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PROCEDURES

Breast

Augmentation

Breast Augmentation is our most popular cosmetic operation making amazing changes to women’s lives. We use only the highest quality implants with the longest safety profile. Our operations are only performed in accredited hospitals using some of Australia’s leading anaesthetic doctors.

Q.

What is the cost of breast augmentation?
What is the cost of breast augmentation?

The total costs for breast augmentation is usually between $9000 and $10,000. That cost covers the leading implants on the market, the accredited day hospital fees, one of Australia’s leading anaesthetists, surgical costs and follow up.

We also include a 3D simulation to see the differences between various implants, see cosmeticdesign.com.au This helps us give you best feel for how you will look after surgery. 

Be aware that the cheaper clinics tend to cut costs in various ways. There was an interesting story on 60minutes regarding this. http://youtu.be/6J5jgt07pFo

Q.

Tear drop or round implant?
Tear drop or round implant?

Tear drop implants give more options in terms of their base size than the round implants. This is critical if a shorter lady is trying to achieve ‘side boob’ to offset larger hips. They also tent to give a more natural look with tapering at the top of the breast.

Tear drop are more expensive however than the round implants, and many ladies like to have a slightly fuller look in the upper part of their breast using the rounds implants.

Q.

Under the muscle or over?
Under the muscle or over?

There are pros and cons to both approaches. I tend to favour under the muscle as the implant is held a little better with more tissue covering it giving a more natural look and feel. However it is a little more painful, with a slightly higher chance of bleeding. If you are after a very fake look, this is best achieved by placing the implant on top of the muscle.

Q.

How to choose the volume?
How to choose the volume?

We help you choose your volume by determining the look you are after first up and measuring your chest to see how much volume is possible for your breast width and breast skin. Based on this assessment we ask you to try various breast implant sizes placed inside a sports bra so you can feel the weight of the extra volume and see the different shape that it creates. Once we have an agreed size, we use a 3D photography machine which enables us to show you a representation of you with your chosen sized implants (cosmeticdesign.com.au).

Q.

How painful is the surgery?
How painful is the surgery?

Intra operatively local anaesthetic is placed around the breast which allows the surgery to be performed as a day case. Depending on pain tolerance, size of implant and implant position, the first night can be uncomfortable. Our anaesthetist makes sure you are sent home with the best regime of analgesia to make your evening tolerable.

Ladies are usually back at work 5 to 7 days following surgery, although this is quite variable between patients.

I recommend a snug surgical bra to be worn for 6 weeks following the augmentation and no jogging for that first 6 weeks.

Q.

Do I need a lift combined with an augment?
Do I need a lift combined with an augment?

Performing a lift with an augment is occasionally required for very droopy breasts. When the nipples are the lowest part of the breast, a lift is generally unavoidable.

Even with less droopy breasts however a lift may be required, depending on how large you are prepared to go. If you have moderately ptotic/saggy breasts but only want a small augment, you may need a lift.

Lift/Mastopexy

Breast lifts are a procedure which repositions the nipple higher up the breast and removes the excess skin. The aim is to preserve as much breast tissue as possible and only dispense with the droopy skin.

Q.

Will private insurance cover the costs?
Will private insurance cover the costs?

Part of the operation cost is covered by most private health funds if you have breast fed more than 1 year ago but less than 7 years ago.

Q.

What incisions are used?
What incisions are used?

The types of incisions and therefore scars vary depending on how much skin needs to be removed. The most common incision is one around the areolar with a vertical line down to the breast fold and then a smaller horizontal line along the breast fold. For smaller reductions some ladies are able to get away with just an incision around the areolar.

Q.

Do I need a lift combined with an augment?
Do I need a lift combined with an augment?

If you don’t want any extra volume then you don’t need a breast augment and you can simply have a lift. If you would like volume in the upper pole then a lift can achieve this for a short time but an implant will maintain volume in this area for longer.

Reduction

Breast reduction is an amazing operation for women with breasts so large they are getting back and neck pain or rashes under the breasts. The relief patients feel after the removal of those kilos of extra tissue often has them asking why it took them so long to have the surgery.

Q.

What incisions are used?
What incisions are used?

