There are films that linger with you, and then there’s Excision—a movie that doesn’t just stick around, it burrows under your skin and sets up camp. I just finished watching Richard Bates Jr.’s 2012 comedy horror masterpiece on streaming, and I’m still processing the beautiful, twisted nightmare I witnessed. This isn’t your typical horror film. It’s a visceral coming-of-age story wrapped in body horror, dark comedy, and genuine tragedy that absolutely floored me.
The Weird Hook That Grabbed Me
From the opening frame, Excision makes it clear: you’re not in Kansas anymore. The film seizes you immediately with its deliciously macabre dream sequences—these hypnotic, blood-soaked fantasies that feel like fever dreams shot through a kaleidoscope of turquoise tiles and arterial spray. Director Richard Bates Jr., making his feature debut at just 25 years old, crafted something that walks the razor’s edge between art film and midnight movie madness.
What hooked me wasn’t just the weirdness—plenty of films try to be shocking. It was how Excision uses its grotesque imagery to tell a heartbreaking story about a girl desperate for love, acceptance, and control in a life where she has absolutely none. The contrast between the mundane suburban horror of Pauline’s daily existence and the vibrant, disturbing beauty of her fantasy world creates a hypnotic push-pull that kept me glued to the screen.
The Camera Work That Elevated Everything
The cinematography by Itay Gross deserves serious recognition. Bates Jr. employs this brilliant visual strategy that I couldn’t help but admire—he frames the film in thirds, creating a compositional rigor that feels both deliberate and unsettling. The “real world” sequences are shot with this almost oppressive normalcy, all yellows and muted tones in Pauline’s kitchen, the banality of suburban middle-class life rendered in perfect, suffocating detail.
But then Pauline closes her eyes, and everything explodes into those fantasy sequences. The dream world is dominated by this bright, almost neon turquoise blue—surgical tiles that line operating rooms that exist only in Pauline’s fractured psyche. It’s perverse color theory at its finest: blue, traditionally associated with calm and stability, becomes the background for carnage and sexual awakening. The juxtaposition worked brilliantly, evoking this sense of wrongness that’s both beautiful and horrifying.
The film’s visual DNA draws heavily from directors like David Cronenberg (that body horror obsession), Todd Solondz (the suburban malaise), and even John Hughes (the teenage outsider narrative), but Bates Jr. synthesizes these influences into something distinctly his own. You can see touches of Eyes Without a Face in the surgical fetishism, and the dark comedy recalls Heathers and Ginger Snaps, but with violence that surpasses both.
AnnaLynne McCord’s Fearless Transformation
Let’s talk about the elephant in the room: AnnaLynne McCord’s performance is nothing short of revelatory. Known for playing glamorous, seductive characters on shows like 90210 and Nip/Tuck, McCord underwent a radical transformation to play Pauline. And I mean radical.
The makeup team went to town making her look, frankly, as unappealing as possible—bad acne, greasy black hair, hunched posture, ratty clothes. But it’s not just the physical transformation. McCord completely inhabits this character, giving Pauline this caustic intelligence, this desperate need for control mixed with genuine love for her dying sister. When McCord first met with Bates Jr., he challenged her to cut her hair to prove her commitment. She grabbed a steak knife off the restaurant table and did it right there. For the final scene, she shaved her entire head.
In the fantasy sequences, McCord’s eyes become bright and alert, alive with purpose and arousal. In reality, she wears this mask of apathetic dismissal, hostility barely contained beneath the surface. She makes Pauline simultaneously repulsive and deeply sympathetic—a socially awkward eighteen-year-old with horrific dreams of becoming a surgeon, picking at scabs, dissecting roadkill, and fantasizing about performing surgery on strangers.
The performance earned McCord “Best Actress” at the Malaga International Week of Fantastic Cinema in 2012 and second place at the Fangoria Chainsaw Awards. She deserved every accolade. This is a career-defining role that showcased acting chops nobody knew she possessed.
