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Medscape
11 hours ago
- General
- Medscape
Woman With Dysphagia, Regurgitation, and Throat Burning
Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians, but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please email us at ccsuggestions@ with the subject line "Case Challenge Suggestion." We look forward to hearing from you. Background and Initial Presentation A 56-year-old woman presents to the clinic with a 6-month history of intermittent dysphagia, primarily with solid foods, describing a sensation of "something stuck in her throat," along with a burning sensation in the throat and esophagus. She denies difficulty swallowing liquids. Her symptoms have remained relatively stable without significant progression over time. She also experiences gagging, coughing, nocturnal regurgitation, and congestion. She has a history of acid reflux that was treated with a proton pump inhibitor, which she is no longer taking. She takes antacids intermittently with minimal relief. She has a history of congenital hiatal hernia, which was repaired at age 11 years. She denies any fever, chills, chest pain, shortness of breath, abdominal pain, unintentional weight loss, hemoptysis, nausea, vomiting, or blood per rectum. On physical exam, the patient's abdomen was soft, non-tender, and non-distended. Her head, eye, ear, nose, and throat exams were also unremarkable, without a palpable neck mass. The rest of the physical exam was unremarkable. Basic labs were ordered, and the results, including thyroid function panel, were within normal limits. Workup Results The patient was prescribed a proton pump inhibitor and referred to a gastroenterologist. Given her persistent reflux symptoms without improvement despite anti-reflux medication, she was sent for esophagogastroduodenoscopy (EGD) to help stage her severity of reflux, to assess for laryngopharyngeal reflux, and to look for underlying structural abnormalities, such as recurrence of hiatal hernia. EGD also helps to evaluate for other potential, although less likely conditions, such as reflux esophagitis, Barrett's esophagus, or esophageal cancer. While ECG may be helpful to evaluate for potential atypical presentation of cardiac causes for her symptoms, it is unlikely given her lack of risk factors such as diabetes or history of cardiac disease. Chest x-ray assesses lung disease and bony structures but is unlikely to provide the anatomical detail required to provide any useful information. Esophageal manometry is useful for assessing for motility disorders and is generally used for esophageal symptoms not diagnosed on EGD or for patients undergoing anti-reflux surgery. EGD revealed mild gastritis without recurrence of hiatal hernia. Biopsies were negative. There was also no sign of laryngopharyngeal reflux, with no presence of pooling or residual material in the hypopharynx. Manometry was offered to the patient, but she opted for additional imaging. To better assess other anatomical factors extrinsic to the gastrointestinal tract that may be causing the patient's symptoms, she underwent neck ultrasonography, which revealed a small right thyroid nodule (0.7 cm X 0.5 cm X 0.8 cm) without any concerning features. She then underwent neck CT, which demonstrated an aberrant right subclavian artery originating from the aortic arch distal to the origin of the left subclavian artery, passing posterior to the esophagus while coursing toward the right. In addition, there is a fusiform aneurysmal dilatation of this aberrant right subclavian artery proximally, measuring approximately 1.6 cm in diameter, compared with a diameter of 0.6 cm more distally along the right subclavian artery (Figure 1). Figure 1. Neck CT showing aberrant right subclavian artery. The CT also demonstrated the sub-centimeter enhancing soft-tissue nodule within the right thyroid gland. No other pathologically enlarged or abnormally enhancing cervical lymph nodes were evident. Discussion Dysphagia lusoria is a rare condition caused by compression of the esophagus by an aberrant retroesophageal right subclavian artery. The right subclavian artery normally takes off as a branch of the brachiocephalic trunk, the most proximal great vessel of the aortic arch. Aberrant right subclavian artery (ARSA), however, takes off distal to the left subclavian artery, which is the most distal branch in a normal aortic anatomy. ARSA is the most common aortic arch anomaly, with a reported prevalence of 0.7%-2.0%.[1] It is caused by the involution of the right fourth vascular arch and proximal right dorsal aorta and the persistence of the seventh intersegmental artery originating from the proximal descending thoracic aorta.[2] Esophageal cancer is unlikely, as no masses were found on EGD. Dysphagia megalatriensis is also unlikely because she has no history or clinical signs of cardiac disease (eg, mitral valve pathology or atrial fibrillation). Zenker diverticulum, or a weakening of mucosa and submucosa in the upper esophagus, can present with globus sensation or dysphagia but also generally presents with halitosis and is usually a disease of the 7th or 8th decade of life. Neither ultrasound nor CT demonstrated this anatomical pathology. Thyroid goiter causing compressive symptoms is usually of significant size and can be appreciated on exam. The clinical presentation of dysphagia lusoria has significant heterogeneity. The most common symptoms are dysphagia, dyspnea, and chest pain.