Facial Rejuvenation: The Five (5) S’s that causes facial skin damage

Often, I’m asked by my Facial Rejuvenation patients about how long their face lift may last. I’m reminded of the French surgeon Dr Vladimir Mitz, a pioneer in anatomy regarding facelift surgery, who told me once he had a crystal ball on his desk to answer such a question! At the time, I hadn’t appreciated how profound this idea was. It makes a lot of sense to me now. Why?

There are several factors to take into account when thinking about treating patients for facial rejuvenation. I call these “the 5 S’s” and they affect your skin and thus the face.  These are:

  1. Stress
  2. Sun
  3. Smoking
  4. Sleepless nights
  5. Sugars

Let’s just take stress’s terrible toll on the skin:

  1. Wrinkles: tensing and tightening facial muscles squeezes and pinches the overlying skin, creating wrinkles and lines.
  2. Acne: hormone receptors connected to the oil glands are triggered by stress hormones, so once they’re stimulated, the gland increases oil production, causing pimples and breakouts.
  3. Hair loss: normally, hair follicles are small and resting, or active and growing, but stress shocks the system, throwing the cycle into chaos and causing follicles to sleep longer rather than produce new hair. Once they wake up, the old hair falls out
  4. Grinding teeth: jaw tension will create lines and wrinkles as skin is pinched and collagen is broken down.
  5. Increased free radicals: stress causes blood vessels to clamp down, causing a shunting of blood away from the skin as blood focuses on internal organs.

Lack of blood leaves skin vulnerable to assault from the sun, cigarette smoke and other outside pollutants that create free radicals. As an example of what stress is capable of, we have all seen people who have lost their loved ones and 6-12 months down the track they’ve seemed to have aged 5-10 years; their skin is more wrinkled, dry and sallow looking. Imagine if you throw in the other factors like sun exposure and smoking and you can see how they can affect the longevity of a face lift. That’s why it’s like looking into a crystal ball. I say to patients that a face lift usually lasts 7-10 years if you are lucky and maintain it with regular microdermabrasion, skin peels and laser skin tightening.

Things that you can do for facial rejuvenation to improve the health of your skin is to:

  1. Use regular sunscreen to protect your skin from free radicals from the outside world.
  2. Use antioxidants either applied topically or consumed orally such as vitamins A, C, E, lycopene, CoQ10, idebenone, green tea and grape seed extract.
  3. Take Vitamin B to stimulate hair growth.
  4. Relax. Calming your central nervous system and mind to give stress hormones a chance to switch off is a good thing. Try meditation, some quiet time or exercise.
  5. Anti-wrinkle injections. These injections not only make you feel better when you look your best, but medically they help muscles relax. There is a biofeedback between muscles and the brain, so if muscles aren’t tense, the brain interprets the quietness as calm and lets its guard down.

Question:  What do you do for facial rejuvenation to prevent facial aging? You can leave a comment below.

Why “Celebrity Imitation” with Cosmetic Surgery?

Why do people try to imitate celebrities’ actual faces and bodies? Why do people think that a celebrity’s physical appearance can be copied? Occasionally I would get a patient presenting to my office for consultation requesting Nicole Kidman’s nose or Kim Kardashian’s butt. Cosmetic surgery is not the same as Mr. and Mrs. Potato Heads, with interchangeable noses, ears, lips etc.

Plastic surgeons must work with what you have (reality) and you must understand that what you want (desire) may not be achievable.

We as plastic surgeons are trained to perform delicate operations to enhance or improve people’s physical characteristics in an effort to acquire a more desirable feature. We are also taught to operate within the safest parameters possible because cosmetic surgery is elective surgery, which means it’s a want not a need. Therefore, it is vital for us to properly screen all prospective patients to be certain that they are safe candidates for this surgery. There are basic conditions that should be considered, contraindications to surgery which include physical abnormalities, medical problems that can complicate the surgery or put the patient at unnecessary risk, psychological abnormalities, unrealistic expectations, inappropriate motivations and inherent physical characteristics that hinder the achievement of the best possible result.

For people considering “celebrity imitation”, you should reconsider why you want to look like a particular celebrity.

Why is it that you are trying to become someone else? Why are you unhappy with you?  Furthermore, what if a celebrity’s image changes? As they say, “the media darling of this week is the rehab tabloid queen the next.”

Cosmetic surgery is a big change and so it’s important not to lose yourself as you start to look like someone else. I am reminded from a quote of Oscar Wilde, ”Be yourself; everyone else is already taken.

