Eyelid surgery for a more youthful look

Eyelid surgery is an operation that can dramatically improve a patient’s appearance within a relatively short recovery time. Droopy eyelids is one of the major reasons why some people often consider eyelid surgery (blepharoplasty) to get rid of excess eyelid skin for a youthful appearance. In other cases, eyelid surgery helps in improving ones vision by offering a field of view that is less obstructed after the removal of excess skin.

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How is eyelid surgery performed?

Eyelid surgery can be performed on your upper eyelids, lower eyelids or both. The plastic surgeon will carry out pre-operative evaluation on factors such as your facial muscles around the eyes, the symmetry or droopiness of your eyebrows and underlying bone structure. After the evaluation your plastic surgeon will be able to determine the amount of skin and/or fat to get rid of. Some points to consider:

  • your plastic surgeon will make accurate markings to show where the excess tissues will be removed on your lower and upper eyelids.
  • On your upper eyelid, they will make a surgical slit concealed in the natural fold of the upper eyelid.
  • In the lower eyelid, the surgical slit will be concealed below your lower eyelashes. When unwanted fat only is being removed, the slit can be made inside the lower eyelid which is referred to as a transconjunctival incision. Laser resurfacing may at times be used together with this method so as to make the lower eyelid skin tighter.
  • The plastic surgeon will also get rid of excess tissue through these slits.
  • At times, fat may need to be redistributed in the lower lids to completely remove bulges or puffiness. Other changes may be made so as to correct special problems such as muscle laxity.
  • The scars are generally inconspicuous after healing.
  • For patients who have dry eyes, very little amounts of tissue are removed to avoid exposing more of the eye to the air which may worsen the symptoms.

When to consider eyelid surgery

  1. If you have too much skin hanging or covering the upper eyelids natural folds.
  2. If loose skin hangs down from the upper eyelids over the eyelashes.
  3. If the under of your eyes has deep grooves and bulges.
  4. If both your upper and lower eyelids look puffy, making your eyes appear aged and tired.

Many people who consider blepharoplasty also consider facelift, wrinkle smoothers, brow lift and dermal fillers for a complete facial rejuvenation look.

What will my eyelid scars look like?

  1. Upper eyelid surgery: The plastic surgeon will mark the natural lines and creases of the lids and keep the incisions as concealed as possible along the natural folds. Thin sutures will be used in closing up the incisions hence making the scars visibility minimal.
  2. Lower eyelid surgery: In the traditional blepharoplasty, the doctor will make the slit in a hidden side along the lash line and smile creases of the lower lid. In the transconjunctival approach, the doctor amends the eyelid puffiness that results due to excess fat by making a cut inside the lower eyelid. This technique doesn’t need an external slit but it cannot be used in the removal of extra skin.

Recovery

This is one of the fast healing surgeries that I undertake. However, it is important that you adhere to all the postoperative procedures that are given. This will include instructions about iced eye pads, bandages and taking of antibiotics if prescribed. I will also offer detailed instructions about the normal symptoms and any signs of complications. The amount of recovery also varies among people so it’s good to be patient and not rush things.

Risks

Fortunately, eyelid surgery has very minimal complications. Thousands of people undergo successful blepharoplasty and are happy with their transformation. However, all surgical procedures come with some degree of risk. Some of the complications may be watery eyes, infection and bleeding, allergic reactions, sensation changes, asymmetrical scarring and haematoma.

Question: What is the most troublesome thing you find with droopy eyelids? You can leave a comment below.

Breast Augmentation Part 1 of 4: The Patient

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

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

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

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

 

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

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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 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 .

Breast Implants & Anaplastic Large Cell Lymphoma (ALCL)- No Cause For Alarm

Breast Implant & ALCL

Only recently described, breast implant–associated anaplastic large cell lymphoma (ALCL) usually presents as an effusion-associated fibrous capsule surrounding the implant and less frequently as a mass. Little is known about the natural history and long-term outcomes of such disease. It is estimated that between 5 and 10 million women have breast implants. Due to the rarity of a diagnosis of ALCL (3 in 100 million per year in the USA diagnosed with ALCL in the breast) a worldwide collaboration is required to provide robust data to investigate this possible link.

ALCL is a lymphoma and not cancer of the breast tissue. When breast implants are placed in the body, they are inserted behind the breast tissue or under the chest muscle. Over time, a fibrous scar called a capsule develops around the implant, separating it from the rest of the breast. In women with breast implants, the ALCL was generally found adjacent to the implant itself and contained within the fibrous capsule. ALCL is a lymphoma which is a type of cancer involving cells of the immune system. It is not cancer of the breast tissue.

The most recent clinical studies state that it is not possible to confirm with any certainty whether breast implants have any relation to an increased likelihood of developing ALCL, and particularly whether any one type of implant can create a higher or lower risk than another of developing the disease. It should be noted that ALCL is extremely rare and treatable. This is evidenced in particular by three recent papers:

  1. A Danish nationwide study – ‘Breast implants and anaplastic large-cell lymphoma: a Danish population-based cohort study’– concluded that in a nationwide cohort of 19,885 women who underwent breast implant surgery between 1973 and 2010, no cases of ALCL were identified
  2. A review of cases within another recent comprehensive article, ‘Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients’ concluded that: “most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.”
  3. In a study reported in the Journal of Clinical Oncology, Roberto N. Miranda, MD, Associate Professor in the Department of Hematopathology at The University of Texas MD Anderson Cancer Center, and colleagues assessed disease characteristics, treatment, and outcomes in 60 cases. They found that outcomes are better in women with effusion confined by the fibrous capsule, whereas disease presenting as a mass has a more aggressive clinical course.Patients should be advised that ALCL is a very rare condition and until any further evidence is presented there is no need to remove breast implants as a matter of course.

 

These data suggest that there are two patient subsets. Most patients who present with an effusion around the implant, without a tumour mass, achieve complete remission and excellent disease-free survival. A smaller subset of patients presents with a tumour mass associated with the fibrous capsule and are more likely to have clinically aggressive disease. We suggest that patients without a mass may benefit from a conservative therapeutic approach, perhaps removal of the implant with capsulectomy alone, whereas patients with a tumour mass may need removal of the implants and systemic therapy that still needs to be defined.

 

We continue to advise that any women with breast implants who experience any sudden unexplained changes, lumps or swelling should speak to their GP or their surgeon.

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.

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

 

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

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During pregnancy, skin may be stretched to the point that microscopic fractures form in the skin, or dermis, resulting in stretch marks (also known as striae). 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 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” and as a bonus the Caesarian scar can be removed at the same time.

Although abdominoplasty (tummy tuck) 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.

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 3 of 4: The Plastic Surgeon

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

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

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

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

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

4)  Subspecialises in cosmetic surgery

5)  Super specialises in breast augmentation

6)  Recommended by a knowledgeable friend or doctor

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

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

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

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

1)  Completed training in a specialty other than plastic surgery

2)  Certified in an unrelated college

3)  Not a member of ASPS and ASAPS

4)  No hospital privileges

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

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

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

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

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

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

 

Watch Dr Tim on Channel 7’s Sunrise morning show, discussing with the crew about the new Brazilian Butt Lift (BBL) task force he is heading up. The task force is investigating the risks associated with the BBL procedure as well as improving patient safety.

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