Breast Lift and Augmentation: The facts you need to know!

The goals of breast lift with or without breast augmentation are to restore shape, volume, and nipple-areola position. However, simultaneous breast lift and augmentation present multiple problems, specifically because it becomes harder to control all of the variables affecting the outcome when combining the two procedures. No single method is best to treat all types of sagging (ptosis), and maintaining a good blood supply to the nipple-areola complex is of paramount importance, so a staged procedure may be necessary at times.

Why is combining a breast lift and breast augmentation the most difficult of all cosmetic breast surgery procedures? The surgery involves manoeuvres that can be counterproductive to each other since the skin is being removed and when closed back up again, pushes the breast in and upwards, whilst an implant stretches the skin in an out and in a downwards direction. These conflicting tensions can adversely affect the blood supply to the breast and skin which may affect wound healing, scar quality etc. Positioning of both the nipple and breast fold also becomes more challenging during simultaneous lift and augmentation. Secondly, no two breasts are the same, and each patient is seeking a different endpoint, sometimes with unrealistic expectations.

The first thing that I do when evaluating a patient for a breast lift is to ask them if they are happy with their present breast volume. You can simply do this by pinching the skin below the breast and pushing it up where it belongs. Most women are amazed at how little of breast volume they actually have. If that is the case, then volume enhancement, usually with an implant, is necessary along with a lift. If the volume is satisfactory, then a breast lift will suffice.

The second thing to do is grade the amount of breast sagging. This is done by using Regnault’s classification which looks at the position of the nipple as follows:

1)  Grade 1 (minor): nipple at breast fold
2)  Grade 2 (moderate): nipple is below the fold but above the lower breast contour
3)  Grade 3 (major): nipple is below the fold and below breast contour
4)  Pseudoptosis (“false sagging”): nipple lies above the fold, there is little breast volume, some of which lies below the fold

Other characteristics that one looks out for are:

1) Skin: elasticity and excess;
2)  Breast tissue:  firm and fibrous or soft and fatty; and
3)  Skin-breast tissue relationship: firm and adherent or loosely adherent and is the breast full or empty. Skin quality and the skin-breast tissue relationship are the key factors in determining the breast lift procedure and the quality and longevity of the final result.

As a general rule, if the skin elasticity is normal, the breast envelope is full, and the skin is adherent to the underlying breast tissue, then the scars would be limited, and vice versa. In other words, one progresses from limited scars such as periareolar scars (scars around the nipple-areola complex) to periareolar-vertical scars (scars that run down the front of the breast below the nipple-areola complex) to more extensive, full-length inverted-T or anchor scars.

For the patient with “pseudoptosis,” inserting a breast implant alone, usually tear-dropped shaped, is typically all that is needed. For Grade I sagging, an implant alone or a lift plus an implant may be required.

Depending on a number of factors, the lift may be performed via a crescent, periareolar, or vertical approach. A vertical approach is preferred if there is significant looseness below the nipple. However, the periareolar incision is generally used in just a few specific situations. Since this skin-only incision is unable to lift much weight, it is an option in women with small breasts who need only a small amount of nipple repositioning, usually < 2 cm.

In addition, it is considered advantageous in women with pointed, conical or tubular breasts, because it causes areolar flattening and eliminates the tubular nature. The main issue I have with performing a periareolar breast lift is its tendency to cause areolar flattening and leave the areola more prone to stretching.

In Grade 2 sagging, especially where the breasts are large and heavy, a vertical breast lift is often required because it will effectively lift the breast tissue to achieve increased projection. However, a periareolar incision may still be considered for women with light breasts. When performing a vertical breast lift, the procedure may be converted into a short inverted-T lift if a difficulty is encountered controlling the nipple-to-breast fold distance.

With Grade 3 sagging, the lift technique depends on the nipple-to-breast fold distance. If it is > 10 cm, most surgeons perform an inverted-T breast lift. Otherwise, vertical breast lift remains an option that will enable control of the nipple-to-breast fold distance, as the vertical scar tends to shorten in the post-operative period with scar contraction.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Breast Augmentation vs. Breast Lift – Know it all!

Like many women, you may find yourself choosing between these two procedures or choosing both. Each has its own unique goals, and the procedures are often combined to achieve an even more attractive curvature.

Breast Augmentation Goals
The goal of breast augmentation surgery is to make your breasts bigger and/or fuller (more projected). Women differ so vastly in shape, size, and frame that a number of options have been developed that offer something for everyone. You can choose from:

  1. Silicone gel or saline implants
  2. Textured or smooth surfaced implants
  3. Implant placement behind the breast tissue or behind the pectoralis muscle
  4. Round or tear-drop (anatomical) implants
  5. Various sizes of implants
  6. Different sites for the incision (breast fold, armpit or nipple areola complex)

Breast Lift Goals
Breast lift surgery is designed to elevate sagging breasts and restore their youthful, perky stature. Gravity, pregnancy and weight gain have a way of stretching even smaller breasts over time. Weight loss may leave breasts less firm and a bit saggy. Breast lift surgery involves elevating the nipples and lightening the breast skin to restore breasts to an attractive shape.

Breast Lift with Breast Augmentation Goals
The lift removes the excess skin and reduces sagging (pushes things “up and in”). The implant fills the remaining breast skin, adding contour and fullness where minimal breast tissue is insufficient (pushes things “out and down”). As you can see, the forces are opposing, and for that reason, there is a 20 % revision rate for this procedure.

