Case Study by Dr. Jagdish Chander, Senior Director – General Surgery at ShardaCare-Healthcity, Greater Noida

Venous malformations are rare congenital vascular anomalies that can progressively enlarge over time, leading to significant functional and cosmetic challenges. When this problem affects the face and area around the eyes, treatment becomes risky due to nearby vital structures and chances of heavy bleeding. This case highlights the successful treatment of a complex facial venous malformation in a 24-year-old patient from Agra at ShardaCare-Healthcity, highlighting the importance of accurate diagnosis, surgical expertise, and multidisciplinary planning.

Patient History and Presentation

A 24-year-old male patient presented with a large swelling over the right side of his face involving the forehead, eyebrow, and upper eyelid. The swelling had been present since birth and progressively increased in size over the years. As the lesion enlarged, it caused drooping of the eyelid (ptosis), visual disturbances, difficulty focusing on objects, and episodes of double vision. The patient often had to close one eye to see clearly.

Beyond physical symptoms, the condition caused severe emotional and social stress. The patient faced social exclusion, teasing, and repeated rejection of marriage proposals due to the visible deformity. Despite consulting multiple hospitals, surgery was repeatedly declined because of the complexity of the case and the high risk of vision loss.

Diagnosis and Findings

Clinical examination revealed a soft, compressible mass over the area around the right eye. External measurement showed the lesion to be approximately 6 × 5 cm, though intraoperative findings later revealed a much larger extension across the forehead and eyelid.

Radiological evaluation confirmed the diagnosis of a venous malformation, a condition where abnormally formed venous channels create a dense, blood-filled vascular network. These lesions are present at birth but often become clinically evident later in life as they enlarge. Venous malformations are frequently misdiagnosed and, if left untreated, can lead to pain, bleeding, visual impairment, and long-term functional complications.

Treatment Approach

The patient had previously undergone an attempted surgical procedure at another hospital two years earlier, which was unsuccessful and resulted in scarring and further inflammation. This made the current intervention a redo surgery, significantly increasing the level of difficulty.

At ShardaCare-Healthcity, Dr. Jagdish Chander planned a complex surgical excision of the venous malformation. The procedure required meticulous dissection through hundreds of fragile venous channels while preserving the delicate eyelid muscles responsible for eye opening and closure. Extreme caution was necessary to prevent uncontrollable bleeding and avoid permanent damage to vision.

Commenting on the case, Dr. Jagdish Chander said, “Redo surgeries for vascular malformations are always challenging. In this case, our goal was not only to remove the lesion but also to restore eyelid function, facial symmetry, and the patient’s confidence.”

Outcome and Recovery

The surgery was completed successfully with complete excision of the malformation. Postoperatively, the patient showed steady improvement. Swelling reduced, eyelid function was restored, and visual symptoms resolved. For the first time in years, the patient was able to open both eyes comfortably and naturally.

Follow-up assessments confirmed preserved vision and satisfactory cosmetic results. The patient reported significant improvement in daily activities and social interactions. Notably, within one week of surgery, he received a marriage proposal—marking a profound personal milestone after years of rejection.

About the Disease

Venous malformations are congenital vascular anomalies affecting approximately 1–2 per 10,000 individuals. Though benign, they can cause significant morbidity due to progressive enlargement, pain, bleeding, and functional impairment. When located in the facial and peri-orbital region, they require early recognition and expert surgical management to prevent long-term complications such as amblyopia caused by disuse of the affected eye.

Conclusion

This case demonstrates the critical role of precise diagnosis, advanced surgical expertise, and perseverance in managing rare and complex vascular conditions. The successful outcome highlights ShardaCare-Healthcity’s capability in handling high-risk redo surgeries and underscores that even long-standing, previously declined cases can be treated effectively with the right approach. Most importantly, it reflects how timely intervention can restore not just function and vision, but dignity and quality of life.