The Newsletter of the Cosmetic and Restorative Surgery Clinic

Volume 6: Number 1: Autumn 2005

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Contents

“The Eyes have it!“

Eyelid surgery is often chosen by many patients worried about some effects of normal ageing.

A Letter from Dr Hodgkinson

The Doctor is in!

“I have a lined forehead but am not keen on surgery. How about BOTOX ... does it work?”

Breast Augmentation - State of the Art

Dr Darryl Hodgkinson talks about advances in breast augmentation

The Trend towards 3-D Liposculpture

ORH celebrates 10 years and 1000 children helped.

Operation Restore Hope is working harder and harder to make the dreams of the poor children of the Philippines come true.

"The Eyes have it!"

Eyelid surgery can improve more than appearance.

Eyelid surgery is often the first entry into a true surgical procedure for the many patients who are beginning to get worried about some effects of normal ageing.

As we age, due to sun exposure, excessive emotional facial expression and genetic factors, the skin around our upper and lower lids becomes loose and eventually descends over the lashes, when we are said to have ‘droopy’ eyelids. This gives a sad, worn-out, bedraggled appearance which is certainly very ageing. Sometimes, the skin can descend in the upper eyelids because the brow has descended and the surgeon must diagnose which is the problem – brow or eyelid, or a combination of both causing the ‘droopiness’.

An outpatient procedure

Blepharoplasty and browlifting are outpatient procedures, the endoscopic browlift resulting in only small incisions in the hairline, concealed by a normal hairstyle. The more expressive appearance and positive feedback leads to a high satisfaction rate from blepharoplasty and a browlift. Other procedures around the eyelids that can be used for fine lines are BOTOX® injections and laser resurfacing.

Many of my Asian patients request the ‘Double-fold’ upper eyelid surgery.

left: before
below: after

Before and after blepharoplasty by Dr Hodgkinson

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A Letter from
Dr Hodgkinson

or at the gym is compounded into difficulties with relationships because of the embarrassment. Rhinoplasty and the operation to correct Gynaecomastia are carried out as outpatient surgical procedures.

The confidence boost seen in teenagers and men relates to their improved body image and comfort in different social environments and in personal relationships.

Sincerely yours,

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

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Teen and Male Surgery

The Media recently has concentrated on questions regarding Teen Surgery as well as Male Surgery. There has definitely been an increase in both these groups having cosmetic surgery. The reasons are multi-factorial. In teenagers, the increase in surgery stems from the coverage that cosmetic surgery has in the media and television shows that have dedicated the episodes to teenage surgery and male surgery.

Cosmetic surgery in teenagers is usually limited to Breast Reductions, Rhinoplasties and Liposuction. One day recently, I performed rhinoplasty on three seventeen year old girls. We realize that teenagers take on a lot more responsibilities in this generation than they did in previous generations. We expect more of them and they are mature at an earlier age.
The empowerment of information with the Internet also allows them to explore options for themselves in addition to relying on their parents for advice or opinion.

In males, the commonest procedures in teenagers are Rhinoplasty, often in male patients after trauma for a twisted nose, and Gynaecomastia (male breasts). This condition in teenage boys does not necessarily go away with age, and self-consciousness in taking off your shirt at the beach

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Dr Hodgkinson answers your questions

Q: “I have a lined forehead but am not keen on surgery. How about BOTOX ... does it work?”

A: BOTOX® or botulinum toxin injections are booming because they temporarily deactivate the over-active muscles of facial expression that create crow’s feet and frown lines. It has been described as the “penicillin of the 21st century” and has been employed in many areas of medicine. Ten years ago researchers found it useful for facial wrinkles.

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At our clinic, we have been injecting BOTOX® for more than seven years and are among the most experienced BOTOX® injectors in Australia. The injections take 10-20 minutes and patients can engage in normal activities.

For more information about BOTOX® and other anti-wrinkle injections, call the clinic on 9362 7400 or visit us online at www.cosmeticsurgeryoz.com

Facial Rejuvenation

Before and after BOTOX® injections - one of a range of rejuvenation procedures.

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Breast Augmentation – State of the Art

Dr Darryl Hodgkinson talks about breast augmentation

Breast Augmentation continues to be a popular procedure, with the number of patients having breast augmentation showing a 25% increase on an annual basis over the last five years.

There is no question that breast implants have improved over the last two decades. After the silica gel scare in the early 1990s, manufacturers have produced gel-filled implants that are more cohesive with a much greater variety of shape and saline implants that are less likely to break.

A recent review by Dr Grant Stevens, my colleague in California, confirmed there is a 1% per year rate of rupture of saline implants and with silicone implants the capsular contracture rate appears to be in the 8%-10% range. Capsular contracture in the saline implant, appears to be in the 1%-2% range.

Of course, there is no perfect implant and the surgeon should have a variety of implants available to satisfy the patient’s particular needs. I have to deal with all ranges of patients from housewives to media personalities. Most of my patients are simply women who have never developed breasts or whose breasts have degenerated after pregnancy.

