> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # 💌 "Ozempic Face" is now a thing, ulnar nerve insights, & updated clinical cases. - URL: https://www.theplasticsfella.com/october-1st/ - Published: 2023-10-01T12:24:56.000Z - Updated: 2024-02-11T20:06:57.000Z - Description: Explore this week's P'Fella digest: Discover the 'Ozempic Face' phenomenon, unravel the mysteries of the ulnar nerve, and get a sneak peek into P'Fella's clinical scenario updates. Dive in for a blend of insights, quizzes, and AI revelations! - Author: PlasticsFella - Tags: thePlasticsPaper, Popular Reads #### In this week's edition 1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/october-1st/#a-letter-from-pfella) "Ozempic Face" - it's arrived. 2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/october-1st/#the-sunday-quiz) Do you **really* know the ulnar nerve? 3. 🔦 [****Spotlight**](https://www.theplasticsfella.com/october-1st/#spotlight) Clinical cases is growing. 4. 📸 [****Image of the Week**](https://www.theplasticsfella.com/october-1st/#image-of-the-week) AI-generated ulnar nerve signs. 5. ****🐣** [****Tweets of the Week**](https://www.theplasticsfella.com/october-1st/#tweets-of-the-week) P'Fella's 3 favourite tweets 6. 🤔 [****Ask P'Fella**](https://www.theplasticsfella.com/october-1st/#ask-pfella) Should we mix local anaesthetics? 7. ****📝** [****Articles of the Week**](https://www.theplasticsfella.com/october-1st/#articles-of-the-week) 3 hot reads on the ulnar nerve! 8. 💕 [****Feedback**](https://www.theplasticsfella.com/october-1st/#feedback) P'Fella spotlighted the ulnar nerve. Do you like this focused format? ****PS -** Collectively, you've spent ****485,000 minutes** reading thePlasticsFella content over the past 30 days. That's phenomenal! ****Thank you!** ## A Letter from P'Fella ### "Ozempic Face" - it's arrived. 👋 ****Hey team!** I've stumbled upon an intriguing trend that's been gaining traction, and it's something we should all be in the know about. So, pour yourself a cup of joe (or tea) and let's delve into the phenomenon known as the “****Ozempic face**”! ****Dive in with me 👇** With the global spike in obesity, the hunt for effective solutions has been fervent. Making waves in this space are Ozempic, Wegovy, and Rybelsus - all champions of semaglutide. While they're predominantly in the diabetes ring, they're also making **off-label appearances in the weight loss arena**. But here's the curveball: Ozempic’s rapid weight loss magic can morph into the “**Ozempic face**,” marked by **drooping** skin and enhanced **wrinkles** due to the dip in facial fat. Picture shedding those cherubic cheeks only to be greeted by a prematurely aged reflection! ![Weight loss drugs: The science and side effects behind Ozempic and Wegovy | New Scientist](https://images.newscientist.com/wp-content/uploads/2023/07/25160939/SEI_165374972.jpg?width=1200) **What do the trends show? Quick Dive into the Latest Trends:** Cosmetic surgery is not just in vogue, it's exploding! There’s been a 19% surge since 2019\. - **Facelifts** alone have climbed by 8% in the last year. Given the “Ozempic face” trend combined with our selfie-dominant era, this spike doesn’t really shock. - **Eyes** are capturing attention, with eyelid surgery ranking fourth in popularity. - And, let's roll out the red carpet for **lip augmentation**! Clocking in a staggering 1,378,631 procedures in 2022, it seems like the globe is all set to flaunt those plush lips post-lockdown. Kudos to the influencer brigade! ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/10/Screenshot-2023-10-01-at-10.17.38.png) Data from the recent [ASPS](https://www.plasticsurgery.org/plastic-surgery-statistics?ref=theplasticsfella.com) publication **In a Nutshell:** While Ozempic and its kin dangle the allure of a trimmer silhouette, they come packaged with the **unintentional tag of accelerated facial ageing**. As we ride this wave, let's ensure our dialogues remain open, guiding our patients with top-tier advice. Cheers and chat soon, P'Fella ❤️ ## The Sunday Quiz ### Cubital Tunnel Syndrome Cubital Tunnel Syndrome arises from the ****compression** of the ****ulnar** nerve within the cubital tunnel, manifesting as ****motor** and ****sensory** deficits. It ranks as the second most common compressive neuropathy ****Common sites of compression are (FLAME)** 1\. ****F** **CU Fascia:** forms the arcuate ligament with Osborne Ligament. 