[3,4] It is more common in women than in men, with the mean age of symptom onset at 49.9 ± 19.4 years.[2] It is frequently associated with a Kommerell diverticulum, a dilation at the origin of the aberrant artery. The diverticulum results from failed regression of the previously mentioned fourth dorsal arch. The natural history of Kommerell diverticulum is unknown owing to the rarity of the condition, but both dissection and ruptures have been reported. In summary, dysphagia lusoria results from compression of esophagus by the retroesophageal aberrant right subclavian artery, which is an anatomical variant. Surgical intervention is generally indicated for patients with compressive symptoms. In asymptomatic patients, there is no established indication for repair. Some have proposed repair if the diverticulum reaches a certain size, with surveillance in asymptomatic cases. Some groups recommend surgical repair in all encountered cases of Kommerell diverticulum owing to a high rupture and dissection rate. In a single-center study of 45 patients, the average growth of Kommerell diverticulum was 1.45 ± 0.39 mm/year, with hypertension being the single statistically significant factor promoting growth.[5] The reported rupture and/or dissection rate at first encounter ranges broadly, from 0% to 50%.[1] A contained rupture of Kommerell diverticulum would lead to aortic hematoma. There are no known associations between Kommerell diverticulum and esophageal cancer. Kommerell diverticulitis has not been reported. Diverticulitis, or inflammation/infection of the diverticulum, generally occurs in the colon. It is caused by obstruction, leading to venous congestion, inflammation, and infection. This pathophysiology is unlikely in a vascular structure with active flow such as the Kommerell diverticulum. Although dissection can occur with Kommerell diverticulum, leading to limb ischemia in flow-limiting cases, it would affect the right arm, not the left. Surgical repair of an aberrant right subclavian artery should achieve two main goals: (1) exclusion or repair of any associated Kommerell diverticulum, which may pose a risk for aneurysmal degeneration or rupture, and (2) preservation or restoration of adequate perfusion to the right upper extremity, typically by revascularizing the right subclavian artery.[1,5] Traditionally, this had been done via an open approach, which requires thoracotomy or sternotomy. The diverticulum is then repaired with graft replacement of descending aorta, resection of aneurysm, or aneurysmorrhaphy. The right arm is then revascularized with either carotid to right subclavian bypass or transposition or re-anastomosis of right subclavian artery onto the aortic arch.[1] With the advancement in endovascular techniques in the last two decades, a hybrid approach is becoming more common. It utilizes thoracic endovascular aortic repair (TEVAR) to exclude the Kommerell diverticulum, along with embolization or extra-anatomic bypass or transposition of the right subclavian artery, as mentioned above. This approach spares the patient from the more invasive thoracotomy or sternotomy, as the open portion can be performed via neck incisions only. One potential complicating factor to endovascular repair is the small distance between the origins of the aberrant right subclavian artery and the left subclavian artery (Figure 2), preventing a good proximal seal zone of the stent graft without covering the left subclavian artery. In these cases, such as in this patient, a more advanced aortic stent graft can be used, such as a branched aortic endoprosthesis. This would allow the stent graft to extend into the left subclavian artery to maintain perfusion, achieve adequate seal, and exclude the Kommerell diverticulum (Figure 3). Alternatively, additional extra-anatomic bypass or transposition of the left subclavian artery can be performed. Figure 2. Measurements of distance between aberrant right subclavian artery and left subclavian artery. Figure 3. Kommerell diverticulum before and after repair by stent (a before repair; b and c after repair). The other answers do not completely address the underlying problem, which include both the extrinsic compression of the esophagus by the retroesophageal aberrant right subclavian artery and the Kommerell diverticulum. An esophageal stent would exert additional force on the esophagus that may exacerbate the patient's symptoms, and it does not address the diverticulum. It will also put the patient at risk of stent erosion or migration. Percutaneous gastrostomy tube insertion would help with supplemental nutrition if the patient had severe dysphagia. However, this patient does not have severe dysphagia, and it would not relieve her symptoms or address their underlying cause. Right carotid to subclavian bypass without aortic repair will not exclude the diverticulum, which will continue to be pressurized by the aorta. This patient underwent TEVAR with branched aortic endoprosthesis into the left subclavian artery, followed by right subclavian to right common carotid artery transposition. She had an uneventful postoperative recovery and was discharged after 3 days. At 1-month follow up, her symptoms had resolved, and CT angiography showed excluded and regressed Kommerell diverticulum with patent subclavian arteries bilaterally. Given the rarity of the condition, no guidelines have been developed for follow-up surveillance after repair of aberrant right subclavian artery and Kommerell diverticulum utilizing a hybrid open and endovascular repair. However, because TEVAR was performed, the patient is at risk for the same postoperative complications as when it is performed for other aortic pathologies, so similar approaches can be taken in terms of postoperative surveillance. Current Society for Vascular Surgery guidelines recommend contrast-enhanced CT angiography at 1 month and 12 months after TEVAR for repair of descending thoracic aortic aneurysms, and then yearly for life, with consideration of more frequent imaging if an endoleak or other abnormality of concern is detected at 1-month follow-up.[6]
