Moments earlier at a Manhasset medical office, 4-year-old Zeenabdeen Hadi had been giddily showing a doctor's aide drawings he had made in a coloring book. But then, gripped tightly by his uncle, the boy was squirming to get free and groaning in pain.
Dr. Kaveh Alizadeh stood over the child, his thumb on the plunger of an enormous syringe. Alizadeh had located one of three balloon-like sacks implanted just beneath the burn-scarred skin of the child's face and, one by one, used the syringe to pump them tight with a saline solution.
"Khalas, khalas, khalas," Zeenabdeen said in Arabic, meaning he had "enough."
Abdeen, as he is called, and his uncle, Hasan Hadi Khazaal, 21, arrived on Long Island last spring from their home in Iraq. The child's parents abandoned him after he was injured, prompting his uncle to aid in his survival.
They have been living in a Ronald McDonald House in New Hyde Park while Abdeen awaits plastic surgery to reconstruct his face, which was badly burned when a car bomb exploded outside his home in Dujail, 35 miles north of Baghdad, a few weeks before his first birthday.
The procedure, done recently at Alizadeh's practice, Long Island Plastic Surgical Group, was one of many Abdeen endured in a monthslong effort to repair damage to his face. The explosion sent electricity from a downed power line surging through his head, tearing his skin.
With each injection, the boy's face was transformed. One injection caused the tip of his chin to hook sharply upward. Another distorted the right side of his face, pulling one eye toward his right ear. A third produced a lump on his scalp the size of a small apple.
Scarring from the blast was so severe that Abdeen's mouth is barely functional. His lips were burned away and he cannot open his mouth wide enough to eat normally. Nor can he close it tightly enough to prevent liquids from dribbling down his chin.
He and his uncle are on Long Island because two nonprofit organizations -- Global Medical Relief Fund on Staten Island and a group formed by Alizadeh's practice, Mission: Restore -- paid for the flight and arranged for medical care.
Earlier this summer, Alizadeh implanted the three balloon-like sacks to create extra skin that could replace scar tissue on Abdeen's face.
He made use of engineered human tissue created by LifeCell, a New Jersey biotech firm, which he will use to replace scar tissue inside Abdeen's mouth. To build the engineered tissue, LifeCell washes cadaver skin free of living cells, leaving behind only a scaffolding of connective tissue.
Alizadeh incubated a 1 1/2-inch-by-3-inch patch of this engineered tissue by attaching it to blood vessels beneath Abdeen's scalp. Once the new blood vessels in the skin patch are fully functioning, Abdeen will be ready to have the scars removed from his face and mouth.
During an operation scheduled for Thursday, doctors will pivot the patch of engineered skin from Abdeen's scalp to where it will take the place of scar tissue inside Abdeen's mouth. "That will be the most challenging part of the operation," Alizadeh said.
Doctors plan to deflate the sacks beneath the skin of Abdeen's face and scalp. The skin over these will have stretched enough to let doctors cut out bits of scar tissue.
Hadi says his nephew is self-conscious about his appearance."When I pick up a camera, he says, 'No, no picture, no picture,' " Hadi said.
But during long days of play at the Ronald McDonald House, Abdeen has seemed oblivious to his appearance.
Recently, he climbed to the top of a sliding board with another child, then called out before scooting downward. "Hey," he said in Arabic. "Look at me!"