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Guide to Cosmetic Plastic Surgery

Plastic Reconstructive & Aesthetic Surgery

Table of Contents Welcome ......................................................................3 Introduction ..................................................................4 Deciding to have surgery ..............................................5 What are your expectations? ........................................6 General Risks & Complications .....................................7 Additional Information....................................................8 Anaesthesia – Information for Patients ..........................9 Risks of Smoking .......................................................10 Patient Consent Form . ...............................................11 Checklist ....................................................................12 Surgical Procedure Information Breast Enlargement / Mammaplasty ..................... 13-16 Breast Lift / Mastopexy . ....................................... 17-18 Breast Reduction / Mammaplasty . ....................... 19-20 Brow Lift / Forehead Lift ....................................... 21-23 Chin & Cheek Augmentation / Facial Contouring ........24 Ear Surgery / Otoplasty ........................................ 25-26 Eyelid Surgery / Blepharoplasty ............................ 27-28 Face & Neck Lift / Rhytidectomy . ......................... 29-31 Portrait / Laser Resurfacing .................................. 32-33 Lipostructure / Fat Grafting .........................................34 Liposuction / Lipoplasty . ...................................... 35-36 Nose Reshaping / Rhinoplasty . ............................ 37-38 Tummy Tuck / Abdominoplasty . ........................... 39-41 Non-Surgical Procedure Information Gentle Skin Treatments – C & E Skin Care, Retin-A ....42 Gentle Skin Treatments – Microdermabrasion .............43 Laser Hair Removal ....................................................44 Lip Enhancement & Quick Wrinkle Treatments – Injection Therapy ............................................... 45-46 Specialised Surgery Breast Reconstruction – after Mastectomy ........... 47-52 Your Next Step ...........................................................53 Notes..........................................................................54

Welcome To Our Practice DR TERRENCE SCAMP One of the most important factors in the success of aesthetic (plastic/cosmetic) surgery is the surgeon you select. That is why you need to know about the qualifications and experience of your Aesthetic Plastic Surgeon.

Thank you for choosing to visit my practice. Over my twenty years as a Plastic Surgeon, I have seen the life changing, positive results that can come of it, and I look forward to working with you to achieve your goals.

Dr Scamp is a graduate of the University of Queensland and underwent his internship at Princess Alexandra Hospital in Brisbane. Two years after graduation he moved into surgical training and obtained experience in vascular, orthopedic, neurosurgery and general surgery. He commenced his specialized training Plastic and Reconstruction Surgery in 1986 at the Royal Brisbane Hospital, returning to Princess Alexandra Hospital in 1987 for further training in Plastic Surgery. In 1988, he commenced three and a half years of international training in Scotland, Bristol, Harley Street London, Belgium, Slovenia, Germany and USA. Dr Scamp received specific training in a Cosmetic Fellowship in Harley Street from Europeâ&#x20AC;&#x2122;s leading aesthetic surgeon, Mr. Frederick V. Nicolle. Dr Scamp obtained his specialist qualifications as a member of the Royal Australasian College of Surgeons in the division of Plastic and Reconstructive Surgery in 1990.

The decision to undergo any surgery is not to be taken lightly. Information and knowledge is essential for any patient, so their expectations are well-informed.

Dr Scamp is invited regularly to give lectures on cosmetic and reconstructive procedures within Australia and overseas.

This book has been designed to help inform patients that may be considering Plastic Cosmetic surgery. The information includes descriptions of procedures, expected results, general surgery risks, and specific procedure risks and complications.

QUALIFICATIONS AND ACCREDITATIONS Fellow Royal Australasian College of Surgeons Member Australian Society of Plastic Surgeons Member Australasian Society for Aesthetic Plastic Surgery Member American Society for Laser medicine and Surgery Corresponding International Member American Society of Plastic and Reconstructive Surgeons

Prior to any surgery, I have a minimum of two consultations with each patient. This is my preferred method so I may discuss at length the best option for you. Should you have any questions at all, please do not hesitate to call the surgery on 07 5539 1000. I look forward to seeing you again,

Making A Change The term Plastic Surgeon comes from the Greek plastikos, which means to mould or give form. Plastic Surgery enables us to mould or re-form the human body. The Plastic Surgery specialty encompasses both reconstructive and aesthetic (cosmetic) surgery. Statistics show that each year, millions of people undergo aesthetic procedures to enhance a particular feature of reduce visible signs of aging. In recent years, aesthetic surgery has grown in popularity among both women and men. Many people choose aesthetic surgery to give themselves added confidence in social or work situations, a psychological boost or simply to help them look as young as they feel. Often, improving a feature of your face or body will enhance self-image, and that can help you to make positive changes in many areas of your life. Having realistic expectations about aesthetic surgery increases the likelihood that you will be happy with the results. If you recognize a specific area in which your appearance could be improved and you have a strong personal desire to make a change, then you may be an ideal candidate for aesthetic plastic surgery.

CHOOSING A QUALIFIED SURGEON One of the most important factors in the success of your plastic surgery is the surgeon you select. Many people are surprised to learn that some doctors performing plastic/ cosmetic surgery today have had no formal surgical training. That is why you need to ask the right questions before you schedule a consultation. Don’t be confused by other official-sounding certifications. A Plastic Surgeon is a ‘specialist’ like a Cardiologist is for the heart or a Neurosurgeon is for the brain. A Plastic Surgeon will have a fellowship of the Royal Australasian College of Surgeons and be a member of the Australian Society of Plastic Surgeons. You can ring the Australian Society of Plastic Surgeons to confirm qualification on: 02 9437 9200. Remember to look for this symbol.

Deciding To Have Surgery If you are well motivated, have realistic expectations and select a qualified Plastic Surgeon, chances are you will be happy with your decision to have aesthetic plastic surgery. Here are some things you should know before going ahead. FEES Fees for Plastic Surgery generally are paid two weeks prior to your surgery. Cost varies and depends on factors including the complexity of the operation, where the surgery is performed and what type of anaesthetic is administered.

BEFORE AND AFTER SURGERY Dr Scamp will give you all the information you need to prepare for surgery and recovery. You will be asked to avoid smoking for six weeks prior to surgery. Certain other medications and supplements are to be avoided two weeks prior to surgery, such as aspirin, red wine and vitamin E. Following your procedure, there may be restrictions to your activities for several days to several weeks. Plan your business and social activities to allow sufficient time for recovery. All patients are provided with our after hours phone number so you may be in contact at all times through your recovery.

PRIVATE HEALTH INSURANCE Some Plastic Surgery is not covered by insurance; however this depends on your Health Fund and type of coverage. There are certain procedures, such as rhinoplasty, otoplasty, breast reduction and abdominoplasty that may address functional problems as well as improve your appearance. In such cases, Medicare will rebate a small amount and your Health Fund may also pay your hospital costs. For other Cosmetic Procedures please contact your Health Fund to see if they cover cosmetic surgery. SURGICAL FACILITY Dr Scamp operates at Accredited Hospital Facilities. This could be Pacific Private, Pindara Hospital or another accredited facility. These facilities will only allow accredited Specialists to operate. ANAESTHESIA Most larger procedures are done under general anaesthesia. Sedation and local anaesthesia may be an option. Appropriate anaesthesia type will be recommended to allow you minimal discomfort. RISKS OF SURGERY Please refer to risks and complications in this book. however, Plastic Surgery moulds and reshapes living tissue, and the results are not absolutely predictable. No surgeon can offer risk-free surgery or guarantee a perfect result.

What Are Your Expectations • To perform any cosmetic surgical procedure an anaesthetic will be necessary, which will be a general anaesthetic or local anaesthesia and sedation if appropriate. • There can be no absolute guarantee with any surgery. The real aim of surgery is improvement. It is important you realize the limitations of what is possible with cosmetic surgery. Further operations may occasionally be needed after surgery to correct complications that have occurred. • It is important that you read all of the risks and complications outlined in this book and discuss these with Dr Scamp. • NO SURGERY IS GUARANTEED. Cosmetic surgery is unique in that you, the patient, request the surgery. Misunderstandings may result if you do not explain precisely to the surgeon what is desired. You must be quite specific as to exactly what you want the surgeon to perform. It is important that you realize the limitations of what is possible with cosmetic surgery. It is also important that you realize that there may not be a successful result after the surgery is performed.

General Risks & Complications “PATIENT MUST READ PRIOR TO ANY SURGERY OR SIGNING OF CONSENT FORM” It is important that Dr Scamp and the Anaesthetist are made aware before the operation of any medical problems or drugs you are taking. If you are allergic to any drugs you must also make that known before surgery.

GENERAL RISKS 1. Would infection (treatment with antibiotics may be needed)

The operation will result in a scar. Make sure you are fully aware before the surgery as to the nature, extent and position of the scar. Occasionally scars can become very thickened, red and painful (keloid). Fortunately this is not common.

3. Haematoma (an accumulation of blood around the surgical site that may require drainage)

Any unwanted bleeding can result in a collection of blood below the tissues. This is called a haematoma. A haematoma can occur after an operation. It increases the appearance of bruising. There will be swelling and the healing of the wound may be slow and it may spoil final results. Re-operation may be required to drain the haematoma.

2. Pain and discomfort around the incisions

4. If blood loss during surgery has been large, a transfusion may be needed: this is uncommon 5. A blood clot in a leg or the chest (deep vein thrombosis) that will require further treatment; rarely, a clot can move to the lungs and become life threatening. Gentle exercise and stopping smoking reduce the risk of blood clots. 6. Nausea (typically from the anaesthetic, usually settles down quickly) 7. Heavy bleeding from the incision

Infection can occur with any surgery. If the wound becomes red and/or painful after discharge it is important that you inform Dr Scamp immediately. If you are on any drugs that thin the blood (Aspirin, Warfarin) you must make sure that your surgeon is aware of this so that they con inform you as to whether you need to stop taking them prior to surgery. Smoking before or after surgery can increase the risk of complications. These range from increased bruising to major would breakdown, skin loss and failure of flap surgery. Smoking must be ceased six weeks (at least) prior to surgery. This includes nicotine patches.

8. Keloid or thickened scars (most scars fade or flatten, but some may become “keloid” and remain raised, itchy, thick and red. A keloid can be annoying but it is not a threat to health. Additional surgery or injection treatment may be needed to try to improve the scar) 9. Slow healing (more likely to occur in smokers) 10. Separation of wound edges 11. Chest infection (more likely to occur in smokers) 12. Complications due to the anaesthesia and allergies to anaesthetic agents, antiseptic solutions, suture material or dressings. Anaesthetic risks are best discussed with your anaesthetist before your surgical procedure.

Dr Scamp may have specific requirements that you may need to undergo before your surgery. This may include exercise, weight loss and cessation of smoking. Should you not adhere to Dr Scamp’s advice then the final result may be impaired.

Additional Information SCARS Every wound in the body heals with a scar formation. It is not always possible to predict the outcome and the quality of the scar. The quality of the scar will depend on the patientâ&#x20AC;&#x2122;s age, healing ability and the site on which the scar is located. However, some scars may take many years to mature. Occasionally further surgery may be required to improve the appearance of scars. PAIN Different patients and different operations will produce differing amounts of pain. Occasionally pain and sensory change may persist for a considerable time. The techniques used are designed to minimize pain. Dr Scamp will discuss with you prior to your operation the amount of pain expected and medication, which will be given. Increase in post-operative pain may be a sign of impending complications and the surgeon must be notified immediately. RESTRICTION OF ACTIVITY Wound healing is aided by some restriction in activities. This will minimize discomfort and reduce the risk of complications. COMPLICATIONS Complications can arise as a result of the anaesthetic or indeed the surgery itself. All of these complications are discussed previously.

Anaesthesia - Information For Patients Dr Scamp likes his patients to have optimal comfort when having surgery. Therefore, he prefers to use General Anaesthetic for most larger procedures; sedation and local anaesthesia may be an option for your procedure. An Anaesthetist is a highly trained specialist who after graduation as a doctor spends at least six more years training in anaesthesia, pain control and the management of medical emergencies. Your Anaesthetist will assess you before the operation, select the most appropriate anaesthetic for you and monitor you throughout the surgery. He is also in charge of pain relief. YOUR ROLE BEFORE SURGERY There are some things you can do to make your surgery safer:

YOUR ROLE AFTER SURGERY When you wake up you will feel drowsy. You may have a sore throat, you may feel sick or have a headache. You may also feel dizziness, blurred vision or short-term memory loss. This should all pass soon. If you are having day surgery, make sure someone accompanies you home and stays with you for the first night. Do not drive or use dangerous equipment, drink alcohol or sign any documents for at least 24 hours. DO NOT EAT OR DRINK ANYTHING SIX HOURS PRIOR TO SURGERY If you have any further questions or concerns please contact the Southport Anaesthetist Group on 07 5532 3667. The staff will be able to assist you further.

• Get fitter – regular walks will do wonders • DO NOT SMOKE – ideally for at least six weeks prior to surgery. Patients are at a higher risk if they are smokers. Smoking can also cause wound breakdown • Drink less alcohol • Tell your surgeon and Anaesthetist of any drugs you may be taking • Do not take any aspirin or aspirin based drugs two weeks prior to surgery • Tell your surgeon if you have any cold or flu Ask your Anaesthetist if you have any more questions or you are anxious about anaesthetics.

