Mirrors -- Can't Get Enough!

Plastic surgeons are trained to watch for would-be patients who suffer from a strange perception of their own bodies. It’s entirely in the person’s mind, but he sees a chest (or nose) as ugly or even deformed.

Known as Body Dysmorphic Disorder (BDD), the syndrome is real enough that researchers have studied BDD sufferers to find their common symptoms and coping methods.

Usually, the sufferer will come into the office of a plastic surgeon, complaining about the ugliness of certain body features that appear perfectly normal – or even comely – to the average person.

Because plastic surgeons are also physicians who act in the best interests of patients, most refer suspected BDD patients to psychologists or psychiatrists.

Cosmetic plastic surgeons who have once treated a BDD patient now avoid these people like the plague,  because n0 improvement nor rejuvenation is ever good enough. Sometimes, the BDD patients become violent or launch groundless lawsuits.

Entertainer Michael Jackson probably had BDD.

Now, a new study of BDD sufferers nails down the case for withholding cosmetic plastic surgery from them.

Katharine Phillips, M.D., director of the body image program at Rhode Island Hospital, studied the medical records of 200 BDD patients who had cosmetic surgery and found only two percent had their BDD symptoms lessened. Some even developed new obsessions with supposedly flawed body or facial features.

BDD patients also:

• Endlessly check mirrors
• Comb and recomb hair
• Snip hair and shave daily
• Put on tremendous amounts of makeup

Earlier, Dr. Phillips found while surveying 265 cosmetic, (not plastic) surgeons that 65 percent reported treating BDD patients, yet only one percent of the treated patients were happy with out comes.

Of the cosmetic surgeons surveyed, 70 percent thought a BDD problem was O.K. for treatment anyhow.

Concluded Dr. Phillips: “BDD is a contraindication for cosmetic treatment.” (“Contraindication” means the doctor should rule out doing it.)

Read more about the study on plastic surgery and Body Dysmorphic Syndrome.

The most requested procedures by BDD patients include:

• Rhinoplasty
• Breast augmentation
• Facial fillers
• Microdermabrasion

In past studies, Dr. Phillips reckons that, of all the Americans who receive cosmetic surgery, seven to eight percent suffer from BDD.

Psychiatric treatments include drugs like serotonin reuptake inhibitors (SRIs) or cognitive behavioral therapy, a treatment plan that changes a person’s flawed thinking or behavior.

Fortunately, times have changed — for the better!

In fact, the newest, most modern and patient-friendly general anesthesia is something that has recently been in celebrity news.

I’m talking about propofol, the substance that entertainer Michael Jackson referred to as “his milk” because of its milky white color. (Read more about Michael Jackson’s death and propofol.)

But Jackson’s untimely and unfortunate death does not mean propofol is dangerous. Quite the contrary – in the right hands and settings.

Propofol, known commercially as Diprivan, is a boon to cosmetic plastic surgery patients. It takes effect quickly yet allows the patient to wake quickly when halted – and with no after effects. The combination of propofol and other medications is known as “twilight sleep” (technically, conscious sedation.)

In the past, with general anesthesia, some would awake with a 24-hour headache or bouts of throwing up. Not so with “twilight sleep” anesthesia!

I now use propofol in every case except for soy allergies. That’s where the drug gets its white color – from its soy base.

Propofol is always administered by a board-certified M.D.-anesthesiologist in combination with other drugs which have different and additive effects during surgery.

The result is a cocktail of small doses of medications which keep patients sleeping quietly and gently, breathing on their own with a quick wakeup with no nasty after effects.

Formerly, general anesthesia – also safe in the right hands — knocked the patent out so the doctor had to insert a tube in the patient’s throat and attach it to a breathing machine. The anesthesiologist then used stronger drugs to maintain the sleep.

After surgery, some patients awoke slowly with a sore throat from the throat tube and had a drug-like hangover.

Some gynecomastia surgeons say they can use only a local anesthetic like lidocaine to numb the treatment area. But I’ve found locals are not comfortable to the patient. Local anesthesia can only be used to treat very small, localized  problems.

As for Michael Jackson’s case: the maker of propofol warns that the substance is only for use in a facility where proper electronic monitoring, resuscitative and support drugs are on hand. It is routinely used only by trained practitioners in certified operating rooms.

My opinion?

Using propofol for better sleep at home – even in the presence of a doctor — is as wise as taking cancer chemotherapy drugs only because you like your head bald.

Look at some before and after gynecomastia surgery pictures.

That may have been the case many years ago, but the world of sedation anesthesia now used in plastic surgery is more kind and gentle, thanks to a product you have perhaps read about.

That product, Propofol (trade name: Diprivan) used in the right hands and right places – specifically, used by an anesthesiologist M.D. or nurse anesthetist in a hospital or ambulatory surgical center – is a wonderful and unique anesthetic drug that has revolutionized office-based surgery.

Nonetheless, Propofol was abused in connection with the unfortunate death of Michael Jackson who called it “his milk” due to its milky white color.

That does not mean Propofol is safe to use at home, away from monitoring equipment and emergency equipment and, most especially, in hands not specifically trained in its use.

If we are to believe news reports, Propofol was used to lull Michael Jackson to sleep every night at his home.

But the drug was never intended nor designed for that use. Moreover, we don’t know how large the doses were nor how often they were administered.

(Side note: medical treatment in the absence of records is malpractice.)

Propofol is known as an hypnotic because it quickly induces sleep and then allows for a very fast recovery after cosmetic surgery with virtually no hangover, nausea, grogginess, sore throat or other undesirable side effects.

Among anesthetic drugs, Propofol is remarkable for clearing itself from the body extremely rapidly.

I commonly use it in my office, along with some other small doses of carefully selected medications. For gynecomastia surgery and other plastic surgery procedures, Propofol is administered by an anesthesiologist with whom I have worked for the last two decades.

Patients virtually always go into a relaxed sleep and have no memory of the procedure, experience no pain and gently wake up just as I’m placing the last stitch. Usually, the patient pleasantly chats with me as the bandages are being placed.

So if you have read about the circumstances of Michael Jackson’s case, don’t conclude Propofol is dangerous for use in an upcoming surgery.

In the right hands and setting, this drug works wonders!