Report: Australian Breast Device Registry
The Australian Breast Device Registry (ABDR) has released their Annual Report, detailing 3,544 reconstructive and 9,337 aesthetic breast procedures performed in public and private hospitals during 2018 and a total of 10,762 reconstructive and 29,206 aesthetic procedures from 2012 to 2018.
The report provides important insights into procedures and implant details, surgical techniques, complications and revision rates on data from 37,000 patients.
Established in 2015, the ABDR is a world-leading registry service led by Monash University, with the support of Australian Society of Plastic Surgeons (ASPS) and the Therapeutic Goods Administration (TGA).
Surgeons are able to voluntarily submit information about the implants they place in patients. This enables patients to have a central national point of registration for their implants, while also facilitating the monitoring of prosthesis’ safety profiles and enhancing quality of care for breast implant patients.
Each of Dr Sharp’s patients have their implants registered (it is free of charge), but can choose to opt out of the registry if they wish.
Australia wide, 514 surgeons operating at 280 hospitals and day surgeries had contributed data. Key findings included:
• The total number of procedures captured by ABDR in 2018 was 13,718, including 3,544 reconstructive and 9,337 aesthetic procedures.
• At the end of 2018, 37,603 patients had procedures captured by the ABDR, an addition of 11,990 in 2018.
• 74% of breast implant procedures were registered (up from 65% in 2017 and 44 % in 2016).
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Considering surgery in 2020? Here are four things to think about…
Great surgical results are the coming together of good preparation, great surgical skills, optimal post operative recovery, good health/nutrition and mental wellbeing. New rules that came into play in recent years ensured that patients and their surgeons can’t rush into cosmetic procedures - which is a good thing! Planning ahead, taking the time to get informed and ensuring that you have considered your recovery process, financial costs and surgical goals, helps set you up for the best possible outcome, and an enjoyable experience along the way. Here are some questions that our patient coordinator, Katy, recommends patients ask themselves if they are considering surgery in 2020:
What do I want to achieve?
Ask yourself to articulate what you don’t like - and importantly - what you do like about your appearance. Think about the specific changes you’d like to see. Is there a certain look you definitely don’t want to achieve? And how do you expect having surgery will make you feel; both during and after the process? Consider whether you’ll be okay with the possibility that your results might be immediately visible (as is the case of breast augmentation) or could take a full year to reveal themselves, as rhinoplasty results can. Talk to a trusted person about your concerns or desires - and feel free to bring them along to the consultation with your surgeon; it might make you feel more comfortable, and can also help you remember what was discussed during your appointment!
What is my ideal time frame for surgery?
If you have your heart set on a specific time of year for your surgery, ideally, book your first consultation 4 - 6 months prior, especially if you’re planning surgery during busy periods, such as Christmas or school holidays. The only downside to choosing a great surgeon is that there might be a wait to get an initial appointment (with good reason - they’re busy because they’re popular!) but we understand it can be very disappointing to find that the theatre lists during your scheduled annual leave break are all booked up. Ask your surgeon if they have a Priority Waiting List. In our clinics, we can often bring our patients’ appointments forward by weeks or months, just by registering them on this list. Most of the time, your surgery will be anywhere from 2-4 months after your initial consultation, depending on availability on theatre lists at your preferred hospital. Often you will have a second or third complimentary consultation in the interim. And don’t plan to have surgery just before major life events; give yourself plenty of time to heal before a wedding, reunion or big holiday!
Can I take enough time off work?
Most procedures require 1-2 weeks off work, and if your job involves heavy lifting or lots of physical activity, you may need to return on reduced activities for up to 6 weeks, longer if you’re a slow healer or have other health issues. Talk to us so we can help you plan ahead. If you have a cosmetic procedure with Dr Sharp, you will have at least 3 post op consultations, so it’s also good to consider how you will be able to attend these around work commitments after your surgery.
Do I need private health insurance?
It’s always beneficial to have private health insurance if you are having surgery. Some procedures, such as abdominoplasty, brachioplasty or thigh reduction after massive weightloss, carry MBS item numbers which significantly reduces your out of pocket costs, and gives you peace of mind knowing you have any post operative hospital admissions covered. But even if your planned procedure doesn’t have MBS item numbers (and is considered entirely cosmetic), if you experience any complications or health issues after surgery, your private health insurance usually covers most of the associated costs. Readmission to hospital after cosmetic surgery is very rare amongst our patients, but it does happen from time to time and when it does, private health insurance is very reassuring.
Have more questions for us?
Our experienced patient care team have extensive experience navigating these questions, and are available for an obligation free phone chat on 3202 4744 to discuss the procedure you are interested in, the potential costs involved and whether or not you might be eligible for rebates.
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Breast implant safety update: the TGA announcement
In recent months the Therapeutic Goods Administration have undertaken an enormous amount of work, commissioning internal scientific reviews, meeting with external advisory groups, liaising with overseas regulatory authorities and research groups to advance public safety on sound scientific evidence for breast implant safety. We welcome news today that following the Therapeutic Goods Administration’s (TGA) thorough review of breast implants sold in Australia, they have taken a range of regulatory actions to address BIA-ALCL risks.
We are also pleased to advise that the high quality implants Dr Sharp uses (Mentor and Motiva) are not involved in any of the suspensions or voluntary recalls resulting from the TGA’s investigations, due to their low incidence of complications and BIA-ALCL rates.
All surgery carries risks, and patient safety is front of mind in every decision we make; as such, breast implant risks have been addressed by Dr Sharp in our clinics for years, with:
- the use of high quality micro and nano textured implants
- Dr Sharp taking the Macquarie University 14 Point Plan Pledge
- use of the Australian Breast Device Register for all breast implant procedures performed by Dr Sharp
- to promote patient awareness, the risk of BIA-ALCL is always included in the informed consent and consultation process with Dr Sharp. We believe that every patient deserves to be fully informed, and so this has been part of our practice, since long before it was recommended or required.
Even if you have macro textured breast implants, the TGA says removal is not required
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is very rare. Evidence based recommendations are that removal of breast implants is not required in a person who has no symptoms or concerns. If you have a breast implant and detect any change in the breast or armpit such as swelling, a lump or pain, you should consult your plastic surgeon.
Some breast implant devices have been suspended. This means that these implants will not be available on the Australian market for the next six months. During this period, the implant providers will have the opportunity to provide additional information to the TGA about their implants’ safety and performance.
The implants Dr Sharp uses are not included in the suspension
Suspended implants are those that are macrotextured - grade 3 and 4 and some microtextured implants associated with higher incidences of BIA-ALCL and other clinical concerns. To support the ongoing monitoring of BIA-ALCL, all cases of BIA-ALCL must be reported to the TGA by implant suppliers within 10 working days of becoming aware of the adverse event.
To support greater vigilance and increased awareness and data collection on this issue, the TGA requires implant suppliers to provide reports every six months. These reports must include supply data and detail all adverse events and complaints received regarding breast implant and tissue expander devices, both in Australia and worldwide, including BIA-ALCL, capsular contracture, or rupture of the implant.
In addition to this, Dr Sharp chooses to independently use the Australian Breast Device Register which records all implants he places. The Australian Breast Device Registry (ABDR) is a Commonwealth Government health initiative that records information on surgeries involving breast devices, such as breast implants. It is are a long term project to help safeguard the health of people undergoing breast device surgery. For many patients, the ABDR provides peace of mind that their device details are recorded. If you’ve had an augmentation, reconstruction or removal and replacement with Dr Sharp, your implant details are registered here for perpetuity.
What are micro and nano textured implants?
Textured implants were an innovation in implant science, developed to reduce the risk of a common complication, called capsular contracture. By texturing the implant’s surface, the body was less likely to create a thick, hardened capsule that constricted the implant and created a hardened, sometimes uncomfortable, result years after implantation. Also, because the implants weren’t textured, they didn’t tend to move around as much or rotate, so different shapes could then be used in a texture implant, like the tear drop or anatomical implants commonly used today - to create a beautifully sloped, natural looking breast many women desire. Prior to this, only smooth implants were used, and these always had to be round. This is because their smooth surface meant they could rotate, and an anatomical or tear drop implant that rotates will distort the breast shape.
We often warn that ‘all implants are not created equal’, because (among other factors), the type of texturing involved in the implant’s surface can determine how much bacteria it holds when being implanted. Some texturing holds a lot, while other texturing is cleverly engineered to offer ‘textured’ benefits with much lower risks of bacterial contamination and ensuing BIA-ALCL. These are the implants Dr Sharp uses.
When placed under a microscope, the difference between the surface topography and area of each implant brand can be seen, as they use very different techniques to create texturing. Learn more here about different breast implant surface textures, safety profiles and quality.
Breast implants and risks
To support informed patient choices, patients undergoing breast implants placement always have access to a patient information documentation that includes information about warnings and risks associated with implants. Information relating to the Australian Breast Device Registry is also included, to support ongoing reporting and monitoring. BIA-ALCL is very rare, and the clinical advice remains that, without symptoms, it is not necessary to remove your breast implants. Instead, patients who have breast implants, should regularly check their breasts and see their doctor if they notice any changes.
The Australian Society of Aesthetic Plastic Surgeons (ASAPS) response
As the preeminent body representing Specialist Plastic Surgeons who specialise in cosmetic surgery, the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) has welcomed the TGA’s findings into breast implants and breast tissue expanders that were released today.
Dr Naveen Somia, President of the ASAPS, said the review has prioritised patient safety with the breast implants that have the highest risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), while leaving viable implant options for patients on the market.
ASAPS recommends that patients prioritise their safety when considering breast augmentation surgery by taking the following steps:
1. Seeking a surgeon who is accredited as a Specialist Surgeon by the Australian Health Practitioner Regulation Agency (AHPRA). These surgeons are committed to life long learning and best practice techniques and procedures
2. Ensuring their surgeon uses stringent breast implant infection control standards, such as the 14-Point-Plan
3. Having the procedure in a licensed facility
4. Confirming that their surgeon only uses TGA approved implants
If you have any questions or concerns regarding breast implant safety, call us on 3202 4744 to book a consultation with Dr Sharp and learn more about the steps you can take to ensure your optimal outcome and long term health when undergoing breast augmentation surgery.
call to book a consultation with Dr Sharp
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How much do facelifts cost?
I’m interested in having a facelift but I’ve heard they are very expensive - and involve a long recovery.
How much do they cost, and how long will I need to take off work?
Dr Sharp:
In contemporary plastic surgery, facelift procedures fall on a spectrum of operations that can be performed to reduce deep folds around the mouth, mid face excess skin, an undefined jawline and sagging in the lower face and upper neck.
Therefore some patients with early lower face aging only require a small amount of excess skin to be removed in front of - or below - the ear to see an improvement in the jawline definition they seek. These are commonly called ‘S’ lifts or mini lifts and are sometimes performed under local anaesthetic, or under general anaesthetic as day surgery. The procedure takes 1 to 1.5 hours and patients can return to work the following day, but most take a week off work until their sutures are removed.
Generally, most facelifts involve some plication or detachment of the SMAS layer, so the underlying facial structure can be lifted and tightened. When this occurs, the surgery is performed under general anaesthetic and takes anywhere from 2.5 to 4 hours. Small drains are required for 24-48 hours and a support garment is worn following surgery.
Most patients take at least 2 weeks off work to allow bruising and initial swelling to dissipate. Patients return to our clinic at intervals during the first 6 months for diligent post operative care.
The total cost factors in the surgeon, surgical assistant, anaesthetist, hospital and theatre fees - as well as post operative compression garment and multiple post operative appointments. Each facelift procedure is tailored to suit the patient, so the cost can vary.
Mini facelifts performed under local anaesthetic start from $4,500.
Full facelifts (including upper neck) costs around $19,500. This includes post operative laser resurfacing/scar optimisation treatment (valued at $1,000).
Facelift is ideal for patients who are at a healthy weight, and is often teamed with fat grafting and blepharoplasty surgery. When other procedures are added, the total cost increase, due to the additional time required in theatre.
As with all cosmetic surgery, our patients are provided with a comprehensive estimate of fees document following their initial consultation, detailing all inclusions.
Cost is an important consideration when undergoing surgery, but its also important to weigh up:
- whether your surgeon performs this procedure frequently
- the information provided to you at your consultation; was your surgeon transparent about the risks and expected results. Honesty (even the bits you don’t want to hear) is very important
- how your surgeon makes you feel during your pre operative process; feeling respected and heard is paramount when embarking upon a surgical journey. It can be an emotional process, so you need to resonate with your surgeon and their interpersonal approach.
Facelifts are expensive, but please keep in mind that this is a lengthy, complex procedure that requires advanced anatomical knowledge, many year of specialist surgical training and skilled post operative support. Ask lots of questions at your pre operative consultations, and seek the opinion of more than one specialist plastic surgeon when planning this procedure.
Ask us your facelift question!
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Lower face aging: what are my options?
I’m 55 and over the last 5 years I’ve noticed a rapid change in my lower face. In what felt like a very short amount of time, I felt like I aged very quickly. I still feel young on the inside, but on the outside I have loose skin around my jaw, jowls and the beginnings of my dad’s turkey gobble neck! What are my options?
Dr Sharp:
The lower face, jawline and upper neck commonly show the first signs of ageing; jowls, folds between the nose and mouth corners, slack skin around the jawline and thinning, sagging skin around the neck. Hence it’s a common focus area for our treatments and procedures. Non surgical options for early signs of double chin/neck and jawline sagging include dermal fillers, fat dissolving injections and strategic use of muscle relaxer or fillers. Surgical options include facelift or mini facelift surgery.
Injectable fillers and muscle relaxers
Dermal filler can be placed along the jawline or cheekbones to lift and firm the early signs of jowling. The cost will depend on the amount of filler required, and usually ranges from $1200 to $2400. Muscle relaxing injections to address muscle issues costs $12.50 per unit. We use only the highest quality dermal fillers and wrinkle injections. Read more about these treatments here.
Under or ‘double’ chin fat dissolving injections
We find most patients with mild to moderate deposits of fat in this area only require 3 treatment sessions to get great results. Fat dissolving injections are not rebatable through Medicare unfortunately, as they are considered a cosmetic treatment. Click here to read more about dissolving double chins and unwanted fat deposits on your upper neck.
Facelift surgery
This procedure can range from a minor operation performed under local anaesthetic in our clinic to remove a small amount of excess skin on the lower face - through to a full facelift with neck lift, tightening the deep underlying structures of the face and repositioning fat pads that have migrated south. To read more about facelift surgery please click here.
Our facelift patients range from people in their late 30’s seeking our unique Sharp Lift technique, which firms and redefines, addressing early jowls and lower face laxity while using nano fat grafting to plump and revolumise - through to men and women in their 70’s who are looking for the natural-looking, ‘total’ facelift results. Each facelift is crafted to suit the individual patient’s anatomy and desired result.
How can I determine the best treatments for my face?
Ultimately the best decision for you will be based upon a number of factors, including:
- how much excess skin you have in this area of your face
- your natural bone structure, jawline and chin projection
- any unwanted fat deposits
- the condition of your skin
- your budget and;
- most importantly, your desired outcome
Not sure? Book a complimentary consultation with our clinician
Call us on 3202 4744 if you would like to arrange a booking – or if you have any further questions you would like to discuss with us. Our team prides itself on delivering gold standard clinical care, whether you are having non surgical treatments or surgery with us, you will always receive honest, transparent advice and plenty of information to make an informed decision about your face.
Ask us your facial ageing question!
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What I wish I’d known before I had breast augmentation surgery…
Breast augmentation surgery is now one of the world’s most commonly performed cosmetic surgery procedures. There are over 60,000,000 implants currently implanted in women around the world. Despite being a popular procedure, there are some important factors and considerations to make when undergoing breast augmentation surgery. We are very up front about costs, credentials, implant benefits, risks and recovery.
We frequently receive enquiries from women who have had breast augmentation surgery elsewhere in the past and wish to have their surgery revised. We’ve collated the most common “what I wish I’d known” statements below. It’s important to ask questions and get as much information as possible (and read it carefully) the first time around, to ensure an optimal outcome:
1. What are my surgeon’s credentials?
Did you know, in Australia, any doctor can legally call themselves a ‘surgeon’ even if they haven’t undergone the Medical Board recognised training with the Royal Australasian College of Surgeons. If your doctor calls themselves a surgeon and isn’t on this list, they aren’t a qualified Specialist Plastic Surgeon. Specialist plastic surgeons undergo extensive training in surgical safety, infection prevention techniques and implant selection to ensure a low risk of infection. To further increase patient safety in breast implant surgery, a 14-Point-Plan has been developed by Specialist Plastic Surgeons to minimise the risk of bacterial contamination of an implant and improve outcomes.
Specialist Plastic Surgeons are committed to lifelong learning in breast implant surgery to update their skills and knowledge continually, ensuring they are equipped with the latest skills and technological advancements.
2. What is the safety profile of my implants and what are their warranty provisions?
Specialist Plastic Surgeons use products that are approved by the TGA. Not all implants are created equal; they carry different risks, warranty provisions (ranging from very restricted short term cover through to life long support should you have a complication). Your surgeon should be able to explain the difference between the key brands of implants currently available. It is likely your surgeon has a specific brand of implants that she or he favours, and they should be able to explain to you in detail as to why they have chosen these. The implants Dr Sharp uses come with extensive replacement and warranty provisions, offering additional peace of mind to patients.
3. What safety measures does my surgeon take when performing augmentation surgery?
In Australia, Specialist Plastic Surgeons operate in licensed hospital facilities that have excellent infection control standards to ensure the best outcomes for patients. The diligent and systematic application of antimicrobial strategies at the time of breast implant surgery has been shown to reduce the risk of implant complications. You surgeon will be able to explain the steps they take to ensure best practice standards are upheld, or exceeded.
4. What might my recovery look like and what do I need to consider when planning my recovery?
Good questions to ask might include:
- How much time will I need off work?
