Body Dysmorphic Disorder - BDD and Plastic Surgery

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Body dysmorphic disorder (BDD) is a syndrome characterized by a strong preoccupation with an imagined defect in a person’s appearance. In cases where the deficit is not imagined and a slight defect is present, the person’s concern is noticeably excessive. Excessive preoccupation with the imagined or minor flaw involves intrusive thoughts about the body part of concern. In addition to daily intrusive thinking, individuals suffering from BDD engage in a variety of compulsive behaviors aimed at alleviating the anxiety caused by the thoughts. Patients with BDD generally engage in thoughts and behaviors related to their perceived deficit for 1 hour or more per day, and that amount has been reported as high as 3 hours per day among adolescents. Symptoms often start in adolescence or early adulthood brought on by remarks made by peers or family members i.e. early bullying and family attachments are significant factors. The average age of onset is 16 to17 years, although it may occur in older adults overly concerned with their aging appearance. Individuals with BDD frequently check their appearance in mirrors to confirm or attempt to conceal the perceived deformity. They may engage in long rituals of grooming, such as repeatedly combing or cutting their hair to make it just so, applying make-up, or picking at their skin. They typically will spend a great amount of time trying to cover up or camouflage the perceived defect employing elaborate clothing rituals. They will seek excessive reassurance from friends, family members, and/or co-workers to elicit placation that the perceived “defect” does in fact exist, or to assure that the flaw is sufficiently concealed. At the extreme they feel anxious around others, avoid social situations, become housebound, only leaving their homes at night to avoid the scrutiny of others. Some drop out of school, avoid job interviews, or do not work in order to avoid public exposure . Patients with BDD have attempted to engage in self-surgery with knives or razor blades to pick at or remove the blemish or with staples to tighten “loose skin". Clearly they see something that others do not see real, imagined or exaggerated.

Plastic Surgery Rehabilitates Criminals

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Between 1953 and the early 1960's Dr. Edward Lewison performed free plastic surgery on inmates of the  Okalla prison in Burnaby, BC Canada. It was renamed Lower Mainland Regional Correctional Centre in 1970. The study involved 450 prisoners and was undertaken with the cooperation of Dr. Guy Richmond, the prison doctor, and Hugh Christie, the warden. Dr. Lewison and a sociologist chose patients on the basis of a  connection between a "bodily defect" and the inmate's behaviour. The idea was that reconstructive surgery that removed deformities would provide such a boost to the prisoners' self-esteem and confidence that they would be motivated to pursue law-abiding lives upon their release from prison. Most of the operations were for congenitally deformed or fractured noses. The rest were for reconstruction of deformed ears, receding chins and removal of facial scars. Almost immediately after surgery, the inmates' behavior improved. "Formerly hostile and incorrigible individuals became polite and gracious in their manner … Among them a keen ambition developed to learn a trade and qualify for transfer to the vocational correctional centre." The studies results were published in the Canadian Medical Association Journal in 1965 citing a 42 per cent recidivism rate for the plastic surgery patients vs. 75 per cent for the general inmate population. Lower Mainland Regional Correctional Centre was closed in 1991. The site is now a park.

Similar studies by different doctors carried out on inmates at Kingston Penitentiary in Kingston, Ont. in the 1960s, in Illinois starting in the 1930s and in Texas in the 1980s had similar results. The theory is still in use today by non-profit organizations in the U.S. which help reformed former gang members to remove facial and body tattoos to help get them out of gangs into jobs. I have been a I volunteer tattoo removal doctor in Los Angeles since the mid-1990s to help get people out of gangs. The patients pay for their treatments by performing volunteer community services and some have gone on to well paying executive or managerial positions. I don't think many people today would support free cosmetic surgery for inmates. In this crazy world some would commit crimes just so they could get the free surgery.

The best way to rehabilitate Two Face back to Harvey Dent would have been Plastic Surgery.

The BBC is currently looking for anyone involved to be in a documentary about the study.

Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Lipedema, Lymphedema and Fat Legs

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The 4 main causes for enlarging leg girth or circumference are lipedema (accumulation of fat in the legs), lymphedema (obstruction of lymph flow in the leg), obesity and impaired venous blood circulation (venous stasis). Lymphedema is observed as swelling that usually involves the feet and shows up as impaired flow on lymphangiograms or lymphoscintigraphy . With time the swelling becomes hard and uncompressible and the skin breaks down and becomes infected. Impaired venous circulation is observed as swelling with brown darkening of the skin color, skin break down and inflammation. The blocked veins are visualized by doppler sonography studies using sound waves transmitted through the skin. This blog will focus on lipedema also known as lipoedema in Europe.