Smoking/Secondary Smoke & Would Healing All procedures in plastic surgery are performed to improve form and, in some cases, function. Our goal as Plastic Surgeons is to have a perfect form and scar. Unfortunately, smoking and secondary smoke affect wound healing in potentially a very devastating way. Any exposure to smoke either directly or indirectly can result in poor wound healing, delayed wound healing, skin loss necessitating skin grafting, increased risk in wound infection and loss of skin and deeper tissues, all resulting from decreased blood supply to those areas. The diminished blood flow to skin wound edges can cause the breakdown of skin and scabbing. FACELIFT OPERATIONS There can be actual skin loss of the face in front and behind the ear. BREAST REDUCTION AND MASTOPEXY OPERATIONS There can be delayed wound healing, resulting in unsightly scarring and skin loss and potential nipple loss necessitating skin graft. In all cases of patients exposed to smoke or directly smoking, wounds do not heal in a normal length of time. Wound healing can be prolonged, as long as three - four months. FOREHEAD LIFT There can be hair loss, poor wound healing and scarring.

ABDOMINOPLASTY Smoking or exposure to smoke again will decrease the ability of the skin to heal properly resulting in unsightly scarring and higher risk for infection and more importantly, skin loss sometimes requiring a skin graft. For any surgery requiring flaps (Facelift, Forehead Lift, Abdominoplasty, Breast Reduction, Mastopexy, TRAM Flap) you need to stop smoking (and patches) six to eight weeks before surgery. Slow wound healing (months instead of weeks); skin loss resulting in scabbing; and prolonged need for dressing changes and infection, usually involving the need for antibiotics (but sometimes another surgery to drain the infection), all are complications that can occur if you smoke or are exposed to smoke. (Instead of less than 5%, it can be as high as 100% risk). Smoking is not as critical for Liposuction, Blepharoplasty, Breast Augmentation or Rhinoplasty as these operations do not involve skin flaps. Ceasing two - four weeks prior to surgery is advised.

Consent Form Please read the information provided in this book about the specific procedure you are having and the risks and complications that can occur prior to signing the consent form. Please make sure prior to signing this form, or having the operation performed, that any questions you have are fully discussed with Dr Terrence Scamp. Please also ensure you have read the general complications and risks and those that apply to your specific procedure/s set out in this booklet. Dr Scamp has discussed all specific complications and risks for my procedure/s with me personally. Knowing the risks and complications, I have requested to undergo the following cosmetic surgery: Procedure Name Address Dr Scamp has explained to me that sometimes during surgery it is discovered that additional or other surgery is needed. Life threatening occurrences will be treated at Dr Scampâ&#x20AC;&#x2122;s discretion. I However, if the additional surgery is not immediately life threatening:

I authorize Dr Scamp to proceed

I do not authorize Dr Scamp to proceed

I acknowledge that Dr Scamp has provided me with information concerning the procedure and available alternative treatments, and has answered my specific queries and concerns to my satisfaction. I acknowledge that no guarantee has been made that the surgery will improve the condition. Signature of Patient/parent/guardian: Date: I declare that I have personally explained the nature of the patientâ&#x20AC;&#x2122;s condition, the need for treatment, the operation to be performed and the risks and alternatives outlined in this book.

To the patient or

To the patientâ&#x20AC;&#x2122;s parent/guardian

Signature of Doctor: Date: CANCELATION POLICY FOR SURGERY All surgery bookings must be paid for two weeks in advance of the surgery date. If surgery is cancelled with less than five working days notice 20% of the total fee is retained by Dr Terrence Scamp which will be credited to your next surgical booking. These monies will not be refunded in the event you choose not to go ahead with surgery. If less than 24 hours notice is given, 50% of the total fee is retained which will be credited to your next surgical booking. These monies will not be refunded in the event you choose not to go ahead with surgery.

I have read and understand the Cancellation Policy

Signature of Patient/parent/guardian: Date:

Patient Checklist – For Cosmetic Surgery QUESTIONS YOU MAY WISH TO ASK (Please tick) What are the surgeon’s qualifications and experience? Does he have a FRACS in Plastic & Reconstructive Surgery? Are they a member of ASPS? Do they perform the procedure on a regular basis?

Are hospital costs included?

Do they have a special technique relating to the procedure? If yes, how does this differ from other surgeons and what is the benefit to me? Are there any complications associated with the procedure? If complications do occur or the procedure is not successful, how will the surgeon deal with these? Where will the surgery be performed? Will a qualified Anaesthetist administer the anaesthetic and/or sedative medication? Are these fees included in the treatment cost? Do they have a consent form outlining the procedure for your review? Will there be any bleeding, swelling or bruising? How will these be managed? Will there be any discomfort following the procedure? How will this be managed? Will I need time off work? Are there other post-operative side effects? Will there be any visible scarring following the procedure? How can this be minimized? What aftercare will be provided and will this be included in the treatment costs?

Do I have any options other than surgery?

Will Medicare cover any of the procedure costs?

MEDICATIONS TO CEASE TWO WEEKS PRIOR TO SURGERY Unless prescribed by Dr Terrence Scamp do not take the following medications two weeks before or after surgery. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Anti-inflamitories Alka Seltzer, Arthrexin, Astrix Aspirin, Aspalgin, Aspro-clear Brufen (Ibuprofen) Cardiprin Cartia, Celebrex, Clinoril Cialis Clexane Codis Codral, Coumadin Diclofenac Disprin, Dipyridamole Dolobid (Diflusinal) Ecotrin Feldene Heparin Indocid, Indomethacin Naproxen, Naprosyn, Naprogesic Nonsteroidal antifalammatories Nurofen, Mobic Orudis Ponstan, Plavix Persantin Repro Solcode, Sulindac, Solprin Sildenafil Tagamet, Tadalafil Ticlid Toradol Voltaren, Veganin Viagra Warfarin

If pain relief is required, you may take paracetamol or codeine such as Panadol, Panamax, Dymadon or Panedine.

Breast Enlargement BREAST ENLARGEMENT Breast enlargement, also called augmentation mammaplasty, is designed to increase the size of small or underdeveloped breasts. Surgery can also restore and enhance your breast volume if it has decreased as a result of having children. The incision for placement of your implants can be made underneath your breast, just above the crease; around the lower edge of your areola (the pigmented skin surrounding your nipple); or in your armpit. A pocket is created for the implant either behind your breast tissue of behind the muscle between your breast and your chest wall.

Breast augmentation enlarges small or underdeveloped breasts. If your breasts have decreased in size, implants can restore and enhance your breast volume.

Following surgery, you may wear a dressing. There will be some swelling and discolouration that will gradually disappear. You should not engage in vigorous activities, especially using your arms, for up to three weeks. You should be able to return to work within a week or two. There is a great deal of scientific evidence supporting the long-term safety of breast implants. During your consultation, Dr Scamp will discuss with you the known risks associated with implants.

The incision can be made underneath your breast, just above the crease; around the lower edge of your areola (the pigmented area surrounding your nipple); or in your armpit

If you are in the appropriate age group for mammographic screening, having breast implants will not change your recommended exam schedule. Following surgery, be sure to select a technician who has experience in mammography of augmented breasts. The presence of breast implants requires modified mammographic techniques and additional X-ray views. The implant is placed in a â&#x20AC;&#x2DC;pocketâ&#x20AC;&#x2122; that is created directly under your breast tissue or underneath your chest muscle.

Following surgery, your breasts will be fuller and you may feel more self confident about your appearance.

Possible complications of mammaplasty LEEDING B Some blood loss during and after surgery is to be expected. This may be drained away by a small drain inserted in each breast. In general these drains stay for one or two days, although this does not mean that confinement to hospital is required for this period. In fact, most commonly surgery is performed as a day patient and you will be discharged with a dressing on your chest and sometimes a drain from one or both sides. If sudden severe bleeding occurs, returning to the operating theatre may be required for control of bleeding and removal of the blood clot. If the blood clot is left, it may result in infection or increased risk of Capsular Contracture (see below). Bleeding is most common where aspirin has been taken recently. This should be avoided for at least two weeks prior to surgery. High doses of vitamin E may also lead to bleeding and this should be avoided for a similar period. Bleeding is more common in smokers and can even occur with increased frequency in people who drink red wine, as this also has a mild aspirin like effect. INFECTION Infection can be serious in breast augmentation. A prosthesis (the breast implant) is a foreign body and does not have your natural immunity to infection. Severe infection may result in removal of the prosthesis and this may have to be left out for three months until the tissues have settled and the infection controlled. If the infection is very severe, the wound may open and the prosthesis may start to come out (extrusion). With some types of prosthesis, a new prosthesis will be required at the second operation. This undoubtedly creates great inconvenience and of course further expense. Every care is taken to carefully clean and disinfect the wound prior to surgery. Antibiotics are given at surgery intravenously and are to be taken as capsules after surgery. Despite this, infection may still occur in approximately 2% to 4% of operations. The signs of infection are increasing pain, redness and swelling in the breast. It is rare for this to occur before two to three days after surgery, but may occur many years after surgery through mechanisms which are not clear.

LOSS OF SENSATION Some loss of sensation after breast augmentation surgery is common. Usually it is at the lower portion of the breast. The site of the incision, be it in the armpit, around the edge of the nipple or below the breast is not related to sensory loss. It is dissection of a â&#x20AC;&#x153;large pocketâ&#x20AC;? to allow the prosthesis to move naturally that tends to stretch and disturb the nerves. In general, sensation recovers well three to six months after surgery. When the sensation to a nipple is lost, this may well take over a year or more to recover. However, most cases recover in the time mentioned above. It is possible to lose sensation permanently to one or both nipples after breast augmentation surgery. Fortunately this is extremely rare. SCARRING To insert the implants, the operative incisions may be made in the armpit, around the edge of the pigmented skin near the nipple (areola) or in the fold below the breast (inframammary fold). Most commonly the incision around the nipple is used. This incision usually heals well to leave a fine scar on the border of the pale and pigmented skin which is not cosmetically obvious. It is also the easiest hidden of all the incisions and permits access if re-operation is required. Rarely scars may remain red for extended periods of time or thicken markedly (keloid). ROTATION OF IMPLANTS Where anatomical form-stable implants are used there is about a 2% risk of rotation which may require re-opertaion. MALPOSITION OR MIGRATION OF THE IMPLANT Malposition or migration of a prosthesis, contraction of the chest muscle or shrinking of the scar capsule can push a prosthesis and make it sit in an inappropriate position. This is usually corrected several months after the initial surgery when the scar is matured by reopening the original incision and relocating the prosthesis. In some people there is a natural difference in the two breasts and therefore the prostheses tend to lie in slightly different positions. If this is a natural and not unattractive feature, it is best left. However, if it is troublesome and can be corrected, it may be possible through the original incision.

Possible complications of mammaplasty CAPSULAR CONTRACTURE Capsular Contracture refers to the shrinkage of the scar lining wall in the large pocket that is dissected during surgery. The prosthesis lies within this pocket and moves within it, as the breast moves on the chest wall. If this scar capsule shrinks and forms a â&#x20AC;&#x2DC;contractureâ&#x20AC;&#x2122;, it may push the prosthesis in an inappropriate position or make it feel firm or hard. It is hoped to prevent this complication by regular massage of the prosthesis within the pocket after surgery where smooth implants are used. If the massage is done properly, a large space should be maintained and the prosthesis should feel soft. Textured implants have a wall that is designed to interact with the scar tissue and generally requires little or no massage. Where the scar capsule shrinks, re-operation may be advised to maintain the new pocket. Capsular Contracture is the most frequent of complications after breast augmentation surgery and occurs in approximately 10% - 20% of patients. It may be subtle and of no particular note, but it can also be quite severe and make the prosthesis feel very hard. Fortunately, this is a rare outcome. Some patients will repeatedly form hard scar tissue, even when scar release has been done. This may lead one to the position where either removal of the prosthesis is advised or one is forced to live with a firm breast. Again, fortunately this situation is a rare outcome. BREAST SAG The presence of a breast prosthesis may contribute to sag as years go by. In general however, the scar capsule lends some support to the prosthesis and the breast, and sag is not a remarkable feature. It is more common to occur if pregnancy also occurs. If sag of a breast occurs, a repositioning procedure (mastopexy) can be performed. This will entail more scarring than the original breast augmentation incision. AUTO IMMUNE DISEASE This is a broad group of diseases which affect the bones, joints, skin and soft tissues. They have no known cause and breast prostheses were accused of causing these also. In fact, scientific research has shown that patients with breast prostheses have no increased risk of these conditions. RUPTURE OR LEAKAGE OF A PROSTHESIS Saline salt water filled prostheses have a leak rate of approximately 1% per year. Leaking prostheses will need to be replaced. Saline-filled prosthesis have the same wall as silicone gel-filled prostheses. This wall is made of plasticized silicone (silastic). Modern silicone gel-filled prostheses are more viscous and less prone to spread if rupture occurs. In general

these prostheses are strong and rupture requires a substantial force. An estimate of leak rate for the modern silicone prosthesis is not yet available. It is known to be substantially reduced on the silicone prostheses of the late seventies about which much adverse publicity has been heard. If a prosthesis is to rupture and silicone leaks into the breasttissue usually there is little to detect. A firm lump may develop which is usually pain-free. Just like any breast-lump, it would need to be investigated and most likely excised. If the prosthesis becomes infected then the breast would certainly become painful and red and further surgery would be required. PALPABLE RIPPLING OR RIDGING Saline prostheses have a tendency to fold when placed in the human body. This may create ripples or ridges that can be felt or seen in certain positions. This is particularly true where there is little overlying covering fat or breast tissue and is therefore more of a risk in the slim patient. Whilst silicone gel-filled prostheses also show folds, these are very soft and it is much less common for them to be visible or felt. As well as being more prone to this complication, saline-filled prostheses are in general firmer to touch than gel-filled prostheses. Saline-filled prostheses are best used in people with sufficient fat or breast tissue to mask this. RISK OF BREAST CANCER Breast prostheses were accused at one stage of leading to an increased risk of breast cancer. In fact, scientific research based on many thousands of patients with or without breast prostheses has shown that patients with breast prostheses have a reduced rate of breast cancer. The reason for this is not clear, but the reduction is quite substantial (over 30%). MAMMOGRAPHY AFTER BREAST AUGMENTATION After breast augmentation, mammography can still be performed. The examination has to be more thorough than in people without prostheses. Even allowing for this, there is still approximately 10% of the breast tissue that cannot be seen on a mammogram when a prosthesis is present. However, combined with careful examination of the breast by the hand, this will hopefully not result in any delay in diagnosis of a breast lump. The occurrence of any complication after breast augmentation can result in further discomfort, inconvenience and expense. Every care is taken to reduce the risks of these complications. Please ask if you require any further information on any of these topics.

