When it can be determined that a hemangioma is unlikely to diminish to an acceptable appearance, surgery may be needed to remove the redundant tissues, restore normal contour and symmetry to the face, and/or restore normal size and function to other parts of the body. In some cases early surgical removal is warranted for hemangiomas that interfere with critical areas of function, including vision, feeding, or breathing.
In general, most children may be considered for surgical treatment as early as six to nine months of life (or when the hemangioma growth phase has completed), and nearly all children are able to be treated well before the age of two years. This timing is important to consider as children under two years of age have not yet developed a mature sense of self and may remain essentially unaware of their appearance. However by age three, most children have developed social awareness of how they are viewed and treated by others. Thus the goal of any treatment plans should be to have completed all therapy well before the child reaches school-age and thereby avoid any negative psycho-social effects.
At NYEE our specialists combine the skills of pediatric plastic and reconstructive surgery to devise the smallest incision permitting the removal of the hemangioma, while leaving the least visible scar. By aligning incisions within natural skin creases, in many cases it may be nearly impossible for family members and friends to even notice the incision after it has fully healed.
Even for patients who were once told surgery was no longer an option, the specialists at NYEE can offer innovative techniques to access previously untreatable lesions through carefully designed incisions. Given the inherent variability in size, location, and progression, each case must therefore be carefully evaluated to determine the best, individualized approach, allowing the birthmark specialist to determine the types of surgical procedures that are most appropriate.
Over time, the natural history of vascular malformations often results in the progressive enlargement of the impacted tissues leading to soft tissue deformity. In many cases, sclerotherapy alone is insufficient to reverse or even control the natural progression of the disease. In these cases, surgery may become necessary to reduce the burden of disease. For large or bulky lesions, where the risks of sclerotherapy are too great, surgical removal can often achieve total or near total elimination of the vascular malformation, with simultaneous restoration and reconstruction of normal bodily contour, symmetry, and function.