MIAMI -- The 3-year-old in the photograph had her mother's nose, big brown eyes, and two baby teeth showing in her wide smile.
But by the time Marlie Casseus was 14, what she saw in the mirror bore no resemblance to the girl in the picture -- or any girl. Whatever was under Marlie's skin looked like a basketball, or two eggplants. All that remained of her nose were two distended nostrils. A single tooth poked through the stretched membrane of her upper lip. She had one good eye.
One night last year she stood at the mirror in her family's home in Port-au-Prince, Haiti, making slashing motions with a knife, as if she wanted to cut the massive deformity out of her face.
Instead, that has been accomplished by a team of Miami doctors who performed four operations to cut away the 16-pound growth, replace bone, and release the girl inside.
Dr. Jesus Gomez, the maxillofacial surgeon leading the teams operating on Marlie at Holtz Children's Hospital, says the mass that engulfed her face probably started growing when she was as young as 5. Gomez said her condition is a rare form of polyostotic fibrous dysplasia, a nonhereditary genetic disease, which affects every bone in her body, though not to the severity with which it disfigured her face.
Over the past year, Marlie has undergone four operations in Miami, the latest in October to replace a titanium plate previously implanted to replace her jaw.
Her features have been repositioned and hard polymer has been used to replace other facial bones. Doctors say she may need more cosmetic surgeries when she stops growing. Gomez says the facial mass won't grow back, though her condition requires lifelong monitoring.
Marlie's mother, Maleine Antoine, said that as a small child her daughter never spoke clearly, and her permanent teeth weren't appearing. Antoine didn't worry until Marlie was 8 and she noticed two small bumps on either side of the girl's nose. Marlie also was beginning to complain her mouth and throat hurt when she ate.
Haitian doctors could do nothing. With no advanced medical imaging in the impoverished Caribbean country, no one could see that the bumps were the bone ballooning and turning to jelly, filled with pockets of liquid and air.
What everyone did see was Marlie's nose stretching into a snout, her eyes sliding farther apar, and her upper lip pushing out past her chin.
Marlie was able to get treatment in the United States through the International Kids Fund, a nonprofit based in Miami that her father learned about .
At Ronald McDonald House at Jackson Memorial Medical Center, Marlie has a bag packed for the day she returns home.
"She's happy she will go back to school," Antoine said, "because she will be like everyone else."