What Makes the Difference?
What makes the biggest difference in outcomes is that the most successful plastic surgeons use the following techniques and protocols:

  1. Minimal blood loss, bruising and swelling by using electrocautery for dissection of the pocket, as well as, gentle manipulation of the tissues
  2. Smaller incisions
  3. No sutures for removal
  4. Specialised instruments for accurate placement of an implant
  5. Adequate pain relief postoperatively
  6. No drains or wraps to manage
  7. Avoidance of blood thinning agents perioperatively (cease multi-vitamins, aspirin, NSAIDs etc.)

 

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Tummy Tuck: 3 essential things you must know!

  1. Before a tummy tuck

When you continually gain and lose weight, the excess tissue composed of skin and fat in the lower part of the tummy becomes a real problem for some people. This excess tissue along with the underlying lax muscles can be dealt with by a surgical procedure known as a tummy tuck, otherwise known as an abdominoplasty. Removing the “muffin top” (the tissues between the belly button and pubis), then re-draping the skin from above the belly button to meet the skin on the pubis and repositioning the belly button, are the basis of all tummy tucks.

One of the keys to a tummy tuck is finding out how much excess skin and fat, as well as, muscle laxity you have in your tummy, is to bend over at the waist and “let it all hang out.” The next step is to pinch these tissues and tighten the tummy muscles, which will give you an idea of how much of the tissues need to be removed.x

Also, you will notice that most of the tissue bulk is in the midline and fades out at the sides. If you imagine this excess tissue as an ellipse on the lower tummy, it will give you an indication of how long the scar will be from one side of the hip to the other. I tell all my patients that the resulting scar can be concealed, that it will generally fade with time, but will always be there.

 

  1. Tummy tuck operation

Just prior to beginning the tummy tuck, I mark the tummy while the patient is standing up. I mark the midline from the xiphoid (“breast bone”) to the pubis. This enables me to realign the midline after removing the excess tissues and to place the belly button in the midline. A second line indicates the position of the lower-tummy incision. This usually lies quite low in the tummy since the most common garment worn by women today is jeans. Finally, areas for liposuction are marked in the upper tummy, the hips and lower flanks (liposuction thins the tissues and allows them to re-drape better).

Our anaesthetists use a laryngeal-mask airway (a breathing tube that sits at the back of the throat) and do not paralyse the patient, allowing them to breathe independently during the entire operation. I begin the tummy tuck operation with liposuction to the tummy, hips and lower flanks.  Then, I incise the skin around the belly button which is still attached to the underlying muscle wall. After making the lower tummy incision, I widely undermine the tissue up to the level of the belly button. I continue the dissection above the belly button to the level of the xiphoid process (lower part of the sternum), making a central tunnel (about the size of a hands width). I then “lace-up” the separated muscles of the midline from above and below the belly button.

Next, the patient is bent at the waist to 45 degrees, and the excess tissues removed so that the two skin edges may be closed without tension. Two drains are brought out below the pubic hairline to capture any excess fluid that may build-up in the tissues. These usually are taken out between day 3 to 5 when the drainage is less than 30 ml’s or so. Lastly, I bring out the belly button at the midline, usually 12 to 15 cm above the lower tummy incision and place a tummy binder on the patient at this time and adjust it to allow for moderate compression.

The patient is kept in a bent position at the waist and knees as they are transferred to the recovery bed.

 

  1. After tummy tuck surgery

After a tummy tuck, the patient will continue to wear TED (compression) stockings and automated calf compressors for 24-48 hours and be commenced on blood thinning agents the following day to lessen the chance of deep vein thrombosis (clots in the legs) or pulmonary embolism (when these clots break away from the legs and migrate through the venous system to the lungs causing a “lung attack”).

The patient is instructed to sleep with several pillows behind her back and a pillow beneath their knees.

They are encouraged to walk to the bathroom the following day, have showers and to undergo regular chest physiotherapy. Patients are advised to wear the tummy binder continuously for the first 4 weeks after surgery, except when they wash themselves or the binder. After this period, I allow them to wear it only at night if they wish, but many choose to wear it longer. I also advise patients that it takes 4 weeks to get back to normal activities of daily living and 6 weeks to resume aerobics exercises.

 

Question: What questions do you have about tummy tuck surgery? You can leave a comment below.

Breast Augmentation Part 4 of 4: The Surgical Facility

Your safety is of paramount importance when undergoing breast augmentation. Always have your surgery in an accredited hospital or day surgery facility. If you are young and healthy, then a day surgery facility is fine. If you are older and have health problems, then a hospital would be a better place to have the procedure performed because of the availability and back-up of an intensive care unit and other highly specialised healthcare professionals.

Accredited means that the surgical facility has passed a set of rigorous examinations to assure that the equipment and procedures meet standards for optimal safety. The hospital or day surgery facility should be fully accredited by the Australian Council on Healthcare Standards (ACHS) or a set of ISO standards that provide the highest standards of service. Patient health, safety, and comfort should be the surgical facilities main concerns and they should continually monitor and evaluate their performance to achieve these outcomes. Another requirement of accreditation is to assure that personnel is trained, experienced, and skilled healthcare professionals and procedures and equipment are in place to deal with any emergency from a power outage to cardiac arrest.

Sometimes it’s reassuring to visit the accredited facility yourself. If you’re not comfortable with a surgical facility, don’t have the breast augmentation surgery there. What you want to see is modern and comfortable surroundings, as well as caring and warm personnel. The operating room should appear state-of-the-art, spotlessly clean, and equipped with the most up-to-date equipment. The recovery area should be immediately adjacent to the operating rooms. Some surgical facilities provide overnight accommodations with one-on-one nursing care especially for patients who need overnight care for more extensive procedures.

