Wabi-Sabi In Cosmetic Surgery – Imperfect, Impermanent, and Incomplete.

Celebrities, models, and socialites have highlighted some severe complications (including death) from undergoing cosmetic surgery in their pursuit of perfection. This is very concerning and makes me reflect on what beauty is all about. I am reminded at this point of Wabi-Sabi, the Japanese philosophy that embraces the beauty of things imperfect, impermanent, and incomplete.

It is a beauty of things modest and humble. It would be interesting to see how much of this ancient Japanese philosophy could be embraced in the world of cosmetic surgery and what a difference it could make.

Wabi-Sabi represents the exact opposite of the Western ideal of great beauty as something symmetrical, extraordinary and enduring. Wabi-Sabi is about the minor and the hidden, the tentative and the ephemeral: things so subtle and evanescent they are invisible to unrefined eyes.

Simplicity is at the core of things Wabi-Sabi. Wabi-Sabi embraces the “less is more” ideal talked about today, yet often ignored. Cosmetic surgery needs a lot of Wabi-Sabi.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

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

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.

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

Breast Lift and Augmentation: The facts you need to know!

The goals of breast lift with or without breast augmentation are to restore shape, volume, and nipple-areola position. However, simultaneous breast lift and augmentation present multiple problems, specifically because it becomes harder to control all of the variables affecting the outcome when combining the two procedures. No single method is best to treat all types of sagging (ptosis), and maintaining a good blood supply to the nipple-areola complex is of paramount importance, so a staged procedure may be necessary at times.

Why is combining a breast lift and breast augmentation the most difficult of all cosmetic breast surgery procedures? The surgery involves manoeuvres that can be counterproductive to each other since the skin is being removed and when closed back up again, pushes the breast in and upwards, whilst an implant stretches the skin in an out and in a downwards direction. These conflicting tensions can adversely affect the blood supply to the breast and skin which may affect wound healing, scar quality etc. Positioning of both the nipple and breast fold also becomes more challenging during simultaneous lift and augmentation. Secondly, no two breasts are the same, and each patient is seeking a different endpoint, sometimes with unrealistic expectations.

The first thing that I do when evaluating a patient for a breast lift is to ask them if they are happy with their present breast volume. You can simply do this by pinching the skin below the breast and pushing it up where it belongs. Most women are amazed at how little of breast volume they actually have. If that is the case, then volume enhancement, usually with an implant, is necessary along with a lift. If the volume is satisfactory, then a breast lift will suffice.

The second thing to do is grade the amount of breast sagging. This is done by using Regnault’s classification which looks at the position of the nipple as follows:

1)  Grade 1 (minor): nipple at breast fold
2)  Grade 2 (moderate): nipple is below the fold but above the lower breast contour
3)  Grade 3 (major): nipple is below the fold and below breast contour
4)  Pseudoptosis (“false sagging”): nipple lies above the fold, there is little breast volume, some of which lies below the fold

Other characteristics that one looks out for are:

1) Skin: elasticity and excess;
2)  Breast tissue:  firm and fibrous or soft and fatty; and
3)  Skin-breast tissue relationship: firm and adherent or loosely adherent and is the breast full or empty. Skin quality and the skin-breast tissue relationship are the key factors in determining the breast lift procedure and the quality and longevity of the final result.

As a general rule, if the skin elasticity is normal, the breast envelope is full, and the skin is adherent to the underlying breast tissue, then the scars would be limited, and vice versa. In other words, one progresses from limited scars such as periareolar scars (scars around the nipple-areola complex) to periareolar-vertical scars (scars that run down the front of the breast below the nipple-areola complex) to more extensive, full-length inverted-T or anchor scars.

For the patient with “pseudoptosis,” inserting a breast implant alone, usually tear-dropped shaped, is typically all that is needed. For Grade I sagging, an implant alone or a lift plus an implant may be required.

Depending on a number of factors, the lift may be performed via a crescent, periareolar, or vertical approach. A vertical approach is preferred if there is significant looseness below the nipple. However, the periareolar incision is generally used in just a few specific situations. Since this skin-only incision is unable to lift much weight, it is an option in women with small breasts who need only a small amount of nipple repositioning, usually < 2 cm.

In addition, it is considered advantageous in women with pointed, conical or tubular breasts, because it causes areolar flattening and eliminates the tubular nature. The main issue I have with performing a periareolar breast lift is its tendency to cause areolar flattening and leave the areola more prone to stretching.

In Grade 2 sagging, especially where the breasts are large and heavy, a vertical breast lift is often required because it will effectively lift the breast tissue to achieve increased projection. However, a periareolar incision may still be considered for women with light breasts. When performing a vertical breast lift, the procedure may be converted into a short inverted-T lift if a difficulty is encountered controlling the nipple-to-breast fold distance.

