Cosmetic Surgery Tip #6: Ask to see their work

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Ask to see examples of your plastic surgeon’s work. Seeing photographic evidence of the results that can be achieved will help you to establish realistic expectations, but it will also give you an idea of the capabilities of the practitioner.  But do make sure that these are not generic pictures of the manufacturer; make sure it is the work of the plastic surgeon themselves that you are seeing.

Photo Credit: Saul Steinberg “Masquerade”

Can you achieve the perfect nose?

Rhinoplasty or nose surgery is one of the most common cosmetic procedures. You only notice the nose if it’s too big, too wide, or seems to be misshapen. In these type of cases, most people would want to have a rhinoplasty, also known as a nose job, to make an improvement in their appearance and thereby, increase their self-confidence and quality of life. Rhinoplasty are also performed to correct an accidental fracture or to improve chronic nasal congestion. In such cases, the surgery falls under functional surgery.

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Who Are Good Candidates for Rhinoplasty?

Rhinoplasty is suitable for anyone in good health. It is advisable that the procedure be done on a fully developed nose. Complete maturation of the nose is developed by the age of 16 for girls and 18 for boys. The commonest age group for a rhinoplasty are the late teens and early twenties. Adolescence and early adulthood exposes individuals to great pressure from their peers and society with regards to the way they look. Having a nose that is unappealing places enormous stress on one’s self-esteem and can cause severe effects on a teenager’s confidence.
Fixing bumps or making the nose smaller usually gives the face better proportion, leading to an improved appearance that will give teens and early adults the confidence they need to tackle  life and their foray into the real world. Older individuals who have rhinoplasty done either do it for cosmetic or for functional reasons, the latter usually to correct difficulty in breathing caused by chronic nasal congestion and other conditions.  For many, a drooping and sagging nose caused by ageing makes them look a lot older and having rhinoplasty can rejuvenate them again.

Insurance Issues

Cosmetic surgery is generally not covered by health funds. However, when a rhinoplasty is needed to correct an injury like a fracture, nasal obstruction, or to correct a congenital nasal deformity, then it can fall under functional surgery and therefore be covered. It all depends on the reason behind the nose job. Make sure you know what your medical insurance covers so you know how to proceed with your planned surgery.

The Steps to Having a Rhinoplasty

Before you consider a nose job, make sure you know where to have it done. Do your research and choose the best clinic or plastic surgeon who will help you achieve the look you want for your nose.  Set an appointment with the plastic surgeon and gauge whether or not you are comfortable and confident with the professional who will be doing the procedure. If everything is in place, such as the look you are going for, the budget, and the schedule, then it’s time you make the appointment for your rhinoplasty. Advanced technology like the VECTRA 3D Imaging System is available in certain clinics, which provide you with computer simulations of your before and after pictures. If you don’t like what you see, you can discuss further with your plastic surgeon about how you want the structure of your nose to look like.

What to Expect with the Rhinoplasty

Rhinoplasty is an outpatient procedure performed under general anaesthesia. The entire procedure takes about 1 to 3 hours or longer for complicated cases. Most plastic surgeons today perform an open rhinoplasty where the the incisions are made just under the nose, as well as,  inside the nose so the scars are inconspicuous once the nose heals. Depending on what needs to be done, plastic surgeons either remove bone and cartilage to make the nose smaller, or add tissue to make it bigger especially in Asians and African-Americans. Once this is done and the structure of teh nose is in place, the skin is re-draped and the incisions closed with fine sutures. A splint is then placed on-top of the nose to provide support to the new shape until it heals.

Recovery

Patients can go home after a rhinoplasty but for more complicated surgeries, patients would need to stay overnight at the hospital. Splints are usually taken off after 7 days. Many patients get to return to work after 1 week but swelling and bruising will still be present. Expect your face to feel puffy, especially on the areas around your eyes and nose. Swelling usually improves after 10-14 days.

Risks

The risks involved with rhinoplasty include infection, bleeding, nasal blockage due to swelling, and asymmetry. It is best to consult with your plastic surgeon should there be any unexpected side effects of the procedure.

Question: What do you think are the  main benefits of rhinoplasty? You can leave a comment below. 

Arm Lift: The Beauty of Brachioplasty

For those patients that have what is colloquially known as ‘bat wings,’ undergoing an arm lift is probably the best way to get rid of it. These so called ‘bat wings’ are nothing more than loose excess skin that jiggles back and forth when the arms move. The cause can be one of two things. The first one is age. As we get older our skin tends to lose its elasticity. Secondly, we also tend to lose some body volume. When you combine the two you get excess skin that doesn’t contract as the underlying volume of tissue disappears. As a result you get flabby loose skin that many find to be unsightly.

The cosmetic procedure known as an arm lift, officially known as a brachioplasty, removes the loose excess skin.  Liposuction (CoolSculpting can be used as well depending on the surgeon’s opinion) may also be performed in conjunction with the brachioplasty to assist in removing stubborn fat, resulting in a more refined arm contour. Once the excess hanging skin is removed, the arm is sutured tightly leaving a firm arm devoid of any flabbiness.

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Types of Arm Lifts

There are a number of different procedures when it comes to arm lifts. The type of procedure performed depends on the patient themselves. This is because every person has varying degrees of skin laxity and flab in the arms which means they may not all need the same type of procedure. It also depends on what they like and the results that they are looking for.