The Stellar Supporting Cast and Legendary Cameos
But McCord doesn’t carry this film alone. The supporting cast reads like a love letter to cult cinema.
Traci Lords as Phyllis, Pauline’s controlling, hyperreligious mother, delivers what might be the best performance of her career. Lords, who famously transitioned from the adult film industry to legitimate acting, gained fifteen pounds for the role to give Phyline that “softness” that helped her disappear into the character. She’s terrifying in her passive-aggressive cruelty, her desperate need to mold Pauline into a “proper lady” through cotillion classes and forced therapy sessions with their priest. Yet Lords layers the performance with genuine maternal concern and, ultimately, devastating grief. That final scene where she embraces Pauline—her scream of horror is absolutely haunting. Lords won the Fangoria Chainsaw Award for Best Supporting Actress, along with Fright Meter and CinEuphoria Awards. Completely deserved.
Roger Bart (best known for Broadway’s The Producers and his villainous turn on Desperate Housewives) plays Bob, Pauline’s father, with this quiet resignation that speaks volumes. He’s completely under Phyllis’s thumb, submissive to the point of enabling the family’s dysfunction. It’s a smaller role, but Bart nails the pathos of a man who’s checked out of his own life.
Ariel Winter (Modern Family) plays Grace, Pauline’s younger sister who suffers from cystic fibrosis. Despite being the one who’s dying, Grace appears completely healthy—a brilliant ironic touch. She represents the only genuine love in Pauline’s life, the one person who accepts her unconditionally. Their relationship provides the film’s emotional core and its ultimate tragedy.
Then there are the cameos that horror fans live for: John Waters as Pauline’s “therapist” (actually just their priest), bringing his trademark subversive energy to the role. Malcolm McDowell (A Clockwork Orange) appears as Mr. Cooper. Matthew Gray Gubler (Criminal Minds) plays Mr. Claybaugh. Marlee Matlin, an Academy Award winner, plays the deaf school counselor who despises both Pauline and her mother. Ray Wise (Twin Peaks) has a small but memorable role. These aren’t just celebrity cameos—Bates Jr.’s persistence in signing this talent (all for a film shot in just 28 days on a shoestring budget) shows the power of the script and his vision.
Pauline: The Protagonist Who’s Also the Villain
Pauline is one of the most complex characters I’ve encountered in horror. She’s the protagonist, yes, but she’s no hero. She’s caustic, aggressive, deliberately off-putting. She asks her sex ed teacher if you can get an STD from having sex with a dead person. She loses her virginity specifically while on her period, making the experience as uncomfortable as possible for her partner. She carves a medical cross into her own arm. She picks at her acne obsessively.
But beneath all that hostility is a girl who’s been emotionally abandoned by her mother, who hears Phyllis admit she finds Pauline “impossible to love.” She’s an atheist in a deeply religious household, a would-be surgeon who gets failing grades, someone whose only therapy consists of weekly sessions with a priest played by the Pope of Trash himself. She’s powerless in every aspect of her life except in her fantasies, where she has absolute control.
The film does something brilliant here—it makes you forget Pauline is genuinely mentally ill and capable of atrocity. The dark humor and her genuine love for Grace create sympathy, even as warning signs accumulate. When the ending comes, it’s simultaneously shocking and inevitable. You’ve been led there the whole time, but you didn’t want to believe Pauline would actually go through with it.
Those Dream Sequences: Beautiful and Horrifying
The fantasy sequences are where Excision truly becomes something special. These aren’t your typical dream sequences—they’re full-blown psychosexual nightmares shot with this lush, almost music-video aesthetic. Pauline lies in bed and has these intense, orgasmic reactions to fantasies of blood, surgery, dissection, necrophilia. She’s dressed like a runway model, dolled up and glamorous in stark contrast to her waking appearance.