With Grade 3 sagging, the lift technique depends on the nipple-to-breast fold distance. If it is > 10 cm, most surgeons perform an inverted-T breast lift. Otherwise, vertical breast lift remains an option that will enable control of the nipple-to-breast fold distance, as the vertical scar tends to shorten in the post-operative period with scar contraction.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

Dr Tim Papadopoulos Named President of ASAPS

dr.tim papadopoulos

President of ASAPS

We are proud to announce that our cosmetic plastic surgeon, DrTim, has been named the new President of the Australasian Society for Aesthetic Plastic Surgery (ASAPS). ASAPS is the most elite and prestigious organisation for cosmetic plastic surgeons in Australia and New Zealand.   DrTim has previously served as Treasurer of ASAPS and says he feels honoured to have the support of his colleagues and fellow ASAPS members. He has received much valued education, support and training from the ASAPS organisation, and he is both privileged and committed to giving back to the organisation over the next 2 years of his term.   Throughout his term, DrTim’s top goals will continue to centre around patient safety and improving surgical outcomes. DrTim also has a passion for mentoring up-and-coming Plastic Surgeons. He is very involved in developing a strong Aesthetic Fellowship program for new plastic surgeons so that they will appreciate and pursue ASAPS membership to keep the quality of cosmetic plastic surgery high for patients.   At the CosmeticCulture Clinics, our entire staff feels privileged to work alongside a surgeon so devoted to bettering the level of care that plastic surgery patients receive not only in our practice, but in practices all across the Australia and New Zealand. Congratulations, DrTim!

How Do You Repair Torn Earlobes?

The earlobes are the lowest part of the ears made of skin and a small amount of fatty tissue in between. There are large variations in size, form, and shape. The earlobes serve women (and men) as popular locations for placing jewellery. Often, the earlobes are pierced to fit various forms of ear ornaments ranging from studs to earrings which can occasionally set them up for trouble.

Excessive weight or trauma can easily overcome the strength of the earlobe tissues leading to a tear, which if complete, results in a split ear. Some people with rather thin earlobes who favour wearing heavy earrings, experience a gradual elongation of the ear-piercing tract such that it becomes slit-like and often too large. Another problem is that the earlobes can be torn by accidental trauma. This split may be unattractive and renders the earlobe unusable for most jewellery. Sometimes, clip-on earrings can still be fitted and are used to camouflage the earlobe tear.

The repair of torn earlobes is relatively simple. The procedure is routinely performed in the office under local anaesthesia with an optional sedative. After planning and marking, a small amount of lignocaine numbing solution is deposited. I favour a three-layer repair done under loupe magnification. But it is very important to remove the damaged ear-piercing tract or to trim the edges of the split if the earlobe has been torn through completely.

Then the three-layer closure consists of closing the outer layer of skin, the fatty tissue between the two layers of the skin and finally the skin in the back of the earlobe. Typically, the surgeon must take great pains to avoid any notching at the bottom of the earlobe. The fine sutures on the skin are usually removed within 7 days. Small amounts of antibiotic ointment are applied at home for a few days ensuring cleanliness. The healed earlobe has usually a barely visible pencil-fine straight or zigzag scar line.

People often ask if the ears can be pierced again. They can but typically you should wait three months after the earlobe has been repaired. Preferably piercing should not be done within the scar, as this can stretch and inevitably result in another clot.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

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

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

 

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.

Like this post?  Sign up for my blog updates and never miss a post. I’ll send you a FREE eBook as a thank-you.

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.

Brazilian butt lift surgery task force set up after alarming death rate

A DANGEROUS butt procedure has a higher death rate than any other and Aussie women are being warned to think carefully before committing to it.

A NOTORIOUS surgical procedure, known as the Brazilian Butt Lift, is now considered so dangerous that a specialist Aussie task force has been set up to warn women of its risks.

Inspired by “bootylicious” celebrities and social media stars such as the Kardashians, Jennifer Lopez and Beyonce, the risky operation has raised alarms after a number of complications and number of deaths.

BBL is the colloquial term for buttock fat grafting, an elective cosmetic procedure which can cost up to $14,000 and involves removing fat from one part of the body via liposuction and transplanting it via injection into the butt for a fuller, perkier effect.

According to the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the mortality rate for BBLs is estimated to be one in every 3000 operations — meaning it has a higher rate of death than any other cosmetic procedure.