Other Issues about Implants MAMMOGRAPHY Implants may interfere with the detection of breast cancer using mammography, a type of X-ray examination. If you have had breast cancer, a family history of breast cancer, or may have other risk factors for breast cancer, tell your surgeon.

OUTCOME IN THE LONG TERM: Breast size and shape will change due to pregnancy, weight loss and gain, and as a normal process of aging. Breast implants will not stop the effects on breast size and shape caused by these situations.

As implants could possibly rupture from squeezing of the breast during mammography, always tell the radiography technician that you have implants.

Report to Dr Scamp at once if you have any of these unexpected side effects:

To achieve a better examination of breast tissue, some women may need to have additional tests such as specialized mammography, ultrasound or MRI (magnetic resonance imaging). Specialised mammography will require more exposure to X-rays, but the benefits in better cancer screening are greater than the risks of the extra X-rays. There is no evidence that breast implants increase the risk of breast cancer, although the question has been considered. It is important that women learn how to perform breast self examination. They should examine themselves monthly for lumps, in addition to having any regular tests as recommended by their doctor. Your surgeon may suggest a follow-up appointment for an examination of the breast for lumps and to asses the implants. BREASTFEEDING Intact implants do not normally interfere with lactation. Many women with implants have successfully breastfed their babies. Not all women can breastfeed successfully, including those who have not had breast enlargement surgery. If complications occur, lactation and breastfeeding may be adversely affected. Questions have been raised about whether the health of babies of breastfeeding women could be affected in some way. Indeed, many children’s medicines contain silicone, as do many other food and drinks. No evidence has been produced to show that babies develop or are vulnerable to any illness because their mothers have breast implants.

• Fever (more than 38oC) or chills • Heavy bleeding from the incision • Drainage of blood or body fluid from the incision that persists beyond the first day after surgery • Increasing pain in the breast • Redness around the incision that is spreading • Tenderness and marked enlargement of either breast • Any other concerns regarding your surgery

Breast Lift A breast lift, also called mastopexy, raises and re-contours loose, sagging breasts. You may decide you would like a breast lift because you have lost tone in your breasts after having children. Another frequent reason for having this procedure is the loss of a significant amount of weight. A breast lift improves the appearance of your breasts in several ways. It elevates your breast tissue, removes excess skin from the lower portion of your breast and then reshapes your remaining breast skin. At the same time, it relocates your nipple and areola (the pigmented skin surrounding your nipple) to a higher position. If your areolae have stretched over time, they can be reduced in size. Women who have their breasts lifted often may decide to also have them enlarged. If this is the case, an implant is placed behind the chest muscle. A commonly performed breast lift technique (see illustrations) uses incisions that follow your breastâ&#x20AC;&#x2122;s natural contour. The resulting scar, which is permanent but will fade to some extent over time, encircles the areola and then extends vertically down the breast and horizontally along the crease underneath the breast. There are other breast lift techniques that may eliminate the horizontal incision, the vertical incision, or both. The use of any particular pattern of incisions depends on individual patient factors and Dr Scampâ&#x20AC;&#x2122;s recommendation.

A breast lift elevates and reshapes loose, sagging breasts

Using this common technique, incisions follow your breastâ&#x20AC;&#x2122;s natural contour, defining the area of excision and the new location for the nipple. Skin in the shaded area is removed, and your nipple is moved higher. Variations in the placement of incisions may be used, depending on individual patient factors and surgeon recommendation.

Following surgery, your breasts will be wrapped in a dressing. Swelling and discolouration are to be expected but will gradually subside. You may experience decreased breast or nipple sensation, which is usually temporary. You should be able to return to work within one of two weeks. When breast augmentation and lift are performed simultaneously, there is a raised risk of revisional surgery being required. It may be recommended in an individual case that these procedures be performed six months apart.

Skin formerly located above and to the sides of your nipple area is brought down and together to reshape your breast.

After surgery, your breasts will be positioned higher and feel firmer. The resulting scars are permanent but will fade to some extent over time.

Specific Risk of Mastopexy The operation will keep the patient in hospital for only a day or two. Sometimes it can be done as a day patient. Although every effort will be taken to make sure that the breasts are made the same size and contour, a small degree of difference may occur. This is common amongst all unoperated breasts also. There will be significant and obvious scars in the early months after the surgery. The prominence of these scars will gradually reduce with time. Usually the shape of the scar will involve a circular scar around the nipple; a vertical scar passing below the nipple line down to meet a curved horizontal scar, which may be long, and passes from near the midline in front to outside the breast near the armpit. The horizontal part of the scar is long, following large reductions, and would normally be visible at each end but usually only on close inspection. The vertical scar usually fades and has a tendency to be slightly stretched. Sometimes the scar may be more thickened than normal and this may be associated with them becoming red, thick and itchy. This is called a keloid change. The scars can usually be improved by a second operation if desired. Sensation of the nipple may be affected. This can range from complete loss through to mild reduction in sensation. Very occasionally there may be a breakdown in the wound edges, particularly near the junctions of the vertical and horizontal scars. This is a temporary nuisance and requires regular dressings but rarely makes any difference to the overall final results. Post-operative haematoma (unwanted blood collecting under the skin and breast tissue) and infection may occur. This can lead to delay or complete failure of the healing process. This may require an operation to drain either the infection or the collected blood. This may have an adverse outcome on the final quality of the result of the operation. The operation is planned in such a way as to try and ensure an adequate blood supply is maintained to all the remaining parts of the breast (skin, fat, breast tissue and nipple). On some rare occasions the circulation is inadequate and some of the tissues may die. Although this is uncommon it is more likely to occur in patients with very large breasts and patients with very poor circulation. This may mean that the surgeon may have to compromise and alter the size and shape from that which is desired in order to maintain an adequate circulation.

Patients who have had a mastopexy (lift) may not be able to breast feed. Part of the breast tissue may be separated from the normal anatomy of the ducts and the nipple. On other occasions circulation may be too limited in reduction operations on enormous breasts. In order to stop the nipple from dying, it may be essential to graft its attached nipple high up on the breast tissue. This will make breast feeding impossible. Often the tip of the nipple can take up to one month to heal after this special operation. Post-operative pain is difficult to assess. Sometimes patients have differing amounts of pain in each breast. There should be no great discomfort and there may be some tender spots but these are usually temporary. Increasing or severe postoperative pain is usually a sign of complications and your surgeon should be notified immediately. Report to Dr Scamp at once if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding from the incision • Leakage of blood or body fluid beyond the first day after surgery • Increasing pain in either breast • Redness around the incision lines that is spreading • Tenderness and marked enlargement of either breast • Any other concern regarding your surgery

Breast Reduction Breast reduction, also called reduction mammaplasty, enhances your overall appearance by making your breasts more proportional to the rest of your body. Large, sagging breasts often interfere with normal physical activities. They can cause back pain, postural problems, deformities of the back and shoulders, skin rashes and breast pain. For these reasons, breast reduction generally is considered a reconstructive plastic surgery procedure. In addition to alleviating physical problems, however, it improves the shape of your breasts and nipple areas.

A breast lift elevates and reshapes loose, sagging breasts

The operation is performed under general anaesthesia and may be done as a day patient or during hospital stay. During the procedure, excess breast tissue and skin is removed, your nibbles and areolae (the pigmented skin surrounding the nipple) are repositioned, and your remaining breast tissue is reshaped. A commonly performed breast reduction technique (see illustrations) uses incisions that encircle the areola and then extend vertically down the breast and horizontally along the crease underneath the breast.

After surgery, your breast will be wrapped in a dressing. Loss of breast or nipple sensation is possible, but usually is not permanent. You should be able to return to work within two weeks.

Skin formerly located above and to the sides of your nipple area is brought down and together to reshape your breast.

After surgery, your breasts will be positioned higher and feel firmer. The resulting scars are permanent but will fade to some extent over time.

Specific Risks of Breast Reduction The operation will keep the patient in hospital for only a day or two. Sometimes it can be done as a day patient. Although every effort will be taken to ensure that the breasts are made the same size and contour, a small degree of difference may occur. This is common amongst all unoperated breasts also. There will be significant and obvious scars in the early months after the surgery. The prominence of these scars will gradually reduce with time. Usually the shape of the scar will involve a circular scar around the nipple; a vertical scar passing below the nipple line down to meet a curved horizontal scar, which may be long, and passes from near the midline in front to outside the breast near the armpit. The horizontal part of the scar is long following large reductions, and would normally be visible at each end but usually only on close inspection. The vertical scar usually fades and has a tendency to be slightly stretched. Sometimes the scars may be more thickened than normal and this may be associated with them becoming red, thick and itchy. This is called a keloid change. The scars may be improved by a second operation if desired. Sensation of the nipple may be affected. This can range from complete loss through to mild reduction in sensation. Very occasionally there may be a breakdown in the wound edges, particularly near the junctions of the vertical and horizontal scars. This is a temporary nuisance and requires regular dressings but rarely makes any difference to the overall final results. Post-operative haematoma (unwanted blood collecting under the skin and breast tissue) and infection may occur. This can lead to delay or complete failure of the healing process. This may require an operation to drain either the infection or the collected blood. This may have an adverse outcome on the final quality of the result of the operation. The operation is planned in such a way as to try and ensure an adequate blood supply is maintained to all the remaining parts of the breast (skin, fat, breast tissue and nipple). On some rare occasions the circulation is inadequate and some of the tissues may die. Although this is uncommon it is more likely to occur in patients with very large breasts and patients with very poor circulation. This may mean that the surgeon may have to compromise and alter the size and shape from that which is desired in order to maintain an adequate circulation.

Patients who have had a reduction mammoplasty may not be able to breastfeed. Part of the breast tissue may be separated from the normal anatomy of the ducts and the nipple. On other occasions circulation may be too limited in reduction operations on enormous breasts. In order to stop the nipple from dying, it may be essential to graft its attached nipple high up on the breast tissue. This will make breast feeding impossible. Often the tip of the nipple can take up to one month to heal after this special operation. There is no documented risk that this operation will produce breast cancer in any way. If anything it actually lessens the chances of this danger because breast tissue is removed. The operation does not make normal breast examinations more difficult once the healing process has settled down. If anything, a smaller tumor would be easier to detect because its relative size is bigger in a smaller breast. Post-operative pain is difficult to assess. Sometimes patients have differing amounts of pain in each breast. There should be no great discomfort and there may be some tender spots but these are usually temporary. Increasing or severe post-operative pain is usually a sign of complications and your surgeon should be notified immediately. Contact Dr Scamp if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding from the incision • Leakage of blood of fluid beyond the first day after surgery • Increasing pain in either breast • Redness around incision lines that is spreading • Tenderness and marked enlargement of either breast • Any other concerns you have regarding your surgery

Brow Lift A brow lift, also called a forehead lift, corrects the loss of tone that causes sagging of your eyebrows and hooding of your upper eyelids. A brow lift usually softens the deep creases across your forehead. It reduces the horizontal frown lines at the top of your nose and the vertical lines between your brows. The result is a more relaxed and refreshed appearance. A brow lift is often performed along with a facelift or other facial rejuvenation procedures. Some people have inherited traits that cause them to have a brow lift as early as early as their 20s or 30s. One technique for performing a brow lift requires an incision across the top of the scalp, beginning above your ears. The incision may be placed toward the middle of the scalp where it is hidden within your hair or at the front of the hairline. Through this incision, you plastic surgeon can modify or remove parts of the muscles that cause wrinkling or grown lines, remove excess skin and lift your eyebrows to a more pleasing position. Most patients are good candidates for an endoscopic brow lift. The endoscopic brow lift is a minimally invasive technique that requires several very small incisions into the scalp. The endoscope, inserted through these tiny incisions, allow your plastic surgeon to see and work on the various internal structures of the forehead. After surgery, you will have temporary puffiness and discolouration that may involve your eyelid and cheek areas as well. You may experience numbness and itchiness of your scalp. You may experience some loss of hair around the scar region. You should be able to wash your hair in a few days and be back to work within 10 days.

A brow lift corrects droppingor drooping eyebrows and eyelid tissues, forehead creases and frown lines that can make you look worried or angry.

One common approach to a brow lift involves an incision across your scalp, a few inches behind your hairline or along the hairline. An alternative for some patients, the endoscopic brow lift, uses several small incisions (indicated by ovals) within the hairline. The number of incisions and their placement may vary.

After surgery, your eyebrows will be elevated, your forehead will be smoothed and you will look relaxed and refreshed.

Specific Risks of a Forehead Lift SCARRING The incision will obviously result in a scar formation. The scars are usually pink to start with, generally fade and become white, soft and supple over the next three -12 months. The scar is in the hairline but may become visible with parting of the hair. Keloid scars are rare and are a thickening, inflammatory process which occurs in scar tissue. These are not due to a surgical fault but due to a peculiarity of the patientâ&#x20AC;&#x2122;s healing process. Small hairless areas can sometimes be found adjacent to the scar but these can usually be hidden with the hair. Hair growth will recommence after three months.

