The Newsletter of the Cosmetic and Restorative Surgery Clinic

Volume 2 Number 1: Winter 1999

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Contents

Body Contour Surgery gets both men and women the body they want

A Letter from Dr Hodgkinson

The Doctor is in!

Holistic Wellness: It's all in the face

Why do I keep breaking out?

New options for lip enhancement

Can I sleep through it? Anaesthesia and Plastic Surgery.

Jazz fundraiser for Operation Restore Hope

Dr Hodgkinson's portrait entered in the Archibald

Body Contour Surgery helps both men and women get the body shape they want

by Dr Darryl Hodgkinson

Body contour surgery, both for men and women, forms a major part of my plastic surgical practice.

In women, the most common procedure to improve the shape of the body is breast augmentation, but liposuction both traditional and ultrasonic is also frequently asked for. However, in our augmentation or enhancement of the body's form, we cannot just shape the body by removing tissue alone. Hence the long, well-established use of body implants for both the breasts and the calves. In males, the commonest body contour surgical procedure is liposuction. Here, ultrasonic liposuction is especially useful for shaping the abdomen, the love-handle areas and the pectoral area. Enhancement implants are also used for the "pec" area and calves and occasionally the upper arm, mainly triceps.

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"Body contour surgery enhances the human shape"

It can improve a woman's figure and produce a more athletic appearance in the male torso. I have also used buttock implants but more for patients with a "flat butt' or an unattractive flat bottom. All these procedures are carried out at the Double Bay Day Surgery, a fully licensed day surgery facility, usually under a light general anaesthetic utilising the revolutionary Diprafuser

A Letter from
Dr Hodgkinson

Breast Implants

There has recently been a lot of "hype" about breast implants and certainly a tremendous amount of discussion regarding new "fillers" for implants. The classic fillers have always been saline and silicone gel. The new firm silicone gel implants are still undergoing clinical trials in the United States, although they are available in Australia on a limited application basis. My experience is that the new firm silicone gel implants are quite useful for patients undergoing reconstructive surgery, those who have had a mastectomy or patients who have extremely thin skin after having had previous implants. However, in many patients these particular implants do not produce the "hot" look often desired.

Younger patients usually want a rounder appearance than the tear drop implant provides. The tear drop might be "natural" but natural is a droopy look and the "young Pamela Anderson" look is generally requested. Many of my patients are dancers or models and the majority of these patients have saline implants. I recently attended and presented a course at the American Society of Aesthetic Plastic Surgery meeting in Dallas, and there is a significant move away from tear-drop to the round smooth implants. Recently, also, I note from "The Lancet" magazine that the soy oil-filled implant has already been withdrawn from the market. I said long ago that I did not think that this

implant would ever come to market and I still believe that. We had Dr Susanne Czech working with us from Germany who had performed studies on this implant and I would say that the disadvantages of the soy oil filled implant far outweigh the advantages over the traditional saline filled implant.

Sincerely yours,

Dr Darryl J. Hodgkinson
M.B. MS. (Hons) F.R.C.S.(C) F.A.C.S.

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Dr Hodgkinson answers your questions

Q: What is a good age to have my nose fixed?

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New options for lip enhancement

Lip enlargement is a popular procedure at the Cosmetic and Restorative Surgery Clinic and we can provide a number of excellent ways of enhancing your lips, either temporarily or permanently. The newest injectable filler are non-permanent injectibles. This normally lasts longer than Collagen, which has now been in use for almost twenty years.

For permanent enhancement, Dr Hodgkinson uses a dermal fat graft or a patient's own fat.

With the trend towards more cosmetic dentistry, we find using the above techniques to frame an attractive smile has become a very popular procedure with people of all age groups.

For more information about lip enhancement, call us at the Clinic on (02) 9362 7400 or visit us online at our website, http://www.cosmeticsurgeryaust.com.

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Why do I keep breaking out?

by Dr John A Doyle

This is a question which is very often asked by women in their twenties, thirties and forties. Most people would naturally feel that their acne should stop when they leave their teenage years behind them. Unfortunately the biological clock in peoples' oil glands does not keep pace with the march of time. Wouldn't it be wonderful if our wrinkles showed the same disregard for advancing years!

It is true that with time the oil glands slowly become less likely to break out when stimulated by factors that we know will cause or aggravate acne in teenagers. These may include stress, dietary factors and the normal hormonal fluctuations which occur with each monthly menstrual cycle.

How can I prevent it?

First and foremost a healthy lifestyle is important. In today's hectic life, stresses - whether they be at home or in the workplace - will tend to make a person's face blotchy and prone to break-out. A healthy and well-balanced diet is also important, as in some individuals fatty foods, alcohol and spices can stimulate an acne tendency.