The following checklist should help you “tie things up” when organising your breast augmentation:

1)  Check the date of surgery and pay scheduling deposit if required

2)  Review surgeon’s financial policies and policies for refunds

3)  Sign informed consent and operative consent forms for breast augmentation

4)  Schedule laboratory tests and mammography/ultrasound if required

5)  Review medications to avoid and ones to take before surgery

6)  Review post-operative instructions the night before surgery

7)  On the day of surgery wear comfortable clothes, get someone to drive you home and be with you overnight, wear no make-up, and leave your jewellery and valuables at home

Question: What things do you consider important in the surgical facility when having a breast augmentation? You can leave a comment below

Breast Augmentation Part 3 of 4: The Plastic Surgeon

I am amazed at how many patients spend more time shopping for a TV or washing machine than they spend selecting a plastic surgeon. Selecting your surgeon should be the single most important thing that you can do to assure an optimal result.

You should have a checklist of essential things to look for in a plastic surgeon:

1)  Certified by the Royal Australasian College of Surgeons, the only college recognised by the Australian Medical Council that can train surgeons in Australia

2)  Be a Member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgery (ASAPS)

3)  Has hospital privileges to do breast augmentation at an accredited hospital or day surgery facility

4)  Subspecialises in cosmetic surgery

5)  Super specialises in breast augmentation

6)  Recommended by a knowledgeable friend or doctor

7)  Has a curriculum vitae that documents scientific presentations and publications

There are also a few less reliable points that I would like to address when choosing a plastic surgeon. Advertisements and media coverage is paid for by the plastic surgeon and does not necessarily reflect how knowledgeable, competent or experienced they are. Your local doctor may not be in the know of who is best to do breast augmentation and may not have an interest in cosmetic surgery to find out either. Some just refer to surgeons who are their friends from medical school, are in the local area and thus convenient, or who may be paid for by the surgeon to refer you. Never listen to recommendations from anyone who is an “armchair expert” or who has no in-depth knowledge of breast augmentation.

At the end of the day, look at the plastic surgeon’s results to see how good they are. Be very careful with “glamour shots” that can deceive because of lighting, patient positioning and camera angle. They may even be “photo-shopped” or airbrushed. Some plastic surgeons may have models as patients that they have operated on their face but not their breasts (which was performed by another surgeon) and use them for advertising breast augmentation.

There are a further number of “red flags” that you should take notice of. These are:

1)  Completed training in a specialty other than plastic surgery

2)  Certified in an unrelated college

3)  Not a member of ASPS and ASAPS

4)  No hospital privileges

5)  If you are given false or misleading information – claims that are too good to be true.

6)  Unwilling to provide you answers to questions regarding credentials or their curriculum vitae

7)  When the office staff are not courteous, knowledgeable, or don’t spend enough time with you, and don’t tell you what you need to know. Beware of staff who give you all fluff, but no substance, and don’t offer to send you any information. Always insist that the price is broken down into the following categories: surgeon fees, anaesthetist fees, costs of implants, operating room fees, hospital stay fees, laboratory fees, mammogram or ultrasound fees, any other fees. Ask how long the prices on the quote last for. Remember, there is no such thing as bargain surgery. Have you ever seen top-quality surgery for a bargain price? How is the bargain surgeon able to offer such a good price?

When visiting the plastic surgeon’s rooms, look around and take notice of the little things. It should be a quiet, comfortable and modern, an atmosphere that reflects the good taste of the plastic surgeon. The organisation, function, and flow of the plastic surgeon’s office is a reflection of the surgeon’s personality and habits. Think about it. If the office looks messy and unclean, doesn’t that reflect badly on the surgeon who accepts this scenario?

Most of the time, you will recognise a good plastic surgeon without the surgeon having to tell you. If they have integrity, are caring and thorough, then this will definitely contribute to what you will get in the operating room and after.

Question:  What factors do you consider important when choosing a plastic surgeon to perform a breast augmentation? You can leave a comment below.

Breast Augmentation Part 2 of 4: The Procedure

The things you need to know to make better choices regarding Breast Augmentation are the following:

 

1)  Match your desires with reality

The surgeon can only work with the issues you bring him. If you want the best result, you have to balance what you want with what your breast tissue will allow you to have and what it can support over time. Also, no woman has two breasts that are the same, and no surgeon can create two breasts exactly the same. Cup size is extremely variable and inconsistent from one brand of bra to another. Women tend to buy a bra that they can fill (or that pushes their breast tissue where they want it to go to create a specific appearance), not necessarily a bra that fits.

Last of all, the bigger the breast you request (i.e. the bigger the breast augmentation), the worse it will look over time. You can’t pick out a breast from a book or magazine and expect the same result unless the woman in the picture looked exactly like you before surgery.

 

2)  Know about the implants

Breast implants are not perfect, don’t last forever, and require some maintenance. If you can’t accept these facts, don’t have a breast augmentation. If you do, then you need to think about:

a) Implant pocket location

Implants can be placed in front of, or behind the muscle. There are less capsular contracture rates when the implant is placed behind the muscle and you can obtain better or more accurate mammograms too. Also, in thin women, behind the muscle is preferable because adequate tissue coverage is most important. Think when you lie in bed, if you are covered by a bed sheet only, one can see the contours of your body a lot better than if you were to be covered by a doona cover, where they are less distinct. Having said that, an implant placed in front of the muscle, will always more predictably control breast shape. How do you decide whether to go in front or behind the muscle? If you pinch the breast tissue in the upper pole and it’s < 2 cm, your best option would be to go beneath the muscle, otherwise, you run risks of seeing the edges of the implant.

