Watching the blood drive known as the Ultimate Fighting Championship one evening in 2007, Las Vegas plastic surgeon Frank Stile sat talking to his guests about the unfortunate nature of cuts. Eventually, the question was posed: Wouldn't it be something if he could take out the raw hamburger - OK, scar tissue - that often predisposes skin to lacerations and replace it with something that would have a fighter looking less like a Fangoria cover?
His guests agreed wholeheartedly. One of them happened to be MMA, or mixed martial arts, fighter Nick Diaz, who had just suffered his first professional loss by stoppage in a fight against K.J. Noons.
With the sharp hands of an athlete dabbling in pro boxing, Noons had sliced Diaz's face to ribbons. It was skill, but it was also the result of dozens of improperly sutured cuts Diaz had previously suffered in his fighting life. They had only healed superficially, leaving behind ground chuck underneath.
Stile had a suggestion: What if he dug out the gunk and replaced it with the "fresh" tissue of a cadaver? Sure, the procedure had been used for cosmetic purposes, but never for athletic performance. And if Stile's hunch was correct, the stronger, reinforced skin might be better than Diaz's baseline - as good as someone who had never been cut at all.
Diaz would be his first attempt, and Stile would do the procedure for free.
Diaz, whose entire livelihood is tied up in his ability to withstand violence long enough to dish out his own, agreed. Even better, the procedure happened without a hitch. Diaz was supposed to wait 90 days before sparring, but Stile figured he wouldn't listen. Still, in the nine fights he's had since, Diaz has barely bled an ounce.
The Enhanced Athlete's New Edge
In "Steel," Richard Matheson's 1956 short story, the author described a future in which fight fans cheered ravenously as large robot athletes engineered to bash one another's CPUs in. (The tale was adapted into a Twilight Zone episode with Lee Marvin, and it'll be reworked again for the Hugh Jackman-led Reel Steel in the fall.)
In the pre-steroid, pre-creatine era, Matheson didn't realise how provocative his idea would become: that audiences would expect athletes to be something other than human, and that many millions of dollars would be spent in pursuit of that goal.
In the case of prizefighting, we want athletes healthy enough to get hurt. And the scalpel is rapidly approaching the steroid, supplement or loaded glove as the new edge.
This is where Stile comes in. Bulky, broad-shouldered, with the features of a B-movie heavy, his Las Vegas practice is in the nucleus of the country's exploding MMA scene. Since his success with Diaz, he's performed the scar-tissue removal surgery on six other fighters. Some semi-pros have even come to him after a single cut in sparring, nervous they might be predisposed to career-altering lacerations.
"When these guys have their original injuries, whether it's in training or in an amateur fight or a pro fight, it all hinges on how well these wounds are addressed," Stile says. "Usually, they're closed by non-plastic surgeons, by emergency room physicians or some guy at the event."
Instead of being shut in layers, only the epidermis (the outermost surface) is stitched. The next time a set of knuckles strikes that area, it's like punching through tissue paper; the skin is closed again, poorly, and the cycle repeats. It's unstable material, and it has cost Diaz, as well as many others, not only fights but also the winner's share of the purse.
It's All in the Bones
In Diaz's case, the issue was compounded by his bone structure.
"Wherever there's a bony prominence or a sharp ridge on an anatomical area on their skull that creates a sharp edge - on the cheek, the orbital rib on the eyebrow, the bridge of the nose - you're going to get cut," Stile says. "If you notice a guy like Oscar De La Hoya, he's a handsome guy still, but it's not because he hasn't been hit.
"It's because he doesn't have the predisposition to [get]cut like some of these other guys."
The surgery for Diaz meant doing something about his sharp bones.
After marking the borders of the scar, Stile wheeled Diaz into the operating theatre and sliced his brow open. All of the scar tissue underneath the epidermis was removed. With the bone revealed, Stile rasped it down with a chisel to a smooth surface.
In place of the scar tissue went a Neoform collagen pledget, made from a cadaver's sterilized donor tissue. Stile sewed it onto the periosteum, a covering over the bone that acts as an anchor. This time, Stile sewed the wound from the inside out.
MMA fighter Nick Diaz, just moments before Stile operates on his face.
For a time, Diaz looked like, in Stile's words, "Frankenstein's monster" while they waited to see if the pledget would absorb and reduce his brow line.
Eventually, it did. "There was a very steep learning curve for both of us," Stile says. "Fortunately, it worked."
Diaz mentioned the surgery to former UFC welterweight Marcus Davis, who had been stitched at least 70 times in his career. He soon became Stile's second patient, and can now wrestle with his son without fear of a collision opening up his flimsy brow.
The Ethics of Surgical Fixes
Stile sees the surgery as corrective, not enhancing. He's merely trying to undo the damage done by a progressive series of inept sutures: "You should see the shit I take out of people's faces. Some people have silk sutures, which veterinarians don't even use anymore."
