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O.C. Surgeon Takes on Intricate Surgery to Correct Man's Shocking Facial Deformity
by: Dr. Bunkis
Garibaldi is currently in recovery. Check back next week for updates.
Garibaldi is currently in recovery. Check back next week for updates.

I’ll stray for the usual question and answer format to bring you some news regarding Manuel Jesus Lizarraga Garibaldi.

Manuel is a 71-year-old, well respected artist in Rosarito, Mexico. A few years ago, he noticed a growth on the tip of his nose but did not have the money to see a doctor, let alone to have it treated. As the years progressed, the lesion grew and by now, has consumed the bulk of his nose and the right cheek adjacent to the nose. Manuel and his wife still talk about seeing a doctor when they sell a few paintings, but they have never been able to get ahead enough to afford a doctor.

Manuel before his procedure


Manuel was born in the Yucatan in 1931. He has been painting and drawing since 1957. He attended art school in New Mexico and in California (at the California Institute of the Arts). Manuel obtained his green card and worked in the United States for a number of years, but decided to return to his native Mexico and his green card has lapsed.

On the 14th of March of this year, Deborah Palermo from Orange County Plastic Surgery walked into the Polo’s Gallery and first met Manuel. She was shocked by the advanced stage of skin cancer she saw on Manuel and utterly surprised that no one had stepped up to help him. Deborah told Manuel that she worked for a plastic surgeon in Orange County, asked if she could take his photograph and offered to help him have his cancer treated. Deborah is the Reception Desk Coordinator at Orange County Plastic Surgery and is an angel for taking it upon herself to help Manuel. Upon seeing the photos of Manuel, I concluded that he had a basal cell carcinoma (although that won’t be confirmed until the pathologist analyzes the tissues). Years ago, this type of skin cancer was called a “rodent ulcer” because it looked like a rat had been chewing on the involved part, in this case, poor Manuel’s nose. I offered our assistance and contacted Dr. Kevin Becker, Medical Director and Head Anesthesiologist at the Laguna Hills Surgery Center to see if the surgery could be performed there. Dr. Becker immediately offered his services but it took him a week to get together with the surgery center brass to get their approval.

Dr. Mark Adlard, a well known family practitioner in Rancho Santa Margarita, offered to do the electrocardiogram and required pre-operative laboratory tests as his donation to this effort. Dr. Becker, the Surgery Center, the preoperative and post operative nurses, the OR nurse, the scrub tech and the pathologist, Dr. Allan Rushovich of Irvine all volunteered their time and expertise for Manuel’s surgery and recovery. Dr. Bunkis and Deborah wrote letters to the Mexican Consulate General and the State Department to get Manuel permission to cross the border. US Immigration had the letters and photos I sent but insisted that Manuel come in person to the Tijuana office so they could verify his problem – the mayor of Rosorito accompanied Manuel and his wife on this important trip, and this past Wednesday the permission to come into the United States for his medical care was granted. That evening, after putting in a full day of work at Orange County Plastic Surgery, Deborah left for Rosarito and brought Manuel to her home in Orange County. He will be staying with the Palermo family while he is here.

Manuel came into the Orange County Plastic Surgery office on Thursday for his pre-op with myself and our nurse, Tracey Prescott. We were all struck by how delightful Manuel was and, typical of many deformed patients I have seen in third world countries over the years, how unbothered he seemed by the aesthetic part of his grotesque deformity.
Manuel speaks English quite well – years ago he taught art at a couple of American colleges. He still plays basketball weekly (in spite of an arm deformity from an old untreated fracture – cannot straighten one arm). He deeply thanked the Americans who are making it possible for him to get rid of his cancer. I just hope that I was able to convey the magnitude of surgery he requires to have his cancer removed.

Manuel’s surgery was performed on Monday, April 12, at the Laguna Hills Surgery Center. I know that removing the tumor, if indeed we are able to surround the tumor completely, will leave a gigantic hole and very little of a nose. If at all possible, my goal will be to close the wound with a flap from Manuel’s forehead. The flap, raised from the central forehead and turned 180 degrees, should cover the defect in the nasal area and some cheek flaps will be required to cover the rest. If a forehead flap is used, I’d have to go back about three weeks later to divide the flap pedicle between the eyebrows and to finish insetting the flap. That would be our ideal scenario, but I was very moved when a reported from Chanel 11 FOX news told me that she knew of a prosthetist that will be able to donate a custom nasal prosthesis for Manuel if I do not have enough of his own tissue left to complete the reconstruction. Come back next week for an update on Manuel's progress.

Here is a photo of Manuel with his wife in their gallery in Rosatito.

Manuel with his wife in their gallery in Rosatito.

As Medical Director of Orange County Plastic Surgery, Juris Bunkis, M.D., F. A.C.S. brings 30 years of surgical expertise to our communities. Dr. Bunkis is a Harvard trained, Board Certified Plastic Surgeon and Member of numerous prestigious organizations including the American Society of Aesthetic Plastic Surgeons, The International Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgeons and the California Society of Plastic Surgeons. Dr. Bunkis, a former faculty member at the University of California, San Francisco, has published more than 40 scientific publications, abstracts and book reviews, and 17 book chapters in plastic surgery text books. For questions or advice, please contact Dr. Bunkis directly at

What do you think? Leave your comment here.

Comment by Terri Olsen (previous client) 4/14/2010 10:00:00 AM

Bless you Dr. Bunkis... you will receive great blessings in heaven. May the Lord bless your practice and give you the ability to continue to share your gift for many years to come.

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