One aspect that often gets overlooked is the way the pocket is created. Blunt dissection techniques are fast and efficient but create more tissue trauma, tear tissues, create more bleeding, and result in longer recovery times. Electrocautery dissection techniques use an electric current to seal blood vessels and are thus, less traumatic and have shorter recovery times.

b) Implant Shape

Shapes of implants can either be round or teardrop (anatomical). There is a trend today of women wanting more upper pole fullness and therefore opting for round implants. Given that the breast is constantly evolving and that over time there is a loss of upper pole fullness as the breast tissue “melts away”, breast augmentation with round implants may be a good option for maintaining upper pole fullness in the long term. The other added advantage is that if it rotates, it doesn’t affect the shape of the breast. In contrast, a teardrop implant which is fuller at the bottom and tapers at the top will give an odd shape to the breast if it does rotate. However, breast augmentation with teardrop implants may be better in women who have oddly shaped chests (either long or wide for example) because you can tailor the dimensions of the implant more specifically to fit the breast “foot print” on the chest. Tear drop implants may also be beneficial in women with mild sagging breasts who do not want scars on their breast from elevating the nipple. Tear drop implants have a “bucket-handle” effect on the nipple, elevating them to a higher position on the breast.

c) Implant surface (or shell)

The surface of the implant is made of a silicone rubber and can be textured or smooth. Textured implants have a lower risk of capsular contracture than smooth implants.

d) Implant “stuffing”

The stuffing or filler of the implant can be silicone or saline. Saline is salt-water and is harmless if the implant ruptures. Its biggest disadvantage is rippling and that it takes up the ambient temperature, meaning if you went to the beach for a swim, when you got out, your implants would feel cold. Silicone gel filler, on the other hand, is more natural, more predictable and it is safe. There are grades of silicone gel that range from “jelly” consistency to that of “gummy bears”.

e) Implant size

Remember, the larger the implant, the more tradeoffs and risks you’ll encounter, especially long term.

f) Incision location

The scar can be placed in three areas. The breast fold incision offers the best degree of control for the wide range of breast types and is the commonest type used by far. The periareolar incision (around the nipple-areola) usually heals well because it’s located in the thinner skin but is limited and can’t be used if the areola is not large enough for access. The biggest problem is the increased exposure of the implant to bacteria if any of the breast ducts were to be cut. The armpit (axillary) incision places no scar on the breast but takes longer to perform and harder to control the position of the breast fold.

 

3)  Get well acquainted with the tradeoffs, problems, and risks

Tradeoffs always depend on the details of each specific case, the characteristics of your tissues, and the experience of your surgeon with different options. Every breast augmentation operation carries inherent risks and medical complications are not totally preventable by you or your surgeon. Remember, don’t have a breast augmentation unless you thoroughly understand and accept the potential risks and tradeoffs of the procedure.

 

4)  Know about the recovery

The more tissue trauma caused by your surgery, the longer and more difficult your recovery. That is why it takes longer to recover from a pocket created behind the muscle. Excessively large implants can produce excessive stretch marks that cause more discomfort and temporary or permanent sensory loss. Most women return back to normal duties within four weeks and athletic activities in six weeks.

Question:  Do you think that the benefits far outweigh the trade-offs for breast augmentation? You can leave a comment below.

Breast Augmentation Part 1 of 4: The Patient

There are generally three groups of women who frequently consider Breast Augmentation:

  1. Nature “missed a beat” during breast development: This usually occurs during puberty where the breasts may not develop at all or only develop slightly, resulting in a “bowling pin” type of a look. Apart from making one feel inadequate because there is a disconnect between the narrower chest to the wider hips, it also makes it difficult buying clothes that fit. Some people revert to using fillers and enhancers, but these techniques never seem to compensate, are temporary measures, and they never feel like a natural part of you in the same way as breast augmentation. Breasts can also develop unevenly during puberty, causing both difficulty in buying and wearing clothes, as well as, making one feel abnormal or like a “freak”.
  2. Nature “took a toll” during pregnancy and breastfeeding: During these times, the breast enlarges and deflates repeatedly. This cycle stretches the breast skin especially in the lower pole, resulting in stretch marks. After breastfeeding, the breast tissue itself may “melt away” (especially in the upper pole), sometimes to a size less than before pregnancy. However, the skin never shrinks back to its original size, therefore, the breasts will appear saggy (think of the skin like an overstretched elastic band which frays at the edges). This is where a breast augmentation and/or a breast lift (mastopexy) can be of great benefit to restore the shape, size, and contour of the breasts to the pre-pregnancy state.
  3. Nature “didn’t match desires” of women who want to enhance the shape and appearance of their breasts: Some women want to be the best version of themselves. Others have underdeveloped breasts or have uneven breasts that makes buying clothes difficult. While other women want to “marry” or improve the balance between their chest with their hips. Breast augmentation to enhance the chest further or balance the hips can make an enormous difference to ones’ body shape and self-esteem.

Women who fall into any one of the above groups have every right to want to optimise any aspect of their breast appearance. If this involves breast augmentation, then she needs to also think about:

These factors will be individually discussed in subsequent blog posts. Remember that no choice is perfect and that every choice has trade-offs (you need to know them) as well as benefits. Therefore, choose carefully.

 

Question: What are your reasons for wanting to have Breast Augmentation? You can leave a comment below.

How Do You Repair Torn Earlobes?

The earlobes are the lowest part of the ears made of skin and a small amount of fatty tissue in between. There are large variations in size, form, and shape. The earlobes serve women (and men) as popular locations for placing jewellery. Often, the earlobes are pierced to fit various forms of ear ornaments ranging from studs to earrings which can occasionally set them up for trouble.