ABC News
2 days ago
- Health
- ABC News
Botox and fillers – facing up to the new normal
Yumi Hey ladies, before we start, I want to ask you a favour. We're looking for feedback. I'd love to know what you think about Ladies, We Need To Talk and the sorts of things you want to hear about more on our show. What do you love? What topics are close to your heart? What things have we missed? And what would you love to hear less of? We've posted a survey on the Ladies, We Need To Talk website and in the show notes of the episode that you're listening to right now. If you could fill it out, it will help us to understand you more and help us to fashion the best possible episodes in future. Please take five minutes out of your day to fill out the survey. You'll be helping our show to be more your show. It's completely anonymous, so you can be brutally honest. Just don't say you love me because it'll make me cry. And thank you. Clinician So we'll probably need at least 30 units, but we'll see how we go. Should I take that personally? Yumi This is a friend of Ladies We Need To Talk who wishes to remain unnamed. She's at her local clinic getting a cheeky little bit of Botox. It's 9am on a workday. Clinician These ones can hurt a little bit because it's right where the nerve runs. But it only hurts for a second, as you can attest. OK, frown again. Now I'm doing the right side of the same corrugated muscle. Relax. So again, two injections on the right side. Anonymous friend Oof, that one hurt more. Clinician Yeah, that's right on the nerve. Yumi Just like women go to the hairdresser to get their regrowth covered, more of us are turning to injectables and other treatments than ever before. And just like covering your grey, it is about looking younger. Clinician And now I'm going to do the crow's feet. Just relax for me into a muscle called ubicularis oris. And that's the one... Yumi These treatments are really accessible. Our nameless friend got her face Botoxed and was back at her desk by 10am after handing over a not insignificant amount of money as tribute. So why are more women getting tweakments? And what motivates us to alter our faces? Polly I don't want to be an old lady and I don't want to look like an old lady. Sam I don't want to look 20 or 30 as a 40 year old. I just want to look good for a 40 year old. Jasmine If you're seeing a lot of the same faces and people are also then liking and commenting on those faces on social media, kind of endorsing those beauty ideals, then people can take them on and then also make comparisons. Polly I'd say probably 75% of my girlfriends would be getting tweaks. There is a teardrop shape to all my girlfriend's faces that I can see that's similar. So our faces start to look alike. Sam When you see young women looking in the mirror and thinking, oh my lips just aren't big enough, my cheeks just aren't big enough, my face doesn't look the way I want it to, I think we have lost a bit of track as to what is normal. Yumi I remember the first time I saw a regular non-famous person who had noticeable filler in her face. This was about 20 years ago at a work lunch and a woman there who worked in PR but was not public facing had lots of filler and an immobile forehead. I was a little transfixed and it was so weird to me at the time. Prior to that I was only ever seeing work on people like Nicole Kidman and Madonna. Yes, we were used to seeing celebrities and wealthy weirdos with blasted skin and implausible lips. But a normie? This was new. Fast forward to now and it feels like every second woman I know is getting Botox or fillers or micro-needling or ablative laser or, or, or, or. And these treatments, or tweakments as they're known, are big business. When we're talking about tweakments we mean anything that's non-surgical for the face. According to APRA, the Australian Health Practitioner Regulation Agency, we are now spending more than a billion dollars a year on non-surgical treatments and a lot of those are happening from the neck up. It's not just women in middle age and older who are spending big. A recent survey from the International Society of Aesthetic Plastic Surgery found that almost a quarter of people who got Botox around the world were between the ages of 18 and 34. And hey, no judgement here if you get face stuff done or not. We're just interested in what is pushing us to push clinicians to push needles into our faces. I'm Yumi Stynes, ladies. We need to talk about whether tweakments are the new normal. Sam I started having these injections at 19. Yumi Sam is a working mum of three living on the Gold Coast and at 40 