- When can I return to the gym (and what I can return to doing)?
- How am I going to lift my young child in and out of the car for the first 6-12 weeks?
- Do I have a special event coming up and will this impact the outfit I can wear or activities I can participate in?
- What if my recovery doesn’t go to plan or takes longer; how will that impact my income, lifestyle or finances?
5. Am I clear on what I do and don’t like about my breasts; and do I have realistic expectations?
Plastic surgery isn’t an exact science (as much as we wish it was). Each patient is unique and comes with a different body shape, chest width, skin condition and health profile. While your surgeon will do their absolute best to achieve your desired outcome it’s important to remember that this procedure is about improving - not perfecting - your breasts. If you are chasing perfection or want to look identical to someone else, you might be disappointed with your end result.
When performed by a specialist plastic surgeons with high quality implants under the right surgical conditions, breast augmentation is very safe procedure. The above information is by no means exhaustive; our patients have at least 2 consultations with Dr Sharp before their surgery and spend at least 1.5 hours in the clinic with us covering off a wide range of information before having their procedure.
Having a breast augmentation can be an exciting experience but it’s not something to rush into. See more than one surgeon, ask lots of questions and do your research!
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In the press: West End News
West End magazine has taken a look at our luxurious new clinic in this article, featuring the custom built space we recently opened in Cordelia Street, South Brisbane!
“For many people who visit our clinics, its the beginning of a new chapter in their lives – sometimes, its the first thing they’ve donee for themselves in decades. so the gravity of their time in the clinic, and what that might represent to them, is never lost on us. Every visit is special, and so we wanted a special space.”
Read more about our luxe new clinic here!
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Textured implant update
The TGA are reviewing textured implants. Not all textured implants are the same; there are different types of textured surfaces (macro, micro and nano) and each carry different safety profiles.
No decision has been made to suspend or cancel the implants Dr Sharp uses.
When a textured implant is required to achieve a specific result that a patient desires, in consultation with the patient, either Mentor Siltex (microtextured) and Motiva (nanotextured) implants are used.
The latest research shows that the Mentor microtextured implants carry a 1 in 86,029 chance of developing BIA-ALCL.
If you have textured implants or are considering them, we understand recent news might raise some questions and concerns for you and your loved ones. Nothing is more important to us than the health and safety of the women Dr Sharp operates on.
Current literature and real world evidence shows that the risk of developing BIA-ALCL differs between different textured implants and has been shown to be rare with the implants we use. Motiva are relatively new to the market in Australia and are nano textured, meaning their surface has been created to specifically avoid the causes of BIA-ALCL. Mentor breast implants are supported by long term clinical data, including three 10 year prospective clinical trials.
If I have textured implants, do I need to have them removed?
If you have no symptoms, you do not need to have your implants removed.
What are the symptoms of BIA-ALCL?
The common presentation is fluid swelling around the breast implant and in the space between the implant and breast implant capsule – called a ‘late seroma’. The diagnosis of the tumor is made by examining the seroma fluid.
Is BIA-ALCL breast cancer?
BIA-ALCL not breast cancer. Breast cancer affects 1 in 8 Australian women. The implants we use carry a 1 in 86,000 risk.
BIA-ALCL is a rare type of lymphoma that develops adjacent to breast implants, usually as a swelling of the breast 3-14 years after insertion. This swelling is due to fluid building up in the fibrous capsule that surrounds the implant and does not develop in the breast tissue itself. It can also present as a swelling or lump in the breast or armpit. The incidence of BIA-ALCL is very low.
How common are textured breast implants?
There are approximately 60 million textured breast prosthesis implanted in women.
All surgery carries risks and no cosmetic procedure is without potential complications. It’s important to be fully informed of your options, and weigh up these risks to make sure they are acceptable to you before undergoing surgery.
Dr Sharp is ethically and clinically committed to providing the safest available prosthesis for patients to achieve their desired results. Implants are selected in consultation with patients, with the latest data and long term safety in mind.
☎️ If you have any concerns or questions, call us on 3202 4744 or email info@drdavidsharp.com.au.
👩💻 To read more, please click on the resource links below:
- About BIA-ALCL and latest research results: https://bit.ly/2UtarRJ
- TGA Website: http://www.tga.gov.au/breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl
5 ways to reduce bruising
A bruise appears when tiny blood vessels are damaged, through surgery, injury or puncture. Blood gets trapped under the skin, causing a bruise. Some people are more predisposed to bruising than others; blood thinning medications or certain vitamin deficiencies can increase the risk of bruising. Bruises will heal in time as the body reabsorbs the blood.
Although bruises are common after surgery and injectables treatments, there are ways to accelerate the healing process:
- Arnica: there’s a lack of scientific evidence to conclusively support arnica as a bruise reduction treatment, but anecdotally, we find arnica tablets speed up the reduction of bruising and swelling in the week after surgery; especially after facelift surgery.
- Hirudoid cream: contains MPS (mucopolysaccharides) which promotes tissue regeneration and reduction of swelling and inflammation. The cream is gently massaged into the bruised area twice daily, avoiding the incision line.
- Ice therapy: for the early stages of bruising. This can prevent the bruise from being as apparent and reduce swelling. Apply ice over the bruised area, but not over your incisions (if you’ve had surgery). Ice the bruise for 10 minutes at a time. Wait 20 minutes before reapplying.
- LED light therapy: can help speed up the breakdown of bruises.
- Conceal: use a high coverage or camouflage concealer such as Dermablend, which is available in pharmacies. This can be applied over the bruise. If you’ve had surgery, don’t apply the concealer over your incision line.
As always, what you put in your body will impact your recovery. Avoiding processed foods, salt, sugar and alcohol before and after surgery - and sticking to good water intake and healthy, whole foods - will assist with optimal healing. Incorporate fruit and vegetables that offer antioxidant and anti inflammatory benefits, such as pineapple - which is packed with bromelain - or celery which offers vitamins B6, C and K. Everything in moderation; ginger and turmeric also have anti inflammatory benefits, but very high doses can worsen bruising, so go easy on them!
If you are a patient of Dr Sharp’s and having a cosmetic or large reconstructive procedure, your black post operative bag will contain some products to assist with your recovery and bruising. Our clinics also offer complimentary Hirudoid cream for our surgical and injectables patients.
How long do bruises take to fade after surgery or injectables?
About 2 weeks; for milder or more superficial bruising (common after injectables), bruises can fade within 1 week to be almost indistinguishable. Bruising can appear immediately as a red or pink patch; within the first 2 days, the hemoglobin (the part of your blood that carries oxygen) changes and the bruise turns a blue, purple or black colour. After 5 to 10 days, the bruise turns green or yellow. Then after 10 or 14 days, it turns yellow brown or light brown colour before disappearing altogether. They can be tender to touch during this period.
How does a bruise differ from a haematoma?
A haematoma occurs when the body cannot heal the bruise as easily or quickly as a minor injury. A bruise occurs when a small amount of blood comes out of the vessel. A haematoma usually involves a larger amount of blood; this sometimes occurs after surgery when blood pools in the tissues, and the body cannot quickly process the blood as it does with a bruise. As a result, a haematoma stays the same color and firmness after several days rather than demonstrating the same aforementioned healing progress as a bruise. If you think you might have a haematoma, contact your surgeon to find out if it requires further treatment. In some cases, the haematoma can be removed through draining or surgically removing the collection of blood.
Should I be worried about my bruising?
Although they can be unsightly, bruises are not typically cause for clinical concern after surgery or injectables. They usually heal on their own. But, in some cases, a patient may need to seek medical attention for their bruising. Your bruise should not cause your limbs to become numb or lose function. This is especially the case if:
- you have recently had a dermal filler treatment and find that part of your face on or near the site of the injections has become blue, purple or black. This can be a sign of occlusion and requires urgent medical attention.
- after surgery, if you find that your bruise is firm and does not fade or change in the manner explained above. This could indicate that you have a haematoma. The location, size, and cause of the haematoma will determine how to treat it.
The information contained in this article relates to bruising after surgery or injectables and does not relates to bruising due to other trauma. The article does not constitute medical advice; if you are concerned, you should seek the advice of your doctor. If you are one of Dr Sharp’s patients, we will monitor your bruising and provide advice as your healing progresses. Any concerns regarding your bruises should be promptly raised with us.
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Lip flip vs lip lift: what is the difference?
My upper lip is very thin and curls under when I smile, showing the gum above my teeth. I’ve found that even when I have fillers, my lip still looks like it curls up and under, especially when I smile.
Can cosmetic injections help or do I need lip lift surgery to correct this?
Deborah:
Cosmetic muscle relaxing injections can be injected into the muscle above the top lip (orbicularis oris) to relax it slightly, softening a gummy smile - or rolling the lip out, giving the appearance of more volume. While both procedures cause the upper lip to ‘kick’ out more, the results of lip lift surgery differs from lip flick injections in that the injections relax the muscles around the upper lip, while surgery shortens the distance between the upper lip and the nose (philtrum). Dr Sharp explains lip lift surgery (pictured above) in more detail here.
Lip flick injections strategically and temporarily reduce repetitive muscle movements associated with the development of wrinkles around the mouth. They are often used in conjunction with dermal filler injections. The treatment takes 5 to 10 minutes, causes minimal discomfort and the results of this procedure last between 3 to 5 months.
When used alone, or in combination with fillers, muscle relaxing injections give lips a subtle pout by flipping out the lip line, rolling the lip gently outward and providing a fuller appearance.
With so many options now available thanks to modern lip enhancement techniques and procedures, it can be difficult to know which treatment works best for you. At our consultations, we will assess your face and upper lip appearance, and advise the best treatment or procedure to achieve you aesthetic goal.
Muscle relaxing lip injections
- slightly relax muscles that surround the upper lip
- reduce gummy smile
- help flick out the top lip making it look fuller
- last 3-5 months
- cost: from $25 per treatment
- takes 5-10 mins per visit
- no downtime
Dermal filler lip injections
- enhances lip volume, projection and shape
- last 10-18 months
- from $499 per treatment
- 20 mins per visit (longer if you require anaesthetic cream)
- sometimes swelling and bruising can be visible for 3-7 days
Lip lift surgery
- reduces the distance between the upper lip and the nose
- incision in crease under the nose
- flicks out the top lip making it look fuller
- long term results
- cost: from $2750
- takes 40-60 minutes
- 1 week downtime
It’s important to remember that dermal filler adds volume, which makes the lip appear larger by literally making it bigger, while anti-wrinkle injections relax muscle around the mouth and rolls the lip outward, creating the illusion of a bigger lip — without the added volume. Dermal fillers can be used in conjunction with muscle relaxing injections as well as lip lift surgery.
Ask us your lip enhancement question!
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IS MODERN BREAST AUGMENTATION SURGERY SAFER THAN EVER BEFORE?
Is breast augmentation surgery considered to be a safe procedure?
Specifically, are modern breast implants safer than the implants used in the past and is there anything I can do to make sure my surgery is as safe as possible?
Dr Sharp:
It’s great to hear you are thinking about these factors before your augmentation surgery, as they are important pre operative considerations.
I only offer procedures that I believe are safe and ethical; if it’s a procedure that I’d caution my family against having, I will not offer it to my patients. Breast augmentation surgery is a safe surgical procedure, if you use a qualified plastic surgeon, opt for high quality implants and promptly seek medical advice if you have any concerns regarding your breasts in the future.
With new-generation implant options and surgical techniques, breast augmentation today is safer than ever and can help women achieve the natural look they want while also improving their breast shape and volume.
While there are many different factors that contribute to ideal results and a safe outcome, there are four key benefits of modern breast augmentation surgery.
Modern implants
Decades of research suggest that breast augmentation surgery is safe when performed by a qualified plastic surgeon using quality implants and best practice surgical techniques. The implants I use are filled with cohesive gel silicone, which means that even if a traumatic injury was to result in a rupture, the silicone maintains its shape and usually stays within the implant capsule. These implants also feature nano or micro texturing, which balances our desire to minimise the risk of implant migration or capsular contracture by using a textured implant - with the safety benefits of a superiorly engineered implant surface.
Sophisticated techniques
In addition to having access to a wider range of implant options, surgeons now often utilise a spectrum of new techniques, with shorter incisions and less downtime resulting.
The use of Keller funnels and micro and nano textured implants - to reduce the risk of bacterial contamination and associated risks - has been accompanied by more long term research and scientific analysis of breast implants than ever before.
Natural looking results
We have moved away from the ‘bigger is better’ mantra; modern breast augmentation patients usually want natural looking, sustainable results. For most women, the goal of breast augmentation is to increase breast volume and improve asymmetry but to do so subtly for a very believable result. More proportionate implants, sized and positioned to suit the natural anatomy, place less strain on surrounding tissues and structures, resulting in a better long term outcome.
Breast augmentation plastic surgery specialists
Not every doctor that implants breast prosthesis in Australia is a qualified surgeon. Sadly, some of them pass themselves off as ‘surgeons’ despite not having undergone Medical Board recognised specialist plastics training. Despite widespread media regarding the potentially catastrophic consequences of choosing an unqualified surgeon to perform surgery, patients still tell us they’re confused about the difference between a ‘qualified’ and ‘unqualified’ surgeon. Choosing a RACS qualified, specialist plastic surgeon (denoted by the ‘FRACS Plast’ after their name) who understands the latest breast enhancement options, techniques and trends is the best place to start. You can locate qualified plastic surgeons in your area here. Your plastic surgeon will be an excellent resource to help you better understand the differences between implant types, and to create a customised surgical plan that is designed to meet your individual needs.
Most importantly…
The current data available to plastic surgeons indicates that breast augmentation surgery is a safe procedure, provided sensible measures are taken by both patient and surgeon to reduce any known risks. But if you are going to embark upon breast augmentation surgery, it has to be something you feel 100% confident and safe undertaking. If you have doubts or feel anxious about the risks, I recommend waiting. Perhaps do more research, get a second or third opinion from other plastic surgeons and talk to women who have implants. Delaying surgery until you feel totally comfortable with your decision is something your surgeon will support - and something you’ll never regret!
Ask us your breast augmentation question!
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How many breast augmentations are performed around the world annually?
Breast augmentation surgery is one of the most common procedures requested in our Brisbane and Ipswich clinics. Figures released by the International Society of Aesthetic Plastic Surgeons in November 2018 show that 1,677,320 breast augmentations were performed internationally in 2017.
Number of breast augmentations performed annually
- Annual Global Aesthetic Survey, ISAPS 2017
Breast augmentation continues to be the most popular plastic and cosmetic surgery procedure around the world, and in Australia. In our clinics, it is closely followed by abdominoplasty, facelift, breast reduction or breast lift and blepharoplasty surgery.
call to book a consultation with Dr Sharp
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Pre operative nerves; how to relieve anxiety before surgery
Pre surgery jitters are very normal; even if you are excited about your procedure and the changes it will bring, it can be hard not to worry about the operation, the possible risks and recovery. Whether you are having day surgery or a lengthy inpatient stay, these feelings are to be expected in the days or weeks leading up to your procedure.
Severe anxiety can cause unpleasant symptoms and stress. Typical symptoms include a pounding heart, a racing heart, irregular heartbeat, nausea or stomach cramps, shortness of breath and sleep problems.
Anxiety can make pain worse, as well as making it harder to cope with the pain. It also becomes a problem if it makes it harder to understand and remember important things you are told about the operation, such as advice about your recovery afterwards.
It’s important to make sure that anxiety doesn’t become too overwhelming before your surgery, or impact negatively on your headspace or emotional preparation. Although there is not much research on strategies for managing pre surgery anxiety, some evidence suggests that certain measures can help:
- Learn how your pre operative nerves are affecting you. Anxiety increases your heart rate, blood pressure and keeps you awake. Over time, most people learn how to manage their anxiety and frightening situations. They develop suitable strategies to cope with what is causing the anxiety. Going into the hospital and having an operation is often a completely new situation, so you might emotional and practical support from friends and family too.
- Talk to other people. People cope with pre operative anxiety in different ways. Some try to prevent it by obtaining information and talking with other people about their concerns. Others use distraction techniques such as reading, exercise or deep breathing. Several studies have suggested that listening to music before surgery can relieve anxiety.
- Let your surgeon and hospital staff know how you are feeling. You won’t be the first person to come to hospital feeling anxious and a good surgical team will be skilled in techniques to put patients at ease and make them feel comfortable.
- Utilise relaxation techniques such as breathing exercises, meditation or muscle relaxation. Massages, acupuncture, homeopathy, aromatherapy or hypnosis aren’t scientifically proven anxiety treatments - but many patients find them beneficial in the lead up to surgery.
- Medication can assist. Benzodiazepines are often used for the purpose of relaxing patients and reducing anxiety. They might also make you feel drowsy. It is important to tell your surgeon or anaesthetist if you already took a sedative before arriving at the hospital.
Smoking before surgery! Many people who smoke tend to smoke even more when they’re feeling worried. But smoking during the lead up to surgery can increase the risk of post operative complications, delayed wound healing and unfavourable scarring. Stop smoking at least 6 weeks before surgery and talk to your GP about obtaining support to break the habit while dealing with pre operative nerves.
Have questions regarding surgery? Call our friendly team on 3202 4744, we’d love to assist.
The information contained in this article in general in nature and does not constitute medical advice.
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Breast implant safety update
France’s ANSM (their equivalent of Australia’s TGA) recently decided to prohibit the use of 13 macro-textured and polyurethane coated implants from six manufacturers. In Australia, the TGA has asked textured implant suppliers to provide detailed information and samples of their implants for analysis before considering whether to suspend or ban the products.
Our clinics do not use ‘macro’ textured implants; the two implant brands that we currently use are not included in France’s ban list; we chose our implant brands based on their very high quality standards.
The TGA announcement has caused understandable concern among women who have had breast augmentation surgery, with many wondering if their implants are safe, or require removal and replacement. The brand we predominantly use had its certification mark (CE) renewed by the European Union only two months ago, and carries the lowest rate of complications - such as BIA-ALCL and capsular contracture - partly due to the quality of its ‘micro’ coating.
