Question of the week: changes to the blepharoplasty item number

My heavy eyelids make it hard for me to see, especially when I’m tired. I often find myself raising my eyebrows to try and elevate my lids. I’ve heard that Medicare’s recent changes mean that I might not be covered by my private health insurance for this procedure anymore. How have the rules changed, and can it be done under local anaesthetic in your clinic, if my fund won’t cover surgery in hospital? - patient above: before and three months after blepharoplasty surgery with Dr Sharp Dr Sharp: Up until the 1st of November 2018, if you had loose eyelid skin that rested on your eyelashes (when looking straight ahead), your procedure met the Medicare Benefit’s Schedule item number criteria for a ‘medically required’ blepharoplasty, as Medicare deemed that the procedure was required to improve your vision. Medicare recently decided that the current criteria wasn’t adequate, and as of last week, the item number criteria was revised. It no longer relies upon only the plastic surgeon’s assessment of the patient, so if you wish to access Medicare rebates or use private health insurance cover, you now also have to make an appointment with an optometrist or opthalmologist to undergo examination and have obstructed vision confirmed, before undergoing surgery with the plastic surgeon. If you think this applies to you, mention this when you book your consultation, so we can provide you with a referral letter to an optometrist or opthalmologist explaining why you require the examination and report. Once this occurs, we can determine your rebates and out of pocket costs. So what do out of pocket costs for blepharoplasty surgery look like now? If you don’t have private health insurance: If...

Question of the week: what are cohesive gel or form stable breast implants?

I want silicone implants for my augmentation, but I’m confused about the difference between gummy bear, cohesive gel and form stable implants. How do I choose the safest? - patient Dr Sharp: It’s good to hear you are thinking about these factors and how they may impact your breast augmentation surgery, as they are important pre operative considerations! Essentially all of the implants you mention come from the same ‘family’ of silicone implants. Implant manufacturers use words such as cohesive gel, form stable silicone and gummy bear implants to describe variants of the same thing; breast implants that contain a silicone that maintains its shape and consistency inside the body - and has a solid (rather than liquid or runny) consistency. This kind of silicone has been successfully used for many years - and in millions of patients. Most specialist plastic surgeons in Australia use modern implants that contain this gel. Breast implants are very strong and ruptures aren’t common, but even when cohesive gel implants do rupture, the gel stays inside the implant - hence the term ‘form stable’. Silicone implants have dramatically changed over the past 40 years; the original silicone gel that was used as early as the 1970s, consisted of a liquid gel. If the outer layer of the implant ruptured, the liquid would leak into the body. In 2006, cohesive gel implants became available in the United States. You may have heard them referred to as the “gummy bear implant”. The big difference between a liquid gel and cohesive gel is that the cohesive gel stays in one solid form if cut or ruptured, mimicking a gummy...

Tummy tucks ease incontinence and back pain

Abdominoplasty surgery is far more than just a cosmetic procedure designed to remove a small post pregnancy pouch of skin. Most tummy tuck procedures reshape and strengthen the abdominal wall, reducing back pain and urinary incontinence after pregnancy. Earlier this year an Australian study found abdominoplasties provided significant functional and medical benefits to women post partum so… Why aren’t abdominoplasties considered a ‘medical’ procedure and subject to rebates after pregnancy? If you’ve lost 5 BMI points (outside of pregnancy) and have excess skin that can’t be conservatively managed, the Medicare Benefits Schedule criteria may deem you eligible for a ‘medical’ abdominoplasty - that is, one that is billed under an item number. However, since late 2015, if you’re a women experiencing rectus divarication, chronic back pain or urinary incontinence post partum, Medicare and health funds will consider the procedure to be ‘cosmetic’. So essentially, if a man undergoes extreme weight loss after bariatric surgery and has excess skin, some of his abdominoplasty costs will be reimbursed under Medicare (and private health insurance if he has an eligible policy), and yet a woman who has torn muscles, incontinence and back pain as a consequence of pregnancy cannot.   above: before and three months after abdominoplasty surgery with Dr Sharp Abdominoplasty repairs rectus diastasis (muscle separation after pregnancy), reconstructing the abdominal wall, removing hernias and restoring core strength - as well as removing excess skin from the lower abdomen. The authors of the 2018 Australian study highlighted the fact that this not only restores the abdomen’s shape, it can also improve core strength, and can impact back pain and pelvic floor control. The study...

