DALLAS - "She is very girly," said Courtney Ferreira of her daughter, Ava. "She is in ballet. She does tap and dance. She loves to shop. Put lipstick on."
Her proud parents are the first to say Ava Ferreira is everything a normal four-year-old girl should be.
"Especially when she was born, the mass was huge," said Courtney, of the tumor that engulfed the lower portion of her daughter's head. "It was so big. And I don't see it. And still to this day, I really don't see it. The only times I really see it [are] looking in a mirror with her."
Ava and her mother were lucky to have survived the dangerous birth.
The massive growth affecting Ava's face is called a lymphangioma. It's an abnormal collection of blood vessels. In Ava's case, the vessels have wrapped themselves in around the nerves and structures beneath her skin.
"We have to carefully dissect individual branches of these nerves, which can be small as a human hair," explained Dr. Andy Chung, a pediatric ear, nose and throat specialist. "And save these nerves, while at the same time removing the vascular formation."
While not cancerous, in Ava's case, the tumor is potentially dangerous. Damaging the delicate nerves could paralyze Ava's face. Removing this tumor has been a slow series of operations, because the possibility of Ava bleeding to death is very real.
"What you don't see is the internal component," Chung said. "The airway compression. The changes in her jaw growth. Her eating patterns, her speech. That's all affected by the extensive nature of her tumor."
At one time, doctors wondered whether Ava would be able to eat, speak or even walk.
Her face used to be about double the size of a child of similar age, because of the tumor. Surgery has gradually reduced the size, so her bone structure is more clear.
She has at least one more major operation, and the removal of a trach tube that helps her breathe, before she starts kindergarten.
"We won't hold her back," Courtney said. "She'll start kindergarten with the rest of the kids."
"I worry more about her psychology," said pediatric plastic surgeon Dr. John Burns. "About other kids making fun of her. Her lifespan is normal. But without intervention, the quality of that life would be severely compromised."
Burns knows well, because he had the same type of vascular tumor when he was a child. As an adult, a long scar below his jawbone is the only outward indication of the tumor.
His personal experience is one the reasons he's helping pioneer treatment at Medical City Children's Hospital, so that youngsters like Ava won't have to travel to other states for help.
He has complete confidence Ava will look no different than other children by the time she's in middle school.
"Looking back on my life, I can see sort of the end of the road for Ava," said Burns with a smile. "I think she is much bigger and much stronger than anything she will face. But, as her doctors, we definitely want to give her the best shot that she has."
"I think she just has this resiliency about her," Courtney Ferreira said. "I mean, she has these ridiculously large surgeries where they go and open up her face and take so much. And by the next day, she's happy and she's laughing and she's playing."
"She's a miracle," Luis Ferreira said, "And a princess."
Courtney and Luis Ferreira call Ava their hero.
But Ava, through her shyness, says she wants to grow up to be the person she most admires.
"A mommy," Ava said, shyly.