  • Elbow to Axilla – In this procedure an incision is made from the fold of the elbow to the axilla or armpit. Liposuction is often used in conjunction with this procedure. The liposuction is used to remove stubborn deposits of fat that give the arm a better final contour. This is a widely common procedure chosen by many patients. 
  • Mini Arm Lift – This procedure is for those who have excess skin mostly in the upper portion of the arm. It is also for those who don’t want  a lot of scarring which can happen in the procedure above. Here, the incision is made under the armpit only. 
  • Arm and Axillary Lift – For those who have too much excess skin in the upper arm and armpits this procedure is for you. This procedure gets rid of the sagging skin from the upper arm and from the armpit as well. The incisions are usually done in two places – the upper arm and under the armpit onto the chest. 
  • Elbow Lifts – This procedure is just what is says: a lifting of the elbow portion of the arm. Some people will have loose and sagging skin over their elbows. This procedure is targeted just for that portion of the arm.
  • Liposuction – If you still have elastic skin then you may not need to have a lift at all. For patients like this, liposuction may just be the solution. With liposuction the incisions are not that dramatic (only 3-4mm long) which means scarring is kept to a minimum.

The Right Candidate

Typically a likely arm lift candidate is one that has lost a lot of body weight. This means that they have lost a lot of body volume that resulted in the excess skin that was not able to adapt quickly to the loss of volume underneath it. It is highly recommended that you be at your target weight before the operation. If you are still in the process of losing weight you should wait until you hit that weight plateau in order to get a good final result from the arm lift. There’s a good reason for this. If you have the procedure and still lose the weight you may find that your arm will still have flabbiness in it even after the operation. That’s because since you still had weight to lose the skin is still stretched out resulting in the extra, loose skin.

It is a good idea to consult with a plastic surgeon when you want to have this cosmetic procedure done. This way the procedure can be explained to you including what you can expect, how your recovery will be and the risks that are involved. For further information call us on 13000DRTIM or email us on info@drtim.com.au.

 

Breast Implants and Anaplastic Large Cell Lymphoma (ALCL). Only recently described, breast implant–associated ALCL (BIA-ALCL) usually presents as an effusion-associated fibrous capsule surrounding the implant and less frequently as a mass.  To the best of my knowledge, this is the first video to demonstrate the unexpected diagnosis of BIA-ALCL.

Little is known about the natural history and long-term outcomes of such a disease. What we do know so far is that BIA-ALCL occurs at a mean of 8 years post implantation and is most commonly a T-cell lymphoma, is CD30 receptor protein positive and does not have an anaplastic lymphoma kinase gene translocation (ALK -). The exact cause of BIA-ALCL is still unknown and not possible to determine if it’s specific to any manufacturer or breast implant type. What we do know is that it may involve a combination of genetic predisposition, biofilm and textured implants

Current recommendations for the diagnosis, treatment and monitoring of BIA-ALCL include:

  1. Any patient presenting with late peri-implant seroma (>1 year), consider U/S (if inconclusive do PET CT or MRI) to rule out effusion, mass +/- lymph nodes and send seroma for culture, flow cytometry and cell block. Note 1 in 8 cases present with lymphadenopathy. There is no role for mammography.
  2. Send tissue samples for CD30 and ALK to haematologist experienced with ALCL.
  3. Confirmed localized BIA-ALCL requires explantation and total capsulectomy (surgical oncologist recommended). Consider removal contralateral breast implant as several bilateral cases detected incidentally. Monitoring by oncologist for surveillance every 6 months for 5 years with annual U/S +/- PET CT for 2 years. Advanced disease requires surgery (mass, lymph nodes), chemotherapy (CHOP: cyclophosphamide, doxorubicin, vincristine, prednisolone), targeted immunotherapy (Brentuximab vedotin) and chest wall radiation for unresectable tumours or positive margins. BIA-ALCL has a more favourable prognosis than systemic forms of ALCL. BIA-ALCL with mass has higher but significant disease recurrence and progression.
  4. Reconstruction suggested >1 year surveillance. Replacement with smooth implants has been performed without reported progression or recurrence of disease but ongoing safety of this strategy is still being investigated. Autologous reconstruction favoured when possible.

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Cosmetic Surgery Tip #14: You can’t go from small to huge all at once

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If you’re starting with a small A cup, don’t expect to go up to a DD cup in one procedure. It’s important to set realistic goals. Your body and skin need time to adjust to drastic changes, so a plastic surgeon will likely suggest going up only a couple cup sizes at first, then increasing the implant size over the course of a few years.

Photo Credit: Saul Steinberg “Masquerade”

Cosmetic Surgery Tip #33: Discontinue taking certain supplements

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Some nutritional supplements may cause adverse reactions during or after cosmetic surgery, including prolonged bleeding, interference with anaesthesia, cardiovascular disturbances, and interactions with prescription drugs.  These supplements including dong quai, echinacea, fish oil caps, garlic, ginger, ginkgo biloba, ginseng, kava kava, ephedra, St.John’s Wort, and vitamin E, should be discontinued two weeks prior to surgery and two weeks after surgery.

Photo Credit: Saul Steinberg “Masquerade”