The types of incisions and therefore scars vary depending on how much breast tissue and skin needs to be removed. The most common incision is one around the areolar with a vertical line down to the breast fold and then a smaller horizontal line along the breast fold, like for a breast lift. For larger reductions the horizontal incision is longer to allow removal of the extra skin and breast tissue.

Q.

Will private insurance cover the costs?
Will private insurance cover the costs?

Part of the operation cost is covered by most private health funds.

Q.

What is the recovery time following surgery?
What is the recovery time following surgery?

Most women are back at work within 2 weeks of surgery. there is a natural variation in this however with some returning much earlier and some a little latter.

Body

Tummy tuck

Abdominoplasty or tummy tuck is a surgical option for people with excess skin around their bellies who would like to regain a flatter tummy. This usually applies to women following childbirth or people who have lost a large amount of weight.

There may be a large hernia in the abdominal muscles which needs to be repaired and this happens at the same time as removing the excess skin.

Sometimes if there are a few pockets of fat deposition tummy tucks can be combined with liposuction.

Q.

I am currently overweight. Is tummy tuck a good option?
I am currently overweight. Is tummy tuck a good option?

The best results are seen in people who are not overweight as the surgeon is able to remove more tissue with less fear of wound healing problems. If you are very overweight then most surgeons will only perform removal of large overhanging ‘aprons’ for hygiene reasons. Generally if someone is very overweight we recommend them seeing a specialist bariatric surgeons. Once they are lighter they should come and see a specialist plastic and reconstructive surgeon for their tummy tuck.

Q.

What scars can I expect?
What scars can I expect?

Depending on the amount of skin which requires removal, the scar can be as small as a caesarian section scar or from hip to hip. We always plan the scar to be hidden under which ever bathers or underwear the patient likes to wear, so very few people will ever see the scar.

If there is a c-section scar this is usually removed as part of the procedure.There may also be a small scar around the belly button if this needs repositioning.

If you have had massive weight loss then a vertical midline scar may be required to remove the skin that a horizontal scar is unable to address.

Q.

What is the recovery time?
What is the recovery time?

Immediately following surgery the tummy is quite tight so for 2-3 days the patient needs to walk in a slightly bent position while everything stretches up. Usually they go home on day 2 or 3 and are off work for 2 weeks. Some people require a few more weeks off work depending on their activities.

Face

Face and neck lift

A facelift repositions the deeper tissue layers of the face and neck thereby tightening the sagging skin caused by ageing or weight loss. Many different types of facelifts exist, is usually combined with a neck lift and may include an upper blepharoplasty and brow lift.

Q.

What incisions are made?
What incisions are made?

Traditionally the incision runs along a crease in the skin directly in front of the ear, around the ear lobe and back into the hair line. If a neck lift is performed as well, there is usually an incision in a skin crease under the chin. These incisions allow for safe, wide undermining of the skin so that the deeper tissue layers can be repositioned and the skin re draped over the top without tension.

Q.

What is the recovery time following face/neck lift surgery?
What is the recovery time following face/neck lift surgery?

The main determinant of recovery is the amount of swelling and bruising the patient suffers following surgery.Generally with delicate tissue handling, close attention to hemostasis, and an excellent anaesthetist most patients are able to go back to work 2 weeks post operation.

It is important to maintain a normal blood pressure during the recovery phase and to not take any medication not suggested by the surgical/anaesthetic team. It is also best to avoid exercising for 3 weeks after the surgery.

Q.

How long does a facelift/neck lift last?
How long does a facelift/neck lift last?

The idea behind a face lift procedure is to return the facial soft tissues to a time many years before the surgery. The face and neck post operatively are not static however and will continue to undergo ageing process’.

Generally speaking a well performed facelift, where the deeper tissues are repositioned will last most people the rest of their lives.

A facelift should reposition the deeper structures of the face (Fat and muscles) but can not change severely sun damaged skin or very thin skin.

Blepharoplasty

Blepharoplasty involves removing the redundant skin from around the eyelids, which is commonly, but not exclusively associated with ageing. Depending on the patients requirements, a small amount of fat and muscle may also be removed from under the eyelid skin to improve the cosmetic appearance. Some people have droopy eyelids or ptosis which would also need to be corrected.

If the operation is removing the skin from the upper eyelids it is called an upper blepharoplasty, and a lower blepharoplasty when the lower eyelid skin is involved. Medicare and private insurance only provides a rebate for upper, not lower, eyelid reduction surgery.

