realize I had this strength until I was faced with this. I think it's important to understand that we're all here to learn lessons and no matter what happens to us, we all have the choice of how we're going to handle that situation. Happiness is a choice, and beating yourself up about it is a choice."
Mr. Martinez is enjoying life as an actor, a job he got two years ago after friends sent him e-mails saying that "All My Children" wanted to audition injured war veterans for a role on the program.
"I love the challenge," said Mr. Martinez, who had never acted before. "But most importantly what I've learned is that I love the platform the show gives me, because I still do a lot of charity work and motivational speaking," and his new visibility has boosted the turnouts for those talks.
And what does he see in the mirror?
"Growing up as a young man, I was always given the praise of being handsome. Every place I lived, I had girls all around. I really did become accustomed to believing that a lot of these people liked me because I was the attractive kid; I really hung my hat on that.
"When I got hurt and I saw my face for the first time, that's when the real war began, because I had to start battling with this new image I had been given."
While he recently had scar relief surgery, he has no plans for more operations and has learned to embrace his new face.
"As you begin to own your scars, people will start to slowly not see your scars and start to see you as an individual."
It also reshaped his personality and values.
"I look at it his way: 19 years after I was born, I died to be reborn as a better person. I am 10 times a better person than I was before."
Earlier this month, Doug Surowiec started riding his bicycle again.
He's nervous about it, and he won't go out in the rain, but "I realized if I didn't start again soon, I'd never do it."
In the past, he said, "I was not that introspective to think every day when I'd leave the house, 'Oh my, what if something happened to my face?' Now I do."
He knows he faces a lot more plastic surgery.
"People have said, 'Oh, they can do wonders.' I just hope they can do the best job they can with what they have to work with.
"As I look around this hospital," he said during his recent visit to UPMC, "I realize there are a lot of people worse off than I am. Not making light of what I went through, but there are a lot of people who are so horribly disfigured.
"It's easy to get down on yourself, but in the end, I just want to be me, or at least close to it. I want the greatest before-and-after pictures you ever saw."