On Saturday, November 2nd, 2019, Nate Diaz fought Jorge Masvidal for the first (and possibly last) BMF title and belt at Madison Square Garden in New York City, NY. The build up leading to the fight was fueled by a special set of circumstances that set the event up to be one of the most unique UFC fights to take place. The winner of the match was ultimately determined by a highly controversial decision made by the ringside physician, but before we explore whether he made the right call, it is important to examine the events that set the BMF event into motion. Click here to skip to the medical analysis.
Nate Diaz made his long-awaited return to the Octagon earlier this year with a strong performance against Anthony Pettis after a 3-year hiatus following his controversial decision loss to Conor McGregor in their highly anticipated rematch in 2016 (Diaz submitted McGregor in their first fight after taking the fight on a 10 day notice). In Diaz’ own words, “the reason I was off is because everybody sucks and there was nobody to fight.” When asked who he wanted to fight next, Diaz called out Masvidal, who unbeknownst to him, was in the audience at the time. Jorge Masvidal, a veteran of the sport, had a very successful year by stopping Darren Till and KO’ing Ben Askren in the fastest knockout in UFC history prior to Diaz’ fight with Pettis. Per Diaz, there were no more “gangsters” left in the fight game and he viewed himself and Masvidal as the last of a dying breed. As a true martial artist, Diaz sought to pit himself against similar ilk to determine the real BMF. With the blessing of Dana White and the UFC, a special $50,000 belt (the most expensive belt ever made in the UFC) was created for the new BMF division (roster of two) and one-time contest to see who the best in the game was: Nate Diaz or Jorge Masvidal.
Once the fight was made, Masvidal publicly announced that should he win, he wanted Dwayne “The Rock” Johnson to wrap the BMF belt around his waist. The Rock heard his request, and equally excited for the BMF fight, answered the call. Dana White and The Rock then announced that The Rock would be present at UFC 244 and would wrap the BMF belt around the victor.
There were several other unique factors at play for UFC 244: President Donald Trump was in attendance (the first president to ever attend a UFC or MMA event), the crowd was sold-out, and the evening served as UFC’s 500th event. This was all in stark contrast to MMA being banned in New York until 2016 when it became the last of the 50 states to legalize mixed martial arts. The draw of the BMF fight was such that the WBO light heavyweight title boxing match between Canelo Alvarez and Sergey Kovalev at the MGM Grand in Las Vegas the same night was delayed until Diaz and Masvidal fought, and Dana White was actually called to see if the MGM Grand could show boxing fans in the arena the remainder of the UFC 244 event to tide them over until their main fight could commence. In other words, UFC 244 all-around was poised to be a monumental evening even before the BMF fight.
In addition to the interesting series of events catapulting the BMF fight into existence, there was the added eleventh hour drama just days before the fight was scheduled to take place that put the fight in jeopardy. Nate Diaz took to Twitter to announce that USADA had told him that he tested positive for an elevated level of a then unknown substance (later identified as selective androgen receptor modulator [SARM] ligandrol and attributed to tainted vegan supplements). Declaring that he cared little for the money to be made from the fight, Diaz stated that he was not willing to sacrifice his reputation or legacy and demanded that the UFC and USADA clear his name otherwise they would not have a BMF fight.
Your all on steroids not me pic.twitter.com/ykrZmRIoPS
— Nathan Diaz (@NateDiaz209) October 24, 2019
The suspense did not last for long as it only took a day for the UFC and USADA to respond with a lengthy statement exonerating Diaz in the fastest rectification ever made in the sport’s history.
The main card itself building up to the BMF title match was replete with great fights including Kevin Lee’s first round knock-out of previously undefeated Gregor Gillespie, Derrick Lewis decision victory over Blagoy Ivanov, Stephen Thompson’s decision win over Vicente Luque, and Darren Till moving up a weight class to defeat Kevin Gastelum by decision. When it was finally time for the BMF fight, The Rock entered the arena with the BMF belt and the crowd in attendance went wild.
