Avoiding Difficult Patients

As a cosmetic plastic surgeon,  I try and avoid the potential wrath of a disgruntled cosmetic surgery patient.  I do this by trying to predict who will not be a “good”  post-operative patient.  The key is the initial interview which is used as an effective screening process to pick out the patient with inappropriate motivation,  unrealistic expectations or those obsessed with imagined physical defects.  I then simply do not operate on these patients who  “fail” the screening.  Certain  patient  types  to  interview  carefully  before making  the  final  decision  on  whether  to  operate  or  not  include:

  • Patients whom my staff or I don’t ”gel with”for some reason. Initial “gut instincts” may be correct.
  • Perfectionists: Those seeking a flawless result, cannot accept minor asymmetries or slight imperfections after surgery.  They have the potential to be unrealistic patients.
  • Dissatisfied patients: Some of these were dissatisfied with previous cosmetic surgery by another surgeon. She or he wants me to  “fix it”.  They often put you on a lofty pedestal ready for when they fall when things don’t work out so well.
  • VIPs: Someone highly visible to the public, such as actors,  TV personalities, and politicians, have bigger stakes.

Research shows that a small percentage of cosmetic surgery patients are at risk of experiencing psychological problems, such as depression, after undergoing elective surgery.  Some of these patients sue, harass and even threaten the doctor who performed their surgery.  It ’s important then for every patient to get it straight with their surgeon as to whether they have a policy about who pays for revisions when necessary and to make sure the policy ’s provisions are clear before surgery.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Supplements and Cosmetic Surgery

Herbal supplements and vitamins are known to have a significant and measurable effect on promoting wound healing, reducing bruising,  enhancing immunity, and reducing oxidation caused by both surgery and anesthetic drugs. However, these supplements are still drugs that could cause dangerous side effects during cosmetic surgery. About 50% of cosmetic surgery patients take supplements (usually more than one), but often do not tell their surgeons because they assume they are safe.  Some  of  the  most  popular  herbal  supplements  taken  are  chondroitin,  echinacea, and  glucosamine:

  • Chondroitin is often used to treat osteoarthritis.  People using chondroitin may suffer from bleeding complications during surgery, particularly when used in combination with doctor-prescribed blood-thinning medications (like warfarin).
  • Echinacea is often used for the prevention and treatment of viral, bacterial and fungal infections, as well as chronic wounds, ulcers, and arthritis.  However, it can trigger immunosuppression, causing poor wound healing and infection.
  • Glucosamine, often offered in conjunction with chondroitin, contains chemical elements that mimic human insulin, and may artificially cause low blood sugars during surgery.

Other common supplements taken by patients that may cause thinning of the blood are the “4  Gs”  (gingko biloba, garlicginseng, and ginger), fish oils and Vitamin E.

Cosmetic surgery should be viewed with the same care and concern as heart or brain surgery. Everything we do is important for our patients, so every precaution and safety should be taken to minimize complications from surgery and anesthesia. Remember, we need your help and cooperation at all times.  Advise us of every drug you take, prescribed and non-prescribed and cease taking any blood thinning agents 2 weeks prior to surgery unless otherwise directed by your doctor.

Thanks for reading!

Dr. Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Laser Hair Removal Mythconceptions

There is no such thing as a single “best” laser for hair removal on all patients.  The best laser for laser hair removal for each person really depends on his or her skin colour. Thus, multiple lasers exist for hair removal. Different laser types, which emit distinct wavelengths of light, are better for treating different skin types. There are a number of manufacturers that make these laser types:

  • Alexandrite lasers. These emit laser light at 755 nm. These lasers work best on lighter skin. In my opinion,  it has been the most impressive laser for hair removal for light to olive skin types.
  • Diode Lasers.  These emit light at a wavelength of 810  nm.  Lighter skin types do well with this type of laser, as do some darker skin types.
  • Nd: YAG lasers.  These emit a 1064 nm wavelength.  This laser is best for darker skin types, as the higher wavelength reaches deeper into the skin.  This helps to avoid superficial skin melanin,  which pigments our skin.
  • IPL or  Intense  Pulsed  Light. It has been used for hair removal.  Lasers emit light at one wavelength (like laser pointers in PowerPoint presentations).  IPL machines produce a range of wavelengths  (like the cone of light from a torch one sees in cartoons) and are not lasers.  So,  there  is  no  such  thing  as  an  “IPL  laser”  or  “IPL laser  hair  removal”-  it’s  a  marketing  ploy  for  businesses  that  have  IPL  machines  and  not  hair  removal  lasers (the  only  exception  to  the  rule  are  the  few  machines  out  there  that  have  both  lasers  and  IPL  machines  in them).  Several studies have shown that  IPL is not as effective as dedicated hair removal lasers, and carry a higher risk of burns, blisters, and changes in pigment.