Among other factors, breast implant related lymphoma (BIA-ALCL) has been linked to ‘macro’ textured breast implants. Due to their quality, the ‘micro’ textured implants we use are some of the more expensive on the market in Australia, but we believe the additional investment is worth the cost, offering unparalleled safety - and peace of mind.
What does this mean? Now more than ever, it’s important to:
- Know the brand and type of implants your surgeon uses
- Dr Sharp use Mentor and Motiva implants. Being able to identify the type of implant your surgeon uses is an important part of your pre-surgery education and informed consent. We believe patients deserve to know the brand of the implant a surgeon uses when they are researching the right surgeon for them.
- Before your surgery, ask your surgeon why s/he choses those implants
- We chose these implants because they are high quality prosthesis with sound science behind their design and warranty provisions; they are backed by reputable manufacturers. Secondary to this, they also provide a more natural feel and better result than other implants, in our opinion.
- Ensure you are aware of the implant’s warranty provisions and safety record
- With Medicare and private health insurers no longer covering implant replacement surgery, warranty provisions for rupture and capsular contracture are very important - not just because they save you money if you need to have the implants replaced, but it also signifies that the manufacturer takes responsibility for its product’s performance.
- Ask your surgeon if they have taken the 14 Point Plan Pledge
- Dr Sharp follows the 14 Point Plan. You can read more about why this improves the safety of our breast augmentation surgery here.
- Ask your surgeon if they register their implants with the Australian Breast Device Registry
- We do. After your surgery, you will receive your implant details. These are also saved to your electronic chart in our practice, and a copy is sent to the ABDR, so you have 3 ways of identifying your implants should you need to in the future. The data collected by the ABDR also unable us to track the long term performance of breast devices, and identify best surgical practices to ensure optimal patient health outcomes.
Are all textured breast implants the same?
No. The coating of the implants we use are calling ‘micro’ textured or ‘nano’ textured and differ significantly from those recalled; adhering to the highest implant quality standards. The safety of our implants is supported by clinical data, with our micro textured implants in particular being examined by three, 10-year prospective clinical trials. The risk of developing BIA-ALCL differs between different textured prosthesis and has been shown to be rare with the kind of breast implants we use; about one in 86,000 according to the most recent risk assessment published in the Plastic and Reconstructive Surgery Journal. Other implants carry a 1 in 2,800 risk, demonstrating that when it comes to safety, all implants are not created equal.
Read more about BIA-ALCL here.
Do I need to have my implants removed and replaced?
Currently there are no recommendations to have implants ‘preventatively’ removed. If your implants are causing you concerns - or if you are encountering a complication such as rupture or capsular contracture - see your GP as a first course of action. Seek the advice of your GP if you are experiencing:
- swelling
- distortion
- changes in shape or size
- pain or discomfort
- discharge
- firmness / hardness
- lumps
- rash
The GP will examine your breasts - and they might refer you for an ultrasound or MRI, along with a referral to a plastic surgeon. If you have a copy of your implant details, please bring them along to your consultation.
View before and after photos and read more about implant revision, which includes removal and replacement surgery, here.
BIA-ALCL: fast facts
• The incidence of BIA-ALCL remains rare.
• Most seromas are not BIA-ALCL
• As of September 30, 2018, the FDA had received a total of 660 medical device reports (MDRs) of BIA ALCL worldwide, including the death of nine patients. In Australia and New Zealand, 94 patients have been identified, a further two being worked up. This includes four women who have died. To put this number into context, in 2017 the International Society of Aesthetic Plastic Surgeons estimated that approximately 1,600,000 breast augmentations were performed that year alone.
• Diligent and systematic application of antimicrobial strategies at the time of breast implant surgery has been shown to be beneficial; that’s why Dr Sharp follows the Macquarie University 14 Point Plan.
• To date, although there are hypotheses, no one can claim to know the exact cause of BIA-ALCL. The hypotheses with most scientific support involve textured implants, the presence of bacteria, host genetic predisposition, chronic T-cell response with eventual monoclonal proliferation and transformation into lymphoma
• Updated Australian and New Zealand figures show that 70% of ANZ cases are diagnosed in stage 1 of the disease. In these cases, complete surgical removal is curative with enbloc capsulectomy and implant removal.
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This article does not constitute individual medical advice; if you have any concerns, please see your GP for referral to a specialist plastic surgeon to receive advice specific to you and your implants.
Ask us your breast augmentation question!
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RETURNING TO EXERCISE AFTER BREAST AUGMENTATION SURGERY
“I would love to have a breast augmentation, but I’m worried about the impact it will have on my daily exercise routine, and the muscle tone loss or weight gain I will experience during the downtime.
How soon after surgery can I return to working out, and are there any restrictions?”
- patient
Dr Sharp:
It’s great to hear you are thinking about these factors before your augmentation surgery, as they are important pre operative considerations.
After breast augmentation surgery you will spend about one week not doing much - you will be able to do basic tasks like showering, getting a drink or chilling on the couch, but not much more than that! During the following week, you’ll return to tasks like making your bed, going for light walks, cooking a meal or driving a car.
The most challenging restriction for many of my breast augmentation patients is the requirement to not lift anything over 2kg for at least 6 weeks after surgery. And that doesn’t mean returning to bench pressing 10kg or lifting a toddler at 6 weeks and 1 day post op! Even at the 6-8 week post operative mark, it’s important to ease back into your exercise routine and tasks like shopping, cleaning and lifting small children. Listen to your body and if you experience pain, discomfort or swelling, cease the activity for another 2 weeks and ease back into it. Upper body workouts or things like rock climbing or ergo work will need to wait much longer than 6 weeks, but in the interim there’s other activities you can do to retain your fitness. We work with an experienced personal trainer to create customised workouts during the months after surgery, so talk to us if you’d like to discuss the options available to you, with a carefully selected workout routine.
It is important to emphasise that it’s still possible to do damage during this period, placing strain on the supporting structures and new scar tissue in your breast, which can have long term impact on your results! So the short term frustration of ‘taking it easy’ is worth it in the long run - and something worth committing to prior to undergoing breast augmentation surgery.
If you use exercise to manage your mental wellbeing, it’s important to discuss this openly with your surgeon prior to surgery, so s/he can discuss the impact that your recovery period could have, and weight up the challenges you might encounter.
Ask us your breast augmentation question!
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What to expect during your first consult
Your first visit to a surgeon can be both exciting, and scary. It’s very normal to experience a mix of nerves, eagerness and uncertainty. To ensure that your visit is as stress free as possible, prior to your first visit, our patient care team will email to you:
- a link to complete our patient registration form online (please complete this at least 24 hours prior to your consult)
- a list of any referral letters, tests or reports to bring along
- directions to our free patient carpark
During your first visit to us for a cosmetic or reconstructive procedure, you will be greeted by our friendly patient care team, who will take your referral letter or reports, and give you a white folder containing your procedure information pack.
Please enjoy a tea or coffee while you wait, and peruse the information contained in your white folder.
We don’t expect you to speed read all the information in this folder before you go in to see Dr Sharp, but some of the key points on the back page of the brochure might help you formulate questions you hadn’t already thought of.
At the end of your consult you will take this folder home; we understand there’s a lot of information to take in during you first consultation, so don’t hesitate to ask questions or request that Dr Sharp elaborate on any information you don’t understand.
During your consult with Dr Sharp he will discuss your concerns - or the areas you’d like to improve. He will examine and assess the area, and take any necessary clinical measurements. You will then step through the surgical options available together. Once you have decided upon your desired procedure in consultation with Dr Sharp, he will step through the surgical process involved - as well as the expected outcomes, risks, recovery period and any considerations he’d like you to make when weighing up the procedure’s pros and cons.
Dr Sharp is very approachable and most patients comment that they quickly feel relaxed and at ease with him - but he also appreciates that talking about your concerns or being examined isn’t something people do every day, and so you might feel uncomfortable; this is very normal. Please let Dr Sharp know if you would like a friend, family member or female observer to be present during your consult. Sometimes it can be difficult to take in all the information discussed during the first consultation and so having a second set of ears present can also be helpful when recalling the procedure/s you discussed. As standard procedure, we always require a friend, family member or female member of our team to be present during genital examinations.
This information will also be contained within the information pack you will take home on the day, along with the consent form explaining the elements of the procedure you need to consider before committing to surgery. If you are considering breast augmentation surgery, Dr Sharp will also provide a sports bra and implant ‘sizers’ to try on.
This enables you to put your own top on (or we have tops available for you to use) and view the different implant sizers in a mirror. You are welcome to take photos of your anticipated breast appearance in clothing, as this can be helpful when considering your implant size selection at home later on.
After your consultation with Dr Sharp, clinical pre operative photos will be taken of the area you are having treated. These photos are securely stored and used as a reference tool by Dr Sharp when planning surgery, and sometimes intraoperatively. 3D simulation technology is also available in our clinic, and if you are having breast augmentation surgery, one of our patient care team members will complete the scan and upload your simulation results to peruse at home.
At the conclusion of your consultation with Dr Sharp he will advise our patient care team of the procedure you are considering and any potential item numbers involved. This will enable us to check if any Medicare or private health insurance rebates apply, and compile an estimate of fees for you. This takes 5-10 minutes, so we thank you in advance for your patience while we collate the different costs for your procedure.
Before you leave the clinic, we will step through the estimate of fees with you and answer any queries you might have regarding costs, as well as providing you with potential surgery dates at your preferred hospital/s.
After your initial consultation if you wish to proceed with surgery, our patient care team will schedule the procedure for you and accept any deposits required. If you are having a cosmetic procedure, we will organise a second - complimentary - pre operative consultation with Dr Sharp. We ask patients to bring their patient information folder back with them for this consultation, as it contains important consent documentation which needs to be signed with Dr Sharp.
We also offer video consultations for regional or overseas patients who wish to see Dr Sharp. Usually at least one of the two consultations is conducted face to face prior to surgery, with the other consult via video (FaceTime or Skype).
Ready to experience the gold standard
in surgical care? Contact us below
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New health fund tiers: what do they mean for you?
Private health insurance is a significant investment for most Australians, with 55% of us covered by some policy. Often, insurance products are complex and difficult to understand and compare.
You might have recently heard from your health fund regarding new policy changes that will commence this year. In an attempt to simplify health insurance, the government has introduced a new tier system, in the hope that it will ensure consumers know what they’re covered for, when they buy a particular policy. It’s hoped that these new changes will provide more clarity for consumers - and less unpleasant surprises when it comes to claiming for procedures. This may also impact your coverage for certain Medicare item numbers.
The private health insurance reforms will bring in a new system for categorising hospital products, breaking policy cover up into gold, silver, bronze or basic cover.
All hospital-based treatments have been organised into 38 categories, based around different body systems, for example: ‘ear, nose and throat’ or ‘bone, joint and muscle’.
Each new hospital policy will fall under one of four product tiers: gold, silver, bronze or basic. Each product tier will cover a specific number of categories in a private hospital:
- Basic – very little if any cover in private hospital
- Bronze – low cover (18 categories of services)
- Silver – medium cover (26 categories of services)
- Gold – full or top cover (all 38 categories of services)
Policies that cover more than the minimum requirement will be called a ‘plus’ policy, for example ‘bronze plus’ would cover some additional benefits, above a standard bronze policy.
Also, member will now be able to choose to pay a higher excess to reduce their premiums. This means they might choose a policy that costs less throughout the year, but will incur a larger excess payment if they do go to hospital.
When will the changes happen?
The changes will start to happen from 1 April 2019. By 1 April 2020, every private health insurance policy will have changed to the new system. Your insurance policy may not change straight away, but if you are planning surgery, we recommend that you call your fund to discuss their changeover date.
I’m planning surgery; should I change my policy before the 1st of April?
Choice recommends that - unless your fund has advised that you will lose cover for an essential item - you don’t need to switch funds or policies before 1 April. They recommend waiting until your fund advises the switch over date, and whether or not they’ll close old policies and move members to a new one. Also, Choice advises that it could be difficult to find the right policy before April 1 as many policies are changing, and will be released after that date.
Finding the right policy to switch to before 1 April might be difficult, because many policies are changing and new ones will be released on that date. If you haven’t already, you’ll receive a letter from your health fund telling you what they’re going to do with your policy; read this handy guide to help you understand the letter from your fund.
If you’re planning surgery, ask your surgeon if item numbers apply. If so, contact your fund and ask whether the item numbers specific to your surgery will be covered in the tier that your policy will be on. If not, ask them if you can select a higher tier - and whether they’ll waive any waiting periods.
Is this a good thing, or a bad thing?
Like all private health insurance policy changes, only time will tell! The government believes the new tiers will make it easier for patients to understand what each policy type covers, and to shop around for the best private health insurance deals. Conversely, there are concerns that consumers will have difficulty understanding the new categories, and ensuring continuity of cover.
We welcome any private health insurance reforms that deliver clearer, fairer and more cost effective options for patients.
While we are not permitted to recommend any specific funds to our patients, our practice manager Carol is able assist you with questions to ask your fund to ensure you are covered for any item number eligible procedures you may be considering in the future. Email Carol any questions at manager@drdavidsharp.com.au
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In the media: Dr David Sharp plastic surgery
Dr Sharp was featured in the QT this month, discussing the tips, trends and pitfalls of plastic surgery in 2019.
He said more Australians are undergoing plastic surgery as taboos fall and surgical advancements evolve.
Below are some excerpts from the interview with QT Editor Shannon Newley:
Why I chose a career in plastic surgery…
The reason I chose plastic surgery as a sub-specialty is because I love performing the full spectrum of procedures it offers. They are all rewarding because they effect positive change in patients’ lives in different ways. For example, blepharoplasty surgery provides an instant reward because the recovery is so quick and it’s a small operation that makes a big change, whereas post pregnancy abdominoplasty and breast lift surgery is rewarding – even though the recovery is longer – because it restores core strength and improves back pain, pelvic floor issues and skin irritations after a woman has given so much of her body over to having a baby.
Future trends in plastic and cosmetic surgery
We will see more interest in minimal downtime surgery such as lip lifts, mini-facelifts and procedures that combine fat grafting. For skin condition and improvement, there is a growing interest in medical grade lasers, micro-needling and PRP therapy to help stimulate the skin’s own natural responses. It’s a more holistic approach than we’ve seen in the past, and I think it’s going to achieve more natural, sustainable results for patients.
Current trends in plastic and cosmetic surgery
The interest in having cosmetic surgery is definitely still on the rise. This is because the taboos that previously existed around these procedures have lifted; they are also easier to access now, thanks to lower costs. Some of the procedures can also be claimed through private health insurance such as breast reduction, abdominoplasty or rhinoplasty, if they are considered to be medically required.
We are definitely seeing more demand for breast augmentations and facelifts than we have in the past. This could be due to a greater awareness of the options available; facelift surgery techniques have evolved to offer a procedure that provides a very naturally rejuvenated look – not the stretched, pulled-back appearance. We’re also seeing smaller facial procedures, such as minifacelifts and lip-lift surgery, grow in popularity as we can perform some of these under local anaesthetic.
The “new generation”, high quality breast implants I use also look and feel more natural than ever before, and along with fat grafting, it means we can tailor the augmentation result to the patient’s unique anatomy. In terms of breast augmentation, the popularity of this procedure has skyrocketed over the past 10 years in general.
Misconceptions about cosmetic surgery
There is still a concerning lack of understanding around credentials. We still speak to a lot of patients who didn’t realise there’s a difference between a doctor that has done 7-10 years of additional training and supervision to become a surgeon, as opposed to a doctor who wants to call themselves a surgeon, and opens up a cosmetic clinic. I encourage patients to check their doctor’s qualifications on the Royal Australasian College of Surgeon’s website’s ‘surgeon finder’; if they aren’t there, they aren’t an accredited Specialist Plastic Surgeon. Meaning, they will not be covered by the same training, hospital operating rights or insurance provisions. The same applies to cosmetic injectables; when you can get a TGA-regulated injection in a hairdressing salon or beauty clinic with no medical professional in sight; we need to ask why patients’ best interests and safety are not being considered.
Four steps patients should take before undertaking cosmetic surgery
1. Look at lots of websites, choose a shortlist of two or three surgeons and check their credentials on the Royal Australasian College of Surgeons’ website (https://www.surgeons.org/ find-a-surgeon/) to ensure the surgeon you choose in in fact a Specialist Surgeon and accredited by the Australian Health Practitioners Regulation Agency.
2. Book a consultation with more than one; it’s a big decision and you need to choose a surgeon that you resonate with and feel comfortable around.
3. Have at least two consultations before your surgery to ensure you’ve had the time to ask all of your questions and that you fully understand the potential complications and how long your recovery is going to take.
4. Have realistic expectations; plastic surgery is about making improvements – not about achieving perfection
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HOW CAN I PREVENT OR TREAT SCAR TETHERING?
“I’ve had surgery and experienced scar tethering in the past. I’d like to have more surgery, but I’m worried it will happen again.
Is there a way of removing it - and how can I make sure it won’t happen again?”
- patient
Dr Sharp:
Scar tethering is sometimes part of your body’s scar healing, with scar tissue under the skin adhering to deeper structures. The scar healing process takes about 24 months in total, and during this period the scar progresses through a number of phases and presentations. How it looks, feels to touch - and the sensations in the area - also change during this period.
During the early phases of healing, everything tightens and can feel very firm and thick. During this time we generally recommend massage as your best prevention/optimisation tool. This can be done without lubrication or with the assistance of an over-the-counter silicone gel from the pharmacy to help with the movement. If you have a surface wound, you can also use our Healing Gel.
Following your post operative instructions and being patient are the best tools in the early stages of recovery, to optimise your results. Attending your post operative consultations so your surgeon can assess your scar development is also essential.
