Quarta-feira, 2 de Abril de 2014
Some Q&A about Body Dimorphic Disorder (BDD)

Body Dimorphic Disorder (BDD): what is it?

 

BDD is a psychiatric disorder with different severities and a broad spectrum of presentations. The diagnosis criteria to BDD are:

       i.     Preoccupation with a imaginary defect or disproportional extreme concern with a slightly defect in appearance
      ii.     Significant distress or impairment in social, occupational or other areas of functioning, resulting from the appearance preoccupation.
     iii.     The preoccupation is no due to other psychiatric disorders (e.g. eating disorders)
The treatment depends on the severity of the disorder.
BDD is included in a group of psychiatric disorder called “somotoform disorders”. However this is controversial, and many experts consider it as a obsessive-compulsive disorder.

 

 What are the signs and symptoms, who is this more prevalent in,males or females and around what age does it begin exhibiting?

  1. The persons who present for cosmetic treatment have  some degree of body image dissatisfaction, and that is the reason why they seek for correction. Plastic Surgeons are trained to identify and correct these problems. So it can be difficult to diagnose BBD based on the above criteria.
  2. For me the most important diagnostic tool is the dimension and the degree of distress the impairment causes. A slightly nose defect is not a reason to abandon school or a job. I value this more than the defect itself when suspicious of a BBD case.
  3. Most of the cosmetic patients are self conscious of an appearance defect, but don’t “allow it” to interfere with their lives, and are functioning appropriately. These are the ones we can help with Plastic Surgery, and affect them positively in improving their body image and appearance and their self-esteem.
  4. It appears to occur equally in both genders. However they differ in their concerns.
  5. Regarding BBD the patients tend to focus more on the skin, hair and nose. But there is also some differences regarding the gender. Man are more preoccupied with their genitals, height, hair and body, where women show more concern about weight, breasts, hips and legs. But there is no rule, as any body details can be of extreme importance and relevance and can cause disproportionate  impairment for persons with BBD.
  6. Typically it begins in the adolescence, as this is the most exposed period regarding body transformation. This age is also prone to other behaviour and somatic disorders like major depression, anorexia or obesity.

  Is this triggered by something in the environment or some kind of media influence

  1. There is a familiar tendency as it is more frequent in families of individuals with obsessive-compulsive disorders. Also 20% of patients with BBD do have a first-degree relative with the same disorder.
  2. From the neurological point, it seems there is an abnormality on one of the neurotransmitter secretion (dopaminergic system).
  3. Psychological and behavioural factors are also involved, as it seems these patients have an increase aesthetic sensitivity. Also they show an increase tendency to display compulsive behaviours in order to reduce their anxiety.
  4. Social and cultural factors can also trigger BBD. Specially if raised in neglectful or critical environments regarding appearance. Also there is a higher incidence of childhood abuse (emotional, physical and sexual).
  5. The media and modern society pressure regarding physical perfection can also be taken in consideration regarding the etiology of body dissatisfaction and BBD.

  What is the link between BDD and plastic surgery addiction?

  1. Plastic Surgery can be a way of treating the problem, if you are not in the pathological range. Actually that is the ultimate goal of Plastic Surgery, considering the reconstructive and cosmetic aspects of it. To enhance the proportion and to correct deformity.
  2. But BBD patients will not be satisfied by one single correction, as the problem doesn’t lie in the body but on their perception of the body. So they will find another problem to correct and to blame for their lack of success and functional impairment. This is the reason why we should pay attention and avoid to treat this patients. They should be referred to Psychiatric care and that will be right way to be treated
  3. But it is not always so simple. Some of the situations are border line and associate with other psychiatric comorbidities like anxiety, substance abuse and dependence, personality, eating and mood disorders.
  4. Mainly because BBD is very difficult to diagnose at the beginning and patients tend to look for different doctors until one will agree to perform what they want to do. We are coming more aware of this condition and avoid to take these individuals into our care. 

How common is this?

  1. It is estimated to occur in 1 to 2% of the population
  2. In the cosmetic surgery patients population the incidence is higher in a range from 3.2 to 16%.

How can you tell if a patent is addicted to plastic surgery?

  1. When I see unusual or excessive request for surgery. But that doesn’t mean that they are BBD patients.

 How ethical is it for the doctor to keep performing surgery on a patient such as this?

  1. In my opinion it is not an ethical problem at the beginning. It could be a diagnosis error or anwarenness of the problem. It will be ethical if the doctor knows that BBD is present and keeps performing treatments (surgical or non surgical) without psychiatric counselling, just for the sake of business.

 Do you have any anonymous case study you are able to share with us?