years old has now been having tweakments for over two decades. The first time she got Botox as a teenager was to treat her migraines. Sam The wonderful side effect was that I really liked what it did for my appearance. I did notice that the expression lines on my forehead were really reduced and I liked it. And I thought, oh, OK, I want to see what that does. Yumi Happy with this smoothing side effect, Sam started getting Botox around her eyes as well and then gradually in other areas of her face as she got a little older. Sam And now I have a significant amount of treatment that has nothing to do with headaches. So when did you start getting filler? Um, mid-20s, I got filler around my lips for the first time. My partner, who is now my husband, didn't even notice. Perfect. That's always been my approach. So really soft, gentle little enhancements that kind of just push that age line back a little bit without going, oh, I can see your lips from across the street. Yumi Yeah. Sam It's terrifying. Yumi After a lip tweak, Sam started getting filler in other parts of her face too. Sam I have had filler over the years in my jawline, in my temples and in my nasolabial folds. Not all at once at different times. Another treatment that I get is something called Profhilo, which is injected into the face as a regenerative type product. It's not a filler, but it regenerates the skin and the tissue. Yumi When you first started choosing to do these treatments for beauty reasons, did you sort of have a threshold where you're like, okay, I will stop at X or I won't go beyond Y? Sam I think that that's an ever evolving, I guess, finish line. Because as you age, you have to have treatments that are age appropriate. Also, as you gain and lose weight, having had two pregnancies, you know, your face changes as you age. So I think for me, it was about having really considered discussions with the practitioner that was working on me and taking advice and really looking to make sure that I looked like me. They wasn't changing my appearance, that I was simply softening things or even preventing things. I don't like it when people don't look like themselves. And I don't like it when you can tell that people who had work done. If someone who knows me sees me and thinks, oh, oh, you look different. That is the line. That's one I've always been really aware of, is wanting to look natural and like myself. Yumi Sam lives in a part of the world where a specific and highly curated look has become the norm among some people. Now, I know this look. I see it in my feet and when I'm walking down the street. It's almost like there's a very short catalogue of the perfect face that women are choosing from. Big lips, straight, narrow nose and glossy skin. And they somehow end up looking the same, like tweakment Barbies. Sam There is a uniform on the Gold Coast right now. It is tiny little gym shorts that are high-waisted. It is a matching bra crop top. They have to be pastel, apparently. No other clothing is to be worn except for high ribbed socks and runners with a very tight ponytail and your face must be completely overdone. I feel like half of the Gold Coast has dysmorphia and we've lost track of what's normal. Yumi But what is normal? It used to be normal to watch older women wrinkle and sag and quote, look their age. Now we're living in a new normal where a 20-year-old gets so-called preventative Botox and a 50-year-old has a face as smooth as the skin on my custard. But how the hell did we get here to this tweakment heavy normal? And will the quest for perfection ever stop? Jasmine Social media use is linked to interest in cosmetic surgery and dissatisfaction with appearance and dissatisfaction with facial appearances. Yumi Dr Jasmine Fardouly is a psychologist and expert in body image and social media from the University of Sydney. She says the rise in social media means that we're now more focused on our faces than ever. Jasmine Before social media, a lot of the places where people consumed images and actually were faced with beauty ideals was in magazines and television. And a lot of the research in body image was really focused on weight and shape. When social media became popular, it also was at the same time that we had smartphones and cameras on our smartphones and then selfies became popular. And that meant that there are a lot more portrait images and a lot more images of people's faces on social media. Yumi As the focus has zoomed in on our faces, Jasmine says that unsurprisingly, we have become more critical of how our own faces compare. Jasmine And then Instagram brought in filters where people could very easily change their facial features to match a beauty ideal. Yumi Even though filters aren't real life, we can't help but compare ourselves. And research has shown that the use of filters is connected to an increase in cosmetic procedures. Jasmine If you're seeing a lot of the same faces and people are also then liking and commenting on those faces on social media, kind of endorsing those beauty ideals, those facial ideals, then people can take them on and then also make comparisons to the people in those images, judge themselves to be worse. And it's kind of like these processes that can make these filters have a negative impact on how people feel about their faces and their appearance generally. Yumi Wow. So where once we used to be quite fixated