Female Genital Cosmetic Surgery

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Apr 16, 2018 - In: Fitzpatrick. TB, Eisen AZ, Wolf K Freedberg IM, Austen K. Dermatology in General ... 9th ed. Philadelphia USA;. Lippincott Williams and Wilkins; 2005. p. ... [Downloaded free from http://www.jcasonline.com on Monday, April ...
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EH has been treated with botulinum toxin (injectable) with good results.[9] Botulinum toxin (Boxtlak-BL) is a potent neurotoxin that blocks cholinergic nerve terminals. It has been used in the treatment of blepharospasm, strabismus, torticollis, hemifacial spasm and other dystonias.[10] It has also been used in the treatment of hyperhidrosis[11] and facial wrinkles. Boxtlak-BL containing BoNT_L peptide significantly inhibits SNAP-25 (synaptosomeassociated protein of 25 kd)[12] of SNARE complex thereby inhibiting the release of acetylcholine from vesicle within the cytoplasm of the motor nerve endings. The end result is chemodenervation of cholinergic nerves targeting the autonomic control of eccrine sweat glands. We propose topical Botulinum toxin like peptide as a painless, non-invasive, cost-effective and safe technique for the treatment of multiple EH with excellent results.

Vijay Gandhi, Geetanjali Naik, Prashant Verma Departments of Dermatology and STD, University College of Medical Sciences and Associated Guru Teg Bahadur Hospital, Shahadara, Delhi, India. E-mail: [email protected]

REFERENCES 1.

Hashimoto K, Lever WF. Tumors of skin appendages. In: Fitzpatrick TB, Eisen AZ, Wolf K Freedberg IM, Austen K. Dermatology in General Medicine. 4th ed. New york: Mc Graw-Hill; 1983. p. 550-1.

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Klein W, Chan E, Seykora JT. Tumours of epidermal appendages. In: Eldn DE, editor. Levers histopathology of skin. 9th ed. Philadelphia USA; Lippincott Williams and Wilkins; 2005. p. 867-926. 3. Robinson AR. Hidrocystoma. J Cutan Genitourinary Dis 1893;11: 292-303. 4. Fariña MC, Piqué E, Olivares M, Escalonilla P, Martín L, Requena L, et al. Multiple hidrocystomas of face; Three cases. Clin Exp Dermatol 1995;20:323-7. 5. Blugerman G, Sehavelzon D, D’Angelo S. Multiple eccrine hidrocystomas, A new therapeutic option with Botulinum Toxin. Dermatol Surg 2003;29:557-9. 6. Tanzi E, Alster TS. Pulsed dye laser treatment of multiple eccrine hidrocystomas: A novel approach. Dermatol Surg 2001;27:898-900. 7. Khunger N, Mishra S, Jain RK, Saxena S. Multiple eccrine hidrocystomas. Report of 2 cases treated unsuccessfully with atropine ointment. Indian J Dermatol Venereol Leprol 2004;70:367-9. 8. Clever HW, Shal WJ. Multiple eccrine Hidrocystomas: A nonsurgical treatment. Arch Dermatol 1991;127:422-4. 9. Correia O, Duarte A, Barros A, Rocha N. Multiple Eccrine HidrocystomasFrom Diagnosis to Treatment: The role of Dermatoscopy and Botulinum Toxin: Dermatology 2009;219:77-9. 10. Carruthers A, Carruthers J. History of cosmetic use of Botulinum A exotoxin. Dermatol Surg 1998;24:1168-70. 11. Glogou RG. Use of hyperhidrosis with botulinum toxin. Dermatol Clin 2004;22:177-85,vii. 12. Aoki KR. Pharmacology and immunology of botulinum toxin serotypes. J Neurol 2001;248:3-10. Access this article online Quick Response Code: Website: www.jcasonline.com

DOI: 10.4103/0974-2077.85048

Female Genital Cosmetic Surgery Sir, The World Health Organisation’s (WHO) definition of female genital mutilation is, all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural, religious, or other non-therapeutic reasons.[1] Women’s concerns about their appearance, fuelled by commercial pressure for surgical fixes, now include the genitalia. A lot more women are stated to be troubled by the shape, size, or proportions of their vulvas, hence, elective genitoplasty is apparently a demanding cosmetic procedure. The latest survey by the British Association of Aesthetic Plastic Surgeons reported that the staggering 31% increase in the uptake of cosmetic surgery in UK women accounted for 92% of this uptake.[2] The

increased demand for cosmetic genitoplasty may reflect a narrow social definition of normal, or a confusion of what is normal and what is idealised. The provision of genitoplasty could narrow acceptable ranges further and increase the demand for surgery even more. Research involving women with atypical genitalia has shown that clitoral surgery is associated with the inability to reach an orgasm and has emphasised the role of the vulvar epithelium in sensuality and arousability.[3,4] Women who seek cosmetic genital surgery fall into two main categories. First, women with congenital conditions such as intersex for which the current standard practice advises feminizing genitoplasty procedures, with the objective of reducing the clitoral size and opening the vaginal introitus.[5,6] Second, some women with no underlying

