A Facelift for a Two-Year-Old: Alternative Use of Facelift Approach, to Achieve Serial Excision of a Medium Sized Congenital Naevus, in a Two-Year-Old Patient

Historically, face-lifting consisted of elevating the skin, placing it under tension to reduce the wrinkles, resecting the skin needed to accomplish this, and then securing the resected edges. However, over time, facelift surgery evolved beyond the Dorland’s definition of “rhytidectomy” (excision of skin for the elimination of wrinkles [1]) and various different techniques and indications have been described.We report of the pre-auricular facelift approach, as described by Skoog [2] for alternative use: The excision of a giant cell tumour, utilizing this facelift technique to achieve serial excision from a two year old, male patient’s face. This has resulted in a satisfactory aesthetic outcome and scar alignment in favourable area as well as excision of a significant part of the lesion, and awaiting further serial excision for completion.

Identifying and managing naevus dysmorphia in clinical practice

Naevus dysmorphia is a form of appearance concern/body image dissatisfaction, which describes a preoccupation withthe appearance of a clinically small melanocytic naevus. The naevus is perceived by the patient to be disfiguring. Such perception leads to maladaptive behaviours and is often associated with low mood, as well as high levels of anxiety and social avoidance. Affected individuals form a diverse group. However, what they have in common is that the distress experienced is disproportionate to the objective visual appearance of the mole. There is a range of severity of the impact on the individual's well being. Naevus dysmorphia may or may not be a cutaneous manifestation of body dysmorphic disorder(BDD). It is essential that patients with naevus dysmorphia are identified and distinguished from patients requesting removal of a mole for other uncomplicated cosmetic reason. Patients with naevus dysmorphia can be challenging to treat and communicate with. Surgical excision of the naevus will not address the underlying psychopathology and so it may not result in long-term positive outcome. Ideally, a detailed psychological assessment and formulation can be made potential y followed by psychological therapy tailored to the needs of the individual. A therapeutic trial of appropriate psychopharmacological course may be indicated in certain cases, e.g., when symptoms of a depressive disorder, anxiety disorder or BDD are present. A case series of 10 patients with naevus dysmorphia is presented, in order to highlight the above issues.