ALOPOECIA Hair loss may occur following brow lift around the suture lines. Patients with thinning hair and those having a tendency to Alopoecia are prone to great hair loss. Most hair loss is corrected by a new growth within six - eight months. BRUISING Black eyes are usual in the post-operative period and may last up to two - three weeks. This bruising may be minor or severe. In some instances, a collection of blood or fluid may accumulate underneath the skin necessitating drainage. A second anaesthetic may be required if this accumulation is large.

INFECTION Infection may occur and will be treated by the usual techniques. This may involve being admitted to hospital for intravenous antibiotics and further drainage procedures. Further surgery may also be required. NUMBNESS It is usual to have some temporary numbness around the forehead and scalp. This is due to surgery coming close to the nerves in this region while the skin tightening is being carried out. The numbness is usually fully recovered within six to 12 months and is rarely troublesome. Post-operatively there is normally discomfort because of the tightening rather than pain. Post-operative pain should be brought to the attention of your surgeon as this may be an indication that complications are developing. NERVE INJURY One of the worst complications as a result of this operation is damage to the facial nerve. This is the nerve that supplies all the muscles of expression to the face. This results in weakness of the facial muscles, causing drooping brows. It is uncommon but it can occur. Fortunately most cases that do occur correct themselves spontaneously within a period of sic months. As with all cosmetic surgery the problems have to be weighed against the benefits. HAEMATOMA A haematoma is a collection of blood under the skin. This is due to bleeding in the post-operative period. This may be severe and may cause loss of some of the skin on the face. It normally requires further surgery to drain and remove the clot as it forms. Every step should be taken to reduce this including the patient stopping treatment with drugs with aspirin or other blood thinning agents prior to surgery.

After the surgery, the aging process continues at its natural rate. Some patients do request a repeat operation years later. It is usually no more difficult than before. It is not usual at the operation to get as much tightening as can be obtained with fingers in front of a mirror. It is, however, possible to produce a significant degree of improvement. The operation lifts the skin off the deeper tissues and thus compromises its blood supply. In most people the normal healthy reserve of skin copes well with this. In the smoker, the pre-existent damage done to the blood vessels in the skin may result in an area of the skin dying leaving a scar. This can also happen in the non-smoker but it is much more rare. For this reason smoking must cease six weeks prior to surgery. In general this allows the tissues to recover although the risk of skin loss still persists and is probably higher than it is for the person who has never smoked.

Specific Risks of a Forehead Lift ASYMMETRY Asymmetry may occur in the final result. Each person has a unique facial structure, which is different from the left to the right side of the face. This may result in some difficulty in achieving complete symmetry of the final result. Many attractive faces are naturally asymmetric. WOUND BREAKDOWN Infection may lead to wound breakdown of part or all of the brow lift suture line. Wound breakdown may require treatment conservatively through dressings and debridement, or surgical treatment, utilizing skin graft and similar techniques. PIGMENTATION Patients who bruise easily have a greater tendency to hyperpigmentation. Patients who have multiple telangiectasis (broken capillaries) frequently have an increase in the number of telangiectasis in the areas of undermined skin. NEED FOR FURTHER SURGERY This is uncommon, but may take the form of scar revision, drainage of haematoma or treatment of infection. This may also include treatment of unforeseeable complications as mentioned before. If this occurs, there may be an additional cost incurred for which you are responsible. Contact Dr Scamp if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding from the incision • Leakage of blood or fluid beyond the first day after surgery • Redness around incision lines that is spreading • Any other concerns you have regarding your surgery

Chin and Cheek Augmentation The contours of your face may be enhanced by a variety of techniques. Chin augmentation (also called genioplasty or mentoplasty) strengthens the appearance of a receding chin by increasing its projection. Similarly, the cheekbones can be made fuller, creating a more sculpted look, using implants. Facial implants provide a permanent and predictable result. Sometimes fat may be injected into specific areas to restore a more youthful fullness to your face. Treatment with fat injections may need to be repeated to maintain improvement.

Chin augmentation strengthens the appearance of a receding chin.

The goal of chin augmentation is to improve your profile by creating a better balance between your chin and other facial features. Increasing the projection of your chin will not affect your bite of jaw function. There are several techniques for adding prominence and contour to your chin. One, performed through an incision inside the mouth, requires moving the chinbone. A more common approach involves insertion of a chin implant. The implant is inserted through incisions inside your mouth or on the underside of your chin. In the latter case, surgery usually leaves only a faint scar that is barely visible underneath the chin.

In one approach, the lower section of bone is moved forward and wired into position.

To permit proper healing following the chin augmentation, you may be placed on a liquid diet for a day or two. Your chin may be taped or bandaged. Augmentation of your cheekbones is achieved by placing a specially designed implant over them. The procedure usually is performed through an incision inside the mouth, but it may be done through a lower eyelid or a brow lift incision. After a chin or cheek augmentation, you will most likely be up and about the same day, but your activities will be restricted. You should be able to return to work within one to two weeks.

An alternative approach involves inserting an implant between the bone and chin tissue through a short external incision under your chin or through an incision made inside your mouth between the lower lip and gum. Similarly, your cheekbones may be built up by placing an implant over them.

A third technique involves insertion of your own fat into the soft tissues of the chin to build it out. This technique is very safe but survival of the fat can be unpredictable and a repeat procedure may be required (see Lipostructure on Page 29).

After surgery, you will have a more balanced profile and pleasing facial contour.

Ear Surgery Otoplasty can improve the shape of positioning of your ears. It also can reduce the size of your ears if they are large in proportion to your other features. If your ears protrude more than normal, surgery can reposition them closer to your head. Ear surgery often is recommended for children of six years or older as they near total ear development at age five of six. Correction of the ears prior to the child entering school helps to eliminate potential psychological trauma from the teasing of classmates. Adults may also have their ears reshaped. As long as you are in good health, there is no upper age limit for the surgery.

Otoplasty to correct large or protruding ears may be performed as early as age 5 or 6, when the ears are near full development.

The supporting tissue of the ears, called cartilage, is reshaped in order to position your ears closer to your head. This usually is accomplished through incisions placed behind your ears. Subsequent scars will be concealed in the natural skin crease. After surgery, you will need to wear a bandage for seven days to ensure that your ears heal in their new, corrected position. You will need to avoid strenuous exercise and contact sports for several weeks. You can resume most non-strenuous activities within a week. You will need to wear a head band at night for four weeks.

Surgery seen from the back of the ear, left to right. (a) Incisions are made and a small portion of skin, sometimes with underlying fat, is removed. (b) Cartilage is recontoured to bring your ear into itâ&#x20AC;&#x2122;s correct position and supported with sutures. (c) Stitches close the incisions, leaving a faint scar.

Surgery seen from the front of the ear. Reshaped cartilage restores the ear fold, making your ear lie flatter against your head.

After surgery, ears have a normal appearance.

Specific Risks of Otoplasty The appearance of the will depend upon its initial size and shape. The healing process after the operation will also be a factor and will largely dictate the degree of normality of the operation. Perfect symmetry between the two ears cannot be guaranteed. The post-operative pain is normally minimal after 24 - 48 hours. If pain persists, Dr Scamp should be consulted as this may be an early sign of complications developing. To be able to reduce the risk of fluid accumulating under the skin, a fairly bulky and tight bandage will commonly be used, which needs to be kept in place for one week. This may cause some discomfort particularly in hot weather. A haematoma is due to unwanted bleeding occurring between the skin and the cartilage of the ear. Immediate post-operative bleeding is a potential but an unusual complication; which may require urgent return to the operating theatre, in order to evacuate any clot that has formed and prevent further bleeding. Any trauma to the ear after the bandages are removed may also cause bleeding and this may necessitate further surgery. However, some oozing can occur following the surgery and may be visible on the outside of the bandage. Provided this does not persist it should not cause any problems. The ears will look a little swollen and bruised when the bandages are first removed. Patients commonly experience some numbness and abnormality in the feeling of touch over the skin of the ear. It should generally return over the next few months. Infection is a rare complication but can cause severe damage and deformity to the ear cartilage. This may prevent adequate wound healing which may require further surgery and may also reduce the quality of the final result. The incision normally heals with only a minimal scar behind the ear. Usually the result is excellent and because of its location the scar is unnoticeable. Some patients, unfortunately, may develop a very thickened, red, itchy, swollen scar (a keloid) which may require subsequent treatment.

Even in the hands of very experienced surgeons, a second operation to correct residual asymmetry or a minor irregularity may also be needed. The operation is usually performed at a patient’s request. If possible, the surgery should not be performed until the child is aware of the deformity and will cooperate with the surgery. This is usually age six or older. The length of hospital stay may vary with individual cases. Almost always the surgery is performed as a day patient. Contact Dr Scamp if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding • Increased swelling around surgery site • Increasing pain • Redness around incision lines that is spreading • Any other concerns regarding your surgery

Eyelid Surgery Cosmetic Eyelid surgery removes the excess fat and wrinkled, drooping skin of the upper eyelids that can make you look constantly tired or sad. It also eliminates bags under your eyes and tightens your lower eyelid skin. The result is a more alert and rested appearance. Eyelid surgery is often performed along with a facelift or other facial rejuvenation procedures. Some people have inherited traits that cause them to have eyelid surgery as early as their 20s or 30s.

eyelid surgery removes puffy bags under your eyes and wrinkled folds of skin hooding your eyelashes on the upper lids.

Fat and loose skin are removed from your upper eyelid area through and incision that is hidden within the natural eyelid fold. The incision extends slightly beyond the outside of your eye where it easily blends into existing laugh lines or other creases. If your upper eyelid problem is aggravated by sagging of your eyebrows, then Dr Scamp may recommend a brow lift. Treatment of the lower eyelids often requires an incision that is hidden just below your lower lashes. Through this incision, excess skin, muscle and fat are removed or adjusted. Sometimes fat may be repositioned to eliminate puffiness or bulges. If your lower eyelid skin is not excessive, Dr Scamp may decide to use a different technique that removes fat through an incision placed inside the lid. A laser is sometimes used, if necessary, to resurface the lower eyelid skin and to achieve a small degree of skin tightening. After surgery, expect some swelling that may persist for a week or longer. Your vision may be somewhat blurry for a few days, and you will want to wear dark glasses to protect your eyes from the wind and sun. Within a week, you can wear makeup to conceal any remaining discolouration. You should be back to work within ten days, but bruising can last longer.

Incisions follow natural contour lines in your upper and lower lids. In some cases, lower eyelid fat may be removed without an external incision; instead an incision is placed inside your lower eyelid.

Stitches close the incisions. Incision lines fade and blend into natural creases.

After surgery, your appearance is brighter, more alert and rested.

Specific Risks of Blepharoplasty Usually this type of surgery results in minimal scars. However, in the first few weeks after surgery, the scar may be pink and slightly thickened. This can be more prominent in the lower eyelid, particularly if the scar needs to be extended past the outer edge of the eyelid by more than 1 cm. This may require some sort of makeup camouflage until this settles down over the first few months. Bruising almost invariable occurs around the eyelids due to the nature of the operation. It may even spread on to the white part of the eye where it lasts for longer than the normal week to ten days. However, in order to minimize the bruising and swelling, drugs such as aspirin or other drugs which thin the blood should be stopped prior to the operation. Immediately after the operation, the patient should avoid over-activity and bending over for up to three weeks. Dark glasses are also helpful in the immediate postoperative period. Swelling may make closure of the upper lid difficult initially. This may result in the upper eyelid becoming slightly opened when asleep. This may persist for some weeks. Should this occur, it is vital that the patient uses lubricating eye ointment during this phase in order to prevent the eye from drying out and becoming sore. If this is not undertaken then the tissues at the front of the eye can dry out and result in a scar which will reduce the quality of vision. Occasionally, prolonged reduction in tear formation or dry eye may result. This requires the use of artificial tears. Another potential complication is ‘ectropion’. This is where the lower eyelid appears pulled down too far. The lower eyelid is a very weak structure and in order to avoid this potential problem, surgeons are careful not to pull down the eyelid too hard or too far. For this reason, the skin below the eyelid may not be as smooth as desired. This surgery will not remove the fine wrinkling lines on the outer edges of the eyelids nor will it raise the eyelid itself. Any weakness of the lower lid which is present will normally last for up to two weeks. This is due to the need to penetrate the muscle of the lid in order to take away the fat from the lid. The situation can normally recover without treatment, but if permanent, may be improved by further surgery. Few patients notice the formation of small lumps in the lower eyelid. These generally disappear over a few months. Unfortunately, during this time, temporary irritation and abrasions may occur.

Blindness is fortunately an extremely remote and rare possibility. It is more likely to occur if patients have pervious eye conditions, e.g. glaucoma or any other ocular problems that may impede vision or tear formation. It is important the surgeon is aware of these conditions before surgery. Every operation will produce a degree of pain. This is not a particularly painful operation. If any post-operative pain develops, it is important that the surgeon is notified, as this may be an indication of early complications developing. However, there is discomfort because of the tightness of swelling and the ointment. There may be excessive tear formation and sensitivity to bright light for the first few days. The post- operative pain is normally minimal after 24 - 48 hours. If pain persists, the surgeon should be consulted, as this may be an early sign of complications developing. Another symptom of the operation is blurring of vision. This normally occurs in the very early post-operative phase and is due to swelling and the use of ointment in the eye. However, there is a temporary impression of double vision which lasts for a day or two after the operation. This usually recovers spontaneously and is a result of the bruising. It is not normally the result of any serious complication of the operation. Very rarely do wounds become infected. This may require drainage of any tissue fluid that is infected or accumulated under the skin. This is more likely to occur in a fairly significant degree of bruising. Bruising, fluid collecting under the skin and infection may delay the speed of wound healing and may also produce an undesired cosmetic result. Report to Dr Scamp at once if you develop any of the following: • Temperature higher than 38oC or chills • Heavy bleeding from the incisions • Severe pain or tenderness • Redness around the incisions that is spreading • Loss of feeling in any area of the face

Face & Neck Lift A facelift smoothes loose skin on your face and neck, tightens underlying tissues and removes excess fat. Your bone structure, heredity and skin texture all play a role in how many ‘years’ a facelift can ‘remove’ and, to some extent, influence how long it will last. There are many variations to the facelift procedure and placement of incisions. The goal of every facelift technique is to keep the incisions hidden as much as possible. Following surgery, scars will be concealed by your hair or with makeup.