  1. I have a 36 years old patient that come to my Lisbon office asking for a eyelid surgery. It would be her 34 surgical procedure and the second one for the correction of eyelid excess skin. It was obvious and I refuse to do it on the base that there were no surgical indication for it. With extreme carefulness we (I and my non medical staff) were able to get her in to psychiatric counselling and end the endless surgical pathway that she was going to.

 How do you, as the doctor, convince the patient that the procedure they are requesting (in the case of addiction) is not necessary? Do you turn the person away?

  1. For me Cosmetic Surgery is like any medical treatment: there is a problem and different therapeutic alternatives to treat it. We just have to find the one that is more adequate to this particular patient. If I cannot do any good or if I am not able to perform what it is required, I just refuse the patient or refer him to someone with the right qualification to handle is problem.

 Are there some celebrities who you feel are visibly addicted to plastic surgery? Who?

  1. Yes. I think any one can spot them. As a doctor I cannot come public with my comments. That would not be ethical.

 What role do media play in all of this in your opinion?

  1. I think media is just doing their job. They inform their public. What the public does with that is their personal concern.
  2. But if we take in consideration that a great number of similar disorders start at the adolescence, than we should be much more careful on what we publish and how we inform. This is a very vulnerable group, particularly when dealing with body and fashion issues. Take the example of fashion models and anorexia.

What are the most addictive kinds of procedures in your opinion?

  1. The ones that work. Specially the small invasive or non invasive as these are not so prone to complications and they have no downtime.
  2. Regarding surgical procedures, liposuction and rhinoplasty are the ones more often repeated. 

Tradução para português: faça copy do texto e use o link: http://translate.google.com/#pt/en/



publicado por Francisco Falcão de Melo às 13:08
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Terça-feira, 1 de Abril de 2014
What is the difference between a breast lift and a breast augmentation?

A breast lift is intended to correct a ptotic breast, independently of the volume correction.  In ptotic breasts the nipple position is at the level of the inframamary fold or lower. In light to moderate cases it can be accomplish only by adding volume as this will give one to two centimetres lift. In the other ones we have also to take skin out, in order to get the desire lift.
Breast augmentation is intended to add volume. It is related to size, not to the nipple position. In most cases, alone, it cannot correct a ptotic breast.
In some cases we just have to combine both procedures. We called it a “mastopexy with an implant”

 

Tradução para português: faça copy do texto e use o link: http://translate.google.com/#pt/en/



publicado por Francisco Falcão de Melo às 13:04
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Sábado, 28 de Setembro de 2013
Look forward to yesterday...

Chegei ao Dubai há uma ano!!


Cerca de 6 meses após ter "aterrado" dei uma entrevista  à revista New You, em que discutimos alguns temas recorrentes na cirurgia plastica e cosmetica e mais alguns assuntos de ordem mais pessoal que tenho todo o gosto em  partilhar convosco. Apresento aqui um resumo.

Podem usar o link http://translate.google.com/#en/pt/ caso queiram fazer a tradução para português.


I arrived in Dubai one year ago!
Almost 6 months after, gave an interview to the magazine New You. We discussed some recurrent themes in plastic  and cosmetic  surgery, plus some more personal matters that gladly want  to share with you.  



Look forward to yesterday...

 

A landmark in Dubai’s burgeoning anti ageing medicine sphere; Aesthetica Clinic is committed to introducing the latest in minimally invasive techniques without compromising on the practice of evidence based medicine. Under the guidance of its founder, Dr. Maria Angelo-Khattar, a veritable pioneer in this field, the clinic ensures reliable treatment choices in rejuvenation and the enhancement of beauty.

 

Meet the Aesthetica Team

Dr. Francisco Falcão de Melo is a  plastic surgeon with his areas of interest embracing plastic, reconstructive and aesthetic surgery in addition to head and neck, breast, body contouring, oncology, chronic wounds as well as hand surgery.

An eminent addition to Dubai’s plastic surgery fraternity, Dr. Falcão de Melo has attended over one hundred conventions and courses on plastic, reconstructive and aesthetic surgery, microsurgery, burn care and hand surgery and has published numerous papers in his field.



What age is appropriate to consider a face lift?

 

Cosmetic surgery should be approached like any surgical issue and performed when there is a relevant problem that cannot be solved with a less invasive solution. Also it is important to note that one should not look to cosmetic surgery as preventive, because it cannot prevent in this instance, facial ageing. 

    

We have different treatment solutions for this specific problem, and they should be offered according to the diagnosis given by the doctor. The difference to other medical or surgical treatments is that the cosmetic surgery is an option so if the patient decides not to do it, there is no health prejudice.