In my experience,  the Alexandrite laser is the most effective laser for removing hair on the lighter skin, whereas the Nd: YAG is the safest and best laser for more darkly pigmented skin.  Remember,  every laser  has  a  “target.”  For hair removal lasers, the goal is to selectively target the pigment (in other words colour) which in this case is called melanin found in hair follicles.  Melanin is the reason why we have black or brown hair or shades in between.  The hair follicles are living cells which make hair below the surface of the skin.  When the melanin is selectively heated, this destroys the hair follicle cells.  The lighter the hair, the less melanin the hair follicles will have in them.  As a result, hair that is blonde, white or grey does not improve with laser hair removal.  In my practice,  I have actually seen some patients notice a decrease in lighter hairs,  but it ’s the exception and not the rule.

Melanin is also present in skin and is the cause for dark skin and suntans.  It is the same target that the hair removal laser is trying to reach in hair follicles.  Hair removal lasers may target the melanin in the skin as well as in the hair follicles which sometimes results in burns,  blisters, and change in skin pigmentation.  As a result,  lower settings and longer laser pulse times must be used for darker skin to avoid damage.  As a consequence, more overall treatment sessions will usually be necessary.

Remember, laser hair removal is a medical procedure and you should always consult with a doctor who has extensive experience in lasers and laser hair removal.  This will maximize your chances of a great result.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Cosmetic Surgery Tourism: Is It Worth It?

Cosmetic surgery tourism is a price-driven phenomenon that has experienced increased growth over the past decade. Numerous companies offering all-inclusive vacation packages that include cosmetic surgery are popping up all over the world and can be easily located via the Internet. The offers generally include private hospital services and tout ”highly trained” and ”credentialed” medical staff. Since elective cosmetic surgery procedures are not covered by insurance, the price is the major selling point of cosmetic surgery tourism, with entire vacation/surgical packages costing less than individual procedures in Australia.

Although there are many skilled and qualified plastic surgeons practicing all over the world, cautions is warranted as it may be difficult to assess the training and credentials of surgeons outside of  Australia.  Patients may take unnecessary risks, when choosing cosmetic surgery vacations, by unknowingly selecting unqualified surgeons and having procedures performed in non-accredited surgical facilities.  Patients should consider the potential complications, unsatisfactory results, and risks to general health that may occur.

I very occasionally see patients who have had cosmetic surgery tourism done abroad that have gone horribly wrong.

This is commonly due to either bad surgical technique, sloppy post-operative care or misinformation that leads to a  less than satisfactory outcome for both patient and surgeon involved.  I  can understand that the lure of cheap cosmetic surgery and a holiday in some exotic destination thrown in for less than the price of comparable surgery at home is often too much of a temptation to resist.  Sadly, most people spend more time anguishing over the purchase of the latest and greatest gizmo than their plastic surgeon.  You next consider cosmetic surgery abroad, always remember to check:

  1. The plastic surgeon is well trained and reputable and that you feel comfortable with them.
  2. Make sure that you can communicate fluently in their native language or vice versa.  Also, don’t forget that you need a good anesthetist to keep you safely asleep during the procedure.
  3. Make sure that the operation you are having is the right one for you.  Often with cosmetic surgery tourism, planning and decision making is necessarily rushed.  You cannot ‘have second thoughts’ and when surgery is planned to often without seeing the operating surgeon or seeing them just before the surgery for the first time, there is no time to contemplate on the decision made or any informed consent.
  4. Determine that the operation is being performed in a safe environment and any prostheses used (eg. breast implants) are of the highest quality. Cosmetic surgery trips are often marketed as vacations  – but vacation activities should be avoided after cosmetic surgery eg; sunbathing, drinking alcohol,  swimming, jet skiing, taking extensive tours by bus or foot.  These can all compromise wound healing and increase infection rates and other problems.
  1. Lastly, you need to establish that there is appropriate after-care in place.  Whilst most things that go wrong usually happen within 48  hours, there are many things that can occur weeks to months down the track.  Revisional surgery may be required when you ’re back home and in these instances can be more difficult because of the uncertainties in surgical techniques used.  Remember,  “forewarned  is  to  be  forearmed.”

