Body Lift: Who is the right candidate?

BC2.005

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.

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

Breast reduction: What’s the recovery like?

Untitled 3.004

One of the amazing 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:

  1. A few days to recover before returning to work
  2. A month for the incisions to heal before resuming exercise
  3. A year to 18 months for the scars to fade to a subtle colour

To learn more about breast reduction, 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

 

Brachioplasty (aka Arm Lift) for “Bingo Arms”

Brachioplasty (or Arm Lift) removes loose skin and fat from the upper arm. It ranks high on the wish list for many plastic surgery patients who have lost large amounts of weight or who have heavy upper arms due to simple genetic factors. Loose skin hanging from the arms tends to make patients self-conscious, limits clothing options and can even cause people to avoid certain activities, like swimming or playing tennis. Good candidates for brachioplasty are often weight loss patients who shed many kilograms, resulting in excess skin and stray fat deposits. Furthermore, post-bariatric patients should be near their desired weight and well nourished. Men or women with loose upper arms due to heredity and ageing may also be interested in brachioplasty. It’s best not to smoke for proper wound healing.

Techniques

There are a variety of techniques to chose from, so choosing the best approach for each patient’s particular needs is the no. 1 priority of the plastic surgeon. Each patient is unique in terms of skin laxity and other factors. Patients may benefit from one or a combination of the following techniques:

  1. ELBOW TO ARMPIT: An incision from the fold of the elbow to the axilla, or armpit, yields dramatic improvement. This approach is frequently combined with liposuction to eliminate stubborn fat pockets and loose skin. Most brachioplasty candidates choose this method.
  2. LIPOSUCTION ONLY: Patients with some skin elasticity remaining may opt for liposuction only. An advantage to this approach is that scarring is minimal. The right candidate can expect significant improvement, but not as dramatic as when skin is removed as well.
  3. MINI-ARM LIFTS: A mini-arm lift is an option for patients with excess skin in the uppermost portion of the arm, and for those concerned about scarring. In this case, I make an incision in the armpit, sometimes extending a 6-8 cms down the arm.
  4. ARM AND ARMPIT LIFTS: Upper arm skin is thin and sags over time. Some people lose so much elasticity that skin hangs down from their armpits as well, causing embarrassment and difficulty with clothing. These patients are candidates for a combination arm/armpit lift with incisions on the upper arm and in the armpit.
  5. ELBOW LIFT: A smaller group of patients have loose skin above and below the elbow. These men and women benefit from an arm and elbow lift. Great care needs to be taken with the incision across the elbow to remove excess skin while preserving range of motion.

Recovery

Most arm lift patients take a week or two off work after surgery. Most of the swelling subsides after 3-5 days and the wound takes about 10-14 days to heal. You will be encouraged to walk as soon as possible, gradually adding light activities over a few days and resuming full workouts and lifting within 6 weeks.

Risks

Complications of brachioplasty have been rare in my experience. These uncommon risks include infection, slow wound healing, bleeding, seroma and venous blood clots. Even if a complication were to occur, diligent post-operative care would still likely lead to a nice result.

 

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

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

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.

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

Beware! Women With Funnel Chested Having Breast Augmentation!

Funnel chest (pectus excavatum) is an abnormal development of the rib cage where the breastbone (sternum) caves in, resulting in a sunken chest wall deformity. Funnel chest is a deformity often present at birth (congenital) that can be mild or severe. The cause of funnel chest is not well understood. Yet, researchers believe that the deformity is caused by excessive growth of the connective tissue (cartilage) that joins the ribs to the breastbone (also known as the costochondral region), which causes an inward defect of the sternum.

While the vast majority of funnel chest cases are not associated with any other condition, some disorders may include the sunken chest feature include:

  1. Marfan syndrome: A connective tissue disorder, which causes skeletal defects typically recognised by long limbs and ‘spider-like’ fingers, chest abnormalities, curvature of the spine and certain facial features including a highly arched palate, and crowded teeth.
  2. Rickets: A deficiency disease occurring primarily in children, Rickets results from a lack of vitamin D or calcium and from insufficient exposure to sunlight, which disturbs normal bone growth.
  3. Scoliosis: A curvature of the spine.

Although the condition of funnel chest is relatively uncommon, it presents its own unique problems for women requesting breast augmentation. The commonest question asked is, “Which pocket is best to place the implants?”

In women with funnel chest deformity, I have tended to place the breast implants under the muscle because the breast and skin can be very thin over the midline of the chest and can make the implants more visible with a higher chance of rippling.

I also inform my funnel chest patients that the breast implants tend to slide towards the middle of the chest creating a very pronounced cleavage with nipples that tend to face inward (“cross-eyed” appearance). Because the patient with a funnel chest has a deeper midline, they will generate much more cleavage faster than patients with a flat chest wall. In worse case scenarios, the breast implants can slide towards the midline and “kiss each other” creating the “figure-of-8” or “bread loaf” deformity. Consequently, the experienced plastic surgeon will use a slightly smaller breast implant and will go under the muscle and make sure to leave enough tissue intact along the midline to prevent the implants from coming too close together.

As you can tell, this is a more difficult operation than regular breast augmentations. In my experience, the breast implants tend to improve the appearance of the “funnelling,” in that the indented area of the chest wall is less noticeable.

Question: Have any women with funnel chest experienced problems after breast augmentation? 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.

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.