 

    A face lift is addressed to correct the facial and neck's sagging skin, skin folds and wrinkles and also the loss and shift of volume that occurs with time. Therefore (a face lift should be consider)  in their mid to late forties , because before the skin is usually supple and voluminous  and is not an issue in the majority of women and men. I stress the importance of having a consultation because there is no set time frame, it all depends on each individual case, and of course lifestyle habits. The most important factors that speed the ageing process are the unprotected sun exposure and smoking and this can be changed or controlled  by you.

 

What book are you reading?

I usually have a couple on the go. Now I’m enjoying The Power of Habit, by Charles Duhigg which is a fascinating exploration of our pathologically habitual society. People smoke, incessantly check their smart phones or chronically choose bad partners. Duhigg digs into why we are this way, and how we can change, both as individuals and institutionally. Essentially his thesis is simple yet powerful: confront the root drivers of our behavior, accept them as intractable, and then channel those same cravings into productive patterns.

 

I also have Winter of the World by Ken Follett on my bedside table. It’s the second in his massive Century Trilogy, a full 960 pages long. The good news is that it’s quintessential Follett. The delight remains in the details.

It may be an intimidating read due to its length and it’s taking me more than a few cool winter nights to finish, but it's a good investment in time. Reading is an all consuming passion of mine.

 

 

What is playing on your iPod?

John Mayer Where the Light Is Live, it captures this rock genius where fans love him most: live on stage. The sounds are hauntingly beautiful, once you hear it once, it stays with you forever.

 

Do you have a favourite website or blog?

I regularly check news websites such as CNN.com, Eurosport  and the Portuguese Press.

 

Most challenging New Year’s resolution?

Taking my cue from Duhigg’s bestseller, it has to be substituting some of my habits by healthier ones.

 



publicado por Francisco Falcão de Melo às 10:48
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Quarta-feira, 11 de Setembro de 2013
Depois da gravidez

Tenho recebido algumas questões sobre a "barriguita" que sobra após a gravidez. Vou tentar responder a todas, pois os problemas colocados são na sua essência os mesmos.

 

 

É natural que após a gravidez fique como sequela uma maior protusão do abdómen abaixo do umbigo. Tal resulta de essencialmente de 4  factores:

 

 


Temas:

publicado por Francisco Falcão de Melo às 08:10
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Terça-feira, 12 de Março de 2013
Sofri um acidente doméstico com fogo / Burn Scars
Boa Noite!

 

Dr. Francisco, meu caso é o seguinte: quando eu tinha um ano e meio de idade, sofri um acidente doméstico com fogo, me resultou em cicatrizes de queimaduras de terceiro grau em região anterior da coxa e região abdominal com aproximadamente uns 30 cm de cicatriz em ambas a regiões, eu gostaria de saber se cirurgia plástica, método expansores, melhoraria o aspecto de minhas cicatrizes em quantos por cento e se vale a pena, já pensei em fazer tatuagem, mais tenho medo pois o local da cicatriz é muito sensivel e a pele é fina  demais, não sei se poderia dar certo tbm, gostaria de saber sua opinião sobre esses assuntos e qual método é mais seguro pra adotar.

 

Desde já agradeço



 To translate into English copy the text to the link http://translate.google.com/#pt/en/





publicado por Francisco Falcão de Melo às 17:43
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Quinta-feira, 7 de Março de 2013
Tenho uma filha com ....que foi mordida no lábio por um cão.

Boa tarde senhor Dr. Francisco Falcão Melo

 

Preciso da sua ajuda!!!

 

Tenho uma filha com 12 anos, que com 8 anos foi mordida no lábio superior por um cão. A parte do lábio onde faz o V caiu e teve de ser reconstruído. Na altura o que o cirurgião plástico receitou para ela pôr no lábio foi o Gentocil, que só passado algum tempo é que vi que era uma pomada oftálmica. Continuei a pôr, porque acreditei no que a médica tinha receitado.

 Foi vista posteriormente no Hospital de Egas Moniz por um cirurgião, que disse que o lábio não estava  mal mas que tinha feito clóide.

Disse que se podia fazer uma reconstrução, mas ela mal saímos do consultório disse logo que não.

Desde então tenho comprado imensos cremes, insisto para que ela ponha todos os dias, pelo menos à noite, que faça uma massagem de pelo menos 3 a 5 minutos. O que é facto é que ela põe, mas devido à idade por vezes esquece-se.

