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An Act of Foresight

Plastic surgery restores form and prevents vision loss

by GAIL JOHNSON

Four days after she delivered twin boys in December 2011, Lea Alas noticed something on son Jireh’s left lower eyelid. The teeny, red dot seemed innocuous. Perhaps, she and her doctors thought, it was some kind of minor rash resulting from child birth.

As time went on, however, the spot became more noticeable. By the time Jireh was six months old, that speck had become bulbous and ballooned in size.

“As he was growing, the ‘rash’ was growing too,” recalls Surrey resident Lea. “It looked like a cherry.”

Jireh was diagnosed with hemangioma, a benign (non-cancerous) vascular tumour. Also known as strawberry hemangiomas, these usually appear as a red birthmark within one to two weeks of birth. About 60 per cent occur in the head or neck area. Although they grow rapidly during the first few months of life, most go away on their own without treatment, shrinking and fading by the time a child is around seven years old.

Sometimes, though, they can cause serious problems. If a hemangioma is very large or affects the airway or lungs or other major systems, it can be life-threatening. Left untreated, Jireh’s hemangioma could have resulted in a complete loss of vision in his left eye.

The solution was plastic surgery. Although Lea and her husband Ronnie were nervous about having their baby undergo such a procedure, they knew they couldn’t run the risk of him losing his sight. The tumour was already obstructing most of his eye.

“Without surgery, he could be blind forever because the hemangioma was so close to the cornea,” Lea says.

Jireh was just seven months old when BC Children’s Hospital pediatric plastic surgeon Dr. Jugpal Arneja performed an operation to remove the tumour. The surgery was a success: today, the scar is barely discernable, and the threat of blindness has been eliminated.

“His eye looks totally normal,” Lea says. “It’s great. We’re happy we did the surgery.”

As with adults, plastic surgery in children has two goals: to restore function and form. In other words, doctors like Dr. Arneja work to address the underlying medical problem while at the same time restoring the patient’s physical appearance.

“The word plastic is derived from a Greek word that means to shape or mould, and one of the premises is that whenever possible we use techniques to try to hide the scar,” explains Dr. Arneja, who’s also a clinical associate professor in the Division of Plastic Surgery at the University of British Columbia. “For Jireh, the tumour is gone, his vision is no longer at risk, and the scar is hidden in the crease of the eyelid. When we restore function and form – with an eye that can see and when there’s limited external evidence of scarring – we’ve done both jobs.”

With a highly skilled, multidisciplinary team of health professionals that includes anesthesiologists, ophthalmologists, dermatologists, occupational therapists, nurses and others, BC Children’s Hospital’s plastic surgery unit treats a vast range of medical issues and vascular anomalies among kids from birth to age 16.

Burns, cleft lip or palate, craniofacial abnormalities, skin lesions, congenital hand anomalies, breast and chest-wall anomalies, and trauma to the face, head, or neck are just some of the conditions the group handles.

“We have kids who are burn victims; kids who have broken their nose or eye socket or cheek bone or jaw,” Dr. Arneja says. “We treat soft-tissue infections, complex lacerations, repair cleft lips and palates, and manage hand pathology as well as various types of birthmarks. We work head to toe, front to back.”

For children in particular, surgery that restores ability as well as appearance gives them a fighting chance at a normal life. Treatment also eases anxieties of parents, who may be worried about a challenging road ahead with all the difficulties that a physical malformation could bring on.

“There’s a whole psychological side,” Dr. Arneja says. “Research shows that kids are able to recognize their own and their peers’ appearance or self-concept by about Grade 1. If we can reconstruct facial or other physical differences by this time, hopefully peer issues will be lessened.”

The plastic surgery unit also conducts research that aims to assess, measure and ultimately improve kids’ quality of life. By combining research, education and clinical practice, the team strives to provide the most advanced, scientifically proven treatments that better the lives of patients and their families.

“I have a dream job,” Dr. Arneja says. “It’s a pleasure and a privilege to work with children.”


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