Kaydence Hughes, of Kaukauna, was in second grade when she and her parents noticed something unusual. She had a bald spot in the center of her forehead, along her hairline. The bald area grew and her forehead began developing an indentation that extended from her scalp to the space between her eyebrows.

Autoimmune Condition Causes Harm to Scalp Tissue

Yvonne Chiu, MD, pediatric dermatologist at Children’s Wisconsin and Medical College of Wisconsin faculty member, took a skin biopsy and diagnosed Kaydence with linear morphea, a rare form of the autoimmune condition scleroderma, which was causing tissue on her scalp and forehead to thicken and harden. Kaydence had a type called “en coup de sabre” because it resembles a wound caused by a sword.

“The day she was diagnosed was a crushing, terrible day,” her mother, Melissa, said.

While there is no cure, the immediate goal was to halt the autoimmune process that was harming Kaydence’s skin. Dr. Chiu prescribed medications to stop the immune system from attacking Kaydence’s body. The therapies worked, putting her disease in remission.

But the damage to her skin remained. Kaydence’s unusual appearance caused difficulty in her daily life. Kids made mean-spirited comments that grew worse as she entered high school.

“I had bangs to cover up the hair loss, but the indentation in my forehead really bothered me,” she said. No amount of makeup could conceal it, and Kaydence struggled with anxiety and depression.

Facial Grafting and Reconstructive Surgeries

Once the disease was in remission, Dr. Chiu referred her to FORME Aesthetic and Vein Center, part of the Froedtert & MCW health network. Kaydence’s first appointment was with Edit Olasz, MD, PhD, dermatologist and MCW faculty member, who weighed the possibility of using synthetic fillers to even out Kaydence’s forehead.

“The problem with fillers is that they are not permanent and they are expensive,” Dr. Olasz said.

She referred Kaydence to her colleague at FORME, Sachin Pawar, MD, surgeon and MCW faculty member, who specializes in facial plastic and reconstructive surgery. He met with Kaydence and her parents and proposed autologous fat grafting, which involved taking fat from another area of Kaydence’s body and injecting it into the indentation in her forehead. He also recommended a tissue expander, which would help Kaydence gradually develop new scalp tissue that could grow hair.

Kaydence had three day-surgeries at Froedtert Menomonee Falls Hospital. The first took place in August 2020, when Dr. Pawar placed a silicone balloon under her scalp and removed a little fat from her thighs and abdomen, processed it and injected it into her forehead. Several weeks later, Dr. Pawar showed Kaydence and her mother, a nurse, how to inject saline solution into the balloon every few days to expand it, encouraging new healthy scalp tissue to grow.

By October, Kaydence was ready for the next surgery. Dr. Pawar removed both the tissue expander and the damaged area of her scalp. He then used the new, expanded skin to make a new hairline and placed more fat in Kaydence’s forehead. In December 2021, Dr. Pawar performed a third procedure to remove more scar tissue from her scalp and place another fat graft in her forehead.

Confidence Through Life-Changing Facial Surgery Results

“My goal for Kaydence was to minimize the abnormalities from the disease and make them less noticeable to others,” Dr. Pawar said.

In his practice, he takes the mental health effects of facial differences seriously. “Plastic surgery can help people feel more confident and comfortable with their self-image and goes well beyond the stereotypes portrayed in the media,” he said.

Kaydence, now 18 and a high school senior, says it’s freeing to pull her hair back without giving a thought to what people will say. She will stay in touch with the Froedtert & MCW team, given that she could need additional treatment in the future.

Kaydence and her family were impressed by Dr. Pawar’s skill, as well as his kindness.

“He was really helpful and caring and gave me a lot of hope,” Kaydence said. She’s looking ahead to college and plans to enter the legal profession.

“I definitely have so much more confidence,” she said. “Dr. Pawar helped change my life.”

FORME Aesthetic and Vein Center delivers a full range of care options, including advanced aesthetic and reconstructive procedures. Visit froedtert.com/forme or call 414-955-1050 to learn more