Now that word has spread, pro fighters who've been cut have trekked to Stile's Vegas office specifically to have stitches pulled in hope of a fresh start.
But Stile also asserts the new skin might indeed be as good as that of someone who had never been cut at all. And if a fighter with "virgin skin" meets another with a Krazy Glued brow, who stands the better chance?
Ask bioethicist Andy Miah, Director of the Creative Futures Research Centre at the University of the West of Scotland about Matheson's vision of a superfighter, and he'll tell you that the idea of corrupting sport or human performance is a ship that's long since sailed.
"We crossed that line many decades ago with the discovery of penicillin or anesthesia, then with the boon in cosmetic and functional surgeries," he said. "Sports will follow, and fighting will lead the way."
‘If you tell an athlete, "hey, you can have one more surgery that's going to enable you to extend your career five years," I think a significant portion would agree to something like that.'
The speculation involves muscle transfers, which could see a surgeon taking a quadriceps muscle and inserting it into the biceps.
Adding stiffness - incidentally, that could be scar tissue - to a joint like an ankle or elbow could make an MMA fighter less susceptible to submissions. Cartilage around the trachea could be reinforced to make someone less likely to tap from a rear-naked choke. And why not insert some silicone around the jawline to make a knockout blow harder to inflict?
If that seems too extreme, then what about Tiger Woods getting Lasik eye surgery and winning seven of his next 10 tournaments with new-found 20/15 vision? Then there's tennis player Simona Halep, who had breast-reduction surgery to help alleviate back pain during her time on the court. And don't forget Gary Sheffield, then-outfielder for the Los Angeles Dodgers, had to be talked out of Lasik by his doctor even though he had better than 20/20 vision.
When your life is tied up in how well your body performs, you will take any and every measure available.
"A lot of the athletes I take care of now, they've had 10 or 15 surgeries," says Matthew Matava, a professor of orthopedic surgery at Washington University School of Medicine in St. Louis.
"If you tell an athlete, ‘Hey, you can have one more surgery that's going to enable you to extend your career five years,' I think a significant portion would agree to something like that. But hopefully, whatever the procedure is, there's going to be peer-reviewed evidence that it does work."
Stile's techniques are undergoing that kind of scrutiny now, as surgeons from New York University are working with him to publish results in a future issue of Annals of Plastic Surgery.
But as with steroids, the number of athletes willing to take big risks creates a new kind of normal: Athletes might one day have to consent to surgery just to be at parity.
"It may mean that the athlete who hasn't gone through the intervention will no longer be competitive and even be forced into retirement or compelled to enhance," Miah says. "Should we care about that? I don't think so. It's a tough world. If you want to be an elite athlete today, you have to make sacrifices."
Is the Era of the Natural Human Ending?
The imminent risk inherent in Frank Stile's procedure is the potential for misadventure - namely, someone other than Stile performing it.
Brazilian UFC middleweight Wanderlei Silva disappeared for a period in 2009 before re-emerging looking like one of the Real Housewives of Sao Paulo, a look that's softened only slightly in the time since.
"Brows in males should remain in a neutral position," Stile says. "You do an incision like this in males, you have to be careful you limit your skin excision to the scar only. If you take out too much skin in addition to the scar, when you close it, it raises the eyebrow, which gives you a feminine, catlike appearance."
Stile is now looking into how MRI and CT scan technology might give some indication of a fighter being more prone to cuts, thanks to those sharp ridges of the skull. There's also the potential to shave down the zygomatic (cheekbone) region, another area likely to cut.
As for Stile's test case, Nick Diaz finally got his rematch with K.J. Noons after three grueling years. Stile watched proudly as Diaz went the five-round distance, getting several cuts without much blood loss - and coming out with a long-awaited victory.
Eventually, Stile might have new answers for nasal issues: UFC veteran Phil Baroni had Stile reshape a nose already several times broken, allowing him to breathe more easily and keep his jaw from hanging open to get air.
"Phil had a deviated septum, which was the main impetus for the surgery, but we also did cosmetic changes," Stile recalls. "His nose became a little more refined and we took some of the irregularities out of the bridge. I think nasal reconstruction will become a huge thing."
It won't be tomorrow, or next year, but eventually athletic commissions across the United States will need to determine the validity of using surgery to improve performance. The Association of Boxing Commissions is investigating the issue in its medical committee, which may issue a report this summer.
"The era of the natural human is slowly coming to an end, both biologically and ideologically," Andy Miah says.
One of the faces of this new paradigm is Oscar Pistorius, the bionic Paralympian with artificial legs. "If he is able to compete in the London 2012 Olympic Games - not just the Paralympic Games - this will signal a massive shift in what we think of as being ‘able-bodied.'
"Then, technology will have outpaced evolution. Quite literally."
Photos: Courtesy Frank Stile
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