O meu pedido para consigo, vai no sentido de me aconselhar algum creme que seja milagroso e também o que devo de fazer para que o lábio dela fique com um aspecto ainda melhor. Durante o verão desde que aconteceu este episódio, que põe sempre protector com factor 50+ e eu ando sempre à procura de um creme que lhe faça desaparecer quase que por completo a maldita cicatriz.

 Ajude - me por favor

 

Muito obrigada e espero ansiosamente a sua resposta


 To translate into English copy the text to the link http://translate.google.com/#pt/en/

 



publicado por Francisco Falcão de Melo às 05:06
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Terça-feira, 5 de Março de 2013
Eyelid Cosmetic Surgery (Blepharopplasty)/ Cirurgia Estetica das Palpebras(Blefaroplastia)

Para traduzir para portugues use o link http://translate.google.com/#en/pt/ 

 

Your eyes are the focal point of your face and puffy bags and excess skin under them could make you look tired and worn. Today, however, there is a surgical technique designed specifically for the removal of that "tired" look that can change your physical appearance by playing a vital positive role in facial harmony and your emotional perspective. Dr. Francisco de Melo Consulting Plastic Surgeon at Aesthetica Clinic conducts eye lid surgery, also known as blepharoplasty, to rejuvenate patients' upper eyelids, lower eyelids or both.

 

more... )


publicado por Francisco Falcão de Melo às 04:50
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Terça-feira, 5 de Fevereiro de 2013
Lipoaspiração e gordura localizada ( liposuction and localized fat)...

Dr. Francisco,

Desde já agradeço a atenção dada a este meu pedido de informações. Desde adolescente que possuo alguma gordura localizada nas ancas e coxas, é sempre muito difícil encontrar calças que me sirvam dada a grande disparidade de medidas, pois tenho a cintura muito fina mas as ancas largas e joelhos grossos. Relativamente as ancas largas, não sinto qualquer desconforto porém no que diz respeito aos joelhos confesso que me causam incómodo e tristeza. Tenho vergonha em usar vestidos ou saias, pois é mais evidente este meu problema. O facto de ter os tornozelos finos e a perna começar a engrossar nos joelhos faz com que estes quase se unam e a perna evidencie gordura na face interna da coxa. Gostaria de saber o que fazer para melhorar esta condição e quais os custos dessa intervenção.
Translate with http://translate.google.com/#pt/en/


 

 



publicado por Francisco Falcão de Melo às 08:58
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Dr. Francisco Falcão de Melo
Licenciado em Medicina pela Faculdade de Ciências Médicas de Lisboa, fez o Internato Complementar em Cirurgia Plástica e Reconstrutiva nos Hospitais Cívis de Lisboa. Assistente Graduado foi o responsável pelo Serviço de Cirurgia Plástica e Reconstrutiva do Hospital Militar Principal até Maio de 2012. Membro da Sociedade Portuguesa de Cirurgia Plástica Reconstrutiva e Estética, da Sociedade Portuguesa de Cirurgia da Mão e da Sociedade Portuguesa de Queimaduras. Exerce actualmente a sua actividade profissional na Aesthetica Clinic, Dubai.

Degree in Medicine from the Faculdade de Ciências Médicas de Lisboa , residency in Plastic and Reconstructive Surgery at Hospitais Civis de Lisboa. Consultant, and was responsible for the Service Plastic and Reconstructive Surgery of the Hospital Militar Principal de Lisboa, until May 2012. Member of the Portuguese Society of Plastic Reconstructive and Aesthetic Surgery, the Portuguese Society for Surgery of the Hand and the Portuguese Society of Burns. Move in to Dubai, and is now the Plastic Surgery Consultant at the Aesthetica Clinic.
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As respostas às suas dúvidas atendem a diversos critérios. Neste serviço, não serão consideradas válidas questões com falta de enquadramento ou situações de emergência que só possam ter encaminhamento imediato.

E-mail: franciscofmelo@sapo.pt
Contactos
Consultório Dubai:
Dr. Francisco Falcão de Melo
Consultant Plastic Surgeon
Aesthetica Clinic
Jumeirah Beach Road, Vila 359, Dubai UAE
Tel: (+971)43428383
Fax: (+971)43428384
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Consultório Lisboa:
Dra. Luísa Magalhães Ramos
Consultório de Cirurgia Plástica LMR
Av. Miguel Bombarda, nº. 37 B
1050-161 Lisboa
Tel: (+351) 213 574 315
Informações- +351 21 099 91 38 | 91 081 29 92
Site

Consultório Leiria:
Dra. Luísa Magalhães Ramos
Centro Hospitalar de S.Francisco,
Tel: (+351)244819300
Fax: (+351)244819301
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