Prevention can be difficult, especially if the area has been operated on before and previously experienced tethering. Sometimes the surgeon can try to release the scar using subcision, whereby they undermine the fibrous bands holding the scar down, however this is not always successful, particularly on tighter areas where the skin is stretched across the bone such as the cheek or jawlines.
After the scarring has settled, scars can soften and loosen up with time – and if this doesn’t occur satisfactorily, Fraxel laser and dermal fillers can be used in small doses to help plump and improve the appearance of the skin in the area. Lasers can commence from week 6 post op, and fillers can be utilised a bit further down the track, once the initial healing period is complete.
During this period you will have routine post op consults booked, but we welcome you to come in and see us for a checkup - or to consult with Deborah, who is experienced with non surgical scar optimisation strategies. I hope this information assists during your healing process.
Ask us your scar question!
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How many cosmetic wrinkle injections are performed each year?
Cosmetic wrinkle injections are the most commonly performed aesthetic treatments in the world, according to figures released by the International Society of Aesthetic Plastic Surgeons in November 2018. In our Brisbane and Ipswich cosmetic clinics, muscle relaxing cosmetic injectables have been performed on a daily basis for many years - and continue to be one of our most rapidly growing procedures, with crows feet, frown lines and hyperhidrosis for excessive sweating three of the most common treatment areas.
Number of wrinkle injection treatments performed annually
- Annual Global Aesthetic Survey, ISAPS 2017
Wrinkle injection treatments work by safely and temporarily reducing muscle activity, smoothing existing wrinkles and preventing more from forming. The effects last 3-4 months and so the 10-20 minute treatment is usually performed 3-4 times a year.
Priced from $12.50 per unit, we use the world’s most reputable wrinkle injection product (which can’t be named here due to TGA regulations) under the clinical supervision of our plastic surgeon Dr Sharp.
call to book a consultation with Dr Sharp
Modern injecting techniques deliver a soft, natural look - rather than the frozen, overly smooth appearance once synonymous with this treatment.
In addition to reducing wrinkles in the upper face, muscle relaxing injections can also reduce the appearance of a ‘gummy smile’ whereby the upper lip curles up, exposing the upper gums - as well as excessive sweating in the armpits, hands, scalp and feet, which is called hyperhidrosis. With its excellent safety record and broad application, it’s not difficult to see why it is literally the world’s most popular cosmetic treatment!
To book a complimentary wrinkle injection consultation, call us on 3202 4744.
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Question of the week: should I lose weight before I have liposuction?
Is liposuction just for people who are significantly overweight; what about people who just want to lose the last stubborn kilograms?
I am close to my ideal weight but can’t seem to budge pockets of fat on my stomach and lower back.
Dr Sharp:
Liposuction is ideal for people who have reached their ideal, healthy weight, and wish to remove stubborn pockets of fat. Lower abdominal fat and love handles respond very well, and it is also a popular treatment for reducing pockets of unwanted fat under the chin, around the knees, back/bra strap fat, inside the thighs and on the back of arms. (Pictured above: liposuction results for Dr Sharp’s patient at 6 months post surgery).
Liposuction is not a weight loss or weight reduction procedure. Patients who are yet to achieve their ideal healthy weight can be disappointed by the results of liposuction as larger areas of fat can experience irregularities and patients can find it doesn’t give them the ‘dress size drop’ they were hoping for via liposuction, instead of weight loss.
While it can be tempting to have liposuction before your weight loss journey is completed, to obtain the best results and ensure a healthy recovery, it’s important to be as close as possible to your ideal weight.
Sometimes Instagram ‘after’ photos of patients on the operating table following liposuction can be misleading and give a false impression of what can be achieved, so it’s important to look at photos three, six or twelve months after surgery to get a realistic indication of your potential outcome.
[Pictured left before and three months after upper arm liposuction with Dr Sharp]
Ask us your liposuction question!
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Question of the week: what’s the best time of year to have a breast augmentation?
If I want to be healed in time for next summer, what’s the best time of year to have a breast augmentation? How long will the recovery take and how soon can I swim?
Dr Sharp:
Breast augmentation in Brisbane is a four-seasons procedure, in that it’s one of those popular operations that I perform every week, every month, of the year. Especially in Queensland, where our weather in warm or mild all year round - women tend to enjoy their results across the year instead of the very cool climates where they are more likely to be concealed by jackets and bulky knits for 6 months of the year.
That said, having breasts that are fully healed by the time summer holidays roll around is a common request. For the first 6 weeks after a breast augmentation, your incisions can’t be submerged in bath, spa, pool or sea water - so if you are planning summer holidays, that’s something to consider. Likewise if you are planning a holiday to Europe during their summer, it’s wise to have the surgery at least 6 weeks beforehand, so you can swim and participate in normal activities.
We also recommend that patients don’t lift anything heavier than 2kg for the first 6 weeks, so that’s something to think about in terms of returning to the gym, lifting older children, returning to a job that is labour intensive or going on holidays and lifting heavy bags.
I encourage my patients to look at the next 6 months and work out where that 6 week ‘gap’ can be - and work backwards from there to find the most suitable time for their surgery.
When planning your breast augmentation, remember that you will probably have 2 consultations with your surgeon, a few weeks or even months apart.
Also keep in mind that most plastic surgeons in Brisbane or Ipswich will have anywhere from a 3 to 8 week wait at various times of year; sometimes longer.
Start contacting your short list of surgeons for available appointments about 4-6 months ahead of your ideal surgery time frame, so you get your pick of preferred dates, and also so you don’t feel like the consultation and surgery booking process is rushed or compromised. It’s an exciting and important process, so give yourself lots of planning time!
Ask us your breast augmentation question!
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2018 Highlights: before and after plastic surgery with Dr David Sharp
It’s been a big year of operating for us - and we love nothing more than to look back through our patients’ surgical journeys and see the improvements they’ve experienced!
From facelift and blepharoplasty through to breast augmentation, abdominoplasty and wrinkle injections - here’s a small selection of results from the thousands of procedures that Dr Sharp performed during the past 12 months. We love being part of every patient’s surgical journey, and witnessing the positive life changes that self improvement can bring; which often reach far beyond the physical transformations seen here. Thank you to all of our patients, for entrusting your care to us - and making us part of your 2018.
Considering surgery in 2019? The best results are planned ahead! Contact us to take the first step...
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What is the short scar breast augmentation technique?
As breast augmentation techniques evolve, the visible signs of surgery have become less prominent.
One of the techniques that Dr Sharp employs during almost every breast augmentation procedure he performs at our Brisbane and Ipswich hospitals, is the short scar augmentation. This technique provides a reduced incision length and less scaring for our patients.
In order to insert the implant, an inframammary incision is made under the breast. In the past, surgeons had to dissect the implant pocket and squeeze an implant through this incision, so they had to make the cut wide enough to accommodate the implant.
However, Dr Sharp is able to make a smaller incision due to his use of a special sleeve to enable narrower insertion of the implant. A tool known as the ‘Keller Funnel’ (which you can watch Dr Sharp use here), allows the smaller incision to be made; the implant is passed into the chest via the funnel and in most cases, the scars are completely concealed in the fold (see images below, taken from underneath with the patient lying down).
above left: six month old breast augmentation scar | above right: six month old breast augmentation scar
In addition to aesthetic benefits of a shorter scar, the funnel also has safety benefits; it enables the silicone gel implant to be placed into the breast without the need for touching, and with more control by the surgeon.
While Dr Sharp does everything possible to minimise every scar created by his surgery, there are certain circumstances where a short scar incision isn’t possible. This includes some removal and replacement or revision procedures.
All surgery leaves scars. Sometimes patients are prone to keloid or hypertrophic scarring which can be prominent, but steps can be taken post operatively if your post op surgical team is made aware of this - using tape, dressings, topical treatments and possibly laser or fractionated needling therapy. Most patients do not require any scar intervention, but if you want to give your scars the best chance of healing well, follow these 3 steps:
- Read the post op instructions your surgeon has provided, and follow them closely.
- When your post op care team indicates the time is right, start massaging your scars daily with the gel provided by Dr Sharp in your post op care bag.
- Keep your tapes on and wear your clinical support garment as per your post op instructions.
- Don’t stretch, over-extend or place pressure on your incision lines; they are under the tension and weight of an implant, so give them support and lots of care!
Read more about our approach to breast augmentation surgery in our Ultimate Breast Augmentation Guide.
above: before and five months after breast augmentation surgery with Dr Sharp
call to book a consultation with Dr Sharp
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How many liposuction procedures are performed around the world each year?
Liposuction is a commonly-requested procedure in our Brisbane and Ipswich clinics, with patients often pairing it with facelift, breast and abdominal surgery. Liposuction can also form part of gynaecomastia, gender confirmation and thigh lift procedures. Figures released by the International Society of Aesthetic Plastic Surgeons in November 2018 show that 1,573,680 breast augmentations were performed internationally in 2017.
Number of liposuction procedures performed annually
- Annual Global Aesthetic Survey, ISAPS 2017
This makes liposuction the second most performed procedure in the world during 2017, closely behind breast augmentation surgery which was performed 1,677,320 times. Liposuction is suitable for people who have achieved their ideal weight and just have pockets of stubborn fat that don’t respond to diet or exercise.
Commonly treated areas include the abdomen, flanks, under-bra area, upper arms and double chin.
call to book a consultation with Dr Sharp
Question of the week: are routine MRI scans necessary after breast augmentation?
How can I tell if my implant has ruptured? I had breast implants last year and was wondering if I need to get routine breast ultrasounds or MRI scans? I don’t have a family history of breast cancer.
Dr Sharp:
Routine MRI or ultrasounds are not recommended unless you:
- have a history of breast cancer
- have noticed changes in your breasts such as the onset of pain, distortion or discharge
- suspect your implant/s may be ruptured
- have experienced trauma to your chest and there are concerns that your implant/s may have been damaged
So if you don’t have a history of breast cancer (and aren’t of an age - or family history - to need routine screening yet), regular scans to check on the condition of your implants is not recommended in Australia.
The specific silicone gel filled implants I use are of an extremely high quality; they are covered by a lifetime warranty for rupture. This means the manufacturers back the implant quality, and they will replace them for free if they are to rupture at any point in the future.
Surgeons can also take certain steps to reduce the risk of breast implant rupture at the time of implant placement, including using a Keller funnel to place the implant with minimal impact on the implant itself. I use a funnel for this and other safety reasons when inserting implants.
In the case of silicone implants, if the implant shell develops a small opening, due to its cohesive nature, the silicone gel will most likely remain inside the implant’s outer shell. If a tear develops in the outer shell, the silicone gel may leave the implant, but will usually be contained within the natural scar tissue capsule that forms a few weeks after the implant is placed.
That means you might not notice an immediate difference in your breast. If you do notice a change in your breast, it might be a shape our outline/profile alteration. You might notice some persistent discomfort in the area. As silicone gel is biologically inert, it does not react with your tissues and research shows that when modern cohesive gel implants rupture, they don’t pose an immediate risk to your health.
If you think you might have a rupture:
- Visit your GP; they will assess your breast (and symptoms) and may refer you to have a scan. Ask for a referral to see your plastic surgeon; a referral from your GP will enable you to receive a Medicare rebate on your specialist consultation fee.
- If you aren’t going back to see your original surgeon, and you don’t have the implant details that were given to you at the time of your augmentation, contact your surgeon to obtain these. This will help you ascertain the type of implants (cohesive gel, saline etc) and the manufacturer’s warranty provisions. Knowing your warranty provisions will help you ascertain the out of pocket costs of any potential revision surgery.
Implants do not last forever; I have seen patients with first-generation implants that have been in place for over 40 years, while other patients have required replacement due to capsular contracture, rupture or migration after 8-10 years.
The good news for women who wish to undergo breast augmentation with modern high quality silicone gel implants is that they are generally very safe and ruptures are rare. When they do occur, they are usually contained within the capsule and easily removed and replaced.
For more information, read our checklist for caring for your breast implants , which includes:
- Self-examination
- Screening when you reach the age where screening is recommend - or if you have a family history that makes you a candidate for early screening
- Watching for changes
Have breast implant questions?
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What Are Mondors Cords?
During breast augmentation surgery, incisions are made under the breast (in the inframammary fold) and vessels are cut; the surgeon uses an electrocautery to stop any bleeding.
Once vessels are cut, blood can no longer flow through and the blood inside the veins naturally clots, causing a mild local inflammation reaction within the veins.
These veins become palpable and visible through the skin, looking like ‘cords’. These care called ‘Mondors Cords’. They can occur a couple of weeks after breast augmentation surgery and they look like vertical bands below the breast, running towards the abdomen. They aren’t painful, but can sometimes feel uncomfortable to tender to touch. The cords are harmless and temporary. The clots inside are not the same as the type of blood clots or deep vein thrombosis that can form in the legs or be harmful.
What do I do if I have Mondors cords?
Contact your surgeon so they are aware of your symptoms; they might ask you to come into the clinic for a review appointment, or if this isn’t possible, send photos of the affected area. Most patients don’t require treatment, but if you have mild discomfort, you might find a mild anti-inflammatory like ibuprofen and heat packs (warm not hot) might be helpful. Eventually the clots break down and are absorbed by the body, and the cords will spontaneously resolve; this can take several weeks to a few months.
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Question of the week: using liposuctioned fat for grafting
I want to have fat liposuctioned out of my thighs and stomach, and put into my breasts and face to fill out my sagging skin.
Is it possible to do this instead of having a breast augmentation and facelift?
Dr Sharp:
Patients also often ask if liposuctioned fat can be injected into other parts of the body, or ‘fat grafted’. The best way to explain my approach to liposuction and fat grafting is that liposuction is all about volume of fat, where as fat grafting is all about quality of fat! I often take small amounts of fat from the stomach or thighs and place these in the face to fill out areas that have experienced volume loss.
Likewise, for slim women who lack fat across their chest to soften the appearance of their breast implants, I often graft small amounts of fat around the periphery of implants, to create a more natural look and reduce the visibility of implant rippling.
Unfortunately it’s not an easy case of liposuctioning large amounts of stomach fat and using it to build breasts that are two cup sizes bigger. This is because liposuction technology aims to remove the maximum amount of fat with the least amount of physical damage to surrounding tissues. And the best way to do that is to break down the fat as much as possible before extracting it. This damages the fat cells and inhibits their ability to regrow when transplanted into another area; so it’s not considered to be ‘good quality’ harvested fat.
One of the biggest downfalls of fat grafting is the fact that some fat always dies off when being grafted to the new site - this can range anywhere from 5% up to 40%. Fat grafting has been around for a long time, but it’s widespread use is a very recent thing and modern medicine is still adapting ways to help reduce the number of fat cells that die when grafted. If large amounts of fat don’t survive the process, fat necrosis can occur. This usually resolves with time, but can cause pain and sensitivity in the area as well as contour deformities and pockets of firmness that are sometimes visible to the eye. Successful fat grafting is a combination of good surgical technique, good fat selection and a good candidate. Patients need to be non smokers, follow a nutrient-rich diet low in processed foods, stay within a normal weight range and closely follow post operative instructions to ensure best possible results.
When I perform fat grafting to subtly enhance parts of the face or body, I use a special fat harvesting kit to strategically extract small quantities of good quality fat, with minimal disruption to the fat cells themselves. In the case of facial fat grafting, the fat is then carefully put through a process that creates tiny ‘nano’ fat that can be injected into the face.
Fat grafting can improve the appearance of an ageing face, but it won’t address all aspects of facial aging, and depending on how much skin laxity you have, you may find that a facelift is unavoidable if you wish to restore your underlying facial structure and skin tightness. It is possible to have liposuction to reduce your unwanted fat deposits, breast augmentation using implants and fat grafting to achieve a fuller breast (a mastopexy may be required if you have significant amounts of sagging breast skin or ptosis) and facial fat grafting with or without a facelift. These procedures can be performed in the one operation, or over separate surgeries. The first step is to consult 2 or 3 plastic surgeons to obtain their opinion about the best procedures and techniques for you and your individual aesthetic goals, so you understand all of your options and the benefits, risks and cost associated with each of these.
Ask us your fat grafting question!
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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?
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 you still meet the MBS criteria for a ‘medically required’ blepharoplasty, Medicare will rebate a portion of your surgeon’s and anaesthetic fee, and you will be 100% out of pocket for your hospital fee. If this is the case, the procedure will cost you about $3,500-$4,000 out of pocket (after rebates). If you don’t meet the new criteria, your costs will total around $5,000.
If you have private health insurance:
If you still meet the MBS criteria for a ‘medically required’ blepharoplasty, Medicare and your private fund will cover your hospital fees (minus any excess payable on your policy) and will rebate part of the surgeon’s and anaesthetic fees. The procedure will cost you about $2,300-$3,000 out of pocket (after rebates). If you don’t meet the new criteria, your costs will total around $5,000.
Should a blepharoplasty be performed in hospital under general anaesthetic, or in surgeon’s rooms under local anaesthetic?
I mostly perform this procedure under general anaesthesia in hospital. This ensures that the patient is not subjected to any unnecessary discomfort, and more extensive blepharoplasty techniques (where muscle or fat can be repositioned) can be utilised without compromising your operative experience. That said, some blepharoplasties can be comfortably performed under local anaesthetic, and this is certainly a possibility for some patients. It’s one of the considerations we discuss together during the initial consultation.
Blepharoplasty under local anaesthetic in your surgeon’s rooms might sound like a convenient, cost effective solution, but it comes with its own risks. The best location for your surgery should be a multifactorial decision made between you and your surgeon, based on your individual circumstances and procedure.
If you’re considering blepharoplasty surgery and want to know how the MBS item number changes specifically impact your procedure, please call our helpful patient care team on 3202 4744.
Please note: the fees provided in this article are only indicative and may vary. When you book a consultation with Dr Sharp, we will check your eligibility for this procedure with your health fund, so if you qualify for the item number coverage, we will be able to supply you with a complete quote (inclusive of all rebates) at the time of your consultation.
