THE
PURSUIT of BEAUTY Dr Anh Nguyen
beauty Beautiful women from all walks of life often do not see themselves as beautiful. Everyday we are bombarded with pictures of beautiful people – flawless skin, alluring eyes, luscious lips, beautiful smile, perfectly styled hair, attractive bodies and so on. We see them on magazines, billboards, television and advertisements. But the truth is… whilst most of us may dream of looking as ‘perfect’ as celebrities do, we know that it is highly unlikely we can be. After all, most of us do not have the personal stylists, trainers and minders to ensure we exercise a lot, keep fit, eat right and in small portions, dress well and follow a beauty regime of skin care, wrinkle relaxants, fillers, microdermabrasion, laser, IPL and the occasional nip and tuck when needed. Luckily, most of us do not have the time or the extreme public scrutiny as pressure to maintain these amazing looks. However, the pressure to look a particular way is largely driven by us as individuals. We want to look good for ourselves because
Is a complex thing. It is so subjective. One dictionary definition of beauty is a quality or a person or thing that gives intense pleasure or satisfaction to the mind.
looking good helps give us confidence. If we had a tummy free of the extra bulges and loose skin that having children has left us with, we could wear the clothes we use to wear and wear them with confidence. If we had the bump off our nose removed that makes us shy away from cameras and photo opportunities, we would look straight into the lens and smile confidently. If we could have the very large breasts reduced, we could stand up straight with our shoulders back and strut around with renewed confidence. If we could have the excess upper eyelid skin removed to open up our eyes, you could then appreciate the beauty of their colour and form…and then fall in love with us again and again. As a plastic surgeon, I see a lot of women and men who may feel that their appearances are affecting their selfesteem and confidence and any help of an improvement is welcomed with hope and excitement. Whilst we cannot carve you into a Jessica Alba or Ryan Reynolds, we may be able to help you get that flatter
tummy or larger breasts or more youthful neckline you desire. It is essential that you are thoroughly assessed by your plastic surgeon, have realistic expectations of what is possible for you, understand what the risks and complications are and do your research well before embarking on any surgery. Having plastic surgery is a major decision and choosing the right surgeon for you is an important choice. Find out their qualifications and experience, examine their pre and postoperative photos, speak to testimonials and seek as many opinions as you can.
Anh
Ultimately, a positive self-image and a healthy dose of vanity and feeling beautiful helps with boosting self esteem and self confidence which all contributes to happiness.
true
Love starts with your own body, so start to love the skin you are in...
plastic surgery for women by women
Dr Anh Nguyen MBBS (HONS) FRACS (PLASTIC SURGERY) FEMALE PLASTIC & COSMETIC SURGEON
Ph 08 6389 1322 | F 08 6389 1122 E: info@femaleplasticsurgeon.com.au 180 Stirling Highway Nedlands WA 6009
www.femaleplasticsurgeon.com.au
look your best ARC Plastic Surgeons are specialists with a total focus on you, your care and your surgical results. You deserve to be professionally assessed and fully informed. Our practice includes a number of
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DR PETER CALLAN
MBBS, FRACS, MBA
Peter Callan is a Specialist Plastic Surgeon with over 20 years of experience based in Geelong, Victoria. His special interests are rhinoplasty, breast surgery, surgical and nonsurgical facial enhancement.
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Suite 3, Level 1, 83 Myers Street, Geelong, Victoria 3220 Ph: +61 3 5222 2440 | Email: simone@petercallan.com.au Web: www.petercallan.com.au | www.rhinoplastygeelong.com.au
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• Experience and quality Geelong Plastic Surgeons are trained to the highest standards anywhere in the world and all have broad Australian and International experience.
• Privacy and convenience Geelong is home for many but only a relatively short distance for others. It is convenient and a town set in beautiful natural surrounds.
• The facilities St John of God Hospital is a state of the art facility and part of St John of God Health Care, one of Australia’s largest Health Care providers. In addition, this already outstanding facility is currently undergoing a multimillion dollar expansion.
“I know what I want, I’m going to Geelong”
• Experience Geelong has some of the most talented and experienced Plastic Surgeons in Australia, the same being true for other specialties and health care providers.
• Staff and care We care about you and your outcome. We will care for you from start to finish with the utmost respect and professionalism, and work with you towards the outcome you want. Our staff are experienced and knowledgeable. Call us.
Dr James Katsaros Plastic and Cosmetic Surgeon • Private Practice 174 Ward Street, North Adelaide • Senior Visiting Consultant, Royal Adelaide Hospital Department of Plastic & Reconstructive Surgery • Supervisor of Plastic Surgical Training, Royal Adelaide Hospital • Clinical Senior Lecturer in the Department of Surgery, University of Adelaide • Examiner, Plastic and Reconstructive Surgery, RACS • Chairman, Save The RAH Committee 2009 - 2011 • Chairman DREAMIN Foundation • Past Patron, Adelaide High School Old Scholars’ Association
North Adelaide Day Surger y Making the choice to undergo surgery can be a daunting prospect for many people. Regardless of your motivation – cosmetic, or reconstructive, it is very important to choose the right professional to guide you through the process. Dr James Katsaros has a background of extensive training and experience in the full spectrum of plastic surgery, and over almost 3 decades has established a loyal following through his private practice in South Australia – The North Adelaide Day Surgery. Born in Greece, he moved to Australia in his youth and was educated in Adelaide. He obtained a Bachelor of Medicine and a Bachelor of Surgery in Adelaide, and after graduating, built upon these qualifications with
4 years post-grad training in Europe and North America. On his return back to Australia he became Senior Registrar in Plastic Surgery at the Royal Adelaide Hospital, as well as holding various other positions there including Consultant Plastic Surgeon and Consultant Burns Surgeon. He also held senior positions at the Adelaide Women’s & Children’s Hospital and Flinders Medical Centre.
He has completed the requisite training to be a fellow of the Royal Australian College of Plastic Surgeons in plastic surgery, was a member of the Board of Studies for the Plastic Surgery Division of the Royal Australasian College of Surgeons for 10 years, and was Board Chairman for 2 years. In addition to private practice, he is currently Senior Visiting Plastic Surgery Consultant at the Royal Adelaide Hospital, and is a supervisor of plastic surgery training.
With over 25 years experience as a Plastic and Cosmetic Surgeon, Dr Katsaros provides the knowledge and expertise that is required for high quality specialist care.
Joanne Heggie our Clinical Nurse Consultant, provides anti-wrinkle treatments, dermal fillers, facial volumising, and medical skincare
Breast Augmentation • Reduction Mammaplasty • Mastopexy • Gynaecosmastia Abdominoplasty • Meloplasty • Blepharoplasty • Otoplasty • Rhinoplasty • Anti-Wrinkle Injections Dermal Fillers • Facial Volumising • Medical Skincare • Skin Cancer Surgery
174 Ward Street, North Adelaide SA 5006 Ph 8239 0115 | Email info@jameskatsaros.com.au
jameskatsaros.com.au
In the field of plastic and cosmetic surgery, expertise, experience and artistry are the keys to success. Achieving the best results possible for my patients in a caring, friendly and professional environment is my top priority. My expertise lies in minimal-scar surgery of the face, breast and body. Pivotal to my approach is creating natural-looking results with minimal scarring in each and every individual case.
QUALIFICATIONS
COSMETIC P L A S T I C SURGEON MBBS, BSc (Med), MS (UNSW), FRACS (Plast.)
PROFESSIONAL ASSOCIATIONS Fellow of the Royal Australasian College of Surgeons Member of the Australian Society of Plastic Surgeons Member of the International Society of Aesthetic Plastic Surgery Member of the Australian Society of Aesthetic Plastic Surgeons
DIPLOMA Fellow of the Royal Australiasian College of Surgeons FRACS - (Plastic and Reconstructive Surgery)
UNIVERSITY QUALIFICATIONS Bachelor of Science (Medicine) - UNSW, Sydney Australia Bachelor of Medicine - UNSW, Sydney Australia Bachelor of Surgery - UNSW, Sydney Australia Master of Surgery - UNSW, Sydney Australia
T 1300 368 107 | drtavakoli.com.au
ADVANCED RESULT ORIENTATED The Skin Synergy product range was developed for advanced results orientated skin rejuvenation treatment by medical professionals. Skin Synergy skin care is known for its innovative formulations and cutting edge technology and our expert understanding of the skin and the effective treatment of various skin conditions. The treatment formulations deliver optimal concentrations of pharmaceutical grade nutrients, cutting edge antioxidants, superior quality phytoceuticals, peptides and other powerful active ingredients where they are needed most – below the skin’s surface to actively improve skin health and appearance. Skin Synergy is recognised for its modern approach to skin classification and recognises the need to reverse Environmentally Damaged Skin, Hyperpigmentation and Problematic Skin. As a dynamic new brand and innovator we continue to satisfy the ever demanding industry with our unique understanding, philosophy and concept.
ENVIRONMENTALLY DAMAGED SKIN Environmentally damaged skin results from a history of overexposure to environmental elements, like the sun and atmospheric pollution. The sun is responsible for up to 80% of all skin ageing concerns. Skin Synergy is designed to promote the constant renewal of the epidermis by increasing cell turnover and regeneration by optimizing the strength of the dermis and support from the subcutaneous layer. What you can expect • Reduction of fine lines and wrinkles • A softer, smoother skin • Increased radiance and vitality • Improved skin firmness and tone • Reduction in excessive dryness • Improvement in overall skin health
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PROBLEMATIC SKIN Problematic skin, also classified as acne affects people of all races and ethnic groups and sometimes persists well into adulthood arising from a number of factors, such as genetic inheritance, environmental pollution, stressful lifestyles and hormonal imbalances. Skin Synergy is designed to reduce the build up of excess oil and dead skin cells, normalise the function of cell renewal, help reduce inflammation and prevent bacteria formation deep within the hair follicle and pores. What you can expect • Helps control the development of problem causing bacteria • Reduction in excessive oiliness • Improved skin clarity • Decreased redness, irritation and inflammation • Improvement in overall skin health • Helps in the prevention and formation of acne scarring
HYPER-PIGMENTATION Pigmentation development in the skin is influenced by of a number of internal and external factors, one of the most influential being UV radiation. This results in the over production of melanin in the skin as a defense mechanism. Skin Synergy is designed to further prevent excess melanin production by inhibiting the enzyme tyrosinase. Thus protecting the skin from harmful elements such as UV-radiation and controlling and reducing damage caused by free radicals. What you can expect • Increased uniformity of the complexion • Improvement in existing hyper-pigmentation • Increased radiance and clarity • Smoother softer skin • Reduction in the appearance of new pigmentation • Improvement in overall skin health
SENSITIVE SKIN Skin Synergy’s new generation derma-cosmeceutical skin treatment offers products that deliver advanced active ingredients derived from natural and biotech sources, for the effective treatment of and maintenance of normal skin. The primary focus of the interactive range is for: • skins that do not manifest typical symptoms of environmental damage, hyper-pigmentation or problematic skin • skins with a minor physiological imbalance or to maintain the normal skin physiology with the option of gradual integration of the active treatment range to maintain optimum skin health through skin rejuvenation • skins manifesting temporary sensitization due to poor health, medication side effects, skin resurfacing procedures or stressed skin
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After completing his medical degree at the University of Sydney, Dr Richard Sackelariou then trained in general surgery, followed by advanced training in Plastic & Reconstructive Surgery. He also undertook training in Cosmetic Surgery in Paris at the Clinique Turin. He is a fellow of the Royal Australasian College of Surgeons (FRACS) and a fellow of the Royal College of Surgeons (FRCS England). He also is a member of the Australian Society of Plastic Surgeons (ASPS) and the Australian Society of Aesthetic Plastic Surgeons (ASAPS).
20
Over
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TREATMENTS Breast Emlargemnt • Breast Lift • Nose Reshaping • Facelift • Eye Lift Brow Lift • Chin/Cheek Implants • Ear Shaping • Liposculpture Abdominal Reduction • Male Breast Reduction
2/15 Cross Street Double Bay NSW 2028 Ph (02) 9362 0676 www.cosmetic-surgery.net.au
Ten Years of Treatments
With more centres in more places, and doing
more than 100,000 treatments every year, it’s no
wonder Hairfree has become the trusted name in gentle, pain-free, risk-free hair removal.
PUBLISHER’S
NOTE
Professional Therapists
Every one of Hairfree’s professional therapists has undergone a laser-safety training course and has
designing treatment programs for every individual client. These women are passionate about
helping their clients to achieve results that will make them look and feel better.
Elli Vuk aso vic & Leasel Avila
a caring, sensitive and professional approach to
As we release our third issue we find it hard to believe how quickly the time has gone since our first! It’s been an exciting few months for the Nip Tuck team. We had an amazing time at the 2013 Plastic Surgery Congress in Melbourne in April and were thrilled to get to meet so many new people in the industry. Some great feedback came our way on the magazine and we left the four day event buzzing with new ideas and plenty of inspiration for this and future issues. This time round we feel we have a deeper knowledge and understanding of our practitioners. We learnt the reasons why many of Australia’s finest surgeons decided on their chosen profession in the first place and their stories are both moving and heartwarming. Some of the most talented reconstructive surgeons in the world are right here in Australia and we bring you the latest on their practice, treatments and philosophies, so you can make the very best choice for what may be one of the most important decisions you will ever make.
Full Range of Treatments: ● Permanent Hair Reduction ● Acne Treatments ● Organic Microdermabrasion ● Skin Rejuvenation ● Anti- Wrinkle Treatments ● Tattoo Removal And Pigmentation
hairfreeforever.com.au 1300 HAIRFREE / 1300 424 737
We have some new faces on the team and together we are thrilled to share with you the passion, professionalism and integrity of our incredible Australian surgeons, practitioners and professionals. We celebrate the natural diversity of people in all their different shapes, sizes and appearances, and support everybody’s right to feel their most beautiful, and radiate the confidence we all deserve to feel. A big thankyou to NipTuck editorial team members Jenni Gilbert and Melinda Barlow (www.dragonflytrading.wordpress.com), graphic designers Krys, Julius and Ruth and social media queen, Kendall Bora.
Elli Vukasovic Publi s hi ng D i re c t or
Plastic Surgery Congress 2013 Melbourne Convention & Exhibition Centre
Abracadabra offers solutions to all of your underwear dilemmas, through group educational workshops and personal shopping. Learn once and for all, how to successfully choose and fit your own bra, by sight and feel.
Specialising in Post Surgical Bra Fittings and Medical Conditions: ªBreast Augmentation ªBreast Reduction and Lift ªMastectomy and Reconstruction ªMedical Conditions (ie Scoliosis, Hiatus Hernias, Asymmetrical Breasts)
DISCLAIMER Nip Tuck Magazine is produced and published by Nip & Tuck Magazine Pty Ltd. With exception of provided material, reproduction in whole or part is not permitted without the written consent of the publishers. All reasonable efforts have been made to trace copywriting holders. Nip Tuck magazine (Nip & Tuck magazine Pty Ltd) may be a distributor of the content supplied by third parties. Any opinions, advice, statements, services, offers or other information or content made available by third parties are those of the respective author(s), and Nip & Tuck magazine Pty Ltd is not responsible for any material published by third parties. Nip & Tuck magazine Pty Ltd cannot and does not endorse in any way, nor does it vouch for, the accuracy or usefulness of such material. Furthermore, Nip & Tuck magazine Pty Ltd expressly disclaims any liability associated with material contributed by third parties. All readers are advised to seek medical advice from a doctor if considering any cosmetic procedure. NIp Tuck magazine does not purport to be a substitute for medical advice. Publishers, contributors and authors do not accept any liability whatsoever in respect to an action taken by a reader in reliance on the recommendations set out in this magazine. Models depicted may not necessarily have received treatment described in this magazine. All advertisers and Nip & Tuck Magazine Pty Ltd follow and uphold the advertising policies set out by the Australian Competition and Consumer Commission (www.accc.gov.au), the Therapeutic Goods Administration (www.tga.gov.au) and individual state medical boards. All reasonable effort is made by Nip & Tuck Magazine Pty Ltd to ensure that all advertisements accepted for publication follow these guidelines. Copies of these guidelines are available from these agencies on their websites. All Nip Tuck Magazine advertisers assume sole responsibility and liability for statements contained in their editorial copy and advertising copy and hold harmless and indemnify Nip & Tuck Magazine Pty Ltd and its offices, Directors and employees from and against all liability, loss, claim, damages, cost or expenses arising out of matter contained in their editorial or advertising. Advertisers accept these terms and responsibilities when signing an advertising contract with Nip & Tuck Magazine Pty Ltd.
elli@niptuckmagazine.com Mobile: 0450 901 773
leasel@niptuckmagazine.com Mobile: 0424 153 240
ABOUT THE DIRECTOR: Julie Lamont is a certified Mastectomy Fitter and a Triumph Corsetiere. Previously a registered nurse and now a post surgical underwear specialist (or bra coach), Julie is well experienced to assist ladies who are post breast surgery of any type, as well as ladies not happy with their current bra fitting. Julie helps ladies learn how to select and fit bras that supports correctly for their own shape.
For more information or to contact Julie:
M: 0431210250
www.abracadabras.com.au www.facebook.com/Abracadabra.com.au
S E C T I O N S
80
SA
106
QLD
124
ACT/NSW
156
WA
180
VIC
Cover Story Krystal Barter Page 26
Actual breast augmentation patient of Dr Miroshnik
DR MICHAEL MIROSHNIK
Breast Augmentation Specialist MBBS, FRACS (Plast.) Plastic & Cosmetic Surgeon
www.drmiroshnik.com.au
T: (02) 9389 8108 or 1300 88 90 50 More information on page 152 (NSW Section)
DR JAMES KATSAROS
SELINA LAM
DR SATERA PAPAGEORGIOU
DR YUGESH CAPLASH
DR ANNE EVANS
DR OSEKA ONUMA
DR JULIE LAWRENCE
SHARYN YELLAND
DR MICHAEL MOLTON
DR BEVERLEY FOSH
DR TIMOTHY GOH
DR PHIL RICHARDSON
DR PETER WIDDOWSON
DR ANNE-MAREE COLE
DR LINDA WILLIAMS
DR PAUL BELT
DR LUKE STRADWICK
DR HANNO VENTER
DR ASH SANKARAYYA
DR RAJA SAWHNEY
DR ALASTAIR TAYLOR
DR MARK EDINBURG
DR ANGELO TSIRBAS
DR JOHN NEWTON
DR ADRIAN KNOX
DR TONY TAN
DR RICHARD SACKELARIOU
DR KOUROSH TAVAKOLI
DR GEORGE LEE
DR ANDREW LEE
DR EHSAN JADOON
DR ARGIE XAFTELLIS
DR MISAGH HABIBI
DR SAHBA HABIBI-THOMAS
RUTH LAVELL RN
DR IAN TIMMS
DR ANH NGUYEN
DR ROBERT PAUL
DR PAUL QUINN
DR JOANNA TEH
DR DAVID GILLETT
DR GLENN LIEW
DR HILLEL NEW
DR PETER CALLAN
DR RAKESH GULIA
DR HOWARD WEBSTER
DR RICHARD BLOOM
DR KIM TAYLOR
DR DEAN TROTTER
DR DAVID MORGAN
DR MANSOOR MIRKAZEMI
DR MICHAEL WEYMOUTH
TANIA FOGNINI
TANIA CAPUTO
DR ADAM KEYES-TILLEY
DR DOUG MCMANAMNY
DR DAVID ROSS
DR PETER OLIVER
DAVID GINGES
CONTRIBUTORS
DR MICHAEL MIROSHNIK
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25
DECISION OF A
LIFETIME Angelina Jolie has brought hope and encouragement to millions of women by going public with her preventative mastectomy to reduce her risk of developing hereditary breast cancer. Sydney mum Krystal Barter took that jour ney anonymously and “alone”. But today she, too, is helping other women with her charity, Pink Hope . Krystal Barter walks into the Darling Hotel at Sydney’s Star Casino and all heads swivel; a brunette beauty who cuts a foxy figure in a tight-fitting cobalt blue dress. But it’s more than that. There’s a mystique about her that just makes you want to look, and know more.
breasts. “So I also grew up being scared that I was going to get cancer,” she says. “At 16 I came running to my Mum saying I'd found a lump that's not normal behaviour for a teenage girl. Of the 25 women in our extended family, 80 per cent of them died from cancer.”
It’s a story certainly worth knowing. Long before Angelina Jolie went public with her decision to have a preventative double mastectomy, Krystal had both her breasts removed to relieve herself – and what it would do to her two young sons, Riley and Jye - of the family curse of breast cancer.
Although she knew she was at very high risk for developing the disease, Krystal wasn’t emotionally ready to be tested for the BRCA1 (breast cancer) gene fault until she was 22.
Four generations of her family had been diagnosed with breast and/or ovarian cancer, including her mother, when Krystal was only 14. “I grew up knowing that there was always something different with my family,” she days. “My greatgrandma was 68 when she was diagnosed. My Nan was 44. My Mum, Julie, was only 36. So I was of a family where pretty much every woman didn't have any
26 NIPTUCK Magazine
“I had a one-year-old baby in my arms and I just thought, 'You know what, it's the gift of knowledge'. So I went in for the test. They took some blood and four weeks later found out that I was positive. I had my husband by my side and my beautiful firstborn in my arms.” In 2008, aged 25, after a mammogram picked up suspicious changes, Krystal made the monumental decision to have a double mastectomy. “I can remember at that moment I was like, 'Whether it's cancer or
not, I just do not want to put my family through that',” she says. “I decided, right then and there, book me in, I'm going to have my breasts removed. That's a lot for a 25-year-old girl to decide but I didn't want to be a statistic.
family support, she says she still felt alone. But her mother had also encouraged Krystal from an early age to be involved in charity work, reaching out to others in need, and this led to her next major decision.
“I wanted to live my life not under the cloud of cancer, but in happiness with my kids. Losing my breasts was such a small price to pay. So I had the operation and it felt like my new life started.”
In 2009, Krystal turned her emotional turmoil into a positive by founding Pink Hope, Australia's first online community focusing on informing, empowering and supporting women at high risk of breast and ovarian cancer and their families.
Although a cloud had lifted, Krystal found she was dealing with new issues. Or, rather, she wasn’t dealing with her decision emotionally, suffering anxiety and insomnia. Preventative mastectomy even as recently as four years ago was a little-discussed issue and the lack of information available created a sense of isolation that Krystal found utterly daunting. The only person she felt she could really talk to, who understood what she was going through, was her mother. Although she had great
It is “a support network, source of accredited information, haven of support and trusted place to ask questions, Pink Hope is a testament to Krystal’s spirit and dedication,” according to the testimonial when she was nominated for the 2012 NSW Premier’s Woman of the Year award. “With more than 2500 forum members, millions of web visits, 50,000 social media followers and hundreds of national ambassadors, the website highlights the
NIPTUCK Magazine
27
DECISION OF A
LIFETIME importance of Krystal’s storytelling and rare ability to bring people together to raise the profile of hereditary breast and ovarian cancer. “Krystal’s success with Pink Hope led to her recent accolade as 2012 NSW Young Australian of the Year finalist, 2012 finalist for the InStyle Audi Women of Style Scholarship, in addition to the Harpers Bazaar Woman of Influence (2011) and the Warringah Young Citizen of the Year (2010). “Always generous with her time, mother of three Krystal is an ambassador for numerous charities, volunteer speaker at various conferences, fundraisers and mentor to local high school students in the benefits of giving back to the community.” Krystal, who turns 30 in August, merely sees it as an opportunity to ensure that no other woman should ever have to face the options and decisions she did alone. But she doesn’t like being called brave or courageous. “I made a decision that saved my life; prevention is the only cure we may ever have,” she says. “I consider myself lucky. I never had cancer, I didn’t have to fight for my life every day and go through gruelling treatment. Those families that face cancer are brave and courageous. I just did the best I could with the information I had. “Having experienced the isolation and lack of information for women like me first hand, I decided to be proactive about helping others. “I created Pink Hope because I didn't want another woman to feel alone navigating this high-risk journey, like I did, during some of their lowest and most fearful moments. “Everyone deals with it differently. I've spoken to some people who literally woke up and were fine. But I felt like a small hippo had taken residency on my chest. It was a hard slog for a good few weeks - I had drains, I had my girlfriends walking in and sobbing at the end of my bed. “It's only when I sit back and
28 NIPTUCK Magazine
contemplate it that I realise it was a big decision to make, but ultimately it saved my life. “My Mum and my Nan were actually among the first people tested for the BRCA gene fault [the same as Angelina Jolie] in Australia. “When you've got a strong family history and they've given you this piece of paper that says there's an up to 90 per cent risk that you're going to get cancer, you're not going to sit there and wait for it to come and get you. You want to act now and that will be the end.” Since her surgery, Krystal has had a daughter, Bonnie, and is now considering having her fallopian tubes, then ovaries removed. “At the moment I feel like I can totally do it - especially on the days when the kids are really naughty! “I'm like, 'take those things out!' But I bet you when they're wheeling me in to do it, I'll be an absolute sob story. Because it's that one last bit that I hold that doesn't make me an empty cupboard, do you know what I mean?” That said, post-mastectomy, Krystal says she “feels amazing”. “I think after breastfeeding two hungry young boys my boobs were nothing to write home about,” she laughs. “I love these ones more than I did my last ones. They're bigger. And I can jog - not that I jog that much - and they don't move. “My girlfriends laugh and say I'll be the sexiest grandma in the nursing home with these two big perky boobs!” With a wry smile she recalls recently being chatted up on a girls’ night out by a hopeful admirer, who had evidently admired her cleavage. “I said to him, `Well, you know I don’t have any nipples, so you are wasting your time?’. He just replied, `Then you’re the sexiest woman without nipples I’ve ever met!”. Chris, my husband and partner of the last 10 years, agrees. I am a lucky woman. Find out more about Krystal, Pink Hope and how you can donate to help employ Australia’s first online genetic counsellor by visiting Pinkhope.org.au
速
Johnson & Johnson Medical Pty Ltd. Telephone: 1800 338 160 or +61 2 9815 3680. Address: 1-5 Khartoum Road, North Ryde, NSW 2113. Email: mentorcustserv@its.jnj.com Johnson & Johnson Medical Pty. Ltd. ABN 85 000 160 403. Mentor is a business unit of Johnson & Johnson Medical Pty Ltd. E201306_103
Medical Advice
It’s surgery
it’s serious
The taboos are gone and that’s a good thing; but that doesn’t mean that Cosmetic Surgery is just another consumer commodity. It’s not like buying a pair of Jimmy Choo shoes or having a spa treatment. For anyone seeking enhancement or rejuvenational surgery you need to first understand that it is real surgery and has significant implications for your health and well being. by Dr Raja Sawhney FRACS Specialist Plastic Surgeon From your first consultation with your surgeon to your last post-operative treatment, your overall health must be the priority. Your surgeon should begin by talking to you about your particular circumstances and what you are seeking to achieve. Then carefully go through your medical history, looking for risk factors that may have implications for your surgery. Even an apparently simple procedure can have complications. A good surgeon will not only explain the surgical steps required to deliver your desired result but also the potential short and long term risks and outcomes. Complications can occur in days, weeks or months and occasionally even later complications over a few years or a decade. You need to be aware of these and be sure that you are happy to take these risks on for your choice of body change. Armed with this information, you then need time to think about all the options and make a thoughtful decision that will prepare you for the surgery, the transformation, the recovery and any potential problems.
“THE OPERATION IS NOT THE FINALE” The operation is not the finale. It’s the significant event between pre and post operative care. After surgery, you will need immediate medical and personal support in the initial recovery period. Later, follow-up appointments at your surgeon’s practice for routine care will pre-empt potential problems which can be dealt with in a timely fashion, protecting you from harm. Ideally, your surgeon should be local and available as you may need to call on your surgeon for advice between appointments or be seen earlier, or urgently, should you be concerned.
30 NIPTUCK Magazine
HOME AND AWAY Cosmetic Surgery is not only a serious medical decision; it’s also a serious financial decision. Surveys show that a lower cost is the biggest motivator for those Australians who choose to go overseas for their Cosmetic Surgery. Tourism and commodity import/export marketing is a fundamental lynch pin of modern global economies. Cosmetic Surgery Tourism is no different in this regard. However, along with lower prices, it’s a buyer beware market place and the onus is on the patient to make sure his/her choices are the right ones. It’s certainly correct that surgery done abroad can be of equivalent quality to that performed in our community and complications can occur in every country. However, compared with some clinics and some hospitals overseas, there are differences in operating standards in Australian hospitals. You are on your own when it comes to your confidence level that what’s on offer outside Australia at least meets Australian surgical standards, device and equipment regulations, integrity of post operative care and long term follow up. Planning a holiday is not the same as planning for cosmetic surgery and the two should never be combined. The prospect of travel to an exciting foreign destination can all too easily cloud our judgement. Of course, if all goes well there are no recriminations and everyone has a good outcome. However, the test of good medical care is in how complications are managed and problems solved. It’s too late to regret a decision after something goes horribly wrong and you find yourself in a foreign country, sick and in pain, most often alone and without a safety net. As the Director/Clinical Lead of Plastic & Reconstructive surgery for the Gold Coast &
Robina Hospitals, I have seen patients who have returned form overseas surgery with significant complications. The delay or lack of timely post operative care has been a factor in often complex medical implications for them. On some occasions the poor results are as a result of poor technique. In others, I have seen high-risk surgery, previously refused by surgeons in Australia, and then done abroad, which resulted in devastating, albeit predictable, complications.
“HER STORY IS NOT UNIQUE BUT SHE WANTS TO WARN OTHERS TO MAKE VERY CAREFUL CHOICES” Not all the complications I see are as extreme as that of a 24 year old woman who came to see me having returned from cosmetic breast surgery overseas. However her story is not unique and she wants to warn others to make very careful choices. I first saw her a number of days after her surgery. Her nipple and areola (darker skin around
the nipple) were dead on one side and partially dead on the other. Underlying this was diffuse breast tissue death on both sides. Healing has taken multiple operations and months of daily dressings. She is now on a waiting list for breast reconstruction, an operation usually performed after a breast cancer resection, not a cosmetic augmentation. The mutilation of her breast tissue was certainly a result of poor understanding by her surgeon of breast anatomy. Pictures taken abroad, at her post surgery checkup, show obvious signs of dead tissue requiring urgent surgical attention. Instead her wounds were covered with dressings and she returned to Australia. Apart from her medical problems, this patient is also suffering severe emotional trauma exacerbated by the additional financial burden of the remedial care and surgery. Promised financial assistance from the cosmetic tourism agency that brokered her cosmetic surgery was not met. While I can give my surgical time and skill for free, there are hospital, anesthetic and nursing costs that have to be met. The
public hospital system is her only resort and her Australian safety net. This 24 year old woman needs our medical care, but along with all tax payers, I have concerns with having to treat complications from overseas non-essential surgery in a publicly funded Government facility already stretched to capacity with the essential emergency, trauma, cancer and chronic disease burden. Ideally people going abroad for such procedures should have insurance policies to cover treatment of complications in the private sector on return to Australia. That said it is our duty as medical professionals to provide medical care. When people return from overseas surgery with open wounds, collections of fluid, bleeding or exposed breast implants through the skin, it is not the time to question their choices. We are here to help them out of immediate danger. If you do choose to go abroad for cosmetic surgery, do your homework. Find the right surgeon and facility and be very certain that post-operative complications, whether large or small, will be managed well and safely. Ensure you have personal and financial support in place to create your own safety net abroad and back home if things don’t go to plan. Where to go for information: www.plasticsurgery.org.au for information on all cosmetic and reconstructive surgery and non surgical treatments as well as a list of qualified Specialist Plastic Surgeons.
www.sculpted.com
Planning a holiday is not the same as planning for cosmetic surgery and the two should never be combined. The prospect of travel to an exciting foreign destination can all too easily cloud our judgement.
www.plasticsurgery.org.au
YOUR BREAST
OPTIONS 32 NIPTUCK Magazine
When seeking a breast augmentation/ enlargement, having a good knowledge of what’s available and the “lingo” helps you become an active participant in your own surgery for a happier outcome. b y Jen n i G i l b ert Women of any age can have an augmentation, to increase the size or improve the shape of their bust.
lacking in breast tissue. This tends to soften the edge of the implant so it is not obvious. Placement of an implant above the muscle is better for curvier, fleshier patients.
Choosing the type of implant that is right for you is a collaborative process between you and your plastic surgeon. You will discuss your concerns and desired outcome and he or she will in turn make recommendations about what is achievable, how and why. Some surgeons now use digital imaging machines that create a 3D mock-up of what your new breasts will look like, and in relation to the rest of your body. This allows you and the surgeon to make “tweaks” to size, shape etc ahead of surgery. NipTuck reviews the types of implants available, where you might have your incisions and where the implants can be placed for the most beautiful outcome.. TEXTURES Pre-filled silicone implants contain a cohesive gel with a strong bond that prevents the silicone from migrating through the body in the rare event the implant leaks or ruptures. There are two types of “shells” available for these implants: smooth and textured. The latter has been shown in studies to reduce the rate of capsular contracture (hardening of tissue around an implant, which the body perceives as a foreign object). The surgical community has differing opinions on the relative benefits of both types varieties. Discuss these with your surgeon. Saline implants are silicone shells that are filled with saline (salt
M e n t o r S i l i c o n e M e m o r y G e l S i l te x Im p l a n t
photo courtesy of Mentor
water) at the time of surgery, and so smaller incisions are required than with pre-filled silicone implants. In standard breast augmentations, the port through which saline is inserted into empty silicone shells until the implant reaches its desired dimensions. The port is then sealed off. When breasts are reconstructed after mastectomy, tissue expanders are used to make room for implants. The volume of saline is adjusted as the tissue expands until the desired size of the new breast is achieved. SHAPES Teardrop (or anatomical) shaped implants contain more volume at the bottom to mimic the breast’s natural slope. They thus give a natural look but a disadvantage can be that if the implant shifts or rotates it can distort the appearance of the breast. Round implants provide the upper breast with more volume and are the most widely used in Australian surgery. They provide more fullness and cleavage and won’t rotate.
PROFILES Moderate-profile implants provide a moderate amount of projection so they won’t “stick out” so much.. Moderate-plus implants are slightly tapered and won’t create excessive width on the side. High-profile implants are narrower, with a smaller base than the others so as to create more projection and fullness and, thus, cleavage. The projection you and your surgeon ultimately choose depends on a number of factors that he or she will discuss with you, including your body shape and size, the proposed placement of the implants and the overall “look” you are seeking. PLACEMENT SITES Sub-glandular breast augmentation is where the implant is placed just below the breast tissue or under the pectoralis muscle of the chest. This method is often used in women who are quite thin and
Dual plane placement is where implants are inserted partly under the breast and partly under the muscle. They are preferred in cases where there is mild sagging of the breasts. An advantage of this technique is that positioning the upper half of the implant under the muscle helps to hide the obvious “step” at the top of the implant, especially in a woman with thin tissue coverage. INCISION SITES Most commonly breast implants are inserted through the inframammary fold, the natural crease under the breast. An incision of 3-5cm is made and the scar remains hidden under the breast. A periareolar incision is made half way around the nipple. The resulting scar is virtually undetectable, but if you’ve not finished having your family, this technique may interfere with breast-feeding. Inserting implants through the armpit is an option for women who are prone to keloid (raised, thick) scarring or for those who don’t want any trace of a scar on their chest, if you are an appropriate candidate of course. The surgeon will use an endoscope, which allows them to see through the whole cavity and guide the implant into the right place.
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速
Johnson & Johnson Medical Pty Ltd. Telephone: 1800 338 160 or +61 2 9815 3680. Address: 1-5 Khartoum Road, North Ryde, NSW 2113. Email: mentorcustserv@its.jnj.com Johnson & Johnson Medical Pty. Ltd. ABN 85 000 160 403. Mentor is a business unit of Johnson & Johnson Medical Pty Ltd. E201306_103
Somet imes it’s the
simple things...
Something as simple as removing unwanted hair can dramatically change the way we feel about ourselves.Hiding hairy legs under pants when we’d rather be in a skirt; keeping our arms close to our sides like stiff soldiers or wearing shorts over our bikini bottoms. There are even men who haven’t been seen without a t-shirt for decades.
U
nwanted hair can place all sorts of restrictions on how we enjoy life. We’ve been removing hair for as long as there have been sharp tools to scrape whiskers of faces. Nothing much changed for centuries, until we discovered that we could pour a layer of hot wax over the hair and rip it out by the roots. If that sounds painful, it feels a lot worse. Then came the messy creams that might or might not work – depending on whether you could understand the directions for use.
after a treatment to get the optimum results. Every consultation is discuss their concerns and ask as many questions as they would like.
Before, During and After Care
Ten Years of Treatments
Not everyone understands how important it is to take proper care of your skin between treatments but Hairfree clients have the advantage of the E+ skincare range, which is exclusive to Hairfree, and has been specially formulated to use with Hairfree treatments. The range includes an exfoliator and sun protector and is designed to ensure smooth, sexy skin all year round.
With more centres in more places, and doing more than 100,000 treatments every year, it’s no wonder Hairfree has become the trusted name in gentle, pain-free, risk-free hair removal.
Hairfree understands that more and more people are time-poor and can’t afford to wait around for things to happen. Hairfree’s IPL treatment machines are designed to provide optimum results with little or no discomfort in the shortest time possible. Treatment times can range from as little as 5 minutes for an underarm or lip to 30 minutes for a full back. There’s no down time for clients so treatments can be scheduled before or after work or during lunch hours. No one needs to know where you’ve been.
Almost 10 years ago, Hairfree offered a new solution to the problem of unwanted hair: simple, affordable treatments using IPL to remove hair once and for all. Before Hairfree, only the lucky few with generous bank balances could afford permanent hair removal using lasers – and even that was hardly pain free.
Professional Therapists
Every one of Hairfree’s professional therapists has undergone a lasersafety training course and has a caring, sensitive and professional approach to designing treatment programs for every individual client. These women are passionate about helping their clients to achieve results that will make them look and feel better. therapist will spend at least 30 minutes discussing the client’s needs and matching treatment programs to expectations and budgets. Hairfree believes clients need as much infor mation as possible before they begin. At Hairfree, your therapist will explain why a single treatment won’t be enough because of the different ways hair can grow in different places at different times. Factors such as any underlying medical conditions or medications being taken by clients will be taken into consideration. The therapist also advises the client on what to do before, during and
Experience Counts
Too often, people choose hair removal from a salon or centre on price alone. But what might seem like an internet bargain can often be disappointing. Clients can feel rushed and literally zapped because with the wrong treatment machine, there can be real discomfort and pain. You want to be sure that the person treating you has the experience and knowledge to treat you properly and not like a voucher to get in and out as quickly as possible.
Range Of Treatments
Hairfree can also offer you a range of the treatments to complement your hair removal – from skin rejuvenation and tattoo removal to acne treatments and anti-wrinkle injections. Hairfree – you’ll love the freedom.
www.hairfreeonline.com.au Book online or Call 1300 HAIRFREE (424737)
New Teeth in a Day: Too good to be true? Perth dental surgeon and implantologist Dr Misagh Habibi explains the concept of ‘Teeth in a Day’ and whether the science matches the hype. If you suffer from advanced dental disease requiring tooth removal, or are already missing more choppers than you’d care to admit, you’re probably well practiced at avoiding the dentist. After all, it’s daunting to think about the stages and complexity of care you might need. Fear of the unknown is a familiar obstacle, and fear of the dentist trumps even that. You may dream of making one visit to a dentist, pain-free, and coming out ‘all fixed’ - a dazzling smile to match your dazzling personality, and strong healthy choppers to boot. One marketable procedure is this process of ‘Immediate Teeth’, ‘Teeth in One Day’ or ‘Teeth in 3-4 Days’. These catch phrases refer to a process where dental implants either replace long term missing teeth, or replace teeth at the same time as they are removed. This can happen immediately, or within days – which is for all intents and purposes still immediate. So what is this procedure exactly, and is the prospect of bypassing months or even years of treatment with one instant fix, too good to be true?
Conventional Dental Implants Dental implants are titanium fixtures that are surgically inserted into the jawbone to act as a foundation for the attachment of case-designed prosthetic teeth. Titanium is not seen as a foreign body by the bone, and bone cells actually grow onto, and attach, to its surface in a process called osseointegration. Once osseointegrated, implants act as a secure, long term and strong foundation to support teeth against the forces of chewing and the challenges of the mouth’s biology. With the advent of the first dental implants, a period of approximately 6 months was given to allow this process to take place, prior to the attachment of teeth. During those months, the patient wears temporary solutions such as removable partial dentures, as we wait for the implants to become ready for the attachment of teeth. These days, depending on the design and surface of an implant, and the quality of the host bone, this process can take as little as 6-8 weeks. This means that where appropriate, teeth can be made to attach to the implants much earlier. 36 NIPTUCK Magazine
materials, not as long lasting. Impressions (or digital scans) One technique of replacing of the implants can be made teeth with implants in 1-4 within the framework of the days is called the ‘All-on-Four’ mouth, and a laboratory technique. This is an fabricates the teeth under the increasingly popular and cost direction of the dentist or effective method of dental specialist. A variety of reconstructing entire sets of materials can be used in this missing or badly diseased process to suit the case, teeth instantly, predictably including zirconia, precious and beautifully – whilst or non-precious metals, Dr Misagh Habibi avoiding the traditional porcelain, composite resin pitfalls and cost/time requirements of bone and and acrylic. Commonly porcelain is skilfully tissue grafting which prepared the jaws for layered and shaded as a cosmetic overlay over a implants. The ‘All-on-Four’ uses specially angled stronger metal or zirconia foundation. implants (usually 4 in each jaw) positioned strategically in a manner that allows a full set of Immediate Implants teeth to be immediately attached. Loyal Nip Tuck readers can find out more about this next With modern advances in the understanding of edition – stay tuned! the biology of bone and soft tissue healing in relation to implants, and the advent of biomaterial and digital dentistry solutions, it has become possible to carry out implant placement and related jaw surgical procedures, and make teeth to attach to the implants, immediately – before the implants have actually integrated in the bone. This has led to ‘immediate techniques’ becoming the favoured or default approach of some operators (including yours truly). Advantages of this approach include preserving as much of the original gum and bone anatomy of the teeth as possible, and the obvious cosmetic outcome of having a nice full smile straight away. But this approach is more technique sensitive and requires precise criteria to be met to ensure success. The patient also has to avoid the area of the immediate implant teeth in their chewing for a period of 2-3 months. If it’s a full set of immediate implant teeth, then it’s important that the patient sticks to a liquid-soft diet for that time. After the 3 months, a normal solid diet can be resumed and the implant teeth can be treated as capable of full normal function.
