A Doctor’s Quick Guide to Facial Wrinkle Injections

Botox is now so widely accepted that both doctors and their patients have reached the stage where a face can be altered to suit a particular individual. This means the doctor and patient should agree before treatment what hey are really trying to achieve. Of course, the eventual outcome is totally dependent on the skill of the doctor performing the procedure. If a doctor is not comfortable with raising your eyebrows or changing your ‘gummy’ smile he should let you know at the outset and not leave someone else to clear up the problem.

The first thing a doctor must understand is beauty or the perception thereof. If you take away a patient’s crow’s feet they may look fresher but not more beautiful. If you change the position of a patient’s brow they may become more beautiful as there is a correct aesthetic level for the brow to remain at within the facial structure. In fact, flattening a patient’s brow or upturning a patient’s lips are both amongst the earlier use of Botox to enhance appearance. This is because both of these conditions are associated with sadness, anger, ill health: all negative emotions. There was a now famous study done on American car salesmen that showed the use of Botox into the frown area of a selected angry looking group showed a 33% increase in car sales. No wonder the garage owners offered them free Botox for life. Note also crow’s feet are often associated with laughter, so doctors should not go too heavy on the syringe if you want to achieve good facial aesthetics. We should also remember that men and women should never get the same BBN…”Botox by numbers”

The male brow is typically flatter than a woman’s, which has a natural middle arch. Knowing good brows is the key to knowing good Botox. Trends also change but facial beauty remains the same over the centuries. Another interesting study showed men to accept the same parameters of what is considered to be female facial beauty whether it is in a niteclub in downtown Santa Barbara or a village in China.

From a doctors point of view it is always better to begin the procedure in the middle of the upper face. It’s a bit like a teacher in front of a class, weighing things up, thinking ahead, waiting to place your next question, or in this case needle. A doctor should always ask the leading question “what way do you want your brows to look next week?” From a patients point of view consider the doctor is like a man with a tranquilliser gun looking at a tug-of-war team. If he shoots some of the players in Team A, then Team B will fall over the line without even trying. It is exactly the same with Botox® or Dysport®. Your brows will end up in a final position dependent on the doctor with the needle. Now there are a few variations on that theme. If you are short sighted and squinting for years then you will have beefed up the muscles that pull the eye down. Let’s call them the “Orbies” because you better get to know the muscles if you want to get ahead in this game. They are actually called the Orbicularis oculi but leave that to the young student doctors trying to impress their anatomy teachers. The orbies pull down and cause wrinkles, crows feet to be exact. They are like Team A pulling away at the brow to bring it down and make you look tired. Now, I hear you think..if I do look tired and want to look more awake could the doctor tranquillise these and waken me up.

You see, you are getting the hang of it already. If the doctor is heavy handed on the orbies or else does not inject the muscle above it, them the eyebrow will rise. Let’s get to know the muscles above the brow. These muscles are called the “Fronties” or frontalis and they are responsible for the expression of surprise whenever we open up our eyes in amazement. Of course, you see the problem whenever Hollywood actresses lose this movement: no expression, blank stare etc etc. They are also responsible for causing the ‘Vulcan’ look whenever the outer edge of the brows goes up in true Star Trek fashion. But don’t panic, this is easily corrected by giving a little more tranquilliser to the outer fronties.

The outer side!!. Just when you were getting the hang of it, there I go and spoil things. Well yes, the brow has an inner and an outer side and we actually have control of both .Thankfully the new fresh wide open eye can easily be achieved by giving Botox to the outer orbie and a little to the inner orbie. Beware, you cannot put Botox® or Dysport® underneath the eye or the bottom eyelid will droop. These lines are better left to the bigger doctors with expensive laser toys to sort out. By the way, the inner brow muscles have two main players: the “Super Sillies” and the “Corries” . No, not from Beth Lynch at Coronation Street but from the medical student word corrugators.

The “Super sillies” and the “Corries” are very important muscles and hold the key to a good aesthetic effect. The “Super sillies” are named after the Depressor supercilii but enough of that medical student jargon for now. Just, let it be known they are on Team B and the pull your brow downwards. The other group the “Corries” are much more interesting as they lie at a forty five degree angle and the outer bit is really difficult to know where it is and the doctor without a special piece of electronic equipment has to find its location. Now, remember, no self respecting Botox doctor worth his business salt in this day and age is going to starting wiring up his Botox patients (but they once did!) to find the corries so the eventual position of your brows (or your eyelid) is dependent on his skill at figuring out where the end of the muscle are. You see, just when you thought this was getting easy.