Question: What are some of the reasons you would entertain in having cosmetic surgery tourism?  You can leave a comment below.

Anti-Wrinkle Injections: The Facts

Anti-wrinkle injections are currently the most common medical cosmetic treatment.  There have been  17 million injections that have been safely administered for cosmetic purposes alone since 2002.  It is currently approved for treatment of glabella wrinkles, which are the frown lines between the eyebrows.  Any other treatments are considered “off-label” (a common and legal practice in which a drug is used for a purpose other than the officially approved one).

Here  are  some  other  interesting  facts  you  should  be  aware  of:

  • Clostridium Botulinum (the bacteria that causes food poisoning) was first identified at the University of Gent, Belgium, in  1895.
  • Anti-wrinkle injections consist of Botulinum toxin type A, which was isolated in the purified form by Dr. Herman Sommer at the University of California in the  1920s.
  • Botulinum toxin type A stops the release of certain chemicals at the junction between a nerve and a  muscle, so the message for the muscle to  ”work” is blocked and therefore relaxes.  Its anti-wrinkle properties were discovered in the 1980s  by  Dr.  Jean  Carruthers  (an ophthalmologist) and her husband  Arthur  (a  dermatologist) when patients being treated for crossed eyes and facial spasms told their doctors that their lines and wrinkles had vanished since starting the injections.
  • Anti-wrinkle injections are approved in more than 75 countries for 20 different neurological indications and approved for cosmetic use in more than 40  countries.
  • In the  20-year history of using the drug for cosmetic treatments, there is no anecdotal evidence of any long-term problems because any muscle weakness from the injections is reversible because Botulinum toxin type A ’s action is temporary.
  • Botulinum toxin type A has been used in other conditions such as migraines, excessive sweating,  incontinence, hemorrhoids and has even been used on patients with gallstones.
  • The cosmetic formula on uses a much lower dose of the toxin than the one used to treat major muscle spasms.
  • Anti-wrinkle injections are not a panacea for every facial wrinkle.  Those caused by other mechanisms such as hereditary,  smoking, sun exposure, and the effects of gravity,  do not respond adequately.  Nor are anti-wrinkle injections particularly effective for wrinkles around the mouth.  Other treatments (such as Retin-A, chemical peels, collagen or fat injections, laser therapy, or facelifts) may help for people who wish to minimize these types of wrinkles.

A  U.S. consumer advocacy group called Public Citizen has recently asked the Food and Drug  Administration  (FDA) to reconsider the safety of anti-wrinkle treatments.  However, my main issue with them is that they have grouped together adverse events from both the medical and cosmetic uses of the drug.  They pointed to  180 cases of serious complications like pneumonia and difficulty breathing or swallowing, which included 16  deaths  (collected from  9 full years of data).  Earlier in 2005,  The Centers for Disease Control and Prevention reviewed  1,437  adverse reports:  406 after medical use of the toxin  (217 of them were serious effects)  and  1,031 after cosmetic use  (36 of them serious).  The proportion of serious reports was  33-fold higher for patients treated for medical problems than for those receiving cosmetic treatments and the worst disasters have occurred when unqualified practitioners administered the drug.  The FDA has also confirmed that there has never been a reported death where a causal link to the cosmetic use of anti-wrinkle injection was established.

Don’t forget that many cancer medications are derived from substances that in other contexts would be considered dangerous.  And many other drugs that are licensed for a  particular condition are used  “off label” to treat other problems.  Remember, all drugs have unwanted side-effects, so that with more people using anti-wrinkle injections, the list of unwanted effects may be growing.

Earlier this year,  the Food and Drug  Administration  (FDA) which reviews the continuing safety of anti-wrinkle injections, notified the public about reports of their serious side-effects.  Most of these,  however, resulted from medical, not cosmetic uses of the toxin.  Medical treatments typically require much larger doses, and many of the patients have other health problems that increase their risk.  For e.g. to treat the furrows between the brows,  a typical dose consists of 20-35  i.u.’s  (intramuscular units) compared to over  200 for neuromuscular disorders.  The reactions included respiratory failure (which sometimes was fatal) in a range of doses and use, many of them “off-label” e.g. limb spasticity associated with cerebral palsy in children.