Teeth in a Day/ Teeth in 3-4 Days This terminology is used to describe the concept of having dental implant replacement surgery and attaching new teeth to those implants on the same day, or within a few days. Generally speaking, for individual teeth a same-day approach is very sensible. But for full sets of teeth, allowing a 3-4 day process to be carried out ensures that the immediate teeth can be made in more advanced techniques, to optimise and precision design the cosmetics and longevity. Teeth that are attached on the same day are, by limitations of technique and
Immediate or Staged Implant Solutions: that is the question. Ay, there’s the rub: for the answer is case specific. The well-trained dental implantologist or specialist would have this technique as one of many in their armamentarium. The key is to assess you for your own unique conditions and circumstances, and make a well-informed decision. Despite the possibilities of immediate teeth, there are still conditions where such a solution may not be the wisest solution. Examples would be insufficient bone volume or quality (in some cases), poorly controlled diabetes, heavy grinding habits or heavy smoking. In such situations extra time, and steps, are taken to ensure a successful outcome. In many other cases, under the hands of a skilled operator, and with respect to the conditions required to ensure success, ‘immediate teeth’ or ‘teeth in a day’ can provide a predictably successful, convenient, cosmetically and even biologically superior solution. A review of the dental implant literature confirms that the experience, knowledge and skill of the operator in the process of ‘immediate implants’ is an important factor in ensuring success. So as always, choosing the right doctor for the job is paramount. If instant new implant choppers are what you’re after, consult a suitable expert who carries out ‘immediate implant’ and ‘teeth in a day/teeth in 3-4 days’ procedures such as the ‘Immediate All-on-Four’ solution, routinely, with good outcomes. They could advise you if you are a suitable candidate for the procedure, or if practicing patience for a staged approach to treatment is better for your case.
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EYE SURGERY 38 NIPTUCK Magazine
Sick of wearing glasses? They feel uncomfortable, they irritate you? Well there are options available to you. point below the surface of the cornea, where thousands of microscopic bubbles are formed to create the corneal flap. Total time for this stage of the procedure is 15-30 seconds. The surgeon controls flap diameter, depth, hinge location and width, and side-cut architecture - factors that can be varied per patient. Bubbles are then stacked along the edge up to the corneal surface to complete step one.The physician then exposes the prepared corneal bed for Excimer laser treatment by lifting the flap. The time taken for the reshaping process is now as quick as 1.4 seconds per diopter of correction required. The LASIK procedure is complete when the flap is securely
Dr. Robert Paul WA LASER EYE
LASIK stands for Laser In-situ Keratomileusis and is the most common form of refractive laser eye surgery, that is, surgery performed to correct refractive errors and reduce or eliminate dependence on glasses and contact lenses. LASIK is a two-step process using the Intralase method. The first step is the creation of the corneal flap using a specialised laser called the Intralase. The second step is the vision correction, using a second laser called an Excimer laser to smoothly reshape the surface beneath the flap. Once the laser treatment is complete, the delicate corneal flap is precisely replaced and sealed in place with no stitches required.
INTRAOCULAR LENS IMPLANTS (IOL'S) necessarily mean you will be free of glasses or contact lenses. After consultation with a surgeon you may be recommended an intraocular lens implant. There are two types of lens implant surgery: Refractive Lensectomy and Phakic IOL insertion. Refractive Lensectomy is a procedure very similar to cataract surgery. The natural (crystalline lens) is removed and an artificial lens of the required power is inserted into the eye. The flap becomes adherent within a few minutes as the healing begins. Most individuals can return to normal activities within 24 hours. LASIK can be used to correct myopia, hyperopia, and astigmatism. Prior to surgery, a thorough assessment is carried out to assess suitability. If the cornea is too thin, or the refractive error to high, alternative surgeries such as LASEK, or the implantable contact lens may be offered. Certain systemic conditions, or progressive corneal degenerations would likely exclude one from treatment options. Modern LASIK treatment has become exponentially more rapid as the technology has evolved.The ultra-fast Intralase uses an infrared light beam, generating up to 60,000 pulses per second, to prepare an optimal corneal architecture below the surface of the cornea. Using an ‘inside-out’ process, the Intralase is precisely focused to a
repositioned on its beveled edge. Visual recovery is rapid, with over 95% of patients achieving 20/20 vision one-day post operatively. For the over forty fives, an innovative, new surgical procedure to treat presbyopia, the eye condition that reduces the ability of the eye to focus on near objects, is now available. The KAMRA™ Inlay may help restore vision of near objects and reduce dependency on reading glasses. The treatment involves implanting a corneal inlay under a small laser created flap in the cornea of one eye. The inlay acts like a pinhole camera inside the eye and helps it re-focus on items that are close. INTRAOCULAR LENS IMPLANTS (IOL'S) Some individuals with very high levels of refractive error and/or thin corneas may not be suited to laser refractive surgery. However, that does not
A Phakic IOL is an intraocular lens that is inserted into the eye without removing the natural lens (crystalline lens). This means that the eye benefits from the combined action of the natural lens and the implanted IOL to correct the vision. Recovery is rapid and most individuals can see more clearly the following day. The Implantable Contact Lens (ICL) is similar to the Phakic IOL, but is placed behind the iris, adjacent to the natural lens. The ICL is a Collamer lens that remains in place indefinitely, but can be replaced or removed should the vision change enough over time. It is biocompatible, provides exceptional quality of vision, and is generally recommended for those persons who either have high refractive errors, or do not have the required corneal thickness to undergo LASIK surgery. Rapid recovery, and a simple outpatient procedure make this a highly rewarding vision correction option. NIPTUCK Magazine
39
L abi a MINORA FUNCTIONAL AND COSMETIC SURGERY
Dr Onuma
Much like the breasts, the labia minora can be a variety of shapes and sizes, but nevertheless there would appear to be a pervading impression amongst women that they should be very small and of equal length. When examined carefully it is clear that the labia minora are rarely of equal length (even though they may appear to be so on brief inspection), shape or diameter. The only comment that can be made with any certainty regarding the size and shape of the labia minora is that they are all very different and that the range of what can be considered to be ‘normal’ is very broad indeed.
Some women report that they have had the impression of the labia minora being too long before they reached puberty, others that it was around the time of puberty that they became more aware of this. Many women comment that they had noticed a gradual increase in the length of the labia minora, some noting that pregnancy appeared to be a trigger factor for acceleration of this growth. The labia minora can become distorted by a variety of conditions such as lichen sclerosus, small cyst formation and hypertrophy (thickening of the tissue) resulting from friction as well as hyperpigmentation (becoming darker, usually at the edges) from a combination of frictional and hormonal forces. Excessive and prolonged irritation can result in swelling and even ulceration of the labia minora. The motive for women requesting reduction of the labia minora falls into two categories: functional and cosmetic, and in many cases the two will co-exist. Common complaints of functional disturbance of the labia minora include pain and discomfort associated with wearing tight fitting underwear and trousers, discomfort during activities such as cycling, horse riding and gym work, and in-folding
40 NIPTUCK Magazine
during intercourse or when attempting to insert a tampon. Dissatisfaction with the appearance of the labia can lead to psychological problems as the woman becomes increasingly selfconscious. These women will describe the labia as ‘too long, too thick, getting darker, having lumps on it, does not look normal, ugly, not right.’ They avoid wearing swimwear, tight jeans, g-strings. They avoid receiving oral sex or their partner seeing their private parts. Many women will report being too embarrassed to get into another relationship because they are bothered about the look of their labia. Doctors must satisfy themselves that there is an indication for surgery and that the person seeking surgery has a realistic expectation of outcome. Making a proper assessment of this requires the doctor to be vigilant, cautious, probing in the questions that they ask of their potential patient, and very honest about potential risks and outcomes of surgery. Labia minora reduction can be achieved using a variety of instruments. These include the laser, diathermy, knife and scissors. Use of the knife or scissors in labial surgery are avoided in my practice. Typically I will use diathermy or laser both of which are associated with less blood loss, report of less pain and are both tools that
can be used with precision. The technique that I employ takes an average of 60 minutes to reduce and refashion both labia minora. If prominent prepuce or paraclitoral folds are also reduced the surgical time may increase by an extra 20-30 minutes. This technique employs a cosmetic approach to achieve a functional result with meticulous attention to tissue handling, dissection and reduction. The upper parts of the labia minora represent the greatest technical challenge with regards to surgery because the clitoris is bounded laterally by the paraclitoral folds, above by the prepuce and below by the
frenulum. These are often prominent and any attempt to refashion them must be tempered by caution and guided by experience. The 3-dimensional anatomical relationship of the prepuce, paraclitoral folds and frenulum is complex. Refashioning to provided a smooth, aesthetic, scar- free result following surgical reduction is an intricate, complex exercise. Reduction of the prepuce is a specifically acquired skill and many surgeons who perform labioplasty will avoid operating on this area. I cannot over emphasise how important it is for any woman contemplating this type of surgery to discuss it very carefully with her surgeon. You will need to feel very confident that your surgeon has great experience in this particular type of genital surgery. Most labial surgical procedures will be performed as day case surgery, with the patient able to be discharged home within 6 hours of surgery. Prior to surgery, patients will receive advice about wound management including strategies for washing and drying the labia, guidance on appropriate clothing and activities to avoid until the healing process is established or complete. Most of the healing process takes place within the first 2 weeks, however complete resolution will take about 6 weeks. For what can be considered to be a very sensitive area, the overall level of discomfort is low and mostly resolved within the first week of surgery. Labia minora reduction is the most commonly requested surgery on the external genitalia. Although hidden from view, the impact of surgical correction of thickened, elongated, uncomfortable and unsightly labia on the self-confidence of the individual patient cannot be underestimated. Labial reduction surgery is a very individual decision, only one that you can make for yourself.
YOU ARE NOT ALONE Dr Onuma receives many emails that reflect the concerns that women have about the length and appearance of their labia: Hi. Could you please send me some information / pricing on having labial shortening? I had my first child 12 years ago and due to not being properly stitched, I was left with quite a prominent labia which seems to be more obvious these last few years. It is now affecting my relationship with my husband as I feel extremely self-conscious. ‘Hi. I had my 1st child 4 months ago and tore a hole in my labia. Despite being stitched initially, then cut and restitched again in day surgery, there is still a small hole and some discomfort.’ ‘I have something that hangs lower than the outside lips which has been like that for a long time, but I don't know what that is and have no luck in trying to stimulate my clitoris. (I don't know if I even have one!).’ ‘I am a female with protruding labia. I am very interested in labioplasty and have been since I can remember. They are noticeable in a swim suit and when wearing some underwear and tight pants which not only embarrasses me but also makes me feel very self-conscious. ‘I'm interested in having a labioplasty procedure done and was hoping you could tell me some extra information. I've recently had a baby and my inner labia now sit quite drastically outside the outer labia. Before childbirth they had sat outside the outer labia but are now a lot worse. Before childbirth sex could be quite uncomfortable as they seemed to get in the way. ‘I have great discomfort with my labial minora; they are both painful and embarrassing. The pain occurs from clothing and movement, because they are so long. There is much discomfort when walking or sitting if they are not 'tucked away'. I have also found sexual activities a great challenge and have not let anybody see or touch my vagina because of my labial minora.’
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UltraShape V3 is one of the most advanced technologies yet to reduce and recontour stubborn areas of fat, in less time than ever before The “muffin top” is a relatively new phenomenon – the term was actually coined in 2003 by Australian TV comedy Kath and Kim.
food. Both are processed by the body’s natural mechanisms.
Photographs Courtesy of Dr Arie Benchitrit
Body Shape
PURE JEANIUS
Some plastic surgeons believe that the distinctive roll of stubborn stomach/hip fat resulted from a generation of people regularly wearing tightfitting, low-slung jeans that forced the fat into an unnatural contour. It’s one of the most difficult areas of fat on the body to reduce and re-shape. Many women despair that ,no matter how much they watch their diet, hit the gym or pound the pavements, some slice of muffin is always sitting at the top their jeans. Ultrasonic body contouring technology UltraShape V3 offers people doing battle with muffin tops, or similarly stubborn fat pockets such as love handles, mid-back bulges and thigh saddlebags, the chance to streamline their shape and likely drop a clothes size or two within weeks of treatment. UltraShape is a clinically proven, non-surgical device that pulses focused ultrasound energy into treatment areas, prompting an instant mechanical (non-thermal) destruction of unwanted fat
42 NIPTUCK Magazine
The distinctive roll of stubborn stomach/hip fat is one of the most difficult areas of fat on the body to reduce and re-shape
cells. It is the first technology to simultaneously treat multiple depths of fatty tissue for greater volume of fat destruction. “In a controlled clinical trial, an average of a 2cm reduction in circumference was achieved after a single treatment,” says Canadian plastic surgeon Dr Arie Benchetrit, who recently visited Australia to give master classes in UltraShape. “Focused ultrasound energy selectively targets fat cells in the chosen body area without harming surrounding tissues such as nerves or blood vessels. The UltraShape V3 emits 50 percent more ultrasonic pulses than previous versions of UltraShape.
“This makes it an even more convenient 'walk-in, walk-out’ procedure. The reduced treatment time and ability to complete a three-treatment series in one month makes it an even more convenient and effective solution for patients.” Dr Benchetrit explains that the ultrasound energy disrupts the membranes of the fat cells. The cells’ content, primarily comprised of triglycerides, is dispersed into the fluid between the cells and is then transported through the vascular and lymphatic systems to the liver. The liver makes no distinction between fat coming from the UltraShape treatment and fat originating from consumed
Sydney cosmetic physician Dr Garry Cussell says one of the greatest benefits for patients is that the UltraShape V3 works on the body’s three layers of fat: two layers of subcutaneous fat (the deep layer and the superficial layer) and the third that is known as visceral fat, within the abdominal cavity and around the organs, making it an extremely effective treatment. “My patients generally have 34 treatments, 2-3 weeks apart. Most start noticing a difference within a couple of weeks of the first treatment,” he says. “I have found it particularly good for treating mothers who have that residual roll of fat around their waist after having children, for people with pot bellies, love handles, muffin tops and thighs. “UltraShape is not for skin tightening. It is not a weight loss treatment. It is not designed for grossly overweight people. It is for reducing and shaping small areas of localised fat that people have difficulty reducing by the normal means. “The treatments are simple and are very well accepted by my patients. It is not painful. Overall I have seen excellent results and some very delighted patients.”
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© 2012. All rights reserved. Syneron and the Syneron logo are registered trademarks of Syneron Medical, Ltd. Ultrashape is a registered trademark of Ultrashape Ltd. Candela is a registered trademarks of the Candela Corporation. PB80781EN
®
SPRING INTO SHAPE
INTO SHAPE Use winter to plan your new and better body shape for the warmer months with surgical and non-surgical options. You can look at the winter months in one of two ways: a chance to cosy up on the couch eating comfort foods, losing muscle tone and gaining weight (then suffer seasonal size panic when the weather gets warmer). Or use them as an opportunity to embark on a plan to get into your best shape yet for the big reveal in spring/summer clothes.
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Surgical and non-surgical body-contouring procedures today offer a vast array of slimming options, but they will be a huge waste of your time and money if you don’t ensure you are eating well and moderately, and getting adequate exercise, before and afterwards. NipTuck outlines your surgical and non-surgical options.
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SPRING INTO SHAPE
Spring INTO SHAPE
YOUR SURGICAL OPTIONS
LIPOSUCTION Traditional liposuction is still regarded by surgeons as the gold standard for sculpting areas of the body (thighs, buttocks, abdomen – even arms, neck and chin) that require significant fat reduction/contouring. A “tumescent” technique is often used, whereby large volumes of fluid (sometimes as much as three times the amount of fat to be removed) are injected into the treatment area. This may negate the need for general anaesthetic and intravenous painkillers/sedation while minimising blood loss. It also may enable a patient to move around while the procedure is being performed to allow greater access to areas being . The key to obtaining a great result is to consult an accredited, experienced plastic surgeon who has excellent artistic sculpting skills as well as practical technique. A good surgeon will also tell you that, if you don't have good elasticity, you won't get a great result no matter what technique is used. Also, that liposuction does not improve cellulite – in fact, can make it worse. Liposuction is also called liposculpture or suction-assisted lipectomy. When combined with other procedures, such as abdominoplasty (tummy tuck), it can imake a dramatic difference to the overall appearance of the body. A cannula [a thin tube inserted into a surgical instrument] is
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attached to a high-powered suction pump is inserted via a small incision so fat stores can be removed. A pressure garment is generally worn for several weeks after surgery to reduce fat thickness and minimise swelling.”
recommended. Liposuction alone to reduce fat may only make matters worse if there is excess loose skin and muscle laxity. Abdominoplasty is a surgical procedure designed to remove excess skin and fat from the lower abdomen and tighten the stomach muscles, reducing and reshaping the abdomen. It is a popular procedure for women who have finished having their families and want to regain their pre-pregnancy shape. Also for people for have undergone dramatic weight loss and have an excess of loose skin. The surgery involves an
To maintain results it is recommended patients follow a healthy diet and exercise regime
Recovery time can vary from a week up to a few weeks – your surgeon will advise when you can return to everyday activities, especially vigorous exercise. The skin normally contracts in the areas where the fatty desposist have been removed but in some circumstances a procedure to remove excess skin (lipectomy) may be required. ABDOMINOPLASTY When a patient is concerned by significant belly sag, likely as a result of pregnancy or dramatic weight loss, abdominoplasty is often
incision being made across the lower abdomen (usually positioned so it can be hidden beneath a bikini or bikini briefs), extending out to the hips. Tummy tucks are performed under a general anaesthetic. Excess fat and skin is removed from the abdomen and the abdominal muscles tightened. In most cases the navel may need to be repositioned. Liposcution is also often used to complement the procedure. A hospital stay of 2-3 days is required, Dr Lawrence says. Most patients will need to take from 2-4 weeks off work, or from daily activities that will
put strain on their bodies (eg. lifting children, carrying heavy shopping bags). Normal exercise can be taken up again after six weeks. A patient may be provided with a supporting girdle to assist in the healing process. YOUR NON-SURGICAL OPTIONS It’s important for patients to understand that non-surgical body-contouring is to reduce stubborn pockets of fat that diet and exercise alone cannot shift. Typical treatment areas include “muffin tops” and stomachs, thighs, buttocks, “tuckshop arms” and “love handles”. It is not designed for weight reduction or as a treatment for obesity. To maintain results it is recommended patients follow a healthy diet and exercise regime. Celebrating size loss and your new, shapelier silhouette by eating more and exercising less will result in remaining fat cells just getting bigger – that means you getting bigger. FAT CAVITATION SYSTEMS The use of energy sources such as ultrasound (sound waves), radiofrequency and infrared at low frequency has been proven successful in reducing unwanted local fat deposits. There are a number of brand systems offering this process, which is non-invasive, with only minimal or moderate discomfort in the majority of cases. A great advantage is that there is no downtime as with surgery, but there can be some redness, bruising and swelling for several days or up to a week or more, depending on the intensity of the treatment. The fat cell cavitation/ disruption process to a highly pitched singing voice shattering glass: the energy waves shatter the wall of the fat cell, causing its contents to leak out, killing the cell:
• The handpieces delivering the energy are only applied to the selected treatment areas. • Energy waves are said to “penetrate”, or go through the skin surface to break down fat cells without causing damage to the skin, or to blood vessels, nerves or connective tissues nearby the treatment areas. • After the breakdown, or “lipolysis”, of fat cells, triglycerides are released in the interstitial fluid, the liquid that is found between our body cells. Triglycerides are the major type of fat within our body, making up 95 percent of fats. • The body breaks down the triglyceride into its two components called glycerol and fatty acids. • The fatty acids are metabolised by the liver, whilst the glycerol (water soluble) is passed through the interstitial fluids, and excreted as waste or also metabolised through the liver. Ultimately, once these fat cells are broken down, the body tries to use them or remove them permanently. Traditionally these procedures have required 3-4 treatments, spaced about 3-4 weeks apart, with optimum results roughly about three months after the cessation of treatment. CRYOLIPOLYSIS This literally involves freezing fat cells to death. A procedure that emanated from Harvard University-associated scientists who observed the fat reduction effect on the cheeks of babies given ice lollies to suck to relieve teething pain, This technology has been one of the big news stories of the fat reduction industry in the last two years. It can target and kill fat cells without harming surrounding tissue. Fat cells are frozen, then crystallise and are eventually eliminated through the body’s natural processes between 6-12 weeks.
It targets a particular area such as “love handles”, “muffin tops” or bellies. The device is positioned on the area to be treated; two “rollers” cooled to 7 degrees C for around 60 minutes.
Body Sculpt with truSculpt
The fatty treatment areas are suctioned between them. The technology has evolved so that larger areas of localised fat than initially possible can be treated in one session. MESOTHERAPY INJECTIONS A more traditional form of spot fat reduction, also known as “lipodissolve”, involves a series of small injections, containing substances such as enzymes, vitamins and phosphatidylcholine (a natural soy substance), into unwanted fat pockets. These increase fat metabolism to break down fatty deposits in order to naturally absorb and remove them from the body. Most patients will experience some degree of redness, swelling, itching/stinging, bruising or tenderness. This peaks at around 45 minutes after treatment and can take 24-48 hours to fully subside. Bruises in tender areas can take a week or more to vanish. As many as six sessions spaced around a month apart may be required and it must be noted that not everyone will be a “responder”. That will only be determined around 4-6 weeks after your first treatment.
• Radio Frequency Platform for targeted fat apoptosis • 16 & 40cm2 handpieces allow for treatments anywhere on the body • Exclusive RF delivery control for easy, consistent & therapeutic delivery of RF energy
For more info, contact Phil Schramm pschramm@cutera.com or +61 4 09470692
www.trusculpt.com/intl NIPTUCK Magazine 47
SPRING INTO SHAPE
NEW FAT BUSTERS ON THE BLOCK Energy devices have revolutionised body contouring over the past decade and they’re just getting better. They work by delivering heat beneath the skin’s surface without causing damage to the upper skin, blood vessels, nerves or connective tissues nearby the treatment areas. The energy waves shatter the wall of fat cells, causing their contents to leak out and stimulate “lipolysis”. This means the fat is flushed out through the body’s normal elimination processes. Depending on the practitioner, these treatments can be conducted once, or over 3-4 treatments. Treatments are usually simple, comfortable and take less then an hour. There may be some swelling and bruising afterwards.
before
after
before
after
before
after
• Results are post 2 treatments
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LIPOSONIX Sydney laser cosmetic surgeon Dr Jack Ting has been using the ultrasound body sculpting technology Liposonix since its introduction to Australia in November last year. Patients are treated in one session. He says the higher energy levels used to achieve his results can be painful for some patients but offers appropriate pain relief medication and sedation if required. Dr Ting has been refining his use of the system since late 2012. He says male and female patients alike have been experiencing anything from a 2cm to up to a 6.5cm circumference loss in treatment areas in three months, when optimum results are expected. This approximates between 1-2 clothes sizes. However, he says patients will likely start to see and feel differences are just a couple of weeks.
ULTRASHAPE “The UltraShape treatment uses scientifically proven noninvasive ultrasound technology to break down unwanted fat,” says Canadian plastic surgeon Dr Ari Benchetrit, one of the word’s foremost practitioners of the technology. He recently visited Australia to give master classes in the new-generation UltraShape V3. “Focused ultrasound energy selectively targets fat cells in the chosen body area without harming surrounding tissues such as nerves or blood vessels.” The V3 emits 50 percent more ultrasonic pulses than previous versions of UltraShape. “This makes it an even more convenient 'walk-in, walk-out’ procedure,” Dr Benchetrit says. “Moreover, the reduced treatment time and ability to complete a three-treatment series in one month make the UltraShape solution more convenient for patients.”
TRUSCULPT Cosmetic physician Dr Lindsey Hooke of Rejuven8Cosmetix believes in the saying “try before you buy”, which she did with the new truSculpt radio-frequency technology. She and two of her team had one session each and all have reported pleasing results. Her clinic on the Gold Coast is now the first in Australia to introduce the system. “I had truSculpt on the fatty areas of my back around the bra line. Within a month of the treatment – which I found painless – the fatty pockets are significantly reduced and my bras fit a lot better. I feel I can now wear closefitting tops and dresses without bulges showing through. One of my staff had truSculpt on her inner thighs and she’s delighted. She says she feels and looks a lot better in leggings and jeans.” Dr Hooke says optimum results are expected after follow up treatments.
ACHIEVE THE ULTIMATE BEACH BODY
Gain confidence in your body The Liposonix treatment uses noninvasive, high-intensity focused ultrasound to target fat around your trunk and lower extremities (abs, flanks, hips, thighs, and buttocks) without surgery. Find a practitioner in your area: liposonix.com/consumer/find-a-doctor
Make sure every day is your Thermage procedures can help smooth and contour your skin for an overall younger looking appearance in a single treatment. Find a practitioner in your area: thermage.com/consumer/find-a-doctor
Š 2013 Solta Medical, Inc. All rights reserved. Thermage and Liposonix are registered trademarks of Solta Medical, Inc. or its subsidiaries. Thermage side effects are generally mild and may include redness, swelling and mild/moderate pain during treatment. Potential risks include itching, blanching, blisters, bumps, burns, scabbing, scarring, bruising pigment changes, altered sensations, surface irregularities, and herpes reactivation. The Liposonix system is for use when there is at least 1.0 cm of subcutaneous adipose tissue beyond the selected focal depth setting of the system in the area to be treated. Most frequently reported side effects during Liposonix treatment are discomfort, pain, cold, prickling, tingling, or warmth. Treatment is contraindicated for patients who are pregnant or suspected to be pregnant. The most frequently reported side effects after Liposonix treatment are pain (discomfort), bruising, redness, and swelling, which are generally described (or rated) as mild.
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SOMETHINGS OPT FOR COSMETIC ANTI-AGEING TREATMENTS TWO IN THREE AUSSIES WORRY ABOUT LOOKING ‘OLD’ While many may say they’re happy to age gracefully, more than 75% of Australians surveyed by the Cosmetic Physicians Society of Australasia (CPSA) think it is okay to have non-surgical aesthetic treatments for premature ageing and 64% of Australians say they worry about looking ‘old’1. The survey also found that 11%, or 2.5 million Australians, say they’ve had some form anti-ageing aesthetic procedure, including antiwrinkle injections, to maintain a more youthful appearance. With the increasing acceptance of aesthetic medicine in Australia, there is also a growing trend of patients in their twenties seeking nonsurgical aesthetic treatments. The CPSA says judicious use with an experienced medical practitioner can reduce the first signs of ageing. The 2013 CPSA survey found that 28% of those that had anti-ageing aesthetic treatments were aged between 18-29 years old and included procedures such as anti-wrinkle injections, dermal fillers and laser or IPL skin rejuvenation. Dr Susan Austin, spokesperson for the CPSA said: “There is evidence to suggest that starting judicious aesthetic treatments such as anti-wrinkle injections or dermal fillers early can delay wrinkles and other signs of ageing. I recommend that patients always visit a medical practitioner when considering these medical procedures or when they start to see changes in their skin like fine lines, folds and pigmentation. Other factors such as genetics, level of sun-damage in childhood and lifestyle habits, such as smoking, can also contribute to early aging. ” “Australia has one of the highest rates of skin cancer in the world, with Australians being four times more likely to develop a skin cancer than any other form of cancer2. Because of our outdoor lifestyle, we’re also prone to looking much older than our international counterparts, I estimate about 15 years older, than our Northern European or American counterparts who experience less sun exposure in childhood. It’s important for patients to realise that to prevent signs of premature ageing they need to avoid sun damage, which means using an appropriate sunscreen daily and covering up when outdoors,” Dr Austin said. The CPSA survey found that approximately 1.3 million Australians (6% of respondents) had undergone a non- surgical treatment, which is an aesthetic procedure that is non-invasive or may slightly break the skin (for example with anti-wrinkle injections). Unsurprisingly, women made up the majority (79%) of these respondents. The most common treatments continue to be microdermabrasion, laser or IPL hair removal, chemical peels and anti-wrinkle treatments, with
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55% of respondents spending $1,000 on these procedures in the last year. The CPSA says advances in technology and the efficacy of non-surgical treatments has helped fuel their popularity. Now patients can expect great outcomes with relatively little downtime, meaning that they can return to their everyday life soon after the procedure. “Importantly, while anti-ageing treatments are a focus for many patients, we also see a number of patients with different concerns such as improving their overall skin tone, scar-reduction and hair reduction or re- growth. We strongly advise that patients seeking an aesthetic procedure visit an appropriately trained medical professional with experience in aesthetic medicine,” Dr Austin said. NineRewards survey of 1,020 Australians, commissioned by the Cosmetic Physicians Society of Australasia, May 2013 2 Australian Government Department of Health & Ageing, http://www.skincancer.gov.au/internet/skincancer/publishing.nsf/content/fact-2 1
Patients interested in finding a doctor for a non-surgical aesthetic treatment can visit www.cosmeticphysicians.org.au
About the Cosmetic Physicians Society of Australasia The CPSA represents the largest body of doctors who perform non- or minimallyinvasive cosmetic medical treatments in Australia. Incorporated in 1997, the society aims to protect patient safety and improve regulations in cosmetic medicine. For further information or to request an interview with a CPSA spokesperson, please contact: Catherine Guyder | Res Publica | cguyder@respublica.com.au | 02 8297 1503
Is your SKIN starting to lose its spring? Dr Argie Xaftellis of ARGERA Anti-Ageing Centre details one of her own favourite treatments in skin tightening As we age our skin becomes less efficient at making collagen fibres resulting in it appearing saggy or crepe paper-like in nature. This is accelerated if there has been a rapid skin expansion then a loss, as in pregnancy or sudden weight loss. We mostly notice this in the face around the eyes, the neck and the jowls and on the body in the arms and abdominal areas. In the past, surgery and telltale scars was the only option. Yet now technology has finally caught up and there is a new, proven alternative in town. The Thermage® device is no stranger to skin tightening having been on the market for over 10years with a million treatments worldwide. It has become a choice of the rich and famous and boasts supporters such as Ellen Barkin, Kim Kardashian, Oprah and more recently Gwenyth Paltrow.
replacing the dermis with new stronger collagen. The whole process only takes 45 to 90 minutes depending upon the areas treated. The final result is that skin appears visibly smoother, thicker and stronger. Thermage® thus resets the skin. Older, more crepe skin will often see greater improvements than younger, thicker skin. However, many younger people are choosing Thermage® to maintain their youthful complexions. Their reasoning being that is better to preserve their looks than have to undergo more extensive treatments later on. Too good to be true! What’s the down side? It’s time. All collagen synthesis takes at least 6 weeks to fully get moving in the body and will continue for up to a year. Thus one opting for Thermage® must be a ‘patient’ patient!
The treatment has no downtime, minimal risks and side effects, can treat anywhere that loose skin exists, and future treatments are at least a year a part. Yet the clincher in the deal is the new CPT® technology, which adds a vibrating tip, making the treatment even more comfortable.
A longtime practitioner using Thermage®, having performed well over 100 cases in the last 2 years, I regularly have patients amazed and impressed with their outcome and eager to have their next. Of course, they have to at least wait 12 to 18months.
So how does this technology work? State of the art sensors fire radiofrequency pulses into the skin, which bypasses the epidermis (top layer of skin) to heat the dermis. This thermal stimulus forces the body into
Like all medical procedures, patients wanting Thermage® should see a fully qualified and experienced doctor to discuss treatment suitability, procedural risks and to ensure realistic expectations exist.
Photos courtesy of
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Varicose veins are not only unsightly but can cause pain, swelling and health problems. Why they happen and how to be rid of them. Winter is a good time to consider seeking treatment for varicose veins - the large, raised, “ropey” variety and surface spider veins. You usually need to wear compression stockings or bandages to minimise swelling and bruising, so what better reason to rug up! Treatments are by no means just cosmetic procedures, as vein disease can cause many health problems. They are carried out by a medical specialist with training in phlebology, the diagnosis and treatment of disorders of venous origin. It is important to have a proper diagnosis to determine whether the problem relates to veins or to something else. Nip Tuck spoke with two Adelaide phlebologists, Dr Anne Evans of Future You and Dr Lisa Marks of Brighton Day Surgery who shared with us their expert knowledge on the very latest in sclerotherapy procedures and treatments for varicose veins.
WHAT ARE VARICOSE VEINS? The large, raised veins more commonly termed as varicose occur when blood flows down instead of up towards the heart because of broken valves. This causes pressure to be applied to the veins, making them enlarge. The most significant cause is heredity and women suffer them more than men due to hormonal differences
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and pregnancy. Lifestyle factors which can affect the veins include standing jobs, obesity and lack of exercise. Zig-zagging reticular, or “spider” veins create the appearance of red or blue blotches on the surface of the skin. They can exist by themselves or in conjunction with the larger, true varicose veins.
YOUR TREATMENT OPTIONS Sclerotherapy is probably the most common treatment of varicose veins. It involves injecting an irritant solution or foam to inflame the lining of the veins, causing them to shrink and nearly disappear. The commonly used solutions in Australia are Aethoxysklerol, Fibrovein and a strong salt solution. “Compression hosiery is recommended for 1-2 weeks after each leg vein treatment,” says phelobogist Dr Lisa Marks, of Adelaide’s Brighton Surgery. “More time may be needed for large veins as multiple treatment sessions may be needed.” This is to minimise bruising and swelling and hasten the healing process. Patients must walk a lot in the first 10 days after sclerotherapy to avoid one of the complications, which is thrombosis (clotting). For the same reason, travelling by air is contraindicated for a period of time advised by the doctor. Ultrasound-Guided Sclerotherapy
(UGS) uses ultrasound to locate hidden varicose veins in order to accurately treat them. “Large varicose veins with major valve failure can be treated by UGS,” says Adelaide phlebologist Dr Anne Evans. “this involves injection of the sclerosant solution into the major veins and, for safety and efficiency, this is done under ultrasound control.” Endovenous Laser Ablation (EVLA) involves a fibre-optic probe containing a laser being inserted into the vein, which is then heated by the laser along its length causing it to shrink. This heating also helps the treated vein develop new collagen while as it heals. The main advantage of EVLT is the effectiveness in treating large veins with a short recovery period. The patient is up and walking immediately. “EVLA in combination with ultrasoundguided sclerotherapy provides a minimally invasive, walk in-walk out treatment option for even the largest varicose veins,” says Dr Lisa Marks. “It can be used as an alternative to surgical stripping.” Lasers are very effective for treating small, spider veins on the legs and especially the face. It is also an option for people who have not responded or are allergic to sclerotherapy. The laser light is preferentially absorbed by the red colour in blood. This light converts to heat, causing shrinkage of the
vein into which the light was directed. No special dressing or compression stocking is required. “Laser treatment of larger leg veins is generally not successful with the exception of EVLA,” says Dr Anne Evans. Surgery is reserved for patients with quite extensive and severe varicose veins. The surgery treats the broken valves, usually in the groin or at the back of the knee, that cause backward flow of blood down the trunks of the superficial (saphenous) vein trunks and into the numerous tributaries (branches). The “trunks” and “tributaries” are treated in the one procedure. The broken valves are tied off and some or all of the backward-flowing trunks and enlarged tributaries are removed (“stripped”) through small cuts on the skin.
THEY WILL (ALMOST CERTAINLY) BE BACK If you have a genetic tendency to develop varicose veins it means all the veins in your legs have weak walls in them. New varicose veins almost always develop after treatment and the chance of this increases over time. By being alert to their recurrence and acting early you will likely only require simple treatments.
#
1 Podiatry Laser System
Clear mycotic nails without drug therapy
Onychomycosis* Warts Scars
Fungus and warts. Even the words are disgusting. How laser is lighting the way to the best treatment yet. Let’s talk about toenail fungus. And leg warts. Hardly palatable topics of conversation but it doesn’t pay to be too squeamish. Onychomycosis (toenail fungus) afflicts a significant proportion of the population and existing treatments - such as topical or oral anti-fungal medications - can be hit and miss. Warts are just downright ugly and annoyingly stubborn. Now there’s a bright ray of hope for clearing up both conditions: the Cutera Genesis-Plus long-pulsed Nd:YAG laser. A clinical study in Japan has shown complete clearance of stubborn toenail fungus in more than 50 percent of cases, and another 30-plus percent showing marked to more-than-mild improvement after treatment with the laser. The trial was led by Professor Yasushi Suga of the Department of Dermatology at Juntendo University Urayasu Hospital in Chiba, Japan. He presented his findings at the recent 46th Annual Scientific Meeting of the Australasian College of Dermatologists in Sydney. “An infected toenail discolours to yellowish white and becomes thicker, brittle and flaky,” says Professor Suga. “The deformed toenail is unsightly and looks dirty – it may even create the impression the sufferer is unhealthy – and
sometimes makes walking painful, thereby significantly impairing quality of life of the patients. “The rate of onychomycosis infection is high. One in 10 Japanese has it. These infection rates tend to increase with age.” Prof Suga says are several theories as to why laser treatment is so effective. The most notable is that laser energy boils water and causes thermal destruction of the fungi while also reducing moisture in the infected nail plate (fungi thrives on moisture). Podiatrist Chris Gardner has been using Cutera Genesis Plus at his Melbourne practice for the past two years. “I’ve treated 1000 toenails for fungus, on people aged 5 to 85, and in that time and we have experienced incredible results,” he says, adding that equally good results have been achieved with fungal fingernails. Mr Gardner says the Genesis Plus laser is also very effective in clearing unsightly warts on the legs and other parts of the body. Warts are caused by HPV (human papillomavirus) and are very resistant to treatment. Many will disappear over time, even without treatment, but "time" can mean anywhere from two weeks to two (or more) years. “The laser targets warts at their source the blood supply that nourishes them effectively cauterising and killing them,” he says. Here’s to happy feet and lovelier legs.
#1 Podiatric Laser System Largest Spot Size in its class (5mm) Real time temprature monitoring Comfortable for the patient
For more info, contact Phil Schramm pschramm@cutera.com or +61 4 09470692
www.genesisplus.com *Clinically proven for the temporary increase of clear nail in patients with Onychomycosis AP0614 Rev A (6/13)
Liposuctii
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LIPOSUCTION IS A FORM OF COSMETIC SURGERY IN WHICH DEPOSITS OF FAT ARE REMOVED TO RESHAPE OR REDUCE ONE OR MORE AREAS OF THE BODY. COMMON AREAS TARGETED INCLUDE THIGHS, BUTTOCKS, ABDOMEN, ARMS, NECK AND UNDER THE CHIN. Liposuction is not a substitute for weight reduction or a cure for obesity. It is often used to reduce deposits of fat that have been difficult to move, even though the person has developed healthy diet and activity habits. Another name for this procedure is suction assisted lipectomy. You need to be fit and healthy Liposuction is best suited to normal weight people with firm, elastic skin who have pockets of fat in certain areas. To be suitable for liposuction you must be physically healthy, psychologically stable and have realistic expectations. Although age is not a significant concern, older people may have less skin elasticity and may not achieve the same results as a younger person with tighter skin.
on o Think about your expectations Before you opt for liposuction, you need to think carefully about your expectations.
Liposuction may improve your appearance and self-confidence, but it won’t necessarily deliver your ‘ideal’ body image. It is not a substitute for weight reduction or a cure for obesity. Liposuction can be used to remove ‘pockets of fat’ Body image concerns are the main reason people consider liposuction. Some people of normal weight have localised pockets of fat that don’t respond to diet or exercise. Common sites include the abdomen, hips, thighs, buttocks, upper arm, neck and beneath the chin. Medical issues to consider Before the operation, you need to discuss a range of issues with your surgeon including: Medical history, since some pre-existing conditions may influence decisions on surgery and anaesthesia Possible risks and complications – liposuction carries greater risk for people with medical problems such as diabetes, significant heart or lung disease, poor blood circulation or those who have recently had surgery near the area to be treated Any medications you take on a regular basis, including over-the-counter preparations and vitamin supplements Any previous bad reactions or side effects from any drugs Your expectations of how you will look after the procedure.
Immediately after the operation After the operation, you may expect: Bruising and swelling Possible numbness and minor pain Antibiotics to prevent infection Insertion of a small drainage tube – this may be inserted beneath the skin for a couple of days to prevent fluid build-up To start walking around as soon as possible – your doctor may advise this to reduce swelling and help prevent blood clots from forming in your legs A pressure garment – this may need to be worn over the treated area to control swelling and help the skin adjust to the new underlying shape. Possible complications All surgery carries some degree of risk. Liposuction should always be performed in accredited medical facilities such as a registered day care surgery or private hospital which are equipped to manage complications should they arise. The risks of liposuction increase if a large number of body areas are treated at the same time, or if the areas operated on are large in size. Possible complications can range from relatively minor to major and possibly even death and may include: • Excessive fluid loss, which can lead to shock • Fluid accumulation • Infection – this is a serious complication, as infections that develop in fatty tissues are difficult to treat • Delayed healing • Friction burns or other damage to the skin or nerves • Irregular skin surface • Asymmetric or ‘baggy’ skin surface • Numbness • Skin pigmentation changes • Perforation injury to the vital organs • Allergic drug reactions • Formation of blood clots or fat clots, which may migrate to the lungs and cause death. Taking care of yourself at home Be guided by your Surgeon but general self-care suggestions include: Strenuous activity should be avoided for about one month as the body continues to heal. You need to see your doctor one week to 10 days after surgery to have your stitches removed. You may need to continue wearing your pressure garment for several weeks. Any bleeding, unusual symptoms or severe pain should be reported to your doctor.
exercise. It is not a substitute for weight loss. Usually the ‘extra’ skin will contract (tighten) after liposuction; however, in some cases, a procedure to remove excess skin may also be needed. If your skin is dimpled before the liposuction, it will probably still be dimpled afterwards as well. Finding a surgeon Liposuction is not a medical specialty. It can be performed by any registered doctor (GP). It is also performed by Specialist Plastic Surgeons and Dermatologists. You should ask your medical practitioner about their training and experience. Don’t be swayed by advertisements which promise amazing results – if they sound too good to be true, they probably are. You should also have a ‘cooling off ’ period after attending your first consultation. This will give you time to think about your decisions. If you don’t feel comfortable with the doctor, seek a second opinion. Other forms of treatment Alternatives to liposuction can include: • Eating a healthier, low fat diet, exercise, massage, accepting yourself as you are Things to remember Liposuction is a form of cosmetic surgery in which localised deposits of fat are removed to reshape or reduce one or more areas of the body. Liposuction is most likely to be successful for healthy weight people with firm, elastic skin who have pockets of excess fat in certain areas. Liposuction is not a substitute for good diet and regular exercise.
How to find a Specialist Plastic Surgeon Australian Society of Plastic Surgeons www.plasticsurgery.org.au ASPS is the peak body for Specialist Plastic Surgeons (both reconstructive and cosmetic). Membership criteria is stringent and by invitation only. All members of ASPS are FRACS accredited Specialist Plastic Surgeons and have undertaken a minimum of 12 years medical and surgical education, including at least 5 years of specialist postgraduate training which is accredited by the Australian Medical Council.
Long-term outlook Liposuction is not a substitute for good diet and regular exercise. Unhealthy lifestyle choices (such as eating a diet high in fats and neglecting to exercise) will result in unwanted weight gain. Suction lipectomy is suitable for people who have bulges which persist after diet and
Patients are also welcome to contact the ASPS office on the Information Hotline 1300 367 446 or by email info@plasticsurgery.org.au
SKIN TREATMENT
See the
LIGHT
Forever Young BBL has been shown to literally turn back the clock in ageing and sun-damaged skin.