Question: Is it worth getting cosmetic surgery to look like a celebrity?  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.

Correction of inverted nipples: the facts that you need to know!

As many as 3% of Australian women have at least 1 inverted nipple but the subject of nipple inversion is seldom discussed amongst family, friends or the media. Clearly, nipples are an integral part of the breast, playing a role in appearance, in sexuality, and in motherhood. Therefore, many women who have inverted nipples, feel that it affects their self-esteem and body image.

Most cases of inverted nipples are just born that way (congenital). However, some nipples become inverted after breastfeeding when scar tissue builds in the milk ducts. Nipples that become inverted after birth are usually caused by one of three things: not enough skin at the base of the nipple, constricted milk ducts, or scarring of the milk ducts due to breastfeeding. There are 2 types of inverted nipples: shy and densely inverted.

  1. Shy inverted nipples– can be drawn out with physical stimulation, either sexually or for breastfeeding. Shy inverted nipples may only cause cosmetic and psychological problems.
  2. Densely inverted nipples– this is where the nipples never come out, even when aroused or in very cold water. Densely inverted nipples also have functional repercussions, such as the inability to breastfeed, infection or irritation of the nipple when natural secretions become trapped.While a procedure to correct inverted nipples can have a great impact on the patient’s psyche and correct irritation problems, the ability to breastfeed cannot be guaranteed, as some or all of the ducts may need to be divided in order to free the nipple so that it is drawn out completely. The particular technique I use to correct inverted nipples was taught to me by my colleague and friend Dr. Grant Stevens, a plastic surgeon in Los Angeles, who is a pioneer in new techniques for procedures in breast surgery. The technique is safe, effective, has a short downtime, and the results are long-lasting. Before the procedure begins, the nipple and areola are numbed with an ice cube or pack, and a local anaesthetic given using a tiny needle the size of a hair. This means the patient experiences little or no pain, despite the sensitivity of the area.

The surgery itself is broken into 3 stages:

Stage 1: an incision measuring 4 to 5 mm is made in the lower portion of the nipple. The fibres or ducts are then released that are pulling the nipple down. The nipple is drawn out with much care in order to preserve the ability to breastfeed.

Stage 2: involves a series of stitches around the nipple.  If the nipple is imagined like a clock, the stitches run from 12 to 6 o’clock, then again from 3 to 9 o’clock.  By bunching up the tissue around the nipple, these stitches create a new pedestal for the nipple to rest on. A dissolving “purse-string” stitch is made around the base of the nipple, weaving in and out of the skin, which tightens the base of the nipple.

Stage 3: a small plastic “stent” – like a tiny medicine cup – is placed over the newly extracted nipple. This stent actually holds the nipple in place and ensures that the nipple heals in an outward position. Not only does it help with the nipples’ projection, but it also protects the nipple in the healing stages. This stent is kept on for 1 to 3 days. The patient then returns for a follow-up visit to remove the stent and the process is complete.

Post-operatively, there is little care needed. While the stent is on, patients cannot get the area wet and sexual contact is discouraged for the first week after surgery. Occasionally, the patient may need an ointment to aid the healing, although this is rare. The wound heals very quickly – to the point where the scar is usually invisible by the time the patient returns to have the stent removed (the stitches dissolve within 10 to 14 days). Possible complications include the retraction of the nipple or a local infection.

Although the correction of inverted nipples is a procedure that can greatly assist both the self-esteem of the sufferer and the function of the breast, more and more women are coming to my practice seeking nipple surgery for repair, correction, and enhancement of other conditions too:

  1. Enlarged nipples can be corrected with simple outpatient surgery reducing the length or diameter of one or both nipples.
  2. Reducing enlarged areolas is a quick fix as the areola can impact the appearance of the breasts more than any other feature.
  3. “Puffy” areolas put a cone-like cap on the breasts that some people find unattractive. A simple surgery can flatten the areola and beautify the breasts.

So despite the fact that nipples are usually hidden, women still want them to look attractive. Many women suffer with nipple and areola abnormalities such as inverted nipples, enlarged nipples, and puffy, enlarged or discoloured areolas.  Many of these conditions can impact breast function, but they all impact the way women feel about their bodies. The nipple can be repaired during outpatient surgery or during breast enhancement surgery.

Question:  Do women feel inverted nipples is such a big issue to warrant surgery?  You can leave a comment below.

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.