Ask us your blepharoplasty question!
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Question of the week: facelift scars
Where are facelift scars located, and can they be positioned so that they are invisible to the eye?
Dr Sharp:
I customise each facelift procedure to the individual patient’s anatomy and their age, degree of skin laxity and hair line. Most standard facelifts usually involve an incision inside the hairline adjacent to the temple, down the earlobe and around the back of the ear, tracking along the hairline down to the nape of the neck (as shown below by the dotted line).
Sometimes the incision is shorter, especially in my shorter-scar Sharp Lift procedure, more common among people in their late 30’s and 40’s who want to redefine their jawline and remove early jowls.
Wherever possible, incisions are placed within the hair or along the hairline, although this can be dependent upon the thickness of the hair, the position of the hairline (some people have receding hairlines, while others sit forward on the face) and how much skin is removed.
How you scar is largely dependent upon your body’s natural predispositions; your ethnicity and genetics play a role in scar colour and texture. Due to neck movement and the pressure on incisions when lying down or turning your head, sometimes the scars behind the ears and along the hairline of the neck can be thicker and wider for the first 24 months, but once you reach the 2 year mark post operatively, most patients find their scars no longer look or feel prominent.
We understand that scars are one of the most common aspects of facelift surgery that deter people from undergoing the procedure. It’s one of the first questions that patients raise; however, post operatively, we find it’s rarely a source of concern. We take a very proactive approach to scar reduction; all of our patients have Fraxel scar reduction laser as a complimentary component of their facelift post operative care with us. Along with daily massage using the scar reduction gel suppled in our facelift post op support bags, Fraxel laser speeds up the scar maturation process, optimising their appearance and helping to reduce their visibility as quickly as possible.
Ask us your facelift question!
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In the media: Dr Sharp featured in breast lift guide
Breast lift (or mastopexy) surgery can be confusing: it’s often mistaken for breast reduction surgery and it’s sometimes recommended alongside a breast augmentation to ensure optimal results.
What makes you a candidate for breast lift surgery instead of breast reduction, and in what circumstances should you consider a mastopexy with your augmentation?
Style Magazines’ recent breast lift feature addressed some of the misconceptions about mastopexy surgery, answering some commonly asked questions about this transformative procedure.
Journalist Siobhan Taylor spoke to Dr Sharp about the surgical process - as well as the risks, recovery and what makes someone an ideal candidate for breast lift surgery:
While the breast lift (or ‘mastopexy’ as your doctor would say) sounds simple enough, there’s a lot going on under the surface that you may not be aware of. In fact, the details of the surgery are significantly different from that of a standard boob job altering everything from your initial consultation right through to the end results.
Because we want everyone to have the tools to make an informed decision, we decided to speak with Dr David Sharp, a highly-regarded Brisbane-based FRACS credentialed plastic surgeon, to learn more about breast lifts. Assisted by a team of clinical and administrative professionals, Dr Sharp is highly sought after for his expertise and down-to-earth approach. We asked him six of the most common questions our readers have about breast lifts.
Read the full article here!
Is breast lift surgery right for you? Get in touch with our patient care team and find out more...
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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?
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 bear.
The cross linking of the silicone in these implants can vary, creating different levels of cohesiveness and firmness. Your surgeon will discuss the appropriate implant for you. New generation implants are able to balance the benefits of form stable silicone with the goal of creating a softer, more natural feel. The implant brands I use do this particularly well, while maintaining an excellent safety record and lower complication rate than other, cheaper, implants - so doing your research and asking your surgeon which brand she or he uses is also important! Experienced surgeons will be attracted to certain implants or deterred from using others, so ask your surgeon how they decided upon their preferred implant type.
Ask us your breast augmentation question!
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Question of the week: what is a Keller funnel and why does it make breast augmentation surgery safer?
My friend has had a breast augmentation and said her surgeon used a funnel to insert her implant and make her surgery safer.
Does Dr Sharp use a funnel, and if so, how does it make the surgery safer – and does it cost extra?
Dr Sharp:
It’s great to hear you are thinking about these factors before your breast augmentation surgery, as they are an important pre operative considerations.
The Keller funnel is an implant delivery system for inserting breast implants into the surgical pockets; a clear funnel shaped tool that allows for easier insertion of the breast implants into the chest cavity without over-handling of the prosthesis.
The Keller funnel was a game-changer in breast augmentation, alleviating the need to insert breast implants by hand, and offering three key advantages:
Decreased breast implant contact
Being able to use additional anti-bacterial measures with a Keller funnel reduces the risk of breast augmentation complications. It offers less risk of damage to the breast implant during insertion, helping to minimise the risks of pre-insertion damage to the breast implant product by reducing the need to manually handle the breast implant. Excessive manual handling of implants has been identified as a potential factor in the compromise of the implant shell, reducing the longevity of the implant.
Easier breast implant insertion
The Keller Funnel’s clear polymeric surface is also believed to help make it easier for the insertion (and potentially orientation) of some types of breast implants. The clear funnel allows for greater visibility of the breast implant at all stages of the implant insertion; assisting surgeons with breast implant placement for cosmetic and plastic surgery breast enlargement procedures. The funnel’s low friction coating allows smooth, texture, high profile, low profile, round and anatomical implants to be guided into their ideal position, rather than inserted solely by hand.
Smaller breast augmentation incision and scar
One end of the funnel is large (to allow the implant to be inserted) and the other end is where the implant is squeezed through; narrow enough to ensure the surgeon can make a smaller incision - meaning that we don’t have to make a large cut in the patient’s skin in order to insert the funnel and deliver the implant. This produces the shorter scar synonymous with my breast augmentation technique.
I use the Keller funnel for breast augmentation procedures when deemed suitable for the patient, type of procedure and implant. Patients are not required to purchase the funnel separately as we stock them in all hospitals that I operate at - nor are patients charged extra for the funnel.
Macquarie University has pioneered the 14 Point Plan to help reduce some of the risks associated with breast implant surgery. You can read more about the plan here and specifically about the 14 Point Plan Pledge I have taken here.
Each week we share one of the questions Dr Sharp has received from patients; to submit a question please email info@drdavidsharp.com.au or use the form below.
Ask us your breast augmentation question!
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What is lip lift surgery?
The skin between the upper lip and nostrils is called the philtrum, and by slightly reducing its height, the upper lip is flipped out - without the ‘duck pout’ appearance that fillers sometime achieve while chasing this look.
Lip lift surgery involves an incision in the fold under the nose and can be performed under local anaesthetic.
As celebrities kiss goodbye to the over-inflated lip look, opting for more subtle pouts, we are finding that women are moving away from the high-projection filled look, and are looking at their entire oral region - seeking ideal proportions and a natural shape.
Lip lift surgery is also popular in men who have previously concealed a disproportionately long philtrum with a mustache. Operating on this area in men requires an astute understanding of ideal male anatomy to ensure the procedure make the face more youthful and masculine.
If demand in our Brisbane and Ipswich clinics is any indication, ‘lip lift’ surgery is growing in popularity among women and men who want to make changes to their lower face that lip fillers haven’t been able to achieve for them. The procedure involves an incision under the nose (usually discreetly located in the junction where the nostrils meet the upper lip). A small segment of skin is removed and the incision closed. The procedure results in a shorter distance between the lip and nose (this area of the face is called the philtrum), enhancing the cupid’s bow and helping the top lip roll outward more, making it appear larger and increasing the amount of pink (vermillion) lip showing.
Lip lift performed under local anaesthetic is priced from $2,750.
Results can be as subtle or dramatic as the patient wishes. The above results are shown at 6 months post surgery. In our clinics, lip lift surgery is also sometimes teamed with rhinoplasty, facelift surgery or chin augmentation surgery, to harmoniously rebalance facial features.
For patients who experience an over-exposure of gum when smiling (often called ‘gummy smile’), a small amount of muscle relaxing product can be injected into the muscle above the lip, bringing the lip down and helping it project outwards more. This is a non surgical treatment that lasts 3-5 months and is called a lip flick. It is sometimes confused with lip lift surgery, but the two are very different and achieve different things for the upper lip.
Lip lift surgery is also known as philtrum shortening. It is a minor procedure, and can be performed under local or general anaesthesia. But it’s not for everyone; when patients are not carefully selected, the surgery can unbalance a face that already has good upper lip proportions. Lip lift also comes with risks and potential complications, such as prominent scarring, nerve damage, asymmetry and unnatural results that are difficult to conceal with makeup. Having lip lift surgery isn’t akin to having lip injections; while dermal fillers can dissolve in a relatively short time, lip lift results are more permanent. When unfavourable scarring occurs, a combination of laser and topical skin treatments might be recommended, to optimise healing and speed up scar maturation.
While lip lift is not a new procedure, a resurgence in lip lift surgery’s popularity is being noted across the world, with women in their 20’s and 30’s primarily seeking a lip augmenting effect, while mature aged patients often find that the ageing process causes their upper lip to thin and elongate - with lip lift surgery creating small, flattering adjustments that can reverse unwanted changes. As the philtrum drops as we age, the top teeth become hidden and ‘mouth frown’ can occur.
Lip liners and dermal fillers play a useful role in improving the appearance of aged, thinning lips, but trying to using these tools to turn a curled-under lip out - or to reduce the length of the philtrum - can create an over-filled, heavy ‘duck bill’ appearance. In this way, dermal fillers are often over-used, as injectors try to shorten the appearance of the philtrum or achieve the rolled-out lip look, when surgery is actually required.
As a lip lift can be performed under local or general anaesthetic, the total cost can vary significantly, as hospital admission and general anaesthetic adds to the costs. If you are considering this procedure, talk to a qualified plastic and reconstructive surgeon that is a Fellow of the Royal Australasian College of Surgeons (denoted by the letters FRACS after their name) to obtain a full facial assessment and ascertain if it is right for you.
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Question of the week: is Fraxel laser painful?
I’ve wanted to have laser resurfacing for many years for lines and pigmentation, but the images of crispy skin and stories of painful treatments has put me off. Does Fraxel laser hurt and is there any way to reduce the pain?
Deborah:
One of the things I love most about Fraxel is that the technology has been industry-leading for around for two decades; it is proven and well-tested science that has stood the test of time and millions of treatments. Like most of the first rejuvenation lasers, it’s true that the first generation of Fraxel was known to have a sting, but the technology has been refined and that reputation is no longer valid. The ‘new’ Fraxel is not painful for most patients; a mild prickling sensation can be felt.
We ensure patients are comfortable by applying a topical anaesthetic cream before the treatment and the machine now comes with a Zimmer device, which blows chilled air on the skin as the laser works, distracting nerve endings. I have personally used most of the other leading lasers, radio frequency and pulsed light machines on the market over the past 15 years and Fraxel is by far the most comfortable. It manages to achieve great results without being ablative, so you don’t get the discomfort, persistent burning sensation, hot spots or ‘crispy’ skin you describe. Fraxel downtime is quite brief in comparison to other lasers, and initially looks like sunburn and develops into a grainy ‘ground coffee’ appearance as the skin exfoliates - you can view pictures of this process on the video we posted here. The Fraxel The new Fraxel is the virtually pain-free for most patients. Our clinic was the first plastic surgeon lead practice in Brisbane to offer Fraxel laser, and we chose it specifically because it is a very high quality, medical grade laser that delivers measurable results without unnecessary discomfort. Most of our team members have had the treatment, so if you want to talk to someone first hand who has undergone Fraxel don’t hesitate to call us on 3202 4744 and ask!
Ask us your Fraxel questions!
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Guess to win!
Want to enter?
1. Estimate the number of bottles in the vase Deb is holding
2. Go to Facebook or @dr_david_sharp on Instagram and comment on the post with your estimate
3. The person who places the closest guess will recieve a $200 PRAHS Skin Voucher
4. Winner will be announced 12th of October 2018
Good luck!
Terms and conditions: Voucher can be redeemed on any skin treatment with Deborah. Cannot be redeemed on surgical fees, surgical consultation or medical treatments. Not redeemable for cash or transferrable. Voucher valid until the 1st of January 2019. Please note the bottles in the image shown are for display purposes only, and do not contain any products.
What's your Summer Skin Plan?
Get started with a complimentary consultation with Deborah to discuss how wrinkle injections, dermal fillers, Fraxel resurfacing laser, micro needling or key active ingredients can help you reach your skin goals!
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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 included 214 women undergoing abdominoplasty in Australia, with an average age of 42 and a history of two or more pregnancies. Before tummy tuck surgery, half of the patients reported moderate to severe disability from back pain, while urinary incontinence was a concern for 42.5%.
At six weeks and six months post surgery, only 2% of the abdominoplasty patients said urinary incontinence remained a significant problem, while only 9% still reported moderate disability from back pain.The study’s findings renewed calls earlier this year to add abdominoplasty to the MBS for women suffering from chronic postpartum medical issues, which would see the procedure subsidised by Medicare - and rebatable through private health insurance - if the women met the MBS criteria for medically requiring the surgery.
There are many operations performed for the relief of chronic pain and it is the Royal Australasian College of Surgeon and Australian Society of Plastic Surgeon’s position that women should not be excluded from having abdominoplasty surgery to address medical problems; it should be considered as a procedure that fixes core strength and pelvic floor instability and addresses function or pain issues.
Postpartum abdominoplasty facts:
- Approximately 1.6 million Australian women are currently suffering with chronic back pain as a result of giving birth
More than 3 million Australian women experience discomfort, functional problems and social concerns that relate to stress incontinence
Tummy tuck surgery can improve back pain and urinary incontinence after pregnancy or childbirth
For more information about how abdominoplasty surgery helps repair pregnancy related abdominal wall defects, hernias and excess skin call 3202 4744 or contact us via the form below.
Ask us about abdominoplasty
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In the media: Style Magazine’s list of Brisbane’s best breast augmentation surgeons
Style Magazines has released its list of Brisbane’s best breast augmentation surgeons.
Dr Sharp was honoured to make the cut (hehe) along with some of Brisbane’s esteemed specialist plastic surgeons, discussing his approach to breast augmentation surgery and some of the things to consider if you are looking at having this procedure.
The magazine drew particular attention to the importance of researching your breast augmentation surgeon thoroughly, to ensure they are qualified as a specialist plastic surgeon:
No matter your reason for considering the treatment, it’s important to make sure you’re going to a qualified expert who can take the vision you have in your mind and make it a reality.
If you’ve been thinking about breast augmentation – “Is it right for me? What’s the procedure like? Where do I start?” – then prepare to breathe a deep sigh of relief, because we’re helping you take your next step with confidence. Here’s our guide to some of the most trusted breast augmentation specialists in Brisbane.
Read the feature in full here!
Have a question about breast augmentation surgery? Contact our friendly team!
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Spring skin treatments
Did you know that after a collagen-stimulating treatment, it takes about 6 weeks to start to see the results? That means now is the perfect time to start planning for summer holidays, skin-baring dresses and your party season glow!
Begin by removing pigmentation and dead, lacklustre skin cells while strategically stimulating collagen with our rejuvenating medical skin treatments:
- FRAXEL LASER
- DERMAPEN MICRONEEDLING
- REVOLUMISING DERMAL FILLERS
- WRINKLE INJECTIONS
- LIP ENHANCEMENT
Kick start your summer skin with a proactive approach to healthy ageing and natural-looking results.
Book a complimentary skin assessment consultation with Deborah for a treatment plan tailored to your skin goals by calling 3202 4744.
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CLINIC NEWS
25% OFF LIP ENHANCEMENT INJECTIONS
Rejuvenate thin, dry or lined lips with our high quality dermal filler injections, using techniques that produce beautiful, natural-looking results. Topical anaesthetic is provided at no cost, for extra comfort. See in clinic for terms & conditions.
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Medicare plastic surgery changes: will they impact you?
Medicare has announced significant changes to plastic surgery item numbers on the Medicare Benefits Schedule (MBS) that will be effective from the 1st of November 2018. If you do not have item numbers listed on your informed financial consent document, this news won’t impact your costs. This will impact rebates and health fund coverage for patients with certain item numbered procedures, so if you are having plastic surgery from the 1st of November onwards, it’s important to be aware of these changes and read on.
What does this mean?
Some MBS item numbers are being abolished altogether, while others will have a tighter eligibility criteria. If we have issued you with a quote that lists an item number, this quote is only valid for surgery performed up until the 31st of October 2018. Dr Sharp’s fees are not changing, but some rebates are, and so for surgery that’s planned from the 1st of November onwards, we will need to provide you with an updated quote based on the final version of the new Medicare item numbers.
Which procedures are impacted?
This list covers some popular procedures involved, and is not comprehensive:
- otoplasty: must be performed before the age of 18 or costs will increase by approximately $2,500
- blepharoplasty: an optometrist or ophthalmologist will need to confirm that your excess eyelid skin obstructs your vision - if you don’t meet the criteria, costs may increase by approximately $2,500
- breast reductions and lifts (mastopexy): in you don’t satisfy the criteria, costs will increase by approximately $3,000 - $6,500 (depending on inpatient stay)
- removal and replacement of breast implants: if you don’t satisfy the criteria, costs will increase by approximately $5,500 - $8,000 (depending on inpatient stay and whether your original implants were covered by a replacement warranty)
lipectomy procedures (abdominoplasty, thigh reduction, arm reduction etc): even if you meet the criteria for these procedures individually, Medicare and private health funds won’t pay any rebates or cover hospital fees if certain lipectomy procedures are performed together as a combined procedure. For example, abdominoplasty and arm lift will be 100% out of pocket, even if you meet the MBS item number criteria, if performed together. But if you meet the criteria and have an abdominoplasty and arm lift performed as two separate operations, they will still be eligible for rebates/cover.
I have surgery booked after the 1st of November; what do I need to do?