How well our skin reflects our age depends on a combination of genetics and lifestyle. There’s a lot we can do to make our lifestyle as youth-friendly as possible – sun protection, a healthy diet, no smoking, less alcohol, regular exercise. And there are plenty of treatments to help undo “external” ageing. But how we will age “intrinsically” is pre-programmed in our genes. There’s nothing we can do to reverse that process - or is there? A recent study by dermatologists at Stanford University in the US has found that older skin treated by Sciton Forever Young BBL (broadband light) technology more closely resembled the gene expression profile of younger, untreated skin, as opposed to older people who’d had no treatment. This resulted in the trial participants’ skin having increased elasticity, more ordered and uniform collagen production and significant improvement in fine wrinkles, pigmentation and vascular lesions. Another, retrospective study was conducted on 11 patients treated with Forever Young BBL over the past nine years. It revealed that those patients appeared not to have aged over the study period and, indeed, looked 10 years younger than their actual age. “BBL uses the power of pulsed light to deliver excellent results in photo-rejuvenation therapy; that is, treating skin conditions associated with ageing and sun damage,” says Sydney dermatologist Dr Bryan Pang. “It can be used to treat sun and age spots, capillaries and other skin blemishes. Overall, the skin’s youthful appearance will be restored to a significant degree.” Says US dermatologist Dr Patrick Bitter, inventor of the FotoFacial, a treatment protocol now used around the world to correct and rejuvenate skin with light pulsed technology: “BBL is really is the
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closest thing we have to a fountain of youth for delaying skin ageing. “Compared with other devices, Forever Young BBL from Sciton has allowed a significant improvement in my FotoFacial procedure to rejuvenate skin, largely because the technology has been easier to use, it’s faster and treats with a large spot size.” As proof, photos of Dr Bitter’s forehead taken at age 55, after BBL treatment, show it looking significantly younger than when he was 43, before treatment. BBL can erase skin spots, blemishes, broken blood vessels, rosacea and redness, according to Dr Bryan Pang. Even port wine stains can be treated. Trouble spots just dry up and fall off within 7-10 days, revealing fresher, clearer skin. “BBL can be done during a lunchtime and any area of the body can be treated, with particularly good results for face, neck, chest and the backs of hands,” he says.
“It is a non-invasive procedure with little down time. Patients might have some redness and swelling after treatment, but this usually settles down quickly, although in some it may persist into the next day. “In most cases, patients should be able to apply makeup (where appropriate) and go back to work or their normal activities. “Before the trouble spots flake off, they will become increasingly darker brown patches, which can lend a rather ‘dirty’ appearance to the skin. The skin might also feel dry and a bit tight. It’s important people are aware of this so they can schedule any special events accordingly. Makeup can usually hide this on the face anyway.” The number of treatments required is usually between 2-5, depending on a patient’s condition, and spaced about a month apart, says Stella Choi-Lombardi, RN, of Sydney’s Westmead Dermatologists, Skin & Cancer
Foundation Australia. “The first treatment uses gives the most significant improvement, as the patient will have had the greatest number of red and brown targets to treat,” she says. “But it also means that in subsequent treatment there is typically less redness and `dirty’ flaking.” Through the series of treatments, the skin repairs and renews itself and looks progressively more youthful. Perhaps we can, after all, look forever younger. WHAT BBL INVOLVES There can be discomfort; it is often described as like having a rubber band flicked at the skin as the pulsed light is absorbed by targeted areas. This sensation varies from patient to patient and depends on the depth of treatment. Topical anaesthetic can be used and also a cold air blower to reduce discomfort. Your eyes will be protected with safety shields or glasses. The BBL treatment may take a few minutes to half an hour, depending on the size of the area to be treated and the type of procedure performed. It is important to note that your skin will be more sensitive after treatment. Covering your skin or using broad-spectrum sunblock during the day is essential, as is avoiding direct sun exposure, at least until full healing has occurred. Patients with a darker skin type are more prone to pigment disturbances, so it is important to consult with only highly-trained and experienced practitioners, who will determine whether BBL is suitable, or how it should be tailored to suit individuals. For people with blemished skin, such as those who suffer from rosacea, maintenance treatments may be recommended every 1-2 years to keep such problematic conditions under control.
Beauty Fillers
FILLING YOU IN Injectable dermal fillers have come a long way since we used collagen (derived from cow hide) to combat lines and wrinkles. We look at the latest products, trends, techniques and the dos and don’ts. Dermal fillers are typically used to rejuvenate ageing faces but, increasingly, younger people without any obvious signs of ageing are seeking injectables to stop their features sagging in the first place. Volume in the cheeks is one of the hallmarks of youthfulness. As we get older, this midface fullness gradually declines and can lead to a hollowed, sagging, aged appearance. “We are seeing a trend towards people even in their early 30s having dermal fillers to maintain their cheek fullness,” says Sydney cosmetic physician Dr Peter Bakaric. “There’s a feeling of `why wait till I’ve lost it’. “Obviously much smaller amounts of filler are required than for a person whose face has already started to lose volume. But that extra bit of support keeps the contours intact and also provides a buffer from the natural deflation process. A treatment roughly every year or two, depending on the individual, would be enough to maintain these effects. “Of course with fillers you can also create the effect of high cheekbones, which are typically seen as being youthful and attractive, where there were none before!” Dr Bakaric says one of the biggest advances in the anti-ageing industry over the past decade has been the introduction of different consistencies of hyaluronic acid (HA) dermal fillers that allow this youth-enhancing “revolumisation”. First-generation fillers were very light in texture and used literally to fill lines, wrinkles and grooves, or add definition to the lip line.
are becoming a lot more savvy about how fillers should be used. “My patients want subtle, natural-looking results. And nowadays in Australia, cosmetic injectors tend to be a lot more conservative in the amount of product they use than, say, is the case in the US,” he says. “The trend here is increasingly to have smaller amounts of filler more often, to maintain a fresher, younger-looking appearance. “Done well, the effect of fillers can be subtle, attractive and rejuvenating but the downside is that it takes surprisingly little extra volume to create a strange-looking face that is very obviously `filled’.” “Pillow cheeks” and “trout pout” lips as seen at various times on celebrities such as Madonna, Lindsay Lohan, Lisa Rinna and Melanie Griffith are examples of going too far. As with cheeks, fullness in lips is regarded as a sign of youth and sexuality. The volume of lips in both men and women reach full thickness in the 20s and start shrinking between 30 and 40 years of age. The upper lip thins and the upper lip line (vermillion border) can become less defined. The Cupid’s bow that forms the centre of the top lip will also lose its projection and flatten out.
But newer products such as Modelis and Fortelis are more “viscous” and so can be “moulded” to strategically build up depleted areas of the face. HA is a sugar that naturally occurs in the body and is capable of holding 1000 times its own weight in water. This capability in dermal fillers further enhances their contouring effects and can help improve skin hydration.
Lips can be beautifully restored to their previous shape and plumpness, or made look better than Nature intended, with HA fillers such as Esthélis. However, overfilling lips, just as overfilling cheeks can make them look like pillows, defeats the purpose. In most cases, the upper lip is smaller than the lower lip and these proportions should ideally be maintained during a lip augmentation. Making the upper lip look larger than the lower can lead to the notorious “trout pout” or “duck bill” appearance.
Dr Bakaric says that injecting techniques have also evolved considerably as dermal fillers have become more varied and sophisticated. Equally, he adds, consumers
Another area at risk of overfill/overkill is around the eyes. Products such as Esthelis to fill the tear troughs is a remarkable rejuvenator. Hollowing under the eyes can
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Photos Courtesy: anteis sa
make people look older than they are, tired or even angry and enhance the appearance of dark circles. Subtle filling in this area to plump out the hollows gives an instant freshening effect to the whole face and reduces the appearance of dark circles. But again, the skill of the injector is allimportant. Too much filler under and around the eyes, especially in people with fat pads in that area, can lead to puffiness or the appearance of bags.
WHAT DERMAL FILLERS CAN NOW DO FOR YOU Leading dermal fillers such as Modelis, Fortelis, Esthelis and Mesolis are variously be used to: • Fill lines and wrinkles • Smooth nasolabial (nose to mouth) folds and marionette (mouth corner to chin) lines • Restore volume to “flattened” cheeks and the temple area • Fill tear troughs to offset a hollowed appearance under the eyes and reduce the appearance of dark circles • Restore or improve lip contours and volume • Hydrate the skin at a superficial level to restore the skin's elasticity and glow and help prevent the appearance of lines and wrinkles. Mesolis is the product of choice for this. These products can last for up to a year, and are gradually resorbed into the body. Modelis can last for up to two years.
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Amazing Filling you in on the multitude of injectable facial rejuvenation options STORY BY JENNI GILBER T Dermal fillers no longer just fill lines, wrinkles and folds, the way Spakfilla disguises cracks in a wall. Neurotoxin muscle-relaxant injections now do far more than “freeze” facial expressions that help cause or deepen these marks of time. Ever-new formulations, injecting techniques and strategic placements areas, as well as doctors’ greater understanding of these products’ potential, mean your face can be smoothed and “resculpted” to more youthful contours in the equivalent of a lunch break, no scalpel in sight. In the process, your skin will get extra oomph and glow. In the 32 years since the world’s first viable dermal filler, bovine collagen derived from cow hide, was approved for cosmetic use by the US Food and Drug Administration (FDA) and, subsequently, the botulinum toxin Botox for “freezing” wrinkles, the ageing process has been turned on its head. Today you can visit a doctor (or registered nurse, under the auspices of a doctor) and leave as little as 15-20 minutes later looking noticeably fresher and younger. In most cases you can go straight back to work or your normal routine. Depending on the area treated and your tolerance threshold, you may feel, virtually nothing, mild to moderate discomfort, Ouch. But there are options such as numbing creams, ice packs and pain relief/calming medication, all of which will be advised by your practitioner in advance. After treatment, there may be some redness and swelling. The latter can last a few hours to a couple of days. Bruising sometimes occurs and, depending on your body makeup and the area treated, may persist for 7-10 days. Nothing usually makeup can’t cover.
The results of Botox and its newer neurotoxin rival, Dysport, usually take a few days to a fortnight to fully kick in. In literally the right hands – because the knowledge, skill and experience of your injector is all-important – no one need be any the wiser, unless you tell them. People will likely remark that you look “rested”, “well”, “glowing”, “where did you go on holidays?”. These treatments can delay the need for facial plastic surgery (if you are so inclined) for years, or even altogether. Increasingly, younger people are seeking these procedures out as preventative measures. Your doctor will advise what is right for you, and when. The arsenal of non-surgical anti-ageing options is seemingly endless and grows all the time. Let NipTuck guide you through the maze so you know all the right questions to ask – and have a good idea of what you want - when you consult your doctor for non-surgical injectable rejuvenation. Although there are many options available, there is no “one best product” for any particular use. Our recommendation is to consult with an ASAPS, ASPS or CPSA member physician to discuss your areas of concern, and to hear the options they suggest.
DERMAL FILLERS
These are injected into various levels of the skin, depending on whether the aim is to revolumise, recontour or fill lines, wrinkles, grooves, folds and scars from the inside out. In the last five years, they have been more frequently used to “revolumise” depleted areas of the face, notably the cheeks, where there has been loss of youthful fat and taken on a “flat” or “hollow” and thus aged appearance.
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Amazing
FACE
There are even dermal fillers whose effects can last 10-15 years, such as Aquamid, for procedures such as augmenting chins or correcting nose contours. However, a patient is recommended to have semipermanent fillers first to see whether they like the results. And only the most experienced and skilled practitioners should ever inject Aquamid.
THE TROUT POUT IS OUT One of the casualties of the dermal filler revolution was the trout pout. The lips thin as we age and new-generation fillers enabled women to recoup the lusher, perter lips of their youth.
When the mid-face is revolumised, problem spots like nasolabial folds are often automatically improved by the subtle lift the face has received. Therefore these folds do not, as in previous years, need ”filling up”. At least, not as much.
Unfortunately the trend got out of hand that many celebrities – even today – were parodied for their so-called “trout pouts”. Injecting has trended away from this overfill to respecting the lips’ natural, ideal proportions, for a more natural, yet plumper, look.
HYALURONIC ACID FILLERS
Nurse injector Leisa Chappel has some great advice for those looking for fuller more natural looking lips. As a nurse injector at Brighton Day Surgery in Adelaide, she's learnt what clients want over the years and surprisingly it is NOT the 'trout pout'. She spoke to us about her experience.
The most popular dermal fillers on the market today are clear, biodegradable gels based on hyaluronic acid (HA). They are safe and require no patch testing (as bovine collagen did because, being animal-based, many people were allergic to it). HA is a sugar found naturally in human skin. It binds 1000 times its own weight in water and thereby hydrates skin for youthful-looking radiance. Young skin is smooth, elastic and contains a large amount of HA, which promotes skin volume, hydration and vitality. As we get older, the ability of the skin to produce collagen and HA decreases. This results in facial lines and wrinkles, as the skin and lips lose elasticity, firmness and volume. Fine lines and wrinkles diminish or disappear and lip volume is enhanced or restored. These fillers create a long-lasting and natural enhancement and can even be used to rejuvenate the neck, décolletage and hands. The effects are immediate and, depending on the patient’s physiology and the area treat, results can last six or more months. Over the past decade, major advances have been made in the formulations of HA fillers. The key brands available in Australia offer different gel densities from very thin and fluid for fine line treatment (eg. Esthelis) to thick and dense for volumising areas such as the cheeks and treatment of the hard facial features such as nose and jaw (eg. Modelis) or correcting very deep wrinkles and folds and adding lip volume (eg. Fortélis). Very smooth gels without the typical filling properties, with added glycerol for moisturisation benefits, are also used for deep hydration (Mesolis.). Think of it as a semi-permanent moisturiser! The facial contouring properties of contemporary dermal fillers have become known as “The Liquid Lift”. This can vary from plumping out the flattened mid face to also lift the lower face, and adding volume to the temple area to further lift the mid face. The jury is out on plumping under-eye hollows with HA fillers. If patients present with underlying fat content, the humectant properties of HA fillers can make the treated area look swollen and puffy. Where greater volume is required in certain areas od the face, more and more experienced doctors are using cannulas, where only one needle-stick is required to insert a “port” through which to inject and mould fillers, as opposed to multiple needle sticks to insert product. This results in far less time, discomfort and potential bruising.
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My clients are not looking for the `Trout Pout’ – rather, the complete opposite. They want natural-looking plump lips with a nice definition of their natural borders. Kissable Lips is sometimes how clients like to term it. Injecting lips is a very exciting facet of injecting and in my experience clients will often bring in a picture and say `I'd like lips like these. If the picture they show me cannot be achieved it is very important to discuss this with them during the consultation process. Assessment and discussion of treatment options is necessary to avoid disappointment with results. Overall these days, dermal fillers are lovely products that allow for ease of injection with minimal discomfort to the client. The non-permanency of these products allows injectors to address the changes that present for individuals as they journey through their years. My signature is providing a great treatment that enhances a client’s natural look and gives visible results.
BIO-STIMULANT FILLERS Another variety of dermal fillers are the bio-stimulants, such as Radiesse. These are used for “global” revolumisation as opposed to instant plumping of specific areas and literally “grow on you”, over weeks and months. Radiesse consists of tiny microspheres of a synthetic material called calcium hydroxylapatite (CaHA) that is combined with a common hydrogel used in vast array of products. The result is a white, creamylike substance. It is injected strategically to look natural and subtle and lasts 9-18 months. It has the added benefit of helping to speed up the production of natural collagen production by up to 20 percent, thus improving skin tone and texture. Typical Radiesse treatments include: smoothing and contouring smile lines or nasolabial folds, wrinkles at the comer of the mouth, vertical lip lines, acne scars, facial defects or recessions, frown lines, restoring volume in and around the cheeks and modest enhancements or correcting asymmetrical features. Radiesse remains soft and takes on the characteristics of the surrounding tissue. It can be used in conjunction with HA fillers for maximum aesthetic improvements.
AUTOLOGOUS FAT TRANSFER Autologous roughly means “your own”. Fat transfers involve
harvesting fat from one area of the body for injection into another area. Fat can be transferred to almost any area of the body. The most common is the face. Hollowness of the cheeks and temples can be treated and the upper cheek fat pad can be increased to give a more youthful look. The procedure is performed under local anaesthetic and the fat is harvested into syringes and cleansed to remove impurities. The fat may be either stored or used immediately in the target area. Only small amounts of fat can be injected into the target area on any one occasion; technology has improved so that more and more even distribution of fat survives in the target site.
PLATELET RICH PLASMA THERAPY (PRP) Often nicknamed The Vampire Facelift, a small amount (approximately 10-30ml) of your blood is drawn, similar to a blood test. It’s then placed into special vials spun in a centrifuge. The heavier cells, such as red blood cells, drop to the bottom of the vial and the plasma that is “rich in platelets” is left at the top of the vial. Once PRP is separated, it’s extracted into a syringe and then calcium chloride is mixed in to activate the clotting cascade and activate the platelets, causing them to secrete growth factors when injected into the treatment area. Platelet Rich Plasma uses your own cells to stimulate natural skin rejuvenation without the use of chemicals. PRP has long been recognised for its wound-healing properties in areas such as surgery and sports injuries, but now this technology is used for cosmetic enhancement. It helps treat skin laxity, dark eye circles, wrinkles and lines. It will increase collagen to gradually give you firmer, younger-looking skin over a period of weeks and months.
MUSCLE-RELAXANTS Let’s get this straight. Botox, Dysport and other botulinum toxin injectables are not fillers. They are substances to inhibit muscle movements in areas of the face and neck to soften, even eradicate, lines and wrinkles. They are a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and so can be artistically used to alter facial expressions. When we read about celebrities whose lips are ludicrously inflated, their “trout pouts” are often attributed to Botox. But it can’t add volume to lips, or anywhere else. Injected strategically it can improve the contour of the lip line, for instance, by lifting the corners of the mouth – but it doesn’t pump or plump. Officially Botox is only approved for treating “glabella” lines between the eyebrows (the pesky “elevens” that form when we squint and eventually take hold even when we’re not consciously frowning). The effect of the injection takes about 2-5 days to become noticeable, with maximum effect at 10-14 days. The effects of the wrinkle relaxer usually lasts 3-6 months (average four months), at which time another injection is required. If you have a repeat treatment, the results generally last longer than the first time. But over the past five years injecting techniques have evolved so that Botox is used to lift and recontour areas of the face and neck. In effect, by freezing muscles in one area it can release others to improve and rejuvenate the overall appearance. NIPTUCK Magazine
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GOOD THINGS COME IN
Sydney cosmetic surgeon
Dr Soo-Keat Lim discusses a revolutionary new facial rejuvenation injecting technique using
Photographs courtesy of Dr Soo-Keat Lim
bio-stimulant filler Radiesse.
Day 1 Facial ageing is a complex process and typically a combination of non-surgical technologies are used to revolumise and recontour features for a more youthful look, to improve the skin’s overall tone and texture and minimise hollows, lines and wrinkles. Now this can be achieved by using just one product in three different ways, according to Sydney cosmetic surgeon Dr Soo-Keat Lim. “I am using the bio-stimulant dermal filler Radiesse in a revolutionary way, that addresses three layers of facial ageing in one treatment,” he says.“Radiesse has a high elasticity and viscosity, giving it an impressive lifting capacity and when moulded and contoured into place it just gives you the look of a mini face lift without surgery. It is more than just a filler.” Dr Lim explains that the key characteristics of the ageing face are: • Thinning of the epidermis (upper layer of the skin) • Atrophy of subcutaneous fat layers, contributing to a hollow or sagging older look. • Progressive loss of collagen and elastin, the building blocks of the skin.
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Day 5
• Weakening of the underlying muscles, again contributing to the sagging. • Bone resorption, which means the facial structure shrinks over time. Radiesse is comprised of Calcium Hydroxylapatite (CaHA) microspheres, identical in composition to the mineral portion of bone and teeth, and a “carrier” gel for the purposes of injection. The gel is resorbed in the body over several weeks, leaving the CaHA to start the process of collagenesis, creating new collagen and elastin, for up to six months, thus making the skin thicker, fresher and overall youngerlooking. Dr Lim has mastered a 3-in-1 technique whereby he uses different volumes and dilutions of Radiesse to perform distinct roles in rejuvenating the face. “I liken it to the building of a road,” he says. “You use big rocks as the foundation, gravel to give it shape and then asphalt to make it smooth. “I inject a denser concentration of Radiesse at a deep level just above the periosteum (outer covering of
Day 12
bones in the body) to replenish volume loss, a slightly more diluted but still significant amount to restore contours and proportions in the subcutaneous level and inject an even more diluted version into the dermis and subdermal level to reduce skin laxity to give patients a smoother, more radiant complexion.
it Replenishes, Restores and Reduces.
“However, the 3-in-1 technique can also be broken into individual treatments, depending on the patient’s needs and desires.
The volumising results are immediate and the contour and the lift remain looking good over the next six months, after which there is a fade-off.
“The Radiesse is mixed with Xylocaine, which is a local anaesthetic to reduce discomfort, and further dilutions are achieved by adding normal saline solution.” Dr Lim says the effects of Radiesse, which celebrates its 10th anniversary this year, can last up to 12 months depending on the technique and site of the injections, a patient’s age and metabolism.
”It is ideal for use in all areas of the face except the glabella (between the eyebrows), tear troughs and lips. “There is initially some swelling after treatment but most of it would have settled after 5-7 days.
“The texture of the skin continues to improve over the first six weeks and remains good over the next 6-8 months and then it starts to fade off.” Dr Lim says that impressive results with Radiesse in rejuvenating hands is one of the last frontiers in skin rejuvenation.
Clinical studies have shown that Radiesse is biocompatible, nontoxic, non-irritant and non-allergenic.
“As you know, hands and neck are the most neglected areas in skin rejuvenation,” he concludes. “Yet, hands are a dead giveaway in terms of showing someone your age.
“Radiesse is a great rejuvenator and can provide a complete upper, mid and lower facial lift and refresh,” Dr Lim adds. “I like to say
“I always say to my patients: `Why just buy that beautiful Chanel bag and not lift the game by having a pair of hands to show it off !’.”
At arc medispa, our dermal consultants use up-todate dermal treatments and skincare products for everyday skin maintenance and skin correction.
Sun damage, uneven skin tone or pigmentation an issue? Interested in anti-ageing treatments for good skin health?
• Skin Assessments • Skin Needling • Chemical Peels • Light & Laser Therapies • Microdermabrasion • Medi-Facials
For an appointment, call Melbourne 03 9828 1300 or Shepparton 03 5820 0500 Member of the ARC Plastic Surgery Group
www.arcmedispa.com.au
Facial Rejuvenation for:
Feel
refreshed & youthful with
FACIAL rejuvenation Freshen up your look with anti-wrinkle treatments and dermal fillers.
• Soften & Smooth
Dynamic Wrinkles • Full & Defined Lips • Cheeks with Volume • Softened Jowls
By Cosmetic Physicians Dr Vilma Di Maria MBBS FRACGP
Dr Lisa Freeman
MBBS FRACGP DRACOG
Dr Fiona Jane MBBS
For an appointment, call Melbourne 03 9828 1300 or Shepparton 03 5820 0500 Member of the ARC Plastic Surgery Group
www.hyperdermics.com.au
NIPTUCK Magazine
67
Scar Treatment
hitting
THE MARK A breakthrough silicone gel formula for professional and home use is helping prevent wounds from turning into unsightly scars, and old scars to fade away. Scars can have both a physical and psychological impact on their sufferers. They may cause problems like itching, tenderness or pain and with scars that continue to grow (hypertrophic and keloid), they can limit movement. The psychological effects can often outweigh the physical, even with the smallest of scars. For some, it’s a constant reminder of a traumatic event. People with scars may feel “different”, even stigmatised. The reaction of others can be cruel and this may lead to loss of self-confidence, feelings of inferiority and social selfconsciousness. Fast healing of wounds is key to minimising abnormal scar formation. A breakthrough silicone gel-based formulation, Stratamed, can be used immediately after surgical procedures, trauma, skin resurfacing and radiation therapy. Stratamed supports the healing process of the skin, which leads to a decreased incidence of abnormal scarring. Introduced in 2011 by SciGen Australia, it is increasingly part of the cosmetic medical industry’s post-procedure care protocol. Stratamed is the first siliconebased scar therapy gel
68 NIPTUCK Magazine
approved for use in open wounds and compromised skin, and can be used just after any procedure including for skin cancer.
“Especially with longstanding keloid scars, I have noticed a significant reduction in redness after this course of action.” Silicone gel is internationally recommended as first-line treatment in scar management. Strataderm dries to form a silicone gel sheet, a protective layer that is gas-permeable and waterproof. It hydrates and protects skin from chemical and microbial invasion and helps normalise the collagen synthesis cycles, producing a normal, mature scar.
Its stablemate, Strataderm, can be used for both old and new scars and also helps soften and flatten keloid and hypertrophic lesions. Dr Samuel Seit has treated over 25,000 malignancies at his practice, The Skin
Cancer and Cosmetic Clinic in Neutral Bay, Sydney, and has been recommending Stratamed and Strataderm since 2011. “After fractional CO2 laser resurfacing, we now ask patients to use Stratamed twice a day (morning and night) to help minimise scarring and as a prevention for hypertrophic scars,” he says. “Patients can now use less Vaseline applications in between (from eight applications a day down to 4-5 times a day following fractional
resurfacing). “During the course of healing, scabs form on the skin’s surface and when these fall off Stratamed can be continued but Vaseline has to be stopped as it clogs pores. “Stratamed can be continued for a few weeks as it accelerates resolution of post ablative laser erythema [redness] on the face and accelerates healing. “For older scars we recommend Strataderm. We treat these with cortisone injections in-clinic, followed by Strataderm for use at home.
Strataderm is easy to use and only needs to be applied once or twice daily but continuous contact with the skin must be maintained 24 hours. Applied properly, it dries within 3-4 minutes, can be used on hairy areas and areas with contours. Make-up or sunscreen can be applied over the top. It is also handy for use in everyday life. Used on things like cooking burns and blisters on the feet from too-tight shoes, it can prevent marks scars and discolouration from forming. The products are effective and affordable and available from pharmacies and cosmetic medical clinics.
Strataderm - effective and affordable silicone scar therapy for old and new scars ƕ 6RIWHQV DQG ˘ DWWHQV UDLVHG VFDUV ƕ 5HOLHYHV WKH LWFKLQJ DQG GLVFRPIRUW DVVRFLDWHG ZLWK VFDUV ƕ 5HGXFHV UHGQHVV DQG GLVFRORUDWLRQ ƕ 3UHYHQWV DEQRUPDO DQG H[FHVVLYH VFDU IRUPDWLRQ
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Switzerland
Will I Age
like my mother?
Have you ever pondered the thought “Will I age like my mother?” According to celebrity Plastic Surgeon and Anti-Ageing Physician, Dr Vincent Giampapa and Medical Advisor to Jeunesse Global, we may actually be able to escape our genetics to a certain extent. Increasingly, research is indicating that genes are no longer the only determining factor in the ageing process. In fact, only 30% of ageing is determined by our genes and 70% is up to us. In other words, the majority of the ageing process resides in our ability to control our lifestyle, environment, and how we look after our bodies and our DNA. Dr Giampapa defines DNA as the blueprint in the millions of cells in our body that dictate our ageing potential. As a result, the most important thing we have learned from both research and at a clinical level is number one -to help prevent damage to our DNA, and number two is to help DNA repair itself. “Typically, the most visible change associated with ageing is seen in the face where the loss of elasticity of the skin results in wrinkles and creases. Stem Cells are a key element in the ageing process. In our bodies there are 2 types of general groups of cells; our
Dr Vincent Giampapa Plastic Surgeon and Anti-Ageing Physician
body cells and stem cells. It is our stem cells that keep our body healthy and create the new cells and determine how well we look and age” says Dr Giampapa. Dr Giampapa explains how stem-cell derived skincare with Growth Factors is able to help support the structure of skin cells and coaxes the skin back to a healthy, regenerative state.
It transforms the skin by encouraging your body’s natural processes to produce more proteins like collagen and elastin. Jeunesse Global’s new LUMINESCETM range of human adipose stem-cell derived skin care containing Growth Factors highlights significant developments that are happening in anti- ageing skin care. The range is based on the principles of Regenerative healthcare; which encourages the body’s own cells to reproduce and repair, maintaining a healthy and youthful status Dr Giampapa believes that; “This is the first time that the principles of regenerative medicine in skincare, or the whole new technology of having the body heal itself and be able to produce compounds that actually make itself better, has been available to the public market, rather than just the medical market... The Luminesce product line is, in my mind, the first real legitimate approach to regenerative medicine and skin restoration.” “With the LUMINESCETM range, we may actually be able to escape our genetics to a certain extent. That is if we look after our DNA and our bodies through good nutrition, exercise, reducing stress and toxicity, and remaining as healthy as possible.
For stockist information please contact P: (02) 8007 3116 or visit www.JeunesseGlobal.com 70 NIPTUCK Magazine
hair
HAIRFREE
Permanent David
GINGES
David Ginges has enjoyed a variety of professions, from pharmacist to rock promoter and now software development CEO, but in 2004 he came across an opportunity that he has found one of his most rewarding. At the time permanent hair technology was usually performed by doctors and expensive. David found a way to make it affordable for everyone – now available at clinics around Australia.
reduction Permanent hair reduction is a process by which an energy source, such as laser or Intense Pulsed Light (IPL), deactivates hair follicles preventing future hair growth. Most people see long-term, even permanent results after a few sessions and enjoy no more shaving or waxing. David Ginges is adamant that IPL is by far the safest option for his clients. At Hairfree, specially designed machines emit short pulses of light that penetrate the skin (whether on underarms, legs, lip and chin, bikini line - indeed, most areas of the body are suitable) and create heat, which in turn destroys the hair. “I will not use laser because there is too much margin for error, especially by practitioners without adequate training,” he says. “Therapists should be experienced and must hold current laser safety certificates to be properly qualified. “If the setting is too high, it can burn the upper layer of the skin and cause blistering, perhaps eventually hyperpigmentation (excess darkening of the skin on the damaged area), or hypopigmentation (loss of colour). “Most hair reduction lasers use a cooling tip, so the practitioner and even the patient can’t always tell there is overheating until it’s done.” David says IPL in the hands of his highly trained and experienced practitioners there is no such risk. “Because the treatment uses only light (no chemicals, radiation etc.) there’s no
damage done your skin, and only hair follicles are affected,” he says. “Generally, all laser and IPL hair removal treatments hurt. It feels something like a rubber band being flicked against your skin. It’s not pleasant, especially in more sensitive areas. Hairfree IPL treatments, however, are pain free.” David says all but Fitzpatrick Type 6 (very black) skins are suitable for treatment. Type 6s have a very high risk for trauma, heat and chemically caused pigmentation, and also keloid (raised, rubbery) scarring. Until recent times, grey, white and red hair was difficult, even impossible; to treat because there was not enough pigment to attract the light and, so, destroy the follicle. However, a patented IPL process used at Hair free targets the blood source around the follicle, effectively cauterising and deactivating it that way. David says the treatment area is waxed by the therapist exactly 20 minutes before the treatment can begin. He says it has been particularly effective for women who start to grow light hairs on the upper lip a chin as they age. “Hairfree’s are the only painless permanent hair reduction treatments around,” David concludes. This is one of the reasons we’re the largest hair removal company in Australia with thousands of happy clients who have done nearly two million sessions with us over the last decade.”
Visit www.hairfreeforever.com.au or call 1300 424 737 for more detailed information, clinic locations and specials. Most clinics open during business hours but can also open in the evenings to accommodate after work appointments.
TRICHOLOGY
CLINICAL TRAINING IN SAN ANTONIO, TEXAS
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A B R A N C H O F D E R M AT O L O G Y F O C U S I N G O N T H E S C I E N T I F I C S T U D Y O F T H E H E A LT H O F H A I R A N D S C A L P.
TINEA CAPITIS
IAT SIGN OF RINGWORM OF THE SCALP
W H AT I S C A U S I N G Y O U R
HAIR LOSS? Hair loss is distressing no matter your age or gender. It is important to have the cause diagnosed by a qualified practitioner - and the sooner the better. It is much easier to stop, or slow the process, if assessed early. Trichology is a branch of dermatology that deals with the hair and scalp. A trichologist not only identifies the causes but is best trained to treat them. Most patients seen by trichologists are women with hair loss problems, but many women still make the common mistake of thinking a hairdresser will have the answers. Hairdressers are not trained for this, according to Australian trichologist David Salinger IAT. Anyone experiencing balding, thinning or unnatural shedding should ideally seek the help of a trichologist. If the problem is discovered to be genetic (that is, Male or female pattern baldness), the trichologist will discuss the possible therapies, including hormonal therapy, topical therapy and natural therapies. Mr Salinger was recently a keynote speaker at a conference held by the International Association of Trichologists in San Antonio, Texas. Other Australian trichologists Kate Dawes, Sue Erickson and Sarah-Marie Morrison also attended.
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By Trichologist David Salinger IAT
ALOPECIA AREATA
POSSIBLE CAUSES
OF HAIR LOSS Apart from hereditary pattern baldness, the reasons for losing hair are multifold: You may be anaemic, have deficiencies in iron, zinc and/or calcium, have been toostrenuously dieting and depriving your body of essential nutrients, or have changed your diet. Perhaps you have knocked your head or are suffering a fungal infection. Hormonal surges or imbalances, particularly during pregnancy and menopause, as well as hormonal medications (such as the pill and HRT), can contribute to or cause hair loss. Anabolics (synthetic steroid substances related to the male sex hormones), including growth hormones and creatine, can trigger or aggravate hair loss, leading US hair restoration surgeon Dr Larry Shapiro told the recent trichology conference in Texas. Certain medications, trauma, extreme stress, thyroid disorders, chronic illness and autoimmune diseases are all known to play a role. Alopecia areata is a common problem; this is a type of hair loss that occurs when your immune system mistakenly attacks hair follicles, leading to patches of baldness. The hair loss is usually not permanent and trichologists use therapies aimed at reducing the auto-immune attack.
â PITYRIASIS AMIANTACEA
â DISCOID LUPUS ERYTHEMATOSUS
Photographs © David Salinger 2013
NEW SOUTH WALES SYDNEY David Salinger I.A.T. (02) 9267 1986 www.hair-loss-centre.com.au QUEENSLAND BRISBANE AREA Majid Iranfard I.A.T. (07) 3262 3666 0405000240 www.triclinic.com.au BRISBANE CITY Carolyn Evans I.A.T. (07) 3229 3242 0414953580 www.absoliquehairhealthclinic.com.au SOUTH AUSTRALIA ADELAIDE David Salinger I.A.T. (08) 8296 4098 www.hair-loss-centre.com.au TASMANIA HOBART Maria Katos I.A.T. (03) 6224 8262 www.tastrichologycentre.com.au VICTORIA MELBOURNE Pam Jameson Smith I.A.T. (03) 5428 2523 0417528903 www.trichotechno.com.au WESTERN AUSTRALIA PERTH Kathryn Dawes I.A.T. 1800 668 480 www.mhra.com.au
Instant
BRAND SNEW MILES It is an amazing time in dental care, with impressive options that, unlike traditional techniques no longer require painful needles and drilling away of your sensitive tooth structure to help you improve your smile. You can ask your own or find a specially trained dentist about LUMINEERS, the world’s leading no needle, no drill porcelain veneers or ‘SnapOn Smile’. Snap-On Smile is an affordable, removable option that
is perfect for those needing a safe and quick result, and available at specially trained dentists around Australia. Snap-On Smile has changed tens of thousands of lives, around the world. Many people have been impressed by the simple and affordable choice that can be used for young and old alike, to replace missing teeth, improve the shape, colour and appearance of
Queensland
smiles, hide chipped or worn or mildly crowded teeth and restore confidence so easily. These are just a few of the wonderful cases from very happy patients around Australia! To find out whether you are suitable for Snap-On Smile – ask your dentist, or to find a specially trained dentist nearby, or for more information, please feel free to email assist@godental.com.au
Dr Saurav Gupta:
SURFERS DENTAL SPA
Before I was one of the first dentists in Australia to provide Snap-On Smile, and I have found many successful applications for patients. There are a number of ways to change a patients’ smile, but few options to do so quickly, affordably, and without having to use needles or drills. We have helped hundreds of patients smile with new confidence, and have patients fly in from around Australia to see us. Lisa, one of our favourite cases, had many fillings and extractions. She was
desperately worried about how her smile would look. Lisa had heard of many options, but chose SOS as it could give her “beautiful teeth like other people” and was within her budget. She cautiously had a top one crafted, but once we inserted it for her she was so happy and insisted that we make a bottom one straight away. She hasn’t stopped smiling since. Lisa tells us how much her life has changed, and how much more confident she is at work and in her private life.
You can contact Dr Saurav Gupta at: Surfers Dental Spa, Level 1 Suite 4, The Hilton, Surfers Paradise Boulevard, Surfers Paradise QLD 4217 – Tel 07 5538 0101
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After Lisa has referred many of her friends and family to us, and she brings a big smile to our faces too whenever she visits us with her new, happy, big smile!
Victoria
Dr Ron Fulop:
MITCHAM DENTAL CLINIC
Before
After
New
You can contact Dr Ron Fulop at: Mitcham Dental Clinic, 24 McDowall Street Mitcham VIC 3132 – Tel 03 9874 2300
South Wales
Our patient was very unhappy with the colour, shape and symmetry of his teeth. He was too self-conscious to smile and lacked confidence in his appearance. He had seen other dentists and was discouraged by so many conflicting, scary and expensive treatment options. Some suggested that he would need ‘tens of thousands of dollars’ worth of treatment, his teeth drilled back, and crowns or traditional veneers placed. He was uncomfortable
with very complex treatment plans that had been presented to him elsewhere. Within two short appointments, without any needles, drilling away of his teeth and much less cost, we were able to help him achieve his aims. We were able to keep things simple and end up with a great result. Now our patient is happy to smile, feels much more confident and has been referring many others to our practice!
Dr Jason Pang:
COSMETIC SMILE DENTAL
One patient had a denture but you could not see any of his top teeth. He used to spend most of his time in his room and now feels much more confident about his smile. He was quite hesitant about getting a SnapOn Smile as he wasn’t sure it would make much difference. However once a diagnostic wax up was made and tried on, he was sold. He loves it and has become a regular patient of the practice.
Another happy patient is a singer and an actress who has been in many Australian films. She is a confident woman but never smiled with her mouth open. She was worried that the Snap-On Smile would be a problem for singing but it has not been an issue. She is now very much more confident with her smile and very happy with the result. She now also brings her husband to the practice. I hope she’ll have a role where we can see her smiling more!
South Australia Dr Timothy Goh:
Before
After
Before
After
You can contact Dr Jason Pang at: Cosmic Smile Dental, Suite 212, 40 Yeo Street Neutral Bay NSW 2089 – Tel 02 9904 2880
OXFORD DENTAL PRACTICE
Heather’s mother brought her in to find out whether we could help her. She had seen many dentists before us, and was quoted between $30,000-$40,000 for orthodontics, implants and veneers. Emma barely spoke at her appointment, and certainly did not smile. Her mother needed something affordable and effective, to improve a smile that was missing teeth, gappy, discoloured, with oddly shaped teeth. In just two short appointments, without the use
of needles or drills, and less than a 10th of the quotes she had been given, we gave her the smile she had dreamed of. After a few months, Heather came back, happy, smiling, and tells us that we have “completely changed her life”. Heather’s SnapOn Smile story illustrates how important your smile is to how you are perceived and how you perceive yourself. We were so honoured to be part of her amazing journey.
Before
After
After
You can contact Dr Timothy Goh at: Oxford Dental Practice, Shop10/169 Unley Road Unley SA 5061 – Tel 08 8357 8900
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Cosmetic Medical Procedures
WHAT HAPPENS IF THINGS GO WRONG?
Are you protected? Written by Dr Michael Molton, principal doctor at epiclinic
Medical Indemnity insurance is mandatory in Australia for every health practitioner to protect patients if ever a cosmetic procedure goes wrong, and the sheer fact is, complications in cosmetic procedures do occasionally happen. Are you, as a patient, always protected by that medical indemnity insurance? The answer is no, you are not in certain circumstances. If a procedure is not strictly lawful, for example performed by an unsupervised non-doctor, or the doctor does not have the proper insurance policy, you may not be protected. If you are not protected, and something goes wrong, the sad fact is, since the procedure you underwent was cosmetic, you may have to foot the bill privately to fix it, because Medicare doesn’t cover cosmetic costs, and that could mean being out of pocket thousands of dollars.
Procedures not strictly lawful If you have ever had to make a claim against an insurance policy you will know about exclusion clauses. Medical indemnity insurance that protects you as a patient is no different. The Australian Health Practitioners Regulation Agency or AHPRA determines the ‘scope of practice’ for all registered health practitioners, but it is the prescribing and administering of prescription-only medications that can be the illegal part. Complications arising from non-doctor prescribing in cosmetic medical procedures has become a major problem in Australia. Nurses, claiming to be ‘supervised’ by doctors are receiving supplies of prescription-only medications and injecting patients without any doctor having examined the patient, or even knowing the existence of the unsuspecting patient. Surely though, the nurses must have their own insurance you say. You guessed it, even if they hold a policy, same circumstances
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stand, there is no cover for illegal acts. But how can that happen in Australia? How do these controlled medicines end up in the hands of unauthorised health practitioners in the first place? Why haven’t the regulators, whose job it is to protect patients, done something? That part is complex but mainly to do with limited resources and arguments about whose job it is to prosecute the offenders. There are at least five government agencies who could act but no one can agree who should do it. The suppliers say they have no control of their products once they are delivered. All it needs is the nomination of a friendly doctor (of anything) and a delivery address to get around supply.
Inadequate doctors insurance Insurance for doctors who perform cosmetic procedures is scaled to specific treatments the doctor performs. If, for instance, a doctor who was not listed by the insurance company for performing liposuction, and he/she performed that procedure on a patient and it went wrong, the insurer would not pay. Some cosmetic clinics falsely state that it is OK for the nurse to treat with prescriptiononly medications without the doctor being involved because of “Standing Orders”. This is definitely not OK and you will be unprotected by the doctor’s and/or nurse’s insurance if the procedure goes wrong.
So how do I as a consumer know I am protected if things go wrong in my cosmetic procedure? 1. Make sure, if something is going to be injected into the body, that the doctor, who is responsible for your cosmetic procedure, attends you in person before treatment by a nurse. It is OK for a doctor to then delegate some medical procedures to an appropriately trained registered nurse and who must also be appropriately insured but the doctor must officially prescribe (write) all prescription-only medications to be used upon each individual patient following an in-person, individual assessment prior to treatment. 2. You are entitled to view both the doctor’s and the nurse’s health practitioner’s ‘Certificate of Currency’ that confirms the existence of medical indemnity insurance 3. There are several levels of cosmetic medical indemnity insurance. Make sure that the procedure you are consenting to is listed on the Certificate of Currency in the doctor’s offices. 4. Check the type of insurance. It must say Medical Indemnity Insurance to comply with medical laws of Australia. Medical Malpractice Insurance is NOT the same and may not adequately protect you. Medical Malpractice Insurance usually does not provide assistance ‘up-front’ for the doctor and affected patient but relies on the assessment of each claim after the matter has been settled. That process could take years 5. Attend a proper cosmetic medical clinic for your procedures, preferably one that is an Accredited Healthcare Facility that must follow policies and protocols that protect patients in times of need. Remember, cosmetic procedures are real medicine and carry real risks. You can minimise those risks by choosing the appropriate professionals. Copyright Michael Molton. Not to be reproduced without permission.