The BMF fight, while it lasted, was an entertaining mix of good fight IQ and comedy courtesy of Masvidal. Masvidal opened the fight with a flying knee feint (the same move he used to take out Ben Askren in under 5 seconds), and blew kisses to the crowd after taking several shots from Diaz later in the fight. Despite a good performance from Diaz, Masvidal was clearly in control of the bout and decisively dominated the first three rounds (the official score cards read 30-26, 30-27, 30-26 Masvidal). A first-round multiple elbow and head kick combination opened up a cut over Diaz’ right brow that fans have come to expect when Diaz fights. Diaz’ scar tissue and its propensity to bleed are so well-known that the brow injury (and re-injury) has been well documented and has become one of the defining characteristics of a Diaz fight. In fact, Diaz acknowledged this storied history in one of the post-fight interviews himself.
Shouts to @UFCDoctor for taking care of Nate's cuts. Those were some nasty lacerations.
(via Getty, Dana White IG) pic.twitter.com/5RTucu455P— Chamatkar Sandhu (@SandhuMMA) November 3, 2019
The infamous right eyebrow laceration
Although many of Diaz’ previous fights where his eyebrow was split open led to blood streaming down his face that sometimes interfered with his vision, the cut to Diaz’ brow during the BMF fight seemed comparable to less significant than what he has previously endured in UFC matches. Throughout the first three rounds, he did not appear to have any brow or eyelid interfering with his visual axis; there was nothing obstructing his view preventing him from seeing, and the stream of blood that he had running onto his eye did not appear debilitating. Contrary to similar facial injuries that different fighters have experienced in other UFC fights, Diaz did not have a significant amount of periorbital, brow, or eyelid edema developing while the BMF fight was ongoing. The laceration in question did not appear so deep that bone was exposed. In short, objectively, to someone watching the fight on a screen, there was nothing preventing Diaz from seeing properly or being able to defend himself.
In fact, Diaz squared off against Masvidal at the top of the fourth round, ready to continue the fight. Although Diaz is notorious for his cardiovascular endurance and his dogged will to fight regardless of the amount of damage he takes, this was not careless bravado on his part – he appeared fine and continually re-assured the ringside physician that he was OK, not having trouble seeing, and able to continue fighting. Per Diaz, the physician, after asking whether Diaz could continue, ignored his response and then went to the referee where the decision was ultimately made to stop the fight before the fourth round could take place.
The question that everyone is debating is this: should the BMF fight have been stopped?
There has been much talk about whether the tide of battle would have changed should the championship rounds have proceeded, but that is speculation and disrespectful to Masvidal’s performance. Instead of entertaining what might have been, the focus of this article are the ophthalmic injuries that Diaz incurred and whether or not they should have led to the anti-climactic stoppage of possibly the most unique event in UFC history.
Full disclosure: I was not present at the fight and only witnessed it on TV. I have reviewed the photos and videos that were shared by the UFC and on social media during and after the fight, as well as Oculoplastic surgeon Greg Hsu, DO’s fantastic post-fight laceration repair.
I got you! Appreciate you! @natediaz209 @danawhite @ufc #UFC244 pic.twitter.com/U34oR33GeK
— Dr. Greg Hsu (@UFCDoctor) November 3, 2019
A close look at the eyebrow laceration
Dana White stated in the post-fight press conference that Diaz’ “eyebrow was literally flipped over in front of his eye”, but from looking at the videos and photos of the fight, the eyebrow (and eyelid) do not appear to be interfering with Diaz’ visual axis. I repeat this not to emphasize a technicality meant to diminish Dana White’s concern, but it is important to note because it means that, barring any other vision threatening or medical issues not visible to spectators, the brow and eyelid were not impairing Diaz’ ability to see, his depth perception, or his ability to protect himself.