A facelift corrects visible signs of aging such as deep cheek folds, jowls and loose skin on the front and sides of your neck.

Your facial skin is lifted from its underlying tissue and the excess is trimmed off. The deeper tissues are also repositioned to restore a more youthful contour to your face. If necessary, a small incision beneath your chin permits the removal of fat and smoothing of the cord-like structures in your neck. When facial sagging in the cheek area is pronounced, a procedure called a mid-facelift may be performed. Incisions are often made inside the lower eyelid or may be placed in another area that provides superior access to the central cheek region.

Your plastic surgeon will design incisions to suit your particular needs. Your facelift incisions may be placed within the hairline and within natural contours in front of and behind your ears, as shown. Modified incisions may be used if, for example, you need correction of only your neck and lower face, or to preserve hair.

After facelift surgery, you will experience temporary skin discolouration and some tightness or numbness in your face and neck. Since your skin will remain somewhat sensitive for a few months, protection from the sun including daily use of a sun block is essential. You can wear cosmetics a few days following surgery and patients often are back to work within two weeks. REDEFINING FACIAL FEATURES Achieving harmony of your facial features is one of the most important goals of aesthetic plastic surgery. Facial aesthetic surgery can help you shape your nose, reduce prominent ears, increase the projection of your chin and create a more pleasing contour in your cheek areas. Sometimes enhancing a single facial feature brings your whole face in balance, enhancing your overall appearance and increasing your self-confidence. Looking your best can give you an important ‘edge’ in both your personal and professional life.

Loose skin is pulled up and back, and the excess is removed.

After surgery, the skin on your face and neck will look smoother, firmer and fresher.

Special Risks of Facelift & Neck Surgery SCARRING The incision will obviously result in a scar. The scars are usually pink to start with, generally fade and become white, soft and supple over the next three -12 months. The scar in the hairline may become visible with parting of the hair. The scar behind the ear may be the most noticeable and it is helpful to have a hairstyle which can cover this area. Keloid scars are rare and are a thickening, inflammatory process which occurs in normal scar tissue. These are not due to a surgical fault but due to a peculiarity of the patient’s healing process. Small hairless areas can sometimes be fund adjacent to the scar but these can usually be hidden with the hair. Hair growth will recommence after three months. INFECTION Infection may occur and will be treated by the usual techniques. This may involve being admitted hospital for intravenous antibiotics and further drainage procedures. Further surgery may be required. BRUISING Bruising of the face and neck is usual in the post-operative period and may last up to two - three weeks. This bruising may be minor or severe. In some instances, a collection of blood or fluid may accumulate underneath the skin necessitating drainage. A second anaesthetic may be required if this accumulation is large. NUMBNESS It is usual to have some temporary numbness around the cheeks and sometimes the ears. This is due to surgery coming close to the nerves in these regions while the skin tightening is being carried out. The numbness is usually fully recovered within six to 12 months and is rarely troublesome. Post-operatively there is normally discomfort because of the tightening rather than pain. There may be tender areas, more commonly below the ears and on the side of the neck. Post-operative pain should be brought to the attention of your surgeon as this may be an indication that complications are developing. NERVE INJURY One of the worst complications as a result of this operation is damage to the facial nerve. This is the nerve that supplies all the muscles of expression to the face. This results in weakness of the facial muscles. It is uncommon but it can occur and the danger is greater when the underlying muscles and fascia are tightened, and when fat is removed from the neck. Fortunately most cases that do occur correct themselves spontaneously within a period of six months. As with all cosmetic surgery the problems have to be weighed against the benefits.

HAEMATOMA A haematoma is a collection of blood under the skin. This is due to bleeding in the post-operative period. This may be severe and may cause loss of some of the skin on the face. It normally requires further surgery to drain and remove the clot. Every step should be taken to reduce this including the patient stopping treatment with such drugs as aspirin or other blood thinning agents prior to surgery. Usually a fine strip of hair is trimmed immediately before the operation and it is this skin, clipped of hair, which is removed during the operation so that afterwards there is little evidence of shaving or baldness along the operation line. Bruising and swelling is usual and varies with each patient; from being virtually invisible to being so severe that a blood clot collects, which may need to be removed back in the operating theatre. Most of the severely swollen cases have settled by the third week. Varying forms of anaesthesia can be used and a day or two in hospital after the operation is usual. In some cases day surgery is possible. The first night is usually spent with the face bandaged but a day or so later the bandages are removed and the operation inspected and redressed. The hair is commonly washed before the patient goes home. Many wear dark glasses if the eyelids are bruised. The hair hides most of the sutures, but a scarf can be helpful. If your surgeon has also agreed to remove some tissue from your eyelids, please read the particular consent form regarding blepharoplasty. Unfortunately the wrinkles on the lips and those ingrained in the corners of the mouth and eyes are not helped by this operation. Fat grafts and/or laser resurfacing may be of benefit. The forehead is not treated by a facelift, it can be improved by a brow lift. In the neck region, improvement will be a reduction in the amount of loose skin but it will not remove the creases in the neck which are normal and present from childhood. Occasionally an extra scar is placed immediately below the chin in order to remove excess fat in this area. A few weeks after the operation when the final swelling from the operation is gradually settling, it may appear that the face is beginning to ‘fall’. This is an inevitable minor consequence of the face that the skin is stretched by post-operative swelling and is usually complete within about three months. Fine wrinkles may occasionally return during this time. The patient must be prepared to be satisfied with an improvement rather than seeking some ‘perfection’ or ‘total rejuvenation’.

Plasma Skin Resurfacing No matter what we do to the structure of our face, if the skin is ‘old’ our look is never entirely rejuvenated. Fine lines, deep wrinkles, sun spots and skin pigmentations all contribute to an ‘old skin’ look. The Portrait, is a skin rejuvenation device which uses plasma (ionized gas) to rejuvenate the skin in a similar way to a laser but with a more rapid recovery. With the Portrait system, the overlying skin stays intact for three to five days. This gives the deeper layer a chance to heal so that when the top layer flakes off there is already healthy healed skin beneath it. This reduces the time taken to heal, reduces the discomfort and minimizes the overall risk (particularly that of infections). Portrait can be performed as an in office procedure with the use of topical anesthetic cream and local anesthetic blocks, rather than being done in the operating theatre under a general anesthetic, as is common with lasers. And, as the overlying skin stays in act the dressing regime for after care is also much more simple. Only a heavy moisturizer is usually required.

Healing usually takes less than a week and further continual improvement is seen in the skin over a year. Areas other than the face such as the backs of hands, limbs and décolletage and neck can also be treated with the portrait device. Portrait is recommended for treatment of sun damage, wrinkles, benign skin lesions, superficial pigmentation and acne scarring. Portrait will not remove the fine blood vessels which are commonly seen on the face as we age. These can be later reduced by use of intense pulse light (IPL). In certain instances where lines are particularly deeper or very close to the eye, laser resurfacing may be preferred.

The Portrait has two effects on the skin. The immediate effect, visible within a week or so, is that shiny, healthy, young-looking skin emerges. This is due to loss of superficial layers of the skin which contain a lot of the aftermath of sun damage and photo-aging. The deeper layers of the skin are also affected by the Portrait. They are strongly stimulated and the cells there become metabolically very active and lay down new collagen. This progressively tightens and smoothes the skin. Even after a year of a single Portrait treatment, increased activity in the deeper parts of the skin are still visible.

Skin Resurfacing Skin resurfacing provides significant and long lasting improvement of sum damaged, unevenly pigmented or coarsely wrinkled facial skin. Usually you will undergo a single procedure rather than the series of treatments commonly recommended for milder skin revitalizing techniques. Laser skin resurfacing is a popular technique. Like other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face of specific areas. The laser also has a mild tightening effect on the skin, particularly in the lower eyelid area. There are a variety of lasers in use today. Dr Scamp can advise you about the specific treatment that would be most effective in meeting your goals. A few days following laser resurfacing, your new skin emerges. Its bright pink colour will fade over the next few months and in the meantime, may be covered by makeup. In most cases, you should be able to return to work within a week or two.

Like other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. Your plastic surgeon is able to precisely control the amount of energy transmitted to your skinâ&#x20AC;&#x2122;s surface by the laser beam

Specific Risks & Complications of Laser Resurfacing There are a number of possible complications, the major ones are listed below: SENSATION OF TIGHTNESS This is quite common in the first one to two months after treatment. Use of specific moisturiser creams can help to relieve this and it is generally not something to be concerned about but is expected as part of the process. MILIA These are small obstructed oil glands in the skin. They can occur normally or after laser resurfacing. They are usually not a major problem and respond to ‘de-roofing’ with a small needle. RECURRENCE OF LINES It is not possible with the laser to remove all lines on the face without inflicting a burn to a depth that has a substantial risk or causing scarring. The philosophy pf treatment is that it is best to accept remaining lines rather than to run the risk of major scarring. In general an 80% improvement is hoped for, but may be less than 50% with acne. There are lines that are present at rest (static) and lines that appear with muscle action. Strong muscle action lines will not be removed by the laser treatment but may respond to Injection Therapy. Most of the static lines will respond to laser except the very deep ones. Attempts to remove these with laser may inflict new scars. ACNE Both the swelling and the use of occlusive dressings and creams may exacerbate acne after treatment. Usually, after approximately 6 weeks of treatment, recommencement of Retin A is possible to help control this. SYNECCHIA These are small webs of skin that occur as the skin heals. They are uncommon and are usually not much f a problem. They occasionally require gentle removal. SKIN ERUPTIONS Laser resurfacing may cause an outbreak of cold sores (herpes). These can affect any area that has been resurfaced and are more common in patients who have a history of cold sores. They can, however, occur with anybody. These outbreaks can result in skin scarring and it is therefore recommended that you take anti-cold sore medications for a period of approximately ten days round the time of resurfacing. These medications are expensive (over $100). Infections may result in the skin after laser resurfacing. These may be fungal or bacterial in origin. Antibiotic or antifungal cream may be required if these arise.

DERMATITIS Skin that has been resurfaced is very sensitive and prone to allergic reactions. Dermatitis that results in this way usually responds to topical steroid creams. PIGMENTATION DISTURBANCES Resurfacing the skin may result in dark patches or a general darkening in the colour of the skin. This is particularly true if sun exposure occurs within the first few months after the resurfacing. Utmost care to prevent sun exposure is required and Retin A is usually recommended six weeks after resurfacing. Subsequently, chemical peels or other topical medications may be required to help fade this pigmentation, but it may be permanent. Conversely, pale patches (hypo pigmentation) or a general paling of the treated skin may result after laser resurfacing. This is uncommon and it occurs in approximately 1 in 50 patients. Deeper treatments to eradicate resistant lines are more prone to this problem. OBVIOUS BLOOD VESSELS Laser treatment does not lead to large blood vessels appearing on the face. It can, however, expose the underlying spider veins as the pigmentation fades with treatment. Treatment with a different laser can often improve these vessels. SCARRING Scarring occurs in less than 1% of patients treated for laser resurfacing. Treatment with steroid injections may be required and it may take a year or more for these scars to fade. Permanent scarring is small but a definite risk. FADING OF THE LIP The redness along the lip border may face with treatment from the laser around the mouth. This is generally easy to mask with lipstick. ECTROPION Treatment of lower eyelids with laser resurfacing may cause a tightening in the skin below the eyelids in the lower lid being pulled down. This is uncommon and usually settles spontaneously, but it may take up to four months to do so. A support procedure (lateral canthopexy) may be recommended to reduce this risk. Report to Dr Scamp if you have any of these unexpected side effects or any other concerns regarding a possible side effect from treatment: • • •

Fever (more than 38oC) or chills Increasing pain or redness in the treated area Any other problems or concerns

Fat Grafting FAT GRAFTING Lipostructure is a technique of fat grafting developed by a New York Plastic Surgeon, Dr Sydney Coleman. The technique entails placing a network of fine interwoven fat grafts into a region to rejuvenate an area or improve the contour of that region. This may leave a more youthful fullness and reduce the lines of a region.

RISKS Infections can occur in the grafts, which will result in pain and swelling. Antibiotics are given at surgery to reduce this risk. Surgery to the lips or face may result in an outbreak of cold sores (herpes) even in someone who has no previous history of these. If cold sores arise, specific medication will be prescribed. This medication is expensive (over $100). Please notify us immediately if you believe you are getting a cold sore or any infection.

Dr Coleman has successfully used these grafts in the brow, cheeks and the eyelids to rejuvenate the upper face.

Fat grafts, ideally, should give a permanent improvement. They can, however, melt away. The risks of this are probably

Grafts to the jaw line may create a more attractive contour and profile. Whilst this surgery to the lips may soften lines and create a more attractive pout.

higher in smokers. Please cease smoking six weeks prior to surgery. In some patients graft shrinkage may be excessive and repeated grafting will be recommended. The possibility of additional costs should be kept in mind.