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A 131 Summers Street, Perth WA 6000 | P (08) 9328 8349 | F (08) 9228 9377
www.medifit.com.au
A PERSONALITY OF ITS OWN ORANGE MOOSE DENTAL
Orange Moose Dental is the name of a new dental practice established by Dr Hanno Venter in the Bundaberg region. After practising in the area for a number of years, he approached Medifit to help create his first dental practice.
“I’ve had a very specific dream for how I want to operate and what I want my practice to personify. Because of these ideas I’ve always had, I was very nervous about finding the right guys to translate these ideas onto paper and share my creativity. After probing the market of medical and dental practice development, I came across Medifit and was impressed by their creativity and individual approach to designing unique practices. “ Moose are known for their strength, their independent spirit and their resolute non conformity, character traits that Hanno shared and admired. With such a strong branding opportunity, the idea of a fully themed business was soon realised and “Orange Moose Dental” was born. Hanno’s brief for his first practice was to create a welcoming environment in warm autumn tones with an earthy feel, reminiscent of his favourite season. The design features wood grain panels contrasting with light modern walls, bringing an earthiness to the interior without losing the contemporary feel. Printed aluminium wall panels replicate the forest texture in the main hallway and across the ceilings, paying homage the moose’s natural environment. The panels feature cutouts of a moose silhouette and are mounted over bright orange stripes bringing the orange moose concept indoors. = “Medifit gave me amazing service and I literally can’t stop telling people I meet how great they have been on this
dream of mine. They continuously push the boundaries without losing sight of reality, what works and what doesn’t. The overall effect is a uniquely branded, contemporary dental practice with a personality of its own. The reception from patients and the local community has been overwhelmingly positive as Orange Moose Dental seeks to establish itself as the practice of choice in the area. “Medifit takes pride in what they do and also how they do it. I am very excited about what they have achieved and it’s great to see that they’ve always been excited with me during the whole process. I recommend Medifit to everyone who is considering building a practice, starting a practice or extending what they already have.” Sam Koranis, Medifit’s Managing Director adds: “Dr Venter is Medifit’s dream client. Someone who is prepared to push the boundaries and live by his convictions. From a design perspective, we enjoyed listening to his vision and wish to thank him for allowing us the creative freedom to deliver such a project.” “On a personal level, it is very rewarding when a client entrusts Medifit with the whole process. It is a great privilege and it inspires the team to deliver fantastic results. “
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USTRALIA
Photo courtesy of www.bradgriffin.com
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• Breast Augmentation • Reduction Mammaplasty • Mastopexy • Gynaecosmastia • Abdominoplasty • Meloplasty Blepharoplasty • Otoplasty • Rhinoplasty • Anti-Wrinkle Injections • Dermal Fillers • Facial Volumising • Medical Skincare • Skin Cancer Surgery
North Adelaide Day Surgery
174 Ward Street, North Adelaide SA 5006 Ph 8239 0115 | Email info@jameskatsaros.com.au
Joanne Heggie our Clinical Nurse Consultant
jameskatsaros.com.au
Best
The
for the Patient
Whether you are considering breast surgery, having a tummy tuck, your eyelids surgically rejuvenated or your nose refined by rhinoplasty, no concern is too small and no detail will be overlooked by plastic and cosmetic surgeon Dr James Katsaros. With extensive training in the full spectrum of plastic surgery, and almost three decades of experience, Dr Katsaros has established a loyal following through his private practice in South Australia – The North Adelaide Day Surgery. “I am passionate about excellence in plastic surgery and this is reflected in the nature of services we provide. We offer the very latest equipment and care, with specialist anaesthetists and we have full ISO 9001 Health Certification.” “Every patient’s presenting problem is unique,” says Dr Katsaros, “For our patients to get a good outcome, the treatment plan must be individualised to their particular physiology, hopes and desires.”
“I am passionate about excellence in plastic surgery and this is reflected in the nature of services we provide.” “I encourage a sense of responsibility in our patients. They must be willing to listen to good advice, and trust in our expertise.”
His mission is to ensure the best possible outcomes are reflected in
North Adelaide Day Surgery offers a comprehensive range of cosmetic plastic surgical procedures including breast surgery (implants, reductions and lifts), abdominoplasty (tummy tucks), rhinoplasty (nose jobs), blepharoplasty (upper and/or lower eyelifts). They also have the full complement of non-surgical anti-ageing procedures, as well as performing skin cancer surgery, and all procedures are offered on site at the one location. Dr Katsaros is joined by Clinical Nurse Consultant Joanne Heggie, who provides facial rejuvenation treatments such as dermal fillers, facial volumising and anti-wrinkle injections and medical skincare.
“I encourage a sense of responsibility in our patients. They must be willing to listen to good advice, and trust in our expertise. They are given comprehensive information so that they can make an informed decision about their surgery and have realistic expectations of what can be achieved.”
the attitude of the staff at North Adelaide Day Surgery centre. They are all long-serving employees who share Dr Katsaros’ dedication to patient service, satisfaction and safety.
Breast Augmentation Before
Breast Augmentation After
North Adelaide Day Surgery Centre offers a convenient, efficient and calming environment for our patients’ surgical needs,” Dr Katsaros concludes. “I am passionate about excellence in plastic surgery and this is reflected in the nature of services we provide. NIPTUCK Magazine
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Beauty&Breast The
Photos and Words by: Selina Lam of Beauty Access
Selina Lam is an experienced Para/Medical Cosmetic Tattoo Practitioner and Trainer. Patients are usually referred by a surgeon or professional consultant. Selina creates a natural looking 3-D nipple and areola, using blends of soft natural coloured pigment.
Areola & Nipple Tattoo YOUR QUESTIONS ANSWERED The natural result of micro-pigmentation of the areola and nipple restores confidence and helps you feel desirable again after losing one or two breasts to cancer after surgery. We understand that after diagnosis and invasive surgery, often the last thing you want to think about is more reconstructive work. Many patients and surgeons will opt for 3D tattoo rather than darker skin grafts taken from other areas of the body. Over the years, para- medical tattooing has proven to give a more realistic and satisfying result. Many clients claim it has changed their lives and increased their confidence and femininity. Services that a Para/Medical Cosmetic Tattooist performs include reducing visibility of scars, improving loss of natural skin pigmentation, areola and nipple creation and re-pigmentation.
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Is para/medical tattoo different to other semi-permanent tattoo procedures? The para/medical or the semi-permanent cosmetic tattoo of the areola and nipple restorative technique is much like a cosmetic tattoo. However, different procedures, tools and needle combinations are used. This specialised work will create a natural looking nipple and areola.
Before - cosmetic tattoo
After - Immediately after micro-pigmentation on both breasts
How long does the procedure take? Micro-pigmentation is usually completed within two hours. This includes the measure and design of the nipples and areolas, colour selection and matching to skin tone and finally tattooing the work of art.
You have a choice? At Beauty Access Cosmetic Tattoo Centre, we appreciate that everyone is different and encourage clients’ involvement throughout the entire process. Once the client is completely satisfied with all aspects of the process, which have been specifically tailored to their individual needs, will the procedure take place.
Any discomfort? Anaesthetics are used throughout the procedure for the comfort of the client completely minimising pain.
Australia
After-care? Instructions will be provided to ensure best results for aftercare. The areola area will be prepared and covered with a gauze swab, and you will be asked to keep the area moist with an ointment to help the healing process. Following the tattoo procedure, you will notice subtle changes and improvements occurring over the next few days. Immediately after tattooing, the tattooed area will look darker than the final result. However over the ensuing couple of weeks, the area will look more natural and softer in colour. When the area is totally healed, usually within 6-8 weeks from the initial procedure, a second session is required called the perfection session. The perfection session completes the process by touching up any colour imperfections and shaping.
BILATERAL
Permanent Cosmetic Training
Beginners • Advanced • Refresher Classes
Training partner RTO:21791
Design and perform cosmetic tattooing/micropigmentation prodcedures (WRBSS505B)
BEFORE
AFTER
Stage 1 –before cosmetic tattoo
stage 2 – designing nipple & areola
Stage 3 – After 3 D Nipple & Areola Re-pigmentation
EMAIL: sales@beautyaccess.com.au
UNILATERAL The Secret is SofTap® Before - Nipple and Areola tattoo
After –Immediately after micro-pigmentation
A nipple has been surgically set in place ready for micro-pigmentation
Designing of Areola and Nipple
Stage 1 – before cosmetic tattoo
After surgery, not all women will have a nipple or alternatively the nipple has collapsed. Artistry in recreating a 3D nipple is important to build an illusion of an erect nipple with colour. Para/Medical Cosmetic Tattoo Specialists, such as myself, need to design areola and nipple according to individual skin tones, surgery results, and patient preferences, creating a beautiful symmetrical work of art.
Permanent Makeup Services at Beauty Access: Eyebrows – Hairstrokes or block Eyeliners • Lips • Scar camouflage Nipple & areola re-pigment Corrections • Removal
Ph 08 8364 2126 M 0419 828 691 E sales@beautyaccess.com.au stage 2 – designing of the nipple & areola
Stage 3 – after 3D Nipple & Areola re-pigmentation
SofTap® Permanent Cosmetic Trainer & Supplier
Before
FRIENDLY, CARING & HIGHLY EXPERIENCED DENTISTRY
DrSatera with
In both practices our aim is to inform patients of their dental needs. This is accomplished by making patients aware of their oral health and offering the most effective preventive and restorative options in order to achieve and maintain optimal oral health.
Dr. Satera Papageorgiou BDS(Adel)
Satera has been a dentist for over 25 years, and has owned 3 practices in the Northern suburbs of Adelaide, this being the only one now, along with Copper Coast Dental in the country. Their team of dentists, dental hygienists and dental therapists at both practices is friendly, caring & highly experienced. With newly refurbished treatment rooms and state of art equipment, they have the very latest in dental technology at their disposal.
Not only do we aim to restore function we also strive to improve the appearance of our patient’s smile. One’s smile can be improved in a variety of ways however, we are continuously aware that no one person’s needs and desires are the same. Improving one’s smile can be achieved in a variety of ways. These may involve teeth whitening, using Smartbleach® Teeth Whitening, which is the latest inhouse LED whitening system, resin and porcelain veneers procedures, addition of natural looking porcelain fillings, dental implants or Invisalign teeth alignment with clear braces. Dr Satera Papageorgiou is the owner and practice principal of Mawson Lakes Dental in Adelaide and Copper Coast Dental at Kadina. She practices all modalities of dentistry and has a keen interest and extensive experience in rehabilitative, cosmetic and implant dentistry. She is also Invisalign trained and accredited. Dr Papageorgiou practices a holistic approach to dentistry and believes in treating all members of the community as equals when it comes
to their dental needs. Equally she enjoys looking after families and seeing her patients and their families return year after year. Dr Papageorgiou has in the past been a councillor for the Australian Dental Association SA Branch and sat on their Peer Review Committee. She has also been the Dental Representative on the Medical Advisory Committee for the Calvary Central Districts Hospital for the past 23 years. She is a keen advocate of improving the health and dental health status of rural Australians. She has involved herself with offering her services to remote indigenous communities in the Northern Territory, visiting such places as Yarralin and Timber Creek. Dr Wayne Lowe is the full-time dentist at Copper Coast Dental and he enjoys all facets of general practice dentistry. He has 35 years’ experience with particular interests in dentures, cosmetic dentistry, crown and bridge-work, and porcelain veneers. He is a member of the Australasian Sleep Association in which he has a special interest in sleep apnoea and oral anti-snoring devices. Dr Lowe’s dental philosophy is to treat patients with high quality and pragmatic dental care. He can often be heard advising “..this is what I’d do if I, or one of my family had this dental problem.”
BEFORE Patients teeth before Invisalign tooth alignment
AFTER Same patient after 17 months of Invisalign tooth alignment. Incisors have been re-contoured to give a softer edge to these teeth
a beautiful smile
Would you like to improve your smile? Mawson Lakes Dental and Copper Coast Dental offer a wide range of treatments that can help to create a beautiful healthy smile. General Dentistry • In-house IV sedation GA in hospital • Teeth whitening Cosmetic dentistry – resin and porcelain veneers Crowns – bridges • Implants
BEFORE Emergency patient – needed an immediate solution after losing front tooth
AFTER Interim direct bonded bridge to replace gap – before going ahead with implant at later stage
CEREC – porcelain restorations • Sleep Apnoea Devices Hygienist • Dental Therapist – children’s dentistry Invisalign accredited – clear braces - tooth alignment Dento-facial aesthetics
BEFORE Worn dentition on male upper and lower anteriors
BEFORE Upper anteriors mottled appearance
BEFORE
AFTER Resin veneers to upper anteriors to open bite, and incisal edge resins to lower anteriors
AFTER Resin veneers to all upper anteriors
AFTER
Teeth whitening procedure using the latest technology; treatment is performed in a single 1 hour appointment with immediate results.
Our most recent news at Mawson Lakes Dental is that we’re in the process of planning our new extension. This will give us almost double the floor space we have now, and it will incorporate an additional surgery, a recovery suite, a dental laboratory, an additional sterilisation room, and a large staff/meeting room to include continuing education workshops and staff meetings. We’re very excited to be able to provide our patients with a state of the art, professional dental practice in a caring and comfortable environment. We look forward to the completion of the extension by mid September 2013.
Dr Satera Papageorgiou | Dr Cathy Wiering | Dr Stephanie Walls Shop 10, The Promenade Shopping Centre, Mawson Lakes SA | Ph 08 8260 2499
www.mawsonlakesdental.com.au
Dr Satera Papageorgiou & Dr Wayne Lowe Shop 2/77 Port Road, Kadina SA 5554 | Ph 08 8821 3096
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www.coppercoastdental.com.au
Dr Yugesh Caplash Plastic & Reconstructive Surgeon
With Experience Comes Expertise Trust In Our Experienced Dermal Practitioners
Here at Advanced Plastic & Cosmetic Surgery we are proud to have two of the most experienced intradermal injectors working with Dr Caplash, namely Ann Dennis who has been an Intradermal Practitioner for 25 years and trained in Harley Street London and Nadia MacPherson who has been working with this practice for 10 years in addition to working as an intradermal practitioner in Sydney.
O
ur knowledge of facial ageing has evolved and we are acutely aware that our skin not only becomes thinner but we lose the underlying supporting volume and we even notice bone reduction. With the advance in fillers and techniques we are able to treat the cause of the problem, to replace this lost volume and to give the face a natural and softer contour. With the new ‘skin boosters’ we are also able to improve the structure of the surface of the skin, so that areas such as hands and décolletage are not an instant giveaway to our age! Injectables can provide many alternatives for a variety of reasons such as: • preventing frown lines from developing into deep folds • softening the texture of the skin • providing volume where volume has been lost with age • enhancing/volumising lips • refreshing your appearance • reducing excessive perspiration
Where To From Here Once you have made the decision that you would like to know more about injectables and facial rejuvenation you can call our practice on 08 8297 1476 and arrange a suitable time to meet with Ann or Nadia to discuss your concerns.
Fat Grafting & Skin Renewal Volumetric enhancement can also be achieved with fat grafting to the normally existing fat pads in our face and hands. Aspirated fat from your body can be concentrated and carefully injected into the fat compartments to restore facial contour and improve the appearance of the dorsum of the hand. Research has shown that fat also contains certain cells and hormones, which help reverse some aging effects, giving you a double benefit.
During this free consultation Ann or Nadia will take down your medical history to check for contra-indications and will discuss your priorities and long term goals. We also engage Dr Caplash in this initial consultation and together a plan is formulated to provide the most appropriate treatment; which can include injectables, skin care analysis & regime, laser rejuvenation or even facial surgery if that is what you are looking for. Working with Dr Caplash not only safeguards you as the patient that we are a professional, qualified practice in all forms of facial enhancement but provides a level of expertise that we are extremely proud of. If you are considering fat grafting Dr Caplash will consult with you and help define your goals and discuss this minimally invasive day surgery procedure and recovery time.
Advanced Plastic & Cosmetic Surgery
DR YUGESH
CAPLASH Intradermal Injector Nadia, Skin Specialist Jaydine and Intradermal Injector Ann
His surgical skill & respect as a leader in the field is matched by his reputation for caring & concern for his patients.
Jan Marini Skin Care & Clear & Brilliant Laser
Dr Caplash is a Plastic and Reconstructive Surgeon and a Fellow of the Royal Australian College of Surgeons, a member of the Australian Society of Plastic Surgeons and the American Society of Plastic Surgeons. Dr Caplash performs a wide variety of aesthetic/ cosmetic surgery procedures and has a special interest in primary and secondary rhinoplasty, breast surgery and facelifts .
In addition to the above we are also very proud to be one of the first practices in South Australia to take on the globally respected and medically validated Jan Marini Skin Care Range & Clear & Brilliant Laser. The skin care component of our practice is managed by Jaydine Mills who also has extensive industry experience with all aspects of the skin.
Products & Treatments There are a variety of treatments available which include: skin analysis | resurfacing facials | anti-oxidant facials age intervention facials | advanced peel systems laser rejuvenation
The Jan Marini Skin Management System
utilizes a layered technology which simply means you apply each product over the previous product. Perfect for “time-poor” patients who want to improve the following conditions; fine lines, rosacea, pigmentation, acne & acne scarring, skin discolouration and of course the general affects of sun damage and aging.
Clear & Brilliant Laser
The Clear & Brilliant Laser is a revolutionary, gentle laser skin care treatment. It is predominantly designed for prevention and maintenance of our skin and is performed with minimal discomfort and downtime. With this laser treatment you can prevent the visible signs of ageing and overall dulling effects that environmental damage and time can have on our skin. By having regular treatments with the Clear & Brilliant Laser your skin will improve and help recover the glow, luminosity and texture of your skin and also can decrease dark pigmentation. The earlier you start taking care of your skin the easier it will be to maintain throughout your life. The Clear & Brilliant Laser is a safe and effective treatment for any skin type and is even safe to use after facelifts or facial reconstructions as it stimulates collagen and elastin in the skin.
Cosmetic Surgery procedures: • Abdominoplasty (Tummy tuck) • Blepharoplasty (Eyelid surgery) • Breast Augmentation • Breast Reduction • Brow lift • Facial Rejuvenation • Genioplasty (Chin augmentation/reduction) • Hyperhydrosis • Labiaplasty • Laser Resurfacing • Liposculpting • Lipoinjection • Mastopexy (breast lift)
• • • • •
Neck Lift Otoplasty (ear pinning) Rhinoplasty (Nose job) Rhytidectomy (Face Lift) Weight loss surgery
• • • •
Breast reconstruction Chest Deformities Facial Reanimation Facial Trauma and Maxillofacial Surgery Hand Surgery Head and Neck Cancer Management Skin Cancer Soft tissue coverage defects in limb trauma
Reconstructive procedures:
• • • •
4 Gordon Street, Glenelg SA 5045
08 8297 1476
yugesh@apcsurgery.com.au
Pigmentation:
WHAT IS PIGMENTATION AND HOW IS IT TREATED? Written by Dr Anne Evans of Future You Many patients seek help from their cosmetic physician about pigmentation, especially if it is on the face. Pigmentation can be moles, freckles, birthmarks, sunspots or age spots. It can also be melasma or chloasma, more diffuse patterns of pigmentation often associated with hormonal factors such as pregnancy and sun exposure. Treatment of pigmentation can be very difficult and take some time to be effective. Assessment of pigmentation Treatment can only occur after a thorough examination of the skin. This must include a determination of the level of pigmentation e.g. whether it is epidermal or dermal. Dr Evans is the founder of the Future you® clinic and has extensive experience in cosmetic medicine starting in 1989 with vascular laser and micro-sclerotherapy. Dr Evans is a Fellow of the Australasian College of Cosmetic Surgery and also a Foundation Member of the Australasian College of Phlebolgy. She is a trainer for Allergan, Galderma ( Q-Med) and Sanofi Aventis. Dr Evans frequently presents papers and conducts workshops at conferences in Australia and overseas. Dr Evans and her extremely qualified team provide a comprehensive and professional clinic to attend to each patient’s needs on an individual basis. This service is provided in a warm and friendly environment at the same time as offering full confidentiality and discretion. The location of Future you® is central, convenient and has good free parking. The mantra of Future you® is to provide a fully professional, high quality and comprehensive assessment and treatment plan for each patient. This is based on scientifically proven and verified treatments and procedures delivered with skill, care and the highest standards.
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The most important factor is the Fitzpatrick scale (see box 1 ). Each patient needs to be assigned to a level on the Fitzpatrick scale as this determines the best type of treatment for that patient. You may hear your practitioner say that you are a ‘III’ or ‘V’ which refers to the Fitzpatrick type. Higher numbers or darker skin types are more difficult to treat as they are prone to a problem called post-inflammatory hyperpigmentation (PIH), which can be a very significant side effect of treatments.
Post inflammatory hyperpigmentation This refers to an increased production of melanin or pigment in response to any inflammation of the skin. This process is more likely in people with higher Fitzpatrick skin types. In other words patients with darker skin types who are more prone to pigmentation in the first place are also more prone to increased pigmentation as they heal from treatment. This can be seen easily in the acne scars of people with darker skin. Avoiding PIH is the most difficult part of treating pigmentation. It does usually settle over time without treatment but increasing the pigmentation problem that the patient presented with is not particularly helpful. In practical terms this means treatment needs to be gentle and slow and using an experienced practitioner is best.
Treatment of pigmentation The most important and simple treatments include being vigilant in the use of 30+ sunscreen every day even in the colder weather, avoiding sun exposure even if wearing sunscreen and wearing hats. There are a number of fading, bleaching, depigmenting and brightening creams available. The main ingredient is usually hydroquinone which works to stop the production of the melanin and so will only treat the next
wave of pigmentation. Newer products use glycolic acid, azelaic acid, ascorbic acid (Vitamin C), retinoids (Vitamin A), kojic acid, arbutin or niacinamide as lightening agents. Chemical peels can be used to treat pigmentation and to maintain results. However the peeling agent must be carefully selected to achieve results with minimum irritation. There are a number of possible peeling agents including glycolic acid, salicylic acid, Jessner’s solution and TCA may be used. Laser treatment can also be used. Melanin absorbs light over a wide range of the spectrum and so many types of laser have been used but results have been variable and PIH can be easily induced. Overall results have been disappointing even with newer fractionated lasers as repigmentation or PIH are common. Recent histological research has shown that melasma has increased pigmentation and also increased blood vessels. This has led to new protocols to treat both pigmentation and extra blood vessels at the same time. There are also other protocols to minimise the side effect of PIH. This means better results for the treatment of melisma. At Future you® we use the Norseld Dual-Yellow laser which has green light to treat melanin combined with yellow light to treat blood vessels and are obtaining good improvement in melasma patients. The laser treatment is combined with other modalities to obtain the best results.
Professional Skincare • Anti-aging & rejuvenation • Acne – active & scarring • Pigmentation & sun damage • Microdermabrasion & professional peels • Daily skincare products • Anti-aging skincare
Advanced Laser Treatments • Dual Yellow photo rejuvenation • TM
Laser hair removal (Diode) • Laser tattoo removal (Revlite) • Laser vein treatments • Laser skin treatments
Vascular Treatments
Go to the Best in the Field Pigmentation can be a difficult problem to treat and a thorough assessment by an experienced practitioner is needed. There are many possible treatments and an individual approach is required. If you have a pigmentation problem, do the right thing and seek the services of the highly renowned expert in the field, Dr Anne Evans.
FITZPATRICK CLASSIFICATION OF SKIN TYPES SKIN TYPE COLOUR I white II white III white IV moderate brown V dark brown VI black
Dr Anne Evans Cosmetic Clinic
REACTION TO FIRST SUMMER always burn never tan usually burn, tan with difficulty sometimes mild burn, tan average rarely burn, tan with ease very rarely burn, tan very easily no burn, tan very easily
• Broken capillaries & rosacea • Facial & leg veins • Birthmarks, pigmented lesions & moles
Anti-aging • Lip enhancement & dermal fillers • Antiwrinkle injections • Fractionated carbon dioxide laser resurfacing
Liposculpture • Fat Transfer • Local Lipolysis
30 Dunn Street North Adelaide SA 5006 Telephone: 08 8239 1800 | Facsimile: 08 8239 1955 Website: www.futureyou.com.au | Email: futureu@bigpond.com
Dr. Onuma An internationally recognised
Gynaecologist & Pelvic Reconstructive Surgeon Highly educated, Dr Onuma has a degree in Pharmacology from the University of Leeds, completed his MBBS (Medicine) at the University of London and gained a Master of Jurisprudence at the Faculty of Law, University of Birmingham.
The Australian Centre for Female Pelvic and Vaginal Rejuvenation ! # " " "
4 Robe Terrace, Medindie, South Australia, Australia, 5081
The Australian Centre for Female Pelvic and Vaginal Rejuvenation
A
fter completing his specialist training in the UK in the 1990’s, Dr Onuma came to Australia, undertook a Fellowship in Minimal Access Urogynaecology and Pelvic Reconstructive Surgery and became a Fellow of the Royal Australian and New Zealand College of Obstetrics and Gynaecology. He was awarded in the UK by elevation to Fellow of the Royal College of Obstetrics and Gynaecology. % of Specialist Training (UK and European accreditation as a specialist Obstetrician and Gynaecologist), and is a Member of the International Urogynaecological Association and the British Society of Urogynaecology. He is an invited reviewer for the European Journal of Obstetrics & Gynaecology and Reproductive Biology in the area of female pelvic medicine and reconstructive surgery.
of Adelaide. The Institute specializes in female sexual function surgery, offering a range of procedures that improve the appearance and functional of the external genitalia, vagina and pelvic structures. Across the spectrum of pelvic reconstructive surgery, Dr Onuma’s patients present with a range of issues. Whether it is to enhance " % urinary dysfunction, to restore pelvic support or for aesthetic or functional labial surgery, the Laser Vaginal Rejuvenation Institute is dedicated to Dr Onuma’s ethos of ‘looking good, feeling better’ using advanced minimal access surgical techniques that promote rapid recovery.
! % Australia accepted to train in Laser Vaginal Rejuvenation™ in Los Angeles, USA, and now directs The Laser Vaginal Rejuvenation Institute
Dr Oseka Onuma
Q&A
BSc., MJur., MBBS, FRCOG, FRANZCOG Gynaecology. Uro-Gynaecology. Pelvic Reconstructive Surgery. # # % % you decide to pursue a career in this area? I am lucky to have been able to meet and train with and collaborate with experts all over the world in different aspects of female pelvic reconstructive surgery. There are a range of pelvic disorders affecting millions of women, and I am motivated in my work to strive to improve the quality of life of women. Many women are self conscious about their gynaecological issues. How would you encourage them to seek treatment? Every individual gets to a point where things are getting worse rather than better. It’s normal to feel embarrassed and afraid, but % % $ you are already on the way to a solution. Patients often comment after surgery that they wish they had done it years ago. How do you make women feel at ease in consultation with you, when discussing issues of an intimate nature? It’s important to listen to patients without judgement and communicate with them in a way that lets them know you are on their side. I have to ask very intimate questions to get to the source
of the problem. I always explain this and let them know that only ! ! % that women, though often initially hesitant to volunteer intimate information, will respond very positively to direct, well targeted questions. With Pelvic Floor Disorders (PFD) affecting so many women, how do women know what they should seek treatment for and what is ‘normal’ or ‘just part of being a woman’? The term PFD covers a range of disorders all relating to the muscles and connective tissue of the pelvis, and resulting from the impact of physiological and traumatic change to pelvic organs. It’s important to be familiar with what your symptoms are and how they bother you. Do not let others patronise you and tell you ‘it’s part of being a woman’. You need to recognise what is normal for you and ask yourself if it is affecting your quality of life. For example, leakage of urine during exercise is not normal but many women put up with it for years before seeking help. During this time they may rationalize the abnormality as their new ‘norm’ until they have an accident in an embarrassing situation.
www.dronuma.com (08) 8344 6085
Dr Julie Lawrence
Day Hospital Facility Brighton Day Surgery OUR VISION IS TO: “Provide a complete Day Surgery service that captures our consumer’s needs and provides outstanding levels of service, care professionalism and value” The Brighton Day Surgery is located in the charming seaside suburb of Brighton in South Australia. The owner and Medical Director, Dr Julie Lawrence, established the Surgery in 1997 and it was declared a day hospital by the Minister for Health and Family Services in 1998. The Brighton Day surgery has been fully accredited by the Australian Council on Health Care standards since 2001. Since then the Brighton Day Surgery has recognised the need for continual expansion in the services provided and is now a leading exponent of day surgery procedures in the south of Adelaide. Surgical Procedures. The Brighton Day Surgery specialises in a broad range of plastic and reconstructive surgery including: breast augmentation, rhinoplasty, eyelid reduction, otoplasty, hand and wrist surgery and the treatment of skin cancer. Surgery for Women. The Brighton Day Surgery offers a confidential surgical service for women, including breast augmentation, labioplasty and the correction of inverted nipples. At Brighton Day surgery we can provide you with female Doctors, theatre and recovery staff.
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Wound Care Clinics. Our nurses specialise in post operative care of wounds, ulcers, grafts and donor sites. Our Nurse Manager, Stephanie Mebberson RN holds these dressing clinics daily. Skin Rejuvenation Clinics. The Brighton Day Surgery has expanded its Skin Rejuvenation Services. We can now provide a full range of dermal fillers, wrinkle relaxants, chemical peels, micro-dermabrasion and skin rejuvenation products, our service also includes a free skin assessment. Our Skin Rejuvenation Therapist, Leisa Chappell RN would be happy to assist with any enquiry. Treatment of Leg Veins. The Brighton Day Surgery has recently expanded our services to include the non-surgical treatment of leg veins. Non- surgical management of varicose veins has become a more common and popular way of managing this condition over the past decade. Dr. Lisa Marks has undergone extensive training in the field and offers advice and treatment for direct vision and ultrasound guided sclerotherapy.
Before Wrinkle Relaxant Injections to Glabella
Two weeks After Wrinkle Relaxant Injections to Glabella
Before Dermal Fillers to Nasolabial Fold
Registrar Training. The Brighton Day Surgery participates actively in the “Registrar in Private Practice Training Program”. The focus of the program, which started in February 2008, is for Plastic Surgery Registrars to acquire knowledge and experience in cosmetic surgery and in aspects of private practice that would be of interest, particularly in the way it differs from the public hospital system. The Brighton Day Surgery is on its thirteenth rotation of Registrars. Each rotation lasts for four to six months with the Registrars attending and participating in 2-3 clinical sessions per week.
One Month After Dermal Fillers to Nasolabial Fold
OCEP Training. Brighton Day Surgery also participates in the Onkaparinga Clinical Education
Immediately after Dermal Fillers to Glabella
Program (OCEP) where third year medical students receive valuable exposure to surgical procedures and wound care procedures through observation and lectures by our Doctors and clinical staff. Continuous Improvement Program. The Brighton Day Surgery recognises the need to continually evolve and so has implemented a management system that looks to improve the Quality and Delivery of our services and products to our consumers on a daily basis. We are dedicated to providing a safe, secure and comfortable facility and developing individual care plans with our patients that have clear and realistic outcome expectations.
Nursing Services: Stephanie Mebberson RN Skin Rejuvenation Therapy: Leisa Chappell RN/Stephanie Mebberson RN Products and Services: Merridy Brown Fees and Estimates: Deb Stone Article written by Graham Ragless, General Manager
Services The
Brighton Day Surgery
BREAST • Breast Augmentation • Breast Reduction • Breast Lift BODY • Liposuction • Abdominoplasty • Labioplasty FACE • Eyelid Reduction • Facelift • Nose Surgery • Ear Surgery SKIN REJUVENATION • Volume Restoration using Dermal Fillers • Wrinkles / Expression Lines • Skin Texture and Pigmentation SCLEROTHERAPY
www.brightonplasticsurgery.com.au 1 Jetty Rd,Brighton, South Australia, 5048 | Ph(08) 8377 1775 E info@brightonplasticsurgery.com.au
breast The
Brighton Day Surgery
augmentation
AFTER
BEFORE
The main reasons for breast augmentation mammoplasty is to increase the breast volume and improve the contour in women who feel that their breast size is too small as a result of either inadequate development or as a result of pregnancy and breast feeding. The other reasons are for congenital asymmetry of the size and shape of the breast and also as an option for breast reconstruction following removal of the breasts for breast cancer.
The decisions about breast augmentation should only be made after discussion with a plastic surgeon. The decision whether to have surgery of course is always yours and should not be based upon pressure from anyone else. At your first consultation with a plastic surgeon you will discuss the benefits and the risks of breast enlargement. You should be given some information to take away and read and then have another appointment to come back and have a further discussion with your plastic surgeon once you have had the opportunity to reflect upon information given to you originally. During your first consultation your surgeon will examine for symmetry of your breasts, the width of your breasts,
your skin and breast tissue characteristics, and discuss with you the location of the incision and the implants. Anatomical or teardrop implants are shaped more naturally to follow the body’s natural lines. The implants fill out existing breast tissue by an increase in the upper pole only subtly and a greater increase in the lower pole volume. The anatomical implants are helpful when the breasts need a subtle lift as well as enlargement. Contoured implants are for women who have little or no breast tissue and prefer not to have the round appearance that a round implant will give. Contoured implants give a subtle shape to the
breast. However there is additional risk of rotation with any shaped implant, and if the implant rotates from its correct anatomical position it may require further surgery to rotate it back into position. Breast implants can either be placed behind the breast, between the breast tissue and the chest muscle, or behind the chest muscle. There are advantages and disadvantages with each location and this will be discussed with you when you see your plastic surgeon. An incision will need to be made to insert the implant and there are three main locations for the incision. The most preferred position is in the fold underneath the breast (the inframammary position).
www.brightonplasticsurgery.com.au
Incision can also be made around the areola or it can also be placed in the armpit. The incision in inframammary fold reduces the risk of nipple numbness and makes it much easier for the breast implant to be placed in its appropriate position.
Capsular contracture is a complication that can occur whenever a foreign body such as a breast implant, a hip replacement or other joint replacement is placed within the body. A scar tissue capsule forms around the implant to isolate the body from the implant. In breast augmentation the scar tissue can become quite thick and hard and it is called capsular contracture. Placing the implant underneath the muscle helps to reduce the incidence of capsular contracture and using textured surface implants also can help reduce the incidence of capsular contracture.
Breast implants are not lifetime devices and breast implantation is not necessarily a one-time operation. Most implants will need to be changed within ten to twenty years. Generally about an eight to sixteen year life expectancy is average. Sometimes removal and replacement of the implant is required as a result of complications such as capsular contracture or shifting of the implant. Most companies who provide implants will provide a lifetime replacement policy if there is a problem with the implant.
With any operation there are complications which are quite general and can happen with any surgery such as wound infection, bruising and swelling, and bleeding from the wound. Abnormal scarring can occur from the incision and some people are at a high risk of developing hypertrophic or even keloid scars.
With breast implants, routine mammography screening for breast cancer is more difficult. It is probably better to request an ultrasound or an MRI scan from your general practitioner when you are referred for your breast examination. Breast augmentation surgery is considered a cosmetic procedure and therefore there are costs involved which are not covered under Medicare or by private health insurance. You should be given a quote from your plastic surgeon at your initial consultation which outlines all the estimated costs for the surgery. The surgery is usually performed as a day procedure and can be done under continuous or twilight sedation with a specialist anaesthetist, and local anaesthetic is used to numb the area. The surgery itself usually lasts one to two hours. You will be required to wear a post-operative surgical bra to help stabilise the breast implants in the immediate healing process and this usually is required for the first six weeks. It is important that you avoid any physical activity in the first few weeks after the surgery. Certainly you should rest for the first twenty-four to fortyeight hours to reduce the risk of bleeding. Generally these first few days are the most uncomfortable and you will require strong pain killers. The average time to return to full activity is about four to six weeks. During
The complications that are specific to breast implant surgery are as discussed earlier, including capsular contracture and rotation of anatomical implants. There can also be changes in feeling around the nipple, the areola and the skin of the breast, but these decreased sensations usually resolve themselves within several weeks or months. the first week to ten days it is important to keep upper body activity to a minimum to reduce swelling and bleeding. Within about two weeks you should be able to do short walks but you should not be lifting anything heavy for about six weeks. Before the surgery you need to be as fit and healthy as possible and it is very important that you stop smoking. If you are taking any medication that makes you bleed such as aspirin or anti-inflammatory medications you need to stop those for at least ten days prior to the surgery. If you have any other health issues or allergies it is important that you discuss these with your plastic surgeon. If you are having a day surgery procedure with sedation you will need somebody to drive you to and from the day surgery hospital, and somebody just to stay with you for at least twenty-four hours after the surgery.
Plastic Surgery for women by women
The size of the implant that you decide upon will be determined by consultation with you and your plastic surgeon. The size of the implant will be limited by your chest wall size. An implant that is too wide or too high will be obvious by feel or you may see the edge of the implant. Therefore it is wise to choose an implant that is within the dimensions of your own chest wall and your plastic surgeon will help you make that decision. Many of the changes to your breasts following implantation are irreversible and if you later choose to have implants removed and not replaced you may experience dimpling, puckering, wrinkling or sagging of the breasts. Breast implants should not affect your ability to breast feed but if you do have a child and breast feed after implants then your breasts will almost certainly sag and you may need corrective surgery.
1 Jetty Rd,Brighton, South Australia, 5048 Ph: (08) 8377 1775 E :info@brightonplasticsurgery.com.au
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www.syluxuryspa.com
Located on the banks of the beautiful River Torrens opposite the Festival Theatre, SY Luxury Spa is the only luxury spa destination on the parklands in the heart of Cultural North Adelaide.
An atmosphere of tranquil escapism offering the finest treatments to rejuvenate both your body and soul, where you will find the serenity, beauty and equilibrium to achieve complete rejuvenation. Pampering, Stress Reduction, Therapeutic or Relaxation options. Enjoy an experience that is quite simply unparalleled!
• SIGNATURE LUXURY HAMMAM RITUAL • EXCLUSIVE SPA FACIAL RITUALS • HAMMAM STEAM ROOM RITUAL • WELLNESS MASSAGE • WELLNESS PREGNANCY MASSAGE
• HANDS & FEET INDULGENCE • STEAM ROOM & SPA • SHARED ENJOYMENT & SPA EVENTS • WAXING • LASH & BROW TINTING • SPRAY TANNING
Signature Luxury Hamman Ritual Melt into your own private steam room, beautifully appointed with star lit sky line, hot stone bed, rain shower and plunge pool. You will be provided with our own Hamman inspired exfoliation smoother infused with crushed coffee, organic cane sugar, almond, cocoa butter, vanilla bean & Moroccan rose. The ideal pre treatment addition to boost circullation, promote detoxification, clear the mind and deepen the benefits of your spa treatment.
Next Generation Club War Memorial Drive, North Adelaide 5006 E: info@lasertechclinic.com.au | Ph: 08 84107877 | Fax: 08 84108187
Situated in the prestigious War Memorial Drive, Next Generation Health and Fitness club, South Australia, Lasertech overlooks the illustrious Adelaide Parklands and the River Torrens.
DR CHOK
Our resident Cosmetic Surgeon Dr Robyn Chok is a highly skilled and respected specialist in PRP regen, anti aging, anti wrinkle injections & dermal fillers.
Lasertech Clinic has the ability to offer multi-faceted treatment options that offer faster, more effective results and allow for a high level of inter-clinic referrals. The health and beauty industry acknowledges the
importance that individuals and society place on looking good and this buoyant market is continually producing new technology, ideas and techniques to keep up with demand for alternatives to traditional or invasive methods. Sharyn has contuinually upgraded her facility and equiptment to ensure the latest technological advances and opportunities are available to both her clients and staff. Consequently we are overwhelmed with options and impressive claims, often without the promised results. The Lasertech team of accredited practitioners is dedicated to providing integrity to an ever-growing market that sometimes confuses the consumer with ill information and unrealistic promises. Lasertech’s success reflects the Clinic’s philosophy to provide both staff and clients
with the best education, resources and equipment available. We strive to provide clients with an exceptionally professional service that continues to deliver results. It is this commitment to providing exceptional value, service and support to our clients that establishes Lasertech as: Adelaide’s Premier Laser
& Skin Rejuvenation Clinic
Continuous research in science and innovation, acquisition of the latest technology - in both Medical Laser and Skin treatments, a culture of complete customer support, education and satisfaction, an ideal location and effective accurate advertising and marketing initiatives, additional to outstanding client results and satisfaction has ensured that Lasertech is respected & recognized as “Adelaide’s Premier
www.lasertechclinic.com.au
ADELAIDE’S PREMIER LASER & SKIN REJUVENATION CLINIC
Lasertech is Adelaide’s Premier Laser and Skin Rejuvenation Clinic for both men and women. With state-of-the art technology, a luxury Medi Spa and a full rang of beauty services, we have created a true world class clinic in the heart of North Adelaide.
SHARYN YELLAND Director /Owner
At Lasertech we are dedicated to providing you with an exceptional service that exceeds your expectations. We understand that your needs are unique, and that’s why our team of professional practitioners will identify your individual needs and deliver personalised treatments that ensure you get the best results every time.
Tr u s t O n l y I n E x p e r i e n c e
• PRP REGEN
• LASER HAIR REMOVAL
• RADIO WAVE SURGERY
• WRINKLE INJECTIONS
• LASER SKIN TIGHTENING
• MEDI SPA
• DERMAL FILLERS
• FRACTIONAL LASER SKIN RESURFACING
• LASER SKIN
REJUVENATION
• LASER TATTOO REMOVAL • LPG ENDERMOLOGIE
• MEDICAL SKIN PEELS
• MICRODERMABRASION • COSMETIC TATTOOING
Laser and Skin Rejuvenation Clinic for Men and Women “.. Inspiring Market Leaders in the Australian Aesthetics arena.
• MAXIMUS ™ BODY FIRMING • MASSAGE
• ACUPUNCTURE
• ALL ASPECTS OF BEAUTY
highest quality service, facilities and technology available coupled with professional education and support from the Lasertech practitioners.
Free consultations to educate clients , regular client education evenings and staff training forums ensure Staff, clients and potential clients have the opportunity to be educated in topics of interest presented by Sharyn and guest speakers. Sharyn travels the world regularly and has had extensive experience and exposure to some of the worlds most prestigious clinics and medi spas that has inspired her vision for the development of her business to provide a truly world class facility for South Australia. Lasertech’s client demographic demands the
War Memorial Drive, North Adelaide 5006 | E: info@lasertechclinic.com.au Ph: 08 84107877 | Fax: 08 84108187
Dr Michael Molton Dr Michael Molton is the principal doctor at epiclinic. He has performed extensive work in laser surgery and facial rejuvenation over a career spanning 14 years in the field of cosmetic medicine and surgery.
It’s not about being twenty again. I just want to look the best I can for my age...for as long as I can...