The main laceration in question is at the superciliary ridge, both deep and wide, and possibly required multilayered closure, although all we can see is what looks like a superficial running suture in the photo shared by Dana White on his Instagram. The laceration above his right eyebrow appears to have gone into his orbicularis oculi, a circular muscle of the orbit that is responsible for giving shape to the eyelid and helping with its closure. Despite how deep the laceration appears, it is superior to the the eyelid, there was no apparent septal violation and no orbital fat prolapse is seen (all of which could be signs of a more severe injury). Could the laceration have extended and enlarged with additional and repeated trauma to that area? Absolutely. But Diaz’ eyelid at the time the fight was stopped does not appear to have been in danger of falling off or flipping down over his eye. As already mentioned, the orbicularis oculi is responsible for eyelid closure, so theoretically, with enough damage rendering it dysfunctional, it could have longer lasting consequences for Diaz. However, this does not appear to be the case given all photos and videos at hand. Despite bleeding profusely as he usually does, Diaz did not appear to be visually compromised or actively at risk of being unable to continue fighting. He appeared no worse for the wear than in many of his previous fights. Dana White noted in the post-fight conference that Diaz will require future plastic surgery for cartilage and scar tissue removal (Diaz didn’t seem convinced this will be necessary), but those are chronic issues that will be addressed due to a lifetime of fighting, not necessarily from facing Masvidal in the closely watched contest to see if West Coast gangster is badder than East Coast gangster.
Should the BMF fight have been stopped?
Ultimately, the decision to stop the fight is in the hands of the ringside physician. That the fight took place in New York with its unfortunate recent history of deaths in combat sports is being speculated by many to have played into the decision. As a martial artist and someone who has seen Diaz’ brow repeatedly opened during many previous fights that there were not stopped, I don’t agree with the ringside physician’s decision. However, as a physician, I completely understand why the fight was stopped and can think of plenty of possible ophthalmic and visual consequences of letting the fight play out should Diaz have continued to receive damage to that area of his face. The only possible decision in order to insure the safety of Diaz and to make sure he did not get hurt any further was to stop the fight. However, fighting in the UFC is not a “safe” activity, and trying to endorse such rationale makes me hesitate. Moreover, this is the fight game, and especially for a fight for the BMF title, this particular decision feels more unsatisfying than most physician stoppages. That being said, hindsight is 20/20 and it is far easier to argue against the ringside physician’s decision after the fact than actually being the physician under the spotlight responsible for determining the well-being of fighters in the Octagon. The other point worth considering is that the ringside physician, a neurologist, might have noted other exam findings or injuries that played into his decision.
To quote the ringside physician (follow the link to see his full response to MMA Fighting):
“Going forward off that third round, I could not guarantee his health and safety. […] When in doubt, you have to do what you have to do to protect the athlete’s safety. His health and safety comes first. Every action of mine has to be viewed with that foremost in everybody’s mind, but that doesn’t happen.” – MMA Fighting
As a side note: In the above article, the ringside physician states that he has been receiving all sorts of online, in-person, and in-office hate, death threats, and poor online reviews being listed about him due to his decision to stop the fight. While everyone is entitled to their opinion, I do not encourage or condone such negative and violent behavior.
Finally, from an ophthalmic standpoint, given both the eyebrow and infraorbital lacerations Diaz incurred, hopefully he received a full ophthalmic exam which would be warranted to make sure that there were no other orbital or ocular injuries .
Who is the BMF?
At the end of the night, Masvidal put on a very strong performance and dominated all three rounds. Diaz looked good and showed great resolve in trying to continue the fight, but ultimately he did not get to execute his game plan saved for the later rounds. So – who is the BMF? That technical onetime honor and belt go to Masvidal. But, without the decisive finish that each fighter sought, the question of who the BMF really is perhaps still remains unanswered. If you were convinced by Masvidal’s win, the scorecards, and the fact that if this wasn’t a “title” fight, the fight would have been over anyway after round three with Masvidal winning by unanimous decision, then you might feel that Masvidal is the rightful BMF and a further re-match is unnecessary. However, if everything that Diaz, Masvidal, and Dana White have said during the post-fight interviews and conference are to be believed, we’ll see both Diaz and Masvidal run it back at some point in the future. Until then, Masvidal gets to enjoy closing off a highly successful year in the UFC, a legitimate bid for Fighter of the Year, and the everlasting recognition of holding the first and maybe last BMF belt. Although understandably disappointed, Diaz remains a BMF for many, and given his mega-fight Conor McGregor trilogy and Jorge Masvidal BMF rematches on the horizon, fight fans will have more action to look forward to from Diaz in the years to come.
The #goon is headed back home #1of1 pic.twitter.com/cqpVfR8hvj
— Jorge Masvidal UFC (@GamebredFighter) November 3, 2019
1 Comment
Great article!