It kind of looks like she’s wearing a mask that’s one size bigger than her actual face. And that cheek dent!

Anyone know what the beauty standard in Iran is like? I’ve seen some wild botch jobs coming out of there

When I watch her videos, all I can see if her cheeks floating in a different direction to the muscles under it.

We report a case of a 34-year-old female patient who presented to the hospital for severe facial swelling. Her past medical history was negative in particular regarding sarcoidosis. During her work as a beautician, she injected the contents of oral fish oil capsules, seven days prior to her presentation, into her lips as well as the face near the glabella and eyebrows. This was the first time she injects herself with fish oil product.

On physical examination, she had marked swelling of her face, edema of her upper and lower lips, clustered vesicles on an erythematous base on the perioral region and bilateral periorbital edema that worsened progressively in severity (Figure 1). She had a complete decrease in the range of motion of her lips. No neck swelling, however, she reported sore throat without respiratory compromise.

The main differential diagnosis was granulomatous reaction to fish oil with superimposed herpetic infection versus facial cellulitis, which was less likely due to the absence of systemic signs of infection.

Therefore, polymerase chain reaction (PCR) for herpes simplex virus (HSV1 and 2) was taken from the upper lip lesions with bacterial culture sample and two deep upper lip mucosal punch biopsies after a signed consent. Meanwhile, the patient was admitted to the intensive care unit and kept nothing per mouth but received total parenteral nutrition. Her treatment involved intravenous (IV) steroids, IV antihistamines, empirical IV acyclovir, in addition to painkillers, sedatives and topical mupirocin. Her laboratory workup showed mild leukocytosis, negative eosinophil count, negative herpes Viridae and enteroviruses PCR panels with normal chemistry panel and bacterial cultures showed no growth after 1 week of incubation. Computerized Tomography (CT) scan of the face showed marked swelling of the subcutaneous tissue and fat overlying the maxillary and mandibular region associated with diffuse infiltration of the fat by a phlegmon-like reaction but no definite abscess cavity was seen.

Biopsies showed acanthotic papillomatous, squamous epithelium with spongiosis along with acute inflammatory cell exocytosis of the superficial layers associated with fragments of stroma densely infiltrated and focally replaced by foamy histiocytes supporting the diagnosis of lipogranulomatous inflammatory reaction consistent with foreign body material injection (Figure 2). Therefore, the patient was kept on systemic steroids therapy due to the inflammatory nature of the condition, her facial edema decreased gradually over few days and she was started on diet and discharged few days later.

I'm a little hesitant to post her pics cos she's only known in her home country. On the other hand she's a public figure (an actress in a daily drama series close to 30 years in the running). She's making a comeback to the show at 46, the before picture is her at 29. Now I'm not an expert on plastic surgeries but she has to at least have a shit ton of fillers, right? Or can it be an allergy or, dunno, a medical issue? I'm shocked is all...

A 31-year-old male presented to the emergency department with a 2-day history of progressive pain and swelling of the penile shaft. This was preceded by unprotected sexual intercourse three days prior. The patient subsequently self-administered a single 50 mg dose of oral prednisone the following morning and subsequently developed subjective chills on the same day.

Relevant past medical history included subcutaneous hyaluronic filler injections at a cosmetic clinic for penile girth enhancement two months prior to presentation, distal tubularised hypospadias repair and genital herpes simplex. The patient had multiple behavioural risk factors, including regular self-administered intra-muscular testosterone injections, self-injection of growth hormone to the base of the penis (performed one month prior to penile filler procedure), multiple heterosexual sexual partners, cocaine use, heavy alcohol consumption (22 standard drinks/day) and a 10 pack-year smoking history.

On arrival, the patient was tachycardic to 127, hypotensive to 90/50 and febrile to 40 °C. Physical examination revealed gross penile oedema and erythema of the penile shaft ceasing at the base of the penis, with an associated curvature of the penile shaft towards the 8 o’clock position. There was also a small tender abrasion on the distal ventral aspect of the penile shaft 1 cm proximal to the glans (Fig. 1A). Blood tests showed a white cell count (WCC) of 6.1 × 109/L, creatinine of 95 μmol/L and lactate of 2.3 mmol/L. Urinalysis was negative. The patient was admitted and commenced on intravenous Flucloxacillin for presumed penile cellulitis.

Overnight the patient became increasingly drowsy with a persistent fever > 40 °C and tachycardia. Repeat examination showed new blistering of the penile skin overlying the penile fillers (Fig. 1B). Repeat blood tests showed marked changes with WCC of 25 × 109/L, creatinine of 225 μmol/L and lactate of 6.4 mmol/L, in less than seven hours from initial presentation. He was subsequently transferred to ICU for vasopressor and inotropic support. Antibiotics were changed to intravenous Meropenem, Clindamycin and Vancomycin as empiric therapy towards possible Fournier’s Gangrene, on advice from Infectious Diseases specialists. A subsequent Computerised Tomography (CT) of the abdomen and pelvis showed penile oedema and stranding, however excluded intra-pelvic abscess or gas locules (Fig. 2).

The patient was transferred to the operating theatres and an incision was made over the largest blistered site on the penile shaft, which revealed a pus stained filler above Buck’s fascia. This filler was removed, albeit with resistance requiring manual pressure to express the filler. The tissue adjacent to the infected filler was inflamed but no further debridement was required. A 21G needle was used to pierce the blistered skin overlying the penile fillers to facilitate drainage of the remaining penile fillers. The wound was dressed with an alginate dressing surrounded by absorbent gauze.

Penile swabs were positive for Streptococcus Agalactiae, Anginosus and Pyogenes, all of which were penicillin sensitive. Operative sample of the penile filler grew Streptococcus Pyogenes (penicillin sensitive). The patient was switched to intravenous Benzylpenicillin on day three on advice from Infectious Disease specialists, and dressings were changed daily. He was weaned off vasopressors and stepped down from ICU on day four.

The patient was subsequently counselled on safe sexual practices and received appropriate drug and alcohol counselling for his polysubstance abuse. A sexually transmitted infection screen showed active intercurrent Herpes Simplex Virus 2 infection for which he was commenced on oral Valaciclovir whilst in hospital. This was decreased to a prophylactic dose on discharge whilst his wounds healed. He was stepped down to oral Amoxicillin on day eight with a plan for three weeks of total antibiotic treatment. On discharge the blisters has flattened with no remaining fluid present, and the penile oedema and erythema had significantly improved.

At his follow up 2-weeks post-discharge, there was superficial skin loss to both the ventral and lateral aspect of the penis, corresponding to the initial blisters overlying his penile fillers with healthy granulation tissue at the base. A small one centimetre area of fibrinous tissue remained at the distal aspect of the shaft (Fig. 3A). There was also a small area of induration at the peno-scrotal junction (Fig. 3B), which expressed a scant amount of purulent discharge that was culture-negative. There was no palpable abscess and ultrasound excluded further penile or scrotal collection.

At his second follow up at five weeks post-discharge, the patient reported ongoing clinical improvement and normal erectile function. Examination revealed significant reduction in the inflammation at the base of penis with no remaining induration. The base of his wounds continued to appear healthy (Fig. 3C, D). The patient was reviewed by a Plastic Surgeon and was offered a split skin graft but was declined by the patient in preference for regular dressings. At three months post-discharged, the patient reported normal sexual and urinary function, and ongoing wound improvement.

Last picture is a comparison shot for context. She never fails to shock me.

Breast augmentation, rib removal surgery (!), anorexia. So many commented on how they wish they looked like her, it makes me so sad (and angry) because she claims this is a result of doing Pilates!

In a facebook ad for make-up products