If you have item numbers listed on your estimate of fees, the item numbers for your procedure may not be one of those impacted at all by these changes, and even if they are, you may find that you still meet the updated criteria. If you are having surgery after the 1st of November and you have item numbers on your informed financial consent document that are included in the list of those changed, our practice manager Carol and patient liaison Katy will identify this and will contact you regarding any estimate revisions required. In some cases, Dr Sharp will be able to ascertain whether you meet the updated criteria prior to your surgery - in other cases, due to the new requirements, this will need to be determined post operatively using intraoperative photography and other assessments.
I don’t have private health insurance; will this impact me?
If your surgery is currently covered by an item number (eg removal and replacement of breast implants due to complications), at the moment you’d receive a rebate on some of your surgeon’s and anaesthetist’s fees from Medicare. If you no longer meet the new criteria, you won’t be eligible to receive any rebates. If you do meet the new criteria, rebates will still apply for your surgeon’s and anaesthetist’s fees. Private hospital fees are never covered by Medicare, so these remain unaffected for uninsured patients.
I have private health insurance; how will this impact me?
Patients who are privately insured may be significantly impacted by these changes. If your private health insurance policy covers you for an MBS item number - and your surgeon and Medicare deems that you meet that criteria - your fund and Medicare pay a rebate on your surgeon’s and anaesthetist’s fees, and your fund covers your hospital fees (minus any excess or exclusions). These changes mean that we need to ascertain if you meet the amended MBS criteria for your procedure; if not, your fund and Medicare will not provide any rebates - so you would be out of pocket 100% for your surgeon, anaesthetist and hospital stay. Again, this only applies if the changes impact your specific item numbers, and you will receive notification from us if this is the case for you.
Why are changes occurring - and will there be more?
The government made these changes because they believe some MBS item numbers are being used for procedures that Medicare perceive to be ‘cosmetic’ rather than ‘medical’. Representatives from the plastic surgery community were involved in the taskforce that contributed to these changes, but not all of their requests and recommendations were implemented or observed in the resulting criteria amendments. Changes to MBS item numbers that impact plastic surgery have been a focus of government cost-cutting in recent years and this may continue. It’s important to remember that when you receive an informed financial consent document, it is based upon the information available to your surgeon, anaesthetist, hospital and health fund at the time; if the government decides to make changes to the item numbers and rebates after your estimate is provided, they are able to do so, and are not required to provide a grace period for people who have already received quotes.
I haven’t booked my surgery yet; is there still time to have surgery before the changes occur?
Out of pocket fees are understandably an important component of your surgical decision making process, however costs alone should not be a reason to rush into elective surgery before you are ready. Currently Dr Sharp’s theatre lists are fully booked beyond the 1st of November at all hospitals, so while we’re able to place you on a waiting list for surgery before this date (if you’ve already had your initial consultation with Dr Sharp and had time to consider your informed consent documents), there is no guarantee your surgery can be performed by the 31st of October 2018.
Please contact Carol at manager@drdavidsharp.com.au if you have any queries or concerns.
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THE $50 LIP INJECTION THAT BOOSTS YOUR POUT
Muscle relaxing or anti ageing wrinkle injections have long been used to smooth lines and soften wrinkles in the upper face, but they’re now also being strategically used to enhance upper lips, in a quick and cost effective treatment that’s being called the ‘lip flick’.
How a lip flick works
Wrinkle injections can be used to create a poutier look, by rolling the lip gently outward, giving the appearance of a fuller upper lip.
Cosmetic muscle relaxing injections are placed into muscle around the mouth (orbicularis oris), targeting only the surface layers of the muscles around the side of the lips. This relaxes muscle fibres enough to flip the lip outward. Another benefit of the lip flip is that it can address gummy smiles, where the lip exposes the gums.
How is the lip flick different to lip fillers?
Lip augmentation is performed with dermal fillers - a hydrous gel that’s created from a naturally occurring sugar, which draws water to the lip to increase its size, shape and projection. But some people also still find their lip curls under, and that’s where the lip flick comes in.
How much does lip flick treatments cost?
Like all muscle relaxing injection treatments, the lip flick is tailored to suit your anatomy and muscle activity, but in most cases the cost ranges from $25-$50. Results are usually visible within 2-7 days and last 3-5 months.
call to book a consultation with Deborah
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What is rectus divarication?
Diastasis recti (also known as rectus divarication or abdominal separation) a gap (usually greater than 2.5cm) between the two sides of the rectus abdominis muscle.
The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath (see right).
In pregnant or postpartum women, the condition is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in women who have had multiple pregnancies, but can occur after just one. Sometimes, the uterus can be seen bulging through the abdominal wall, beneath the skin.
Women are more susceptible to develop diastasis recti when over the age of 35, high birth weight of child, multiple birth pregnancy, and multiple pregnancies. Abdominal muscles separation can appear as a ridge running down the midline of the abdomen; it becomes more obvious with straining and may disappear when the abdominal muscles are relaxed.
In an abdominoplasty or tummy tuck, diastasis recti is corrected by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall and restores the stomach to a flatter, more aesthetically pleasing appearance while most importantly restoring core strength, and often, pelvic floor integrity.
Sometimes, hernias may also be present alongside abdominal wall weakness. In most cases, Dr Sharp’s abdominoplasty procedures include the repair of any hernias as well.
To find out if you have muscle separation after pregnancy, speak to your GP. If this is causing back ache, urinary incontinence, poor core strength or difficulty with certain exercises, ask for a referral to a qualified plastic surgeon to discuss whether or not post pregnancy abdominoplasty surgery might be right for you.
Contact us
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Safe breast augmentation surgery – the 14 Point Plan Pledge
Breast augmentation surgery is a very safe procedure. Statistically it has a low rate of complications and research shows it provides measurable improvements for women’s quality of life and sense of wellbeing. Despite this, safety is at the forefront of women’s minds when considering a breast augmentation - and so it should be!
Key considerations pertain to the choice of surgeon, selection of implant, the facility where the surgery is performed and the technique used. It’s important to put your safety interests ahead of finding the cheapest ‘deal’ or a surgeon that can perform your surgery asap! Optimal safety measures take time, and steps such as using an accredited hospital and anaesthetist - or taking extra precautions to avoid bacterial contamination - might add to the costs involved, but they can also significantly impact your short and long term outcomes.
Macquarie University has put together a 14 Point Plan which offers proven strategies for surgeons to use when they are inserting a breast implant. Published in 2013, it is now adopted around the world as best practice for plastic surgeons who frequently perform breast augmentation surgery. Each step aims to reduce bacterial contamination, which in turn minimises the risk of breast implant complications.
Dr Sharp is one of the specialist plastic surgeons in Brisbane and Ipswich who has chosen to taken the 14 Point Plan Pledge. This means he has committed to using techniques and practices that help reduce the risk of bacterial contamination (listed below) including the use of a Keller funnel to deliver the implant into the breast pocket, using form stable breast implants and submuscular placement. While it isn’t possible to completely eradicate the chances of complications, these factors have all been shown to help lower the risk.
The Macquarie University 14 Point Plan:
- Use intravenous antibiotic prophylaxis at the time of anaesthetic induction
- Avoid peri-areolar incisions
- Use nipple shields to prevent spillage of bacteria into the pocket
- Perform careful atraumatic dissection to minimize devascularised tissue
- Perform careful hemostasis
- Avoid dissection into the breast parenchyma.
- A dual plane pocket has anatomic advantages
- Perform pocket irrigation with correct proven triple antibiotic solution or betadine
- Minimise skin-implant contamination
- Minimise the time of implant opening, reposition and replacement of implant
- Change surgical gloves prior to handling the implant. Use clean or new instruments that were not used in the pocket dissection
- Avoid using a drainage tube, where possible
- Use a layered closure
- Use antibiotic prophylaxis to cover subsequent dental or surgical procedures that produce bacteremia, and have lifelong follow-up
To ensure your surgeon is following best practice it’s important to:
- check they are a qualified specialist plastic surgeon using the RACS Find A Surgeon portal
- confirm they are a member of the Australian Society of Plastic Surgeons
- see if they have taken the 14 Point Plan pledge
want to know more about Dr Sharp's approach to breast augmentation?
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GOOD THINGS TAKE TIME
There are some inconvenient truths when it comes to plastic and cosmetic surgery that should be part of the decision making process when considering surgery. Behind the exciting before and after photos - and happy outcomes - there’s a massive amount of discipline, patience and consideration that goes into each procedure. Healing takes time. Scarring doesn’t always behave as we want it to; in each body it can evolve, change and mature differently. Recovery can be painful. Friends and family can be judgemental. Surgery can trigger anxiety. And if you are aiming for perfection, you will always be disappointed (in life, and in surgery).
Some patients find it easy. We had a visit this week from one of our beautiful patients, who had undergone a breast reduction with Dr Sharp three months ago. She wanted to let us know she’d breezed through the entire process - felt great after surgery, bounced in for all of her post op appointments and patiently waited for her results to settle in. But the same procedure for another patient can be a difficult journey overwhelmed by anxiety and uncertainty - which is why it’s important to embark upon surgery with an open mind and an understanding that the process can be a marathon rather than a sprint.
Over the years we’ve noticed some commonality between patients who enjoy the process of surgery, and the results they achieve in the end:
They have reasonable expectations
They have sensible expectations of how their body will heal and recover from surgery. If their bodies don’t behave exactly as they imagined it would after surgery, they nurture it and are patient with their bodies, rather than engaging in negative self-talk. Likewise, they have reasonable expectations of their outcomes. Absolute perfection is a myth; if you are considering surgery in order to look ‘perfect’, you will always feel disappointed. Discuss your honest expectations with your surgeon - and likewise let them know that you expect honest feedback and guidance by them. It’s important for your surgeon to understand the key reasons why you wish to have the procedure, and the outcome you are hoping to achieve. Dr Sharp’s pre operative consultation process is very detailed and covers an exhaustive list of risks, complications and potential outcomes. If you are having a cosmetic procedure, you will have at least two of these consultations before your procedure. Even after these consults, if you have any doubts, ask for another pre operative consultation to discuss any concerns - they are free of charge, as we want to encourage patients to have as many as they need in order to feel fully informed!
They understand the uniqueness of each body
The advent of online surgery forums has in most part been a wonderful thing for patients, enabling them to find information and first-hand accounts that were never accessible in the past to people considering surgery. However, the flip side of this is that there’s a lot of misleading, inaccurate (and sometimes, dangerous) medical information shared between users. Every single body is beautifully unique, and what worked for one forum member might not work for another, for many reasons. In addition to starting off with different anatomy, proportions or disease progression, how your body responds to surgery after the procedure can be totally different to the next person on the forum. Some people are unlucky to be more prone to swelling, infection or suboptimal scar healing. While forums are a great way of doing ground work, it’s important to understand that everyone will have different outcomes.
They adhere to post op instructions
Your recovery is a team effort, often involving you, Dr Sharp, our post op care nurse and - sometimes if you live regionally - your local general practitioner. Before surgery, your informed consent process will include two written documents that clearly outline what to expect after your procedure; it is important to go through these with Dr Sharp and then go home and read through them again at least twice! Particularly observe the post operative information, risks and potential complications. This greatly assists patients in understanding what to anticipate from their procedure. On the day of your surgery you will receive a post operative care envelope containing your post op instructions and another copy of the appointment schedule you will have received earlier. Your post op instructions can’t cover off every possible scenario, they also rely on common sense - such as, if you have had surgery on your right ear today, don’t lie on that side when you go to bed tonight. Keep your support garment on for as long as Dr Sharp recommends after surgery (and even longer if you can), even when its cramping your style and you think you’ve healed enough to stop wearing it. Use your judgement and if you are unsure, call your post operative care nurse on the number we provide you with on your day of surgery; she’s available to talk to you anytime. There’s no such thing as a silly question when it come to post operative care - so stay in touch! Most importantly, if you haven’t adhered to your post op instructions and something has gone wrong, don’t be too nervous to get in touch and tell us; we aren’t here to berate you, we just want the best result possible for you - and the sooner you ask for help, the better your outcome will be.
They attend their post operative appointments
Our post op appointments with Dr Sharp are free of charge for twelve months after surgery - to encourage patients to come back in and receive optimal post op care and support with us. Before you undergo surgery, we will schedule your post operative appointments with you. In our experience, patients who attend their post operative appointments are more satisfied with their outcomes in the long term. Attending these free sessions ensures your healing progression is monitored, keeping healthy lines of communication with your surgeon open and enabling your care team to observe your results and support you through the recovery process.
They are patient!
It’s very understandable for you to want to cast off your dressings or support garments and see a swelling-free, scarless result smiling back at you. It’s also understandable to wish that your bruising, swelling, scars or irregularities would just spontaneously disappear tomorrow. The reality is, time is a wonderful healer, and patience is incredibly important. Some procedures are more prone to having more high risk or lengthy recovery periods that others. The amount of swelling you accumulate can vary greatly, depending on your body. And it can take longer to subside, depending on your body and your post operative activities. Scars can heal at breakneck speed, and they can also grumble along and develop nuances, discolouration, puckering and tethering. Have faith that your body will heal over time, with the ongoing monitoring and care from our surgical team and our post operative recommendations. Follow Dr Sharp’s instructions - and know that we feel just as invested as you are, in your end result - whether that be a journey of weeks, months or years.
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Question of the week: what ingredients do wrinkle injections contain?
I’d like to have cosmetic injections to reduce my crows feet and the lines on my forehead but I’m worried about the toxins and chemicals in them. What are wrinkle injections made of and are they safe?
Dr Sharp:
It’s always important to understand the ingredients that go into anything you are putting into your body. The active ingredient is a neurotoxin. The toxin is made by bacteria that is extracted using a fermentation process. Anti-wrinkle injections also contain two inactive ingredients called human albumin and sodium chloride.
Human albumin is a common protein in blood plasma which is produced by the liver. Sodium chloride is salt, and this is used in the dilution process with sterile water. It does not contain animal products, but has been tested on animals, so that’s an important consideration to make if you are vegan, or do not use products that have been developed through animal testing. In terms of safety, it is important that the active ingredient is stored and transported correctly by a reputable supplier - and then diluted accurately with saline by a qualified clinician. And that’s before its injected.
When injected, this extremely small amount of toxin attaches itself to nerve endings, temporarily stopping the synapses that trigger muscle action and reducing the activity of the muscle. This causes a temporary reduction in muscle activity lasting 3 to 6 months.
Wrinkle injection therapy is very safe if administered correctly. The product we use for wrinkle injections in our clinics is the longest standing product in the market, with a remarkable safety record and TGA approval and a scheduled therapeutic drug. These muscle relaxing injection are also used clinically to treat migraines, muscular disorders and excessive sweating.
To ensure patient safety, the injections should be administered in a clinical environment (not a home, hair salon or beauty salon) and by a doctor - or a skilled nurse who is under the supervision of a trusted qualified doctor. The main risks of wrinkle injections exist with injector error, which is why it’s important to choose the right clinician.
Side effects are usually limited to a small mosquito-bump like lump over the injection site, which subsides within 15 minutes – or small bruise at the injection site. Sometimes patients report a mild headache after having the injections. Misplaced wrinkle injections can cause droopy eyelids or overly-arched eyebrows, a crooked smile or drooling. It’s important that injections be placed precisely in order to avoid side effects.
Ask us your cosmetic injectables question!
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Question of the week: can I increase my implant size after breast augmentation?
I had a breast augmentation 5 years ago and after putting on a bit of weight, it feels like my breasts are now too small for the rest of my body. Is it possible to increase the implant size, and how do I find out the biggest possible size, without looking ridiculous?
Dr Sharp:
It is certainly possible to increase your breast implant size after having a breast augmentation. This procedure is called breast implant removal and replacement surgery, and involves a very similar process to your primary (first) augmentation, occasionally with the additional removal of implant capsule, or creation of an internal sling or support to provide additional structure at the base of the breast.
Often, patients undergo this procedure primarily to remove ruptured implants or to address capsular contracture, and decide to increase their implant size at the same time. Other patients are dissatisfied with the appearance of their original implants and wish to increase their size.In most cases, an implant size increase is not an issue, especially when a patient wishes to have a moderate size increase; I frequently perform this surgery in my practice. [Right: before and after breast implant removal, replacement and lift surgery with Dr Sharp].
To ensure the best possible outcome, there are some important considerations to make before undergoing removal and replacement surgery to increase your implants size:
- If you are unhappy with the appearance of your breasts due to normal anatomical anomalies such as asymmetry, large areolas or chest wall deformities, increasing your implant size may make these more obvious, as they are being magnified by the additional size of the implant. Your surgeon will take steps to mitigate this, but it’s important to weigh this up against your desire for a larger implant. Your breasts will look bigger in clothes, but they may not look as you’d hoped, when naked.
- Increasing your implant size may cause your breasts to sit higher on your chest, and create a more unnatural appearance. Some women like this look, but it is important to decide if this is something that may bother you in the future.
- A larger implant will place additional strain on your supportive tissues and stretch your skin; this is something to consider down the track, as breast lift (mastopexy) surgery may be required if you wish to downsize or remove your implants in the future.
- Larger implants can impede on physical activities, sports and even sleeping positions; discuss this with your surgeon.
- Anecdotally, we find that the larger the implant size, the greater risk of revisional surgery; it’s important to consider if your budget and lifestyle will be able to accommodate this if the need arises in the future.
These considerations are not intended to sound negative or foreboding, but it’s far better to let them run through your mind before having surgery, than after!
Part of a surgeon’s job is to counsel patients to make sustainable, sensible decisions about surgery – this should be explained at length during the pre-operative process. Simply putting in oversized implants might please patients in the short term, but in the long term we know this is not always the ethical choice. Sometimes that means the end result is a compromise in the middle between what a patient wants, and what is safely achievable.
During the pre operative consultation process, your surgeon will take your individual chest measurements and use the clinical guidelines based upon these to arrive at the ideal implant size ‘range’. This guideline determines the maximum implant size that your breast base anatomically will accommodate; it protects patients from potentially long term implant complication, and based on this, your surgeon will work closely with you to formulate an effective plan to achieve optimal breast augmentation results.
