Tummy Tuck (Abdominoplasty ) for a Contoured Waistline

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Loose skin, stretch marks and abdominal fat are among the most common reasons patients seek help from a plastic surgeon. In some cases, patients have excess skin and fat on the abdomen due to weight loss. In other cases, age or pregnancy has changed the contour of the abdomen. Many people get frustrated about diet and exercise being unable to tighten their lower abdominal skin. Some even lose the motivation to exercise because they can’t see any improvement. For many patients, abdominoplasty (tummy tuck) is their best option to reclaim a youthful figure.

Candidates For A Tummy Tuck

Candidates for a tummy tuck have some (or all) of the following problems:

  • Loose skin on the lower abdomen
  • Stretch marks on the lower abdomen
  • Abdominal muscle laxity
  • Pubic laxity

Good abdominoplasty candidates should be healthy non-smokers. Although it’s better for patients to be close to their ideal weight, many patients who are overweight are still good candidates for the procedure.

Mommy Makeover

During pregnancy, skin may be stretched to the point that microscopic fractures form in the skin, or dermis, resulting in stretch marks. Caesarean section scars may accentuate fatty bulges by tethering the skin to the underlying muscles, causing the fat and loose skin to fold over the scar. The rectus abdominis (“six-pack”) muscles on the abdomen may become separated in the midline, creating a potbelly appearance. Fat also redistributes with age, becoming concentrated in the lower abdomen. The hourglass waistline of youth gives way to a larger midsection. That’s why many women choose abdominoplasty as part of their “Mommy Makeover“.

Although tummy tucks can achieve dramatic improvements, it’s important to also consider adjacent areas of the body for optimal results. For many patients, liposuction around the waist and thighs will provide more comprehensive results. Mothers will frequently choose breast surgery as well. This combination of procedures completes their transformation back to the hourglass figure they once had.

The Procedure

The tummy tuck procedure involves the following steps:

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

Tummy tuck procedures (and results) vary substantially. Tummy tuck techniques have evolved significantly over the last decade in an attempt to achieve the best possible results for patients.

Recovery

Following a tummy tuck, patients should take at least 2 weeks to recover before returning to work. Normal exercise routines may be resumed approximately 6 weeks following surgery.

Take the first step toward restoring your body with a tummy tuck. Request a consultation online or call our office at 13000DRTIM.

Can Breast Implants Raise a Low Nipple Areola Complex?

A youthful, cosmetically ideal breast has a nipple areola complex diameter of about 38-42mm.  Some breasts have large areolas from the time that they develop during puberty, and some enlarge later in life with pregnancy and breastfeeding. A large areola tends to make a breast look ’matronly’ even if it is not sagging. Nipple-areola complex diameter can definitely be reduced or enlarged, and this can be performed as a stand-alone procedure or as part of any breast enhancement procedure such as a lift, augmentation or reduction.

An attractive, well-positioned, and proportionate nipple areola complex is an important goal for many women looking to achieve a beautiful breast appearance. This small area of a woman’s anatomy can have a big impact on her satisfaction with her breasts. Women who are unhappy with the appearance of their nipple areola complexes, can have them corrected either alone or in combination with any breast enhancement procedure.

Breast augmentation with breast implants will not necessarily raise the nipple areola complex position in sagging breasts and in fact in some cases may make the areola larger. There are techniques to allow the implant to fall into the lower pole of the breast to create the illusion of lifting with more of the breast volume sitting lower on the chest. This is where using a tear drop (anatomical) breast implant can help as it creates a” bucket-handle” effect on the nipple areola complex.

The submuscular (below the muscle) breast implants are” innocent bystanders” to whatever happens to the breasts, as they are really chest wall implants that simply push the breasts forward. The submuscular breast implants are supported by the overlying pectoralis major muscles. In contrast, subglandular (above the muscle) breast implants are more likely to fall with pregnancy or weight loss, as they are supported only by the overlying breast tissues.

A periareolar (around the areola) or circumvertical (lollipop type) breast lifts are reasonable choices to reduce the nipple areola complex size and raise its position on the breast. These techniques reliably elevate the breast while keeping scars to a minimum. These breast lifts are desirable because of the nipple position (usually at or below the breast fold) and because of breast sagging. Neither nipple areola complex position nor breast sagging would be corrected with breast implants alone. “Blowing up the balloon” with larger breast implants will only create excessively large, still very saggy breasts. Reshaping the breast and elevating the nipple areola complex and breast back up onto the chest will play an important role in helping one achieve a cosmetically pleasing result.

Most plastic surgeons have a clear policy defining the financial responsibility of the surgeon and the patient in case of complications involving breast lifts, both short and long term. The policy should be made clear to each patient before surgery. It may differ from surgeon to surgeon with the majority of surgeons not charging their fee for reoperating on the patient but the patient having to pay the facility and anaesthesia costs.

Many women feel uncomfortable with their breasts their whole life because they had ’droopy’ or enlarged nipples or areolas that looked abnormal. A small surgical procedure to enhance the nipple areola complex can be extremely important for a woman’s self-esteem and self-image.

Question: Does it matter to you whether the nipple areola complex is proportionate to the remaining breast? You can leave a comment below.

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

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

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.

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.

3 Tips to Consider Before Body Lift Surgery

Body lift surgery is a complex operation that requires a lot of information to be processed and considered. There are 3 main points that people interested in this procedure should keep in mind especially that this involved both a major physical and psychological recovery period.

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1. Make Sure You Have Appropriate Motivation & Realistic Expectations

Make sure you are doing the body lift surgery for yourself and for the right reasons and that you have realistic expectations.  Be aware that an improvement in the problem area may not necessarily translate to an overall improvement in your life or home situation.  You are bound to be disappointed with results of body lift surgery if your motivation is not intrinsic.
 Timing of your body lift surgery is crucial. Generally, it is not a good idea to have body lift surgery done during or immediately after a stressful period in your life e.g. divorce or death of a loved one. The additional stress of body lift surgery will undoubtedly be  more challenging to deal with if your emotional reserves are already exhausted. Take note that an improvement in your physical appearance will not necessarily translate to an improvement in your life situation.
 Lastly, keep in mind the end results as you go through the sometimes tough, emotional times after your body lift surgery.

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

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Breast reduction surgery is considered to be medically necessary if a patient suffers from symptomatic macromastia. The typical criteria for health fund coverage of a breast reduction include: bothersome symptoms detrimental to quality of life, failure of medical therapy prescribed by another doctor, 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. The best way to determine if your procedure is medically indicated is in a consultation with me at the clinic.

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

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.

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