The lipostructure technique has also been used in acne, as substantial thinning of the fat layer may happen in this condition. Lipostructure may give acne patients better texture and improved appearance. The surgery is commonly performed under general anaesthesia as a day patient. Swelling and bruising to the face may be quite marked, especially in the first two weeks, but sometimes as long as four or more weeks. In general, the final result is visible by eight weeks. The abdomen is commonly the site the grafts are taken from. Again bruising, swelling and some numbness are to be expected at least temporarily. Bruising is worse if aspirin is taken in the two weeks before surgery.

Conversely, there is also a risk that grafts may be too large or irregular (lumpy). Again, revisional surgery may be recommended. Removal of grafts is technically difficult and may entail additional scarring. Please ask if you have any further questions.

Liposuction Lipoplasty, also called liposuction or liposculpture, removes localised collections of fatty tissue to give you a smoother and slimmer body contour. For the best results, you should be of relatively normal weight with extra fat localised in specific areas such as the hips, buttocks and abdomen. Lipoplasty is also effective in removing fat deposits from the back, legs, arms, face and neck. Lipoplasty is neither a substitute for proper diet and exercise nor a method for overall weight loss. It cannot eliminate cellulite or correct loose, hanging skin. In fact, the best results from lipoplasty are achieved when you have health, elastic skin with the capacity to shrink evenly after surgery. If your skin has lost much of its elasticity, you may need a skin tightening procedure such as a tummy tuck, thigh lift, buttock lift or arm lift. General anaesthesia is used for this procedure for maximum patient comfort. Lipoplasty is usually performed using a suction pump device to vacuum away excess fatty deposits. In some cases, hand-held syringe may be used instead of a pump. There are a number of variations to conventional lipoplasty. Ultrasound-assisted lipoplasty, for example, uses energy from sound waves to liquefy the fat before it is removed. The technique chosen for your specific case depends on individual factors that Dr Scamp will discuss with you. Following surgery, you will need to wear a snug pressure garment for 6-12 weeks, to promote skin shrinkage and to minimise swelling and bruising as you gradually resume normal activities. You can expect to return to work within one or two weeks.

Lipoplasty helps to eliminate, unsightly bulges by removing localised fat deposits

Collections of fatty tissue in the shaded areas are removed through short incisions that are discreetly placed

A long, hollow tube, called a cannula, with an opening at one end, is inserted through a small incision. At the tubeâ&#x20AC;&#x2122;s opposite end, a vaccum pressure unit suctions away the fat. Ultrasonic energy sometimes may be used to liquefy the fat before it is removed.

After surgery, your body contour will appear smoother and slimmer.

Specific Risks of Liposuction The capacity of the skin to contract (shrink) determines the maximal advisable amount of fat to be removed. There is no guarantee that it will be possible to remove just the right amount. As a result, too much or too little may be removed. This may result in a contour defect such s rippling or dimpling if the skin fails to shrink. This may require a second operation. Patients who are overweight or over the age of 35 must be willing to accept a greater possibility of these contour irregularities and poor skin redraping in exchange for looking better in clothing. Post-operative pain is experienced by most patients. This is usually just discomfort and lasts for several days to one week after surgery. The amount of pain will be based on the size of the procedure and each patient’s individual tolerance. Numbness may also occur but this usually disappears after some months. Bruising is characterised by skin discolouration, blue and black areas, and texture irregularity. This can last for up to three weeks and longer in many cases. In some cases lumpy areas may last longer and may be improved by massage. Infection is an infrequent occurrence. It may produce altered cosmetic results or delay healing of the wound. A collection of blood (a haematoma) or a watery fluid (seroma) may arise but occurs infrequently. These two will produce the worst cosmetic result and may delay wound healing. A second operation may be necessary in order to evacuate the blood or serum which has accumulated. An area of skin loss can occur and this has been reported in the literature. This is a very infrequent occurrence. Swelling occurs when the knees and inner thighs are treated. In particular, ankle swelling can occur and may last longer than a week. It may take up to six to eight weeks before the benefits of the procedure are visible. Patients can be expected to wait up to six months to see the final results. The procedure tends to use very minimal incisions. Areas of contour defect can be improved by liposuction of the face, the neck, breasts, fatty areas above the breast near the arm crease, fullness lateral to the breasts, breast enlargement in men, the waist area in both sexes, the buttocks, the outer thighs (jodhpur deformity), the inner thighs, knees, calves, ankles and also the arms. The abdomen can also be recontoured using this technique. Post-surgical or posttraumatic fat deposits can also be suction contoured.

Using liposuction alone, the skin is not tightened surgically. Therefore, it is best suited to people who are in good physical shape and who have skin quality which has youthful characteristics. This is best performed for people under the age of 35. There are specific cases in which excess skin may present following this procedure and surgical removal of the skin may be necessary to achieve a good cosmetic result. The procedure is usually performed under a general anaesthetic. Local anaesthesia is usually limited for small areas. Out patient liposuction may be able to be performed, but admission to hospital may be required for more extensive liposuction. Following the surgery the patient is normally in hospital resting in bed for up to 24 hours. The average stay is between one to three days. When a lengthy procedure is performed on multiple extensive areas, a blood transfusion may exceptionally be required. Post-operatively, a snug garment will be placed on the wound. Where possible a commercially made support garment such as a long-legged pantigirdle, support tights, abdominal binder or surgical bra will be used. Some form of support dressing will normally be utilized for up to six -12 weeks. Normal bathing and shower facilities can be resumed within a few days. Ask your surgeon prior to the surgery, regarding the massage program to use in the postoperative period. After six weeks, strenuous activities can usually be resumed though more reasonable activities can normally be carried out in an earlier period, usually two to three weeks. Contact Dr Scamp if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding or oozing from any incision • Increased swelling around the surgery sites • Increasing pain • Redness around incision lines that is spreading • Any other concerns regarding your surgery

Nose Reshaping The goal of rhinoplasty is to reshape your nose so that it complements your other facial features. The earliest recommended age for rehinoplasty is the mid-teens when the nose is near full development. As long as you are in good health, there is no upper age limit for nose reshaping. Reshaping, generally, is done through incisions inside your nose. In some instances, there may also be an incision on the underside of your nose between your nostrils. The resulting scars fade and ultimately should be barely visible. Your nose can be reduced, or built up, by adjusting its supporting structures. This is done either by removing or adding bone cartilage. Your skin and soft tissues will assume their new shape over this â&#x20AC;&#x2DC;scaffoldingâ&#x20AC;&#x2122;. If you have breathing problems because of irregularity in the internal structures of your nose, adjustments can be made to improve your nasal airway. This can be done at the same time as alterations to the external appearance of your nose. Dr Scamp will operate with another specialist (ENT) surgeon if required. After surgery, some discomfort, swelling and bruising can be expected. You will need to wear a nasal splint for a week. You can begin wearing cosmetics as soon as it is removed. Your routine will be severely restricted for only a day or two, but it will be a few weeks before you can resume bending, lifting and exercise. As long as your job does not involve activities that raise your blood pressure, you should be able to return to work within 10 days. Minor swelling of your nose may persist for up to a year, but most likely this will not be noticeable to others. The final results of rhinoplasty are permanent and well worth the wait.

Rhinoplasty can reshape your nose to remove nasal hump and reduce an enlarged tip. It can also improve the angle between your nose and upper lip.

Incisions usually are made inside your nose to provide access to cartilage and bone which can be cut and reshaped to alter the external appearance. the nasal bridge can be narrowed by moving the bone inward, as shown by the arrow. In some instance, an open technique, which requires an incision on the underside of your nose between the nostrils, may be used.

Areas where cartilage and bone have been readjusted to improve the shape of the nose are shown.

Following surgery, your nose will complement your other facial features.

Specific Risks of Rhinoplasty Infection may occur and will be treated by the usual techniques. Swelling of the lining of the nose occurs along with the general swelling of the region and produces a mild temporary obstruction of the air passage. Do not blow the nose for one month after the operation as this may cause troublesome bleeding. The tip of the nose often feels numb for some months but this is quite normal and usually recovers completely. Minor irregularities along the bridge-line may be felt by a discerning finger. These should not be regarded as serious because they are seldom visible. However, persistent irregularities of contour in the bridge-line do occasionally follow this reconstructive surgery. If still present one year after the operation they may be removed by a further operation but this is necessary in only 10%. There may be a feeling of stiffness or numbness in the upper lip which may be persistent in the first few weeks due to the swelling in the nose, which can affect the movement of the lip. The lip or a front tooth may also be temporarily numb. Smoking is known to interfere with the quality of blood being supplied to the skin. Smoking markedly increases the risk of skin loss, although this is rare in rhinoplasty. Severe bleeding requiring re-operation occurs in 1%. The length of hospital stay may vary with individual cases. Almost always the surgery is performed as a day patient. Contact Dr Scamp if you have any of these problems: • Fever (with a temperature of more than 38oC) or chills • Heavy bleeding • Increased swelling around surgery site • Increasing pain • Redness around incision lines that is spreading • Any other concerns regarding your surgery

Tummy Tuck A tummy tuck, also called Abdominoplasty, is designed to give you a smoother, flatter abdomen. The procedure removes excess abdominal skin and usually reduces fat and tightens the muscles of your abdominal wall. Often performed to correct the muscle weakness and loose skin that can occur following multiple pregnancies, significant weight loss or abdominal surgery. Abdominoplasty will be performed as an in-patient in hospital. Usually you will stay for 3 days. General, a horizontal incision is made just within or above your pubic area. The contour of this incision may vary. The resulting scar is permanent, but your plastic surgeon will try to place it within the lines of a bathing suit or undergarments that you typically wear. To correct loose skin above your navel (belly button), your surgeon will make a second incision around your navel so that the skin can be pulled down and the excess removed. The position of your navel will not change. If there are stretch marks on your lower abdomen, these may be removed. Any remaining stretch marks may be somewhat flattened, but don’t expect a dramatic improvement. Abdominoplasty sometimes may be combined with liposuction to achieve the best results, but this may need to be done at a second stage. If your skin laxity and muscle weakness are limited to the area below the navel, you may be a good candidate for a modified abdominoplasty that leaves a shorter scar and requires no incision around the navel (‘Minituck’). Another technique for minimizing scars uses an endoscope; this procedure may be an option if you have only a minimal amount of excess skin and muscle laxity. The day after surgery, you will be encouraged to get out of bed and walk for short periods to promote blood circulation. You will be instructed to wear a support garment for several weeks. You will need to avoid strenuous activity for a while but should be able to return to work within two - four weeks.

An abdominoplasty incision usually is made just within or above the pubic area and around the navel. Skin in the shaded area is separated from your abdominal wall.

To tighten your abdominal wall, your plastic surgeon will bring loose underlying tissue and muscle together with sutures.

Abdominal skin is drawn downward and the excess is removed. A small opening is made for your navel so that it’s position remains unchanged.

After surgery, you will have a firmer, flatter abdomen. The resulting scars are permanent but will fade to some extent over time.

Specific Risks & Complications of Abdominoplasty SCARS There will be a long, horizontal scar which is usually placed low enough to be hidden by most moderate two-piece bathing costumes. It is usually quite noticeable but will generally fade. No surgeon can guarantee that such scars will be hidden by all swimming garments. The desired result is to improve the shape and contour of the abdomen. Sometimes the scar can be keloid in nature. This means there is a red, thick and itchy scar. The final scar may still remain thickened after a period of time. Patients can reduce the risk of this occurring and aiding the healing of the scars by avoiding over-activity and straining for three

POSITION OF UMBILICUS Position of the umbilicus may be difficult to calculate preoperatively. This is particularly true in a patient who has lost a lot of weight. Occasionally ‘normal’ navels are not central. There is also the possibility of loss of the navel. However, the scar may provide a reasonable substitute.

to four weeks.

SENSORY CHANGES The area of skin that has been pulled down below the umbilicus may sell be numb for up to a year or so. This is because the operation will disturb the nerves present within the skin and the fat. Sometimes this loss of sensation is permanent. Occasionally there may just be numbness on each side. This may extend well on down to the thigh.

Because the redundant tissue is taken out vertically, there is a small tendency for the pubic hair to be pulled up approximately 2cm. This may counteract the descent that occurred with pregnancy. A bulge may be present above or below the suture line. This may occur when thicker, fatty upper abdominal tissue is sutured to thinner pubic tissue after removal of the abdominal excess tissue. Follow-up liposuction may be required. This may necessitate additional surgical, hospital and anaesthetic costs. FAILURE OF THE PROCEDURE Sometimes it is impossible to ring down the skin below the navel to meet the pubis in a horizontal scar. On these occasions, a vertical segment of the scar is included in the reconstruction of the abdominal wall. This tends to leave a scar like an upside down T, though occasionally there may be two scars, a horizontal one and a vertical scar. Where previous surgery has been performed on the abdomen (e.g. Caesarean section, hysterectomy or gallbladder operation) it is more likely these scars will end up in this configuration. Previous scars from other operations also reduce the amount of blood flowing into the skin and fat of the stomach wall. This means that circulation to the remaining skin is not as good as in regions where there are no scars. Because of this, the remaining skin is at risk of ‘necrosis’ or dying. A recognized, although rare complication of this operation, is for necrosis (death of skin) to occur adjacent to previous surgical scars.

ABDOMINAL WALL MUSCLES The operation will also involve the repair of stretched or separated abdominal wall muscles. This can produce a muscle soreness immediately after the operation.

WOUND BREAKDOWN Infection may lead to wound breakdown of part or all of the Abdominoplasty suture line. Wound breakdown may require treatment conservatively, through dressings and debridement or surgical treatment, utilizing skin graft and similar techniques. SKIN NECROSIS OR SKIN LOSS May occur post-operatively and is caused by poor blood supply to the skin. This complication is much more common in smokers, as smoking has been proven to cause a decrease in superficial blood supply. Necrosis may vary from a mild lever, which will create minimal or no scarring, to severe, which could result in permanent and disfiguring scarring. NERVE INJURY Transient numbness of the abdomen may occur for the first two to six months following Abdominoplasty, as a result of interuption of the small sensory nerves during surgery, and to some extent this is unavoidable. Liposuction can further cause damage to sensory nerves. This sensory loss may be permanent.

