By Tae Ho Kim, M.D., The New York Group for Plastic Surgery
A mom and dad came into my office, pushing a stroller with a baby blanket draped over the front to block their baby from view. These parents loved their child dearly, but could no longer stand the stares and comments from people at the sight of their child’s visible facial growth. After unveiling the blanket, they introduced me to their child with a large fleshy growth on the forehead. The parents called it a "doorknob."
This particular facial growth or tumor is known as a “hemangioma.” Hemangiomas are benign (non-cancerous) capillary (blood vessel) tumors. When a hemangioma is big and superficial to the skin, it looks like a reddish-fleshy tumor on the face or body. Some people call it a strawberry patch. A hemangioma is the most common tumor of infancy.
A hemangioma usually appears at birth as a reddish blush of the skin; the baby otherwise looks normal. A hemangioma will grow rapidly for the first three to four months, then more slowly up to one year of age. Then the hemangioma will slowly get smaller and may disappear completely. When the hemangioma is small and flat, it will most likely fade away completely without leaving any scar or skin deformity. This process may take several years, but in the end the skin can look completely normal. Occasionally, lasers may help to treat any remaining reddish areas.
The problem is that not all hemangiomas go away. Sometimes a hemangioma will grow quite large, and not disappear on its own. Parents may be told by well-meaning pediatricians or surgeons that this hemangioma will shrink over time without leaving a visible scar or facial disfigurement. But though the hemangioma will shrink from its largest size, it’s likely to leave behind noticeable scars and residual boggy skin and soft tissue that can even drag down one side of a child’s face.
Clearly, our society is image-conscious and looking normal or attractive is one important component to the psychological and emotional well-being of a child. If a child’s hemangioma is very noticeable, parents may feel embarrassed, and guilty about feeling that way. Parents have to confront negative comments or long stares from family and strangers alike. Parents feel frustrated and sad if their child is teased. Going out in public may be stressful and difficult. As many parents know, a child as young as two years old is self-aware and can recognize that something about him or her is “different." A large, visible deformity, especially on the face, can negatively impact a child’s self-esteem during critical years of development.
Rest assured, most children are born free of birth defects like a hemangioma. Also, most hemangiomas are small and flat and will eventually go away without any medical interference. Therefore, when a pediatrician says, ‘don’t worry, it will go away’, it is good advice. Yet there are occasions when the hemangioma grows very fast and very large. There are children with permanent disfigurement from the remaining hemangioma left behind after waiting five or seven years. For those children, operating early may be most beneficial if done by an experienced pediatric plastic surgeon. For children with such large fleshy tumors, especially on the face, one operation could help prevent the many years of emotional and psychological distress for the child and parents.
Dr. Tae Ho Kim, a board certified plastic and reconstructive surgeon, is Assistant Professor at New York Medical College and Chief of Pediatric Plastic and Craniofacial Surgery at the Maria Fareri Children's Hospital at Westchester Medical Center. He is a partner with the New York Group for Plastic Surgery. http://www.nygplasticsurgery.com