Our Services: • • • • • • • • • •
Facial Rejuvenation Body Rejuvenation The Fraxel Laser Thermage Selphyl PRP Coolsculpting Dermal Fillers Wrinkles Relaxants TCA Chemical Peel Severe Sweating
Contact Us
245 Wakefield Street, Adelaide, 5000 (Opposite Wakefield Hospital) Phone: +618 8227 2242 Fax: +618 8227 2442
www.epiclinic.com.au
Cher Zollo RN Every team member at epiclinic® plays an important role in the support of our cosmetic medical patients. Cher joined the epiclinic® team in 2011 and is epiclinic’s respected and skilled specialist cosmetic nurse. Cher’s bubbly personality, precise artistry and professionalism bring her a strong following in Adelaide.
Preventative MA STECTOMY? Dr Beverley Fosh Breast and General Surgeon Adelaide Plastic Surgery Associates
Some women are at an increased risk of breast cancer. These women often have either a family history of breast cancer, have been tested positive for the BRCA 1 or 2 gene or have been diagnosed with cell changes to their breast tissue. These women face the dilemma that no woman wants to face. Do I remove my breasts before this disease develops and potentially takes my life? Especially topical at the moment is the BRCA 1 gene (think Angelina Jolie). Often women who have a strong family history of breast cancer will have themselves tested for the presence of this gene. For those women who test positive, the incidence of developing breast cancer in their lifetime is 70-90% (along with a 30%-50% of developing ovarian cancer). These are not pleasant statistics, no matter who you are. For those women who choose to act, there are further decisions to make. What type of mastectomy should I have, and should I have a reconstruction at the same time?
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In a traditional total mastectomy, the surgeon removes the entire breast, most of the skin and nipple. There is also the option of sparing the skin and/or nipple. There is a slight increased risk of developing breast cancer in a skin sparing and nipple sparing mastectomy over a traditional one. IS THIS SURGERY EFFECTIVE IN PREVENTING BREAST CANCER? Existing data suggest that preventive mastectomy may significantly reduce (by about 90 percent) the chance of developing breast cancer in moderate- and high-risk women, although there is no guarantee that preventative mastectomy will achieve this. ARE THERE ANY ALTERNATIVES TO SURGERY? In the case of BRCA 1 gene most surgeons would discuss the possibility of performing
bilateral prophylactic mastectomies. It is normally advisable to remove the ovaries and fallopian tubes as well to decrease the risk of ovarian cancer, but this also further reduces the risk of breast cancer. With BRCA 2 carriers, studies have shown that some medications can decrease the chances of getting breast cancer. BREAST RECONSTRUCTION Breast reconstruction is a plastic surgery procedure in which the shape of the breast is rebuilt. Many women who choose to have prophylactic mastectomy also decide to have breast reconstruction, either at the time of the mastectomy or at some later time. Whatever your circumstance, discuss your options with a surgeon to develop a plan that is tailored to you.
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QU E E N 106
SLAND 107
Dr Phil Richardson MBBS (Hons), FRACS (Plast.)
Brisbane Plastic and Cosmetic Surgery
Level 1, 38 Misterton Street Fortitude Valley QLD 4006 | 1300 789 240 Dr Richardson also consults at Kippa-Ring on the Redcliffe Peninsula:
Suite 22 Peninsula Specialist Centre Cnr George and Florence Streets Kippa Ring QLD 4021
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Actual patient of Dr Phil Richardson
Dr Phil Richardson MBBS (Hons), FRACS (Plast.)
Dr. Philip Richardson is a skilled and accomplished plastic and cosmetic surgeon and a certified member of ASPS (Australian Society of Plastic Surgeons), ASAPS (Australian Society of Aesthetic Plastic Surgeons), and RACS ( Royal Australian College of Surgeons). After graduating with First Class Honours in Bachelor of Medicine and Bachelor of Surgery from the University of Queensland, Dr. Philip Richardson completed a three-year residency at the Princess Alexandra Hospital, Brisbane. He was then immediately accepted into the Plastic and Reconstructive training program where he undertook four years of specialised training at the Princess Alexandra Hospital, Mater Children’s Hospital, the Royal Children’s Hospital in Brisbane, and the Royal Children’s Hospital in Melbourne. Dr. Philip Richardson’s areas of interest include breast augmentation and breast reduction. He also works as a visiting reconstructive surgeon at the Royal Children’s public hospital in Brisbane. From initial consultation to post-operative care, Dr. Richardson and his professional staff are committed to ensuring the absolute comfort and safety of each patient, whilst utilising the most advanced techniques to achieve desired results. With Dr. Philip Richardson’s extensive education and experience, you can be confident that your well-being and appearance are in the hands of a knowledgeable and skilled plastic and cosmetic surgeon.
Breast ASYMMETRY Before
After
Before
After
Breast asymmetry is common at all stages of life. Most asymmetries are very minor and certainly do not need any treatment however patients with more significant asymmetry often come and see me to explore what treatment options are available. Asymmetry can relate to a patient’s chest wall or the breasts themselves. The breasts can be different from each other in terms of their size and shape, nipple position, the position of the fold under the breasts, width of the breasts and the projection of the breast. It’s important that both the patient and the surgeon are aware of what these differences are and what can be done to treat each of them and the limitations of each form of treatment. What a patient would like her breasts to look like at the end of the day is very important and this may or may not be able to be achieved, however, of course it allows me to be aware of the patients expectations and gives us something to work towards. The following techniques can be used to alter the breast and chest wall and can be used in combination to try and achieve the desired outcome. With respect to chest wall, chest wall implants can be used and in addition to this, more recently fat grafting; using a patient’s own fat, can be used. To increase breast volume on
one side relative to the other or on both sides, fat can be used as a fat graft or a breast implant can be used. Both of these have different indications depending on the circumstances and are not appropriate for every person. As well as making one or both breasts bigger, one breast that may be too large can be made smaller in size and this is called a breast reduction. Very rarely this can be done through liposuction but mainly it’s done through surgical excision. Nipple position can be altered usually by elevating the lower of the two nipples and this is called a breast lift and usually involves some degree of skin tightening as well. The fold under the breast can also be manipulated so that it sits more symmetrical with the other side. Breast width and height can be increased by again fat grafting or using a breast implant. There’s no doubt in the future that fat grafting will be used more extensively to correct asymmetry. One other principle in asymmetry correction is that if both breasts have about the same amount of natural
tissue and a similar volume of breast implant then long term they will behave very similarly. If one breast is all implant and has the same volume as a normal natural breast without an implant then over the years the breast without the implant will drop a lot faster and therefore the asymmetries will reoccur. Therefore if a patient has a very large breast on one side and a smaller breast on the other side, it’s often better to reduce the big breast down to the size of the small breast and then if the patient wishes to have both sides augmented then this is possible and the implant size will be similar. Overall, correcting asymmetry has very high levels of patient satisfaction and extremely high levels of surgeon satisfaction. It requires the potential use of multiple techniques often in conjunction and sometimes at separate times. With the increasing use of fat grafting in the future this will no doubt improve results even further.
w w w. b r i s b a n e p l a s t i c s u rg e r y . c o m
NIPTUCK Magazine 109
Nurse Injectors Patricia Hampson RN and Marie Steele RN
BLEPHAROPLASTY The skin around the eyes is often the first area of the face to show signs of ageing. Loose skin and herniation of fat pads may give an appearance of tiredness, especially in the morning when fluid worsens the appearance. Surgical correction of upper and lower eyelid loose skin and fat pads can cause a dramatic improvement to self-esteem and provide a more youthful appearance. With continuing age, loose skin of the upper eyelid may cause obstruction to vision, especially on the outside of the visual field. This may be dangerous in activities such as driving. Upper and lower eyelids can be operated on at the same time or separately, depending on the problem and can be done as a day case. Bruising usually takes about 2-3 weeks to disappear. Whilst blepharoplasty can eliminate loose skin and fat pads, the lines around the eyes are best treated with muscle relaxant injections. These can stop the creases from forming and need to be performed every 4-5 months. Skin needling with a Dermaroller (home or clinic) or DERMASTAMP is now available at the Lotus Institute. It is a new procedure to help greater absorption of skin products into the depths of the skin, through the tiny holes produced by the roller/stamp. This helps to soften wrinkles or pores, reduce pigment spots and produce a softer more youthful skin.
before
after
INJECTABLES FOR A NATURAL, YOUTHFUL AND REFRESHED LOOK The Lotus Institute has a highly regarded and professional aesthetic injecting department. Here we can offer our clients softening, volumising and enhancement of the tissues, especially of the face, using a variety of injectable products. These consist of: • Muscle relaxant treatments where wrinkles of the forehead, around the eyes and the lower face and neck can be softened. • Dermal fillers of a temporary or permanent nature which plump out wrinkles and creases.
before
after
Tissue injecting with these products is highly specialised and our two injectors, Patricia Hampson, registered nurse and Marie Steele, registered nurse have more than 24 years combined experience in this very skilled profession. Patricia has been with the Lotus Institute for 12 years after previous injecting experience elsewhere and is also an injector/trainer for a notable Sydney product company. Marie has been with the Lotus Institute for 5 years after working as an injector elsewhere for a number of years. With their expertise, Patricia and Marie’s aim with all their clients is to keep a natural appearance at all times. Using these injecting techniques, a refreshed and more youthful look can be obtained at the Lotus Institute’s Aesthetic Injecting Department.
DR PETER
WIDDOWSON M.B, CHb, F.R.A.C.S (Plastic and Reconstructive)
Following his graduation through the Royal Australasian College of Surgeons with a Gold Medal in Surgery in 1982 and post graduate study in Glasgow, Scotland, England and Australia, Dr Widdowson accepted a Consultant position at Waikato Hospital, Hamilton, New Zealand in 1987. As Director of Plastic Surgery at Waikato Hospital for 12 years Dr Widdowson’s work included burns victims, art of microsurgery, paediatric surgery (cleft lip and palate), skin cancer patients and hand surgery. In 1999 Dr Widdowson joined the Lotus Institute on the Gold Coast and for the last 13 years has established his reputation in the cosmetic industry through commitment, integrity and excellence. Dr Widdowson specializes in all types of cosmetic surgery including breast enlargement, reduction, uplift and reconstruction, body contouring, facial surgery, ear pinning, nose reshaping, abdominal surgery, male breast surgery and some reconstructive and skin cancer surgery. Dr Widdowson believes that a holistic approach to health and beauty is important – nutrition, exercise, spiritual well being and the use of tried-and-true skin products and surgical and non-surgical procedures, all combine to create an individual that is healthy, younger looking and better equipped to face the years ahead.
• Abdominoplasty • Brachioplasty (arm reduction) • Breast Augmentation • Redo Breast Augmentation • Breast Reduction
HEAD OFFICE: Level Two, 2 Short St Southport 4215 Tel: (07) 5509 4488 Fax: (07) 5528 4166
• Breast Mastopexy (uplift) • Breast Reconstruction • Facelifts • Upper and Lower Blepharoplasty (eyelid reduction)
MAILING ADDRESS: PO Box 796 Dr Peter Widdowson M.B, CHb, F.R.A.C.S (Plastic and Reconstructive)
• Browlift • Rhinoplasty • Facial laser • Liposuction • Gynaecomastia • Otoplasty
www.lotus-institute.com.au
Is snoring wrecking more than your partner’s peace and quiet? By Dr Anne-Maree Cole
Snoring is so common that it is thought by many to be normal, a natural part of aging but research shows that it is a serious health risk not only to the snorer but to their bed partner as well.
Snoring can be a symptom of a serious health disorder – obstructive sleep apnoea. The gravest consequences of sleep apnoea are to the heart and blood vessels, leaving the sufferer at high risk to death from stroke and heart attack. In fact, sleep apnoea sufferers are at 5x the risk of dying from any cause including motor vehicle accidents because poor sleep quality impacts every part of our lives.
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When we go to sleep, many things change. Certainly our awareness of the world around us diminishes but so does postural support of our muscles. The normal muscle tone that keeps us upright and functioning during the day switches off and gravity takes over when we sleep. This means that for people whose airway may already be compromised for reasons such as poor jaw development, a large tongue, bad posture
Dr. Anne-Maree
COLE B.D.Sc MICCMO Aesthetic Excellence 151 Robertson St. Fortitude Valley, Brisbane Telephone 07 3257 1577
A NEW FOUND SELF-CONFIDENCE or weight gain, they can become very vulnerable to the airway collapsing when they are asleep. Sometimes this can occur more than 40 times an hour. If it happens more than 5 times an hour, it is indicative of sleep apnoea.
Advanced Dental Wear
After Dental Rehabilitation
As you can imagine not being able to breathe is a very stressful event to the body. Blood pressure and heart rate seesaw throughout the night. The brain gets roused out of the deeper restorative sleep and sleep turns into a state of survival rather than rest and recovery. Sometimes as a result of the arousals or in an attempt to stabilize the jaw, many people with sleep apnoea will grind or clench their teeth. Due to decreased awareness during sleep, these forces can be extreme – much greater than is possible when you are awake and the teeth start to breakdown. Another problem can be gastric reflux due to the strain from trying to get a breath. In this situation, the acid from the stomach ends up in the mouth and it erodes the enamel off the teeth, which accelerates the wear and tear and damage.
NIPTUCK Magazine 113
Is snoring wrecking more than your partner’s peace and quiet? Photographs of common damage as a result of sleep apnoea are depicted in this article. Short, worn down teeth are not normal. There will be a reason behind it and that reason could be sleep apnoea. Unless the underlying cause is addressed, fixing the aesthetic problem that results is destined to fail because the problems will continue. Diagnosis, treatment and, where necessary, rehabilitation can turn a serious health issue into one which is well managed and gives you back your smile. At Aesthetic Excellence Dr Anne-Maree Cole, who in addition to providing excellent aesthetic and rehabilitation / rejuvenation dental care for her patients, is also currently studying a Masters Degree in Sleep Medicine and helping many people with complex dental problems and / or problems with snoring and sleep apnoea to: • Get the diagnosis or rule out sleep apnoea • Provide supportive sleep apnoea dental appliances that are custom made to provide balance and support of the jaw and airway and minimize snoring • Monitor their progress in managing the sleep apnoea • Restoring their broken down teeth to excellent aesthetics and function when the damage incurred is already advanced.
continued from previous page
Worn teeth – young man
Close-up Aesthetic Restorations
Severe Acid Erosion
Of course, prevention is always better than cure. Please call for a consultation with AnneMaree to find out how we can help you too.
Dr. Anne-Maree COLE Telephone: (07) 3257 1577
Balanced, supportive, protective sleep appliance
TIRED OF YOUR TEETH MAKING YOU LOOK OLDER THAN YOU FEEL? SPEAK TO SOMEONE WHO LISTENS, UNDERSTANDS AND CAN HELP.
BEFORE
AFTER
DR. ANNE-MAREE COLE B.D.Sc MICCMO 151 ROBERTSON STREET FORTITUDE VALLEY QLD 4006 PHONE: 07 3257 1577 WWW.AESTHETICEXCELLENCE.COM.AU CONNECT@AESTHETICEXCELLENCE.COM.AU
Fuller & Firmer
TOTAL FACIAL REJUVENATION
Before
After
The ageing process is not only a matter of lines and wrinkles— volume loss in the cheeks and around the mouth, as well as skin laxity is generally noticeable from our mid 20’s. Brisbane doctor of 28 years, Dr Linda Williams, founded one of Brisbane’s first cosmetic clinics, Artisan Cosmetic and Rejuvenation Clinic. Over the past 11 years Artisan has earned a reputation for its unique approach to non-surgical, NATURAL LOOKING rejuvenation and enhancement. Dr Linda explains to NipTuck the latest nonsurgical treatments that restore the mid and lower face to its former fuller and firmer glory. During the ageing process, we lose collagen in our skin which makes it sag. We also lose facial volume in the form of bone, muscle and fat, flattening our natural contours and ‘deflating’ the face. This changes our overall facial dynamic. Fortunately, it is possible to restore volume to the face, and improve firmness of the skin in a simple, two-step, minimally invasive process. Best of all, the results look natural and healthy; not frozen, fake or overinflated.
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Before
After
The first step involves our 8 Point Approach. As we age we lose volume across the face and often the first signs can be seen in 8 distinct areas. This is where our specially-trained clinicians use dermal fillers, including those made from naturally occurring sugars, to replace volume, enhance rejuvenation and recreate youthful curves. The cheeks and jawline are given back their structure and curves with natural looking results. The mid and lower face looks firmed and lifted. The deep folds between the nose and mouth are also filled and their volume restored. The result looks very fresh and natural, feels smoother, moves normally, and lasts for up to 18 months. The second step involves firming and rejuvenating the skin using TITAN®, the latest innovation in light based technology. TITAN® safely uses an infra-red light source to gently heat the dermis of the skin, causing existing collagen fibres to immediately contract. Over the following months, new collagen growth is also stimulated which results in further tightening and the development of a more youthful complexion with fewer lines
After
and folds and reduced looseness of the skin. TITAN® reduces smile lines, lifts the brow and firms the neck and jaw line. Results continue to improve for up to six months after treatment. Although suitable for all skin types, a consultation is recommended to create an optimal treatment plan. The initial treatment should ideally be repeated 6-8 weeks later for best results. Sometimes described as a ‘nonsurgical facelift’, this treatment takes about an hour and requires no down time. TITAN® has become very popular in Hollywood as a yearly collagen ‘boost’ for the face and neck. Choosing the right clinician is just as important as selecting the best treatment. Artisan has a combined experience of over 60 years in the cosmetic industry. Our experienced cosmetic injectors and skin technicians take a scientific approach to rejuvenation and anti-ageing treatments. Under the medical direction of Dr Linda Williams (MBBS, FRACGP, FFMACCS), Artisan’s highly trained team has built a reputation for providing natural results and improved confidence for 11 years.
Before
SERVICES
SEE THE RESULTS. FEEL THE CONFIDENCE
• Muscle relaxant wrinkle injections • Lip enhancement & rejuvenation • CoolSculpting® Fat Reduction • TITAN® skin firming & tightening • Photorejuvenation • Skin revision
After • HyrdaFacial™ • 8 Point Approach • Volume & filler injections • Pigmentation & capillaries • Pulsed light hair removal • Healthy ageing nutritional supplements • Relaxation & beauty
DR LINDA
Williams Dr Linda Williams graduated in Medicine from the University of Queensland in 1985. Following 5 years experience at the Mater Hospital in Brisbane and St Mary’s Hospital in London, she returned to General Practice in Brisbane and gained her Fellowship in The Royal Australian College of General Practitioners in 1993. She subsequently worked for 8 years as a Surgical Assistant for Plastic and Orthopaedic Surgeons before establishing her own clinic, Artisan Cosmetic Clinic in Brisbane in 2002. Dr Williams now specialises in non-surgical cosmetic procedures using non-permanent fillers, wrinkle correction, skin rejuvenation with peels and pulsed light, HydraFacial™, CoolSculpting® non-surgical fat reduction and TITAN® thermal skin tightening. Her expertise lies in Natural Look™ total facial rejuvenation that will leave clients feeling confident and comfortable in their own skin. Dr Linda’s keen interest in maintaining ‘best practice’ skills and experience in cosmetic enhancement techniques and anti-ageing medicine has resulted in her regular attendance and involvement at national and international conferences and events. She has been a national and international trainer for Allergan since 2007. From anti-wrinkle injections, lip enhancement and photo rejuvenation – through to acne solutions and preventative treatments that contain ideal anti-ageing ingredients — Dr Williams and her highly experienced team at Artisan offer a customised approach to support both men and women of all ages in looking and feeling their best.
NATURAL-LOOKING REJUVENATION BEGINS HERE The Miro, 3/41 Robertson St, Fortitude Valley Ph 07 3852 3211 | www.artisanclinic.com.au
Dr
Paul B E L T
If you would like to book an appointment with Dr Belt call the team at breast.com.au on 1 800 32 34 36
Dr Paul Belt
MA, BM, BCh (Oxon), FRCS (Eng.), FRACS(Plast.) www.paulbelt.com.au
Two case reports on combined radical abdominoplasty and bilateral breast augmentation after childbearing and weight loss. CASE 1
Case 1
A twenty nine year old mother of two who was requesting rejuvenation of her breasts after breastfeeding and removal of the excess skin from her abdomen as well as removal of a previous abdominal scar from a surgical laparotomy at the age of fifteen.
Before
After
Case 2
She underwent a radical abdominoplasty with removal of the previous abdominal scar and plication of the rectus abdominis muscles. She also underwent a breast augmentation through an inframmary fold incision with high projection, high profile 380cc Mentor CPG 333 anatomical implants placed under the muscle.
Before
After
Case 2
This patient was delighted with the change in the contour to both the chest and the abdomen. She also went from a very small 10B to a very large DD.
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After
At the time of the abdominoplasty she had 768 grams of tissue removed. After the breast augmentation she went from a 14B to a 14D, she was very happy with the final outcome of her surgery. It should be noted that a combined radical abdominoplasty and breast augmentation produces an affect where the “whole is greater than the sum of the parts”. The affect of combining both procedures produces a result that is better than performing the two individual procedures alone. It completely transforms the entire shape of the torso.
CASE 2
In both of these cases the breast augmentation has achieved a subtle correction of the breast droop (ptosis) as well as restoring the volume where tissue has been lost through a combination of pregnancy, breastfeeding and weight loss.
She underwent a radical abdominoplasty where the excess skin was removed and breast augmentation performed using an incision underneath the muscle with high projection, high
These are common procedures that are performed in a classic “mummy makeover”. Other procedures can also be performed and are tailored to the individual.
A thirty seven year old mother of three who had lost over forty two kilograms in weight.
Before
profile 330cc Mentor CPG 333 anatomical implants being placed on top of the muscle in the sub fascial plane.
upper pole The
DILEMMA
If you would like to book an appointment with Dr Stradwick call the team at breast.com.au on 1 800 32 34 36
Dr Luke Stradwick
MBBS (Hons) BMedSci (Hons) FRACS www.drlukestradwick.com.au
Most women I see for breast augmentation understand that a natural breast has a gently sloping upper pole, a nipple positioned at or above the breast fold and a full rounded lower pole. However this natural breast shape is not usually equated with beauty. I often see women with an existing natural breast shape telling me their upper pole is flat and “empty”. What they consider a youthful and beautiful breast has an un-naturally full round upper pole as well. Round, textured, moderate projection, 290cc, sub muscular pocket
Anatomical, full projection, MF335cc, sub muscular pocket
Before
After
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Before
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Before
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WHY IS THIS? I used to think the push up bra was to blame. And plunging necklines. However at a recent conference in Stockholm another explanation occurred to me. At a presentation by one of the American pioneers of the new generation shaped silicone gel implants, it was clear that Australian plastic surgeons are a long way ahead of America in the use of these implants. When the FDA in America abruptly and without hard scientific data banned the use of silicone gel implants for breast augmentation, American surgeons had no choice but to switch to using round saline filled implants. This was ironic given the Americans had designed the new
implants. They literally had the rug pulled from beneath their feet. Australia and Europe were able to continue using these new implants and now have a solid 10- year head start in using shaped gel implants. The FDA finally lifted the moratorium in 2006, but American plastic surgeons have been slow to change their practices. I was surprised to learn that most breast augmentations in America are still performed with round saline filled implants. There is no doubt that the largest media influence in our lives is the United States. We are bombed with images of American “celebrities” in various states of undress. Without necessarily realising it, we are often
looking at un-natural breast shapes produced using round saline implants. I find the easiest group of women to educate about this phenomenon are the “establishers”. These women have never had any breast shape or size and are most often seeking a natural breast. Although this can be done with a round implant by limiting the projection and size this approach still produces a rounded breast as in the example above. In my opinion these patients are the ideal candidates for shaped gel implants. When correctly selected and placed in the appropriate pocket they produce a very natural result with a gently sloping upper pole.
NIPTUCK Magazine 119
healthy teeth for a
healthy life
Orange Moose Dental is a brand new innovative concept, bringing a fresh approach to dental care in the Bundaberg region. Dr Hanno Venter chose the unusual name for his practice, mainly because he loves Moose, but also to inject some of his personality into his practice. “Moose have many fantastic qualities that make them unique in the animal kingdom. I want to express that we at Orange Moose Dental are also unique, and have a sense of fun and independence.” Practice principal Dr Hanno Venter is a fully qualified Dental Surgeon and a member of the American Academy of Cosmetic Dentistry. He has also recently written the primary and final exam for the Royal Australian College of Dental Surgeons on oral medicine, oral pathology and oral surgery. Orange Moose Dental opened in 2012, with a fabulous fit out from Medifit design and construction. The brand new practice has five team members in total and has a commitment to high quality service but also patient comfort. Appointments are scheduled a little longer than standard and there are complimentary beverages available. State of the art treatment rooms have TVs for that little bit of distraction and treatment planning is comprehensive and inclusive of the patient’s individual needs. Dr Venter offers a complimentary appointment to plan your treatment program. “New patients come in for a full mouth exam. I take a look, collect the information and take the necessary pictures and xrays, then I get them back in a few days time for a free case presentation. This allows me to present all the options to the patient – the different options for different budgets and time frames, the pros and the cons, and they have the chance to ask all the questions they need to ask.” Of course resistance to going to the dentist is common, but thanks to technology, Orange Moose Dental has some innovative equipment on site that may very well take all the pain out of your trip to the dentist.
The cone beam unit has become the gold standard of equipment, particularly in American implant dentistry. Where a procedure legally requires a medical CT scan as standard for all implant patients, Dr Venter can provide the same result but with a cone beam unit which uses much less radiation than a medical CT scan. This is safer as it can be more closely focused, and image just a section of jaw for example rather than the whole head. It also produces a 3D image that can be acquired in a shorter period of time. Wishing for a magic wand is now a reality as Dr Venter uses ‘The Wand’ painless injection system. By controlling the amount, pressure and flow of anaesthetic into tissues, the process is considerably less uncomfortable, and provides a much safer and calmer experience for the patient. Dr Venter and the staff at Orange Moose are committed to providing a ‘one stop shop’ for their patients. “We want our patients to feel like guests rather than patients. If possible, we avoid referring people elsewhere for other aspects of their treatment plan, and we try to do all analysis and assessment on site with a fast turnaround. A lot of patients love coming back and referring us to their friends because of the personal attention. We are able to offer them so much more and are always striving to improve the patient experience.”
Bourbong St Medical Centre | 288-292 Bourbong St, Bundaberg QLD 4670 APPOINTMENTS (07) 4152 4404
www.orangemoosedental.com.au
LUMINEERS
TM
Can Make Everyone’s Smile More Beautiful
NOW YOUR DENTIST CAN CREATE A NEW SMILE WITHOUT REMOVING PAINFUL TOOTH STRUCTURE WHAT ARE LUMINEERS? LUMINEERS is a painless, permanent cosmetic solution for stained, chipped, discoloured, or crooked teeth. LUMINEERS is a porcelain veneer that can be made as thin as a contact lens and is placed over existing teeth (unlike traditional veneers).
Clinically proven to last up to 20 years
Ask for LUMINEERS by Name * No Needles * No Drilling of Sensitive Tooth Structure * Instant Whitening * Extraordinarily Strong
Before
* Natural Looking * Reversible * Limited 5 Year Warranty
After
Call Today: (08) 8271 1184 or go to www.godental.com.au
• Anti-Wrinkle Injections • Dermal Fillers • Platelet Rich Plasma (PRP) • Skin Rejuvenation • Acne Treatment • Microdermabrasion • Skin Pigmentation • Cosmetic Mole Removal • Skin Cancer Checks • Fractional RF (New for Skin Rejuvenation)
the cosmetic studio Dr. Ash Sankarayya o one should ever compliment you on your cosmetic surgery because they should never be able to tell that you had it. The Cosmetic Studio Brisbane 485 Adelaide Street (corner of Boundary & Adelaide St)
Brisbane 4000 Ph: 30128023 E: ash.steny@bigpond.com
Darwin Clinic 1/53 Ross Smith Avenue, Parap, Darwin NT 0820 Ph: (08) 8981 5227
www.thecosmeticstudio.com.au
AUSTRALIAN CAPITAL TERRITORY
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NEW SOUTH WALES
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Getting To The Core Of The Problem DR ALASTAIR TAYLOR, A HIGHLY QUALIFIED, ACCREDITED PLASTIC SURGEON WITH MANY YEARS’ EXPERIENCE IN ALL AREAS OF RECONSTRUCTIVE, COSMETIC AND MICROSURGERY, REVEALS HOW HIS UNIQUE APPROACH TO ABDOMINOPLASTY CREATE A DESIRABLE HOURGLASS FIGURE.
There are many reasons women come to me for a tummy tuck. Often they just don’t like the look and feel of their abdomen after pregnancy, or they’ve lost weight and are concerned by excess skin. Others are confused by bulges that have no apparent cause. It’s a bit of a lottery how abdomens fare after pregnancy. Some women have stretchmarks while others can get through the process without a single one. There are also women for whom pregnancy can result in hernias. For whatever reason a patient is seeking a tummy tuck (abdominoplasty), I first assess risk-versus-outcome and ensure she can undergo the procedure safely and achieve her desired goals. A large majority of my abdominoplasty patients are fit, well-toned women who are regular gym-goers. Often they’ve spent hours working on their abs to improve muscle tone and strength, to no avail. Unfortunately, exercise won’t help a sagging or bulging tummy, as exercise will only tone muscle. Exercise can’t tighten skin or fascia [a structure of connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together], nor can it repair the torn or separated muscle wall that can occur during pregnancy. Pregnancy stretches the midline of the abdomen. If this doesn’t shrink back after birth it may leave a permanent weak area. This alters the way the abdomen works – it bulges when a woman is standing and the weakness also spreads to the back and pelvis, leading to back pain and a weak pelvic floor with stress incontinence. The skin of the abdomen stretches in pregnancy and this may not shrink either, especially after the second, third or further child. It can cause stretchmarks, localised fat collection and sagging.
About Dr Taylor Dr Taylor is a highly qualified, accredited plastic surgeon with many years’ experience in all areas of reconstructive, cosmetic and microsurgery. In his continued pursuit to provide outstanding commitment to his patients, and after years of research, Dr Taylor is also proud to have pioneered and to deliver a program designed to layer and sequence non-surgical rejuvenation treatments. He has a well established practice in Canberra at the purpose built Canberra Aesthetic and Plastic Surgery (CAPS) Clinic. Dr Taylor works only in Canberra which ensures his availability to his patients pre and post operatively, and to those patients being treated with non-surgical modalities. Dr Taylor is a Fellow of the Royal Australasian College of Surgeons (FRACS) and a Member of the Australian Society of Plastic Surgeons (ASPS). Trained in the major teaching hospitals of Sydney, Dr Taylor maintains industry-leading surgical techniques through regular involvement at international surgical meetings.
CONTACT DR TAYLOR AT THE CAPS CLINIC 7 PHIPPS CLOSE, DEAKIN ACT 2600 Phone (+612) 6282 1177 www.capsclinic.com.au
Many women put up with this as they relegate their needs to the background while raising their families. There is a tendency to accept that their bodies have “changed for the worse”; the “price of pregnancy”.
BEFORE
BEFORE
AFTER
AFTER
But it doesn’t have to be that way. It amazes me the things women put up with. If your knee was injured, you’d get it fixed. The post-pregnancy abdomen has the same impact on daily life. It can affect your ability to get out of bed in the morning, get up off the floor, lift children or heavy shopping bags into cars, jump on the trampoline - even laugh or cough without bladder leakage.
“If your knee was injured, you wouldn’t just accept it, you would get it fixed.” - Dr Taylor An abdominoplasty operation will restore everyday life function core strength, continence and, as a side benefit, the wrinkly lower abdominal skin will be removed. The waist is lowered and narrowed, producing a more desirable hourglass shape. In the same way pregnancy alters both the form and the function of the abdomen, so too does the development of umbilical or abdominal hernias [unusual protrusions of abdominal contents through a hole in the abdominal wall]. Unlike pregnancy weakness, the weakness associated with abdominal hernias is much more significant and clinically more concerning.
Beating The Bulge TREATING HERNIAS DURING ABDOMINOPLASTY FOR TRIMMER, HEALTHIER TUMMIES
BEFORE
BEFORE
AFTER
AFTER
The development of abdominal hernias following pregnancy is very common. Some women’s abdominal midlines are stretched so severely, the previously thick tissue becomes very thin and can tear like Swiss cheese (see Diagram 1). This leaves holes for the abdominal contents to poke through. However, there are a number of women who suffer from hernias prior to pregnancy who can also benefit from this procedure. To use a medical definition, a hernia is “an unusual protrusion of abdominal contents through a hole in the abdominal wall”. They are usually seen in the midline of your abdomen as a lump about the size of 20 cent piece and are frequently tender. Symptoms can include soreness and uncomfortable swelling and bloating.
“I am finally confident again and not ashamed to walk around.” Helen - CAPS Clinic Patient
THE PROBLEM
“The development of abdominal hernias following pregnancy is very common.” Occasionally, layers of the bowel can be caught up in the protrusion and this could be serious if it gets twisted or gangrenous in the hernia. Generally this situation is operated on by a general surgeon who places plastic mesh on the hole to prevent the protrusion. It fixes the hernia but not the problem that led to it in the first place. The muscular split (diastasis) remains following the repair along with the weakness (see Diagram 2). I have seen many men and women who come to me following multiple failed hernia repairs, performed by well-qualified and very experienced general surgeons. Patient photos used with permission.
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TRADITIONAL REPAIR
DR TAYLOR’S REPAIR
The very nature of the abdominoplasty surgery allows a more exposed repair which is stronger and more reliable than the traditional methods. Operative exposure of the abdominal wall during an abdominoplasty allows easy reduction of the hernia and the extending of the muscle repair from the chest to the pubis, removes the weak midline problem. With the tension shared equally down the abdomen in a muscle repair, no plastic mesh is required. Hernias can also protrude from the umbilicus (an “outy” belly button). This will need to be fixed at the time of the tummy tuck, as an “outy” belly button generally looks worse when the abdomen around it is flatter. Most of these hernias are small and are found incidentally during the operation.
“I have seen many... who come to me following multiple failed hernia repairs, performed by well qualified and very experienced General Surgeons.” Removing an umbilical hernia at the same time as the abdominoplasty can be tricky, as the blood supply to the remaining umbilicus can be affected by the hernia repair. Sometimes the umbilicus needs to be sacrificed and reconstructed with a skin graft. This should not be too much of a surprise during the procedure as generally a hernia of this size will be noticeable pre-operatively.
Discover how an abdominoplasty can change your life. Contact The CAPS Clinic Ph (02) 6282 1177 capsclinic.com.au
READ MORE OF HELEN’S AMAZING STORY AND OTHER LIFE CHANGING MOMENTS AT THE CAPS CLINIC WEBSITE
www.capsclinic.com.au
DR MARK
EDINBURG
Aesthetic Expert Plastic, Reconstructive & Cosmetic Surgeon
Plastic, Reconstructive & Cosmetic Surgeon Dr Mark Edinburg MBBCH FRACS is Medical Director of The Eden Institute of Plastic & Cosmetic Surgery and MediSpa, with more than 20 years of outstanding medical service and achievements. Dr Edinburg’s decades of breast augmentation knowledge and experience combined with his understanding of the individual needs of each of his patients combine to deliver excellent natural-looking aesthetic results. Renowned as an expert in natural-looking surgical outcomes, Dr Edinburg is dedicated to enhancing each person’s individual form and being. He believes that a good surgeon has to have a combination of expert surgical and technical skills and an appreciation for well defined beauty combined with a real understanding that each patient is an individual and each procedure needs to be assessed in terms of that specific patient’s individual needs. As well as being a leading Plastic and Cosmetic Surgeon, Dr Edinburg is also a specialist Skin Cancer and Hand Surgeon, based on decades of training, locally and internationally, including a Fellowship at Canniesburn Hospital in Glasgow, Scotland. Even though Dr Edinburg has two decades of successful surgical experience, he is vigilant about being committed to advances in Plastic Surgery as a regular participant at Advanced Training updates at the Royal Australian College of Surgeons and the Australian Society of Plastic Surgery, and also regularly spends time operating with other surgeons all over the world, exchanging ideas and techniques. In a field where education and technical skill is of paramount importance to ensure safe and effective surgical and non-surgical treatments, Dr Edinburg’s credentials position him as a pre-eminent Plastic Surgeon in Australia, delivering outstanding results for surgical and non-surgical rejuvenation for face, breast, body, hand, skin cancers and skin health treatments.
AESTHETIC EXPERTS
CONTACT US: BAULKHAM HILLS CLINIC Clinic C1 Solent Centre 3 Burbank Place Norwest Business Park Baulkham Hills T (02) 8814 5800 E doctor@edeninstitute.com.au
CHATSWOOD CLINIC 201/443 Victoria Ave Chatswood Sydney T (02) 8814 5800 E doctor@edeninstitute.com.au
RICHMOND CLINIC
47 East Market St Richmond Sydney T (02) 4588 5636 E doctor@edeninstitute.com.au
www.edeninstitute.com.au FIND US ON
DR EDINBURG’S PROFESSIONAL A F F I L I AT I O N S • Australian Society of Plastic Surgeons ASPS • Australasian Society of Aesthetic Plastic Surgeons ASAPS • Australian Hand Surgery Society AHS • American Society of Plastic Surgeons ASPS USA • Royal Australasian College of Surgeons FRACS • Australian Medical Association AMA • International Society of Aesthetic Plastic Surgeons AUGMENT BEFORE
AUGMENT BEFORE
AUGMENT AFTER
AUGMENT AFTER
SPECIALIST SURGICAL SKILLS
AUGMENT ASYMMETRICAL BREASTS BEFORE
• Facial Cosmetic Surgery • Blepharoplasty • Rhinoplasty • Face Lifts • Breast Reduction • Breast Lift (Mastopexy) • Breast Augmentation • Gynaecomastia (Male Breasts)
AUGMENT ASYMMETRICAL BREASTS AFTER
• Abdominoplasty • Liposuction • Otoplasty • Hand Surgery • Lesions, benign or malignant, face & body • Skin Flaps & Skin Grafts • Advanced Medispa • Anti-wrinkle treatments
THE
BREAST O P T I O N S
LEADING PLASTIC SURGEON DR MARK EDINBURG DISCUSSES YOUR OPTIONS FOR A MORE BEAUTIFUL CLEAVAGE.
You have decided you want a breast enlargement with implants or lift and/or reduction mammoplasty. Perhaps you have wanted to do this for a long time because you have small breasts or because, after childbirth and breast-feeding, everything seems to have disappeared or your breasts have become saggy. AUGMENT BEFORE
At the Eden Institute, you will enter a beautiful practice location and be welcomed by friendly and professional staff to make your visit pleasant and to allay any fears that you may have. During consultation, I will provide you with comprehensive detail and information about what breast enlargement is all about, what is suitable for you as an individual, what the operation entails, your hospital stay, your recovery and what you can and cannot do during your recovery, and what potential problems can occur. You will then decide on what shape you would like to be with my assistance by trying out various implant sizes and shapes. This is the very exciting part of the consultation process and a lot of fun at the same time. You can bring your partner, a relative or a friend or you can do in the privacy of your own home if you wish. I will also show photos of past patients, with their permission of course, and we would be delighted for our past patients to discuss their experiences with you. Once the history is completed I will carry out a thorough examination which will include many measurements including
132 NIPTUCK Magazine
height of the nipple, the breast base, how much existing breast tissue you have, and so forth. I will check for lumps and bumps and relevant scars as well as checking for nipple discharge, inversion and the size of the nipple-areola diameter (can this be changed). This information is vitally important in obtaining a good outcome and reducing any of the potential problems in the future. Once I have all this information, we will talk about where the incisions can be made, implant types (saline or silicone), implant shapes (round or anatomical) and projection levels (low, moderate or high). There are usually advantages and disadvantages to each option and I am happy to discuss each of these thoroughly with you. You may have your own thoughts and preferences - that’s okay.
AUGMENT AFTER
AUGMENT BEFORE
I will also talk to you about recovery, potential risks and implications. Can your operation be done as a day stay or will you need to stay overnight? In my practice, if the implant is placed behind the muscle, I would encourage you to stay as you may require more pain relief. The
AUGMENT AFTER
MASTOPEXY BEFORE
MASTOPEXY AFTER
MASTOPEXY BEFORE
MASTOPEXY AFTER
hospitals in which I work have private rooms, ensuites, TV, telephones, three good meals a day and lovely staff. I will see you before you go home. You will receive all the relevant information on what you can and cannot do and what tablets you should and should not take. I would like to see you at a week and then again at six weeks and six months. It would be nice if you would visit me yearly to keep a progress report and for scientific and data purpose. This will allow me review my work and make appropriate changes if necessary. We finally need to discuss potential problems of this operation and I will do this with you in detail. I believe that you should be aware of the potential problems because you have to make very serious decisions about your choices. Problems do happen but thankfully, these are not common. This will also give you the opportunity to ask as many questions as you like. Please bring your list along. I know you have a huge amount of information to think about. You probably will only remember about 40 percent of what I have told you.
AUGMENT BEFORE
Do not despair. This is all this stuff written down for you and you can take it home and read at your leisure. If there are more questions, phone in. I may not be available straight away, but I will get back to you.
Finally, if you decide you would like to go ahead with the surgery, I invite you to return for a fitting. Please bring the bra cup size that you would like to have, a tight-fitting top to see how you would look – and a friend. I will help you to help yourself make the final decision on size. If you choose the wrong one I will tell you and why.
I will send you out information about the costs of the procedure. This is comprehensive and will include my fees, the anaesthetist’s, the hospital and the theatre.
Breast augmentation can help bring your body into proportion and create a more pleasing cleavage if your: • natural breasts are on the “flat” side
AUGMENT AFTER
• breasts are asymmetrical and different in size • breasts are spaced far apart resulting in a lack of cleavage • breasts have reduced in size due to breast feeding • breasts have aged naturally and lost their volume
GIVEN ALL THE INFORMATION AND READING SUGGESTED, 98 PERCENT OF PEOPLE MAKE THE CORRECT CHOICE.
Dr Mark Edinburg MBBCH FRACS
NIPTUCK Magazine 133
Oculoplastic Surgeon | MBBS (Hons) | FRANZCO
Dr Angelo Tsirbas is a renowned orbital and Facial Plastic and Reconstructive Surgeon who has pioneered some of the most innovative eyelid, brow and orbitofacial surgical techniques in the world, receiving international recognition for his work. He is regularly invited to appear in the media, providing expert option on plastic surgery and facial rejuvenation. He has been keynote speaker at a number of international conferences, is widely published and continues to be actively engaged in a number of research projects.
Graduating at the top of his medical
He is a member of the Australasian
developed during long term and
school in the early 1990’s, he was
Association
Plastic
intensive experiences in Los Angeles
awarded the prestigious University
Surgeons, the American Society
and New York, treating patients
Medal. He trained in General
of
requiring
Surgery in Adelaide and completed
Reconstructive Surgery and the
of whom were in the media and
ophthalmic training in 1997 at
European Society of Ophthalmic
motion picture industry.
the Royal Victorian Eye and Ear
Plastic & Reconstructive Surgery
Hospital. Dr Tsirbas was awarded a
and the APSORS. On top of these
“I am meticulous, focused and what
Fulbright Scholarship to further his
vast qualifications, Dr Tsirbas is
allows me to obtain great results is
research into Thyroid Orbitopathy
also a founding member of the
understanding the often minute
at Columbia University in NYC. He
International Thyroid Eye Disease
and subtle challenges that are only
trained at the Manhattan Eye and
Society.
recognized after extensive training.
of
Ophthalmic
Facial
Plastic
&
Ear hospital and the New York Eye
blepharoplasty,
Subsequently,
I
am
many
confident
and Ear hospital.