Breast Reduction for Symptomatic Macromastia

Breast reduction surgery patients are among the happiest  because they both look and feel better following surgery. When women have large, burdensome breasts, they frequently suffer from a condition called symptomatic macromastia which may include the following symptoms:

  1. Pain in the neck, shoulders, breasts, and upper or lower back
  2. Bra strap indentations
  3. Rashes underneath the breasts (intertrigo)
  4. Little finger numbness
  5. Difficultly exercising, fitting into clothing or examining the breasts

Breast reduction surgery is designed to make the breasts smaller and lighter to alleviate the problems of symptomatic macromastia. However, the plastic 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 their own preferences based on experience and patient needs. Often, breast reduction is combined with a breast lift on the other side.

Techniques

There are basically 2 types of techniques used commonly throughout the world:

  1. Wise Pattern (also known as the “Inverted T” or Anchor Scar) describe a technique with a scar around the areola with a vertical scar extending downwards to a horizontal scar in the breast fold.
  2. Vertical (also known as the Circumvertical or “Lollipop” Scar) describe a technique with a scar around the areola with a vertical scar extending downwards to meet the breast fold.

The choice depends on the extent of ptosis (sagging) and the surgeon’s experience. Liposuction is commonly used with the Vertical techniques and less frequently with the Wise pattern except to remove unwanted fatty tissue from the armpit regions.

Medicare & Health funds

Breast reduction surgery is considered to be medically necessary if a patient suffers from symptomatic macromastia. The typical criteria for Medicare Item no. coverage of a breast reduction include: bothersome symptoms detrimental to quality of life, failure of medical therapy prescribed by another doctor, physiotherapist or chiropractor, and removal of a minimum estimated weight of breast tissue.

Most health funds  will cover this procedure for patients with these symptoms if they have attempted conservative medical treatment without success. Most commonly, this conservative medical treatment is provided by a GP, physiotherapist or chiropractor. Typically, there is a minimum weight of breast tissue that must be removed from each breast to qualify as a medically necessary breast reduction for health fund coverage. The best way to determine if your procedure is medically indicated is in a consultation with me at the clinic.

Recovery

One of the best things about recovering from breast reduction surgery is how quickly patients experience relief from their symptoms. The morning after surgery many patients already feel symptomatic relief, even though their recovery has just begun. Many comment that they even breathe easier when they no longer have so much weight on their chests.

Recovery from a breast reduction tends to be quick because it does not involve the underlying muscles, bones or internal organs. Most women will need a few days to recover before returning to work, up to 2 weeks for the incisions to heal before resuming exercise and 12-18 months for the scars to fade to a subtle colour.

To learn more about your breast reduction options and whether or not you are a candidate, email us at info@drtim.com.au or call our clinic at 13000DRTIM .

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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 

Breast Augmentation revisions: 3 facts you must know!

Designing a surgical plan that can deliver a satisfactory result for women seeking surgical revision after breast augmentation can be quite difficult.  It still requires the plastic surgeon to obtain a good history, perform a careful clinical examination and identify the woman’s concerns and goals.

Revisional surgery after breast augmentation is typically more complex, because of the diversity of presentations and the interval elapsed since their primary surgery.  Additional surgery may be required because of anatomical changes caused by the previous procedure or that have occurred over me.  This information must be explained to and understood by women who may be expecting an easy fix. Furthermore, plastic surgeons may face the challenge of communicating with a dissatisfied and angry patient and therefore, in-depth and honest discussions outlining the risks, benefits, and costs of the various options remain paramount for achieving success.

There are 3 key facts women seeking revisional surgery after breast augmentation need to consider:

1)  Your plastic surgeon needs to listen carefully to what you’re saying.  They must find out what’s motivating you in order to satisfy your goals.  If your problem, however, is imperceptible to them, or you’re seeking an outcome they consider unattainable, they may not be able to help you reach your goals.

2)  Use visuals to enhance your consultation.  Visuals are extremely useful in helping you to understand all your options.  Your plastic surgeon should draw schematic diagrams to explain the various techniques and present you with lots of pictures of previous patients, which should be catalogued by physical attributes, rather than by implant volume or bra size.

3)  Make sure all your options are given to you in detail.  Your plastic surgeon should take a systematic approach to counseling you about your surgical options, beginning by describing the simplest, least-expensive procedure and moving up in terms of complexity and cost. Outlining all of the information so that you understand the basis for your recommendations and the likely outcomes should help you reach an informed decision and choose an operation that will deliver a satisfactory result.