on our bodies, it's now much more about the face. Jasmine It's still about the bodies, but we're exposed to more faces. And there is a trend in the literature showing that facial satisfaction does seem to be really important to consider with social media. So there potentially is a bit more of a shift to facial beauty ideals since social media was created. Yumi That's fascinating. And the idea of filters is fascinating because it's not like you really engage or care that much about what filter you use. You just whack on a filter and then suddenly you're immersed in this sort of way of thinking about your own face. Jasmine In some filters, you can just press a button and then there's of course, there's other apps like Facetune where you can put more specific focus on aspects that you want to change. But the ease with which these filters are available is an important thing to consider. And I think that's why it's also so widely used. Yumi And Jasmine, what does the current beauty ideal that filters can help create? What does that look like? Jasmine Generally, in our research, we find that kind of the ideal face has larger eyes, a smaller nose, sometimes straighter nose, larger lips, less wrinkles, clear complexion. There is some research suggesting there's like Eurocentric beauty ideals and Western standards and lighter skin. Yumi Do you think we're more dissatisfied than we used to be with how we look? Jasmine So there is maybe some evidence that we're more dissatisfied with how we look, but it has been a problem for a very long time. It is not a new problem. And the reasons it's harmful is similar. I come back to the same two things that ideals are really specific and unattainable and the pressure people put on appearance is being important for them. That has been the same for a long time. But with social media, we're just exposed to so many more faces, so many more people's match these beauty ideals, just the sheer volume. And then of course, there's all the context, there's the comments and the likes and all of that, which can really emphasize that as well. Yumi Okay, so let me just say this back to you. If you're seeing a sea of beautiful looking unattainable faces, you feel like that's quite normal and you fit, you're outside of this population as an outlier or an ugly person. Jasmine Yeah, I mean, that's the kind of comparison aspect of it. You think that most people look more attractive than you, whereas it's not the same when you go offline. Yeah, so we've got studies that have shown that as well. In person, they're more varied. So some people might think that others look more attractive than them, but some are similar and some might be perceived as less attractive. On social media, because people do present this most attractive version of themselves, research shows that most of the time people think other people look more attractive than them and particularly in regard to facial appearance. Polly I don't want to be an old lady and I don't want to look like an old lady. Yumi This is Polly. She's 62 and started getting Botox when she was 47. Polly So when I first went, I said to the doctor, I just want to feel fresher. And I was single, nearly single. And I wanted a boost to confidence and maybe a boost to fun and a boost to there's still life in me yet. And maybe it was a preparation. It was a part of the mating game. I don't know. I haven't thought about that. Yumi Well, let's unpack that a bit, Polly, because you mentioned being single in the absolute same sentence as starting to get things done. Yeah, maybe. So surely that must play. Polly It must. I didn't think very much about beauty when I was a lot younger. I had a mum who never thought about beauty. She was almost a natural feminist, didn't shave her legs, didn't shave her underarms, didn't even think about it, never wore makeup. I actually thought I was a really hairy person until I was about 21 and understood that everybody else shaved their legs, shaved their bikini lines. I didn't even know that. I didn't know that. Yumi So how, Polly, did we get from this young girl and a young mum to here where you're in the studio looking at me to talk about tweakments? Polly I don't get tweakments to be beautiful. I don't feel like any miracle is going to suddenly make me. And why would I suddenly look beautiful at my age in my early 60s? That's not even what I'm trying to achieve. I just get a little tweaky bit of Botox to stop frowning. Since I was a little girl, people, my mum used to say, stop frowning, stop frowning, stop frowning. I, even in all the way through my professional life, people would say to me, oh, you know, she's really scary. You know, those people are intimidated by you. And I think intimidated by me. Yumi You've said that you've never traded on your beauty. And I believe you. I know exactly what you mean. But can you be a woman in the world, age 60, age 16, without sort of needing to care about your face and how you look? Polly No, probably not. If I stopped caring, I'd stop caring about a lot of things, wouldn't I? You know, caring about your face and caring about how you present yourself to the world is part of, it's still part of my work. It's still part of showing up for my kids. It's part of showing up for my friends. Yumi The clinic that Polly has been going to for the last 15 years is chic. It's well lit. There's champagne if you want it. It's