Anchor Bay

'Excision' is a delightfully gross little coming-of-age story about a misguided and hormonal teen girl (AnnaLynne McCord) with some very nebulous and bloody sexual inclinations -- but mostly she's just an awkward teenager with no friends and a family that's driving her nuts.

Pauline is a relatable teenage girl -- a senior in high school with dreams of becoming a surgeon. And like any teenager, her hormones are raging and no one understands her. At night, her mind retreats to a dream world with surgical equipment, naked bodies wrapped suggestively in gauze, and pools of blood and guts. Pauline's fetishization of surgery is the cumulative result of a repressive religious mother, her own awkward social limitations, and her desire to cure her younger sister Grace ('Modern Family''s Ariel Winter) of cystic fibrosis.

It's easy to dismiss Pauline's dream sequences based on shock value, but they're orchestrated in such abstract fashion that even the more horrific elements (when she imagines removing a fetus from her body and handing it off to be burned) are almost cartoonish in that they represent a vivid imagination, and not her genuine urges. As teens, our sexual desires often manifest themselves in ways we don't understand, and our earliest proclivities and kinks may not always be well-defined or even clearly understood. It's a confusing time, sexually, because we have an idea about what we want, but we aren't sure how to communicate that want, much less explain our kinks to someone when we barely have any idea how to explain them to ourselves.

Pauline may seem tough and like the kind of awkward girl who doesn't care what people think -- the kind of weird girl in high school you'd actually admire -- but a few interactions with the popular girls show us that Pauline is indeed fragile. She uses her weirdness as armor, playing to the ways people are put-off by her by finding what bothers them most about her and sharpening those parts of herself like a knife.

AnnaLynne McCord plays Pauline almost startlingly well, given her previous work on shows like 'Nip/Tuck' and '90210' -- shows that portray her as very glam and polished and shallow. Her work here is incredibly empathetic because she seems to understand that Pauline isn't ugly or even disgusting, but that she's just awkward and socially disconnected -- retreating into her own mind and cultivating her delusions are what make her feel safe. McCord gets this and relates it to the audience well, capturing a brilliantly bizarre mixture of confidence and fragility and teenage confusion.

Her family is also surprisingly empathetic -- from Peter Bart's castrated father-figure to Traci Lords' religious and overbearing mother. Bart may seem like a wuss, but he's a guy that really loves his family and the kind of dad that appreciates his kids' jokes when their mother doesn't, as if he has a secret bond with them that they keep from their mom. Lords plays conservative mother well (suspiciously, almost too well), and we learn to understand that her pushiness is born of love and concern and a desire to bond. Her religious leanings are learned behaviors, but with Grace's serious illness, it's easy to see how so much of what Lords' character does here is a facade -- not too dissimilar from the one Pauline puts on.

Pauline's father once performed CPR on her when she almost drowned at a local pool, but he did so with a cold sore on his lip, forever cursing Pauline with a form of herpes -- essentially, her father gave her an STD. It's a quirky element, but unsurprising for a film that also features John Waters as a Catholic priest. If anything, this glorified cameo is the one weakness of the film, using time that could have been spent fleshing out Pauline's psyche even further.

Little can be said about the glorious, gut-check of an ending without spoiling, but it subverts expectation in a manner befitting the theme of teenage delusions and misguided behavior -- Pauline wants to help her sister, and she wants to make her mom proud. She wants to be a surgeon, but like most teens with dreams of their future, she has no idea what it takes to get there. She blows off math class because a surgeon doesn't need math, not taking into account that failing a class hurts her GPA and her ability to get into a good college. She thinks she can just get a GED and open a private practice with some self-training by reading books and performing surgeries on animals to hone her skills. Yes, it's almost unbelievable that a teenage girl with book smarts wouldn't have a firm grasp of the collegiate requirements she must fulfill to achieve her dreams of being a surgeon, but it's a heightened version of reality. Most kids in high school don't realize what they need to do to get from point A to point Z. They want to take shortcuts and they're all delusional about how real, adult life works.

The end of the film takes that idea -- of delusion, of a desire to prove to your parents that you can do something without taking the road most-traveled -- and encapsulates it in a moment that is both quietly startling and poignant, while never letting us forget that this is a teenage girl, and more than being troubled she is misguided, hormonal, confused, alone, and -- really -- just scared.