Journal of Cutaneous and Aesthetic Surgery - May-Aug 2011, Volume 4, Issue 2

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condition affecting their genital development also seek surgery to alter the appearance of their genitals, for example, labial or clitoral reduction.[7,8] Patients (women) desired alteration of their vulvas and vaginas for reasons of cosmesis, increasing self-esteem, and improving sexual function. The patients must be assured that their surgeon is properly trained and should understand that few validated long-term safety or outcome data are presently available in this relatively new field. It is important that training guidelines for practitioners be established and that long-term outcome, psychosexual, and safety data be published. The genital plastic surgeon must have sufficient training in sexual medicine, to withhold these procedures from women with sexual dysfunction, mental impairment, or body dysmorphic disorder.[9] It is important for these physicians to be adequately trained in the vulvar and vaginal anatomy and the intended surgical procedure(s), and the patients should understand their surgeons’ professional training and background.[5] It is the obligation of the surgeon to inform the patient fully regarding the treatment options and the potential risks and benefits of these options. Once the physician is satisfied that the patient fully comprehends the options, the patient’s autonomous decision should ordinarily be respected and supported. [9] It is necessary to examine these procedures through the lens of the established and accepted principles of biomedical ethics: respect for autonomy, beneficence, non-maleficence, justice, and veracity.[10] With striking accessibility of pornography in everyday life, women and their sexual partners are a lot more exposed to idealised, highly discriminating images of the female genital anatomy. Thus, in the future, more women may request genital surgery because a solution involving experts with minimal personal responsibility is more appealing than a personal commitment to problem solving. In the absence of measurable standards of care, lack of evidence-based outcome norms, and little standardisation, either in

nomenclature or training requirements, concern has been raised by both ethicists and specialty organisations.

Rajiv Saini Department of Periodontology and Oral Implantology, Rural Dental College-Loni, Tehsil - Rahata, Ahmednagar, Maharashtra, India. E-mail: [email protected]

REFERENCES 1.

Conroy RM. Female genital mutilation: Whose problem, whose solution. BMJ 2006;333:106-7. 2. Liao L, Creighton S. Request for cosmetic genitoplasty: How should healthcare providers respond. BMJ 2007;334:1090-2. 3. Minto CL, Liao LM, Woodhouse CRJ, Ransley PJ, Creighton SM. Adult outcomes of childhood clitoral surgery for ambiguous genitalia. Lancet 2003;361:1252-7. 4. Crouch NS, Minto CL, Laio LM, Woodhouse CR, Creighton SM. Genital sensation following feminising genitoplasty for congenital adrenal hyperplasia: A pilot study. Br J Urol Int 2004;93:135-8. 5. Goodman MP. Female cosmetic general surgery. Obstet Gynecol 2009;113:154-9. 6. Jong TP, Boemers TM. Neonatal management of female intersex by cliterovaginoplasty. J Urol 1995;154:830-2. 7. Rink RC, Adams MC. Feminizing genitoplasty: State of the art. World J Urol 1998;16:212-8. 8. Creighton SM, Crouch NS, Foxwell NA, Cellek S. Functional evidence for nitrergic neurotransmission in a human clitoral corpus cavernosum: A case study. Int J Impot Res 2004;16:319-24. 9. Choi HY, Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction labioplasty). Plast Reconstr Surg 2000;105:419-22. 10. Beauchamp T, Childress JF. Principles of biomedical ethics. 3rd ed. New York (NY): Oxford University Press; 1989. Access this article online Quick Response Code: Website: www.jcasonline.com

DOI: 10.4103/0974-2077.85049

Recurrent Granuloma Faciale Successfully Treated with the Carbon Dioxide Laser Sir, Despite evaluation of a plethora of modalities, treatment of Granuloma Faciale (GF) remains disappointing. Search for an effective, low-risk treatment led to the use of Pulsed Dye Laser (PDL) in GF with variable results.[1,2] In a recent series assessing the role of PDL in GF, Cheung and Lanigan noted a significant cosmetic improvement in

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two of their four patients.[1] Cosmetic improvement was maintained for at least 12 months in one patient. Here we report a patient in whom GF relapsed two years after it had partially responded to a series of PDL treatments and its subsequent response to the carbon dioxide (CO2) laser. A 51-year-old man with biopsy proven GF of the right cheek

Journal of Cutaneous and Aesthetic Surgery - May-Aug 2011, Volume 4, Issue 2