like a high-end day spa. She's been seeing the same doctor the whole time whom she trusts implicitly. Polly A lot of people, I think, go to clinicians and say, do this, do that. I never have. I don't talk to the hairdresser either. I say, you tell me. And the first thing she said is, well, how do you feel about your jawline? Because I think it's the first sign of ageing. And I said, I hate my jowls. I've always felt a bit jowly here. And she said, no, well, that's, you know, we can do something about that. And I was thrilled when I first, I can really feel when that starts to wear off the jowl line. People never talk about that, but I can really feel that. Yumi You're making me self-conscious. You haven't got any jowls. Touching it. Not yet. So she's looking at you while you're talking and she's politely sussing out your face. It's hard to be objective about your own face. So Polly has an agreement with her squad. Polly I have a pact with my girlfriends. There's no point in, you know, we have a pact. We have the same pact about clothes with my closest girlfriends. If you see me wearing something that I look terrible in, say, not really working for you. But when it comes to Botox or fillers, it was like no point saying just after I've had it done that it looks ridiculous. But just before I tell you I'm going again, that's the time to say don't do it again. I don't know if this is a common thing in aging. Maybe it is. My girlfriends and I, we go out to dinner and I'll see somebody my age, so another 62 year old, and I'll think, you know, we don't look like that. And then I look at us and think, of course we do. Of course we do. We must look exactly like they do. Because I totally get that old story of you walk past the mirror and you go, who is that person? Because I want my face and my clothes and the way I present myself to the world. To match what I feel on the inside. Yumi Yeah. Why don't we want to be seen as old ladies? Polly Because I'd probably fight just as hard against the image that an old lady that I should be sitting at home on my couch watching telly with a blanket over my knee. So I'm fighting that. That sounds great. Well, if you're watching a good show. Yeah, I think there's a lot of, I guess, it's staying relevant. It's staying part of. Yumi Culture? Polly Part of life. You know, I've got a place here. I'm not going to, maybe it's fighting that too. Fighting this idea that women of our age should be at home now, don't try and do this. Yumi Polly, is looking old connected to death for you? And is Botox about looking more alive? Polly Oh, that's a very interesting question. That may be actually right. Looking more alive may be exactly what I'm trying to do. Looking healthier, looking happier, looking more relaxed, looking more relevant, looking more part of life. I don't know if I associate it with death, but I guess I do associate it with ageing. And I do associate that with death. Yeah, so maybe. Yumi I want you to meet Tingting. When she was growing up, Tingting considered herself pretty. But as the child of Chinese immigrant parents, she was more focused on her studies than her face. Tingting The biggest honour I can give for my family is being that studious, good girl. And being a good girl kind of meant not paying attention to beauty. There's a Chinese saying, it's called 身体发福受之父母, means your body is given by your parents and hence, like you should take care of yourself. Yumi Taking care of yourself in this context means not tampering too much with your body, no tattoos, no cosmetic interventions. Trusting what nature and your parents gave you. My mum, who's Japanese, not Chinese, has the same idea. Why muck with what was divinely given to you? But for Tingting, nature didn't necessarily deliver when it came to mainstream beauty standards. I wanted to know what is the conventional look that everybody wants? Tingting White. V-face. Big eyes. Yumi This V-shaped face that Tingting is talking about, with a sharp jawline and defined cheekbones, has become popularised by K-pop stars and is seen as desirable, particularly in Asian cultures. A couple of years ago, Tingting gave up her safe job in engineering to dance to K-pop music on TikTok, where she makes money as an influencer. She soon realised that the better she looked, the more likes and follows she would get. Tingting got Botox for the first time. Tingting And I wanted to have a smaller face. And I've always had this insecurity. And I looked up, it's safe. Then it's like, why not? Yumi After this initial Botox experience, Tingting went to Seoul, the cosmetic capital of the world, with her Korean-born husband and mother-in-law for a glow-up family holiday. Tingting When I went to Korea, I did a little filler. The filler under my eyes is like the most painful thing I've ever experienced. Because your skin is so thin. Oh, yeah. So your skin was like, oh no, what's happening? Yumi So you went to Korea and your souvenir was some face zapping? Tingting Tax-free. Yumi Why was it tax-free? Tingting Because the government is pushing it. Yumi Stop it. Tingting Of course. Yumi What? Tingting And the other thing I did was this salmon sperm. Yumi Salmon sperm? Yeah. Tell us about it. What's salmon sperm? Tingting It plays a similar sort of role where they inject many, many, many, many holes in your skin. And then it's supposed to like activate your skin to be like, hey, we