Dr Tsirbas’ work is in great demand
specializing in upper and lower
Subsequently, he was asked to join
all over Australia, and he is sought
eyelid blepharoplasty. I often see
the faculty at the Jules Stein Eye
out for his skills in obtaining the
patients that have had problems
Institute at UCLA and thrived
finest and most natural results.
from other corrections or revision
during his time on the West Coast.
He brings to his practice expertise
surgery. Paying attention to all the
NIPTUCK Magazine 135
continued from previous page
intricacies and subtleties that lead to a youthful rejuvenated look without the tell tale signs of a surgical correction, allows me to achieve great results.” Due to his international exposure, Dr Tsirbas has a vast range of experiences and different strategies for blepharoplasty for various ethnicities and facial shapes. “Having worked in Los Angeles and New York City, this allows me to come up with a surgical plan that’s individualized rather than a cookie cutter approach that may be used by someone less experienced in this area of cosmetic surgery.” It’s vital to have an armamentarium when consulting patients with aesthetic problems around the eye. Often surgeons suggest that a simple excision of skin will rectify the problem, but of this strategy Dr Tsirbas states, “if you only have a hammer everything looks like a nail!” It’s vital to be able to offer multiple options to patients. This may include fat preservation, or repositioning blepharoplasty as well as surgery to tighten the muscles that lift the lid. The eyes are the windows to the soul and often a great result in this area improves the whole face as well as the outlook and confidence of the patient. It’s absolutely critical that when you are considering blepharoplasty surgery you go to someone who does that all day, everyday.
Ph 1300 37 87 47 Fax 02 8362 9441 Email pa@drtsirbas.com Web www.drtsirbas.com
136 NIPTUCK Magazine
Sydney Rooms About Face Level 1, 21 Spring Street Bondi Junction NSW 2022
Bondi Junction Private Hospital Level 2, 21 Spring Street Bondi Junction NSW 2022
Macquarie University Hospital 3 Technology Place Macquarie Park NSW 2113
Canberra Rooms Suite 9, 3 Sydney Avenue Barton ACT 2600
OCULOPLASTIC SURGERY Before and After
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
Oculoplastic Surgery, also known as Ophthalmic Plastic and Reconstructive, Oculofacial or Eye Plastic Surgery, is a surgical subspecialty of Ophthalmology that deals with the medical and surgical management of deformities and abnormalities of the eyelids, lacrimal (tear) system, orbit (bony socket) and the adjacent face. An Oculoplastic Surgeon is an Ophthalmologist (medical doctor and eye surgeon) who has completed additional advanced training in plastic surgery as it relates to the eyes and surrounding structures.
NIPTUCK Magazine 137
THE SKINNY
ON LASERS with Dr Jack Ting
NEW ERA OF BODY SCULPTING DR TING BEGAN USING LIPOSONIX –NEW ULTRASONIC DEVICE FOR FAT REDUCTION/BODY CONTOURING– LAST NOVEMBER WHEN IT WAS INTRODUCED TO AUSTRALIA. HE HAS SINCE BEEN REFINING HIS TECHNIQUE SO THAT HE IS NOW ABLE TO ACHIEVE INCREDIBLE RESULTS IN PATIENTS’ SIZE AND SHAPE AFTER JUST ONE TREATMENT.
“After using Liposonix over successive treatments for the first few months I decided to raise the energy levels to achieve more significant results in just one session. It is very motivating for them to see results in as little as two weeks, with full results in around 12 weeks.” Because he uses a higher level of energy it can be painful and so Dr Ting offers appropriate pain relieving medication during treatment. Patients can also expect to have bruising for a week or more afterwards. “I believe in the `no pain, no gain’ approach,” he explains. “And certainly my patients have been happy with their results. Some have experienced a reduction in treatment areas of as much as 6.5cm. Many patients report dropping a clothes size. Liposonix uses specific High Intensity Focused Ultrasound (HIFU) targeting fat cells under the skin. It works through vibrations of fat molecules, causing
138 NIPTUCK Magazine
friction and generating heat to kill fat cells. Liposonix also denatures collagen through heat; this process stimulates the regeneration and remodeling of collagen; thus, the tightening of skin. The body naturally processes and removes the destroyed fat tissue over the next 8-12 weeks. The treated fat cells are permanently destroyed but if you gain weight, remaining fat cells will enlarge. A recent patient, Victoria, 42, reports that only seven weeks after treatment on her upper and lower abdomen and hips, her jeans feel much looser and her
BEFORE
AFTER
stomach and midriff significantly flatter, meaning she can also wear tighterfitting tops. “I can really feel a difference,” she says. “I look better in my clothes and definitely feel slimmer and more comfortable, especially around my stomach and hips. This has made me feel a lot more confident, especially as I’m about to go on holidays to Hawaii. My husband is so impressed with the change he’s seen in my body that he’s now doing it too. “I still have five weeks before I will see the full improvement, so I am really excited. I am so glad I did this.”
BEFORE
AFTER
RAYS OF HOPE FOR SKIN SCARS FROM INJURIES, OPERATIONS, BURNS AND ACNE, STRETCH MARKS, SEVERE HYPERPIGMENTATION (DARK DISCOLOURATIONS), AND HYPOPIGMENTATION (LOSS OF PIGMENT), ONCE YOU HAD THEM, YOU WERE STUCK WITH THEM FOR LIFE. THEY MIGHT SOMETIMES FADE, BUT THEY WERE ALWAYS THERE.
BEFORE
AFTER
Fraxel lasers have changed all that in the past decade, according to Dr Ting, one of Australia’s foremost practitioners in the technology. “Whatever skin problem a patient comes to me with I can mostly fix it with one of the Fraxel lasers. If the condition is severe – such as one patient who travelled from Adelaide several times over a couple of years to have her motor vehicle accident scars treated – it may take a while to achieve optimal results, but I get there”. “I have spent a great deal of time developing new methods of treatment and then refining them so I can achieve outstanding results on notoriously difficult skin problems.” All Fraxel lasers rejuvenate skin. Fraxel lasers are fractional lasers, meaning they do not remove the entire surface layer of skin, instead, they make thousands of microscopic “pinpricks” of variable depths, causing injury to collagen to stimulate
BEFORE
AFTER
collagen regeneration and remodeling and rejuvenate the skin; in the process, Fraxel lasers can remove skin blemishes, pigmentation, repair scars, reduce stretch marks and tightening of skin. Fraxel re:store Dual is one of the most recent advances in the technology, consisting of 1 device with two lasers: 1) Fraxel re:store 1550nm wavelength, the original Fraxel laser used to remove scars on the face and entire body; 2) Fraxel re:store 1927nm wavelength is very effective in removing pigmentation in 95% of cases. There is 5% recurrence of pigmentation due to intrinsic medical causes or unknown cases. Fraxel re:pair 10,600nm wave length is mainly used for skin tightening. It is more useful for reduction of wrinkles, treating acne scars where other treatments failed. The initial recovery time for facial skin is 7-8 days, but patients may only need one treatment for outstanding rejuvenation results that last for many years.
Dr Jack
TING Dr Jack Ting is Australia’s most experienced laser cosmetic surgeon, with a reputation for outstanding results in Fraxel laser skin rejuvenation and correction at his clinic in Coogee, Sydney. A pioneer in the field, he performed among the first eye lifts (blepharoplasties) in Australia using laser rather than a scalpel 21 years ago. Dr Ting continues to lead the way in innovative, safe and highly effective laser procedures. He is also one of the first doctors in Australia to use the new Liposonix non-invasive fat reduction technology. He talks to NipTuck about the impressive results he has achieved so far with Liposonix and the many ways in which he uses Fraxel to change patients’ lives.
LASER COSMETIC DAY PROCEDURE CENTRE 218 Coogee Bay Road, Coogee NSW 2034 Tel 02 9665 3247
www.drting.com.au A Division of Cakuva Pty. Limited A.C.M. 001 230 440 A.B.N. 63 228 152824
Dr. John Newton, M.B.B.S., F.R.A.C.S. COSMETIC PLASTIC SURGEON Phone 02 4948 4200
The Knowledge, The Experience, The Wisdom as used in my website
Meet Dr John Newton Dr. John Newton is an experienced, fully qualified surgeon practicing in Warners Bay, a suburb of Newcastle in the Lake Macquarie region. He has higher qualifications in both cosmetic and reconstructive plastic surgery. A native of Newcastle, NSW, he has studied plastic surgery in Melbourne, Australia and London, England. Among other professional affiliations, Dr. Newton is a fellow of the Royal Australasian College of Surgeons. Dr. Newton always strives to produce high-quality surgical results at his Warners Bay practice and always treats his plastic surgery patients with absolute integrity. If surgery is not the right option for you, he will tell you so. Dr. Newton uses only proven, established plastic surgery procedures that produce reliable and aesthetically pleasing results.
14 Howard Street, Warners Bay | 02 4948 4200 www.cosmeticplasticsurgery.com.au 140 NIPTUCK Magazine
Dr. John Newton, M.B.B.S., F.R.A.C.S. COSMETIC PLASTIC SURGEON Phone 02 4948 4200
A
Stitch
IN TI M E “Is now the right time to have this done?” seems a very common question. It comes from all types of people considering operations across the whole spectrum of cosmetic plastic surgery. Newcastle plastic surgeon Dr John Newton discusses the pros and cons. Patients often ask me about appropriate timing for their elective cosmetic surgery operations. It seems a simple question but, in fact, it is a very important question and the answer can involve a number of issues, some of them complex. I feel the bottom line for a patient considering a cosmetic operation is that they should have the operation when they feel they want it and they need it. If this basic rule is followed then an improvement to satisfy the patient’s desires can be expected. I think it is wrong for a patient to have an operation too early; that is to say, in anticipation of a deterioration in their appearance or physique over time. In this circumstance some mild improvement may be achieved but it may not be enough to make a person feel that the effort was worthwhile. Sometimes I advise patients to hold on and not proceed with an operation now but to allow the circumstances to develop a little further so that a real and evident benefit can be perceived.
with respect to interactions at school and the subsequent teenage years of significant self awareness.
well in anticipation of the spring so that her recovery period is over before the highlights of summer begin.
I think however, that cosmetic surgery for adolescents is generally not an appropriate thing. On the other hand, old age is not necessarily a barrier to surgery either. Some cosmetic plastic surgery procedures such as breast reductions and tummy tucks can considerably assist the lifestyle of older people. The overriding factor for these patients is their fitness to undergo surgery.
Patients also ask me about timing with respect to events in their lives. Sometimes they don’t actually ask but I pick up on events which will be influential.
I am often asked questions with respect to timing in relationship to the seasons of the year. Some patients would prefer to have procedures which require extensive dressings performed during the autumn and winter months (although air conditioning goes a long way to resolving these problems). Procedures which require minimal dressings such as procedures around the face are perhaps not as influenced by the weather.
There are, however, a lot of other intricacies involved in timing operations.
I think it is also important to plan surgery with respect to the seasons. If a patient is contemplating breast surgery in the anticipation of a coming summer, then it is best that this be planned several months prior to the summertime.
The age of a patient is often a consideration. In some cases such as prominent ears [otoplasty] surgery can be carried out at a very early age. This can have significant benefit for a child
A classic example would be a patient contemplating breast augmentation. If she anticipates an active summer at the beach or on a boat, I would suggest that she have the surgery
Functions such as weddings and anticipated holidays may need to be taken into account. Recovery periods from operation can be as long as 8-10 weeks. This means that the surgical procedures need to be performed well in advance if the mother of the bride, for example, is to look her best at the wedding or indeed the bride is to have a comfortable honeymoon/holiday. I also think stressful events need to be considered. I would suggest that a patient who has had significant stress in their immediate lives, particularly stress within a relationship, should take the time to ensure that this stress is not going to impact on his/her procedure or recovery. If it is, then I would recommend that he/she perhaps hold back with the procedure until the stress is largely resolved. So timing is important when considering cosmetic plastic surgery. I feel that it does need to be discussed with patients, perhaps in many facets depending upon the individual to optimise the outcome.
Dr. John Newton, M.B.B.S., F.R.A.C.S. COSMETIC PLASTIC SURGEON Phone 02 4948 4200
A WEIGHT
OFF YOUR CHEST The popular media would h ave us believe th at most girls want large breasts. In fact, for many girls the option of small er breasts is something the y would prefer.
Large breasts can be uncomfortable, inconvenient and socially embarrassing. To manage this, a large number of women undergo breast reduction surgery. Warners Bay Plastic Surgeon Dr John Newton sees a large number of women who wish to discuss the awkwardness of their breast size and consider breast reduction. “Very many women are inconvenienced by large breasts,” he says. “The overall bulk is uncomfortable for them and they can suffer neck, shoulder and back pain. In the summer months it is often inconvenient and uncomfortable with sweating. “I see a number of young women who feel awkward because of their breast size. They do not only feel awkward because of the physical discomfort and the difficulty fitting into clothing but in the company of other people who appear to focus their attention on the girls’ breasts.” Mother Nature and childbirth are not always kind to girls’ breasts either. For some the breasts become smaller and flatter, for many breasts become larger and dropped. As well as causing shoulder, neck and back pain, the skin between the breast and chest can become inflamed during hot weather. There is no doubt that minimiser bras and sports bras can help but for some girls resorting to surgery is a definite consideration. “A large number of patients I see have had large breasts for a long time and have finally decided
142 NIPTUCK Magazine
to at least find out if not venture into breast reduction,” says Dr Newton.
moved. It is rare that the nipple is removed and replaced as a graft.”
There are an increasing number of younger women whom I also see with respect to consideration of breast reduction.
Very substantial changes can be achieved using surgical breast reduction but of course it has its negatives in the form of scarring, possible interference with the ability to breastfeed and possible variation in nipple sensation.
For all of these women some form of breast reduction or lifting can be of significant value. It is not at all surprising to have some woman came back after the procedure and say I wish I had done this twenty five years ago.”
Liposuction is a less traumatic procedure to go through and the recovery period is reasonably short but support garments do need to be worn for a prolonged period post-operatively.
So what are the surgical options? Dr Newton states that they range from liposuction through lifting and tightening to a combination of lifting and tightening with reduction. “In general, if the patient is a young woman and is single and perhaps has not had children, I like to ask myself if liposuction is a viable option. It can reduce breast volume and if the tissues of the breast are still elastic enough it can allow the breast to drift upwards on the chest wall. The scarring is minimal and breastfeeding and nipple sensation should remain as normal. There is no doubt that liposuction is however, a compromise and the same degree of lift and reduction cannot be obtained as from a more formal breast reduction. More traditional breast reduction does involve cutting of the breast tissue with surgical removal of breast tissue, re-suspension of breast tissue within the breast and then suturing of the wounds. The nipple is usually left intact on the breast and
Dr Newton states breast reduction is a more invasive procedure, generally with a short inpatient stay. The recovery period back to full activity is between 6-8 weeks. The vast majority of patients who undergo breast reduction are happy with the results and state that they wish that are much more comfortable physically and confident socially. It should be emphasised that anyone considering any kind of Cosmetic Plastic Surgery should consult an accredited Plastic Surgeon and discuss their expectations and surgery in detail. Qualified Cosmetic Plastic Surgeons in Australasia are members of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgeons (ASAPS).
DR JOHN V NEWTON
Tummy TUCK
If you would like to book an appointment with Dr Knox call the team at breast.com.au on 1 800 32 34 36
Dr Adrian Knox MBBS FRACS www.sgsplasticsurgerycentre.com.au
A “Tummy Tuck” procedure is amongst the most sought-after body shaping or contouring operations. fig. 1
fig. 2
fig. 3
fig. 4
fig. 5
fig. 6
1 week post surgery fig. 7
fig. 8
1 week post surgery
WHAT IS IT? The “tummy tuck” label usually covers two surgical alternatives: an “abdominoplasty” and an “apronectomy”. An apronectomy aims to remove an overhanging “apron” of skin and soft tissue from the lower abdomen usually via an horizontal incision. An abdominoplasty takes this further by lifting and tightening the soft tissues all the way to the top of the abdomen. A benefit of this extended approach is the opportunity to tighten the abdominal muscles (the “abs”) as well as the skin over a larger area. Generally the belly button is also adjusted. Deeper supporting stitches are inserted before the skin is finally closed. Liposuction is generally added to optimised shape – particularly at the sides (the “muffin-top” zone) but sometimes in the pubic area as well.
WHAT DOES IT INVOLVE? Surgery takes about 3 hours. Expect a 3 – 4 night stay in hospital. Your stay can be shortened, but a “tummy tuck” is a significant procedure and short cuts may increase risks like wound problems or bleeding. You will probably be given a support garment to wear for about a week. Plan to take life very quietly for another 10 days. Activity that work your “abs” or twists your torso, eg standing still but twisting to look behind you, should be minimised. You’ll need 4-6 weeks to feel like getting back to full activity levels. Many women report the early level of discomfort as being similar to a caesarean section.
WHO IS IT FOR? Mothers who have finished their family and now want to tighten up the damage from pregnancies commonly seek this surgery. Secondly, women or men who have had weight loss surgery and who have now reached their target weight are also great candidates (fig 1-4). A third group have split/weakened muscles from previous damage causing pregnancy-like bulging. (fig 5-8).
Get good family support around you – you need to be the patient, not the boss, for a couple of weeks.
OTHER CONSIDERATIONS: You can combine this with other procedures like breast augmentation and lift (“mummy makeover”)
You may lose a little weight but this surgery is mainly for reshaping. Ask your surgeon about breast screening before you eliminate that spare abdominal skin. This is very effective surgery if it is well prepared for, but it can be a bit more than a “nip and tuck”!
NIPTUCK Magazine 143
Dr TONY
TAN
MB BS, Bachelor of Science (Medicine)
After graduating from the University of NSW, Dr Tony Tan trained in emergency medicine but over the last four years has dedicated his focus to cosmetic medicine, working full time in same. He is passionate about his work and believes that everyone has natural beauty potential, and that it is the duty of the treating physician to release this potential within the process of facial rejuvenation, or rather beauty maximisation. This can be achieved non-surgically using a combination of therapies in a comprehensive “pan-facial� approach. He is the founder and director of Oz Locums Medical Staffing’ agency and Beauty Logic cosmetic clinic in Fairfield, Sydney.
FACE OF THE
FUTURE COSMETIC PHYSICIAN DR TONY TAN, OF SYDNEY’S BEAUTY LOGIC CLINIC, UNVEILS HIS TAN-FACIAL (PAN-FACIAL) APPROACH TO BEAUTY MAXIMISATION, TWO YEARS IN THE MAKING. The TAN-facial is not just rejuvenation but Beauty Maximisation, addressing every aspect of the facial ageing process for more beautiful, longer-lasting results, according to Dr Tony Tan. “I use this technique is to create a more attractive version of a patient, not a different look, “ he says. “It is based on an age-old mathematical ratio Phi:1.618 that the ancient Greeks called the Golden Ratio and Renaissance artists the Divine Proportion. It has been used for thousands of years in art, music and architecture. Now it is being embraced in cosmetic rejuvenation to achieve the most beautiful proportions and contours possible for a patient’s individual face.” Whether we realise it or not, irrespective of our age, nationality or racial background, we are subconsciously programmed to recognise what constitutes a beautiful base. This is based on proportions that approximate the Phi mathematical ratio. This is the basis of the TAN-facial. Dr Tan uses these mathematical principles when determining the best holistic or “pan-facial” approach to treating a patient’s face. He doesn’t just deal with the surface lines, wrinkles and folds or skin laxity but goes deep beneath the surface to restore the foundations and, thus, more youthful contours. “Most of my clients tend to be focused on the lines and creases on their face, such as the jowls, the
deep nasolabial folds that run from their nose to their mouth and the marionette lines that run from the corners of the mouth to the chin,” he says. “But it important they understand what has caused these age-related concerns, that they are largely a byproduct of volume loss underneath the skin. So I spend a great deal of time with each patient discussing the ageing process.” Of course everyone ages differently and at a different rate but the basic process applies: the skin thins, muscles lose bulk, fat disappears and bones resorb. This leads to what Dr Tan describes as Deflation, Deterioration and Descent. Dr Tan uses a combination of dermal fillers, anti-wrinkle injections and other non-surgical procedures such as laser and Intense Pulsed Light (IPL). “My technique has been two years in development and streamlining and I am now ready to call it the TANfacial approach,” he explains. ”I first assesse volume loss in each tissue layer to identify negative vectors (directions). Then I use a Phi caliper to measure a patient’s face and so help determine how I will treat them to achieve the most beautiful proportions – and that I don’t over-correct certain areas. “In effect, I rebuild the facial structures. I start by replenishing volume loss in the bony regions first to create better structural support
for the face and improve contours so they look more youthful. Then I work my way up through the layers of the skin.” If there is significant sagging of the face, my also recommend thread lifts to gently raise the brow and contour the lower face, reducing jowls.
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“As ageing is global and three dimensional,the rejuvenation process, or Beauty maximisation process, should be three dimensionalmoving superiorly (Upward), laterally (sideways) and outwards,” he says. “Lines and folds are secondary manifestations of ageing, not the primary problem. Filling these lines and wrinkles without addressing volume loss would achieve a two dimensional improvement but would not address the real issues.” The TAN-facial can be carried out over several stages. When the treatment has been completed, Dr Tan recommends freshen-ups every 8-12 months to maintain results. “One of the greatest benefits of the TAN-facial is the natural-looking results that attract my patients comments like `you look great’, `you look so well’,” he adds. “It pleases them that, unless they decide to tell people what they’ve had done, no one would know. The TAN-facial is designed to release a patient’s natural beauty potential, create a more attractive version of themselves, not a different look.”
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Ageing is a choice
Let us help you make the right beauty decisions READ ABOUT OUR BEAUTY PHILOSOPHY
Phone 1300 196 196 or 02 8212 5557 196 The Boulevarde Fairfield Heights Sydney NSW 2165
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WHAT PRICE FOR YOUR
DECIDING TO HAVE COSMETIC SURGERY OVERSEAS ON THE BASIS OF IT BEING CHEAPER THAN IN AUSTRALIA? IT WILL LIKELY COST YOU A LOT MORE, AND IN SO MANY WAYS. SYDNEY PLASTIC SURGEON DR RICHARD SACKELARIOU EXPLAINS. You have only one face, so choose it wisely. Sound strange? Not if you realise how many Australians are travelling overseas, entrusting surgery on their facial features, breasts and other parts of their body to doctors they have not previously met because it’s ‘cheaper’ and they can have a ‘holiday’ in the process. Over the last few years I have seen some shocking results of surgery performed overseas; desperate people who come to me in the hope I can undo damage done by practitioners without adequate qualifications, training or experience in that particular field. People aren’t always looking for the best local surgeon in these cases, they are usually looking for the best deal. This of course means they compromise on the quality of care they receive. It is devastating for the patients, and for me as a surgeon who really cares, because it is not always possible to restore their appearance in a way they will ever
be completely happy with. This, of course, is not to say all doctors on these so-called ‘cosmetic surgery holidays’ are not good at what they do. However, the surgery itself is only one step of a very comprehensive process. I have more than 20 years’ experience in Australia, the UK and France in plastic and reconstructive surgery. I have patients who travel from interstate and around the world, and who come from across the social spectrum. What they are looking for from me is not only excellence in the aesthetic results they will achieve, but to be able to feel confident and at ease. I am a fully accredited plastic surgeon, with extensive experience and offer dedicated pre- and post-operative care. Forging a relationship with my patients - the consultations and planning prior to the operation and the follow up in the weeks and months afterwards - is essential for a good surgical outcome
and, equally importantly for me, happy patients. You might be one of the lucky ones and have a good experience overseas, but I can only tell you of the surgeries that have not gone well. Clear communication between surgeon and patient, and a concise interpretation of what they are hoping for, what is achievable and what will meet their expectations is a fundamental part of what I do. It is highly unlikely that you would receive this depth of care and attention if you fly into a destination one day and are operated on the next by someone you may meet only briefly beforehand. Companies may organise these ‘holidays’ saying they handle the consultation process and liaise with the operating surgeon, but developing a direct surgeon-patient relationship is irreplaceable.
As mentioned, you may be lucky and overseas procedures will go according to your expectations and without any complications, but if not, you may endure years of stress, distress and expense to fix the result of ‘cheaper’ surgery. Is it really worth it?
2/15 Cross Street Double Bay NSW 2028 Ph (02) 9362 0676
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FORTUNATE OUTCOMES: CHOOSE WISELY Actual Patients of Dr Richard Sackelariou
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AVOID UNFORTUNATE OUTCOMES: CHOOSE WISELY
‘Cosmetic surgery holidays’ are fraught with danger for a number of reasons, including: • The patient has no previous, or very little knowledge of the operating surgeon and his/her experience and credentials in the field. • There is no opportunity to forge a real relationship with that surgeon prior to surgery and, so, communicate your hopes and desires, and have your expectations managed. • Once you have been discharged from hospital, the postoperative follow-up is minimal – after all, you will soon be back on a plane home. Then, medically speaking, you are pretty much on your own.
• If infections or other complications develop, you will need to seek the help of an Australian plastic surgeon. Unfortunately you may find some reluctant to become involved and often there aren’t always the solutions you may think there are, to correct the problem. • Corrective treatment in Australia will cost you more money, as you will not be insured for the procedure performed overseas. How much expense it ends up being depends on the extent of your problem and the amount of treatment it will require.
Dr Kourosh Tavakoli is a renowned, fully qualified Australian-trained plastic surgeon specialising in cosmetic surgery of the face, breast and body. He is a member of the Australian Society of Plastic Surgeons (ASPS) and Australian Society of Aesthetic Plastic Surgeons (ASAPS). These are the societies affiliated and recognised by the Royal Australasian College of Surgeons for bona fide plastic surgeons.
T 1300 368 107 | drtavakoli.com.au
Dr Tavakoli believes that the future of Plastic Surgery is “super-specialisation”, in either cosmetic surgery or reconstructive surgery. Although trained in both, he is one of handful of plastic surgeons in Australia who has total commitment to cosmetic surgery. A significant proportion of Dr Tavakoli’s practice is devoted to breast augmentation and rhinoplasty. After graduating from high school in 1988, Dr Tavakoli spent the next 16 years training to become a plastic surgeon, graduating in 2003. Since January 2004 he has been in private cosmetic surgery practice in Sydney. He also does plastic and reconstructive surgery free of charge on patients born with congenital disfigurement ,or victims of trauma who have genuine financial constraints. Dr Tavakoli has travelled to some of the major European and American cosmetic plastic surgery centres in order to keep abreast of the latest surgical techniques. He has a commitment to Continuing Medical Education (CME), attending and participating in meetings to provide a continuing high level of expertise in his practice. Fundamental to his personal and professional philosophy is family. Dr Tavakoli is happily married, with a young son and daughter. Mrs Tavakoli’s support of, and involvement in the practice is integral to Dr Tavakoli’s success.
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Contact details: 246 Glebe Point Rd, Glebe NSW 2037, Australia T: (02) 9660 2927 | F: (02) 9552 1330 | W: www.glebedental.com.au | E:info@glebedental.com.au
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Studies show that well over half the population has crooked teeth and many of these people are unhappy with their appearance. One of the common methods recommended to correct crooked teeth would be porcelain crowns or veneers. While this can be a good method in the right situation, the teeth have to be drilled, sometimes quite a lot, in order to make room for the crowns to fit. Many people are reluctant to have otherwise healthy teeth cut down just for cosmetic reasons. The other alternative would be braces to straighten the teeth. So if braces are required, what prevents people from doing something about it? The reasons are many and varied but really boil down to three - cost, time involved and the appearance of traditional metal braces. Many of us will remember teasing at school of those with metal braces. Remember metal mouth? Railway tracks? The solution may well be a technique pioneered in the USA called Short Term Orthodontics. Traditional braces look ugly and can often take up to 2-3 years to complete. This is because the bite is usually being changed as well as the teeth being straightened. This is the right approach for younger people as well as for adults with bite problems. This bite changing
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process is complex and can take a long time and therefore costs more. Straightening the front teeth if the bite is not being intentionally changed is much quicker. Many people are happy with their bite but are unhappy with their crooked front teeth but were previously put off doing anything about it. This new technique of Short Term Orthodontic treatment would be appropriate for many adult patients whose main concern is crooked front teeth. Ugly metal braces are also no longer an issue as new technology means clear braces and tooth coloured wires are now available and can make “railway tracks” a thing of the past. Crooked teeth can now often be straightened in 3-6 months, without metal braces and at an affordable cost.
Dr Andrew Lee
If more severe conditions are present, Short Term Orthodontics can often still be used in combination with other techniques to achieve a great result more easily. Come in to see us to find out if you too could benefit from this method and get a new smile in just a few months without cutting down your teeth.
Dr George Lee
Treatment completed in 5 months.
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Our Treatments Cosmetic Dentistry • Dental Implants • General Dentistry • Gum Disease Treatment Invisalign™ and Orthodontics • Headaches & Migraines TMJ Treatment • Laser Dentistry Children’s Dentistry • Smile Makeovers • Teeth Whitening • Wrinkle Reduction Treatment
Interest free payment plans available *Conditions apply*
Tetracycline stained teeth?
Call us for a complimentary consultation regarding our revolutionary teeth whitening system with proven results.
Breast
Actual breast patients of Dr Miroshnik
Creating body balance and Breast augmentation has come a long way in recent years. Today in 2013, every aspect of the procedure is customisable so whatever style or shape you desire, there is usually a solution available to give you results that will match your expectations. Dr Michael Miroshnik is a fine example of the excellent surgical care available to women today for breast augmentation procedures. “Women undergo breast augmentation for a variety of reasons, and all have different personal outcomes in mind. In 2013, breast augmentation is not simply about size but also about shape. Some women lack inner cleavage, whereas others lack upper fullness or outer curvature, whereas others again
are more concerned about an element of droop to their breasts that they would like corrected.” says Dr Miroshnik. Achieving the best possible result requires a great deal of surgical planning in every operation. “It’s vitally important to gather the right information during the consultation process, both in terms of the patient’s physical needs as well as her own perceived requirements from the operation. Many of my patients start with small, A-cup sized breasts and desire a result that looks as natural as possible. Others, on the other hand, are looking for a fuller, more enhanced look with accentuated curves and cleavage.”
Breast Augmentation
Actual breast patients of Dr Miroshnik
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T: (02) 9389 8108 (Sydney) | 1300 88 90 50 (Intertstate)
Perfection
with Dr Michael Miroshnik
harmony with each surgery.
Actual breast patients of Dr Miroshnik
Dr Miroshnik practices the ultrafast recovery technique. Almost all procedures today can be conducted in a day hospital setting, with the patient returning home within a few hours of the procedure being completed. Due to modern anaesthesia and pain control, time back to work is faster than ever at approx. 7 days for office based jobs. Due to his detailed, systematic and comprehensive approach, Dr Miroshnik has achieved widespread acclaim for his skills and expertise in all forms of cosmetic breast surgery. As a result, he has patients that travel to see him in his Sydney clinic from all over Australia and even abroad!
DR MICHAEL MIROSHNIK
Plastic & Cosmetic Surgeon MBBS, FRACS (Plast.)
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www.drmiroshnik.com.au
Perth PROMOITALIA Thread Lift Specialist
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Actual Patient: Blepharoplasty
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www.medaesthetics.com.au
Dr Ehsan Jadoon MBBS, PGradDip Cosmetic Med (Australasian College of Aesthetic Medicine)
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TREATMENTS AVAILABLE INCLUDE: MEDICAL Non Surgical Facial Makeovers Cosmetic Injectables Promoitalia Thread lift Fraxel Repair Alma Pixel Perfect
Actual Patient: Liposculpture
SURGICAL Eyelid trim Liposculpture Breast Augmentation Mini face and Neck Lift Fat Transfer
Flagship Clinic Now Open in Subiaco WA
A: 324 Hay St Subiaco | For appointment, call 0889536162
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AUSTRALIA Photo courtesy of www.davidbroadway.com.au
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Argera
ANTI-AGEING
What do you look for in a
COSMETIC DOCTOR? Female | Experienced | Fully Qualified | Practices at the highest standards | Of Good Standing within the industry | Personalized service | Caring, gentle Knowledge of Artistry and balance | Prefers a natural approach | Latest in technologies and techniques Provides detailed consultations | Listens
CENTRE WHY CHOOSE ARGERA?
Any of the above?
Then consider ARGERA Antiaging Centre for your next medical cosmetic treatment.
‘IT’S WORTH TRAVELLING FOR GOOD CARE’
TREATMENTS
Safe wrinkle relaxers and fillers including facial volumizing and lip restoration/augmentation • Latest skin treatments for pigment, texture, poor elasticity, acne and acne scarring • Thermage® • Spider Veins • Fat dissolving • Liposuction • Thread lifting • Medical Strength IPL • Excess Underarm Sweating • Medical Strength Skincare
Joondalup, West Australia PH (08)93014244 | E: info@argera.com.au W: www.argera.com.au
In an unregulated industry what makes the ARGERA Centre stand out as a first choice for prospective patients.
PERSONALIZED APPROACH The ARGERA Centre is renowned for its personalized approach to patients needs. All patients receive a detailed consultation with Dr Argie who listens to their desires, makes an assessment of the suitability of appropriate procedures, discusses risks, costs and provides a realistic outcome. The information given is honest. Results are tailored to the individual with an emphasis on a natural looking outcome. Dr Argie and her staff understand the experience from the patient’s point of view since they too have procedures. They genuinely care and get to know their patients well. This is made possible by the fact that ARGERA has the same staff it opened with in 2006.
As they say at ARGERA, “We just want happy long term patients”.
VALUE FOR MONEY The ARGERA Centre is unique in that it is dedicated to providing its patients with value for money treatments by offering various options to save money. In fact, ARGERA boasts some of the least expensive treatments in the country without compromising on standards. FACILITIES Dr Argie regularly searches the world for the latest in technologies and techniques to improve the results for her patients. All facilities at the ARGERA Centre remain state of the art and the most proven in effectiveness.
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INDUSTRY RECOGNIZED QUALIFICATIONS AND EXPERIENC Dr Argie has been practicing cosmetic medicine since 1996 and has performed 10’s of thousands of procedures since then. She is only one of two doctors in WA with a Fellowship from the Australasian College of Cosmetic Surgery (ACCS), the highest qualifications possible in Australia. She is also a recognized advance injector and trainer of wrinkle fillers and relaxer, and lectures academically on various cosmetic procedures. She also sits on various boards dedicated to standards in cosmetic medicine. This level of dedication is filtered through to her staff, which must undergo regular training and quality assurance checks. The ARGERA Centre is a clinic leader in many of the results it has achieved for its patients.
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LOCATION The ARGERA Centre’s main rooms in Joondalup are located directly across from a major hospital making them one of the most desired locations in Perth for medical procedures. The location is also discrete and provides access to 6 car parks within 1km radius, and easy public transport. The East Perth rooms are equally easily accessible and centrally located to provide a convenient alternative for those travelling from South of the river.
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Photographs are actual patients of Dr Argie
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Dr Argero Xaftellis, or “Dr Argie” as she is affectionately known, has been working in the cosmetic medicine field since 1997 and is now acknowledged as one of Australia’s advanced cosmetic injectors. Dr Argie was an early member of the Cosmetic Physician Society of Australasia and is also a Fellow of the Australian College of Cosmetic Surgery (the highest qualifications possible in Australia with only 2 doctors in WA currently achieving the required standards). She is also a trainer for a number of the leading cosmetic products on the market and lectures regularly on various cosmetic medical treatments. Dr Argie is dedicated to raising standards within the industry since it is currently unregulated. She
Argie takes a minimalist approach to avoid complications, preserve a natural look and to help the budget conscious patient.
serves on various committees nationally to ensure that doctors work within ethical and legal bounds, to educate the public and to promote safe and satisfactory treatments for patients.
Before undergoing any procedure, Dr Argie recommends that her patients first form a realistic desirable result in their mind. Through the consultation process, she explores how the desired outcome can be achieved and any risks involved. Despite cosmetic medicine being one of the safest fields of medicine, any medical procedure runs the risk of adverse reactions. Some are preventable while others are not, no matter how experienced and qualified your doctor.
Dr Argie believes that the key to good health is a balance of the physical, emotional and spiritual. Dr Argie practices what she preaches and has her own maintenance program of cosmetic treatments to attempt to look her best. She believes that it is never to soon to start but encourages her younger clients to begin with good quality skin care and daily sun protection. Prevention is always better than cure! More advanced treatments should begin when a problem actually starts and Dr
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And so what is Dr Argie’s favourite non-surgical treatment? It turns out that its lips having performed thousands of treatments. Dr Argie believes it’s not the size or even the shape of the lip, it’s about balancing the lips to the individual’s face. “There is a true skill in doing lips. Its not good enough to be just an injector, you must be an artist and know your canvas well”. Having seen Dr Argie’s work, we have no doubt that she is the “Lip Queen” of Perth.
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Photographs are actual patients of Dr Argie
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What do you look for in a
COSMETIC DOCTOR?
• Female • Experienced • Fully Qualified • Practices at the highest standards • Of Good Standing within the industry • Personalized service • Caring, gentle • Knowledge of Artistry and balance • Prefers a natural approach • Latest in technologies and techniques • Provides detailed consultations • Listens
ANY OF THE ABOVE?
‘EAST PERTH CLINIC
NOW OPENED’ Unit 3, 135 Royal St East Perth 6004 WA info@argera.com.au P : 08 9301 4244 F : 08 9301 4355
Then consider ARGERA Anti-aging Centre for your next medical cosmetic treatment.
TREATMENTS
Safe wrinkle relaxers and fillers including facial volumizing and lip restoration/augmentation • Latest skin treatments for pigment, texture, poor elasticity, acne and acne scarring • Thermage® • Spider Veins • Fat dissolving • Liposuction • Thread lifting • Medical Strength IPL • Excess Underarm Sweating • Medical Strength Skincare
J o o n d a l u p , We s t A u s t r a l i a P H ( 0 8 ) 9 3 0 1 4 2 4 4 | E : i n f o @ a rg e r a . c o m . a u | W : w w w. a rg e r a . c o m . a u
BRIAN MUIR PROCEDURE: Full mouth dental rehabilitation with implants and bone grafts in the upper jaw, and crowns/ veneers in the lower jaw. In a team approach, the crowns and veneers were carried out by Dr Sahba Habibi-Thomas, and the implant and bone grafting surgeries by Dr Misagh Habibi.
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Porcelain teeth in progress before being attached permanently to the dental implants
Brian
brilliant smile
I had suffered from asthma when I lived in Scotland. I had recurrent chest infections, got a collapsed lung and had huge amounts of antibiotics. This caused a lot of damage to the enamel on my teeth. Subsequently the weakened enamel made my teeth chip easily. They were in quite a bad way so I started to go to a dentist. Eventually the repairs and bridgework I had failed and it was time for a proper solution.
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hat’s when I went to see Dr Thomas and Dr Habibi at Churchill Dental.
implants. It was a very successful procedure and I couldn’t even feel it afterwards.
Dr Habibi put implants in for my back teeth, which had been missing for many years. Because they had been missing for a long time, the bone had shrunk away so Dr Habibi performed bone grafts and sinus lifts to create bone for the new implant teeth. That was very successful and painless and went very well.
Because I’d had old porcelain crowns on my upper teeth for many years, my lower teeth which had soft enamel, had been worn right down. So Dr Sahba Habibi-Thomas used porcelain crowns to skillfully restore all of my worn down lower teeth. The purpose was to bring my teeth back to their original height, so they could function properly against my new top teeth and look harmonious.
Therefore when the teeth under my other old bridges started to fail I spoke to him about doing the same to the front teeth. He agreed it was possible to extract these teeth and put the implants in straight away. He did it all in one day - pulled the teeth out, put the implants in and grafted a small amount of bone around the
I cannot tell them apart from my own teeth now. All the staff at Churchill Dental went out of their way to make me feel comfortable. That’s why I drive in from out of town to see them. It’s all been a stress free and pain free process. NIPTUCK Magazine 163
Cosmetic Nurse Ruth Lavell of Looks Divine shares her 18 years of beauty secrets.
Today’s woman is savvy and educated about what she wants. She doesn’t want the buff and fluff of our mothers and grandmothers - she wants something that is going to ‘work’ and give her long lasting results. She educates herself with the Internet and social media and looks hard to find the right answers. In my 18 years as a cosmetic nurse a lot has changed. We want things to work NOW, we want results NOW, we want to see a difference NOW! I am no different. Products that perform and do what they promise are top of my list. Skin care that delivers the clean, glowing, youthful and plumped up look - that’s what I want because if my skin looks good, the lines and imperfections don’t show as much. I use Skin Synergy. Skin Synergy is an Australian made ACTIVE skincare product that is full of Glycolic acid to clean away dead skin cells and Vitamin C to feed my skin and promote collagen growth. It also contains Vitamin A for skin turn over and stimulation and hyaluronic acid, a powerful
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ingredient to provide moisture and plumping of the skin. The best thing about Skin Synergy, is that it works! To see more, go to www.skin-synergy.com.au I also must confess that I use: • A wrinkle relaxer; • A dermal filler in my lips; and • A dermal stimulator in my cheeks to add volume to to my skin. Let’s face it, at 50, things are all a little looser than they used to be. Make sure you don’t overdo it – you need to keep it natural looking. The other special ingredients are a lot of laughter and wine - life is too short to be miserable!!!! For more helpful tips on cosmetics email me at info@looksdivine.com.au
Ruth
The Looks Divine E
X
Since opening in 2007, Looks Divine has become one of Perth’s most well known and respected clinics with locations in Nedlands and the CBD of Perth.
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Both Looks Divine centres are accredited with the ISO 9001 International Standard of Excellence in Aesthetics and Cosmetics – recognised for respecting international standards.
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• realistic expectations on what can be achieved; and • minimizing any discomfort associated with these treatments.
Looks Divine offer a wide range of Beauty, Skin treatments, the latest cosmetic treatments and plastic surgery. This includes anti-wrinkle treatments and dermal fillers, peels and facial plastic surgery.
Looks Divine carefully explain the risks associated with each procedure and offer up-to-date information on skin, cosmetic procedures and hormonal replacement as well as the best products and equipment for all each treatments.
Their team of professionals’ aim to ensure everyone’s experience is second to none by providing: • honest advice about the most effective treatments;
The specialist team of Doctors, Nurses and Dermal Therapists on site are carefully chosen and undergo continuous training to provide you with the best service in a friendly and relaxed environment.
SERVICES
Anti Wrinkle Treatment | Body & Spa Packages | Chemical Peels | Dermal Fillers Facials | IPL Treatments | Massage | Microdermabrasion | Products Tattoo Removal | Wrinkle Relaxers
1 2 2 b D a l k e i t h R d Nedlan ds | Ph 9386 9699 • level 1/ 663 H ay St Per th CBD | P h 9321 3551 E ma i l in fo@ loo ks divine.com .au | We b www.looksd ivine.com.a u
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www.skin-synergy.com.au NIPTUCK Magazine 165
DR I A N TIM M S
MB BS, BSc,
FRCS, FRACS (Plastic and
Reconstructive Surgeon)
Having grown up in the south of England Dr Timms studied medicine at University College and the Middlesex School of Medicine. After graduating Dr Timms completed his Fellowship with the Royal College of Surgeons of England prior to emigrating to Australia in 2000.
