Tuesday 24 June 2014

Hyperhidrosis - excessive sweating

Excessive sweating of the underarms or palms of the hands can be a terribly embarrassing condition.  Many patients will find that their social life suffers due to this.
Unfortunately many also done realise that this condition can be treated very successfully with Botox.
There are certainly also other treatment modalities available, although these can be more invasive.

Mechanism of action
Botox has an affinity for the receptors of the sweat gland.  Once it attaches to these receptors the nerve impulse that stimulates sweating is blocked. The hand and armpit this remain dry.

Majority of patients will choose to have the underarm treatment at the beginning of spring.
The palm treatment so common throughout the year as it is not so season dependent.
The effect of the treatment lasts about 6-9 months, but can vary in patients. 

Treatment
I generally use topical anesthetic cream, but one can also use nerve blocks for the palm.  This stays on for about 45min.  This depends on the threshold of the patient.
For the underarm (axilla) I dont use anaesthesia as it is well tolerated without.
The treatment takes about 15min.  The effect will be noticed at about day 4 and will reach its maximum intensity at about 2 weeks.

Iodine test
This test can be performed to confirm the exact area of sweating.  I don't routinely undertake this.

This treatment changes peoples lives as they can resume normal social activities without feeling self-conscious or embarrassed.
Some have said that "its the best thing they have ever had done......."


Non-surgical Facelift -Thread lift, Suture Lift facial rejuvenation

On my consultation days I see many patients that come in for facial rejuvenation advice.
Granted, many come for Botox, fillers, lasers and IPL rejuvenation.
There is, however, the group of patients that are not interested in those sort of treatments, but sit in front of me and move certain parts of their face to a position it once was.  They tell me that they are not interested in a FACELIFT, but would like something of the sort that takes a few years off your perceived age.
I think we've all done that in front of the mirror- elevating the hair just above your ear to remove the nasolabial lines and jowls. This can have a very dramatic, although, subtle effect.

Threadlifts have been around for years and basically involve thin threads that are placed under the skin and anchor or reposition certain parts of your face.

We can split the face into zones - upper, mid and lower face and neck
Upper - brow and temple
Mid - cheeks
Lower - jowls and jaw line
Neck

As we age we typically lose volume as some of the fat in our deeper skin layer atrophies.  This can leave us looking fairly gaunt.  Signs of this are loss of cheek volume, temple volume and sunken eyes.
Unfortunately our elastin fibres also deteriorate and thus we get the sagging of skin with the effect of gravity.
Our cheeks drop leaving us with nasolabial lines, and jowls will form on the jawline leaving us with marionette lines.  The aim is thus to reposition these areas to their original position.


So, by placing some thin threads into positions that lift the areas that have dropped we can give the face a rejuvenated look which makes you look fresher.

The procedure is performed under local aneasthetic and everything is done through tiny needle holes thus leaving you with no scars.
The threads eventually dissolve over a period of 18-24 months.
I often perform this in combination with something called Serdev suture lifts which are a little stronger.  These are also performed under local anesthetic and through tiny puncture holes.
The majority of patients will have no bruising and may require some pain relief for the pulling sensation experienced.
It is important to treat your face very gently over the first 4 weeks to prevent the threads from losing their hold.


VASER post op aftercare

I get asked time and again about the aftercare following a VASER procedure.  I thought it was thus time to write something about it.  Ideally you should be reading this before the procedure so you know what to expect.

The recovery period is the most important part besides the actual procedure itself.  Although I go through the aftercare at the consultation period and again immediately after the procedure, I suppose it cant be stressed enough.  In most cases it is your first procedure and you are not really sure what to expect.  Every patient will also retain and remember different points of the conversation.
I have actually made a video on this topic this passed weekend and hopefully, once edited, will add this to the post.
Immediately after the procedure you will be really padded up to absorb all the leakage.  This will stay in place for the first 24hours.
If there is any leakage beyond the padding then its just necessary to add some more.

DO NOT REMOVE THE GARMENT in the first 24 hours.

I advise my patients to make sure they sleep on old towels and mattress protectors- this will prevent soiling of your bedlinen in case there is some leakage while you are sleeping.
We generally give you ample padding to take home, but it is worthwhile to have some more sanitary towel available.

The following morning I insist that you prepare for a shower.  In preparation to remove the garment I advise that you lie on the bed or on the floor.  Slowly open the clasps and remain in that position for a few minutes.  This allows your blood pressure to normalise and prevent you from fainting and injuring yourself.
Remove all the soaked padding and discard it.  Keep some gauze at hand so that any drips don't soil your carpet.  Get yourself into the shower and have a gentle wash.  Try not to rub any soap into the access points.
Once done, gently pat yourself dry.  You may notice some leaking from the lower access points (pink stained fluid) which is normal.  It is best to resume the lying position again.  Place some small padding (size of the palm of your hand) onto the access points and close the garment again.  During the day it will be necessary to replace the padding.  The is will vary between patients, but a guide is really just when it gets soaked then replace it.

During the following days you will notice that the leakage will reduce to just a trickle and thus you can reduce the padding and the number of times it will need replacing.

Remain vigilant and keep a close eye on the access points.  If you are worried, best to just call your treating surgeon for some advice.

READ THIS AGAIN so you know what to expect.

Have a look at this video for further clarification.....