Mel Harper noticed the tiny spot on her daughter's nose about a month after her birth.
"It look just like a little freckle or scratch," she said. "But that freckle grew rapidly into a little red ball."
By the time Ziyho'n was a year old, it was the size of a large golf ball. Kids called her Rudolph. Adults glared.
"Her nose was really, really red and looked like a little clown nose and that's what people would think it was," Harper said. "Everywhere we went we had a stare-down contest."
But finding a treatment was not easy. Doctors urged Harper, who lives in Fort Worth, to be patient and insisted that the blood-filled birthmark, which is called a hemangioma, would eventually go away, most likely before she started kindergarten or certainly by age 8.
That seemed like a long time to live with something that attracted so much attention and would no doubt, over time, eat away at the cheerful toddler's self-esteem.
The hemangioma also became heavier, drooping over Ziyho'n's nostrils and making breathing difficult.
"At night I was scared to go to sleep because my daughter was having so much trouble breathing because of the weight of the hemangioma," Harper said. "It got to the point where we were actually holding it up at night so she could breathe."
At a doctor's suggestion, Harper used sterilized tape applied to her daughter's nose and anchored to her forehead to help her breathe. Thirteen times, steroids were injected into the hemangioma, but the shots did little good. Laser treatment did not help either.
Then Harper heard about an event raising funds for the Vascular Birthmark Foundation, a nonprofit organization that helps families receive proper diagnosis and treatment. At the gala, she met another North Texas family that had been through a similar experience.
Nicole Bolinger, 8, was born with a tiny hemangioma on her cheek that grew. Physicians were reluctant to perform surgery on Nicole because of the potential blood loss. But her parents, Brian and Natalie Bolinger, searched until they found a doctor out of state who was experienced in performing the operation.
Their struggle to get treatment for Nicole led to their involvement with the Vascular Birthmark Foundation and the annual Angel's Kiss Gala that they host every year. Over the past seven years, the galas have raised $250,000 for the foundation.
Vascular birthmarks are the most common birth defect in infancy, affecting 1 in 10 children, according to the Vascular Birthmark Foundation. About 400,000 children are born with port-wine stains and other birthmarks that never pose a serious problem.
The average patient has a small spot on a leg or arm that grows dramatically during the first year of life, before it starts to shrink and fade into the skin, said Dr. Fred Ghali, a pediatric dermatologist in Grapevine.
But some kids have more complicated vascular birthmarks, including hemangiomas that grow quite large and pose serious health risks.
"The most challenging are not a solitary red spot but take up a segment of the face," Ghali said. "They go down one side of the face, across the chin, and up to the opposite ear."
For about 40,000 children, the birth defects can affect breathing, vision, hearing and eating.
Such was the case for both Ziyho'n and Nicole, who have only tiny scars where their birthmarks once were.
In Nicole's case, what looked like a scratch on her cheek grew so rapidly that her parents could hardly believe what they were seeing.
"We were taking pictures of it every day, tracking its progress," said her dad, Brian Bolinger, of Corinth.
Like Mel Harper, the Bolingers were told that the hemangioma would go away, and often they do. In about 50 percent of cases, the blood-filled benign tumors disappear by age 5 and, in 90 percent of cases, by age 9.
But Nicole's tumor was not only large, it was pressing against her eye, causing vision loss. Her parents feared that if they waited too long, she would lose her eyesight. They went from doctor to doctor looking for treatment.
But finding a specialist to accurately diagnose and treat these large hemangiomas is often difficult.
Before 2008, the standard of care for these birthmarks was oral steroids, but the side effects were severe and affected the immune system. Laser treatment is another option, but neither treatment helped Nicole or Ziyho'n.
In 2009, Ziyho'n traveled to Arkansas for surgery to remove her hemangioma. Nicole had been to a different doctor in the same state a few years earlier.
Although surgery is an option in extreme cases, there are two schools of thought on when it should be performed, Ghali said. In North Texas, it is more common to wait until the child is older and the hemangioma has started to shrink, he said.
In the past two years, the drug Propranolol has offered hope to children with these disfiguring birth defects.
The drug has been approved by the Food and Drug Administration for the treatment of heart conditions, but some doctors, including Ghali, have started using it to treat hemangiomas. It has been effective 95 percent of the time, Ghali said.
Ghali called the drug the "biggest breakthrough in the treatment of hemangiomas in the last 20 years."
Physicians began using it after a doctor in France discovered that the drug shrank the hemangioma of a boy whom he was treating for a heart problem.
Although it is unclear as to how the drug works, it has fewer side effects than steroids, said Ghali, who has used it successfully on about 60 patients.
Although the medication came too late for Nicole or Ziyho'n, their parents aren't complaining. Today Nicole is a beautiful little girl who loves riding her bike, playing the piano and hanging out with her friends.
Ziyho'n is a joy to be around, her mother said.
"After the surgery, she looked in the mirror and didn't recognize herself without the hemangioma on her nose," Harper said. "She's beautiful."
Jan Jarvis, 817-390-7664