How a forehead wrinkle can indicate something much worse...

The patient, a female, came into my office to treat deep creases on her forehead. She was most concerned with a small vertical crease between her eyebrows. She explained she had been to various spas and cosmetic clinics for Botox and Fillers over the years, but the creases on her forehead kept reappearing even deeper and larger than before. She came to see me specifically for Radiesse injections, a long-lasting calcium hydroxylapatite filler, to plump the deep vertical crease between her eyebrows, as well as a deep Laser Resurfacing consultation.

While examining her, I noticed that in addition to the creases on her forehead, her nose bridge was quite broad and flat, and both her brow and jawline were slightly protruded. I knew then that these were possible symptoms of a rare condition that I had only experienced once before in my 30 year medical career (as a page in my medical school textbook). So as to not alarm her unnecessarily, I began pulling the necessary supplies for the cosmetic injections while asking her a series of questions...

"Does your wedding ring fit a little tight on your finger?"

"Have you had more headaches than usual?"

"Have you experienced any changes to your eyesight?"

"Have you had to change shoe sizes in the past year?

She responded, puzzled and incredulous, why yes! Now that I mention it, she was having more headaches than normal, and had to get a stronger prescription for eyeglass just a few months ago. Her hands and feet had grown significantly in the past 3 years, to the point she had her wedding ring re-sized twice and had gone up almost a full shoe size.

At this point, my suspicions were confirmed and I explained that I needed to cancel the cosmetic injections, and refer her instead to an Endocrinologist. She had a very uncommon hormonal disorder called Acromegaly, which is caused by a pituitary tumor.

The patient unwittingly believed that her enlarged hands and feet, persistent forehead wrinkles, and worsening eyesight were just the results of getting older. While Acromegaly is an uncommon disorder, it is still very disheartening to me that so many nurses and 'doctors' simply injected her with fillers, without ever taking a full medical history.

Without proper diagnosis and treatment, Acromegaly results in major health problems and complications, including blindness, cardiomyopathy and premature death.

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