Dr Ian Timms
MB BS, BSc, FRCS, FRACS
Plastic and Reconstructive Surgeon
Cosmetic Surgery Breast Reconstruction Facial Aesthetic Surgery
Dr Timms was appointed to the advanced Plastic & Reconstructive Surgery training programme in Western Australia where he worked in both Perth and for some time in Sydney. Upon successful completing the exams Dr Timms was awarded Fellowship in Plastic and Reconstructive Surgery from the Royal Australasian College of Surgeons. In 2007 Dr Timms returned to the U.K. for one year undertaking a Cosmetic and Microvascular surgery Fellowship at The London Clinic. In March 2008 Dr Timms commenced a private practice and now operates at Mount Hospital, Hollywood Private Hospital and Cambridge Day Surgery and is accredited at SJOG Subiaco and Murdoch, and Bethesda Hospital. Dr Timms is passionate about providing individualised care with empathy to each patient’s needs and along with his personally selected and well trained staff is determined to provide this care to the highest possible standard. All patients are warmly welcomed, cared for and treated with dignity and compassion. Dr Timms’ practice has the latest in 3D camera systems, the Vectra XT imaging system that greatly assists in educating patients and demonstrating the likely outcome of surgery particularly in Breast Augmentation.
Hand Surgery
Dr Timms’ specialty clinical interest is in Breast Reconstruction and all other aspects of breast surgery including Augmentation, Mastopexy, Reduction and correction of asymmetry.
Suite 3, 200 Rokeby Road Subiaco 6008
Additionally Dr Timms undertakes a wider range of cosmetic procedures including Blepharoplasty, Rhinoplasty, Abdominoplasty, Labioplasty and Body Contouring (body lifts, arm reduction and thigh lifts).
Phone: 08 9381 3288 Fax: 08 9381 5333 Email: info@sculptingsurgery.com.au
P E R S O N A L PROFESSIONAL PROGRESSIVE
b re ast
R E C O NST RUCTION Entitled to a Superior Result Being diagnosed with breast cancer need not be all doom and gloom, however the necessity for removal of breast tissue in the form of a mastectomy is, for the majority of women, an incredible emotional challenge to face. The loss of a breast to cancer is for many unavoidable, however reconstruction offers light at the end of a difficult tunnel for many women and their families. Dr Ian Timms believes that women who have had to have mastectomies for this reason are not only entitled to breast reconstruction, but are also entitled to a superior result. “Women should not have to accept an inferior or non aesthetically pleasing reconstruction, they should be given the best reconstruction possible”. In undertaking breast reconstruction, obviously the goal is to achieve the best aesthetic result for the patient. This means customizing and tailoring the surgery to the individual’s body shape and desires.
DR TIMMS SHOWCASES TWO RECENT CASES AS EXAMPLES
Pre-Operative | Previous Augmentation with 500 gm Sub Glandular Smooth Round Implants
Post-Operative | Lat Dorsi Reconstruction with 295 gm Textured Anatomical Implants
CASE STUDY ONE
A 48 year old woman presented to me after a breast cancer diagnosis, to discuss a reconstruction. On examination, it was apparent that the surgery she had undergone previously, had results that were less than ideal. “If you’re going to fix up one side,” she said, “maybe you can make me look better on both sides?” The breasts she had were the results of an augmentation procedure some 7 years earlier, and it is shocking to think that she had lived with them for so long. The images speak for themselves. Because of the poor quality of the augmentation she had previously, essentially she had to have a bilateral breast reconstruction to get things back where they should be. The results were breasts that were an appropriate size and shape for her body, and her nipples were relocated to the right place. Although it took a cancer diagnosis to repair the damage done years before, she couldn’t have been more pleased with the results.
Pre-Operation | Previous Reconstruction with 275gm Implant
Post-Operative | After Re-Do Tissue Expansion and New Implant 520gm Textured Anatomical
CASE STUDY TWO
A 52 year old woman was referred to me by a GP, having had a breast reconstruction that she wasn’t happy with. I saw her almost 4 years after her initial reconstruction, and it took over 5 months to restore her breasts to a normal appearance again. On presentation, one breast was a different size, and her nipple pointed in the wrong direction. Initially the reconstruction was of her right breast, however the sizing had been wrongly estimated. This meant that basically the whole procedure needed to be repeated, by undertaking tissue expansion and exchanging to an appropriate sized implant. The size also needed to be changed on the left side. Her reconstruction was the result of a right sided mastectomy, and it was so frustrating for me to see that not only was it the wrong size implant but it was also in the wrong place. By changing the implant we were able to shift the placement so it sat in a better better position. Now, she couldn’t be happier. NIPTUCK Magazine 167
Alex
new confidence ALEX HORVAth PROCEDURE: Full mouth dental implant reconstruction. Extraction and replacement of all teeth with dental implants. All of the work was completed by Dr Misagh Habibi.
BEFORE
168 NIPTUCK Magazine
AFTER
I had a lot of problems with my teeth when I was young. I had lost quite a few teeth and in Romania, where I grew up, if you had problems with your teeth, they came out. I had some bridges put in that were too big for my mouth when I was about 22 and they really damaged my other teeth. I had gingivitis and a lot of other problems.
I
thought maybe I would need dentures, and I’m afraid of dentists but I was so desperate I had started to look around for a suitable clinic. I went to consult Dr Habibi after reading about his sedation dentistry and implant procedures on the Internet. We sat and talked and it was only then I realised the seriousness of my situation. That existing bridge had been in my mouth for 26 years! Other dentists told me I needed implants or false teeth. It seemed the best option was to get rid of all my existing teeth and get implant replacements. When he confirmed this I felt like someone had knocked me over. But Dr Habibi reassured me, and
BEFORE X-RAY
IN THE LAB
outlined the process for me. I felt comfortable and decided to go ahead with it. I had 16 implants plus bone grafting under sedation. After the operation I was amazed that I didn’t feel any pain and there was no swelling or bruising. When this whole thing came to be, I knew I had to go through it. Now if I look back on it, I can’t believe I even hesitated. Absolutely it improves your life and gives you a quality of life. The state of my teeth before was terrible - I didn’t exactly look like a civilized man. You tend to withdraw, not smile, and it gives you a bit of a complex. Now I have more confidence than I ever had, and usually I forget about them and just chew away.
AFTER X-RAY
mummy makeovers Reclaim your pre-baby body with the help of our mummy makeovers…
reduce sagging. Liposculpture and Abdominoplasty can help flatten the tummy, contour and reshape the body.
Our bodies are built to accommodate and give birth to babies, unfortunately the process of pregnancy and childbirth has a large impact on our bodies – breasts enlarging or deflating, the body holding more fatty tissue and a stretched abdomen. Many women find they are underwhelmed with their post-pregnancy bodies, and even with diet and exercise, feel their youthful body is gone forever.
It’s time to leave your insecurities behind…
Your pre-baby body doesn’t have to be a thing of the past… Mummy makeovers help women regain their prepregnancy shape and confidence by utilising several different surgical treatments in tandem. Dr Nguyen will discuss with you at your consultation how she can help you reclaim your pre-pregnancy body. Tummy tucks, liposuction, labiaplasty and breast surgery are popular procedures among new mothers. Breast augmentations (boob jobs) can restore volume loss. Breast lifts (mastopexy) can reshape the breasts and
Dr Nguyen is a female plastic surgeon, and leads an all-female team to ensure your comfort is always top priority, blending your needs with the sensitivity, understanding, compassion and attention to detail that only an all-female surgical team can provide. This team includes a female plastic surgeon, anaesthetist, surgical assistant, cosmetic consultants, dermal therapists and nurses.
Capture that sensuous essence and achieve your body goals… Dr Nguyen’s team are highly professional, talented and trained in all aspects of female cosmetic procedures, and provide patients with the highest quality treatments combined with an unsurpassed level of care. Unleash your full potential with Dr Nguyen and her team and help your confidence soar.
www.femaleplasticsurgeon.com.au
passionate I am passionate about helping patients look better and feel more confidetn. Leave your insecurities behind and let me help you to adore your true feminine form and be your ultimate and most beautiful you.
• Breast Augmentation • Breast Lift • Breast Reduction
• Abdominoplasty • Liposuction • Labiaplasty • Mummy makeovers • Body lift • Thigh lift • Arm lift • Liposonix
• Face and neck lift • Eyelid rejuvenation • Rhinoplasty • Brow Lift • Non-surgical rejuvenation • Fraxel Laser
SE RVICE S
Anh Nguyen
Dr Anh Nguyen Dr Anh Nguyen is a female plastic surgeon, and leads an all-female team to ensure your comfort is always top priority, blending your needs with the sensitivity, understanding, compassion and attention to detail that only an all-female surgical team can provide. Dr Nguyen obtained her Bachelor of Medicine and Bachelor of Surgery with Honours from the University of Melbourne in 2001. She completed general and advanced surgical, plastic and reconstructive surgery training in both Melbourne and Perth and obtained her fellowship from the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery. Dr Nguyen’s team are highly professional, talented and trained in all aspects of female cosmetic procedures, and provide patients with the highest quality treatments combined with an unsurpassed level of care. Providing a comprehensive range of services for the breasts, body and face, their approach focuses on refining your shape, loving and enhancing your contours and supporting you to embrace ageing with confidence and enthusiasm. Dr Nguyen has an inherent understanding of the vulnerabilities and insecurities women experience as they progress through life’s changes. She is passionate about women celebrating their full potential and being the very best version of themselves they can be. Unleash your full potential with Dr Nguyen and her team and help your confidence soar.
Ph 08 6389 1322 | F 08 6389 1122 | E: info@femaleplasticsurgeon.com.au 180 Stirling Highway Nedlands WA 6009
DR PAUL PROFILE Dr Robert Paul is renowned as one of Perth’s finest refractive eye surgeons. After completing Ophthalmology specialist training in WA, he undertook Fellowship training in Laser Eye and Refractive Surgery and Corneal Transplantiation, in Canada. He returned to Australia to establish the WA Laser Eye Centre, and was the first surgeon in WA to perform laser eye surgery and insertion of Phakic Intraocular lenses.
Dr Paul was awarded the Helen Jane Lamard Prize by the University of WA for ‘Best student in Surgery’ in 199, and was runner up for best paper at the Toronto Research Day presentation in 2002. He has maintained involvement in development of the profession, as an examiner of Canadian Ophthalmologists and Western Australian medical students and through training of Eye Surgeons as an Ophthalmology Consultant at Fremantle Hospital 2002 - 2007. He is a mentor for Fellowship training in laser refractive surgery and the Treasurer of the WA Branch of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO).
www.walasereye.com.au
WA LASER EYE CENTRE WA Laser Eye Centre is one of Perth’s premier refractive surgery centres operating under the experienced guidance of our principal surgeon, Dr Robert Paul. He was the first surgeon in WA to have formal higher training in Laser Eye Surgery and is one of Perth’s most experienced and qualified refractive surgeons. WA Laser Eye Centre offers the most advanced techniques available in laser and refractive eye surgery, specialising in LASIK, PRK, and the new Femtosecond
laser assisted cataract surgery procedure along with Multifocal and Refractive Intraocular Lenses to correct shortsightedness (Myopia), long-sightedness (Hyperopia) and astigmatism. Our treatment centre is located in our rooms at Melville, and appointments are available at our branches in Melville and Hollywood Medical Centre in Nedlands for pre and post-operative assessment. Our friendly team are here to help you with any questions you may have. We offer the highest level of expertise
and experience as well as the latest technology for vision correction. WA Laser Eye Centre uses the worlds’ most advanced technology and our staff are trained specifically for this high precision surgery. This is apparent from the first consultation through to treatment and post-operative care. We would like you to feel confident that you are making a well informed decision about your treatment options and encourage you to contact is with any questions you may have.
Hollywood Medical Centre, Suite 30 Level 1, 85 Monash Avenue NEDLANDS WA 6009 Melville Suite 1, 533 Canning Highway MELVILLE WA 6154 Phone: (08) 9330 8463 | Fax: (08) 9330 6994
Quinn P L A STIC
S U R G E R Y
DR PAUL QUINN IS A SPECIALIST PLASTIC SURGEON WHOSE INTEREST IN PLASTIC SURGERY BEGAN EARLY IN HIS LIFE WHILE WATCHING A PROGRAM ABOUT A VIETNAMESE CHILD WITH A SEVERE FACIAL DEFORMITY, AND UNDERSTANDING HOW SURGERY CHANGED THE BOY’S LIFE.
“This little boy had an extra nose and jaw, and a deformed head shape. He was ostracized in his community, not attending school and walked through the village with a bag on his head. A visiting plastic surgeon heard about the boy and took him back to the USA to perform more than half a dozen surgeries on him to reconstruct his face. The transformation was unbelievable and the impact the change had on his and his family’s lives was phenomenal.” After experiencing this inspirational story as a teenager, Paul was then committed to his passion – a career in plastic and reconstructive surgery. “Our focus at Quinn Plastic Surgery is to provide surgery of the highest standards, and deliver safe and predictable results to our patients. The practice focuses on safety and professionalism and we take the time with patients to tailor procedures to suit the individual, including discussions about their post operative recovery, and any potential complications that may arise for the individual.” Dr Quinn has a primary interest in reconstructive and cosmetic plastic surgery of the breast and body and at Quinn Plastic Surgery there is a comprehensive range of procedures available. In addition to performing vast numbers of primary breast augmentation procedures, Dr Quinn is renowned for performing revisional or secondary breast augmentation surgery for complicated cases. Reconstructive breast cases presenting to Dr Quinn include developmental abnormalities, breast asymmetry, damage from trauma or deformity to the breast, as well as required lumpectomies, mastectomies, and the subsequent reconstruction that may be necessary. Body contouring procedures have come a long way since the introduction of liposuction.
Surgery may be required after massive weight loss, pregnancy or simply to remove mid section excess, or the dreaded ‘man boobs’ (gynaecomastia). Most recently Dr Quinn has performed a large number of circumferential body lifts. This is a powerful global procedure that flattens the tummy, reshapes the waistline, provides an outer thigh and buttock lift and reduces love handles and flank folds. Radical abdominoplastly, lipoabdominoplasty and mini abdominoplasties are also available. For more specific areas, Dr Quinn has refined his procedures as a result of years of requests for the same things. “I offer a vertical as well as an inner or medial thigh reduction, arm reduction surgery and then resection of any additional skin folds people complain about. This may be folds of skin overlying the bra strap, or rolls of back fat in unusual places.” If performed correctly, body contouring surgery can address multiple areas of concern through single scars. “When holding the arm up, you can feel the excess skin dangling from underneath. If you were to continue the arm reduction down through the armpit to the lateral chest wall in a vertical direction, a tightening of the chest wall would also be achieved, and this would also assist in tightening skin overlying the bra strap and the semi oblique rolls of fat on the back. Furthermore, if desired this resection can be carried down and incorporated into a breast tightening procedure”. Dr Quinn has a high regard for handling body tissues and is particular about treating them very delicately, thus allowing for a quicker recovery and less trauma to the tissue. As a result of this, a lot of the procedures can be performed as day surgery. For more information on Dr Quinn and his practice go to www.quinnplasticsurgery.com
BEFORE
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Dr Paul Quinn MBBS (HONS) FRACS (PLAS
Aesthetic and reconstructive Plastic Surgeon Dr Paul Quinn is a specialist plastic surgeon, who along with his busy private plastic surgical practice in Subiaco, continues to maintain a strong commitment to the teaching and training of the next generation of Plastic Surgeons in Western Australia. Dr Quinn obtained his Bachelor of Medicine and Bachelor of Surgery with honours at the University of Western Australia and was later awarded the Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic Surgery following many years of distinguished training both in Australia as well as internationally with some of the world leaders in specific Plastic Surgery fields. He is a member of the Australasian Society of Plastic Surgeons (ASPS), the Australian Society of Aesthetic Plastic Surgeons (ASAPS), the International Society of Aesthetic Plastic Surgery (ISAPS), the American Society of Plastic Surgeons and the Royal Australasian College of Surgeons (RACS).
44 Churchill Avenue Subiaco, Perth, Western Australia 6008 Tel (08) 9388 8886 | Fax (08) 9388 3908 Email info@quinnplasticsurgery.com.au
www.quinnplasticsurgery.com.au
PROCEDURES Facelift • Facelift (non surgical) • Wrinkle relaxer • Wrinkle filler • Browlift • Eyelid lift • Nose Reshaping Lip Enhancement • Necklift • Breast Enlargement • Breast Reduction • Tummy Tuck • Liposuction
Innovative ways to
look great without surgery. F O R YO U R A G E
Joanna TEH Dr
Dr Joanna Teh graduated from the University of Western Australia with a Bachelor of Medicine and Surgery and completed her Fellowship at the Australian College of Aesthetic Medicine. She is a member of the Australasian Society of Cosmetic Physicians, is a registered doctor and licensed to use medical grade lasers. Dr Teh is affiliated with a number of cosmetic medical & dermatology associations nationally and internationally.
With more than 10 years specializing, she is known for her artistic eye for beauty, and her desire to enhance her client’s appearance. Taking a sensitive approach towards her client’s needs, as a female doctor she understands even the smallest concerns that are unique to the ageing woman. Her passion for cosmetic medicine developed because she loves not only the aspect of being able to change her patients’ appearance but also the change she can see in her patients’ confidence and self esteem. She has seen many of her clients transform in their persona after the treatment. Her special interest is in nonsurgical cosmetic procedures
because she feels that this form of treatment is the safest option. “My approach is to aim for a more natural looking result, so you still look like you, but a fresher version of you. It’s important that I understand patient’s expectations so that I can select treatments that provide the result they desire. My practice combines a focus on beautifying your features and slowing down the ageing process.” The most popular treatments offered at Dermedica are wrinkle relaxers and fillers, IPL Hair removal, skin tightening, facial peels and resurfacing.
When I look at a face, sometimes one treatment modality is not enough. I approach the face in a holistic manner. I want to provide treatments that give good results but it’s important that the treatment blends with your existing appearance. Sometimes another treatment is added in conjunction to ensure the face looks natural and there is consistency across the appearance.
The
Five Rs of
Anti Ageing
with Dr Joanna Teh
Dr Teh believes in ‘the 5Rs’ of anti ageing to keep a fresh and youthful looking appearance.
• Relax wrinkles – wrinkle relaxers minimize the
appearance of expression wrinkles by reducing muscle movement to soften fine lines. These wrinkles can look more prominent as skin ages due to loss of collagen and elastin.
• Refill – wrinkle fillers are excellent for lines that are already formed and for volume loss. Improving the contours of your face around the cheeks, jowls and nasolabial folds gives extra definition and a more youthful appearance.
• Remove pigmentation & blemishes
– removing the signs of the environmental effects of UV light on our skin such as sun spots and freckling can give a smoother finish. These signs of damage along with broken capillaries and brown marks that create a weathered appearance can be easily removed by IPL or laser treatments.
• Redraping – as collagen loses its resilience and
the skin loses elasticity, skin can start to appear looser around the jaw line and under the chin. Contraction of the skin using collagen stimulators and/or medically proven radiofrequency skin tightening treatment provides tightening/firming effects in these areas so definition to the chin and jaw line is restored.
• Retexturing – polishing and resurfacing improves the dull appearance of skin, and smoothes the damage caused by acne scarring and wrinkles for example. Ageing causes deepening of scars and wrinkles. Fractional resurfacing using radio frequency device has a resurfacing effect while tightening the skin at the same time. Platelet rich plasma treatment, using your bloods rejuvenative properties to stimulate collagen is another effective option to improve the quality of the ageing skin.
Specialising in non surgical treatments for the face and body, Dr Teh stresses how important it is to see an experienced cosmetic doctor who knows how to make the correct assessment, understands the techniques, technologies and their limitations and is able to advise the patients on the right combination of treatments to achieve the desired result.
CONTACT DERMEDICA:
08 9205 1995 info@dermedica.com.au Unit 1,257 West Coast Hwy, Scarborough 6019 www.dermedica.com.au
David GILLETT
Mr
If you would like to book an appointment with Mr Gillett call the team at breast.com.au on 1 800 32 34 36
Plastic and Reconstructive Surgeon Craniomaxillofacial Surgeon
Specialising in Cleft Lip and Palate Surgery, Rhinoplasty and Facial Aesthetic Surgery and Breast Augmentation
Before
After
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After
Beauty is something that we all recognise. To describe what makes a particular person “beautiful” is far more difficult. Great artists, scientists and engineers have all struggled to describe what makes someone beautiful. Symmetry and appearing “normal” make someone appear more attractive. When several faces are morphed into one the resulting face is usually considered more attractive than any individual face. Several canons or rules have been proposed along with ideal ratios to help artists, and more recently plastic surgeons, create that elusive quality of beauty. The development of 3D surface scanners has helped to further our understanding of what people perceive as beautiful. 178 NIPTUCK Magazine
After Due to its position in the centre of the face the nose, more than any other feature, influences overall facial balance and harmony. A large or crooked nose can often distract the observer’s eye from the overall beauty of the face. It is often said that a good rhinoplasty highlights the eyes, the windows to the soul, by removing any distraction. If you are considering rhinoplasty, or any other facial aesthetic surgery, your surgeon will fully assess the entire face and how the parts relate to each other, surgery is then planned to optimise these relationships. Planning surgery in this way can be the difference between a good looking nose and a beautiful, balanced and harmonious face. Any nasal surgery however that doesn’t also maintain or improve the nasal airway can never be considered successful. This process
of dimensional planning for facial aesthetic surgery is an important part of the training of all Plastic Surgeons. This process entails discussing with you your concerns and desires. This is followed by an in depth assessment of the entire face including an examination of the nasal cavities, jaw relationships and teeth. Your surgeon will then discuss the results of the assessment with you and if appropriate a plan for surgery can be made. This discussion generally entails photographs or 3D images which can be modified in the computer to demonstrate areas to be changed and to simulate the expected result of surgery. It is very important that your surgeon takes the time to get to know you and your wishes. It’s also a time for you to get to know your surgeon as you must feel confident that he or she is really listening to your concerns and working with you to get the kind of result you want.
Current trends in aesthetic medicine show that most clients prefer minimally invasive and non-surgical procedures which involve little to no downtime while still maintaining a natural-looking appearance. This is the area of specialty of cutanius. Our entire focus is to help our clients attain better, healthier skin with safe, reliable treatments of the highest standard. Our aesthetic medicine doctor is Dr Glenn Liew who has more than 20 years of experience in clinical medicine and has trained under the world’s leading specialists in this field. Dr Liew is a fully certified facial rejuvenation specialist who personally performs all consultations and treatments at all times. No therapists, no nurse injectors. This is how we have established our reputation and maintained consistent quality, transparency and outstanding value for all our services. Our clinic offers various personalised skin treatment and maintenance programmes which are tailored to suit our client’s requirements. Come and experience the CUTANIUS difference today... you will be glad you did.
Anti-wrinkle Treatments • Chemical Browlifts • Lip & Face Fillers Thermage Skin Collagen Tightening Skin Cancer Screening & Treatment Minor Skin Surgery • Permanent Hair Reduction Pigmentation & Birthmarks • Facial Veins & Red Blemishes IPL Photorejuvenation • Photodynamic Therapy Excessive Sweating (underarms) • Intradermal Rehydration
LIP FILLERS
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After
TREATMENT OF FROWN LINES
Dr Glenn Liew Medical Director
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After
TREATMENT OF CROW’S FEET
Before
Suite 3, 10 McCourt St West Leederville WA6007 (opp. SJOG Hospital Subiaco)
T 08-6161 0661 W www.cutanius.com
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Photos of actual clients of Dr Liew. Please note that individual results my vary.
CALL TODAY to book a consultation and experience the CUTANIUS difference
V I C T 180 For more of Dr Lanzer turn to pages : 4-5, 120-121 & 144-145
O R I A 181
Smile with confidence
At Cosmetic Dental & Implant Centre our main focus is you. Our aim is to offer you optimal treatment options and service with a smile. We strongly believe in a preventive approach to dentistry, rather than a reactive one.
April Nguyen
Dr Hillel New
CosmeticDentalandImplantCentre CDICdental
@
www.cdic.com.au
101 Wattletree Rd, Malvern, VIC 3144 Phone 03 9509 7356 Email info@cdic.com.au Office Hours: Monday-Thursday 8.30am-5.30pm Friday 8.30am-5pm
Before Veneers
TOOTH
are capable of transforming not only a smile but a
VENEERS After bleaching and porcelain veneers
B
ut it is important to understand what these so-called “smile makeovers” involve and whether they are the right solution for you.
“For instance, I hear of veeners being promoted to achieve a straighter, more even smile but they should not be used to correct tooth alignment,” says Dr New. “Ideally if a patient wants a more attractive smile and achieve straighter teeth, orthodontic treatment should be carried out prior to tooth preparation for veneers.” This is what often puts a lot of patients off - but at the Cosmetic Dental and Implant Centre, Dr New is a certified ‘Inman Aligner’ practitioner.
Before treatment
He can use a specially-designed, removable appliance, like an orthodontic plate, to straighten teeth in significantly shorter times (8-14weeks) when compared with conventional orthodontics. “Inman aligner treatment is not suitable for everybody, but by getting the teeth better aligned prior to tooth preparation, a more even tooth reduction is carried out,” says Dr New. “The veneers will be of similar thickness, so they will look better and, most importantly, feel better in the mouth.” Dr New explains there are essentially two types of dental veneers: • A material commonly referred to as composite resin (very similar to the white material used to fill cavities) is placed by the dentist directly onto the tooth’s surface and built up by hand and cured (hardened) with a special blue light. These veneers are significantly cheaper than porcelain veneers. • Porcelain veneers are manufactured in a dental laboratory by a ceramist on a model of the patient’s prepared teeth - hence the need for at least two visits. Following the preparation of the teeth for porcelain veneers, an impression is taken that is sent to the laboratory. The patient will need to have temporary veneers constructed and placed that will remain on the teeth until the veneer insert visit. “Porcelain veneers are significantly stronger, and have better aesthetics when compared to direct composite veneers,” says Dr New. “They are less likely to chip, crack or stain when compared to composites. “On the flip side, composite is much cheaper and more predictable to repair if these problems occur.
After ‘gum lift’
“If porcelain veneers chip or break they are often repaired with composite material, as they cannot be removed, repaired and placed back on the tooth.” Dr New says that people seeking veneers need to understand that preparation of teeth for porcelain veneers is an irreversible process. “Teeth are prepared by removing tooth enamel that can never be put back,” he explains. “For this reason, a proper assessment of the teeth must be carried out prior to the treatment.
After Porcelain Veneers
184 NIPTUCK Magazine
“This may involve, model-taking and bite assessment, radiographs, a laboratory diagnostic
person’s whole face, and may make them look younger, healthier, more approachable and, certainly, more attractive.
‘wax up’ of the proposed treatment (that is, a model of the patient’s teeth is prepared in the laboratory to resemble the completed case) and the teeth must have their vitality/nerves checked as well. “Informed consent discussions must be carried out whereby the proposed treatment is explained in detail, the possible risks and complications associated with the treatment discussed, a quote for the treatment is provided as well as a discussion with the patient regarding alternative options.” Dr New points out that not everyone will be a suitable candidate for veneers. “With respect to the enamel removal/tooth reduction for veneers, a thin layer of enamel must remain present otherwise the porcelain veneers - and for that matter composite – may not bond effectively and will be at risk of failure. “This is why crooked teeth cannot be ‘straightened’ with veneers. Some teeth will need more reduction than others and some may be left totally without an enamel surface and compromised bond strength. “The teeth will all have different thicknesses and feel awful in the mouth. This is why porcelain veneers ARE NOT a substitute for orthodontic tooth alignment. “Dentists who prepare teeth and place porcelain veneers to make crooked teeth look straight are likely to face ongoing problems with these veneers.” Porcelain veneers are best used to improved tooth crown shapes, surface irregularities, staining problems and occasionally teeth can be lengthened for cosmetic reasons. “Very few patients will be unsuitable for veneer treatment,” Dr New concludes, but the question is … are veneers right for you? Do you have enough enamel? I think this is the single most important factor. “Patients who grind or clench their teeth subconsciously during the day or while sleeping may not be ideal candidates and will have to wear a night guard/splint every night (forever) when sleeping to protect the veneers from the excessive forces generated between the jaws of a sleeping grinding or clenching patient. “But if well cared for, porcelain veneers can last between 10-20 years and beyond.”
Cosmetic Dental & Implant Centre
Dr Hillel
New
Since launching the ‘Cosmetic Dental and Implant Centre’ 11 years ago, Dr Hillel New has changed the lives and smiles of many. As more and more dentists offered quick fix solutions, he saw the need for a centre of implant and cosmetic excellence. Using a preventive, rather than reactive approach, the clinic ‘treatment plans’ all patients, without judgement or pressure. “The important thing we concentrate on is educating patients as to causes and the prevention of dental disease. When addressing underlying causes you set patients up for a much better prognosis and motivate them for ongoing regular attendance” says Dr New. “Many patients attend with misconceptions about dentistry. In some cases, cosmetic work can’t be done until the patient’s periodontal health is at an optimum level. Otherwise their gums may shrink, and the new work looks terrible. Good oral health and hygiene is fundamental to achieve the full aesthetic benefits of cosmetic dentistry”. Patients attend the Cosmetic Dental and Implant Centre for a range of reasons, but many attend for rejuvenation and repair work, such as replacement of old metal fillings and worn crowns with a range of new ceramic materials that are much stronger than previous porcelains, with a more natural appearance. Dr New also believes in ongoing professional development to ensure his patients continue to receive the latest treatments. Advancements in dental CADCAM technology, has enabled computer animated treatment planning, design and manufacture, meaning virtual treatment can occur before the patient attends the clinic for treatment. He has spent time in Switzerland participating in a master clinicians course and more recently Hong Kong learning the latest evidence based treatment protocols. He is passionate about the industry and shares his expertise through private tuition and mentorship of other dentists, as well as lecturing regularly on implants and implant techniques.
NIPTUCK Magazine 185
SoSO GOOD Far Dr Peter Callan
Geelong plastic surgeon Peter Callan describes why a rhinoplasty not only needs to be about form and function, it also has to last a lifetime. Rhinoplasty: what some feel is the most demanding surgery in the plastic surgery repertoire. Why is that? Because it needs to look good, and it needs to function well, so the patient can breathe. But it also needs to be stable over the patient’s life. From this has come the term ‘structural rhinoplasty’ and the three tenets of rhinoplasty - cosmesis, function, and stability. Why does Peter Callan love rhinoplasty? There are so many reasons. The effect can be truly beautiful. When someone has a nose that balances their face, their entire
appearance changes. But often this is not noticed because it looks like it ‘belongs’ to the face, and is the nose you were always meant to have. One needs the ‘before’ and ‘after’ photographs to truly appreciate the result. Surgically it is demanding yet rewarding. Occasionally rhinoplasty can thwart even the greatest rhinoplasty surgeons. But it is what keeps us striving to make it better than it ever was. Rhinoplasty has changed a lot over the last 20 years since Dr Callan first trained as a plastic surgeon. “My favourite meetings
are rhinoplasty meetings where the best rhinoplasty surgeons in the world gather to share ideas to benefit their patients.” Rhinoplasty is sometimes described as ‘the surgery of millimetres’ because a tiny measurement can make a massive impact – for better or worse - not only to a person’s nose but the look of their whole face. “Rhinoplasty is the most technically challenging of all plastic surgery procedures and, even then, it’s not just a matter of technical ability,” he explains. “It is not just about taking
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a series of measurements, however correct on paper these may be. For an excellent outcome, a surgeon must also have an eye to visualising the bestshaped nose for that person’s face and the one that will enhance their whole appearance. “The new nose must seem completely natural, not ‘operated on’. You should never be able to point out a person and say, “oh, they’ve had a nose job”. “Results must not only look good but improve the physiological functions of the nose and the result should last.” Rhinoplasty surgery is a question of balance. The size and shape of the ‘new’ nose must be in harmony with the patient’s facial structure - even personality and ethnicity– as well as being aesthetically appealing in itself. Rhinoplasty may affect the breathing and the singing voice. Is this why Barbara Streisand never had a rhinoplasty? Take the example of actress Jennifer Grey. The distinctive bump on her nose was her signature when she became an international star opposite Patrick Swayze in Dirty Dancing. A few years later she underwent rhinoplasty to have the bump removed, to her great regret. “I went into the operating room a celebrity and came out anonymous,” she said. “It was the nose job from hell. I’ll always be this once-famous actress nobody recognised because of a nose job.” Dr Callan will see a patient at least twice before proceeding with surgery, and the consultations involve lengthy discussions. “We will discuss what
bothers them, what they would like to achieve, take a thorough medical history and then digital photos,” he says. “With these photos we perform a 3D simulation with our Vectra machine to give you an idea of what type of changes we would attempt to make. This is not a perfect science, as every patient will heal differently according to their physical makeup, but the 3D simulation will get us as close to what we predict should be realistic and even with the most outstanding rhinoplasty surgeons, up to 5-10 percent of patients may require some degree of revision surgery after the initial healing.” Dr Callan uses almost exclusively what is known as the ‘open’ technique. A small incision is made in the columella, which is the little column of skin that separates the two nostrils. That incision allows the nasal skin to be lifted off of the tip of the nose. In both open and ‘closed’ rhinoplasty, other incisions are used inside the nose, but the open technique has that one little extra incision in the base of the nose. “It enables us to see everything,” explains Dr Callan, “and the subsequent scar is usually barely perceptible. Rhinoplasty may be performed for chiefly cosmetic reasons, where one would just like the shape of the nose corrected and there are no previous injuries or breathing problems. Rhinoplasty is often performed for breathing or posttraumatic problems as well. However even in purely cosmetic cases we always need to perform techniques to maintain breathing.” concludes Dr Callan. “We would always recommend you get a referral from your GP, who can help determine your situation”.
DR PETER CALLAN MBBS, FRACS, MBA
“The decision to have plastic surgery may be one of the most important decisions you will make.” PROCEDURES
BREAST
BODY
COSMETIC
FACE
HAND
SKIN
Suite 3, Level 1, 83 Myers Street, Geelong, Victoria 3220 P: +61 3 5222 2440 | E: simone@petercallan.com.au W: www.petercallan.com.au | www.rhinoplastygeelong.com.au
MR HOWARD
Webster MBBS Hons FRACS (Plast) MBA
CHOOSING THE RIGHT SURGEON Surgery was once only performed on sick people, to try to make them better. We now live in a very different world. Most operations today are performed because the patient chooses to have them (elective), rather than needing them to stay alive. People can now have surgery to relieve pain or distress that is not able to be relieved by any other means.
Mr Howard Webster is a Specialist Plastic Surgeon at ARC Plastic Surgery. He consults in Melbourne and regularly in Shepparton. With more than 18 years experience in private practice, he focuses primarily on body, breast, face and nose cosmetic and reconstructive surgery. Howard trained in Melbourne and Brisbane. And subsequently spent three post-graduate training years in the UK and US.
An operation such as a hip replacement to cure the pain and disability of severe arthritis seems just part of our lives now. But when it was invented in the 1950s it was a miracle, solving what was until then an impossible problem to treat. Millions of people have since had vastly better lives after a hip replacement. With cosmetic plastic surgery, people almost always seek to treat a part of themselves that is causing distress and can’t be treated effectively by a nonsurgical method. The difference is that there is a commercial aspect to cosmetic surgery. Nobody is “selling” you a hip replacement – you need one or you don’t. In cosmetic plastic surgery, operations are being “sold”. This has become widespread. Australians are marketed to by all kinds of providers seeking to sell them procedures. That provider can be a Specialist Plastic Surgeon, a non-specialist with no Governmentrecognised specialist training, or even an overseas hospital and/or surgeon. Of course, when people or businesses market themselves, they are trying hard to convince you that they are the best person to do your procedure. As we know, marketing can gild the lily. You have to be careful. So how do you choose? You’ll hear all kinds of opinions and promises. You’ll be offered great recoveries and supreme artistry, all in beautiful surroundings.
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Don’t believe all you hear. Be a bit sceptical. Do your research and ensure you know a lot about the provider you choose. Your most important decision is: Who is your surgeon? Followed closely by: What are the factors that make operations safer? What is really important? As an Australian Specialist Plastic Surgeon, what would I recommend? I say simply this: a good person, expertly trained as a registered Specialist Plastic Surgeon, with professional and easy-todeal with staff, who can care for you in facilities that are as safe as it is possible to make them. How do you find them? • They will have a FRACS (Fellow of the Royal Australasian College of Surgeons) qualification. Only real specialists have these. It is the most important qualification to look for when deciding on your surgeon. It means they have completed their surgical training supervised by the Royal Australasian College of Surgeons. • They will be a member of ASPS, the Australian Society of Plastic Surgeons. • They will be happy to verify with you that they are a Medicare and AHPRA (Australian Health Practitioner Regulation Agency) registered specialist. You can check this yourself on the AHPRA website, www.ahpra.gov.au, where specialist qualifications are publicly listed. There are many reasons for my recommendations but the main one is that operations are safer and more predictable when in the right hands. The outcome of choosing the right surgeon - who follows proper planning procedures and gives his or her patients plenty of thinking time about what their surgical options might be, how these can be done and what kind of results they might expect - is quite amazing.
DR KIM
Taylor MBChB FRACS (Plast)
CONSIDERING BREAST REDUCTION For women concerned by breasts that are disproportionately large for the rest of their bodies reduction mammaplasty (breast reduction surgery) can be lifechanging. Dr Taylor says they are probably the happiest of her patients with their results. NipTuck finds out more.
After graduating from medical school in New Zealand in 1996, and undergoing specialty training in Sydney, and fellowships in Melbourne, Dr Kim Taylor now receives wide recognition for her work as a plastic surgeon and is the recipient of a number of awards.
What are the reasons women come to you seeking breast reduction? The most common reason women seek a breast reduction is that they are suffering pain from the weight of their breasts in their back, neck and shoulders. Other reasons include: the size of their breasts makes them feel self-conscious or perhaps they receive unwanted attention. Their breasts may feel uncomfortable and make physical activities such as running, playing golf, tennis or taking fitness classes quite difficult. Women often suffer rashes under heavy breasts, particularly in summer months. The inability to even find a bra or nice clothes that will fit is also an issue. Women can be dismayed, too, that large breasts make them look larger overall than they really are. I also perform breast reduction to correct asymmetry (where one breast is significantly larger than the other) or to match the opposite breast if it has been operated on for cancer (lumpectomy or mastectomy and reconstruction; also after radiotherapy, which can lead to reduced breast volume). How early would you consider performing breast reduction surgery? Any girl who has completed her breast growth or has largely stabilised is a candidate. This would usually be around 16 or 17. If under 18, I would see her with a parent or guardian. If surgery is performed while a girl is still developing then it may have to be repeated and an ideal outcome would be less likely. When do women typically seek a breast reduction? I find a lot of women won’t see me until after they have completed their family. This is not unreasonable, as inability to breast feed thereafter is an issue that needs to be considered. Also, the breasts can change quite considerably after pregnancy and/or breast-feeding. It is
unpredictable which way they will go: bigger, smaller, saggier. So if there are pregnancies subsequent to a procedure, this must also be taken into account. When would you decline to perform a breast reduction? In someone who: doesn’t have large breasts, is unaccepting of the resultant scars, is being pushed into the surgery by someone else (eg. parent or partner), has a strong wish to breast feed and wouldn’t be able to accept not being able to. They can always return after completion of their family. In someone with known severe keloid scarring I would think very seriously about not performing this surgery. Smokers are 100 percent nonos, as they have wound-healing issues. How do you prepare a patient for what the surgery will involve? I draw out the incision lines for each woman. There is always one around the nipple and one going down to the chest from there. Usually there is also an incision in the crease underneath the breast. To minimize scarring I recommend simple taping with paper tape for three months. I ask patients to come back for early review if they have any scarring issues and other management can then be implemented; for example silicone tape/gel or steroid injections. I don’t think I’ve ever had a woman not go through with the surgery because of the resultant scars. Most of the ladies I see are so happy to feel more comfortable that they are very accepting of them. Is this a traumatic procedure for patients? It is not a very painful operation to undergo. Indeed, breast reduction patients are usually my happiest postoperatively. They often feel more comfortable even immediately after waking up from their anaesthetic. What typically are the reactions of your patients to their results? Most are ecstatic even whilst they are in hospital. They are generally superexcited to go and buy their first nice bra off the shelf ever! I tell them to wait for six weeks, until the swelling has all gone down, but my last patient was brashopping at two weeks!
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MR RICHARD
Bloom MBBS Hons FRACS (Plast)
BREAST AUGMENTATION Breast augmentation is one of the most sought-after cosmetic surgery procedures in Australia. Mr Richard Bloom tells NipTuck how technology has enabled him to achieve even more beautiful, rewarding results for his patients.
Specialist Plastic Surgeon Mr Richard Bloom trained in Melbourne and attained a full fellowship in 2002. He undertook further training in the UK and US prior to commencing practice as a plastic surgeon in Melbourne in 2003. He is Currently the National Board Chairman for Plastic Surgery Training through the Royal Australasian College of Surgeons and is a member of the Australian Society of Plastic Surgeons council. With a wide field of expertise across all areas of reconstructive and plastic surgery, his main focus and interest is with breast surgery patients, facial rejuvenation procedures and body contouring surgery, particularly for patients who have undergone dramatic weight loss.
Before
Before
After
After
Before and after breast augmentation. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
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Who are your typical breast augmentation patients? Broadly speaking, I would categorise women seeking breast augmentation in three main groups. By far the largest group is younger women with normalshaped, but small breasts looking to increase size and volume. The second group is women whose breasts have become smaller, and less firm, after children. They have usually completed their families and are now unhappy with the size (and often shape) of their breasts after the effects of pregnancy and breast-feeding. The final group is women seeking to enhance breast size after massive weight loss. Particularly with the advent of lap-banding procedures [for obese patients], we are seeing more women in this group. What interview processes and techniques do you specialise in? We first introduced Vectra 3D imaging into our practice in 2009 and I would have to say that, now, I could not do a breast augmentation consultation without it! Vectra uses multiple cameras to take a number of simultaneous pictures that are then used to build a three-dimensional model of the patient. The system then uses special simulation software to show the possible results with different-sized implants. The patient actually gets to see what different implants will look like and actively gets to choose the size of their implants. What other advances can you offer patients? Our latest communication tool is TouchMD. This is interactive software that we use with virtually all of our cosmetic patients. It works through a touch-screen in our office and allows us to show patients on their own photos exactly where the implants will be placed, where the scars will be and where the relevant anatomy lies. All of the images we use to discuss during the consultation are then available to the patient via their internet browser when they get home. They essentially have an instant replay of the consultation, as well as information sheets, and their
simulated photos. It is a great way for patients to show their friends and family what they have discussed and what they are planning to do. Patients absolutely love it. What are your most popular breast implant types and procedures? The most common incisions I make would be the inframammary. This gives a well-hidden scar under the breast and also gives me the best access to the surgical site and the most control over the pocket. The second choice is where to place the implant. For me, where possible I would place the implant above the muscle just under the breast tissue. In my opinion, this is where the implant will have the most effect. Just imagine putting something under your bed sheets versus putting it under the mattress! Over time I think the breast will maintain its shape better, because the implant is linked to the breast tissue not stuck up under the muscle that allows the breast tissue to droop separately with age. With regard to the type of implant, my most common combination is to use smooth, round, silicone implants. Smooth because of a lower risk of capsular contracture. Round because, for the majority of women, an anatomical (tear drop-shaped) implant runs the risk of rotating, distorting the look of the breast. Finally, I use silicone implants because they look and feel better than saline implants, and we know they are just as safe. What are Australian women now looking for from breast augmentation? They are no longer wanting massive breasts but subtle, yet significant, recontouring and/or restoration. Most patients are now looking for a natural shape rather than a really obvious “implant look�. Are patients happy with their results? Patients are simply delighted by their breast augmentation procedure. They often comment on how it has improved their overall self-esteem, making them happier, and feeling more secure within themselves. The benefits of the procedure often gives patients a new lease on life with a new sense of confidence.