If after pregnancy the breasts have become too droopy, a special Anatomical Implant can be used or they may need a breast lift. This can be done as a one stage procedure on an outpatient basis at our day surgery in Double Bay.

All patients must understand that a change of implant may be necessary during their lifetime, due to the possibility of capsular contracture or rupture that can occur.

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The Trend towards 3-D Liposculpture

Dr Kourosh Tavakoli explains

In the past five years or so the trend in Europe has been towards three-dimensional superficial liposculpture. This is moving away from traditional liposuction, which entails taking volumetric fat from difficult areas, in particular deep fat, and not necessarily paying attention to creating shape,’ says Dr Kourosh Tavakoli.

‘Three-dimensional superficial liposculpture was pioneered and promoted by Dr Marco Gasparotti from Rome, Italy, and it is now the buzzword in Europe. With this new trend, far more attention is paid to a harmonious understanding of the human form and redefining of the body in a three-dimensional way.

Evolution in Liposuction

The basis of superficial liposculpture is the controlled scar retraction of the thin cutaneous skin that is left behind after the treatment. ‘This skin retraction allows the formation of a final shape of the body,’ Dr Tavakoli explains. ‘Previously surgeons performed liposuction primarily as a means of reducing fat. There was a lot of emphasis on volume, and large body liposuction was very much in vogue. The next evolution in liposuction came about when surgeons realised this was not the way to go because of the possible dangers associated with large volume liposuction.’

Sculpturing the body

Dr Tavakoli says the current thinking is that liposuction should not be used only for fat reduction but instead as a means of sculpturing the body into a three-dimensional shape comprised of convexity and concavity.

‘We are moving more towards patients who want to have slight changes in body shape. Imagine there are three areas of fat under the skin and muscle layers – the superficial fat, the middle fat and the deep fat. Traditional liposuction removed the deep fat but this new form of liposculpture takes the superficial fat. By removing the superficial layer, the skin is allowed to move freely as an independent entity and resume the new shape that the surgeon intends to provide.

This means that, if necessary, to achieve the best result patients need to be committed to undergoing a dietary and lifestyle change at the time the liposculpture procedure is performed.’

For women, areas that are suitable for reshaping with liposculpture include the upper arms, outer thighs, inner thighs, buttocks and around the knees. Men tend to require reshaping around the abdomen, the flanks and to a lesser extent the buttocks region. The surgeon who performs the procedure must be highly experienced.

‘Because the removal of fat is not purely in the deep skin plane this procedure must be performed by very experienced hands – otherwise damage to the skin is possible,’ Dr Tavakoli concludes.

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Operation Restore Hope Celebrates 10 years - more than 1,000 children helped.

A pat on the back for all our volunteers, supporters, surgeons, anaesthetists, nurses and our Filipino colleagues for a job well done.

Alia Cortes,an ORH patient, before and after 1998 surgery, and in 2005 singing with Nurse Maureen Eddison, our Cebu Coordinator whose first mission was 1998 when Alia was treated.

Operation Restore Hope was very active in November 2004, spending two weeks in Cebu with two missions, one headed by Dr Geoff McKellar and Dr Ann Collins and the other by Dr Robin Dyleski, co-ordinated by Nurse Maureen Eddison RN in Cebu. 130 patients were operated upon.

To our gratification an evening of celebration for ten years’ service on over 1,000 patients was arranged and one of our early patients, who had a cleft lip and palate repaired, sang to us as did other patients during the celebration. This was a moment of joy for us and one of the reasons that we stay in the same communities is to take the responsibility of seeing these children grow up, go to school and become useful members of our society. To have a child waste their life because they could not have a cleft lip or palate operation is a tragedy we are trying to avert.

Second Centre in Manila

Our other team operated in Manila at a new hospital, the President Diosdada Macapagal Memorial Medical Center. This was a new facility but with very few instruments or equipment, so we totally equipped the hospital with operating beds, anaesthesia machines, monitors and sterilizers. We also stocked the hospital with necessary sutures, bandages and anaesthetic medications.
Our team comprised three Anaesthetists, three Surgeons, eight Nurses and two Administrators none of whom received any financial compensation. They operated on 57 patients doing 67 operations - and these were complex operations. We performed 30 cleft palate operations in that time, difficult and demanding procedures but imperative to perform because the patients will not be able to speak unless the gap in their palate is repaired early in life.

Throughout the year, the Australian Filipino community has been a wonderful sponsor to us, with Mrs Via Hoffman and her team working tirelessly raising funds and organising the infrastructure both here and in the Philippines, invaluable to the success of the mission.

We ask for membership from you to help us keep up this good work.

We are already planning our next year’s mission as this goes to press and are excited by the fact that we are now associated with the Central Manila University and integrated into the teaching programs for Filipino Anaesthetists and Surgeons at that University.

MEMBERSHIPS

If you didn’t renew for 2003, please do so soon as 2004 renewals will be coming out soon. If you are not a member, why not join. Membership costs only $10 per year with a one time $10 application fee. Membership is your way of saying, “Thank You”, to our volunterers, “Keep up the good work!”

You can contact ORH on 02 9362 7480 or at ORH@operationrestorehope.org

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