This frown area has in fact six injection points, the corries, the super sillys and the prossies. The prossies are called after the procerus muscle group and this is why it takes the doctor a bit longer to do your frown area when he can quickly speed through the muscles on your forehead. Oh, and the reason it’s sore is that two little nerves run right through the area he is targeting.

The doctor should now move into your forehead to look at Team B. in general this is much easier as the whole muscle involved: the frontie, is large and flat and covers all of your forehead. It spends its life holding up your eyebrows and making you look surprised when your wife tells you how she spent the credit card. Your doctor should know never to treat it on its own as everything will fall. This look is known as the FRED: forehead right eyebrows down.

In general the fronties are easy to treat as long as the doctor stays at least 3 to 4 cm above the brow and goes all the way up to your hairline. If there are lines close to your brow this is a bit like sailing a hip too close to a rocky shoreline and it is advisable to leave them alone rather than chance sinking the ship. If the doctor needs to go a little closer to shore, he can compensate by keeping his ship in safe waters by giving a little more Botox® or Dysport® to the prossies, which are located at the top of your nose in the centre of your forehead.

When treating the crow’s feet area, you have to be careful of puffiness underneath your eyes. These orbies hold in your fat pads as well as letting you wink at strangers. If your doctor is heavy handed in this region you may find out quickly that you have acquired a new look, the PENAL: puffy eyes, no adjacent lines. It would be no use winking if the stranger sees those tired looking eyes.

Burkitts Lymphoma and the Epstein-Barr Virus

Denis Parsons Burkitt was born in Enniskillen on Feb 28 1911, in the same year that the Norwegian explorer Roald Amundsen became the first man to reach the South Pole. Amundsen had arrived there only five weeks before the British expedition led by Capt. R.F.Scott and a few days before Capt.L.E.Oates from the 6th Inniskilling Dragoons walked out his tent in the Antarctic and died rather than be a burden to his colleagues.

They had sailed from port in Dunedin N.Z. where I myself once had a position with the naval reserve. Burkitt was deeply influenced by the courage of these explorers and intended that he would travel on completion of his medical studies. He joined the British Army as a surgeon and ended up serving in Europe during the Second World War. The War also held up his studies but he finally obtained a M.D. from Trinity College in 1946. He then decided to join the colonial service and became a government surgeon at Makerere University in Uganda in the same year.

In the late 1950′s as the cold war was developing, Burkitt sent out hundred of questionnaires to doctors and travelled some 16,000kms across Africa to study hospital records on a form of malignant facial tumour that he was noticing in young boys under twelve years of age. He discovered that the tumour occurred mostly in Uganda and Kenya in areas above 500ft altitude but didn’t occur in the islands around Zanzibar.

It was also predominant along the coast and rivers but didn’t appear to follow population densities. Burkitt stated that these factors suggested a vector (mosquito) was responsible for transmission of a disease agent (probably a virus). His research demonstrated that the lymphoma was endemic only in the mosquito-ridden equatorial areas and occurred in young children whose immune system was depressed by chronic malaria.

In 1961 he had gathered enough epidemiological data to present his findings to a group of doctors in the Middlesex Hospital. He was probably influenced in returning to speak in London by another doctor , Hugh Trowell who had been in his clinic studying the effect of malnutrition in starving African children. They both noted that patient’s in Uganda never appeared to suffer from diverticulitis or colon cancer and they supported the work of Dr. A. Walker from South Africa who postulated the beneficial effects of the native diet. One of the people who was present at the medical meeting was a Londoner called M.A. Epstein.

He had studied medicine in Cambridge University and did his postgraduate training at the Middlesex. Epstein decided to investigate this unusual lymphoma for causative viruses. He was helped in this quest by another Londoner, a scientist called Yvonne Barr. Before long they discovered that they could culture these cancerous B cell lines indefinitely and that they all seemed to contain what biological tests proved to be a new Herpes virus which they called the Epstein-Barr virus.

Around this time Werner and Gertrude Henle discovered an antibody test that was specific for the antibodies formed by the EB Virus. It caused a lot of consternation when a technician who was suffering form glandular fever proved positive for the test and his cell grew the same virus which had previously been isolated by the London team. The new virus was found not only to be the cause of infectious mononucleosis but also to be associated with different pathologies, including a form of nasopharyngeal carcinoma common in southern China.