2\. ****L** **igament of Osborne:** roof of the cubital tunnel. 3\. ****A** **rcade of Struthers:** from intermuscular septum to medial triceps. 4\. ****M** **edial Intermuscle Septum** ****5** **.** ****E** **picondyle** ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/09/Cubital-Tunnel-Syndrome-2.png) Reveal this week's question A 50-year-old pianist presents to the clinic with complaints of paresthesia in her little finger and the ulnar side of the ring finger. She also reports reduced grip strength. On examination, the physician notes clawing, little finger abduction, and wasting of the 1st webspace. She demonstrates a positive Tinel’s test at the cubital tunnel and a positive elbow flexion test. To confirm her diagnosis, which investigation would be most indicative? - A) High-frequency ultrasound of 14 Hz measuring the ulnar nerve cross-sectional area of 0.065 squared cm. - B) MRI visualization of the C8-T1 nerve roots. - C) Two-point discrimination test in the little finger. - D) X-ray showing the presence of bone spurs at the elbow. Name: Email: ## Spotlight ### Clinical Cases is growing! In this section, you'll discover noteworthy events, must-attend webinars, and curated courses tailored just for you. Plus, get exclusive first looks at our latest features. ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/10/a-Clinical-Cases-1.png) #### Clinical Scenarios 🌍 Real-world scenarios to mirror clinical practice and exams. 🎤 Structured as an oral "viva" to assess clinical expertise 🔍 Detailed exploration of the current evidence. 📅 Regularly updated cases, ensuring current content. 🚸 Coverage of a wide range of topics 💡 Learn decision-making and management skills. [Check them out! ](https://www.theplasticsfella.com/tag/clinical-cases/) ## ## Image of the Week ### AI-generated clinical images ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/10/aCubital-Tunnel-Syndrome-2.png) AI-generated ulnar nerve palsy [Check out this ulnar nerve palsy patient](https://www.theplasticsfella.com/ulnar-nerve-palsy-clinical-case/) ## Tweets of the Week ### Don't forget to follow [P'Fella](http://twitter.com/plasticsfella?ref=theplasticsfella.com)! > Guyon's canal: > An anatomic space along volar ulnar aspect of wrist,contains distal branches of ulnar nerve &artery ;venous & lymphatic vessels. Ulnar n can be compressed at 3 zones at canal: > Zone 1👉results in mixed motor & sensory symptoms > Zone 2👉only motor > Zone 3👉only sensory [pic.twitter.com/nNCUxUGTrr](https://t.co/nNCUxUGTrr?ref=theplasticsfella.com) > > — Dr.OMID BANDARCHI ,M.D. (@OBandarchi) [August 2, 2023](https://twitter.com/OBandarchi/status/1686608120565407744?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > just another of hundred cases with (sub)luxating ulnar nerve[https://t.co/x8goQJJCYS](https://t.co/x8goQJJCYS?ref=theplasticsfella.com) [pic.twitter.com/mYo82p5hED](https://t.co/mYo82p5hED?ref=theplasticsfella.com) > > — Sᴡɪss Uʟᴛʀᴀsᴏᴜɴᴅ Cᴇɴᴛᴇʀ - UZR (@Rheumatology) [September 10, 2023](https://twitter.com/Rheumatology/status/1700879916449861678?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > Spotlight: Snapping Ulnar Nerve 🦾[#Diagnosis](https://twitter.com/hashtag/Diagnosis?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) is made from [#physicalexam](https://twitter.com/hashtag/physicalexam?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) where the ulnar nerve is observed to snap over the inside part of the humerus [#bone](https://twitter.com/hashtag/bone?