Posted on Nov 17,2017
For 15-year-old Emma, the memories of her traumatic injury are still fresh.
Last year, on the night before Thanksgiving, she and her sister, Sharon, were watching TV in the family room. Nothing special, just a low-key evening before the holiday. Sharon was on the couch and Emma was on the floor about 2-feet from her dog and best buddy, Bruno. They were inseparable.
“We were super close,” Emma says. “We did all sorts of things together. We would mess around, play tug-of-war a lot. He would sleep in our beds all the time. He was really nice.”
But in an instant, her young life was about to change.
Emma stood up to leave, and, in a flash, her dog lunged for her and began to attack her, tearing at her face.
Sharon, who is Emma’s legal guardian, sprang into action, forcing the dog’s jaws apart to free her little sister.
Emma says from there, it all unfolded like she was in a dream.
“I didn’t have much of a clue. I saw myself, but I just saw blood. I didn’t realize that my nose was actually off of myself.”
We see dog bites all the time. But three or four times a year, we see truly awful dog bites. Emma rose to the level of being one of those.
Dr. Alex Rottgers, M.D.
Pediatric Plastic and Craniofacial Surgery
Emma doesn’t really remember pain in those moments, but rather, flashes of imagery and sensation. The cold press of the ice pack her sister applied while waiting for the paramedics. The ambulance ride. She even remembers her anxiety about the prospect of getting an I.V. Emma could not have known what trouble she was in, but her sister saw it clearly.
“Her nose was gone. And her mouth—her jaw, was split open completely. It was in two pieces,” Sharon says.
Emma was rushed to a nearby hospital and had emergency surgery. The next day, on Thanksgiving, she was transported to Johns Hopkins All Children’s Hospital, where her long journey to healing would begin.
Emma would meet Alex Rottgers, M.D., the plastic surgeon destined to play the leading role in her restoration and recovery. Rottgers is the medical director of Plastic & Reconstructive Surgery at Johns Hopkins All Children’s Hospital. He’s no stranger to difficult cases. Over the years, he has performed surgery to repair everything from birth defects, such as cleft palates, to serious injuries sustained from accidents. His analysis of Emma’s injury was sobering.
“We see dog bites all the time, unfortunately,” Rottgers says. “But three or four times a year, we see truly awful dog bites. Emma rose to the level of being one of those.”
The dog had broken Emma’s mandible—her jaw. She would require bone plate fixation in order to put her jaw back together, so that her teeth would come together appropriately. She had a cut on her eyelid that had sliced one of her tear ducts, so Rottgers would need to reconstruct the tear-draining mechanism. And then, most noticeably and most challenging, he would have to determine a plan for reconstructing almost all of her nose.
“Nasal reconstruction is one of the hardest things we do,” he says. “One of the most difficult operations we perform is rhinoplasty. It is very unforgiving. Millimeters make a difference.”
Add to that the extent of the injury, the amount of tissue missing, and the fact that this was an adolescent girl at a time in her life where physical differences can take an especially difficult toll socially, it was the perfect storm of challenges.
During the first operation, the surgical team fixed Emma’s jaw. They repaired her tear duct, and did a full assessment of the damage to her nose.
It was during those early days in the hospital, between those first surgeries, that Emma wanted to see herself in the mirror. Her family had shielded her from it up to now, worried that it might frighten or discourage her. When she insisted, she stepped gingerly to the mirror to take full inventory of what had happened.
”When I looked, I think my heart dropped,” Emma says. “I didn’t think my dog would do something so … destroying and hard, you know? I didn’t expect that of him.”
Emma knew that her dog had been put down, and she knew it was for the better. She would need all her strength to stay strong through the next several surgeries.
It’s crazy that I once looked like a swollen watermelon and he just changed me back to my normal self. I feel like I look almost exactly the way I did before.
Rottgers’ plan was to proceed with a three-stage forehead flap, a technique that takes skin from the forehead to help reconstruct the nose. He wanted to make sure Emma was clear on every detail of the plan.
“His bedside manner is just excellent for a child who is going through something like that,” Sharon says. “The way he explains things so that she completely understands. He just helped her get through the process.”
Successive surgeries were painstaking procedures. They would involve cutting away extra tissue, and taking cartilage from Emma’s septum to help rebuild the structure of her nose, all the while, keeping the "big picture" goal in mind of normalcy for Emma—for the rest of her life.
“We needed a nose that would take her through high school, graduation, college, career, marriage, children,” Rottgers says.
With each new surgery and the healing that came after, Emma would notice that her face looked a little better.
By mid-summer, Emma and her sister were genuinely amazed at her progress.
“It’s crazy that I once looked like a swollen watermelon and he just changed me back to my normal self. I feel like I look almost exactly the way I did before,” Emma says.
“It was scary, the damage that was done,” Sharon says. “But then to see what he was able to do with her face was unbelievable. To have it look so similar to what her nose looked like. He did an awesome job.”
Emma has the option of one more surgery to refine her nose and minimize her remaining scars, but she’s not really interested in that for now. The scars are part of her story, she says.
For this family, Thanksgiving not only marks the end of a life-altering year, it also brings a keen sense of gratitude and clarity. Sharon always will remember the hospital staff who helped her little sister to heal.
“These people enjoy what they’re doing and you can tell. This hospital was like no other hospital I’ve ever been in.”
Emma says she is thankful to be alive, and forever grateful to Dr. Rottgers.
“I was very lucky to get him. He’s an amazing doctor.”
As this holiday nears, Emma is especially thankful to look in the mirror and see … herself.
Johns Hopkins All Children's Plastic and Reconstructive Surgery
As a parent, you probably never expected your child to need a plastic surgeon. Whether they have a birthmark or a complex malformation, our pediatric plastic surgeons are sensitive to the ongoing health and confidence of your child. We work with you to explain all your options, and what to expect, so together we can choose the best treatment plan.