Excessive weight or trauma can easily overcome the strength of the earlobe tissues leading to a tear, which if complete, results in a split ear. Some people with rather thin earlobes who favour wearing heavy earrings, experience a gradual elongation of the ear-piercing tract such that it becomes slit-like and often too large. Another problem is that the earlobes can be torn by accidental trauma. This split may be unattractive and renders the earlobe unusable for most jewellery. Sometimes, clip-on earrings can still be fitted and are used to camouflage the earlobe tear.

The repair of torn earlobes is relatively simple. The procedure is routinely performed in the office under local anaesthesia with an optional sedative. After planning and marking, a small amount of lignocaine numbing solution is deposited. I favour a three-layer repair done under loupe magnification. But it is very important to remove the damaged ear-piercing tract or to trim the edges of the split if the earlobe has been torn through completely.

Then the three-layer closure consists of closing the outer layer of skin, the fatty tissue between the two layers of the skin and finally the skin in the back of the earlobe. Typically, the surgeon must take great pains to avoid any notching at the bottom of the earlobe. The fine sutures on the skin are usually removed within 7 days. Small amounts of antibiotic ointment are applied at home for a few days ensuring cleanliness. The healed earlobe has usually a barely visible pencil-fine straight or zigzag scar line.

People often ask if the ears can be pierced again. They can but typically you should wait three months after the earlobe has been repaired. Preferably piercing should not be done within the scar, as this can stretch and inevitably result in another clot.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Wabi-Sabi In Cosmetic Surgery – Imperfect, Impermanent, and Incomplete.

Celebrities, models, and socialites have highlighted some severe complications (including death) from undergoing cosmetic surgery in their pursuit of perfection. This is very concerning and makes me reflect on what beauty is all about. I am reminded at this point of Wabi-Sabi, the Japanese philosophy that embraces the beauty of things imperfect, impermanent, and incomplete.

It is a beauty of things modest and humble. It would be interesting to see how much of this ancient Japanese philosophy could be embraced in the world of cosmetic surgery and what a difference it could make.

Wabi-Sabi represents the exact opposite of the Western ideal of great beauty as something symmetrical, extraordinary and enduring. Wabi-Sabi is about the minor and the hidden, the tentative and the ephemeral: things so subtle and evanescent they are invisible to unrefined eyes.

Simplicity is at the core of things Wabi-Sabi. Wabi-Sabi embraces the “less is more” ideal talked about today, yet often ignored. Cosmetic surgery needs a lot of Wabi-Sabi.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

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

Tummy Tuck Gives You a Waist You’ve Been Longing For!

Flabby bellies are notoriously difficult to control through diet and exercise.  Liposuction may be beneficial for someone who has extra fat around the abdomen, but anyone who also has lost muscle tone and developed extra sagging skin will require a tummy tuck, otherwise known as an abdominoplasty, to achieve a flatter waistline.

A tummy tuck addresses all three major problem areas at once. In one operation we remove:

1)  excess fat,

2)  saggy skin, and

3)  tighten abdominal muscles that may have become distended with pregnancy or age.

Men and women can develop abdominal wall weaknesses as they age that can be repaired during a tummy tuck.

During pregnancy, women lose their waistline as a result of the spreading of the surrounding tummy muscles. This spreading is referred to as ‘diastasis recti’ and is not an actual hernia but does cause a bulge from the pubic area to just above the belly button. Men may also experience this spreading following weight gain or in the presence of abdominal hernias.

The modern tummy tuck is not only a removal of skin but also an operation on fat, and muscle. Incisions for a tummy tuck are made below the bathing suit line from hipbone to hipbone and are generally tailored to the patient’s wishes. Some female patients prefer to wear french cut bathing suits. In that case, the incision comes up a little higher on the side extension. For those patients who prefer a traditional cut swimsuit, the incision is made right at the hip line. In all cases, the incision and resulting scar are fashioned to meet the patient’s wishes and afford them complete camouflage in a bikini or other bathing suit.

Next, an incision is made around the belly button. While the belly button is left intact on the underlying muscle, the tissues beneath are elevated from the lower tummy to the rib cage area and redundant skin and fat are removed, exposing the abdominal wall. At that point, the abdominal wall is lightened by suturing together (or “lacing-up”) the abdominal muscles and repairing any damage that occurred during pregnancy or weight gain. At no time are these muscles actually cut.  It is the lightening of the muscles that really reduces the waistline (and is the main reason for the post-operative pain in tummy tucks). We then perform liposuction on the abdominal wall, waist, hips and “love handles” in an effort to create a smooth, pleasing contour across the entire waistline.

Finally, the tummy skin above the belly button is stretched down to the meet the incision at the pubic hairline. A small incision is made for the belly button, which will reach back through the abdominal wall as usual. The shape and nature of the belly button don’t change unless a patient specifically requests it. Any hernias of the belly button can be corrected. For example, ‘outies’ can be made ‘innies’ or it can be made a bit smaller if the patient so desires. Patients are usually instructed to wear a ”girdle” or medical compression garment over the entire tummy area to provide support and comfort while healing. It takes generally two to three weeks to make a complete recovery, and most of our tummy tuck patients are back to work within three to four weeks.

Question: What steps do you take to try and get rid of that bothersome flabby tummy? You can leave a comment below.

Why a Body Lift Can Help You After a Massive Weight Loss

If you desire a firmer, more youthful-looking body contour, then a surgical body lift may help achieve your goals. It improves the shape and tone of the underlying tissue that supports fat and skin. In addition, the procedure(s) can improve a dimpled, irregular skin surface, commonly known as cellulite.