THE BOOTYLICIOUS EFFECT

The BBL’s popularity has increased over the last few years, with the American Society for Aesthetic Plastic Surgery tracking a 26 percent jump from 2016 to 2017, making it the surgical procedure that saw the second most significant increase performed year over year.

However, its complications have thrust it into the medical spotlight and plastic surgeons across the world have expressed deep concerns over its increasing popularity.

ASAPS has now backed a new “patient safety task force” to investigate the risks and improve patient safety of the increasingly popular procedure in Australia.

“In short, the butt is becoming the new breast,” Dr Tim Papadopoulos, specialist plastic surgeon and past president of ASAPS said.

Kim Kardashian has always denied having a BBL procedure. Picture: Mega Agency
Kim Kardashian has always denied having a BBL procedure. Picture: Mega Agency Source: Mega
‘Bootylicious’ singer Beyonce is an inspiration for many young women. Picture: Mega Agency
‘Bootylicious’ singer Beyonce is an inspiration for many young women. Picture: Mega Agency Source: Mega

Five of the world’s leading plastic and cosmetic surgery-related organisations have banded together to form an “Inter-Society Buttock Fat Grafting Task Force” to research complications and deaths associated with BBL.

“Action must be taken now in order to prevent further tragedies from occurring,” Dr Papadopoulos said.

“The task force is concerned with the high mortality rate of this operation and is aggressively investigating ways to make this procedure safer.

“This new warning emphasises the continued risk that is being encountered with this procedure. Patient safety is the highest priority for plastic surgeons and this multi-society task force is an important and unprecedented collaboration.”

He said the procedure had resulted in an “alarming rate of mortality”.

“This rate of death is far greater than any other cosmetic surgery,” he said. “Having said that, there has been no reported case of a death from BBL in Australasia.”

He this may be due to the cultural and ethnic differences and perceptions of beauty regarding bums.

“Although social media has had a huge influence in promoting BBL, especially with celebrities like Kim Kardashian and Jennifer Lopez, the volumes of buttock fat transfer overseas don’t necessarily translate to what’s going on here in Australia,” Dr Papadopoulos said.

The surgery can cost up to $14,000. Picture: Supplied/ Cosmos Clinic website
The surgery can cost up to $14,000. Picture: Supplied/ Cosmos Clinic website Source: Supplied

“In the USA, the large African-American and Hispanic populations have generally dictated their beauty norms which promote larger backsides and smaller breasts.

“This is not the case in Australia where women generally prefer larger breasts and smaller backsides.”

WHAT THE TASK FORCE WILL DO

The task force will examine the causes behind complications and deaths to try to prevent them from occurring through a variety of doctor and patient safety education measures, including unprecedented research.

Once those results are finalised, a comprehensive set of guidelines for the procedure will be submitted for publication in major clinical journals.

“Interestingly, while this procedure has been done for decades, it wasn’t recognised as risky until recently,” Dr Papadopoulos said.

The alarm bells started to ring for some surgeons after a 2015 study which looked at 19 BBL-related deaths in Colombia and Mexico over a 15-year period.

A 2017 report also noted at least 25 fatalities in the United States in the preceding five years.

WHY IS THE BBL SO DANGEROUS?

Dr Papadopoulos says every BBL-related death is caused by bits of fat (or “emboli-globules”) which enter the blood stream and clog up the patient’s heart.

“The cause of death is emboli-globules of fat that inadvertently enter the gluteal veins and swiftly make their way up to the heart and lungs, causing patients to arrest and die usually in the operating room during the procedure or in the recovery room shortly after,” Dr Papadopoulos said.

Tim Papadopoulos said women should research the procedure carefully.
Tim Papadopoulos said women should research the procedure carefully. Source: News Corp Australia

“These emboli are unique to the buttock area, as fat injections in the breast, face and thighs don’t produce this same phenomenon.

“The gluteal veins’ distinctive anatomy makes them especially vulnerable because they’re very big and thin, and only one tributary away from the inferior vena cava, which is the major vein in the body running from the pelvis to the heart.

“If a surgeon nicks one of these gluteal veins or they tear because of traction from pooling of fat beneath the muscle, it’ll act like a siphon, sucking in fat around it, and ultimately sending fat up into the heart.”

WHAT TO DO IF YOU WANT A BBL

Dr Papadopoulos said any patients interested in the procedure should research and trust only FRACS-qualified Specialist Plastic Surgeons at accredited and licensed facilities or hospitals. “You should ask to see before-and-after photos and ask for patient references,” he said.

“You, too, should stay informed on the issue, and when consulting with doctors, don’t hesitate to question their approach.”

To find a suitable surgeon search through the Australasian Society of Aesthetic Plastic Surgeons Member Database.

– Ben Graham 

Article Source: news.com.au