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Pediatric Plastic Surgery

She Can See Clearly Now

Just after Carolyn Treanor gave birth to triplets at 30 weeks, she noticed that one of the three baby girls had a tiny, heart-shaped pink spot between her eyes. She and her husband, Jason, were actually grateful for the spot: Two of the girls were identical; without the facial mark, Sydney would have been nearly indistinguishable from her sister Kelsey.

Doctors identified the mark as a hemangioma, a mound-like collection of blood vessels usually present at birth. This kind of birthmark, which affects about one in 50 babies and is more common among girls and preemies, grows rapidly for eight to ten months and then tends to shrink over time. "I wasn't worried about it-at that point, it really wasn't very big," Carolyn says. By the time Sydney was 3 months old, however, the hemangioma was the size of a marble; when she reached 6 months, it had grown dramatically larger.

Fearing that the birthmark might affect Sydney's brain, the couple, who were living in North Carolina at the time, consulted Michael J. Denk, M.D., a Virginia Beach, Virginia, plastic surgeon who specializes in pediatrics. A CAT scan showed that Sydney's brain and skull were fine but that the birthmark would probably not disappear on its own. Dr. Denk told them that about 70 percent of hemangiomas on the face and head require treatment. He suggested removing it sooner rather than later because young children recover more quickly from surgery and tend to scar less. And Sydney's hemangioma was already attracting attention. "What's that thing on her face?" a little boy at the pediatrician's office wanted to know, pointing at Sydney. She was still too young to understand the comments and stares, but her parents knew that would change in a few short years.

Two months later, Sydney underwent surgery to remove what was by then a walnut-size growth. The Treanors were thrilled with the results-and with the way that Sydney, free of the vision-obstructing bulge between her eyes, seemed to view the world in a new way. Today, a tiny scar between her eyes is the only reminder that Sydney, now 2, had such dramatic surgery as a baby. "I can't tell Sydney and Kelsey apart anymore. I have to really look closely to see who's got the scar," Carolyn says.

Bye-Bye, Birthmark

When her son, Joseph, was born, Kim Dibiase immediately noticed a large spot that stretched across one side of her baby's face. It was a port-wine stain-a flat, purplish-red overgrowth of blood vessels in the skin. This type of birthmark shows up in about three of every 1,000 newborns and tends to darken and thicken as the child ages. "I was a little in shock," Kim recalls. "Having this baby was the greatest joy of my life, but I felt sad for him too."

Once the doctors had ruled out a more serious medical syndrome associated with port-wine stains, Kim and her husband, Joe, focused on treatment options, ultimately pursuing laser therapy. The decision to seek treatment was not a casual one. But the Ocean Township, New Jersey, couple knew that such a large birthmark could affect their son's self-esteem.

Joseph started laser therapy (which damages the blood vessels and causes them to shrink) when he was 7 weeks old and continues to get periodic treatments. "My belief is that we do better if we begin treatment during infancy," says his doctor, Roy Geronemus, M.D., director of the Laser and Skin Surgery Center of New York, in New York City. The therapy is mildly painful (Dr. Geronemus compares it to a rubber band snapping against the skin), so it is emotionally draining for Joseph-and for his parents. "He screams through the whole thing. It probably lasts six minutes, but it seems like an eternity," Kim says.

After treatment, Joseph's face is swollen and bruised for a few days. But the couple stays focused on the fact that, after 19 treatments (the frequency has dwindled to about twice a year), the birthmark has faded dramatically. Though he can't predict how many more treatments Joseph, now 4 years old, will need, Dr. Geronemus is confident that the stain will eventually be nearly invisible. The laser therapy will also keep the area from becoming thick, bumpy, and prone to spontaneous bleeding.

In the meantime, Kim finds comfort in the pictures she has been taking of Joseph's face since treatment began, and in the reaction of an adult acquaintance who has a port-wine stain covering half of his face. Before beginning treatment, Kim recalls, "I asked him, 'If this treatment had been available when you were a child, would you have wanted your parents to do it?' His response: 'Absolutely.'"

Ears Back, Confidence Up

Kayla Johnson was only a preschooler, but already she was feeling self-conscious about her ears. They were large and jutted out from her head like jug handles. "She'd ask me, 'Why are my ears so big?' " says her mother, Tracy. Protruding ears occur when the ears form abnormally, causing them to pull away from the head. The condition is often hereditary.

Tracy and her husband, Vince, weren't planning to do anything about Kayla's ears. The suburban Ohio couple was more concerned about a birthmark on her forehead that they had been told could eventually become cancerous. But during a consultation about the birthmark with James Lehman, M.D., a plastic surgeon at the Children's Hospital Medical Center of Akron, Tracy broached the subject of her daughter's ears. Dr. Lehman suggested pinning them back and removing the birthmark at the same time. Kayla would already be under anesthesia, he reasoned. Tracy recalls him saying, "Her ears are going to have to be done at some point. Let's do it now before it becomes a bigger problem in her life."

In November 2000, 4-year-old Kayla had her surgery. Dr. Lehman created a fold along the ear rim and removed some cartilage from the bowl-like section surrounding the inner ear; he also removed her birthmark. When the mass of white bandages came off a week later, Tracy and Vince were amazed. Their daughter's ears were flush against her head, and the scars were undetectable. Kayla was no less thrilled. "Let's go show Grandma!" she said.

For months after the surgery, Kayla would proudly show off her new ears to friends and family members. She got her hair cut, and more than a year later, she still makes a point of tucking it behind her ears-something she wasn't able to do before the surgery. "These little things have made such a big difference for Kayla," Tracy says. "I had some doubts at first, but now I think it's the best thing we could have done for her."

Bright-Eyed at Last

When Heidi Coleman's daughter, Lauren, was a baby, people always commented on how tired she looked. "They'd tell me she looked like she was ready for her nap-even after she'd been sleeping for hours," Heidi says. Lauren was born with droopy eyelids, or ptosis, which is usually caused by poorly developed eyelid muscles. About one in 20 kids are born with the condition in one or both eyes. Heidi and her husband, Larry, didn't worry too much about it. But one day, a physician friend told the Colemans that Lauren's condition was easily treatable. Heidi brought it up with her pediatrician, who referred her to a pediatric ophthalmologist.

"We went to see if she would grow out of it and to make sure that her vision was okay," Heidi recalls. Lauren's eyesight was fine, but she was at risk of developing vision problems because the eyelid was keeping light from stimulating certain parts of the brain, says her surgeon, Sharon S. Lehman, M.D., chief of pediatric ophthalmology at the Alfred I. duPont Hospital for Children, in Wilmington, Delaware. Lauren's parents-and her doctors-were also concerned about the emotional ramifications of her sleepy appearance. Lauren has cystic fibrosis, and they agreed that she didn't need another physical obstacle in her path.

The operation, performed when Lauren was 2, went off without a hitch. To lift each eyelid, Dr. Lehman tunneled a piece of donor connective tissue under Lauren's skin and suspended it from a muscle in her forehead. "Her spunky personality shines through now that you can see her vibrant eyes," Heidi says.

Copyright © 2002 Lauren Picker. Reprinted with permission from the April 2002 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.