Body lift surgery essentially sculpts the body by excision of excess skin and fat and reconstruction of what remains into some reactive contours. Body lifts can be performed in two different ways, to treat either the upper or the lower body:

  • Lower body lift: The lower body lift is the most common type of body lift in my practice. It typically includes a tummy tuck (abdominoplasty), thigh lift, and buttocks lift performed at the same time. The incision is concealed around the hipline so that it’s not visible when wearing underwear or a bikini.
  • Upper body lift: For patients with severe skin laxity of the upper torso, an upper body lift may be the appropriate treatment. This typically includes a bra line back lift and upper abdominoplasty. The procedure is individualised for the particular patient.

Candidates for body lifts typically have lost large amounts of weight. They should be healthy and well-nourished without vitamin or mineral deficiencies. They should not smoke, as smoking increases the risk of complications.

Body lift is performed under general anaesthesia, with the patient positioned on their stomach, and the surgeon removes a large, belt-like segment of skin above the buttocks, up to the lower back. When the wound is closed, the thighs and buttocks are lifted. The patient is turned over and the surgeon continues to work on the front of the thighs and abdomen. Indeed, when a surgeon performs a circumferential removal of skin and fat of the lower abdomen, and when combined with undermining of the thighs, it will lead to a lift of the buttocks and thighs. A body lift can be done in two stages, with a three-month gap between procedures, or as a single stage surgery.

Patients usually take at least two weeks off from work following a body lift. I encourage patients to ambulate shortly after surgery. They may resume full exercise approximately 6 weeks following surgery. The results of a body lift are visible almost immediately. However, it may take as much as one to two years, or more, for the final results of the body lift procedures to fully develop. Since weight loss patients have poor skin elasticity, the closure must be as tight as possible. However, over-resection of the skin followed by overly tight closure of the tissues can lead to wound rupture or to broadly depressed scars resulting from suture pull through, breakage or premature dissolution. At the same time, insufficient removal of skin and low-tension closure leaves sagging tissues, skin rolls and/or wrinkles. A body lift should be seen as a critical step in overcoming obesity, with the potential of ceasing or reducing medications used for diabetes and high blood pressure. Patients need to take steps following surgery to maintain a healthy lifestyle, ensuring that their new shape will be long term.

Question: Do you feel that a body lift can improve self-esteem following massive weight loss? You can leave a comment below.

What Is a Mummy Makeover?

Many of today’s mums don’t feel they should sacrifice the way they look just because they’ve had children. After multiple pregnancies and breastfeeding, many women find it impossible for diet and exercise alone to restore their figures. These women usually want their tummies and breasts back the way they looked before pregnancy.

These so-called “Mummy Makeovers” are usually performed on women in their 30s or early 40s. There are multiple variations of the Mummy Makeover, of course, and I individualise the plan for each patient depending on their needs. Many women will not need or desire all of these procedures. Each patient determines what her personal Mummy Makeover will involve after we discuss her concerns and options in a thorough consultation.

A Mummy Makeover may be performed in one or more stages. Age, health, needs, and desires are all considered carefully when I formulate a plan for each patient. The majority of my patients choose to do more than one procedure at a time. I’ve had a great deal of experience performing these combined surgeries over the past decade. We take many steps to assure both minimal pain and maximum safety during our procedures:

  1. TUMMY TUCK: The tummy tends to experience the greatest change following pregnancy with stretch marks, loose skin and lower tummy fat being the most common complaints. The tummy muscles may also be stretched to the point that they remain separated in the midline, accentuating the patient’s lower tummy bulge. To treat these problems, I perform a tummy tuck where I remove the excess skin and fat from the tummy and tighten the muscles. Whenever we do a tummy tuck as part of the Mummy Makeover, we perform liposuction and pay special on to the belly button to help create a nice looking midriff.
  2. LIPOSUCTION: After having children, fat tends to redistribute to new areas on the body where it may be unwanted. This is frequently true even if women are successful at losing their baby weight. Most often, bulges of fat accumulated around the waist and on the thighs. On these areas, I frequently perform liposuction as part of a Mummy Makeover.
  3. BREAST SURGERY: The breasts go through dramatic changes with pregnancy and breastfeeding. Patient concerns about their breasts vary greatly, but the most common breast procedures I perform as part of a Mummy Makeover include:

Many of our patients for the Mummy Makeover travel from places outside of Sydney. Our staff can help with the planning of these sorts of trips through our CosmeticCulture Makeover Vacation Program, which makes travel for cosmetic surgery quite easy. More information is available on our website www.cosmeticculture.com.au, including descriptions of tummy tuck and breast augmentation or breast lifts as well as liposuction. You can also email us for more information at info@drtim.com.au or call us at 13000DRTIM.

Question:  Which parts of your post-childbirth body would you like to change with a Mummy Makeover? You can leave a comment below.

Look Younger for 2019!

 

These are my top 10 hints for looking good next year:

  1. Eat well. Preferably, eat smaller meals as the day goes by and eat frequently. Make it a habit not to eat after 9 pm.
  2. Exercise regularly. Remember: ”healthy body, healthy mind!”
  3. Keep your weight stable and within normal limits. Being overweight can predispose you to certain cancers and diabetes, not to mention, heart attacks, strokes and leg ulcers.
  4. Get your general practitioner to do a physical examination and if necessary, run some basic blood tests.
  5. Avoid the 4”S”: sun, stress, smoking and sleepless nights. These can hasten your aging!
  6. Think skin rejuvenation i.e.; microdermabrasion, peels and laser skin tightening. These will give your skin a definite glow!
  7. Start getting anti-wrinkle injections to iron-out those wrinkles that make you a more youthful appearance!
  8. Use fillers to pump-up that lost volume in the cheeks etc. As we age, the fat melts away in certain pockets in the face as does the underlying bony platform. The end result is excess skin that combines with gravity to make it sag. This effect can be countered by using either synthetic fillers or fat injections.
  9. Think minimal scar surgery to rejuvenate the face e.g. a neck lift or remove those bags under the eyes.
  10. Think about a surgical rejuvenation of the upper eyelids and brows by giving them a lift. The eyes and brows are often the first signs of aging in a woman and they usually start to sag in their early 40s.  Remember, ”the eyes are the windows of your soul” and may tell us a lot about your self-esteem and body image.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Teenage Cosmetic Surgery: Why So Much Pressure?