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Sunlight avoidance is also important, but this relates more to freckling and wrinkling that we associate with increasing age. Fortunately, there are many very effective topical agents that can improve the texture and tone of the skin.

And there are a number of effective topical antibiotic preparations which can avoid the need for oral antibiotics. Retin-A remains a very effective topical therapy, not only for acne, but also in terms of correcting the irregular pigmentation and loss of collagen that are inevitable as one passes from the twenties into the thirties.

Oral therapies now available

Oral therapies available include low dose and mild oral antibiotics; mild hormonal blocking agents, including various forms of the oral contraceptive pill; and in severe and resistant cases in which scarring is beginning to develop Roaccutane can also be considered. Don't feel depressed. Adult acne is an all-too-common affliction, but there are now many simple and effective therapies available.

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Jazz Fundraiser for Operation Restore Hope

Don't miss the Jazz Fundraiser for Operation Restore Hope! Put this date in your diary: Saturday, November 20th. That's the day we're holding a not-to-be-missed jazz afternoon at Manly for Operation Restore Hope. There'll be food, drink and good music for you to enjoy - and it's all for the best of causes. Please call Kim or Katherine at the Clinic to reserve your ticket. Dr Hodgkinson and the team look forward to seeing you there!

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Can I sleep through it?
All about Anaesthesia amd Plastic Surgery

by Dr Howard Roby

Just as for any type of surgery, providing optimum anaesthesia for plastic surgery carries its own particular challenges. In cosmetic plastic surgery more than most other areas of medicine, anaesthesia which is less than optimum can detract from the ultimate result. So, as well as keeping the patient unconscious, immobile and ventilated (i.e. breathing actively or passively), the anaesthetist tries to control/regulate the patient's circulation to minimise blood loss. This process continues into the post-operative period, particularly in surgery on the face, nose and eyelids.

Day Surgery complex at Manning Rd

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Many operations in all surgical specialties can be done under local anaesthesia, and the same applies to cosmetic plastic surgery. However, surgery on deep tissues and surgery involving extensive body areas are best done under General Anaesthesia. Surgical preference is also a most important consideration. For all these reasons, the most common technique at the Cosmetic and Restorative Surgery Clinic is the combination of general and regional anaesthesia.

One also hears the term 'twilight sleep' anaesthesia describing techniques using local anaesthesia in combination with sedative drugs given intravenously. Such techniques are used in the Clinic only for a limited number of brief procedures. In major cosmetic work their use can be less than satisfactory, usually because the patient's breathing is depressed, a side effect of sedative drugs. An anaesthetist must still be there to administer the twilight anaesthetic. It would be unthinkable for a surgeon doing major cosmetic surgery also to be responsible for sedation and monitoring.

Day surgery challenges the anaesthetist to have the patient fit to leave the Clinic a few hours after their operation, wide awake, able to walk unassisted, and pain free or very nearly so.

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Dr Hodgkinson's portrait entered in the Archibald

Naomi Berns painted this striking two metre high portrait of Dr Hodgkinson which now hangs by the stairs in the Clinic at Double Bay, Have a look at it and tell us what you think!

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Holistic Wellness:
It's all in the face (Pt IV)

by Dr Jennifer Hunter
B.Med; MScPH. D.L.S.H.T.M.

For a thousand years, Chinese doctors, herbalists and acupuncturists have observed the correlations between certain facial features and our internal health. They use Meridian theory to understand the health of the whole person - body, mind and soul, There are 14 Meridians and each has a separate function. This is the last of five articles where I review the face diagnosis of two of the ten main Meridians.

If we have a problem in an area, what do all those wrinkles, sags and blemishes mean?

The Liver Meridian

The main facial features can be seen as a central frown line between the eyebrows, lines extending from the corners of the mouth down the chin and in the eyes, such as redness or jaundice (yellow discolouration) and cataracts in the lens. The Liver Meridian is described as the "Emperor", storing our nutrients and vitamins and setting the standards for the rest of the body. This Meridian governs the functions of the liver, tendons, joints and eye sight. It enables us to think laterally and with vision. However, if these standards are not met, the personality rnay be bossy or angry, sometimes hot-headed, Problems with addiction can also be seen with the Liver Meridian.

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The Gall Bladder Meridian

The main facial features can be seen on the upper eyelids extending to the outer edges of the eyebrows and along to the temples. Swollen or excess skin on the upper lids and receding hairlines over the temples may be seen. Pronounced nasolabial folds are also a common feature. The Gall Bladder Meridian governs the function of the gall bladder and the digestion of fat. The Chinese often describe it as the Prime Minister who carries out the tasks set for it by the Ernperor (Liver Meridian). Problems with the Gall Bladder Meridian may manifest as tension in the shoulders and headaches with pains focussing over the sides of the head and temples. They may have stones in the Gall Bladder. These people tend to be practical and ordered and are easily frustrated when events do not go according to plan.

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