The Incision Before the Excision
Let’s get one thing straight: Excision is not for the faint of heart, the morally squeamish, or anyone who believes high school movies should end in prom. It’s for the rest of us—the ones who like our teen angst served with surgical precision, buckets of blood, and a side of dark, existential humor.
Written and directed by Richard Bates Jr., Excision is part Heathers, part Carrie, and part anatomy textbook from hell. It’s a horror film, yes, but also a pitch-black comedy about puberty, repression, and the fine line between self-discovery and psychosis. Think Napoleon Dynamite directed by David Cronenberg after a Red Bull and an emotional breakdown.
And yet, beneath the arterial spray and awkward sex, Excision is weirdly touching—a film about love, longing, and the tragic dream of wanting to fix everything, including yourself.
Meet Pauline: The Surgeon General of Delusion
AnnaLynne McCord gives the performance of her career as Pauline, a teenage girl who looks like she wandered out of a John Waters fever dream and into the wrong high school. She’s awkward, pimply, and disturbingly confident in her ability to perform major surgery without medical training.
Pauline lives with her brittle, ultra-Christian mother Phyllis (Traci Lords, wielding passive aggression like a holy relic), her well-meaning but neutered dad Bob (Roger Bart), and her sweet younger sister Grace (Ariel Winter), who suffers from cystic fibrosis.
Where Grace is fragile and angelic, Pauline is a walking open wound—sarcastic, perverse, and obsessed with blood to a degree that makes you wonder how she hasn’t been expelled from the Red Cross. Her dreams are elaborate operatic fantasies of dismemberment and gore, complete with blood-drenched nudity and moaning ecstasy. It’s puberty through the lens of a surgical snuff film, and somehow, it makes perfect psychological sense.
The Weird Science of Teenage Rebellion
Pauline isn’t just misunderstood—she’s a budding Dr. Frankenstein in Doc Martens. She wants to be a surgeon, which, given her fascination with the color red, might be the most optimistic career choice imaginable.
When she decides to lose her virginity to Adam (Jeremy Sumpter, blissfully unaware of the danger), she does it during her period, because of course she does. Her post-coital scene involves blood, confusion, and a mortified boy who learns the hard way that sometimes “red flags” aren’t metaphorical.
Later, in biology class, Pauline casually draws her own blood to test for STDs—during a lecture. The teacher (Malcolm McDowell, probably wondering how his career went from A Clockwork Orange to A Clockwork Menstrual Cycle) is understandably alarmed. But Pauline? She’s proud. She’s her own experiment.
There’s a twisted purity to her madness—like she genuinely believes that by dissecting the grotesque parts of life, she’ll find beauty. And, disturbingly, she sometimes does.
The Family That Prays and Preys Together
Excision might be a horror movie, but it’s also a satire of suburban family dysfunction so sharp it could sterilize itself.
Traci Lords, in a performance that deserves its own hymn, plays Phyllis as a woman whose faith is her last defense against total mental collapse. She’s the kind of mother who says “I love you” like it’s a threat. Her dinner table grace sounds like it’s directed at God’s HR department.
Her relationship with Pauline is an Olympic event in passive aggression. When Phyllis tells Pauline she’s praying for her, it sounds more like she’s drafting an exorcism request. You can practically feel the decades of repressed rage fermenting under her conservative pearls.
Roger Bart, as the father, is present mostly in body, rarely in spirit—an emasculated bystander in a war between two unstable women. It’s a performance that screams, “I had dreams once.”
And poor Grace—Ariel Winter, still in her Modern Family years—plays her as the saintly sibling doomed to become the emotional and literal sacrifice in Pauline’s blood-soaked awakening.
Sex, Blood, and the Biology of Madness
Excision dives into bodily horror not as shock value, but as metaphor. Puberty, menstruation, lust, and disease—all become tangled in Pauline’s grotesque fantasies.
Her dreams—beautifully shot, disturbingly sensual montages of surgical ecstasy—blur the line between eroticism and butchery. One moment she’s a goddess in a crimson cathedral, the next she’s elbow-deep in her own psyche.
These scenes are not for everyone. They’re explicit, surreal, and weirdly artful—like a medical textbook illustrated by Salvador Dalí after a breakup. But they capture something profound: the terror and exhilaration of inhabiting a body that’s changing, leaking, and betraying you.
The Climax: DIY Surgery and Family Therapy, Pauline-Style
The final act is what elevates Excision from twisted teen comedy to Greek tragedy by way of a Home Depot scalpel.
When Grace’s condition worsens, and the family’s faith proves useless, Pauline decides to take matters—and lungs—into her own hands. She drugs her father, kidnaps a neighbor, and sets up an impromptu operating room in the garage.
It’s a scene so horrifying and absurd you almost admire her dedication. She’s not evil—just delusional enough to believe she’s performing a miracle. And in a sick way, she is.
When her mother finds her standing over two stitched-up bodies, smiling like a child showing off a science project, the movie reaches a crescendo of madness and heartbreak. Pauline proudly declares it’s her “first surgery.” Then, as reality dawns, her smile collapses.
The last image—Pauline’s mother embracing her in hysterical grief while Pauline finally breaks—hits harder than any jump scare. It’s not blood that horrifies you—it’s the realization that this girl wanted love so badly she mistook murder for mercy.
The Cast: Saints and Sinners
AnnaLynne McCord is jaw-dropping. She takes what could have been a camp caricature and turns Pauline into a tragicomic icon—a grotesque prodigy with the soul of an artist and the hygiene of a morgue attendant.
Traci Lords delivers the film’s emotional core—a performance so brittle it could snap in half at any moment. Ariel Winter is heartbreakingly sincere as the doomed Grace, and Roger Bart’s exhausted dad energy grounds the insanity in something painfully real.
And then there’s John Waters, appearing as a priest, because of course he does. When Divine’s favorite director shows up in your movie about menstrual blood and garage surgery, you’ve officially entered the Church of Cult Cinema.
Style and Substance (and a Lot of Blood)
Richard Bates Jr. directs like a mad scientist dissecting Americana. His tone shifts from deadpan humor to operatic horror without warning. One moment you’re laughing at Pauline’s teenage bravado, the next you’re staring in awe at a tableau of surgical horror that looks like it belongs in an art museum curated by Satan.
The cinematography is vivid and painterly, especially in the dream sequences—imagine Amélie with more blood loss.
And the script walks a tightrope between humor and heartbreak. Bates doesn’t mock Pauline’s insanity—he invites us to see it as a distorted reflection of something universal: the desperate desire to be loved, to be seen, to matter.
Final Cut: Bloody, Brilliant, and Beautifully Wrong
Excision isn’t just a horror film—it’s a psychotic fairy tale about the dangers of perfectionism, parental pressure, and hormonal ambition. It’s gross, funny, tragic, and weirdly touching, like if Carrie had gone to med school.
It’s not an easy watch, but it’s a necessary one—a film that reminds us that true horror doesn’t live in monsters or ghosts. It lives in families, in mirrors, and in the quiet insanity of wanting to fix what can’t be fixed.
So yes, Excision is disturbing. It’s also magnificent. You might gag. You might laugh. You might need therapy.
But you’ll never forget it.
Final Rating
4.5 blood-soaked scalpels out of 5.
A coming-of-age story where growing up hurts, love bleeds, and self-discovery involves organ theft. And honestly? That’s kind of beautiful.