These sequences serve multiple purposes. On one level, they’re visceral horror—genuinely disturbing imagery that reportedly caused at least one person to pass out at the Sydney Film Festival screening. But they’re also windows into Pauline’s psyche, revealing her conflation of medical procedures with sexual desire, her need for power and control, her genuine fascination with the mechanics of the body.
The film uses these moments to flesh out Pauline as a character. Despite the overwrought violence, she’s vulnerable here, expressing honest desires she can’t articulate in waking life. Her bird autopsies and gruesome daydreams reveal depth that would otherwise be missing. She’s not a budding serial killer—she’s a deeply disturbed girl whose fantasies of power compensate for her complete powerlessness in reality.
That Ending: The Devastating Payoff
I won’t spoil the specifics for those who haven’t seen it, but the ending of Excision is a masterclass in tragic inevitability. When Pauline overhears that Grace needs to be on the lung transplant list, she devises what she genuinely believes is a solution. She drugs her father. She kidnaps the rude neighbor girl who’s been mean to her. She shaves her head. And in the garage, dressed in white and splattered with blood, she attempts to perform her first “surgery.”
What makes this ending so effective is that Pauline truly believes she’s saving Grace. She’s studied in the library, she’s prepared, she’s confident. But of course, you can’t just perform a lung transplant in a garage with no medical training, no sterile equipment, no respirators. The delusion is complete.
When Phyllis comes home and finds the scene, the final moments are devastating. Pauline initially smiles with pride—she’s finally accomplished something that will earn her mother’s love. But when Phyllis embraces her and screams in horror and grief, Pauline seems to finally snap back to reality, wailing along with her mother as they both mourn what Pauline has done.
It’s horror, yes, but it’s tragedy first. This was a girl who needed psychiatric help, who should have been hospitalized, who was failed by every adult in her life. Her mental illness was dismissed, her mother tried to fix her with cotillion classes instead of therapy, and the one person she truly loved is now gone by her own hand.
Why This Film Matters
Excision premiered at Sundance 2012 in the Park City at Midnight section, and Bates Jr. reportedly gave out fake bloody tampons to press and attendees (because of course he did). The film earned an 85% on Rotten Tomatoes and won 24 awards at horror festivals during its run.
What makes Excision significant beyond its shock value is how it uses body horror as genuine character development. This isn’t gore for gore’s sake—it’s a crucial storytelling element. The film explores mental illness without exploiting it, showing genuine sympathy for Pauline even as we recognize she’s dangerous. It’s about the suburban horror of families that can’t communicate, religious zealotry that prevents real help, and the tragedy of a girl who needed intervention long before she committed atrocity.
Bates Jr. wanted to make the kind of film he and his friends would have loved in high school—a midnight movie that pushed boundaries while exploring complex themes. He succeeded brilliantly. This is a film that respects its audience’s intelligence while delivering visceral thrills, that generates genuine empathy for a protagonist who does unforgivable things, that’s simultaneously hilarious and heartbreaking.
Final Thoughts
Excision isn’t for everyone—if you’re squeamish about blood, menstruation, surgical imagery, or any combination thereof, this will challenge you. But if you’re willing to go along for the ride, you’ll find a film that’s smart, visually stunning, impeccably acted, and genuinely moving beneath all the gore and dark comedy.
Richard Bates Jr. announced himself as a major talent with this debut (he’d go on to make Suburban Gothic and Trash Fire), showing that you can make midnight movies with real artistic ambition. AnnaLynne McCord proved she’s far more than a pretty face from teen soaps. Traci Lords confirmed she’s a legitimate actress capable of complex, award-worthy work.
This is a film about adolescent alienation taken to its most extreme conclusion, about the desperate need for love and acceptance, about delusion and tragedy. It’s Heathers meets May meets Cronenberg. It’s one of the most impressive horror debuts of the 2010s, and it’s absolutely worth your time.
Just maybe don’t watch it right after dinner.
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