Waner with Aslynn, several days after her surgery, in the Beth Israel playroom.   (Photo: Courtesy of Jill Brown)

Jill was in a panic. Her mother-in-law had been researching Aslynn’s condition, and learned about a doctor in Little Rock, Arkansas, named Milton Waner, whose practice was devoted exclusively to treating vascular anomalies like hemangiomas. The Internet was brimming with testimonials to Waner’s miraculous skills. Jill and Paul put Aslynn in the backseat of their Toyota Echo and made the ten-hour drive through winter weather. They stayed at a Ronald McDonald House. In Waner’s waiting room, they saw other children with hemangiomas for the first time. When they met Waner, “he seemed to have all the time in the world for us,” Jill says. She was impressed with how gently he played with Aslynn. He was soothing and confident in equal measure. He glanced at Aslynn’s hemangioma. “Oh, this is a big one,” he said. “I can fix it.”

Milton Waner is a slight, scholarly-looking man of 50 whose wanderings have taken him from South Africa to Australia to Arkansas to the Upper East Side of Manhattan, where, on April 28, in Operating Room 11 on the neurosurgery ward of Beth Israel Medical Center, he peered down at the inflamed mass on Aslynn Brown’s head.

Waner, the object of a year’s wooing by Beth Israel, had moved to New York two weeks earlier (he was still living in an extended-stay hotel) with the intention of pushing his vanguard work on vascular lesions to an even higher level. In New York, he could collaborate with some of the world’s leading researchers and specialists, experts in neurosurgery, radiology, and orthopedics, people he described as doing “space-age” work. As for Aslynn Brown’s parents, they had come to the city for the most elemental of reasons: to save their daughter’s life.

The Browns had never before been to New York. The previous day, at Waner’s urging, they had taken Aslynn to Central Park, and for a ride on the subway. They had glimpsed the Statue of Liberty and toured ground zero. Aslynn was delighted by the sights and sounds of the city. Passersby paused to greet her, and she beamed. No one had remarked on her appearance.

Now she lay on a steel table in the eerie stillness of anesthesia, wearing only a diaper, her 29-inch, 19-pound body covered to the chest in a sheet of plastic and a warming blanket. A clip on her big toe ran to a computer that monitored her vital signs. One thigh bore a patch that connected her to an electrical ground. Her head was partly shaved, and the skin surrounding her tumor was painted with a rust-colored anti-microbial paste. A ventilator tube ran down her throat.

Waner and his entourage—a surgical assistant, a technologist in charge of the instrument tray, an anesthesiologist, and a nurse directing the flow in the room—hovered over Aslynn. She looked perfectly serene.

“Remind me,” Waner said. “How old is the child?” Fourteen months, he was told. Waner turned Aslynn on her side. The mass on the back of her head accounted for 10 to 20 percent of the girl’s body weight, Waner estimated. He poked and prodded it, trying to get a feel for the best spot to make his incision. He asked for a marker and began to trace a fine black line around the edges of the mass. He moved with a deliberation that could have been mistaken for hesitancy. “If you’re too sure of yourself,” he says, “it’s a recipe for disaster.”

Aslynn’s case made Waner anxious. He had stayed up late the previous night studying an MRI of the tumor, and had awakened before dawn to clear his mind by playing guitar in the dark. He knew that Aslynn’s hemangioma crisscrossed the neighborhood of hair-thin facial, cranial, and spinal nerves, any of which, if severed, could leave her with a variety of irreversible paralyses. The tumor would have to be shaved off muscles on the back of Aslynn’s neck, a procedure that could saddle the infant with chronic, debilitating neck pain. Great care would also be needed to skirt the jugular vein and the carotid artery. “The neck,” Waner says, “is tiger country.”

Above all, “the problem is how to cut through the patient and not have her bleed to death as a result,” Warner says. Aslynn’s hemangioma had developed an artery whose purpose was to shunt blood from her heart to the tumor. The artery was as thick as a straw, and was feeding the tumor half of her blood supply. It bulged from the base of her neck. “She would be in a lot of trouble if I made a hole in that vessel,” Waner says.

Waner asked for a cold steel scalpel. He brought the blade to a point above Aslynn’s ear. He paused. He applied pressure to the knife and sliced into the tumor. “It bled and bled,” he says. But “I kept cutting.”

Waner is far and away the world’s leading expert in the treatment of vascular anomalies. He has pioneered groundbreaking methods that have provided safe surgical treatment for patients with all manner of deforming, and often life-threatening, problems, and he has operated on more than 4,000 such cases—far more than any other surgeon.

To hear Waner tell it, he didn’t set out to revolutionize the field of vascular anomalies. He simply happened upon a problem that had confounded medicine for years, gave the matter some probing thought, and went about finding new solutions. Waner was born in Brakpan, South Africa, a small town near Johannesburg. His father, who immigrated to South Africa from Lithuania as a child and had little formal education, worked as a tailor, and gradually became a prosperous men’s clothier. Waner’s mother, a Greek Jew whose family fled the Nazis, landed in South Africa via Egypt and the Belgian Congo. Waner trained as a surgeon at the University of Witwatersrand, and specialized in head and neck cancers. In 1985, after being posted to Namibia for compulsory military service—an experience he found “loathsome”—he began to research the use of lasers in cancer treatment. A year later, during a research stint in Australia, he helped to develop one of the first lasers that was capable of “selective destruction”—it emitted just enough energy to cook the targeted tissue without damaging surrounding, healthy areas. The laser turned out to be ideal for treating birthmarks like port-wine stains, which are caused by an abnormal pooling of blood beneath the skin. Soon Waner was restoring long-suffering patients to an unblemished state.

Word spread, and before long, Waner was being sent patients with more severe vascular lesions, like hemangiomas. Although vascular anomalies are not rare—in the U.S., 40,000 infants are referred to specialists each year for examination of a range of abnormal birthmarks—the dominant protocol for treating hemangiomas has long been benign neglect.