 

There has been a storm brewing for some me now regarding teenage cosmetic surgery.  A concoction made up of quick fixes,  a society obsessed with beauty, and the commercialisation and overexposure of cosmetic surgery. This has all lent themselves to the growth of cosmetic surgery for  Generation  X and younger.  This has been further compounded by the increasing number of medical specialists entering the cosmetic arena.

My worry is that this Generation X and their successors wanting teenage cosmetic surgery may become an abused marketplace.  It would appear that they have it a little easier, in the sense that, they have parents or relatives who have had cosmetic surgery and are approving of it, in an economy that has been both buoyant and robust for some time now.  This takes away from the fact, that teenage cosmetic surgery needs much more scrutiny because it can play on people’s insecurities and promises of an instantly better life.

Most plastic surgeons I believe are responsible individuals with a conscience who try and counsel teenagers, usually in front of their parents, of the risks, benefits, and outcomes of procedures, as well as whether they are appropriate or not. They try very hard to show that TV programs like Extreme Makeover,  Dr.  90210  and  The Swan trivialise and glamourise cosmetic surgery and that glossy magazines like Teen Vogue or Teen Cosmo display airbrushed photos of models and celebrities that are in reality unachievable.

Now teenagers who want to have cosmetic surgery usually have different motivations and goals than adults.  They too have cosmetic surgery to improve physical characteristics they feel are awkward or flawed,  that if left uncorrected, may affect them well into adulthood.  Teens tend to have cosmetic surgery to fit in with peers, to look similar.  Adults tend to have cosmetic surgery to stand out from others.  Teenagers frequently gain self-esteem and confidence when their physical problems are corrected.  In fact, successful teenage cosmetic surgery may reverse the social withdrawal that generally accompanies teenagers who feel different.  Not every teenager seeking cosmetic surgery is well suited for an operation.  Teenagers must demonstrate emotional maturity and an understanding of the limitations of cosmetic surgery.

I would caution teenagers and parents to keep in mind that cosmetic surgery is real surgery, with great benefits, but also carries some risks. Teenagers should have realistic expectations about cosmetic surgery and what it can do for them. In addition, certain milestones in growth and physical maturity must be achieved before undergoing cosmetic surgery. The most rewarding outcomes are expected when the following exist:

  1. The teenager initiates the request.
    The young person must appreciate both the benefits and limitations of cosmetic surgery, avoiding unrealistic expectations about life changes that will occur as a result of the procedure.
  2. The teenager has realistic goals.
    While parental support isn’t lessened at all, the teenager’s own desire for cosmetic surgery must be clearly expressed and repeated over a period of time.
  3.  The teenager has sufficient maturity.
    Teenagers must be able to tolerate the discomfort and temporary disfigurement of a surgical procedure.  Cosmetic surgery is not recommended for teens who are prone to mood swings or erratic behavior, who are abusing drugs and/ or alcohol, or who are being treated for clinical depression or other mental illness.

Some of the commonest teenage cosmetic surgery procedures include:

  1. Rhinoplasty (nose reshaping)

Cosmetic surgery may be performed on the nose to straighten the bridge, remove an unsightly hump, reshape the point or open breathing passages. Ordinarily, this is not performed until the nose reaches its adult size –  about age 15 or 16 in girls and a year later in boys. The procedure accounted for nearly 50 percent of all cosmetic surgical procedures performed on this age group.

2.Otoplasty (ear surgery)

Surgical correction of protruding ears, in which the ears are pinned back, may be performed any time after the age of five. Otoplasty made up 11 percent of all cosmetic surgical procedures performed on this age group.

3. Correction of Breast Asymmetry

When one breast grows to a much larger size than the other, an operation may correct the difference by reducing the larger breast, augmenting the smaller, or both. Many teenagers who want breast augmentation tend to have one breast that is larger than the other – sometimes a full cup size or more in difference. This condition is called breast asymmetry. Using a breast implant in the smaller breast allows the patient to have breasts of the same size. Although waiting may prolong the physical awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

4. Breast Augmentation

Breast implants can be used for breast augmentation in women 18-years or older and for breast reconstruction.

Many teenagers who want breast augmentation to have one breast that is larger than the other -sometimes a full cup size or more in difference. This condition is called breast asymmetry. Using a breast implant in the smaller breast allows the patient to have breasts of the same size. Although waiting may prolong the physical awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

5. Breast Reduction

Surgical reduction of very large breasts can overcome both physical and psychological burdens for a teenage girl.

In fact, many teenagers suffer ongoing back pain due to overly large breasts. Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result.

6. Acne and Acne Scar Treatment

Acne eruptions may be controlled by the proper use of modern prescription drugs. In addition to supervising the use of these medications, plastic surgeons may improve acne scars by smoothing or “refinishing” the skin with a laser or with a fine sanding technique called microdermabrasion. Other treatments for acne related skin problems include laser skin resurfacing, dermabrasion, and chemical peels.

7. Male Breast Reduction (Gynaecomastia)

Teenage boys with large breasts, known as gynecomastia, are often eager to undergo plastic surgery. Surgical correction can be accomplished in a variety of ways including liposuction and/or surgical excision of the breast tissue.

