A nevus is a birthmark, a mole. The treatment for a mole is relatively straightforward: Just do a simple procedure to cut it out and close it up,” said Dr. Albert Oh, director of fellowship for craniofacial and pediatric plastic surgery at Children’s National Medical Center. “But in this patient's case, because it involved a good one-third to half of her face, you couldn’t just cut it out. It was too big.” Agusta was born with a dinner-plate-size mole that swept across her scalp and the right side of her face. Others stippled her body. Besides being unsightly, these large moles have an elevated risk of turning into melanoma. They also can enter the brain and spine, causing seizures. Doctors in Iceland knew it would take a series of operations to remove the facial birthmark. They told Agusta’s parents the last procedure would be when she was 15. Meanwhile, her parents had gotten in touch with Dr. Oh, who at the time was at Hasbro Children’s Hospital in Providence, R.I. He said he could finish by the time Agusta started school at age 6. “When I had to choose between the age of 15 and the age of 6, I would always choose the age of 6,” said Agusta’s mom, Sigrún Thorsteinsdóttir. The first few operations were done in Rhode Island, the final ones at Children’s Hospital, to which Dr. Oh moved in 2009. He used a technique called tissue expansion to enable Agusta to grow herself extra, blemish-free skin.
A sterile plastic balloon was inserted under Agusta’s normal skin. Every week over the course of a month or two, saltwater was injected into the balloon, swelling it. Over time, a hillock of pristine skin — from the size of a lemon to the size of a banana — grew over the balloon.Once enough new skin had grown, Dr. Oh cut into the birthmark right down to the fat layer, removing it and covering it up with the graft. In all, Agusta had eight surgeries: four to insert tissue expanders, four to remove parts of the nevus. Agusta’s family lives in Gardabaer, near Reykjavik. Agusta is now 6, the middle of three children, with an older brother and a younger sister. Sigrún is a flight attendant with Icelandair and so is very familiar with Washington. Agusta is now, too. Last time they were here, mother and daughter stayed in Columbia Heights. “It was such a good time, though it was always a hard time,” Sigrún said. “She always looked forward to going here. She thought it a little like a vacation, though she knew she was going for an operation. She has never complained when she comes here.”Agusta had her last procedure in October 2011. Then she started school. “I was so scared,” said Sigrún. But it went well. Other students asked about Agusta’s scars. “She just tells everyone, ‘I’m born like this,’ and it’s over and they don’t ask anymore,” Sigrún said. “Hopefully it will stay like that. She’s very strong. She’s very joyful. She’s always smiling.”