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) called the medial epicondyle. > > MRI & X-Ray are also frequently obtained to assess for other associated [#injuries](https://twitter.com/hashtag/injuries?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) [pic.twitter.com/tVdes2EeYE](https://t.co/tVdes2EeYE?ref=theplasticsfella.com) > > — Dr. Chris Ahmad (@drchrisahmad) [August 22, 2023](https://twitter.com/drchrisahmad/status/1693906412668334279?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) [ ](https://x.com/OBandarchi/status/1708214418998468789?s=20&ref=theplasticsfella.com) ## Ask P'Fella ### You ask, I'll answer Every Sunday, you can ask P'Fella anything related to plastic surgery. You'll be answered the following week. Let's check out what questions came in. ❓ ****Libby's Question** Hello, I was wondering if you could help with a question about local anaesthetic. If mixing lidocaine and bupivacaine, can you use the maximum dose of each or do you have to taper it (e.g using 50% of the maximum dose of each)? I’ve had registrars and consultants telling me inconsistent things so hoping you could shed some light! Thank you 😊 Hey there! **This is a great question.** Thanks for bringing up this question about mixing lidocaine and bupivacaine. It's a grey area with varying practices. **I personally do not mix local anaesthetics.** Both these local anaesthetics are amides that **block** sodium channels to stop nerve signals. Some folks mix them for a better balance of fast action and long-lasting relief, while others stick to one based on the situation. The main thing to watch out for is keeping the total dose within safe limits to dodge toxicity. Some references like [Budney](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635186/?ref=theplasticsfella.com) (2019) suggest sticking to a combined max dose. **So, if you go half-max on lidocaine, the other half should be the max you go with bupivacaine.** For a quick example, in a 50kg person, 10ml of 1% lidocaine is half the max dose, and 10ml of levobupivacaine at 2.5mg/ml is a quarter of the max. Mixing 20ml of these two stays within the 75% of the max dose, which is on the safe side. But a 40ml mix hits 150% of the max, which could lead to trouble. Throwing adrenaline into the mix can up the max dose allowance for lidocaine, letting you use a larger volume safely ([French](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954146/?ref=theplasticsfella.com), 2012) ![The class, duration, dose and toxicity of different local anaesthetics](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Local-Anaesthetic.png) [Types of LA](https://www.theplasticsfella.com/local-anaesthetic/) Hope that clears things up a bit. Feel free to bounce back any more questions or thoughts P'Fella --- Ask P'Fella Now 4 questions submitted in the last 7 days... ## Articles of the Week ### 3 must-read articles! 📚 #### 3 Must-reads 1. [****What to do if you injure an ulnar nerve?** ](https://pubmed.ncbi.nlm.nih.gov/25442770/?ref=theplasticsfella.com) Woo A, Bakri K, Moran SL. Management of ulnar nerve injuries. J Hand Surg Am. 2015 Jan;40(1):173-81\. doi: 10.1016/j.jhsa.2014.04.038\. Epub 2014 Nov 6\. PMID: 25442770. 2. [****An algorithm for cubital tunnel syndrome** ](https://pubmed.ncbi.nlm.nih.gov/26243318/?ref=theplasticsfella.com) Boone S, Gelberman RH, Calfee RP. The Management of Cubital Tunnel Syndrome. J Hand Surg Am. 2015 Sep;40(9):1897-904; quiz 1904\. doi: 10.1016/j.jhsa.2015.03.011\. Epub 2015 Aug 1\. PMID: 26243318. 3. [****What actually is Guyon's Canal?**](https://pubmed.ncbi.nlm.nih.gov/25446410/?ref=theplasticsfella.com) Maroukis BL, Ogawa T, Rehim SA, Chung KC. Guyon canal: the evolution of clinical anatomy. J Hand Surg Am. 2015 Mar;40(3):560-5\. doi: 10.1016/j.jhsa.2014.09.026\. Epub 2014 Oct 29\. PMID: 25446410; PMCID: PMC4791630. ## Feedback ### P'Fella is trying out a new format, spotlighting one major topic each week. Do you prefer this focused approach?