As a plastic surgeon, I am an advocate for the right teenage cosmetic surgery, at the right time, and for the right reason. Things like correction of prominent ears, breast reduction in adolescent boys or breast reconstruction in young girls with an underdeveloped breast can truly advance the person’s quality of life. It is our responsibility as plastic surgeons to guide teenagers (and their parents) in the right direction and to educate them that cosmetic surgery is not a panacea for the everyday pressures that teenagers’ face. Cosmetic surgery can make you more attractive but not necessarily happier!

Question: What do you think is the commonest reason teenagers want cosmetic surgery? You can leave a comment below.

Dangers of Excessive Weight Loss

Many women that I see for body contouring usually have tried exercise and dieting to some extent or other prior to resorting to liposuction or surgery. A minority of women have taken drastic measures like excessive gymming or starvation diets to try and fit into single digit or low teen dress sizes. This can, however, cause irreparable health problems like the following:

  • no menstrual cycle or abnormal menstruation in women.
  • prevent women from becoming pregnant.
  • cause premature delivery, the birth of low-weight babies who are also undernourished.
  • loss of libido due to suppression of Follicle  Stimulating  Hormone (FSH) and other secondary sex hormones in the brain.
  • suppress the hypothalamic-pituitary-adrenal axis which is responsible for the release of sex hormones
  • anorexia or poor nutrition can lead to osteoporosis.

My advice is that no weight loss or fitness program should be undertaken without the direct supervision of your doctor.  Whether you should lose weight, how much you should lose and how you should lose it are decisions that should be made by a medical professional, who may need to refer you to a nutritionist or endocrinologist for further work-up and counseling.  If you want to lose weight and keep it off, your doctor must be part of the equation.

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.  Before 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 anaesthetist 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, too 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 having cosmetic surgery tourism?  You can leave a comment below.

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 anaesthetic 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 minimise complications from surgery and anaesthesia. 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

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

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

Cosmetic Surgery Tip #26: Stay well-hydrated by drinking water

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It is important to drink at least 6-8 glasses of high quality water each day and especially the day prior to surgery, to help cleanse and hydrate the body.  Water is especially important prior to surgery, as fluid intake is reduced the day of surgery.  To avoid complications during surgery, be sure that you do not drink anything after midnight the night prior to your surgery, unless told otherwise by your plastic surgeon.

Photo Credit: Saul Steinberg “Masquerade”

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During each breast augmentation operation, a long-acting local anaesthetic is placed around the implant so that patients will feel only minimal discomfort following surgery. Most of my breast augmentation patients take only a few days off from work to recover whilst others take up to a week. Patients may ease back into their normal exercise routine beginning several weeks after surgery.

 

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

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Breast reduction surgery is designed to make the breasts smaller and lighter to alleviate the problems of symptomatic macromastia. However, the surgeon performing the breast reduction is the most important determinant of the quality of the result. There are many different techniques for breast reduction, and each surgeon has his or her own preferences based on experience and patient needs. Often, breast reduction is combined with a breast lift.

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

Cosmetic Surgery Tip #1: Know your practitioner

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Select a qualified, reputable plastic surgeon to perform your procedure and research them thoroughly. Find out how long they have been practicing, what qualifications they offer, which areas or procedures they specialise in, and you will slowly get an idea whether they are the right doctor for you.

Photo Credit: Saul Steinberg “Masquerade”

Download FREE Mommy Makeover Guide now!

Are you frustrated with unwanted, loose, stretched skin following pregnancy?  Tummy muscles that have lost their tone causing you to have a round belly? Sagging breasts that have lost their volume and shape?AUGMENTATION MASTOPEXY ABDOMINOPLASTY IMAGE.001Mothers dedicate a great deal of themselves to their families. It starts with the pregnancy, where the mother’s body changes dramatically. Finally, there comes a time when mothers feel they’re able to address their own needs. 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. A Mommy Makeover refers to the common group of procedures (like abdominoplasty and breast lift) that many mothers seek after they are finished having children. Many times, the operation is performed in one stage, but other moms will prefer to do the procedures over time. In either case, it gives many mothers comfort to know that the changes they see in their bodies following pregnancy may be improved dramatically by a skilled plastic surgeon.

I’ve just put together a step-by-step guide called the “Mommy Makeover: Get Your Pre-baby Body Back! To learn how to remove unwanted abdominal skin and tone your tummy muscles, make your breasts perky and youthful again, download this PDF file now!

Fill out the details below to learn more:


To learn more about what a Mommy Makeover can do for you, request a consultation with DrTim by calling us at 13000DRTIM .

Cosmetic Surgery Tip #31: Increase your protein intake

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Two of the most important healing elements are calories and protein.  Extra protein is needed to build new tissue and blood vessels, repair injured tissue and step up production of cells that repair the wound.  Choose high quality protein sources like fish, poultry, beans & legumes or lean cuts of meat.

Photo Credit: Saul Steinberg “Masquerade”

Cosmetic Surgery Tip #16: You might lose feeling in your nipples after a breast augmentation or reduction

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Loss of sensation in the nipples can occur whenever there is surgery to the breasts. This depends on a number of factors, including breast shape and surgery type. Even if you lose sensation in your nipples, they will still respond to cold and stimulation ie. they will still be able to get hard even if you can’t feel it.

Photo Credit: Saul Steinberg “Masquerade”

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A body lift is designed to tighten the skin of a patient all the way around their body. The improvements may be dramatic like the patient above. Patients who benefit from this surgery have typically lost a large amount of weight and have significant deformity from skin laxity. The body lift may address the lower body or the upper torso.

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