Saggy Necks and Jaws : The Nefertiti lift.

2012-01-17T03:31:00.000-08:00

An article written by Dr Geraldine McKeever:

"As we age our faces appear to move South. Many people are aware that Botox in the upper face can reverse or help to defy the laws of gravity. More recently however, Botox has been used in the lower face and neck to conquer the appearance of Jowls and to give a more defined jawline. The Platysma muscle is a broad muscle which runs over the chin and neck and which pulls the neck skin downwards. By injecting this muscle along with other jowl forming muscles around the jaw bone we can defy the effect of gravity. We call this a Nefertiti lift after the Egyptian queen Nefertiti who was renowned for her great beauty. Many pictures of Nefertiti show her well defined Jawline. Two to Three weeks after this procedure one can notice an obvious re-contouring of the jowls and jaw line.

"For further information on the Nefertiti neck and jaw lift please contact Stepback cosmetic Medincine on www.step-back.com or 0870 161 0860

Embarrassing Sweating

2011-12-05T07:39:00.001-08:00

An article written by Dr Geraldine McKeever:

"Are you one of those people who suffer from underarm sweating? If so help is at hand in the form of Botulinum toxin injections. Often used for facial anti-ageing purposes or migraine, Botulinum toxin is also remarkably efficient at decreasing sweat gland activity. Small and almost pain free injections of the toxin are placed at regular intervals under the arms and can leave the sufferer almost sweat free in these areas for up to a year in some cases.

"Botulinum Toxin (Botox, Dysport, Azzalure) MUST be prescribed by a doctor or, in a few cases only, a nurse who is a qualified prescriber. You should always ask your therapist to tell you which Doctor is responsible for prescribing this for you and refuse administration if you are not happy with the information given. For further information on the use of Botulinum toxin for any purpose contact Dr. Christopher Davies or Dr. Geraldine McKeever of Stepback Cosmetic Medicine on 0870 161 0680.

Body Dysmorphic Disorder (Facts)

2011-12-02T05:19:00.001-08:00

An article written by Dr Geraldine McKeever:

"BDD is a psychiatric disorder marked by a fixation on an imaginary flaw in the physical appearance. Sometimes called Dermatological hypochondriasis. It results in significant suffering, occupational dysfunction, and/or social malaise. Individuals with BDD have variable degrees of awareness concerning the psychiatric nature of the illness. Many continue to agonize about an imagined defect although aware that their concerns are excessive. Others are regarded as delusional and have no insight into their unusual behavioural tendencies. They may exhibit violent behaviour toward their treatment providers. There may be psychiatric co-morbidity. Early diagnosis is important to avoid needless use of time, resources and money.

Frequency

It affects 1-2% of the population. Males and females are equally affected.
Presents in 6-15% of patients seen in cosmetic medicine/surgical clinics.
Usual onset is in the teenage years however the average age in people receiving dermatologic care is 33.7 years.

Mortality/morbidity

Suicide rate is 4 times the norm.
Causes clinically important distress not explained by any other medical disorder.
It tends to be chronic with remission probabilities lower than for mood disorders, anxiety disorders and personaility disorders.

History

1886 first described by Morelli
1997 classified in DSM 1V

Aetiology

Heredity:Unknown but may play a part. BDD is 4 times higher in first degree relatives of those with BDD and it occurs more frequently in people with OCD and their relatives
Biologically: Sufferers appear to have a lesion in the frontostriatal area.
Psychologically: There is a distorted self image

Differential Diagnosis

OCD
Depression
Bipolar Disorder
Schizophrenia
Anorexia Nervosa

Symptoms

Compulsive mirror checking, exorbitant grooming, skin picking.
Deliberate covering of the “defect”
Compulsive skin touching.
Constantly seek reassurance.
Social withdrawal.
Excessive grooming.
Folliculitis and scarring may occur due to skin picking and plucking of non-existant hair and can add to distress.
Repeated consultations with dermatologists and cosmetic surgeons with unsuccessful treatments.
Obsession with procedures

Body areas most commonly affected

Skin, hair (thinning usually) and nose defects are most common.
Can also involve wrinkles, spots, acne, large pores, vascular markings, greasiness, scars, paleness, redness, too much hair.

BDD and cosmetic consultations

Procedures are rarely beneficial
Repeatedly consult
Repeatedly ask for procedures
Often dissatisfied
Court cases against the doctor are common
Suicide is a real risk

Diagnosis

Some practitioners use a disorder questionnaire:
Does the patient avoid social situations?
How much distress is the defect causing the patient?
Does the patient spend a lot of time concealing the defect?
Does the defect prevent intimacy?

Treatment

There are no large scale trials. Patients often refuse psychiatric referral because of poor insight.

Dermatologic/ surgical intervention frequently fails to improve their symptoms.

CBT to change the patient’s attitude and behaviour eg: discourage skin picking and gradual desensitization for social withdrawal. Group therapy in a supportive environment may be adequate for those who are not truly delusional.

SSRIs in particular fluoxetine and citalopram are the most effective treatment. High doses for a prolonged period are needed and the response to 60mg fluoxetine ( as in OCD) is quite good.

Antipsychotics: People with a delusional problem may benefit from an antipsychotic and pimozide (Orap) has proven useful.

TCAs in particular Clomipramine are good when OCD type symptoms are prevalent

Buspirone may be useful when added to SSRIs when they don’t work alone.

In resistant cases SSRIs and Clomipramine together.

Prognosis

Sufferers frequently develop Major Depressive Disorder with a high suicide risk.

Psychosocial functioning remains poor over time ‘with few attaining functional remission.

Medicolegal pitfalls

Failure to recognise the disorder.
People with dysmorphophobia may blame the physician for producing what is perceived as an unacceptable outcome.

Don’t judge the patient solely by appearance
6th Sense exists- use it!!