Being a teenager is hard enough on its own. But, when your younger, much prettier, sister has cystic fibrosis, and is the favored one of the family, and you’re already ostracized from the rest of your school…well, sometimes it’s a bit much for some teenagers. These are the cards that have been dealt to Pauline, who has been living in the shadow of her younger and more popular sister, Grace. Determined to actually make her mother love her, Pauline harbors fantasies of becoming a doctor and being able to cure Grace and become a hero. Of course, she’s a teenager, and these wires get cornered with body image issues and sexual fantasies, making for a particularly gruesome mixture.

For a first film, written and directed by Richard Bates, Jr., Excision is surprisingly assured. Pauline engages in surreal body horror fantasy sequences that horrifies and disgusts as it amuses and endears. Pauline’s batch of teenage angst is instantly recognizable and sympathetic, unique to her, rendered in the extreme, but hardly foreign to most people. Bates finds a difficult and sometimes uneasy balance between grim body horror and Lynchian dark comedy rendered through a teen girl coming of age. By giving Pauline agency in her fantasies that she doesn’t possess in her real life, Bates explores the balance of the real and the surreal even as the line between the two begins to collapse.

Ballsy, hilarious, and brutal, Excision was a special something that never quite got the love it deserved due to a tiny release and the disappearing into the ether. It’s a hard sell of a movie that never quite obeys the rules of the road, making it a difficult watch for some who can’t easily categorize its intentions which seem to straddle multiple genres. Back in my day, we used to pass around video tapes of weird indie films like Freeway, Welcome to the Dollhouse, Clerks and Pink Flamingos, creating our own high school canon among the misfits, and Excision would have fit right in to that collection of imperfectly amazing film that energized us through its bizarre use of the medium.

Excision is now available on Hulu.