After several surgeries in Binghamton, Karime returned to Iran to recuperate.
Allowing some time to pass in between surgeries, in September, Baghaei-Rad and Latham board-certified surgeon Lucy Capek decided it was a good time to bring the boy back to America to have a nose constructed.
"First of all," said Capek, "he was basically born, among other things, with just a real tiny nubbin on his face instead of a full-sized nose. If you could picture that all you had was one nostril and one kind of notch over it, that was his nose."
According to Capek, when she first met Karime, she could see that some work had been done to construct elements of his face that were not previously there, however, the work that had been done by surgeons in Binghamton needed to be updated, due to natural erosion.
"They brought in something called a forehead flap, which is bringing in a lot of skin and soft tissue and building it up with some bone grafts," said Capek. "After a couple of years, it began to shrivel down to nothing again."
Capek said that when she met Karime, "On profile [his nose] just looked completely flat. What we did was put in something called a tissue expander, that's kind of like a balloon, and you blow that up over a series of weeks and you stretch the skin that is there."
Capek said, unfortunately, because the skin surrounding the area that would be his nose was affected by so many previous surgeries, the skin on the area where Karime's nose would have been was so thin that the expander actually poked through and needed to be replaced by a softer brand expander.
Next, Capek took some cartilage from Karime's rib and built a nose from there.
"He still has just one tiny nostril, but we have to wait until the bone heals before we can do anymore," she said. "The great thing is that the nose came out looking a lot like his mom's."