need more collagen. We need to self-generate collagen. So imagine it's just like skincare, but injected into your skin. That's how people sort of see it now. Yumi So tell me about becoming more online, more on TikTok. Has that made you more exposed to K-pop beauty ideals? Tingting For sure. Yumi Right. Tingting For sure. I think maybe 50% of the reason I glowed up like in one year. Yumi Oh, own it. Own it, Ting Ting. You had a glow up, yeah! Tingting Is because I'm creating content around this area. And it's kind of a positive reinforcement. If you're on social media and then you kind of look prettier and then you get the positive feedback and it's useful. Yep. So to grow your audience or just for your own ego boost, I'm not sure. Yumi Can I ask you, do you notice a difference? And I guess by difference, I mean a benefit in how people treat you when you kind of got the polish on. Is it worth it? Is there a payoff? Tingting The biggest benefit isn't from, for me, it's not people treating me different. It's just like me feeling better about myself. Yumi What about being an Asian woman online? Like, does that add an extra layer of pressure? To look pretty? To look perfect? Tingting Yeah, I think the Asian beauty standard is more uniform and more strict. Yumi Even though she's creating this kind of content herself, Tingting knows that it's easy to forget most faces online are probably not as perfect as they seem. Tingting Because what people see on the internet, especially celebrities, they have insanely perfect shape. Flawless, like actually flawless. And it's hard to take into the account that the photos are not perfect. The photos are edited. And when you look at yourself in the mirror, it's very easy to make comparisons with them and feel bad about yourself. Yumi Tingting has noticed a shift in how women talk about altering their faces. Tingting I remember back then when I was in uni, people would refrain from talking about plastic surgery and stuff. But now it's almost like, hey, what are you getting done? Like, what? Oh, really? Like, oh, what do you think about this? Yumi Remember Sam? She's the 40-year-old mum of three who started injectables at 19 years old. Sam has 12-year-old twin girls and wants them to know that a face like hers requires intervention and maintenance. Sam I'm very, very open with my kids about everything that I do in regards to my body and my face, because I want them to understand that it's not normal or natural to look a certain way. I feel like they'd be thinking, well, why don't I look like this or that in the future if I hid that information from them? Yumi Sure, yeah. Sam, you sound really confident about these choices that you've made and you sound happy in your skin and in your body. The next thing that's coming is aging, which really lands, I think, in your 40s and 50s, where you have no control. But there is a universal disapproval of us getting old. Sam Yes. I think ageism is definitely alive and well in our society. And I do also think that there is this kind of lack of respect for women ageing, because men age and we all go, ooh, silver fox. Women age and we go, ugh, old. And we're like, why? That's really unfair. Like, what's going on there? Yumi Would there be consequences if you stopped getting filler and Botox? Sam I mean, yeah. When I was pregnant, in both my pregnancies, I stopped. And then with breastfeeding, I didn't love what I saw. And there was lots of products that I couldn't use during pregnancy and breastfeeding, like a lot of the lasers and a lot of the topical stuff. So my skin quality really was impacted. Yumi So you didn't like it, but do you think there'd be professional consequences or social consequences, or maybe even romantic consequences? Sam No, not at all. I mean, my husband could not care less whether I do it all or don't do it at all. He was kind of quite resistant and a little bit like, what on earth? When I first started kind of divulging the treatments I was having when I was younger. But again, if I stopped doing it all, I can't see him caring at all. There's only so much you can do to make a 40-year-old look 30. And I don't want to look 30. I just don't want to look like an old 40-year-old. Yumi Sam, how open are you with the people around you about the stuff that you've had done? Sam Brutally. I'm really brutally, brutally honest. I think that if you are going to do stuff like this, you have to own it. Otherwise, I'm a little bit worried that you're not actually that convicted about doing it and that you have your own concerns and your own questions that you personally haven't worked through. If it's bringing up feelings of guilt or worry, then maybe you shouldn't be doing it in the first place. You really have to be on board 100 percent or maybe go back to the drawing board. Yumi How common is this in your friendship group? Like, are all your friends having Botox and filler and needling? Sam I mean, I have friends who have nothing at all. Like, literally not a single thing. And then I have friends who have more than me. And then I think probably most of my friends, I'd say probably 60 to 70 percent of my friends have at least some kind of treatments regularly. Polly I'd say probably 75 percent of my girlfriends would be getting tweaks. Yumi This is Polly again, our 62-year-old tweak veteran. She's seen the transition from tweakments being something that you were super secretive about to it becoming a casual, everyday brunch topic. 