Specific Risks & Complications of Abdominoplasty ASYMMETRY May occur due to small anatomical differences in underlying structures on the left and right sides of the abdomen as well as muscle tension and tone. Small skin dimples are possible from deep sutures. PAIN Pain after an Abdominoplasty procedure may vary from mild to severe. Discomfort and tightness in the abdomen may be more widespread, covering those areas treated. SUCTION Liposuction is used in some Abdominoplasties; however Abdominoplasty does not involve treatment of the hips or fatty deposits on the side of the waist or back. If this is required and can be performed at the same time as the abdominoplasty, additional complications specific to suction include the following: • Dimpling of the skin due to uneven fatty deposits • Skin laxity if skin elasticity does not allow for retraction • Further scarring from insertion of suction catheters in other areas including the back and loins, if treated • These complications may produce permanent disfigurement in the form of thick scarring, asymmetry and skin laxity • Further revisionary surgery may be required as a result of these complications • Compression garments may be required in the postoperative period to minimize the risk of developing complications Report to Dr Scamp or ring our after hours number if you develop any of the following: • • • • •

Temperature higher than 38oC or chills Heavy bleeding from the incisions Severe pain or tenderness Redness around the incisions that is spreading Any concerns you have regarding your surgery

Gentle Skin Treatments – non surgical UVB damage than vitamin C and vitamin E alone. When used with a sunscreen a combination of vitamins C + E provides enhanced protection against UVA damage.

Microdermabrasion is a popular technique that uses a stream of micro-crystals and suction to gently ‘polish’ your skin, giving your complexion a healthy looking glow. Many people would like to improve their appearance, but are not ready yet for cosmetic surgery. For those people we can offer a range of non-surgical treatment to give them that little lift. Skin care and conditioning programs, utilizing clinically proven ingredients such as retinoids, fruit acids, vitamin C and other antioxidants. We have a special product range designed to reduce the excessive facial pigmentation that is commonly seen after pregnancy or just too much sunshine. C & E SKIN CARE Everyday, environmental elements like sunlight, smoke and air pollution cause free radicals to form in the skin. These free radicals attack your skin’s collagen, causing lines and wrinkles to appear. This process is called photo-aging. Antioxidants (like vitamin C and vitamin E) fight free radicals, helping to prevent premature environmental damage, and improving the appearance of fine lines and wrinkles. We have a number of skin care and conditioning programs, utilizing clinically proven ingredients such as vitamin C, vitamin E, retinoids, fruit acids and other antioxidants. One such highly effective antioxidant product combines, for the first time, vitamin C (L-ascorbic acid) and vitamin E (alpha-tocopherol). The antioxidant benefits of vitamin C and vitamin E are wellestablished medical facts. Recent studies show that using a combination of vitamin C and vitamin E provide even greater benefits for the skin than using vitamin C or vitamin E alone. This combination of C + E provides better protection from

RETIN-A Sun damage in skin has been found to be much more common that thought. The effect of this exposure is to cause a low-grade inflammatory reaction in the skin which results in damage to the fibrous supporting network of the skin (collagen). The loss of support makes the skin looser and it becomes wrinkled and saggy. In addition, the out layer of the skin also becomes thicker which leads to a dry leathery texture. Also, the skin may become irregularly pigmented or mottled. Microscopic examination of the skin treated with Retin-A shows a range of changes. There is increase in collagen formation which expands the dermal compartment of the skin and flattens out wrinkles. The activity of the pigment producing cells of the skin are reduced which causes the fading of areas of hyper-pigmentation or mottling. There is exfoliation (peeling) of the skin resulting in a smoother surface. Areas of thickened pre-cancerous change in the skin are obliterated. It is hoped that this latter feature plus the anti-tumor effects of Retin-A will help prevent progression to skin cancer. As Retin-A decreases the activity of the oil glands and improves their drainage it will usually quieten acne and may assist in the recovery of skin scarred by acne. Retin-A used alone or in combination, will usually lighten pigmented patches by thinning the epidermis and decreasing activity in the pigmented cells. Although improvement may be apparent after only a few weeks, substantial benefit from Retin-A may take four months to show. Maximum benefit is usually apparent after a year at which stage treatment is reduced in frequency. The aim of Retin-A therapy is to progress to maximal amounts of Retin-A as soon as the skin will allow. This will cause some redness, itching, peeling, dryness, tightness and even soreness. These symptoms are more marked in the first month or so of usage.

Gentle Skin Treatments â&#x20AC;&#x201C; non surgical MICRODERMABRASION Microdermabrasion fills the middle ground between facials and laser resurfacing. The progression of time, our environment, our lifestyle (especially smoking and sun exposure) and the natural aging process adversely influence our skin. The components of skin aging can be categorised as intrinsic (genetic) or extrinsic (environmental) factors. Physiologically, the skin is affected by both aging influences with profound changes in the dermis (the elastic deep layer of the skin). During the aging process, fibroblast activity decreases, affecting skin strength and elasticity. The dermal degradation is observed as lines and wrinkles. Meanwhile, there is a decrease in the flood flow to the skin and the growth of new skin cells drop dramatically. The skin loses its ability to spring back to shape. Microdermabrasion is the holistic option for modern skin care. It complements other health programs without interference. It provides a gentle yet effective mechanical peeling, using micro diamond shaped crystals to slough off dead cells. Microdermabrasion treatment is fast and pain-free, leaving little or no redness. Use it to treat and minimize the most difficult skin conditions, or just to rejuvenate and maintain the health of the skin. Today, microdermabrasion is the fastest growing application for skin resurfacing technology. As a non-invasive technique, it respects the skinâ&#x20AC;&#x2122;s integrity, minimises trauma and created health, vital skin. The Diamond Dermabrasion technology features a patented dual control system with an adjustable applicator head that delivers a steady, powerful stream of fine diamond crystals to the skin, leaving it smooth and fresh, while promoting new collagen growth. The crystals themselves have extraordinary qualities. The exquisite hardness, shape, purity and efficiency deliver a more efficient exfoliation. Microdermabrasion works best when used in a series of treatment. Results and benefits are delivered with each treatment and ongoing revitalized health skin results.

Laser Hair Removal When dark and coarse hair appears in places we don’t like or expect – like on the face, neck, abdomen, breasts and/ or the backs of arms, it can affect our lifestyle dramatically, preventing us from wearing clothing or participating in activities such as swimming etc. For long-term hair removal, electrolysis is popular and effective, but can be painful and slow. Hair by hair an electric current passes through a needle to destroy the hair root’s ability to grow. It typically takes months or even years of regular visits – ever for small areas, like the upper lip. Risks include electrical shock, infection, pitting and scarring. The Light Sheer Diode Laser is a state-of-the-art system specially designed to remove unwanted hair faster, less painfully and more reliably than electrolysis. A laser produces a beam of highly concentrated light. Different types of lasers produce different colours of light. The colour of light produced by a particular laser is the key to its effect on hair follicles. The pigment located in hair follicles absorbs the light emitted by the laser. The laser pulses for a fraction of a second, just long enough to vaporise the pigment, disabling many follicles at a time to eliminate or significantly impede the hair’s regrowth. The Light Sheer Diode Laser is a 4th generation laser with a special contact cooling handpiece, designed for sensitive skin. It directs the laser energy to the hair root while protecting and cooling the surrounding skin. At the time of consultation for hair removal, you will be asked a number of questions in regard to your general health, ethnic background and expectations. You will also be offered a test patch of laser so that you know what to expect if you decide to proceed. This test patch is not a pre-requisite to treatment; you may simply proceed with treatment without this test.

For laser to be effective a series of treatments is necessary. This varies on average between four and six, depending on the area to be treated, skin type and the amount of hair. Treatments for those areas above the neck are usually scheduled for three to five weeks apart, and those below the neck for eight weeks apart. All patients are advised to avoid waxing, plucking, depilatory creams or electrolysis for at least four to six weeks prior to treatment. Shaving can be continued and you are asked to shave the day prior to treatment so that the area to be treated can be easily seen. You are also asked to avoid tanning the area to be treated prior to treatment and during the duration of your treatment. If the area is exposed to the sun following treatment, the risk of pigment change is greatly increased. Short-term side effects may include slight reddening of the skin or local swelling, which typically lasts less than an hour. In rare instances there may be some grazing or blistering, which subsides over a relatively short period.

Lip Enhancement & Quick Wrinkle Treatments Injection Therapy is a popular technique for treating facial wrinkles. Patients usually are pleased with the results of these minimally invasive procedure. Injectable wrinkle treatments, however, cannot achieve the same results as a facelift, eyelid surgery, brow lift or skin resurfacing. INJECTION THERAPY In plastic surgery, Botulinum Toxin has enabled us to treat several conditions. After injury to the facial nerve, for example from Bell’s Palsy, a skull fracture, over activity of the facial nerve may be produced as the nerve recovers. This can help to control this unpleasant over activity. It has also been useful for Blepharospasm, a troublesome condition that impairs the eyesight. However most commonly now in plastic surgery, injections are used for treatment of what are called habitual lines. These are lines on the face commonly due to over activity of certain expressive muscles. The frown lines between the eyebrows (glabella) are due to over activity of the frowning muscle (corrugator). Injecting into this region will cause relaxation of the muscles with a resulting improvement or even disappearance of the lines there. In general, the best results are obtained with younger people whose lines are not so long standing, but improvement is usually obtained in any age group. ‘Crows feet’ can also be improved. By injecting above the bone, beside the eye, the muscles are encouraged to relax and the lines there frequently soften. Injections may be used for the transverse creases on the forehead and sometimes even for stronger lines in the upper lip. Injections may be just part of the treatment that is required. Where lines have been long standing, soft tissue fillers or Laser Resurfacing may be recommended to further enhance the result. Injections are inserted as an office procedure. An ice pack is usually held to the site and several injections are inserted via a fine needle. The procedure causes some discomfort but it is very rapid and usually causes little problems. There is little to be seen after the injection. Usually just the fine prick of a needle may be apparent or nothing at all may be seen. It is possible however, to get a bruise.

Injections are best suited for treating expression lines caused by muscle contraction. Common sites for injections include; Horizontal forehead furrows, vertical lines between the eyebrows and ‘crows feet’ around the eyes

Injectable fillers help to diminish the appearance of facial lines and wrinkles by ‘plumping up’ the soft tissues. This is a popular technique for lines and wrinkles. Patients usually are pleased with the results. It is recommended that the site of injection not be massaged and when injection is inserted into the frown lines between the eyebrows, one should not lie down for four hours after the procedure. Massage or lying down may cause displacement which can lead it to migrate into the muscles of the upper lid. This can cause drooping of one eyelid (ptosis) which is fortunately uncommon. It may appear three weeks after the injection and last for one to two weeks. In the first 48-72 hours after injection, no effect is usually seen. However, at about three days it will start to work and one will notice that using those muscles requires and increased effort. The peak effect is usually seen at about two weeks. Duration of effect varies from person to person but three to six months is common. There is a theory that repeated injections of the muscles over a two year period to keep them weak will lead to their total inactivity. At this stage this is just a theory and has not been completely proven. By weakening the muscle’s action it requires conscious effort to use the muscle. This means that one does not tend to absentmindedly reinforce these deep lines by constant over activity of the muscles, and the lines therefore tend to improve.

Lip Enhancement & Quick Wrinkle Treatments Allergic reactions re extremely rare and “immunity” to the Toxin has not been reported. The material is relatively costly and in our practice we prefer to use higher concentrations to obtain a better and longer lasting correction of frown lines. Naturally the higher concentrations used are more expensive but the improvement is also greater.

During treatment the crystal-clean gel is injected into the skin in tiny amounts with a very thin needle. The gel then gives natural volume and smoothes the wrinkles. The ability to integrate with adjacent tissues allows the free passage of vital elements like oxygen and hormones to pass between fragments of the gel. The result is healthy, natural skin.

If you have any further questions please ask at your next consultation.

After the treatment some common injection-related reactions may occur, such as swelling, redness, pain, itching, discolouration and tenderness at the implant site. These typically resolve spontaneously within one to two days after injection into the skin and within a week after injection into the lips.

SOFT TISSUE FILLERS Water is the source of all beauty. Water gives lift and resilience to your skin, creating the contours of your lips and chin. The resilience and youthful contours of your skin – its ability to counter the effects of time, wind and weather – owes much to hyaluronic acid. It exists in all life and its most important function is to bear and bind water. When injected into the skin the gel binds with water and generally remains for many months. We use a totally nonanimal product, so there is no risk of transmitting disease or eliciting allergic reaction in patients who are sensitive to common foods such as beef, chicken and eggs. A consultation with one of our paramedical aestheticians will enable you to choose a product to give you optimal results.

Nasolabial, Periora Lip Line Before

Nasolabial, Periora Lip Line After

Oral Commissures and Perioral Before

Oral Commissures and Perioral After

Lips Before

Lips After

Glabellar Before

Glabellar After

One of the great advantages of the filler is that it is long lasting but not permanent. How long a treatment holds its effect is very individual. This depends on many factors such as your age, skin type, life style and muscle activity, as well as on the injection technique. Gaining the look you desire is as easy as it is quick. And the results are instantaneous. No pre-testing is needed and a session often takes less than 30 minutes. Depending on the effects desired, an initial visit is usually maintained with occasional follow-up treatments. For wrinkle treatments no pain relief is generally necessary, however it can be arranged at your request. When enhancing the lips, pain relief in the form of a local anaesthetic if often used.

