We need to talk about Pauline… 

Ticking off the plot points in director Richard Bates Jr’s Excision should be an exercise in eye-rolling. Teen misfit? Check. Dull suburban setting? You bet. Sexual urges on the path to womanhood? Of course. Overbearing parent? And then some.

Given the number of times audiences have been bombarded with all of those concepts, the big surprise is that first time feature director Bates is able to wring so much blood from such an old corpse. He takes his mission to bring fresh horror to these stale elements very seriously and the well-worn cliches of a nice family home, nagging parents and awkward teen exchanges become a suburban landscape so weird it is no surprise when a resident of Twin Peaks shows up (Leland Palmer – aka actor Ray Wise, playing the school headmaster).

The story follows Pauline (AnnaLynne McCord), a delusional teenage outcast who spends her time browsing surgical equipment on eBay and bunking off school to read medical books in the local library. This unhealthy anatomical obsession is not helped by the fact that her sister Grace (Modern Family’s Ariel Winter) has cystic fibrosis and may need a serious operation to save her life.

Pauline’s blossoming sexual awakening also brings with it the kind of erotic dreams Ken Russell (The Devils) would have loved, full of semi-naked, writhing extras with a fetish for blood. It is clear from the very first frame of Excision that Pauline is heavily aroused by these nighttime visions, and they become more intense as her mental state deteriorates.

While the world inside Pauline’s head is disturbed, the one outside it isn’t much better. Family dinners provide endless drama as she battles a repressive, disapproving mother (ex-adult film star Traci Lords), who dotes on the younger, sickly daughter. Meanwhile, at school her classmates view her with suspicion and disgust, the word “Gross” already hanging in the air before they speak it aloud. Her social standing isn’t helped by her boyish, spotty looks. The one time she does properly scrub up, it’s a real transformation.

However, Pauline is not a powerless victim to her circumstances. McCord plays her as an angry outsider, full of rage and dark thoughts. Bates adapted Excision from his highly-praised short film of the same name, which picked up 24 awards from more than 50 film festivals – including Austin Fantastic Fest and the Sundance Film Festival. His snappy dialogue in this extended version provides Pauline with plenty of zingers that lift the humour up from those murky depths, her quick wit and outspoken remarks leaving other characters stunned.

Excision is released in UK cinemas on 2 November 2012, with the DVD and Blu-ray arriving in shops just 10 days later. Bonus features include the film’s original theatrical trailer and a feature commentary with  director Bates and star McCord.

Extras aside, this is one to buy for the genuine laughs Bates manages to create from such taboo material. Be warned though, this is humour so dark you’ll want to check there are candles in the house before pressing play.

Verdict: 8/10

Excision is released in UK cinemas on 2 November 2012, and on DVD and Blu-ray on 12 November 2012.