15 years ago, her cosmetic doctor had measures to keep the identities of her clients secret. Polly She used to have a back door. She used to have a back door. A back door and once or twice you'd see the celebs. And they spaced out the appointments so people didn't see each other. Right. I've noticed that's changed. Now you can sit in the waiting room with lots of people and we'd just all chat to each other. Yumi This openness also extends to Polly's friendship group. Polly I think that one of the nicest things about all our girlfriend groups is, you know, that's pretty much no judgment, whatever works for you. Yumi But Polly has noticed something else in this group of friends. Polly When you have a bit of Botox shaping your face, there is a teardrop shape to all my girlfriend's faces that I can see that's similar. And that has got to be from years of shaping of our jaw lines. So our faces start to look alike. What? I don't know that anybody else sees it, but when we take a photo of us all, we go, wow, you know, are we starting to look more and more alike, even though we used to look very, very different? Yumi Being candid about the work we do and the expenses we incur to fit in, to look and feel better, that openness seems kind of like an improvement over the past 20 years. No, do not shuffle me out your back door of shame, Dr. Face Zap. But if this new normal means we all look like a more generic version of each other than ourselves, our natural, weathered, sun damaged and uniquely wrinkly selves, then that seems like a bit of a shame. I don't love to think that as we age, we'll all be injected into a uniformity of face like an army of Joan Riverses. Dear God, it's evidence of gendered beauty standards still chasing us, even as we gallop past menopause, past trying to attract a mate and slow down to trot into what is meant to be our tranquil old age. I asked my mom, Yoshiko, who's in her 80s, if she wanted me to take her to get our faces injected with hot burning lasers next time she visited. And she said, why, Yumi, why? And ladies, I didn't have an answer. Hey ladies, we're planning an episode about what happens to your dating life when you decide to ditch the apps. Have you signed yourself up to a running club? Have you started watching men's football? Have you, heaven forbid, started watching male sports? Have you taken up line dancing to find love? Or are you like going out to bars and trying to talk to real people in real life, in real time? We want to hear from you about your experiences. Please send an email or a voice note to ladies@ This podcast was produced on the lands of the Gundungurra and Gadigal peoples. Ladies, We Need To Talk is mixed by Ann-Marie de Bettencor. It's produced by Elsa Silberstein. Supervising producer is Tamar Cranswick and our executive producer is Alex Lolback. This series was created by Claudine Ryan.
Yahoo
3 days ago
- General
- Yahoo
New extended-hours clinic opening at El Paso VA
EL PASO, Texas (KTSM) — The El Paso Veterans Affairs (VA) Healthcare System is opening a new extended-hours clinic for El Paso veterans. The clinic, at the main VA facility at 5001 N. Piedras, will open on Monday June 2. It will be open from 4 p.m. to 7:30 p.m. Monday through Friday. The clinic is available for walk-ins only. 'This clinic is designed for enrolled veterans who need after-hours primary care for minor health conditions. If you can't wait to see your primary care doctor or find yourself traveling and in need of prompt attention, this clinic is for you,' said a news release announcing the new clinic. Services include treatment for: Coughs/cold/fluSore throatEarachesUrinary symptomsSkin conditionsMinor injuriesStrep throatSprains/strainsAcute lower back painX-ray or laboratory services will not be available at this clinic. However, Community Care Network Pharmacy services will be available. Information: (915) 564-6100, ext. 6686. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
South China Morning Post
21-05-2025
- Health
- South China Morning Post
Disabled Chinese man inspires many by starting primary school at 16, medical school at 25
A Chinese man with cerebral palsy has inspired many by chasing his dreams with perseverance, becoming a primary school student at 16 and then entering medical school at 25. Advertisement Now 37, Li Chuangye, from central China's Henan province, has opened a small clinic in Yunnan province in southwestern China, fulfilling his dream of becoming a doctor. Li contracted cerebral palsy at the age of one. Unfortunately, due to a lack of timely treatment, he had to walk with a squat gait for his entire life. Li's parents exhausted the family's savings on his treatments. After a failed surgery at the age of nine, Li decided he did not want to burden his family any more and sought out a man who promised to give him a job. Sadly, he was deceived by this man, who exploited disabled children for begging, profiting from their plight. Advertisement From the ages of nine to 16, Li was forced to beg on the streets, earning only 100 yuan (US$14) a month.
Yahoo
18-05-2025
- Yahoo
AP top stories May 18
Here's the latest for Sunday, May 18: A Mexican navy ship hit the Brooklyn Bridge, killing two; A clinic blast in Palm Springs killed one, hurt four; A bomber in Mogadishu killed 18; Pope Leo XIV pledged unity.
