August 2, 2019: Gregory M. Levitin, MD, with baby Noor Nunez, and her mother, Rania Al-Mutairi; father, Joe Nunez; and brother Omar Nunez, 10 days after the July 23, 2019, surgery.
It first appeared as a small rash a few weeks after Noor Nunez was born in 2018 in Kuwait, where she lives with her three older siblings, her Saudi mother, Rania Al-Mutairi, and American father, Joe Nunez. The red mark on her skin, however, was not a rash, but a bright red hemangioma, a benign tumor caused by an abnormal cluster of small blood vessels on or under the surface of the skin. As it grew, it looked as though baby Noor had a small tomato in the middle of her face—located right between her eyes.
Doctors in Kuwait, however, didn’t seem to know how to treat it. They told her parents that it was superficial, and they prescribed topical creams, assuring them it would go away. When it kept growing in size and thickness—and people had started pointing and staring at Noor—her father, a contractor based in Kuwait with the U.S. Army, became determined to find treatment, even if it meant leaving the country.
When Noor was about 5 months old, and as the hemangioma continued to grow, Mr. Nunez started to research treatment options online. “I knew we had to do something to correct this, or it would affect her for the rest of her life,” he says. “I started contacting centers specializing in vascular birthmarks all over the world, but few doctors responded.” However, when he sent an email to Gregory M. Levitin, MD, Director of the Vascular Birthmark and Malformations Program at New York Eye and Ear Infirmary of Mount Sinai, Dr. Levitin replied immediately.
January 2019: Baby Noor, left, with the growing hemangioma. November 2019: Four months after surgery: the hemangioma will continue to shrink and fade.
After reviewing the photos that Mr. Nunez had sent, Dr. Levitin knew he could help Noor. In late July 2019, around the time of Noor’s first birthday, the Nunez family traveled to New York Eye and Ear for surgery. Dr. Levitin, who is also Senior Faculty in Ear, Nose and Throat (Otolaryngology)–Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai, is a nationally recognized expert in the diagnosis and management of hemangiomas and vascular birthmarks.
Hemangiomas typically begin to appear one to three weeks after birth and often fade with time. However in Noor’s case, the hemangioma was so large and deep that it blocked almost half of her eye’s visual field and distorted the bridge of her nose. It was so deep that 90 percent of it was below the surface of the skin. Due to its location and size, it was one of the most challenging hemangioma cases Dr. Levitin says he has ever encountered.
“It was highly vascular, so there was concern about excessive bleeding, and it was in the middle of her face near her eyes, so we had to find the precise place to make an incision in order to debulk the tumor without leaving her disfigured,” recalls Dr. Levitin. “In the end, we placed the incision within the shadow line between her eyebrow and her eye—then, millimeter by millimeter, we carefully removed each feeding blood vessel in a three-hour surgery during which she lost no more than three teaspoons of blood.”
Due to the complexity of the case, the hemangioma could not be removed in its entirety without risking complications or skin grafts, but Dr. Levitin was still able to remove more than 80 percent of the tumor, leaving Noor’s eyes and eyebrows symmetrical, restoring her nose, and significantly improving her appearance. The family regularly shares updates with Dr. Levitin on the hemangioma as it continues to shrink and fade; however, Noor will likely return to New York Eye and Ear this year for two laser treatments to reduce the redness and improve the texture of the hemangioma. According to Dr. Levitin, “In two or three years—maybe less—she will appear almost normal.”
Dr. Levitin fully understands how the family was willing to do everything they could for Noor. “I became passionate about this specialty when one of my twin daughters was born with a disfiguring hemangioma,” he says. “As a head and neck surgeon, and as a parent, I knew I could give other patients the medical expertise and the attentive care they need during a difficult time. I feel like my patients are part of my extended family.”
Beyond the successful surgery, Mr. Nunez says his family was additionally impressed with the caring staff at New York Eye and Ear. “My wife was floored by the treatment Noor got,” says Mr. Nunez. “Watching how the nurses and staff treat patients and their families, it was beautiful to see,” he says.