May people who appear to have excess skin around the upper eyelids actually have a normal amount of upper lid skin, but the entire brow has dropped. These people are better off having a brow lift.

Q.

What is the recovery time following blepharoplasty surgery?
What is the recovery time following blepharoplasty surgery?

Most patients are still swollen and slightly bruised at 5 days post operatively but they are able to work and socialise with a little eye shadow to hide any residual discolouration. That being said occasionally a patient will take the full 2 weeks to be comfortable with presenting themselves in public.

For a complete recovery of swelling it may take up to 3 months. This can be minimised with icing post operatively, sleeping with the head of the bed raised for 36 hours post op and massage to encourage fluid drainage once the sutures are removed at day 5.

Q.

What is the cost of blepharoplasty surgery?
What is the cost of blepharoplasty surgery?

Currently there is a private health fund rebate for upper eyelid reduction surgery where the skin of the upper lid is obscuring vision (as evidenced by the upper lid skin resting on the eyelashes on straight ahead gaze)

This significantly reduces the cost of surgery for those with private insurance.

For those without insurance, the costs can still be minimised by having the procedure performed as a day case under local anaesthetic.

Q.

Do I need a brow lift or a blepharoplasty?
Do I need a brow lift or a blepharoplasty?

Most people who present for blepharoplasty have a degree of both brow ptosis and excess skin in the upper eyelids. To decide which procedure the patient would benefit from most, the eyebrow skin is repositioned into its ideal position and the amount of excess upper eyelid skin is re-assessed.

Depending on which manoeuvre provides the greatest degree of improvement in appearance and relief of symptoms determines the best operation for you. Keep in mind though that some people need both a blepharoplasty and a brow lift.

Otoplasty

Otoplasty is the surgical correction of bats ears. This involves recreating the crease in the ear to establish a natural looking fold so that the ears don’t stick out any more. It is very important that this is done very carefully as ears which have been over corrected look very peculiar.

Q.

How are the ears folded back?
How are the ears folded back?

There are many different techniques described for otoplasty surgery.

I tend to favour using a combination of suture techniques and sculpting the surface of the cartilage to form a permanent natural fold.

Q.

What is the cost of otoplasty surgery?
What is the cost of otoplasty surgery?

Currently there is a private health fund rebate for correction of bats ears.

This significantly reduces the cost of surgery for those with private insurance.

For those without insurance, the costs can still be minimised by having the procedure performed as a day case and avoiding the cost of an anaesthetist by only using local anaesthetic.

Q.

What is the recovery post operatively?
What is the recovery post operatively?

A head bandage is used for 5 to 7 days following surgery to maintain the sculpted shape. Once this is removed patients wear a neoprene removable head band at night and when ever the ears might get knocked for the next 5 weeks.

At a week most of the swelling has resolved and the sutures are removed from behind the ears.

Brow Lift

A brow lift is a surgical procedure which elevates the eye brows into a more attractive position and smooths the forehead lines. As the skin tightens it also reduces the wrinkling of the upper eyelid skin, allowing more definition of the eyelid crease.

Q.

What techniques do you use for brow lifts?
What techniques do you use for brow lifts?

There are many different techniques which can be used for a brow lift and the best technique depends on the your requirements and affordability.

The most technically demanding procedure involves an endoscope. Using tiny cameras, via an incision in the scalp, the skin is elevated all the way down to the eyebrow. Then sutures are placed to fix the brow into the new position.

A simpler, but very effective method is the direct brow lift, where skin is excised just above the eyebrow. Generally the direct brow lift scar settles down extremely well, and can be performed under local anaesthetic.

Q.

What is the recovery from brow lift surgery?
What is the recovery from brow lift surgery?

This really depends on the technique which is used. Using the direct brow lift mentioned previously, you can have it performed under local anaesthetic and be home the same day. The sutures are removed on the 5th day. There is very little bruising, but it does take time for the scar to fade to the point where it can’t be seen.

Using the more invasive techniques you need to be in hospital at least overnight. Often there is a drain placed to remove any fluid build up under the scalp. There can be some significant swelling and bruising which can last up to 2 week.

Q.

Do I need a brow lift or a blepharoplasty (eyelid skin reduction)?
Do I need a brow lift or a blepharoplasty (eyelid skin reduction)?