The areas of fat concentration tend to be abdominal in aging men, hips and thighs in aging women and buttocks in certain races as those individuals age. The age at which this occurs varies from person to person. Changes in metabolism and fat deposition can also occur more quickly at puberty, after childbirth, gynecologic surgery, with the onset of thyroid disease or menopause. It is easier to lose fat from areas in which your body tends to not concentrate fat. The fat doesn't go to one place and then another as in first, second etc.. It goes all over but more of it is stored in specific areas and it is mobilized from other areas more easily. In some cases the concentration can be dramatic such as very large buttocks with skinny arms and legs, steatopygia, which is more common in certain African tribes.

Ear Pinning - Otoplasty

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Prominent ears can be socially traumatic for children in their early school years.
It is sad that we have non-surgical ways to treat this in infants using the EarWell so they never have to go through this type of bullying yet many parents do not have their babies treated.

The surgical treatment in children or adults involves making an incision behind the ear and placing shaping sutures in the cartilage to create the missing fold that makes the ear stick out. Over the course of a month or two the cartilage reshapes itself to the shape held by the sutures so they are no longer necessary, though we do not usually go back to take them out. Depending on surgeon preference sutures are placed between the cartilage and the side of the head, skin may be removed from behind the ear and/or some ear cartilage is removed to obtain the best longest lasting ear shape.

Before  and After Ear Pinning Otoplasty

Dr. Aaron Stone - Plastic Surgeon Los Angeles
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New Break Through Treatment for Keloids

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Keloids are the overgrowth of scar tissue in response to skin injury or irritation. They frequently persist at the site of injury, often recur after surgical removal and overgrow the boundaries of the original wound. They can itch, be painful, restrict movement, interfere with sleep, block a vital function like hearing and cause cosmetic disfigurement with significant psychological effects. The usual treatments of surgery, radiation, cryotherapy and injections can be costly and time consuming. The Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, in Singapore has just developed a new treatment modality that could make it easier and cheaper to treat this problem. They combined a microneedle transdermal delivery system with medications like 5-fluorouracil that have been used to treat keloids. The system consists of a flexible patch, containing microneedles 0.7 to 0.9mm in length and 1/3 mm in diameter, that is applied to the skin. The microneedles are loaded with the drug, 5-fluoro-uracil (5-FU) in a solid form. The patches are flexible so they can adjust to surface contour. The microneedles penetrate the superficial skin and swell on exposure to tissue moisture opening pores along their surface that release the drug. The release is slow and sustained rather than a sudden release of the drug. The 5-FU concentration in each patch can be varied as needed. Their price points on the product are in the range of 20 cents per patch and their goal is for patients to treat themselves replacing the patch every 12 hours without ever seeing a doctor.

Micro-needle transdermal delivery system patch

So far they have only proven the patch can be applied to pig skin, the medication is delivered over time and the product stops keloid cell proliferation in petri dishes containing such cells.. Trials in human beings have not begin so we are no way near FDA approval. We do not even know what the optimal doseage for these patches should be in different patients.The 5-FU has the potential to leave you with an open wound where the keloid once was. Therefore, I cannot see the FDA allowing a chemotherapy agent like 5-FU to be used by patients without a doctor prescription or supervision.

Scars, Keloids and Hypertrophic scars
Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Types of Breast Lift - Mastopexy

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New plastic surgery statistics released 3/31/14 by the American Society of Plastic Surgeons (ASPS) show that breast lift procedures are growing at twice the rate of breast implant surgeries. Since 2000, breast lifts have grown by 70 percent, increasing from 53,000 in 2000 to 90,000 in 2013 vs only a 37% increase in breast augmentation surgery over the same time period. Breast implants are still by far the most performed cosmetic surgery in women, but lifts are steadily gaining. In 2013, 70% of these women were between the ages of 30 and 54.

At a young age the breast skin is taut and elastic and the ligaments holding the breast tissue to the chest wall are short and tight. With aging, exposure to gravity, weight changes and pregnancy the ligaments and skin are stretched and disrupted leading eventually to drooping sagging breasts, especially after breast involution following pregnancy and breast feeding. Surgery to correct this drooping is termed a mastopexy or breast lift and involves surgery on the breast skin and/or deeper breast tissue. The pencil test is a simple way for a woman to assess if breast lift surgery could be beneficial. A pencil is placed under her breast.  If the breast tissue holds the pencil in place against the chest that implies that there’s a hanging nature to the breast that may be improved with a lift. In assessing these patients the surgeon needs to know the history of breast sizes with changes in weight or pregnancy, breast measurements (breast volume, amount of breast skin envelope filling, nipple position on the chest, distribution of breast tissue, skin quality and amount, areola size, amount of skin show below the nipple on standing and asymmetry/symmetry).