So,  my  advice  to  patients  and  clients  seeking  anti-wrinkle  injections  would  be:

  • Choose your doctor or nurse injector carefully.  They should be both experienced and competent and make you feel safe and at ease.
  • Injectables should be performed in an approved medical office or medical spa.
  • Ques on the authenticity of the injectable.  Ask to be shown the brand packaging.
  • Pay close attention to the potential complications which should be thoroughly discussed during the informed consent process.

Thanks for reading!

Dr. Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

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There are many reasons why women seek breast augmentation. Some women feel that increasing their breast size will give them greater self-confidence. Others would like to feel more proportional between their top and bottom so they fit better into their clothing. Mothers frequently seek breast augmentation to restore what was lost with breastfeeding and ageing. Supporting loose skin and giving upper breast fullness are also common reasons for choosing breast enlargement.

Good communication with patients in breast augmentation is key. There’s a need to review their medical histories and ask patients what their goals are for breast augmentation. In some cases, it is a modest increase in size to fit better in their clothing. Other times it’s a significant increase in volume to change their look. A patient may desire an improved breast shape or, possibly, better symmetry is their goal. Still others may want to restore their pre-pregnancy figure and may choose to combine their augmentation with a breast lift or other procedures.

On examining the patient, one needs to consider many features including breast volume, width, height, nipple position, areola size, ribcage curvature, skin tone, droopiness, asymmetry, and crease position. Breasts are highly variable, and I help the patient understand what their best options are based on their physical characteristics. We then come to a common agreement about what our goal will be. Remember, that “breast are sisters, not twins” so more often than not there is quite some variation between the two breasts so you can’t expect a perfect match following breast augmentation.

When the patient returns for their pre-operative visit, typically 1-3 weeks before surgery, I have them look through many digital photographs of breasts to show me their desired result. If there is a discrepancy between what we have discussed and what the patient is showing me with pictures, I’ll identify the difference and sort out what they really want, often using the 3D VECTRA which can simulate what the breasts may look like after augmentation. At the end of our meeting, I’m fairly confident that I understand what the patient desires. Likewise, the patient feels comfortable with our communication and our plan.

The photographs are then brought with me to the operating room. When the patient is asleep, I create the pockets for the implants on each of the breasts, and I occasionally use implant sizers to confirm the volume and shape of the optimal breast implants for the patient. Most patients are back to work and most of their usual routine in several days or up to a week. Strenuous exercise should be avoided for several weeks.

To learn more about breast augmentations, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Download FREE Tummy Tuck Guide now!

Are you frustrated with unwanted, loose skin following pregnancy or significant weight loss?

I’ve just put together a step-by-step guide called the “Tummy Tuck Edge: The Power to Shape Your Destiny. To learn how to remove unwanted skin, unleash the energy within you today and turn your life around, download this PDF file now.

Fill out the details below to learn more:

 

Mommy Makeover with Body Lift & Breast Reduction. The Mommy Makeover is a term for a group of cosmetic procedures that many mothers seek following pregnancy. After multiple pregnancies and breastfeeding, many women find it impossible for diet and exercise alone to restore their figures. Fortunately, mothers with permanently altered figures find that a Mommy Makeover is an excellent solution just like this patient found after having a Body Lift and Breast Reduction. The B & A photos at 3 months show a much more youthful figure and perkier, more shapely breasts.

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Loose skin, stretch marks and fat on the abdomen are among the most common reasons patients seek an abdominoplasty from a plastic surgeon. In some cases, patients have excess skin and fat on the abdomen from weight loss. In other cases, age or pregnancy has changed the contour of the abdomen. Many are frustrated that diet and exercise don’t tighten their lower abdominal skin. Some even lose the motivation to exercise because they can’t see their muscles underneath their loose skin. For many of these patients, abdominoplasty (tummy tuck) is their best opportunity to reclaim a youthful figure.

To learn more about abdominoplasty (tummy tuck), request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

 

This middle aged lady underwent a Body Lift following massive weight loss of 70kg with diet and exercise alone. DrTim demonstrates the 2 phases of the operation- starting on the back by removing excess tissue and lifting the buttock region and finishing on the front by further excising tissue, performing a lateral thigh lift, tightening the separated rectii muscles and reconstructing the belly button. The B & As show a much better contoured torso with an improved waistline.

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