If you live in or near the Brisbane or Ipswich areas, or if you are considering traveling to these cities to receive treatment for breast augmentation revision, Dr Sharp would be more than happy to speak with you about your various options and help you make the correct decision for your unique situation. To book a consultation, please call 3202 4744.
Ask us your breast augmentation question!
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Breast augmentation question of the week: the difference between an augmentation mammoplasty and augmentation mastopexy
What’s the difference between a breast augmentation mammoplasty and breast augmentation mastopexy, or are they both the same thing (BAM)? I’ve been told I might need the mastopexy version with my implants.
Dr Sharp:
A mastopexy is another word for a breast ‘lift’. A breast augmentation mastopexy is a combined breast enlargement and lifting procedure; it involves the placement of an implant to increase breast size and fill out the skin, while excess skin is removed and the nipple is lifted to sit higher on the new breast shape. Incisions are made around the nipple, with a single vertical incision down the middle of the lower breast, and in the inframammary fold.
A breast augmentation mammoplasty, on the other hand, is commonly referred to as a ‘BAM’ involves the placement of an implant, normally using a single incision in the inframammary fold of each breast.
Mastopexies can be performed on their own to lift a breast, or in combination with an augmentation to lift and enlarge.
There are a few reasons why your surgeon may recommend a mastopexy with your augmentation. For some women, the position of their nipple and areola complex sits lower on their chest.
This can be due to weight loss, genetics, breastfeeding or the natural ageing process.
If the nipple and areola sits below the inframammary fold (see right), this is classified as ‘nipple ptosis’. There are various grades of ptosis.
When seeking breast augmentation, it is often the case that an implant alone will not move the nipple upward enough so that it’s centered on the implant, forming a more pleasing shape. A mastopexy may be recommended as part of your surgical plan. Mastopexy removes skin, lifts the nipple and reshapes the breast; there are various techniques for mastopexy and it’s important to ask your surgeon to explain and show you a picture of their recommended approach, and scar placement, so you know what to expect. My typical incision placement is shown in the first set of before and after images below.
Patients often wish to avoid a mastopexy for understandable reasons, and shop around for surgeons to find one willing to do the augmentation without a lift. However, if your specialist plastic surgeon has advised you that a lift is indicated to achieve a good result, it’s because they’ve seen enough to know that both you, and your surgeon, will eventually be disappointed with the outcome of an augmentation alone. While your scars will always be visible, if you are concerned about scarring after a mastopexy, ask your surgeon to create a scar reduction plan for you to commence straight after your surgery. Our mastopexy patients receive a scar reduction treatment plan included as part of their surgery with us, however many indicate that they don’t even feel the need to utilise the full program, as they’re satisfied with how their scars have matured and faded with just the use of topical scar reduction products, massage and time.
A final note about ‘borderline’ or ‘pseudoptosis’ - whereby the nipples/areola is sitting lower on the breast, but not entirely below the inframammary fold. After discussing the pros and cons, your surgeon may be able to use a well-chosen implant and pocket placement to utilise the augmentation for a slight lift of the nipple/areola, instead of performing a mastopexy. In these cases, it’s important for the patient to understand that they may require a mastopexy further down the track if the ageing process or weight fluctuations cause more sagging.
These photos show a patient who had clinical ptosis and wanted a fuller breast with a higher-sitting nipple/area complex. She underwent a breast augmentation mastopexy as a combined procedure, with a typical ‘lollypop’ scar. Photos show results at 6 weeks post surgery.
Ask us your breast augmentation and breast lift question!
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A Contemporary Approach to Breast Reduction Surgery
Excessively large breasts create both physical and psychological problems, including severe neck and back pain, bra strap indentations, skin irritations and embarrassment. Today, breast reduction surgery is widely accepted as a solution to treat ‘macromastia’; but our mature-aged patients tell us it was not alway so. Previously, breast reduction surgery was considered taboo and embarrassing, and often hidden from family and friends. [Left, before and after breast reduction with Dr Sharp].
Thankfully times have changed, and the social environment in which women undergo plastic surgery has evolved. Although it offers cosmetic improvements, breast reduction surgery also follows reconstructive principles and techniques, involving flaps and medical indications - that is, it is considered medically required due to the health benefits it brings.
This means that the procedure is listed on the Medicare Benefits Schedule and in most cases, an item number applies to the procedure. Women are able to claim a rebate on some of their costs, both via Medicare and their health fund, if applicable.
This has been one of many contributing factors that have seen breast reduction surgery rates increase significantly. As these rates have increased, surgical techniques have been refined and improved.
Dr Sharp is skilled in modern breast reduction techniques, enabling him to treat breasts of all sizes. By employing advanced techniques, Dr Sharp is able to help patients achieve physical relief from the weight of exceptionally heavy breasts, while creating a natural looking, rejuvenated overall appearance.
Breast reduction surgery requires an astute aesthetic eye as well as extensive expertise in both cosmetic and reconstructive breast surgery. Dr Sharp takes pride in being able to offer this procedure to patients seeking to alleviate the physical and psychological impact of disproportionately large breasts. [Right, before and after breast reduction with Dr Sharp].
Want to learn more about breast reduction? Call to book a consultation with Dr Sharp
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Dr David Sharp Plastic Surgery featured in Style Magazine’s Brisbane A to Z Style Guide
Style Magazines featured Dr David Sharp Plastic Surgery in its 2018 A to Z Style Guide for luxury services in Brisbane. The feature points out that Brisbane is very fortunate to have a wealth of “amazing” options, and it showcased an ultimate edit of 26 favourites; “the best retailers and services in Brisbane…to help you live your best, most fabulous, life”.
From reconstructive and skin cancer surgery through to breast augmentation, facelift and cosmetic injectables; the team at Dr David Sharp’s practice are all about providing holistic solutions, natural results and prevention over cure. They thrive on diversity and are the experts in combining surgical procedures and non-surgical therapies for optimal results.
We were especially chuffed that the feature celebrated our modern approach to giving patients the tools to embrace their individual beauty - whatever that may mean for them - saying it flouted “preconceptions” of plastic surgery.
From reconstructive surgery and skin cancers through to abdominoplasties, facelifts and breast augmentation, providing a personalised approach to plastic surgery - in a compassionate, supportive environment at our Brisbane and Ipswich clinics - is at the core of why we love what we do!
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Breast augmentation – question of the week: internal support
I’m worried about the implant slipping or internal structures being weakened by a breast augmentation. One of my friends said her sutures came apart while she was lifting weights in the gym and now one of her implants has moved out of the pocket. Can this happen?
Dr Sharp:
It’s great to hear you are thinking about these factors before your augmentation surgery, as they are important pre operative considerations.
Sometimes due to a patient’s anatomy or previous breast surgery, the surgeon will need to apply additional inframmammary support for the implant. This can come in the form of additional sutures, or even an internal sling using a dermal matrix. It’s important to ask your surgeon should be experienced with these techniques, and will be able to advise upon examination if this was required for your augmentation.
An implant will inevitably add additional weight to your internal structures, and that’s why we advocate a very thorough and careful selection process for the right implant, and pocket plane placement, for your body. Lifestyle factors - such as regular weights sessions at the gym, heavy lifting in your job or repeated movements with hefty objects at home/caring for children or elderly need to be considered as well, because yes, in some cases there can be too much pressure on the internal structures and the implant can ‘bottom out’ or migrate. While this is rare, it does happen.
There are a number of decisions before your surgery that can help reduce this chance, as well as lifestyle/activity considerations to make after your augmentation that can mitigate the risks of this happening.
Ask us your breast augmentation question!
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Dr David Sharp Plastic Surgery in Queensland Times
Dr Sharp was featured on the front page of Saturday’s Queensland Times in a special feature about the new plastic surgery procedures and services he performs in the region that spans between Brisbane and Toowoomba.
In the feature Dr Sharp discussed the skin cancer surgeries he performs often due to high UV exposure levels - as well as the cosmetic procedures, such as breast augmentation, breast reduction, abdominoplasty (tummy tucks) and facelift surgery. He also explains the advanced training that plastic surgeons undergo to specialise in their field.
LIFE in plastic might be fantastic for Barbie, but for Ipswich’s leading plastic surgeon, there is a much more human focus at the heart of breast augmentations and tummy tucks.
Plastic surgeon Dr David Sharp has been changing the lives of Ipswich patients for two years - his work fundamental in helping cancer patients recover from treatment, those who have lost excessive weight take the final step in their health journey and trauma victims return to normality.
He said plastic surgery included everything from breast enlargements and reductions, tummy tucks and face lifts to re-construction following cancer treatment and skin cancer treatment.
Dr Sharp discusses the fact that while breast augmentation is one of his most popular procedures, there is a perception that plastic surgery is only about making breasts larger - whereas in reality, many women who suffer from the size of their breasts are actually reducing their size, in record numbers.
One in eight women in their lifetime will be affected by breast cancer, and Dr Sharp also spoke to the newspaper about the flap reconstructions that local patients once had to travel elsewhere to undergo - which are now available closer to home.
The article features one of our amazing patients, Jenny, who underwent breast reconstruction with Dr Sharp last year, after a 20 year journey.
Ms Dixon was diagnosed with breast cancer in 1991 and had a mastectomy on one of her breasts and only opting for re-constructive surgery with Ipswich plastic surgeon Dr David Sharp last year. She said there were limited choices for breast cancer patients before Dr Sharp opened his practice and, not wanting to have silicone in her body, waited more than 20 years to have her breast re-constructed.
Ms Dixon said she opted for a new breast reconstruction technique that took tissue from her abdomen and used it to mold a new breast.
Dr Sharp explained that the plastic surgery industry did not gain its name from creating a Barbie-like effect in patients, but instead derived its origins from the Greek word ‘plastikos’ which means to shape or mould.
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What is the Golden Ratio or phi – and what does it have to do with modern beauty trends?
Despite the sensationalised celebrity headlines that dominate a lot of cosmetic surgery media coverage, the overriding goal of modern plastic surgery is to attain age-old natural beauty. Trends may come and go, but the formula of natural beauty - of at least, what the human eye is designed to calculate as such - hasn’t changed over millenia.
Described as the Golden Ratio or Golden Triangle, the numerical definition of ‘perfect’ beauty dates back over 2500 years, as a ratio of 1:1.618, known as ‘phi’.
The ratio refers to a ‘triangle’ of aspects for facial beauty; the width of the mouth to the width of the cheek, the width of the nose to the width of the cheek and the width of the nose to the width of the mouth. The result is a healthy, natural appearance - not over-enhanced or age-defying. It might sound like a cookie cutter version of beauty, but in application by a skilled surgeon, it tailors the objectives of the surgery around the proportions of - and distances between - each patient’s unique characteristics.
It’s often joked that plastic surgeons should be into the ‘face protection’ - not the witness protection - program. And most progressive plastic surgeons don’t want their patients to look unrecognisable or significantly altered by their surgery; they just want them to look as good on the outside, as they feel on the inside. The overdone, over enhanced look of the past is a relic of the past, and timeless beauty is in.
In our clinics, we aim to achieve this by adhering to several principles:
- We perform age appropriate plastic surgery and non surgical procedures
- We have confidence and expertise in tailoring our treatments and surgical techniques so that the patient and their plastic surgery will age well
- We work with what the patient has; their natural proportions
- Sometimes the best thing to do, is nothing at all
- We are willing to say no if a patient has unrealistic expectations of their face, breasts or body. Yes, this has disappointed and frustrated some patients, but we’d rather deal with their anger now, rather than perform a procedure that isn’t in their best interest. We’re wiling to accept that even if they vent their frustration with a nasty comment online, at least we can sleep at night knowing we’ve done the right thing!
- Unique asymmetries and facial quirks can be beautiful; some of the most universally recognised beautiful people naturally have disproportion and nuances that make them far more intriguing and interesting to look at than a formulaically beautiful person.
- We never aim to make our patients look like someone else. If they bring in a photo of a celebrity, it’s a red flag that their expectations may not be met by their end result.
- A holistic approach is always best; there’s no point having great bone structure if your skin doesn’t look healthy - or perfect symmetry if premature ageing or hollowing has taken effect. The true value and longevity of surgical results can only be realised when there is a foundation of good health and lifestyle, optimal skin care and dermal support.
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Dr David Sharp before and after photos 2017 highlights
This is a small selection of our before and after photos from 2017! Thanks to all the lovely patients who permitted us to share their images this year, to help educate others about plastic surgery and the outcomes that can be achieved.
Our patients come in all shapes, sizes and ages - and from the young to the mature aged, we believe it’s important to provide insight into the ‘real’ faces of plastic surgery; everyday patients!
Despite the fact that much of what we see on social media probably reflects otherwise, the average plastic surgery patient is not a size 8 model with perfect breasts, a blogger’s body or celebrity with deep pockets; they’re everyday people investing in their health, wellbeing - and aligning how they look on the outside, with how they feel on the inside.
This video provides an insight into the spectrum of procedures Dr Sharp performs every week.
Happy New Year to all of our amazing patients, and thank you for making us part of your journey in 2017!
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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 hype surrounding stem cell enriched fat grafting, urging caution until there is more peer reviewed research on the treatment.
There’s still a lot that is scientifically unknown about fat grafting and the general message was that we still don’t know enough about the long term risks of stem cell enriched fat grafting for aesthetic purposes. It’s hoped that current research being undertaken will shed more light.
The longevity and potential complications of both fat grafting and dermal fillers was also discussed, with some surgeons indicating a preference for fat injections for facial rejuvenation and others favouring the predictability of dermal fillers.
Panellists generally agreed that – while fat grafting results can look great for the first 4 - 6 months – about 50% of transferred fat dies off after the procedure, additional fat transfers are often required to achieve the patient’s desired result.
Brow lift vs muscle relaxing wrinkle injections
Traditional invasive brow lift procedures are reportedly dropping by 70% in the US, with some surgeons stating that cosmetic wrinkle injections are helping to stave off surgery by smoothing the forehead and subtly lifting the brow - along with a preference towards less invasive endoscopic brow lifting techniques. This discussion underlined the importance of choosing a surgeon who is familiar with progressive techniques.
Blepharoplasty (eyelid reduction)
Upper lid blepharoplasty discussions focused on the aesthetic goals for different ethnicities to retain a natural look, and the resection of skin, fat and muscle depending on the patient’s anatomy. It emphasised the importance of tailoring each procedure to the patient, and having a surgeon that feels confident with a range of techniques to make small adjustments to the structures and tissues around the eye, to provide an optimal result. Lower lid blepharoplasty (or canthoplasty and canthopexy) is performed less than upper blepharoplasty surgery; it carries greater risk of complications and disfigurement. Nonetheless it is in demand, particularly among patients who want to address sagging and hollowing under their eyes. It was interesting to hear the panel discuss their varying approaches - some of which are hybrids of common techniques - to help reduce the chance of complications and provide a natural looking result.
Facelift
Modern facelift surgery has moved leaps and bounds beyond the former ‘stretched back’ look seen in decades past, evolving into a more technically complex and nuanced procedure, so this was a very exciting segment of the program. In facial aging, changes are commonly represented by ‘vectors’, of which gravity, actinic damage, and natural aging contribute to soft-tissue ptosis (sagging). The panel shared their preferred optimal incision points, repositioning of fat pads, the use of flaps and the various depths and vectors they use for different facial types and age groups.
Also discussed was the use of laser for both scar reduction and dermal rejuvenation in conjunction with facelift surgery; something our patients routinely undergo as part of their facelift journey. It was also great to see that the SMAS technique most commonly used by Dr Sharp is considered the gold standard.
Necklift
A sagging neck and undefined jawline is one of the first signs of ageing that people notice; and one of the most commonly enquired about facial areas in our clinics. Creating noticeable, but natural, results in this area can be challenging due to the underlying structures and the fact that large, visible incisions in this area aren’t desirable and residual skin laxity and visible bands can cause dissatisfaction post operatively. The panel discussed both open and endoscopic techniques for neck lift (or platysmaplasty) to sculpt the neck, and demonstrated some hybrid techniques to provide skin reduction and contouring without large visible incisions.
Breast augmentation and implants
The second day kicked off with debates about the functional and aesthetic benefits of smooth vs textured implants, and then a discussion about subpectoral (under muscle), subglandular (above muscle) and dual plane placements . It was interesting to hear about the increased use of a combination of both implants and fat grafting for selected patients - the benefits, and the challenges that fat graft reabsorption can pose for long term results. Fat grafting is also used sometimes for mastopexies where upper pole fullness is often lacking; certainly amongst the US panellists it appeared that fat grafting is currently being used more commonly than it is here in Australia for cosmetic breast enhancement. There was an update on BIA-ALCL, with rates continuing to remain extremely low. The faculty reported that there had been 360 cases and approximately 15 deaths worldwide. The importance of following the 14 point plan pioneered by Australian plastic surgeons, and which Dr Sharp has committed to, was emphasised as a way to reduce the risk of BIA-ALCL occuring. Dermal matrix, which Dr Sharp uses for reconstructive as well as breast augmentation revision surgery, was discussed as its uses for a wider range of applications in breast surgery continue to be explored.
Breast lift and reduction
Patients often ask us if it’s possible to perform a breast reduction or lift using a periareola incision (an incision around the areola only). While the appeal of this incision is understandable, resulting in less scarring, it was emphasised that this technique is rarely suitable for large breast reductions or lifts, and often results in dissatisfaction as it limits the amount of breast tissue and skin that can be reduced. It was interesting to observe techniques being used to utilise existing breast tissue to build shape and volume during a breast reduction or lift.