To decide which procedure the you would benefit from most, the eyebrow skin is repositioned into its ideal position and the amount of excess upper eyelid skin is re-assessed.

Depending on which manoeuvre provides the greatest degree of improvement in appearance and relief of symptoms determines the best operation for you Keep in mind though that some people need both a blepharoplasty and a brow lift.

Chin Augmentation

Chin augmentation is a good option for people with an extremely convex facial profile. These people often present for a rhinoplasty, when their nose is actually quite normal, but their very small chin is making the nose appear large.

Q.

How is a chin implant performed?
How is a chin implant performed?

There are two ways to augment a chin. The first is to use an incision under the chin and place a prosthetic implant onto the chin, fixing it into place to stop it moving.

The second option is to place the incision in the gum of the mouth and use your own chin bone. This is achieved by making a bony cut and sliding the cut piece of bone into a more prominent position.

Q.

What other procedures are commonly performed at the same time?
What other procedures are commonly performed at the same time?

Occasionally a patient with a very small chin has an associated small jaw. This can lead to problems with your bite. In this instance the bony cuts are made further back in the lower jaw to slide the entire jaw forward, so that your bite can be improved as well as improving your facial profile. This is called a sagittal split osteotomy and is a form of orthognathic surgery.

Another procedure which can go very well with a chin augmentation is a rhinoplasty. In the patient with a very convex facial profile there is often an element of a small chin and a large nose, which by addressing both at the same time gives a very impressive result.

Q.

What is the recovery following chin implant surgery?
What is the recovery following chin implant surgery?

Generally the swelling is quite minimal and a patient is able to return to work in 7 days. The skin over the chin and lips will feel tight for a few months following surgery, but this improves with gradually stretching of the skin. Occasionally secondary to stretching there is numbness over the lower lip following surgery. This generally removes very rapidly.

Rhinoplasty

Rhinoplasty is complex, demanding surgery aimed at improving the shape of the nose and increasing nasal air entry.

Q.

What is the cost of a rhinoplasty?
What is the cost of a rhinoplasty?

If you have significant nasal airways problems, suffered a traumatic injury or been born with a congenital deformity involving your nose the private health funds will cover a large majority of your treatment. If the reason for a rhinoplasty is purely cosmetic then the patient has to bear the costs of the entire procedure.

In cosmetic cases the costs come down to how long the surgery will take, as this is the main determinate of fees for the hospital, surgeon and anaesthetist. Patients are usually able to go home on the same day, which saves the cost of an overnight bed.

The second option is to place the incision in the gum of the mouth and use your own chin bone. This is achieved by making a bony cut and sliding the cut piece of bone into a more prominent position.

Q.

What is the recovery time following rhinoplasty?
What is the recovery time following rhinoplasty?

Rhinoplasty is usually performed using an ‘open’ approach which means a small incision is made at the base of the nose in the columellar, then continued around the inside of the nose. The nose skin is then elevated off the underlying structures to enable the best opportunity of seeing and correcting the deformity. This obviously leads to significant swelling which takes a long time to recover. The sutures in the columellar are removed at 5 days and the scar generally settles down very quickly to be almost invisible.

If the nasal bones have been fractured to straighten a crocked nose the patient has a plaster protecting the repair for a week.

To maintain the new nasal shape a new framework needs to be put in place under the skin to maintain an improved position. This framework is cartilage. The new cartilage leads to a stiffer feeling nasal tip and rim.

Obtaining enough cartilage can be difficult. In a simpler cosmetic rhinoplasty there is usually enough spare cartilage to be found in the nose, however with significant deformity cartilage needs to be sourced from further afield. In these instances rib cartilage is taken via a small incision under the breast. While the scar heals very well, this is quite uncomfortable for a number of months after the operation.

Q.

How can I be sure that my surgeon and I are aiming to achieve the same goals?
How can I be sure that my surgeon and I are aiming to achieve the same goals?

I find the best tool for discussing the changes to be made in rhinoplasty is using a 3D simulation. I use a vector machine for each rhinoplasty patient which is included free with the consult. Please see cosmeticdesign.com.au for more information on this.

While performing virtual surgery on a 3D simulation is no guarantee that the result is transferable to the operating room, it is invaluable in ensuring patient and surgeon have the same goals.