MR DEAN
Trotter MBBS FRACS (Plast)
BREAST RECONSTRUCTION OPTIONS Angelina Jolie and our covergirl Krystal Barter both decided on risk-reduction mastectomy as a result of carrying the breast cancer genes (BRCA1 or BRCA2), raising awareness around the world. Mr Trotter discusses with NipTuck the breast reconstruction options following this, and cancer mastectomy procedures.
Specialist Plastic and Reconstructive surgeon Mr Dean Trotter studied medicine at the University of Melbourne and trained at Melbourne’s major plastic surgery centres including The Alfred, The Royal Children’s and St Vincent’s hospitals. He completed a fellowship with the Royal Australasian College of Surgeons (FRACS) in 2009 and went on to complete a microsurgical fellowship in the UK, with a focus on breast procedures. Dean completed an additional fellowship in Buenos Aires, focusing on aesthetic plastic surgery and the use of cosmetic fat grafting.
What is your preferred breast reconstruction technique? I don’t have a preferred technique. Breast reconstruction must be tailored to the patient with consideration to their breast cancer treatment, their health, physical condition, age, anatomy, and their ability to address the issues of reconstruction in a considered state of mind. Some patients are better candidates for implant reconstruction, whilst others are better candidates for flap reconstruction. Some patients are best treated with a combination of both techniques. What does implant reconstruction involve? Implant reconstruction following mastectomy is generally a two-stage reconstruction. At the first stage, tissue expanders are placed that prepare for placement of an implant. The second stage follows several months later with the insertion of implants. The immediate use of implants at the time of a mastectomy is not widely practiced but is increasingly popular, especially with the use of dermal substitutes. What are “flaps” in terms of breast reconstruction? Tissue flap surgery is a way to rebuild the shape of a breast using skin, fat and muscle from another part of the body. Flap surgery tends to provide a more natural and longer lasting reconstruction than implant reconstruction. There are two types: • Pedicle means the flap of tissue from another part of the body is moved to the chest without cutting its original blood supply. • Free Flap means the tissue and blood vessels are divided. After the flap is moved into place, blood vessels in the flap are microsurgically reconnected to vessels in the chest area. There are several flap techniques: • The TRAM (transverse rectus abdominis muscle) flap is one of the most common, where muscle and tissue are taken from the lower abdomen and moved to the chest. This results in a “tummy tuck.” • The DIEP (deep inferior epigastric artery perforator) flap is a modern
refinement of the TRAM flap. It uses the same fat and skin from the lower abdomen as a TRAM flap but doesn’t use the muscle. By saving the muscle, it helps avoid later abdominal weakness. It also results in a “tummy tuck.” • The Latissimus dorsi flap uses muscle, fat, and skin from the upper back. The scar on the back can be placed at the bra line to make it less visible. It is often combined with an implant in order to create an adequate breast volume. • The TUG (transverse upper gracilis) flap uses skin and fat from the upper inner thigh. Sacrifice of the muscle does not result in functional problems and the scar is well concealed as well as providing a medial thigh lift. This may be a good choice for thin women who don’t have enough abdominal tissue for breast reconstruction • The GAP (gluteal artery perforator) flap uses muscle, fat and skin from the upper or lower buttocks to create a new breast. The scar is hidden by underwear. Can a mastectomy patient’s nipples be saved? Nipple-sparing mastectomy (NSM) is an advanced technique which is increasingly popular. NSM removes the breast gland but allows a woman to keep her nipple and areola. It is intended to improve cosmetic outcomes following mastectomy without compromising cancer care or the effectiveness of risk reduction surgery. The characteristics of the cancer and the breast will determine which women are candidates for this procedure. Are there other means of reconstructing a breast? Fat grafting, also called autologous fat transfer, is emerging as a new breast reconstruction technique. Adipose (fat) tissue is removed from other parts of the body, usually thighs, abdomen or and buttocks, by liposuction. The tissue is then injected into the breast area to recreate a breast. Will mastectomy incisions still be apparent? Although breast reconstruction can rebuild your breast, visible incision lines will always be present, whether from reconstruction or mastectomy. However, there are many excellent scar reduction techniques about which you can discuss with your surgeon. Is breast reconstruction worth it? Patients that decide to undergo breast reconstruction find the results very worthwhile. Restoration of breast form and symmetry allows a return to a normal quality of life for most women after the trauma of breast cancer.
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Level 17, 190 Queen Street, Melbourne, Victoria 3000 | Ph (03) 9642 8955, 9642 8893 | F (03) 9642 8755
AnneMulcaire “I had been really unhappy with my teeth for a long time, and had consulted a dentist about it 20 years ago but without success. At the time I was told that due to my underdeveloped jaw it was a complicated case and at the very least I would need several extractions. I was also told that to achieve a good result, they would have to break my jaw. I had left the appointment that day in tears and for more than 20 years I stayed that way, always conscious of my look and my crooked teeth. A routine visit to Art De Dente got me back on track though and after talking to the team there about a new procedure ‘Get Teeth in a Day’, my interest was renewed and I was once again excited about the prospect of fixing my teeth. I finally decided to have the ‘Get Teeth in a Day’ procedure. Anne Mulcaire’s treatment, first published in the March Issue, are now finished.
The work that has been done has been amazing. My confidence in myself has changed and my smile looks great. I really did this for myself, and it has been an important personal journey to go on. I turned 50 recently, and had decided
my gift to myself was a dental makeover. I couldn’t be more delighted with the results – they look great!” The ‘Get Teeth in a Day’ service involves the entire procedure to be carried out on the day itself. This may involve the removal of the teeth, placement of the implants and providing a fixed temporary prosthesis. On completion, healing of the bone and gums, can take up to 3-6 months, after which modifications are made to the temporary prosthesis, keeping in mind an individual’s desires and requirements. The 3 vital parameters to be considered are aesthetics, speech and ease of maintenance. The temporary prosthesis is then copied, incorporating those changes into the final fixed prosthesis. The temporary prosthesis allows for the individual to assess the aesthetics, speech and ease of maintenance and is critical to a satisfactory and pleasing result.
MikeGreer “I was always terrified of the dentist. As a child, I have vivid and horrid memories of my dentist actually tying me into the dental chair to do treatment. This caused me great distress and scarred me psychologically. It then got worse as an adult when my next experience involved the army dentist – after my experiences with that dentist, I was now scarred for life! So, as an adult, I just stopped seeing any dentist, as my belief was that ‘all dentists hurt’. Then, due to an accident, I was forced to face my fears. I had no idea where to go or who to see, as I knew it was going to be a very bad day no matter what.
My wife worked at HBA and a friend of hers recommended Art De Dente. My first visit revealed an abscess with my front teeth and extensive loss of supporting bone. I was then referred to a specialist for treatment. After that consultation I was not happy and because of the attention and care received from everyone at Art De Dente, I returned and asked them to do the job instead. The process took about 6 months and I am extremely happy with the results, plus, I have regained my confidence with the dental profession. I can see now the value in finding a good dentist who understands the fear involved.”
The ‘bone ring technique’ procedure utilized for Mr Mike Greer is a single stage procedure involving bone transplantation and implant placement at the same time. This procedure is utilized to minimize the total treatment time to 6 months. Bone Ring Graft + Implant Placement
Prosthetic Restoration
Total treatment time 6 months
6 months Conventionally, a two-stage technique is employed with required healing times in between the procedures taking the total treatment time to almost a year. Bone Block Graft
Implant Placement
5 months
Prosthetic Restoration AT consultation appointment
On the day Bone Ring Tech
Healing 5 months
Final Prosthesis
6 months
‘Bone ring technique’ is routinely performed at Art De Dente reducing the total treatment time to 6 months. Dr Rakesh Gulia at Art De Dente trained under the expert guidance of Dr. Bernhard Giesenhagen in Vienna who has pioneered the ‘bone ring technique’, which allows bone transplantation and implantation to be performed on large three-dimensional bone defects in a single operation. This technique can be used for almost all indications, including sinus lift procedures.
GET TEETH in a
DAY ASK US HOW?
Using dental implants and a new technique called “All-On-4”, we can now replace missing teeth and full dentures in one day.
BEFORE
AFTER
Am I an Ideal Candidate? Patients with missing and failing teeth as well as patients with full or partial dentures can benefit with this technology. What is “All-On-4”? An All-On-4 is a procedure to replace full conventional removable dentures with permanent fitting teeth. Using 4 implants, we permanently anchor the teeth in place so they look and feel like your original teeth. How long does the actual procedure take? It usually takes 2 to 4 hours under sedation to complete the surgery. What’s different about this procedure? This procedure is less invasive than other implant techniques. Using advanced x-ray and 3D imaging we can accurately predetermine the most suitable site. The implants are paced in the front part of the upper and lower jaws and the back implants are placed at an angle, so as to avoid where possible, anatomical structures and to maximize the stability of the bridge. Unlike conventional procedures, patients can avoid healing times of (up to) a year.
BEFORE
AFTER
The procedure illustrated above may not be suitable for all patients. The before and after pictures are indicative only and individual results may vary. Any surgical procedure carries its own risks and we advise you to seek an independent opinion.
When will I get my teeth? In most cases you will get your teeth on the same day. However, depending on the treatment, for your comfort, it may take 1-2 days from surgery to placement of the new teeth. It must be painful? This procedure is done using anti-inflammatory medication prior to surgery. On the day we use effective pain management and long acting local-anesthetics. Most patients experience little or no discomfort and/or swelling. How long does it take to heal? The integration of the bone and the implant can take up to 6 months. Some modifications to your diet will be recommended to insure the best possible outcome. I have several missing teeth, how can we replace those? If you only need to replace individual teeth, then we can use immediate replacement implants to fill in those gaps. Generally, each missing tooth will have its own prosthetic implant to replace the original tooth.
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Can this technology be used to replace a bridge? Yes. In most cases a crowned bridge can be replaced with implants
Overcome your fears with
Dental fear, anxiety and phobia (F.A.P) or essentially feelings of unease and concern are more common than some may realise. F.A.P can affect anyone and is not limited by age, gender, cultural background or location. The cause of dental F.A.P can be the result of three factors; personal experience, watching others and verbal accounts. Regardless of the orientation of F.A.P – those who suffer these disorders will often avoid making an appointment with a dentist which consequently may lead to poor dental health and may also affect a person’s general well-being and lifestyle.
Our Philosophy
Our Practice
Our Program
From the first conversation, our team are conscious about the care of the patient and potential dental concerns a person may have. Our treatment coordinator is qualified in dealing with fears and phobias, and as a trained counsellor, has used her expertise to assist many patients in overcoming their dental F.A.P.
Art De Dente has been designed to offer an immediate sense of serenity and harmony amidst lush green foliage, cascading waterfall, tropical aquariums, soft music and soothing aromas to set the ambient tone for the entire dental experience. This unique approach to create a dental oasis was to assist patients to overcome their concerns by changing the environment from “dental” to “day spa”. Our team will gradually introduce you to new, positive stimuli, all the while explaining the process and allowing you time to adapt. Our primary focus is the well-being of the patient while dental treatment becomes complimentary to this.
To reduce dental fear/anxiety/phobia, we incorporate various techniques to aid in patient comfort and care. These include oral medication, inhalation sedation, general anaesthetic and other technology and gadgets. All methods are designed to help you, the patient, relax to ensure the best possible treatment outcome.
Collins St Plastic Surgery is a boutique practice located in the heart of Melbourne CBD. Conceived by the renowned designer Nicholas Burns, the elegant and innovative contemporary design affords a dynamic, yet tranquil environment. Specialising not only in cosmetic procedures, there is a large reconstructive focus as well, dealing with everything from skin cancer, hand surgery, burns, reconstruction of breast cancer and other restorative procedures. Dr Mansoor Mirkazemi and Dr Michael Weymouth deliver impeccable standards of care in a very professional, friendly and empathetic manner. Both are qualified plastic surgeons and take a multifaceted approach to their practice. “We take the time to get to know our patients, understand their concerns, provide treatment options, and help them to make an informed choice”, says Dr Weymouth. Collins St Plastic Surgery is renowned for its treatment of patients requiring breast reconstruction. With so many options available for breast reconstructions, the decision can be
quite overwhelming. Michael and Mansoor guide their patients through various modalities of treatment to achieve the best reconstructive outcome. “The diagnosis of breast cancer often culminates in a highly stressful period of life for patients and the treatment usually appears overwhelming. We realise this and support the patients and their families along the entire reconstructive journey”, says Dr Mirkazemi. “Nothing is too much trouble. We will spend as much time as they require and do whatever it takes to help them through the whole process. “ Dr Weymouth agrees. “We are both passionate about breast reconstruction surgery. I have a personal family experience with breast cancer
and have seen the psychological effects that an unreconstructed mastectomy can have on some women. It gets emotional at times, but that value of being able to make someone feel as close as they possibly can to being whole again, to restore and preserve their femininity, it’s immeasurable”. Recent interest regarding prophylactic mastectomy generated by the publicity surrounding Angelina Jolie has led to an increase in the number of women seeking genetic testing and breast reconstruction. With their experience in managing breast cancer, Mansoor and Michael have utilised their expertise to facilitate reconstruction when such women are contemplating the difficult decision of prophylactic mastectomy.
Dr Mansoor Mirkazemi
Plastic Surgeon B.Med.Sci MBBS FRACS (PLAS) Dr Mansoor Mirkazemi is a fully qualified Australian Plastic Surgeon who specialises in cosmetic and plastic surgery. He graduated from the University of Tasmania in 1995, moved to Victoria in 2002 to undertake two years of advanced training in General Surgery followed by an extra four years in Plastic and Reconstructive Surgery under the auspices of the Royal Australasian College of Surgeons. He has performed hundreds of operations in breast augmentation, nasal refinement, facial aesthetic and body contouring, including breast reduction and lift and abdominoplasty. He works closely with breast cancer surgeons in public and private hospitals to reconstruct breasts following mastectomy. Mansoor is actively involved in teaching of plastic surgery trainees and travels to a remote island in Indonesia every year as an Interplast volunteer to treat children with cleft lips and palates, burn contractures, hand injuries and tumours. He ensures the best outcome for every patient with a caring, compassionate and gentle attitude to complement his meticulous and innovative surgical techniques.
SURGICAL PROCEDURES
• Facial aesthetic procedures • Nasal Refinement • Breast surgery – cosmetic and reconstructive • Abdominoplasty (tummy tuck) • Body contouring • Skin cancer and hand surgery
Dr Michael Weymouth Plastic Surgeon MBBS FRACS (PLAS)
Mr. Michael Weymouth is a fully qualified plastic and reconstructive surgeon, holding a fellowship from the Royal Australasian College of Surgeons (RACS) since 2008. He is also a current member of the Australian Society of Plastic Surgeons (ASPS) and the International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS). Currently, he holds consultant plastic surgeon positions at The Alfred hospital, where he is a member of the Victorian Melanoma Service and the oncoplastic breast reconstruction unit. He is also the supervisor of plastic surgical training at Austin Health. In addition, Michael is a member of staff at the Victorian Adult Burns Service, at The Alfred hospital, being one of the principal surgeons involved in treating burns victims of the now infamous Black Saturday bushfires. Michael is known for his high standard of surgical competency and his genuine, caring manner. He applies this altruistic approach to all facets of his work, whether it be aesthetic or reconstructive.
NON-SURGICAL PROCEDURES • Anti-wrinkle treatment • Fillers • Skin needling • Skin care • Facial peels
A Level 8, 267 Collins Street Melbourne 3000 | Ph (03) 9016 7822 | W www.collinsstplasticsurgery.com.au
Melbourne Laser & Aesthetic Centre Melbourne Laser & Aesthetic Centre was established in 1990 by co directors and senior Dermal Clinicians; Ms Tania Caputo and Ms Tania Fognini. Over the past 23 years the company has grown to become one of the most reputable cosmetic Laser clinics in Melbourne offering cosmetic treatments in the CBD to local, national and international clientele.
Tania Fognini
Tania Caputo
Today, the Melbourne Laser & Aesthetic Centre offers a specialised team of medical professionals; Laser therapists, Dermal Clinicians, Cosmetic Nurses working in collaboration with leading female Plastic & reconstructive surgeon; Dr Niamh Corduff. Directors; Tania Caputo and Tania Fognini lead the Melbourne Laser & Aesthetic Centre (MLAC) team who are highly experienced and university educated with a Bachelor in Health Science specialising in Laser treatments and aesthetic technologies for cosmetic enhancement, skin rejuvenation and scar reduction.
The centre is equipped with a diverse range of specialty medical grade Lasers, IPL and RF (Radio Frequency) technologies, with clinical treatments aimed to rejuvenate, correct skin conditions and enhance overall appearance. The clinic offers advanced laser technologies which are able to be used on all skin colours, from very pale to very dark including Indian and African-American skin colours. Melbourne Laser and Aesthetic Centre offers the most advanced scientifically proven nonsurgical cosmetic and laser skin and body treatments available.
SCAR TREATMENT Over the past 10 years scarring has become one of the centre’s areas of specialty. Scar reduction and remodelling is a specialised area of practice incorporating various modalities. Scars may be treated with fractionated laser resurfacing, fractional radio frequency treatment and collagen induction therapy. Specific laser technologies are also incorporated which target various colours within scars to achieve a more uniform skin colour. There are many different types of scars, with different causes and origins, and each scar is treated individually based on a comprehensive assessment by the treating practitioners. The dermal clinician’s experience in treating scarring is essential in obtaining optimal results. Both MLAC directors have not only had extensive experience, they have developed clinically proven methods in treating all types of scarring. Tania and Tania have been pioneers in many cosmetic methods used in aesthetic practice. Originally renowned for their pioneering practices in Photorejuvenation plus more recently with collagen induction therapy and now again with their scar revision methods, surpassing any conventional methods being used today. All patients are assessed, consulted and reviewed by either Ms Tania Caputo or Ms Tania Fognini throughout their individualised scar remodelling program. “Often a person presents with different types of scars, so various modalities need to be considered to achieve optimal results. It is essential that we take into account not only the type of scar but which aspect of the scar is causing the greatest concern, for example; it may simply be the colour or the texture, thickness, indentation, etc.” explains Tania Fognini. All scars whether new or old, can be treated.
Consultation appointments can be made without referral by contacting the clinic on 03 8686 5786.
TYPES OF SCARRING
T RE A T ED ACNE SCARS • most commonly indented, raised, red or purple and/ or pigmented.
ATROPHIC SCARS • indented, pitted or sunken scars
BURN SCARS • acquired through burns
CONTRACTURE SCARS • occurs frequently after burns, affects movement in and around the area.
HYPERTROPHIC SCARS • often red, raised scars and regularly mistaken for keloid scars.
KELOID SCARS • often red, thickened mass of fibrotic tissue which overgrows beyond the original injury.
STRETCH MARKS • occurs when the skin is stretched rapidly; such as teenage growth spurt, pregnancy or simply weight gain.
SURGICAL SCARS • usually fairly undetectable but may result in red or hyper pigmented, thickened and rope-like scarring.
Suite 1/ Exchange Tower 530 Lt. Collins Street, Melbourne, Vic 3000 Ph: 03 8686 5786 | E: info@melbournelaser.com | Find us on
www.melbournelaser.com
THE BEAUTY OF
HARD EXPERIENCE Plastic Surgery is not all breast augmentations and facelifts as we know, and Mr David Morgan’s practice is a fine example of the incredible transformations that can happen in the hands of a highly skilled surgeon. Mr Morgan’s motivation every day is not just about changing faces, but changing lives.
Cosmetic Rhinoplasty Pre-Operative
Cosmetic Rhinoplasty Post-Operative
A fully qualified Specialist Plastic Surgeon in Melbourne, he takes enormous pride and satisfaction in the work he has done in Australia and overseas during the past 20-plus years with accident victims and people of all ages suffering congenital and other disfigurements. It’s said that plastic surgeons with extensive knowledge and experience in performing facial procedures on trauma patients and those with deformities, especially children, make outstanding cosmetic facial surgeons. “It is a great passion of mine and I am grateful for the broader insight it
has given me with my private cosmetic and corrective practice, Renew Plastic Surgery,” he says “but the greatest benefit has been the difference it has been able to make to these people’s lives. I am very privileged to be in a situation to help make this happen.” Stints at several major Melbourne hospitals, including St Vincent’s, The Royal Melbourne, The Royal Children’s and the Victorian Plastic Surgery Unit gave him his initial experiences in all aspects of reconstructive plastic surgery and cosmetic surgery. He subsequently commenced private practice and was appointed as a Consultant Plastic Surgeon at The Peter MacCallum
Cancer Institute, dealing with the effects of all types of early and advanced skin cancers. “A desire for further knowledge and skills led me to Toronto, Canada, in late 2004 to undertake a Clinical Fellowship in Craniofacial Trauma and Reconstruction under the auspices of the University of Toronto,” he recalls. “This was followed by a further Clinical Fellowship in Aesthetic and Reconstructive Breast Surgery through the University of British Columbia in Vancouver.” Mr Morgan returned to Australia in 2006 and was appointed as a
Mr David Morgan Mr Morgan graduated from the University of Melbourne in Medicine in 1993 and after completing four years’ post-graduate surgical training at St Vincent’s Hospital in Melbourne, was accepted into the Plastic and Reconstructive Surgery training program, successfully completing this rigorous process in 2003 and becoming a Fellow of the Royal Australasian College of Surgeons. His career progressed with stints at several major Melbourne hospitals, until commencing private practice when he was then appointed as a Consultant Plastic Surgeon at The Peter MacCallum Cancer Institute. His passion for reconstructive surgery took him to Canada in 2004 where he undertook clinical fellowships in Craniofacial Trauma and reconstruction and Reconstructive Breast Surgery in Toronto and Vancouver.
Plastic and Reconstructive Surgeon
On his return to Australia in 2006, Mr Morgan was appointed as a Consultant Plastic Surgeon at The Alfred Hospital and The Royal Melbourne Hospital and has recently been appointed as the Head of Unit of Faciomaxillary Surgery at the Alfred Hospital. He has recommenced private practice at Renew Plastic Surgery and is directly responsible for the Victorian plastic surgeons Training Program in his role as the Regional Chairman of the Board of Plastic and Reconstructive Surgery. Mr Morgan is a member of the Australian Society of Plastic Surgeons (ASPS), the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the Australian & New Zealand Society of Craniomaxillofacial Surgeons, and is an International Member of the American Society of Plastic Surgeons.
Reconstructive Rhinoplasty Pre-Operative
Reconstructive Rhinoplasty Post-Operative
Consultant Plastic Surgeon at The Alfred Hospital and The Royal Melbourne Hospital, Melbourne’s two major trauma centres, to specifically deal with major facial trauma. He has recently been appointed as the Head of Unit of Faciomaxillary Surgery at the Alfred Hospital and is involved in the management of all types of acute facial trauma, the correction of secondary facial deformities and the ongoing management of congenital craniofacial deformities. “Surgery dealing with patients who have suffered significant facial trauma and/or disfigurements has given me a thorough understanding of the
elements of the face and how they can be reshaped – from the bones, to the subcutaneous tissues and the upper layers of the skin. This, in turn, I believe, makes me better equipped to understand cosmetic facial issues, such as ageing changes, and particularly rhinoplasty to help correct nose shapes and sizes.”
“Maintaining training standards, and therefore the quality of our future Plastic Surgeons, is vitally important and serves to protect our patients by continually striving for better outcomes. Of course, I carry these standards across into my private practice and hope that my patients can see this in the quality of their own results.”
Mr Morgan also has a personal interest in the training of our future plastic surgeons and is very serious about his role as the Regional Chairman of the Board of Plastic and Reconstructive Surgery, which makes him directly responsible for the Victorian Training Program.
Mr Morgan has recommenced private practice at Renew Plastic Surgery with a specific focus on rhinoplasty, cosmetic facial surgery, cosmetic and reconstructive breast surgery, and skin cancer management.
Cabrini Brighton, Suite 4, 243 New St. Brighton, 3186 | Tel 9591 0422 | Fax 9591 0290 | A/H 8508 9000
www.renewplasticsurgery.com.au
ArtOf&A Science Smile
The
The difference between Cosmetic and Aesthetic Dentistry. Traditionally, dentistry consisted of oral hygiene, fillings and pain relief. Then out of the 80’s new materials and techniques emerged and suddenly everyone wanted a ‘Hollywood Smile’, tooth whitening and porcelain veneers. The early 90’s saw a fundamental change in dentistry. For many patients, the health and function of their smile took a back seat, as dentists honed their skills and helped patients achieve a perfect smile, with the symmetry and whiteness they’d always dreamed of. After years of creating these smiles, patients began asking for a different kind of smile. They wanted a younger, more natural, version of themselves, rather than a completely new version. They wanted changes that would last, rather than a ‘Hollywood Smile’ needing constant repair and maintenance.
Multidisciplinary Dentistry: Orthodontics, Surgical repositioning of the Maxilla & Mandible, Implants, Tooth whitening, Crowns & Veneers.
After developing his skills in the area of Cosmetic Dentistry, Melbourne Dentist Dr Adam Keyes-Tilley realised that creating truly beautiful, natural, individual smiles wasn’t as simple as creating nice white symmetrical teeth. So Adam went back to study, to explore all of the advances in modern dentistry. Not just the cosmetic advances but to truly understand the key ingredients of a beautiful, healthy and lasting smile.
Before
After Surgery & Orthodontics
After tooth whitening
After many years of postgraduate study in Cosmetic, Implant & Reconstructive Dentistry, Adam gained two Fellowships in General Practice, Restorative/Periodontal Dentistry & Orthodontics in General Dentistry. Based on his studies of the whole face, the ‘Aesthetic Smile Makeover’ process that Adam now undertakes with his patients is vastly different to the ‘Cosmetic Makeover’ process of the 90’s. The focus of his ‘Aesthetic Smile Makeover’ is delivering beautiful smiles, whilst minimising the ‘biological cost’ to the teeth and surrounding structures and maximising the longevity of the smile.
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New Crowns & Veneers placed
THE PRINCIPLES OF
SMILE DESIGN Dr Adam Keyes –Tilley’s ‘Aesthetic Smile Makeover’ begins with a series of questions: • What type of smile do you want? • Do you want a smile that will have people asking who did your teeth? Or would you prefer them thinking what a great smile you have and not considering whether you’ve had work done or not? Finding out what a patient doesn’t like about their teeth is equally important. The colour, the shape of the teeth, how a smile looks from the side as well as the front, the appearance of the gums and the soft tissue and the way the lips work with the smile. Taking all of these things into consideration, Adam can then determine if adding, subtracting or moving teeth is needed to achieve the desired result. Adam also believes it’s important for patients to understand that some ‘Aesthetic Smile Makeovers’ can be achieved quickly, while others can take years, depending on the complexity of the work and the desired end result. As Adam says “Smile Makeovers can be simple and delivered quickly by changing colour and negating ‘visual
tension’ in a smile. Sometimes by creating a balancing of imperfection, increasing soft tissue support and facial fullness with injectable facial rejuvenation techniques. On other occasions, there might be a need to create adequate soft tissue support and fullness by moving teeth, moving jaws, grafting hard and soft tissues and placing implants. This can be a longer process. Soft tissue fullness and facial harmony or lack thereof can make or break a great smile.” • -What technique is best for you? With his cross-disciplinary training in so many fields of dentistry, Adam is able to design, coordinate and deliver a customised ‘Aesthetic Smile Makeover’ integrating all the latest advances in modern dentistry and facial rejuvenation. Invisible orthodontics, Porcelain Veneers and Crowns, Implants to All-on-4 full arch rehabilitation on implants or a combination of all these treatments is sometimes required to achieve the desired result.
Adam’s overriding philosophy is: ‘Above all, a ‘Smile Makeover’ must balance health, function and longevity with a patients aesthetic desires.’ This is essentially the difference between regular Cosmetic Dentistry and Dr Adam Keyes-Tilley’s ‘Aesthetic Smile Makeover.’ Whether your concerns are as simple as the colour of your teeth or more complex, we invite you to make an appointment with Dr Adam Keyes-Tilley to discuss your smile.
Please call CDC on 03 9866 1171 to book a consultation
w w w.cd c.n e t. a u
BDSc (Melb) FRACDS FICCDE
Dr Adam Keyes-Tilley has been practicing since 1991. He is experienced, dedicated and highly skilled. He has postgraduate training in many areas, including General, Aesthetic, Reconstructive, Orthodontic and Implant Dentistry. He is dedicated to studying and investigating the latest advances in dentistry and where appropriate incorporating these into his practice. Adam is passionate about using his cross-disciplinary dental knowledge to help his patients achieve the smile they want. Developing and sequencing complex, integrated dental treatment plans that deliver predictable aesthetic and functional outcomes. Careful planning and coordination of care ensures minimal impact on his patient’s life and work commitments. Dr Adam Keyes-Tilley is the Director of Complete Dental Care (CDC) St Kilda Road, Melbourne. His practice includes two additional Dentists, three Dental Hygienists and 8 support staff.
Breast S U R G E R Y
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The appearance of a woman’s breasts is extremely important to her, so the decision to undergo any kind of procedure can be a challenging time. During your consultation, Dr McManamny will listen to your expectations and help you decide on the best breast technique for your particular case. He will ensure a tailored and individualised approach to your procedure. Whether you are looking for an augmentation, a reduction or a breast lift, Dr McManamny and his team have
a highly professional, warm and engaging approach, to help you feel at ease and provide reassurance that you are in good hands. WHY CONSIDER BREAST SURGERY? Many women are unsatisfied with the size or shape of their breasts, which can in turn affect their self-esteem and
confidence. Breasts may be too big, too small, have changed shape or size following child birth, or have changed shape and ‘sagged’ down after weight loss. Whatever the cause of your dissatisfaction, there is an appropriate procedure to help restore your shape and give you the appearance you want.
31 Jackson Street Toorak VIC 3142 (Just off Grange Road, near the Freeway) Melbourne, Australia Tel (03) 9827 7179 • Fax (03) 9827 9879 Email info@aesthetic.com.au
www.aesthetic.com.au
Dr Douglas McManamny Dr Douglas McManamny is a Cosmetic Plastic surgeon providing breast, face and body surgery to a wide range of patients from his private clinic in Melbourne’s Toorak. He completed a Bachelor of Medicine and Bachelor of Surgery through Monash University and a Fellowship from the Royal Australasian College of Surgeons. Through his long and distinguished career, he has worked at the Royal Children’s Hospital, the Royal Melbourne Hospital and the Victorian Plastic Surgery Unit at Preston and Northcote Hospital. He also spent time at Frenchay Hospital in Bristol, England, with work in Cleft Lip and Palate repair, and then returned to Melbourne and a consultant position at the Royal Children’s Hospital. His work at the Aesthetic Surgery & Laser Centre has focused more on elective aesthetic procedures and cosmetic plastic surgery as well as a wide range of non surgery and ancillary procedures.
For women who have lived with a less than ideal breast size their whole life, a breast augmentation can provide the opportunity to improve their shape and enjoy the benefits of improved confidence and quality of life. Many other women have suffered for decades with large breasts which are heavy, can affect posture and cause chronic back and neck pain. A breast reduction
provides an opportunity for increased comfort and enhanced appearance for these women and in many cases changes their lives. For many women, breast size and shape alter following weight loss, pregnancy or breast feeding. Provided general health is good and there are no medical reasons to avoid breast surgery, an operation to
lift and improve the shape of the breasts is an effective and safe procedure. “Our primary concern is the welfare of our patients and the effectiveness, safety and appropriateness of the treatments we provide. Our team are all here to help you transition from initial consultation to surgery to recovery, with the best possible results as the final outcome”
PRACTICE
The Aesthetic Surgery and Laser Centre in Toorak, Melbourne provides surgical and non-surgical cosmetic procedures for men and women . With a belief that everyone should feel comfortable and confident in their appearance, the team is committed to helping you achieve your goals in an honest, friendly environment that supports your personal safety, comfort and privacy.
SURGICAL SERVICES
Breast Augmentation • Breast Reduction • Breast Lift (Mastopexy) • Face Lift Abdominoplasty and Liposuction • Nose, Neck, Eyelids and Forehead procedures • Skin Rejuvenation Anti-Wrinkle Treatments • Non Surgical MediSpa services
Paloma MediSpa offers solutions for all skin conditions and treatments designed to enhance your appearance. Inge’s philosophy is ‘change the outside and the inside just follows.’ For people looking to address the status of their skin and skin conditions Paloma MediSpa offers an approach that focuses on the uniqueness of each individual’s skin. “We have an integrated range of services designed to make the Paloma experience rewarding with the desired results being delivered,” says founder, Inge Drucker. The Paloma experience starts as soon as you arrive. “My aim was to create an experience from go to woe. It starts with a clinic layout that conveys a mix of an industrial design, by Melbourne architect Warwick Sassman, and is complemented by fittings and furniture to create an inviting and chic ambience. The waiting area blends replica furniture with concrete and chrome, yet delivers a soft, soothing, relaxing and peaceful environment.”
Treatments range from customised skincare treatments using world-renowned DMK products, to anti-ageing and profile enhancing injectables under the Dermox Group brand. DMK products are the brainchild of biochemist Danné Montague-King from California. DMK believes that the origin of most skin conditions is a result of disharmony within the skin. Using the principles of biochemistry, DMK has formulated a range of treatments and products designed to educate skin to perform like youthful healthy skin. DMK’s revolutionary concept of REMOVE, REBUILD, PROTECT, MAINTAIN aims to match an individual’s biochemistry with the appropriate skin therapy. Botanical-based paramedical products make up the DMK skin care program. Paloma MediSpa offers skin revision procedures for those who want results. Specific treatments are designed for addressing pigmentation issues, rosacea, acne, open pores, scarring, milia, wrinkles, sun damage, fragile capillaries and premature ageing. There is a solution available for all skin types and conditions, so why not meet with Inge and the team and enjoy the full Paloma MediSpa experience today.
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FAC E AND B O D Y T R E AT M EN TS • S K I N C A R E • A N T I - A G E I N G I NJE C TAB L E S
A B EA U TY E X P ERIENCE LIK E NO O THER Pa lo ma Me d i S p a i s a n e w a n d un iqu e con ce pt in skin care tre at me n t, of fe ring cutting edge t r e a t me n t s f r o m a c r o s s t h e g l obe in a st u n n in g in du strial style space in inner suburban Me lb o u r n e. C r e a t o r I n g e D r u c k e r h as e n su re d e ve r y de tail h as be e n con sidered in the design o f h e r g l a m o r o u s a n d t o t ally re laxin g space at S tocklan d Tooron ga in G len Iris.
www. p al o m am ed i s p a. co m . au NOW OPEN POD IU M L E V E L ST OC KL AN D T OO R O N G A C N R TO O R A K A N D TO O R O NGA R DS GL E N I R I S | P H ( 0 3 ) 98 2 2 7 7 1 8 NIPTUCK Magazine 207
The Safe
ALTERNATIVE
If you would like to book an appointment with Dr. Ross call the team at breast.com.au on 1800 32 34 36
David A. Ross FRACS(Plast.) Bayside Plastic Surgery
Saline filled breast implants If you are considering undergoing breast enhancement surgery it is important to know that the implants used are safe for your general health and long lasting to give you peace of mind for the future. If you are concerned about the safety of the implants in your body I would suggest you consider saline filled breast implants. Saline filled breast implants were designed after complications were identified with silicone gel filled implants soon after their inception 50 years ago. They have been available now for over 40 years and are generally recognised as the safest of breast implants available. In the time they have been available, saline filled breast implants have never been removed from sale in any country due to safety concerns. They are currently used in many countries around the world with excellent aesthetic outcomes and without many of the concerns that affect silicone breast implants, such as silicone leakage and silicone bleed causing capsular contracture. The advantages of saline filled breast implants are compelling, here are some of the reasons why I often recommend them:• As they are inserted deflated, they can be inserted through very small remote incisions (2-3cm), usually with the operating endoscope through the armpit, resulting in a virtually imperceptible scar within 6 months and no breast scars. • As saline implants are inflated during insertion they can be filled differentially to correct minor asymmetries in the pre-existing breast size. Also the implants can be overfilled to give a more
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Case Studies
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shaped and projecting breast form. • Saline filled breast implants are less dense than particularly high cohesive silicone gel implants so they feel lighter for the same sized implant. • Saline implants are radiolucent, meaning that X-rays can pass through them making it easier to assess a mammogram and
exclude breast cancer. Also a breast lump in a saline implant augmented breast is virtually never related to the implant. • Leakage of a saline implant is uncommon but readily detected clinically without complex and expensive investigations and the leaked saline contents do not pose a health risk to the body. • Saline implants do not have
“silicone bleed” (where silicone gel permeates out of the implant into the surrounding breast) and therefore the long term capsular contracture rate is very low so that replacement of the implant at 10-15 years is not usually necessary. • Statistics collected over the past 40 years have shown that the 5 year reoperation rate (chance of needing a second operation within 5 years after initial breast augmentation surgery) is about half for saline implants than that of silicone implants because of their fewer complications.(12% vs. 21%) • In my experience of nearly 20 years, I have undertaken over 250 revisionary breast augmentation procedures for implant complications and close to 80% of these procedures were due to silicone filled breast implant problems because saline filled implants have very few long term complications. If you are interested in undergoing breast augmentation surgery, take a look at results with saline filled breast implants or speak with other women with saline filled breast implants and then discuss the procedure with your fully credentialed Plastic Surgeon. You will be grateful for the peace of mind that salinefilled breast implants provide.
Creative DENTISTRY
DR PETER OLIVER of Creative Dentistry
Dr Peter Oliver of Creative Dentistry specialises in cosmetic dentistry, and the treatment of jaw, neck and shoulder problems caused by dental issues. He has a special focus on catering to nervous patients with a range of treatment options (including sedation and general anaesthesia) that help to alleviate the anxiety experienced by many in anticipation of, and during dental procedures. Dr Oliver graduated from the University of Adelaide in 1972. “I have been practicing for more than 40 years and I am still passionate about dentistry,” he says. “I am an empathetic dentist and I understand my patients’ concerns. I know what they want and I care.” Dr Oliver explains his top options for improving patients’ smiles and therefore, their lives.
Creative dentistry is all about creating an image for the patient that will give them confidence about their appearance – and, thus, in themselves. With more than 41 years’ clinical experience Dr Oliver believes his understanding of what a patients needs and wants is of utmost importance. “We are about solving problems involving teeth and facial muscles. Many of the techniques used involve no, or little drilling, which can be a source of distress for patients.”
These techniques include:
impression is needed. No more partial dentures! QuickSmile is another, similar option.
LUMINEERS For the smile you always wanted, a contact lens-thin porcelain veneer is placed over existing teeth like a fingernail. They are clinically proven to last up to 20 years, and simply require a very accurate dental impression of a patient’s mouth.
NO MORE GRINDING AND CLENCHING (BRUXISM) The same botulinum toxin injections that are used to “iron out” wrinkles on the face can be used to relax the muscles of the jaw that are engaged when people grind or clench their teeth. This allows symptoms like headaches and temporal-mandibular joint (TMJ) problems to be controlled, and minimise damage to the teeth themselves.
SNAP-ON SMILES These are teeth made from a proprietary formula of hitech dental resin, very thin yet extremely strong, that fit over your own teeth to give you a beautiful, natural looking smile – and can be inserted and removed whenever you want. Ideal for replacing missing teeth and hiding discoloured, worn or cracked teeth. Again, no needles or drills – simply an accurate
DENTISTRY HAS CHANGED:
We listen, we solve, we act. www.creativedentistry.net
ORTHODONTICS Invisalign, so-called “invisible braces”, are clear retainers worn for 12-18 months to correct crooked teeth. Ideal for adults who would feel self-conscious wearing traditional metal braces.
INMAN ALIGNER This is the fastest technique to straighten anterior teeth (the front six teeth, which are also referred to as incisors and cuspids), in most cases within 4-16 weeks. It is a removable orthodontic plate, not fixed. TOOTH WHITENING We offer immediate in-clinic bleaching and also offer patients take-home bleaching kits. MINI-IMPLANTS These are used for the anterior and premolar (located between the canine teeth and molars) areas. They are small diameter titanium alloy implants (less then 3mm wide). After injecting local anaesthetic into the gum, the implants are inserted into the bone. They can be used for crowns, short bridges, partial dentures or full dentures.
83 Raglan St, Port Melbourne VIC, 3207 creativedentistry@hotmail.com Ph 03 9939 9658 | Mo 0411 148 645
CREATED BY PLASTIC SURGEON DR MICHAEL MIROSHNIK
The medispa was developed with the philosophy of providing the very latest and best in injectables and non-surgical enhancement therapies. All treatments are delivered by industry leading nurses and dermal therapists, each of whom was hand picked by Dr Michael Miroshnik: • Anti-Wrinkle Injections • Injectable Fillers
• Antiaging Volume Replacement
• Facial Glamorisation & Reshaping
• Non-Surgical Nose Job/Jawline Reshaping • Fractional Laser Treatments • Optimised Light Treatments
• Pigmentation/Spot Removals • Exilis(™) Skin Tightening
• Non-surgical Body Contouring/ Fat Reduction • Customised Skin Treatments & Medifacials
To complement our treatments, we are proud to offer an elite range of take home skin care featuring some of the most proven anti-aging ingredients in the market today. Available for online purchase: www.elixxir.com.au
Suite 701, Level 7, 28 Spring Street, Bondi Junction, NSW 2022 T: 1300 854 610 Elixxir Medispa: www.elixxirmedispa.com.au • Elixxir Skincare: www.elixxir.com.au
DR MICHAEL MIROSHNIK Plastic & Cosmetic Surgeon MBBS, FRACS (Plast.)
www.drmiroshnik.com.au T: (02) 9389 8108 (Sydney) 1300 88 90 50 (Interstate)
Cosmetic Dentistry | Dental Implants | General Dentistry | Orthodontics | Endodontics Restorative | Prevention and Maintenance Address Level 17, 190 Queen Street, Melbourne, Victoria 3000 Telephone (03) 9642 8955 / 9642 8893
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