Liposuction
Liposuction is commonly performed Australia, but greatly eclipsed by the scale of the procedures performed in the US. It was interesting to note that it was more routinely performed under twilight or sedation and local anaesthetic, whereas in Australia it is usually performed in accredited hospital facilities under general anaesthetic. Anecdotally, it was noted that contour deformities (the irregularities that can sometimes be observed after liposuction) occur in up to 20% of patients and that patients should be prepared for the possibility of two liposuction procedures to achieve the look they desire. With the emergence of high profile SnapChat and Instagram lipo sculpting surgeons in recent years, it was good to note that most speakers emphasised that the great before and after results we see are usually only achieved through a combination of weightloss, workouts, diet and lifestyle change and liposuction - rather than purely being in the hands of the surgeon alone. Being motivated and investing in lifestyle change as well as surgery was integral to good results.
Buttocks
The benefits and challenges of large volume fat grafting and buttock implants was discussed on day three of the symposium, with different liposuction methods compared and discussed. It was recognised that different ethnicities and body shapes compliment different buttock ideals, and that aiming to sculpt a typically Latino shaped buttock on a Caucasian male or female is unrealistic. This procedure is more popular in the US than Australia, and it was interesting to hear surgeons who see large volumes of buttock augmentation patients evaluating the risks of this procedure, and the long term results.
Thanks to the Cutting Edge faculty for hosting a highly informative and thought provoking event.
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Question of the week: do cosmetic injectables contain animal products?
I’d like to have wrinkle injections and dermal fillers but I am vegan and don’t want to use products that contain animal derivatives. Do these cosmetic injectables contain animal products, and if so, which ones?
Dr Sharp:
The products we use for wrinkle injections (muscle relaxing injections) and dermal fillers do not contain animal ingredients. Some of the first fillers did have animal origins, using cow cells.
But the modern dermal fillers we use don’t contain ingredients derived from animals.
Cosmetic injectables are TGA regulated drugs, meaning that they are medical products that require animal testing in order to be approved as safe for human use in many countries. Therefore, the cosmetic wrinkle injections and dermal fillers we use have been tested on animals, as are most medical products. Ultimately you will need to choose whether you feel comfortable having cosmetic injections, and if the procedure is aligned with your lifestyle and ideals.
Ask us your cosmetic injectables question!
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Question of the week: how many liposuction sessions will I need?
I’d like to have liposuction but I’m not sure how many treatments I will need to get a good result. I’ve also been looking into fat freezing and I’m weighing up the general anaesthetic against the number of treatments I’ll need. Will I need to have regular treatments with liposuction to maintain the results and how does it compare to non invasive options?
Dr Sharp:
Liposuction permanently removes fat cells; so once those cells are gone, they can’t return. However, if you gain weight after surgery, the remaining fat cells can grow larger, impacting your results. So maintaining a stable weight after surgery should ensure you don’t need repeat treatments in the future. Most patients with small to medium pockets of stubborn fat only require one liposuction treatment to achieve their ideal result.
The jaw-dropping total body makeover liposuction results you see on celebrities and social media are sometimes the result of multiple treatments in multiple areas, so patients can sometimes understandably have unrealistic expectation about what liposuction can achieve in one session! Patients looking to debulk entire areas such as the thighs or abdomen will sometimes require more than one session of liposuction to achieve their desired result.
In terms of fat reduction options, a number of non surgical modalities now exist that use cryolipolysis or lasers, including CoolSculpting, Clatuu, TruSculpt and SculpSure.
Whereas liposuction produces immediate fat removal with a short downtime (usually a few days to 1 week off work), non surgical fat reduction usually involves no downtime, but multiple treatment sessions with 1-2 month intervals in between; meaning the final result takes much longer to achieve.
Both can result in contour irregularities and loose skin where the fat has been removed. However, I find the ability to use a liposuction cannula to fine tune the amount of fat removed, offers unparalleled control over the final result.
Non invasive fat removal is certainly appealing for patients who have small pockets of fat, time up their sleeve to wait for results to appear - and who don’t want to undergo a general anaesthetic or downtime.
If you have loose stomach skin or muscle wall separation (rectus divarication), neither liposuction or non surgical fat removal will address your concerns and an abdominoplasty might be required.
It’s good to hear you are considering these aspects prior to having surgery; understanding the uniqueness of your body and the areas that you want to focus on is vital to choosing the right treatment plan. Talk to your plastic surgeon about your desired results and the best way to achieve your goals.
[Below: before and three months after liposuction with Dr Sharp]
Ask us your liposuction question!
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Facial Ageing Series: Upper Face Ageing
The signs of ageing are often caused by invisible changes beneath the skin’s surface. Anti-wrinkle injections can reduce fine lines and deep furrows in the upper facial area by relaxing the muscles underneath, while dermal fillers can restore lost volume. The aim is to create a relaxed look - not frozen or puffy!
SKIN
Lines appear on the forehead, between the brows and around the eyes, causing frown lines and crows feet - and a sagging appearance that can give a tired, worn look. Prolonged sun exposure causes pigmented age spots to appear, while skin around the eyes can become darker in colour and start to ‘hollow’. Wrinkle injections, dermal fillers, laser therapy and the right combination of active skincare ingredients can address these concerns.
MUSCLE
Repeated muscle action from expressions like smiling or being angry causes wrinkles to appear around the forehead between the brows and around the eyes. These wrinkles can then deepen and become more permanent - they are called ‘static’ lines, and can be softened through the use of cosmetic wrinkle injections. Likewise, as we age, we loose muscle tone in our face, which changes the shape and firmness; this can be replaced by dermal filler.
FAT PADS
The smooth, full curves that give our face a healthy, vital appearance are largely due to fat pads under our skin, which shrink and move south as we age. Diminishing fat pads cause a reduction in facial volume and the hydrated appearance of our skin. As a result, it also creates hollowing around the forehead, eyes and temples, giving a ‘sunken’ look. Dermal fillers restore lost fat, with a soft range of gel options, mimicking lost volume.
BONE
Just like other areas of the body, our facial bones also begin to diminish as we age. Even the healthiest people find that the actual structure that once provided support to the skin, muscle and fat pads decreases, loosing shape, firmness and volume. Bone loss around the eye and temples area contributes to the formation of hollows that give a sunken appearance. A firm dermal filler can be strategically placed to replace lost bone structure in the upper face.
What causes upper face ageing?
Lines on the forehead, crow’s feet and those deep furrows between the eyes are the result of repeated muscle contractions from our facial expressions.
When our skin loses elasticity as well, these lines stay put, even when our face is at rest - these are called static lines. These lines can prematurely age the face, making us look older or more worn than we feel. Consequently, they’re an areas that areas many women and men would like to do something positive about. [Right: before and after wrinkle injections for crows feet].
Will I look frozen puffy or fake with cosmetic injections?
Our approach to upper face ageing is committed to producing natural-looking results. This is achieved through our techniques, the type of product injected - and the amount used.
What is it like to have cosmetic wrinkle injections or dermal fillers?
Anti-wrinkle injections are a quick, safe, non-surgical option for smoothing out the upper face area. For muscle relaxants, minute injections into the muscles underneath cause them to temporarily relax. The treatment takes a few minutes, and over the coming days and weeks you’ll notice a softening of the appearance of lines and creates smoother looking skin. Dermal fillers can also be used to restore the volume and moisture loss that also accompanies the passage of time, creating a plumper, more hydrated look. Around they eyes they can add volume above your eyes to achieve a less tired look and, when combined with anti-wrinkle injections, contribute to an overall rejuvenation of the upper face. Dermal fillers are injected using a fine needle or cannula, and create an immediate result.
Simple and in most cases very tolerable, anti-wrinkle injections have a greater effect when they are done regularly - every 3 to 4 months preferably.
How long will the treatment last?
Fillers last up to 24 months, and anti-wrinkle injections last 3 to 4 months.
Which cosmetic injections are right for me?
Consult an experienced and qualified clinician before undertaking any cosmetic facial changes; despite being non-invasive, incorrectly administered wrinkle injections and dermal fillers can still create undesirable alterations to the face. Dermal fillers and wrinkle injections should only be prescribed after a facial assessment has been undertaken to ascertain the best products, and placement, for your long term results. To talk to a clinician about your areas of concern, and which treatment plan is best for you, call our friendly team on 3202 4744 or email info@drdavidsharp.com.au
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The Difference Between Saline and Silicone Breast Implants
Breast augmentation surgery increases the volume of the breast for women with naturally small breasts, as well as replacing depleted volume following breastfeeding or weight loss.
It can also be used to change the breast shape for women who have developmental and chest wall deformities, such as tubular breasts or asymmetry. We often get asked about the difference between saline and silicone implants, and their risks and benefits.
The ‘shell’ of a breast implant is made from an inert polymer called silicone; this can be either smooth or textured. Smooth walled implants move around subtly in the breast pocket, which means they can mimic the movement of a natural breast - and textured implants encourage soft tissue ingrowth into their small surface interstices, keeping the implant more stiffly in place.
Breast implants have a variety of base widths, projection amounts and volumes (measure in ‘cc’). There’s no one size fits all approach to breast augmentation; the best implant for each breast is thoughtfully selected and matched to the corresponding space to achieve the specific goals for each patient; indeed, sometimes two different implants will be selected for one patient, as each breast can be different.
What are breast implants filled with?
Silicone gel breast implants
Silicone gel is an inert polymer with no known human allergies, sensitivities or reactions. Likened to the consistency of turkish delight or gummy bear sweets, the molecules are stuck to one another in a cohesive matrix. In comparison to saline, it flows differently within its shell and can often create a more natural look and feel to the breast, like breast tissue, while retaining more form and shape. These are by far the most-commonly used type of breast implants in Australia.
Saline breast implants
Saline is sterile water. These prosthesis consist of a silicone shell containing saline water. Underneath thin skin, folds of a saline implant might be seen or felt more easily, causing a rippling or wrinkling appearance. These implants are less commonly used in modern plastic surgery.
How have breast implants improved or changed over the years?
Silicone gel implants were first created in the late 1960s and have undergone several different evolutions, with modern generation implants featuring technological improvements. Saline implants are an alternative to silicone, becoming popular in the 1990’s, and decreasing in popularity since the early 2000’s. Over the last 20 years, significant advances have been made in silicone gel implants; both in safety and function, but also in their physical characteristics, options and the aesthetic result they produce. Contemporary silicone implants have a slightly higher fill (96% fill versus the previous generation’s 85% fill) and more cross linking of the silicone molecules, increasing the cohesiveness of the silicone.
What variants of silicone implants are available?
Variable cohesiveness of silicone implants
Different degrees of cohesiveness (cross linking of the silicone molecules) are now available in silicone gel breast implants. The least cohesive implants are softest and flow most easily, and are most commonly used for routine breast augmentation using round implants. Higher cohesive silicone implants tend to hold their shape most firmly, with potential advantages for post-mastectomy breast reconstruction. For anatomical implants, a higher cohesive gel is used in order for them to hold their shape, and achieve the specific projection or balance of fullness that the patient requires to achieve their desired result.
How do we know breast implants are safe?
Silicone gel breast implants are the most widely studied medical device in the history of medical devices; primarily because so many women have them (last year 1.5 million implants were implanted worldwide). Historically, silicone gel implants received negative publicity in the 1980s and 1990s, with apparent claims of adverse associated health problems, prompting removal and replacement of older silicone implants with saline filled devices. But since that time, silicone implants have changed dramatically - and extensive clinical research with long term follow up has confirmed no association between silicone gel implants and breast cancer or chronic autoimmune disease. In more recent times, breast implants have been linked to anaplastic large cell lymphoma (ALCL); a very rare cancer of the implant capsule (not cancer that originates in breast tissue) and that can be effectively treated, when detected early. Recent media reports may have caused confusion amongst women who have - or are considering getting - breast implants for augmentation or reconstruction. This post clarifies what we know about BIA-ALCL.
The breast implants Dr Sharp primarily uses are of extremely high quality, and carry the lowest possible risk of ALCL forming.
For more information about breast augmentation, breast implant science and safety, visit a RACS qualified plastic surgeon who is an ASPS member - and #doyourhomework before having any cosmetic surgery procedure.
Ask us your breast implant questions!
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Can I Breastfeed After A Breast Reduction?
Research shows that when women who have had a breast reduction are compared to a group of women of similar weight who haven’t had a breast reduction, their breastfeeding rates are about the same (approximately 65%).
It is important to remember that breast reduction surgery involves the nipple being moved to a new position, which can result in disruption of the nerve supply to the nipple and areola. It can also disrupt the milk glands and milk ducts.
%
can breastfeed
However, it’s important to note that nerves can regrow, albeit slowly - and glandular tissue can develop during pregnancy. In most cases, we find this occurs and patients are able to breastfeed successfully.
If you are having a breast reduction and plan on breastfeeding in the future, you should discuss this with your surgeon. [Left: breast reduction before and after surgery with Dr Sharp].
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BIA-ALCL breast implant associated cancer update – August 2017
Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is a very rare cancer that can be effectively treated, when detected early. Recent media reports may have caused confusion amongst women who have - or are considering getting - breast implants for augmentation or reconstruction. This post seeks to clarify what we know about BIA-ALCL.
Last year 1.5 million implants were inserted worldwide. The number of people having breast implant surgery in Australia has risen by more than 1,000% since 2005, from approximately 4,000 per year - to over 40,000. More people have implants now than ever before, and so we would expect the number of people reporting complications now to be proportionally higher than what they were 5, 10 or 20 years ago.
The TGA has been posting updated information about BIA-ALCL since 2011. As of August 2017, we haven’t seen one case of BIA-ALCL in our clinic, nor amongst our patients.
What is BIA-ALCL?
It is a cancer of lymphatic cells; a form of Non-Hodgkin’s Lymphoma (not breast cancer).
What causes BIA-ALCL?
Media focus has concentrated predominantly on implants, but there’s actually 4 unifying factors that contribute to an increased risk of BIA-ALCL:
• Textured implants with a high surface area texture
• Bacterial contamination at the time of surgery
• Patient genetic predisposition
• Time for the process to develop
How long does BIA-ALCL take to develop?
An average of 7-10 years after implant insertion. But women who have breast implants should regularly check their breasts for changes at any stage after breast augmentation surgery - most of all for actual breast cancer, which occurs in 1 in 8 women, whether they’ve had augmentation surgery or not.
What is the treatment and prognosis?
Early stage disease is curative with surgery alone. Advanced disease requires chemotherapy. Disease which has spread through the capsule and formed a mass - or which has spread to local lymph glands - has a worse prognosis. There have been 12 deaths world wide; 3 of these were in Australia.
How common is BIA-ALCL?
It is a very rare cancer. Patients who have the implants in place that Dr Sharp predominantly uses (see below) have a 1 in 60,000 chance of developing ALCL.
If I have textured implants, do I need to have them removed?
If you have no symptoms, you do not need to have your implants removed.
Do some implants have a reduced risk?
Yes; as mentioned above, according to the current available data, the chance of developing ALCL if you have the textured cohesive gel implants that Dr Sharp predominantly uses, is 1 in 60,000. For other brands of implants, this rate can be as high as 1 in 4,000.
What are the symptoms of BIA-ALCL?
The common presentation is fluid swelling around the breast implant and in the space between the implant and breast implant capsule – called a ‘late seroma’. The diagnosis of the tumor is made by examining the seroma fluid.
Is BIA-ALCL breast cancer?
BIA-ALCL not breast cancer. Breast cancer affects 1 in 8 Australian women
How common are textured breast implants?
There are approximately 60 million textured breast implants implanted in women. Of these, there have been only 388 independent confirmed cases of BIA-ALCL. 55 of these were in Australia.
Which breast implants does Dr Sharp use?
It is important to know the name of your breast implants, however TGA regulations prevent us from naming the brand publicly. Dr Sharp’s patients receive their breast implant identifying details (including brand name, style, size and lot/reference number) after their surgery. If you can’t locate this information, we are able to provide the implant details if you send us an email or call us on 3202 4744. The implants Dr Sharp uses are backed by substantial clinical data demonstrating safety. The evidence continues to support the safe use of these implants, which have the lowest rate of BIA-ALCL.
What does Dr Sharp do to reduce his patients’ risk of developing BIA-ALCL?
ALCL has been associated also with bacterial infection at the time of surgery. Dr Sharp upholds the highest hygiene standards when implanting. He only performs breast augmentation surgery in accredited hospitals. He has committed to the Macquarie 14 Point Plan which is a series of steps that can be taken by surgeons to reduce infection risk for implant cases. The names of the surgeons committed to these risk reduction measures in their operative techniques are publicly available here.
Further information from the TGA, ASPS (Australian Society of Plastic Surgeons) and ASAPS (Australian Society of Aesthetic Plastic Surgeons) is located in this media release and information sheet.
If you have had breast augmentation surgery and have any concerns, it’s important to:
- Promptly discuss any concerns you have with your treating surgeon.
- Be informed about the type of implants you have had placed; your surgeon should be able to provide you with this information.
- The Australian Society of Plastic Surgeons and the Australian Society of Aesthetic Plastic Surgeons urges women with breast implants to be vigilant in monitoring for any changes or swelling in their breasts and to contact their doctor if this occurs.
BIA-ALCL is a very rare disease, but as always, it is important to know your breasts, monitor them and if you notice changes, promptly speak to your surgeon – we encourage regular self examination and prompt investigation of any concerns. We always set aside consultation time for urgent concerns, to ensure our breast augmentation patients are offered a consultation with Dr Sharp as quickly as possible if they are worried about their implants.
If you are considering breast augmentation surgery and have any concerns:
- Ask your surgeon as a first point of contact; with so much information online, it’s easy to consult forum chatter before your surgeon! Your plastic surgeon is being kept up to date with the latest facts and research, so they have the most accurate information available.
- Don’t proceed with surgery if you have doubts or concerns. Breast augmentation surgery isn’t medically required or something you have to do in a fixed time frame. It’s important to feel 100% comfortable and confident before proceeding with any cosmetic procedure, so don’t hesitate to postpone or cancel your plans if you are unsure of, or uncomfortable with, the risks.
- Book additional consultations with your surgeon if you need more information.
If you have any concerns, please contact us on 3202 4744 or info@drdavidsharp.com.au
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