Five Skin Care Tips for a Healthy Skin

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This is a guest post by Alyssa Furnell Content Writer/Proof Reader at Authority Specialists. Authority Specialists provides top-quality, value-filled content with the goal of building the authority of your website.

For busy individuals wanting to have their skin pampered, going for an intensive skin care is not easy. If you have a healthy lifestyle and practice good hygiene - especially in caring for your skin, then there is no need to go to a dermatology clinic. Unless of course your problem is getting rid of those hideous scars, then you really need the help of a professional, where they have a laser clinic.

Laser Hair Removal and Hidradenitis Suppuritiva

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Lasers and Laser Hair Removal

As described in my previous blog Hidradenitis of the Armpits Hidradenitis occurs when a plug of dead skin in the duct of a gland emptying into a hair follicle initiates an infectious process as bacteria multiply within the plugged gland. As the gland swells a boil becomes visible. The obstructed gland or boil ruptures into the deep layers of the skin; adjacent glands become involved; and abscesses form. Subsequently, multiple draining sinuses or holes appear on the skin surface and the whole hair bearing area may become inflamed. Such inflammation may result in star shaped skin scars and tunneling, causing ridging of the skin. The association of Hidradenitis with hair follicles has fed the notion that removal of this hair early in the process can cure or ameliorate Hidradenitis. Since the 1990s laser treatment to remove unwanted hair has become increasingly popular therefore such treatments should to some degree treat Hidradenitis.

A laser is basically a container of some medium (such as a liquid dye, gas, etc) into which an electrical charge  or flash of light is introduced. The charge or flash excites electrons in the material at the molecular level and the material gives off a narrow band width of light as the electrons come out of excitation. The exact wavelength of light created depends on the material itself and the characteristics of the charge or flash. Mirrors inside the container bounce the light around to create a chain reaction of molecular excitation and the emitted light is allowed to escape through a pinhole. This single wavelength coherent light is then focused down into a hand piece so it can be applied to tissue. The effect on the tissues depends on which tissue components absorb the specific wavelength of light, the depth into the the tissue that the laser can penetrate, the duration of exposure to the light (pulse width), the power of the light at the point of tissue contact, etc.

Laser penetration is a factor of light wavelength with usually greater penetration for lasers with higher wavelengths of light. The wavelength also governs which tissue component will absorb a specific wavelength.
 
 

Do It Yourself Plastic Surgery Devices and Gadgets

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As mentioned in my previous blog Plastic Surgery in South Korea South Koreans get more plastic surgery per capita than citizens of any other country in the world. In that country it is seen as a prerequisite for success in work and relationships. The patients are also getting younger so patients in their first or second year of high school are becoming common. With this high demand a number of citizens especially teens cannot afford to have the surgery so they are turning to cheaper devices and gadgets to mold their features into a desired shape or appearance. Most of these devices are designed to supposedly change facial appearance and are sold online. The sellers of these devices make claims that have no scientific basis and there are no studies proving the efficacy of any of these devices. In fact looking at some of these devices would make one think their application is more suited to a form of torture. The use or overuse of these devices could very well result in infections, permanent scars or other irreversible deformities especially in young people who are still growing.

Here is a list of available devices.

Double Fold Eyelid Glasses

Bandages and Dressings for #HidradenitisSuppuritiva

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As described in my previous blog post Hidradenitis of the Armpits - Boils Under the Armpits a plug of dead skin in the duct of a gland emptying into a hair follicle in areas of opposing skin surfaces like the armpits, under the breasts and in the groin initiates an infectious process as bacteria multiply within the plugged gland creating a skin boil. The obstructed gland or boil ruptures into the deep layers of the skin; adjacent glands become involved; and abscesses form. Subsequently, multiple draining sinuses or holes appear on the skin surface and the whole hair bearing area may become inflamed. We call this process #HidradenitisSuppuritiva (HS).

As I described my first choice of treatment for this process is surgical removal of the involved skin and closure of the resulting wound with a flap of adjacent normal skin. However, this aggressive surgery is not always the best near term option because of insurance, financial, work or personal reasons. For early stages of the disease temporizing the situation with topical treatments is appropriate and can provide significant relief.