Breast Reconstruction – after Mastectomy There are many techniques available to reconstruct a breast that has been removed due to cancer, or which has failed to develop. Your consultation with Dr Scamp, will be to inform you and help you to select a procedure that will best suit your body and your wishes. Remember the aim of Breast Reconstruction is to make two breasts that match. Naturally these should be two breasts that you like. One of the most important things to consider at the very beginning is whether you have a desire to make any alteration to your normal breast. Some people feel they are too big, too small, or sag too much. The appropriate surgery for the opposite breast can be included in the plan to construct your breast. In most cases, two operations at separate stages, some months apart are required. But even after the first operation, at least a breast ‘mould’ will have been created, which will make dressing and wearing of normal clothes much easier for you. In warm climates, one really needs to be able to wear a swimsuit or a t-shirt to get through normal activities. The aim of Breast Reconstruction is to make this possible. Dr Scamp has a special interest in Breast Reconstruction. He trained in Australia, Britain, Europe and USA in Breast Reconstruction techniques. Dr Scamp is a trained Microvascular Surgeon and uses this skill in many of his Breast Reconstruction techniques. The following website will answer some of the basic questions about Breast Reconstruction – www.plasticsurgery-aust. com. More detailed information can be found in a book called A Woman’s Decision by Karen Berger and John Bostwick 111, MD. This is published by Quality Medical Publishing Incorporated St.Louis, Missouri. This book is commonly provided for patients to read after consultation with Dr Scamp. If you are traveling from a distance to see Dr Scamp, ask his staff to send you the book in advance or get a copy from a bookstore. It is very readable and contains a lot of useful information. WHO CAN HAVE BREAST RECONSTRUCTION? Any patient who is medically fit for surgery and who desired Breast Reconstruction is a suitable candidate. Naturally, it is best if the breast cancer is under good control. Reconstruction will not increase your risk of the breast cancer coming back. If you have any doubt, you may ask the surgeon performing the mastectomy, when he feels the right time would be.

Naturally you want to be in the best of health for Breast Reconstruction surgery. Cessation of smoking and attention to things such as obesity and high blood pressure would be prudent. Even if you decide to defer Breast Reconstruction, or not to proceed at all, you may find some comfort in knowing that these options are open to you. WHEN CAN I HAVE A BREAST RECONSTRUCTION? In many cases it is possible to perform Breast Reconstruction at the same time as the Mastectomy. This requires cooperation between the surgeon performing the Mastectomy, and the plastic surgeon who does the reconstruction. If your Mastectomy surgeon feels that this would be unwise, he will inform you of this. But feel free to ask him if he thinks that this might be possible. If Breast Reconstruction is not performed at the same time, it can be performed at any later stage, when you are recovered from the initial surgery. Some of the procedures for Breast Reconstruction are complex and have a significant recovery period. It may be that you simply don’t have time to proceed with Breast Reconstruction at the time of your Mastectomy. However, knowing that you can proceed at a later date at your convenience, will give you a bit more hope to see you through the hard times. For women where a breast has failed to develop on one side, Breast Reconstruction can be tailored to be performed as a teenager and adjusted as they grow. WHY SHOULD I HAVE A BREAST RECONSTRUCTION? Although the Breast Reconstruction can look remarkably life-like and feel quite real, you will never have your true breast back again. What you will have is something that helps you dress more easily, and pass unnoticed in most social situations. A successful procedure will permit you to wear a swimsuit and the usual casual clothing that you wear now. It will also save you the bother of worrying abut an external prosthesis, which may fall out, or feel hot and uncomfortable. Reconstruction of the nipple is commonly performed at a second stage and this makes the reconstruction look just that little bit more life-like.

Breast Reconstruction – after Mastectomy HOW IS THE BREAST RECONSTRUCTION DONE? Broadly speaking, Breast Reconstruction can be performed by use of prostheses, or by use of your own tissue. Sometimes a combination of both are required. Prostheses are often used in a two-stage procedure known as tissue expansion. Tissue expansion involves insertion of the tissue expander (an inflatable prosthesis) at the first stage. The wound is closed and over the ensuing months, in the doctors office, saline (salt water) is injected into a valve within the tissue expander to ‘blow it up’. The skin gets a gentle but persistent stretch and is moulded into the shape of a new breast. When the skin has stabilised and the internal scar has matured (usually six months after the first operation), the second stage procedure is performed. In this procedure, the tissue expander is removed and the final prosthesis is inserted. This prosthesis may be either made of silicone gel (especially the new cohesive ‘leak proof’ gel) or salt water (saline). You will be asked to choose your prosthesis type after being informed of the alternatives. Reconstruction of the nipple is usually performed at the second operation. Tissue expansion may be performed as a day patient, as the surgery is less extensive than techniques which use your own tissues. Insertion of a tissue expander runs much the same risks as you will see on the ‘Breast Augmentation’ web site – www.plasticsurgery-aust.com. The second stage of this surgery can also be performed as a day patient. Tissue expansion therefore suits somebody who has a busy lifestyle, who would find it difficult to get enough time away from their activities to recover from a large procedure. In the long term, tissue expansion suffers from some of the risks seen in ‘Breast Augmentation’. A tissue expanded Breast Reconstruction feels less natural than a breast that has simply been enlarged cosmetically, as there is less healthy normal tissue overlaying the prosthesis. It is however a particularly useful technique where two sides have been removed (for example, as a precaution to prevent the development of cancer in someone with a string family history of breast cancer).

Previous radiotherapy does not make tissue expansion impossible, but it does increase the risk of complications occurring. Sometimes tissue expansion is combined with the use of a flap of your own tissue, such as the latissimus dorsi flap. This provides a bit more healthy tissue in front of the prosthesis to make it feel a bit more life-like. In most cases however, this is not usually required. Reconstruction using your own tissues is most commonly done these days by means of the Tram Flap (Transverse Rectus Abdominis Myocutaneous Flap). This ingenious operation uses your ‘spare tyre’ to create a breast made of the skin and fat of your abdomen with a small piece of the muscle attached. In most cases, no prosthesis is required to reconstruct the breast and these reconstructions are commonly the softest and most natural to feel. The added benefit is of course removal of your ‘spare tyre’. Thus the successful Tram Flap patient gets a trimmer tummy s well as a new breast. Again, the nipple reconstruction is commonly performed at a second stage. If your tummy is small, you may be unsuitable for a Tram Flap, or you may require insertion of a prosthesis beneath the flap at a second stage to provide adequate size. Dr Scamp will advise you on the method the he thinks will best suit your physique and your wishes. The Tram Flap procedure is a bigger operation. You will be asked to give your own blood prior to surgery, in case transfusion is required. You will be in hospital for approximately five nights and it will take you three to four weeks to get your old strength back. We usually start you on iron and folate pills (FEFOL) prior to surgery, to ‘build up’ your blood level. Patients who have gone through this procedure, feel that the benefit of having a reconstruction made from all their own tissues and getting a trimmer tummy as well, makes the extended recovery period required worthwhile. The Tram Flap is often called the ‘Rolls Royce’ of Breast Augmentations, as it can provide particularly life-like results.

Breast Reconstruction – after Mastectomy The Tram Flap is moved based on the blood supply that comes through the muscle beneath it. Dr Scamp uses the ‘free’ Tram Flap procedure, which takes the smallest piece of muscle possible with the blood vessels attached to it coming up from your pelvis. These small blood vessels are divided and re-attached beneath the microscope, to blood vessels in your breast region. The alternate technique to this, the ‘pedicled’ Tram Flap uses the more distant blood vessels that run down the muscle from above. A larger piece of the muscle is taken to shift the pedicled Tram Flap, and this may weaken the abdomen more. This can cause a hernia. The latissimus dorsi was the most popular method of reconstructing the breast with your own tissues, before the advent of Tram Flap. It uses a piece of skin and muscle from your back, which is ‘tunneled’ through your armpit and brought to the breast. Usually a prosthesis is required with this flap, as the flap is not sufficiently bulky to reconstruct an entire breast. However, it may be useful technique for bringing in healthy blood supply to an area that has had radiotherapy, so that tissue expansion can proceed more safely or to cover a prosthesis where the overlying skin and fat is very thin. The latissimus dorsi muscle is mostly used in climbing or rowing and it is not missed by most people. It does leave a scar on the back and we try to design this to fit into the line of your clothing. Nipple reconstruction is performed usually by taking a graft of slightly darker skin high up in your groin crease and performing a flap on the breast mound to provide projection. Tattooing can be used to better match the colour. The reconstruction of the nipple can be remarkably life-like, and makes the reconstructed breast look more natural and less ‘surgical’. As said above, the nipple reconstruction is usually performed at the second stage of either the tissue expansion or Tram Flap procedure. If you feel your other breast is too large, a Breast Reduction can be performed to better match the size. This may be performed at the first or second stage of your reconstruction. If the size is good but there is too much sag, a lifting procedure (Mastopexy) can be offered to better match the two breasts. Where the size of your other breast is too small, Breast Augmentation can be offered to achieve the size that you desire.

Some patients have even said they feel their breasts look better then before their Mastectomy. This is certainly the aim of the reconstructive procedure, but cannot be promised in all cases. WHERE IS BREAST RECONSTRUCTION PERFORMED? A Tram Flap is performed as a hospital in-patient. Usually you will stay for five nights. Tissue expansion can be performed as a day patient, under general anaesthetic, or in hospital with an overnight stay, as you prefer. This is particularly used if surgery to the other breast is done at the same time, although this can also be performed as a day patient. The nipple reconstruction at the second stage is usually done as a day patient. You will be asked to decide whether you would prefer to have your surgery performed as an in-hospital patient or as a day surgery patient. In both cases general anaesthesia is used for your comfort. REMEMBER THERE ARE RISKS: The general risks of surgery such as bleeding, fluid collection, excessive scarring or anaesthetic difficulties, also apply to Breast Reconstruction. Fortunately these are relatively uncommon. Smokers increase their risks of surgery substantially, and you will be asked to cease smoking for at least six weeks prior to undertaking this surgery. Remember, we both want you to have the smoothest perioperative course and the best possible result. Nicotine patches also need to be ceased six weeks prior to surgery. Where complications are severe, secondary surgery may be required and more expense will result. Where an implant is employed, the risk associated with breast prostheses, such as hardening (capsular contracture) also apply. This is due to shrinkage of the scar tissue around the prosthesis and may require an operation to divide this hardened scar tissue. The tissue expanders used are designed to weaken the scar as much as possible and reduce the risk of this occurring. Capsular contracture does not occur where a Tram Flap is employed and no prosthesis is required.

Breast Reconstruction – after Mastectomy Infection can occur around the expander of the final prosthesis. If it does occur, usually these need to be removed for at least three months. This is obviously disappointing, as it will leave you with a flat chest for three months while your body recovers. Fortunately infection is uncommon (24%). Your reconstructed breast and nipple will never have normal sensation, but remarkably some sensory recovery does occur. Minor adjustment to the scar, or to the opposite breast for a better match may be required. We try to give you a perfect breast, but realistically our aims are to enable you to dress comfortably and wear the clothes you like.

PREPARING FOR SURGERY: Apart from ceasing smoking and nicotine patches at least six weeks prior to surgery, you should try to get yourself in the best possible condition. Obesity increases your risks of almost all perioperative complications. It is a substantial risk to your heart. Getting fitter prior to surgery will hasten your recovery from surgery. Avoid aspirin, red wine and high dose Vitamin E for at least two weeks prior to surgery, as these compounds can make you bleed. RECOVERING FROM SURGERY:

On the positive side, research has shown the remarkable psychological benefit of reconstruction surgery. This is particularly true when reconstruction is performed at the same time as the Mastectomy. PLANNING YOUR SURGERY: After your consultation with Dr Scamp, you will be given a book to read on Breast Reconstruction (A Woman’s Decision). When you have read this book, you will return for your second consultation with Dr Scamp. At that stage a firm plan for your surgery will be made. In the interim, Dr Scamp’s staff will provide you with an idea of costs of each of the alternative procedures you may be considering. Plan your time off work to rest at home. Arrange your surgery for when you can get sufficient support to make your recovery better. The more warning you give us, the better we are able to fit in with your timetable.

Before Mastectomy

As mentioned above, it may take you up to four weeks or more to get back to feeling your old self, less if a tissue expander is used. Swelling at the operation site may take even longer to disappear. The swelling may cause some difficulty with dressing. Tissue expanders commonly sit a little high and cause excess fullness at the upper pole of the breast, in the initial stages of expansion. This may mean that you will have to adjust the clothes that you wear to mask this at first, but of course it will be less inconvenient than the mastectomy was. Most patients find that this surgery does an enormous amount for their self-esteem and the quality of their life. Write down any questions you have and ask Dr Scamp at the time of your consultation.

Your Next Step Now that you have read this overview of the most common aesthetic procedures, you probably have some questions. If you are considering surgery, your next step is to consult with Dr Scamp. He will discuss detailed information about the specific procedure or procedures in which you are interested. Dr Scamp may also discuss with you his preferred variations to the surgical techniques described in this booklet. Advances are constantly being made in the field of aesthetic plastic surgery. While â&#x20AC;&#x2DC;newâ&#x20AC;&#x2122; procedures do not always prove to be better than established ones, Dr Scamp may feel that you can benefit from a recently developed or modified technique. If there is an aesthetic procedure that you have hear about from another source, such as a magazine article or television program, be sure to ask Fr Scamp about it. He can advise you whether a specific technique would be beneficial for you. If there are any problems or safety questions, he will be able to alert you to them. Above all, confide in Dr Scamp by thoroughly discussing your coals, expectations and concerns. His most important job is to help you safely and comfortably achieve both physical well-being and satisfaction with your appearance.

After Mastectomy

Notes

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