The Story of the Discoverer of Penicillin

Alexander Fleming was born near Darvel in Ayrshire, Scotland in 1881, a few weeks after Sheriff Pat Garrett killed his outlaw friend Billy the Kid in a house in Fort Sumner, New Mexico. He was the seventh of eight children who grew up on a large isolated farm, and who moved to London after the death of their father. His older brother Tom had a medical practice near Regent Street and apparently encouraged him to go to the nearby Polytechnic School and enter business. He spent four years in a shipping office, but eventually became bored and decided to use his qualifications to study medicine. He had a choice of many medical schools in the area and only chose St. Mary’s, because he had once played water polo against them.

In 1900, Fleming joined a Scottish regiment, intending to fight in the Boer War, which was being fought between the British and the Afrikaners of the Orange Free State and the Transvaal. It is known that he never actually went to South Africa, but instead used the time to improve his skills in shooting, swimming, and water polo. After the war ended, his uncle died and left him 250 pounds which his brother encouraged him to put toward the study of medicine.

In 1905, he was pursuing a career in surgery, as Albert Einstein was trying to convince the world that light should be considered as a stream of tiny particles. Meanwhile back in St. Mary’s, the Captain of the Rifle Club was concerned that if Fleming became a surgeon he would have to leave the hospital and his team would lose their best marksman. The Captain worked in the Inoculation Service of the hospital and he convinced Fleming to switch over to bacteriology in an effort to save his team. The unusual career move meant that Fleming would stay at St. Mary’s for the rest of his career. He qualified with distinction in 1906 and began research under Sir Almroth Wright, who is remembered as a pioneer in vaccine therapy.

He was awarded a Gold Medal in Bacteriology in 1908, and became a Fellow of the Royal College of Surgeons in 1909, the same year that the German chemist Paul Ehrlich developed a chemical treatment for syphilis. Erlich had tried hundreds of compounds, and the six hundred and sixth worked. It was named salvarsan (meaning “that which saves by arsenic”). The only previous treatments for this disease had been so toxic that they often killed the patient. Fleming became one very few physicians to administer salvarsan by the new technique of intravenous injection. He soon developed such a busy practice he got the nickname “Private 606.”

In 1914, an assassin gunned down Archduke Francis Ferdinand in Sarajevo, and started the First World War. Fleming convinced his staff to go to France and set up a battlefield hospital laboratory. He was horrified by the vast numbers of soldiers who died from simple infections caused by exploding shells and became convinced that there must be another chemical like salvarsan that could fight microbe infection. When the war ended he returned to St. Mary’s, determined to find an effective antiseptic. In 1921, he discovered an important bacteriolytic substance, which he named Lysozyme. After returning from a holiday in 1928, he observed the dissolving of staphylococci by a Penicillium mould, and the rest of that stroy is well recorded history.

It is less well known that the young Irish mycologist C. J. La Touche worked in the laboratory below Fleming and that he isolated the powerful penicillin-producing strain of mould (Penicillium notatum). Because his laboratory lacked a fume hood, the room was contaminated with these spores, which probably wafted up to Fleming’s laboratory. It is also of interest that despite the myth, Fleming usually left his door open because it was actually almost impossible to open his window. He named the active substance penicillin and found that it prevented growth of staphylococci, even when diluted 800 times. In 1915, he married Sarah Marion McElroy of Killala, Ireland, who died in 1949. Their son is a general medical practitioner. Fleming married again in 1953, to Dr. Amalia Koutsouri-Voureka, a Greek colleague at St. Mary’s.

In 1929, Josef Stalin became dictator to the Soviet Union. It was the same year that Fleming published a report on penicillin and its potential uses in the British Journal of Experimental Pathology. His paper apparently raised little interest. He worked with the mould for some time, but found out that refining the active substance was a difficult process better suited to chemists. The work of purification was taken over by a team of chemists and mould specialists, but the research was terminated when several of them died or relocated. The battlefield infections of World War II revitalised interest in penicillin and the scientists Howard Florey and Ernst Chain eventually purified the compound.

Alexander Fleming was knighted in 1944 in recognition for his contribution to the development of Penicillin and he was awarded the Nobel Prize in 1945. He was appointed Rector of Edinburgh University in 1951, and it is less well known he was also elected Honorary Chief Doy-gei-tau of the Kiowa tribe in the same year. He retired in 1954 and was buried in St Paul’s Cathederal a year later. It was 1955, and across the Atlantic, Walt Disney was preparing to open his first theme park, Disneyland.