The Aston Baker Cutting Edge 2017 Highlights

The Aston Baker Cutting Edge Aesthetic Surgery Symposium has been running for 37 years and brings together some of the world’s leading aesthetic plastic surgeons. This year, Dr Sharp and practice director Liz Washington joined hundreds of plastic surgeons and their clinic teams to learn more about the innovative techniques for facial and body rejuvenation. The program featured 94 instructive surgical videos, 26 presentations, 13 expert panels and 8 debates. Dr Sharp loves being abreast of the latest advancements in plastic and cosmetic surgery, and these forums provide a valuable opportunity to hear about the techniques, trials, anecdotal experiences and standards from across the world. The overall message from the symposium was: aesthetic surgery has changed, and the over-stretched, over-enhanced, over-done look is a thing of the past. Progressive surgeons are working together to develop new techniques to approach cosmetic surgery to achieve a more balanced, proportionate and natural look than ever before. We thought some of our patients may be curious to hear more about the ideas discussed, so in these videos, Liz briefly covers some of the symposium topics that often arise in our discussions with patients. Fat grafting Fat grafting has been used for reconstructive purposes for many decades, but its use for rejuvenation and enhancement is still a relatively new concept, and something that surgeons are still experimenting with to perfect and hone the right technique for different areas of the body. We saw some exciting results from the panel, and of particular interest was ‘micro’ and ‘nano’ fat grafting for facial rejuvenation, which is providing not just volume replacement, but also dermal rejuvenation. The faculty also addressed the...

Research indicates confusion over ‘surgeon’ qualifications

According to a report in the February issue of Plastic and Reconstructive Surgery, a study undertaken by the American Society of Plastic Surgeons (ASPS) has revealed widespread confusion around the titles ‘plastic surgeon’ and ‘cosmetic surgeon’. In Australia, the Medical Board only recognises the Royal Australasian College of Surgeons (RACS) as the training body for qualified surgeons. Upon completion of this training, the surgeons display the letters FRACS as their credentials, the ‘F’ standing for ‘Fellow’. However many doctors who have not undergone RACS training and examination, still openly call themselves ‘surgeons’, despite not having RACS qualifications. Cosmetic surgery is no different to other surgery; it carries a risks of infection, complications, nerve injury and adverse anaesthetic events. And yet the study results showed significant misperceptions about the qualifications needed to perform this type of surgery: 87% of respondents believed that surgeons must have special credentials and training to perform cosmetic surgery, or to advertise themselves as aesthetic/cosmetic/plastic surgeons. More than half of respondents were unsure about the training needed to become a board certified plastic or cosmetic surgeon. Most respondents stated their discomfort with specialists other than plastic surgeons performing surgery to improve their appearance. Here are some facts to help clarify the status of ‘cosmetic’ and ‘plastic’ surgeons in Australia: Plastic surgeons are also called ‘plastic, reconstructive and cosmetic - or aesthetic - surgeons’ because they have undergone advanced training in major public and private hospitals under a traineeship with the Royal Australasian College of Surgeons in plastic, reconstructive and cosmetic fields of surgical study; under the supervision and mentorship of experienced and RACS qualified surgeons. This training process...

Popular procedures for modern men

Men are more open to the options that aesthetic surgery and cosmetic medicine offer than ever before. And while women still comprise the majority of our patients, data from the American Society of Aesthetic Plastic Surgery indicates that the number of men having cosmetic procedures increased by more than 106% between 1997 and 2012; an ongoing trend echoed by the growing number of men seeking cosmetic improvements at our clinics. Often, male patients say they don’t like the tired, stressed or unhealthy appearance they see in the mirror - because they still feel young, strong and fit on the inside. Others are looking to freshen up their appearance before re-entering the dating scene. And many mention a desire to stay competitive in the workplace, linking their looks to their recruitment and promotion prospects - something noted by London economics Professor Daniel Hamermesh in his study of the financial benefits of aesthetic appearance. Here are some of the surgical and non-invasive treatments most commonly requested by men in our clinics: Rhinoplasty Nose jobs are a powerful way to change the entire dynamic of the face. Previous surgery, nose trauma or genetics can leave men with misshaped, prominent or irregular nasal characteristics. It can also cause breathing problems and snoring. Rhinoplasty surgery reshapes bone and cartilage, changing the underlying structure of the nose and creating functional improvements - such as improved breathing - while making aesthetic adjustments that improve its appearance and proportion with the rest of the face. The surgery requires about 7-10 days off work while bruising and swelling subsides. Dr Sharp’s patients receive a post treatment care pack that assists with accelerating...

Mums lead the way in cosmetic surgery

  Reported by Anna Hartley | 6th April | Queensland Times: SOME might be quick to assume young women would make up most cosmetic surgery candidates. According to Ipswich plastic and reconstructive surgeon Dr David Sharp, the majority of people who come to him for plastic surgery are in fact women in their 40s and 50s. The surgeon said the most common cosmetic procedures he performed were tummy tucks, breast reduction and augmentation surgery. “There is a large group of patients who have thought about having cosmetic surgery for years, usually females in their 40s or 50s who’ve had their children, who say, ‘I want to do something for myself now’.,” Dr Sharp said. “After skin cancer there is a lot of cosmetic stuff coming through and of that it’s mainly abdominoplasty, breast reductions, and breast augmentation.” Dr Sharp said his biggest concern when it came to cosmetic surgery was the trend of people choosing the “cheap” option. “The only people who are qualified to call themselves surgeons in Australia have to have a fellowship with the Royal Australian College of Surgeons,” he said. “My advice would be for cosmetic surgery candidates to really do their research. “I’ve heard some horror stories. The cheapest option is not necessarily the best.” Read the full article at The Queensland Times.  ...