If you have cost in mind and are dissatisfied after your recent primary surgery, then try and rectify the situation by returning to your previous surgeon. If this is not an option because of poor surgeon-patient communication, then you should seek another surgeon.

Thanks for reading!

 

Dr Tim – Sydney Cosmetic Plastic Surgeon

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

 

Facial Rejuvenation’s 5Rs: Relax, Refill, Resurface, Redrape and Remove

Although the hands of time cannot be completely turned back, facial rejuvenation can slow down or even reverse some of the natural aging processes which produce lines and wrinkles, age spots, broken capillaries, dull skin, and uneven tone and texture. Other flaws include loss of collagen and elastin, resulting in sagging skin, gaunt faces, dark circles and puffiness under the eyes. Open pores and acne scars also appear more visible.

There are 4 things that happen to our face as we age:

  1. Volume loss (mainly fat)
  2. Sagging tissues because of gravity
  3. Facial bones thin out and become lighter
  4. Skin thins, develops fine lines and wrinkles, as well as, brown patches

I think of skin and facial rejuvenation in terms of the 5 Rs:

  1. Relax: refers to using anti-wrinkle injections which so often wrinkles caused by muscle movement.  The facial muscles of expression, if used too much, can result in “frown lines” between the eyes, “worry lines” of the brow or “crow’s feet” beside the eyes.  By relaxing the muscles responsible for these expressions, we are able to interfere with the development or progression of such lines.
  2. Refill: various products, from fillers to one’s own fat, can be used to address facial volume loss. Such techniques are used in the treatment of deeper wrinkles, folds and expression lines that are too deep to be adequately affected by resurfacing.
  3. Resurface: refers to methods that remove the outer layers of the skin to yield a smoother, more even-coloured texture. These techniques are used to treat sun-damaged, weathered, or aged skin. These are useful for dealing with wrinkling of the skin, blotchiness, roughness and loss of lustre e.g. facials, microdermabrasion, chemical peels, and lasers.
  4. Redrape: refers to traditional surgical interventions that improve areas of redundant skin. Overtime and with accumulated sun damage, the skin loses its elasticity and may begin to sag. This is especially true in the lower face and neck although laxity of the brow skin and eyelids is also common. Most treatments for significant sagging of the face require surgical interventions e.g. facelifts, brow lifts, eyelid lift surgery.
  5. Removal: It is not uncommon to develop unwanted bumps, broken blood vessels, brown spots or tags on the skin, especially on the face and neck. All of these can be treated by simple removal techniques. In many cases, liposuction (removal of fat) can tighten the neck adequately without actually removing skin surgically.

Today, in the field of cosmetics, refill is much more appreciated in our approach to facial rejuvenation. Temporary fillers like hyaluronic acid (HAs) are considered the gold standard. Fillers are often combined in different areas of the face to recreate youthful contours, sometimes referred to as a “liquid facelift.” My go-to fillers for correcting hollows under the eyes, cheekbones or lips are HAs or fat. Vertical lip lines are treated with a combination of HAs and anti-wrinkle injections or laser resurfacing.

Fat transfer can be used to replace volume in most areas of the face including the temples (a much-neglected area until recently), cheeks, jawline, nasolabial folds, and marionette lines. It gives reliable, natural-looking results, and even improves the texture of the skin. Fat transfer is an easy, economical, safe, and comfortable means of volume replacement for the face. Fat is harvested from an area of excess fat such as the hip, thigh, or abdomen.

The fat is then processed and placed in small amounts to resculpt the facial contours of the face. Fat transfer is usually done under general anaesthesia. Fat is also an excellent choice for rejuvenating the hands, as it camouflages the appearance of visible tendons and dilated veins.

There are so many choices available for skin and facial rejuvenation. One can create a natural and gradual volume replacement. The “cookie cutter” approach to fillers is out. Discussing the 5 Rs and how the various techniques are used in combination for skin and facial rejuvenation can aide in maximising outcomes.

Question:  What signs of facial aging trouble women the most?  You can leave a comment below.

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An abdominoplasty (tummy tuck) procedure involves the following steps:

  1. Removing a large amount of lower abdominal skin (and stretch marks)
  2. Removing a large amount of lower abdominal fat
  3. Tightening the rectus abdominis muscles of the abdomen
  4. Redistributing the upper abdominal skin over the entire abdomen
  5. Creating a new belly button within the tightened abdominal skin
  6. Tightening the pubic area

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