Our Face To The World
Our face is a big part of how we see ourselves and how others see us.
Plastic surgery has long been involved in the restoration, reconstruction and alteration of the human face and body.
Reconstructive surgery aims to reconstruct a part of the face or improve functioning after accident or illness, cosmetic or aesthetic surgery aims at improving the appearance.
These surgeries can also have the psychologically benefit of restoring or increasing self confidence by improving our perception of ourselves.
Ear Surgery - Otoplasty
Prominent Ears – Ear Pin-back surgery is a realativly straight forward operation. Around five percent of the population) are born with ears that haven’t fully unfolded.
Most of our patients are younger children who come in with their parents wanting to have their child’s prominent ears pinned back. However we also see quite a few adults who have always wanted to have it done. Our oldest patient was in his seventies.
For children, surgery is best timed when the child is old enough to understand and cooperate with postoperative healing. This is usually around the age of six or seven, just before starting school.
Dressings are left on for a couple of days before switching to a lighter dressing and a head band protecting the ears is worn for a few weeks until the wounds mature and the reshaped cartilage has healed.
The surgery takes about 1.5-2 hours usually under a general anaesthetic. For older adults a general anaesthetic is necessarily so if the patient prefers this surgery can be done with a local anaesthetic.
An Incision is made behind the ear to hide any scaring and to access the cartilages. The cartilage is refashioned to the desired shape and special sutures are put in place to pin the ear back.
On occasions the ear lobes may also need to be adjusted to achieve a better balance. The postoperative pain is normally not bad and settles quickly in the first day or two and can be easily managed simple Panadol not long after surgery.
What are some the risks of Otoplasty?
Infection– this is rare and usually easily treated with oral antibiotics. Occurring even more rarely, infection of the cartilage is possible and treating this is slightly more involved.
Bleeding– While also vary rare can occur. If blood accumulates under the cartilage it may require another trip to the operating theatre to clear it out so that the ear heals nicely in the intended shape.
Recurrence- The risk of ear “popping out again is very small. We use special sutures and suture techniques designed to prevent this and if it ever happens, we would redo the procedure and waive our surgical fee.
Risk of poor scar healing– the incision site normally heals very well but the scar risk for each individual is different.
My Baby's Ears look Different- What Can Be Done?
There are many differences in ear size and shape. Some ears are big, some are small, some children are born with no ears some others have an extra fold called crus in the ear.
If attended to very early (in the first few weeks of life) surgery can often be avoided. This is because in the new born there are still mother’s oestrogen circulating in the baby’s system and this makes the ear cartilages very malleable.
New moulding techniques can be used over a course of 2 months to permanently correct ears. There are proprietary kits now available such as Ear Well system (google it) that avoids surgery in babies. Custom made moulds and splints can be created and be applied.
Different looking ears may improve over time without any intervention. However there are specific ear differences that do not. If remedial action is taken early, a much better result may be achieved without the need for surgery.
Ear Lobe Correction
Repairing stretched or split earlobes is a very common reason for seeking surgery.
Stretched earlobes are most often caused by wearing heavy earrings’ over many years and while this can in some cases also cause split ear lobes these patients have usually experienced some trauma such as an earring accidentally being torn out.
Correcting these problems can be an office based procedure under local anaesthetics, or if a patient would prefer it can be done under general anaesthetic.
What can be done depends on the laxity of the remaining skin. The fix the problem, depending upon the extent of the damage, there are a several different patterns of “skin flaps” that can be raised to close the gap. This allows us to refashion the ear lobe so that once the wound heals any scaring is hidden. The soft tissue is rearranged to close the ear lobe and in most cases it is possible to have ear rings again.
The Risks from Earlobe Surgery are Minimal
Infection– very unusual and effectively treated with oral antibiotics.
Bleeding– very unusual.
Scarring– Scarring while generally not an issue it toes tend to be specific to your genetic makeup, skin colouring etc.
We will consider your past history in this area and discuss this with you on the day of the consultation.
With care and maintenance the effects of time and ageing can be delayed. However the inevitable process eventually brings about particular changes in the face.
Changes in the fat distribution is the most obvious. Volume around the eyes is lost, bone structures around the face change and soft tissue descends to form the well-known Marionette lines and jowls.
Facial rejuvenation is about a combination of techniques to bring about a fresher appearance. Fillers or more permanent solution like fat grafting can be used to restore the volume where it has been lost. Other non- surgical options such as Botox and laser can also be helpful in improving the overall appearance of a person’s face. If needed a facelift and or neck-lift can also be done to address the areas where non-surgical options aren’t able to be applied.
Sometimes when the non-surgical options aren’t enough, a face-lift aimed at addressing extra skin and smoothing out jowls can dramatically reduce the signs of ageing. When this is combined with a neck lift it results in a better profile and much fresher appearance.
The scar is usually hidden just in front of the ear. Also depending upon what is required, It is sometimes placed behind the ear and into the hairline.
The skin tension of closure must be carefully planned to ensure that after the initial healing period the scar is not noticeable.
The time taken for the operation depends on the type of facelift but is usually between three and five hours under general anaesthesia.
Are There Different Types of Face-lifts?
There are different types of face-lift which are all largely dependent upon what is needed.
In most cases a face-lift requires much more than just tightening the skin. It usually requires that that the firm underlying layer of the face called the SMAS (Superficial Muscular Aponeurotic System) is also lifted.
The SMAS is the layer that has the strength and firmness to hold the newly refreshed facial contours.
Over tightening of this layer is what gives the terrible “wind-blown” look, an unfortunate hallmark of bad surgery.
What Are The Risks In Face-lift Surgery
Infection– relatively rare and it can be effectively treated with oral antibiotics.
Bleeding– This is also fairly rare but can occur after any operation. If this bleeding causes a collection of blood under the skin, called a haematoma, it rarely impact on the long term outcome but it can require returning to the operating theatre to clean out the blood and stop any points of bleeding that were not evident at the time of surgery.
There are a number of factors that predisposes one to increased risk of bleeding- blood thinner medications, fish oil, many food substance starting with “G“- garlic, ginkgo, ginseng. Interestingly males are also predisposes to an increased risk of bleeding.
Poor scar healing– As a general rule the darker your skin the greater the risk of a scar not healing well. While this does not take into account each individual’s variation in genetics the pigment in your skin does dictate the likelihood of you forming obvious scars. We will be discussed with you in detail on your consultation.
Please note Dr Kim will not perform facelift on current smokers, the risk is just too high. All aesthetic procedures are a partnership between the patient and the surgeon- you must stop smoking for 2 months prior to all aesthetic surgery.
Nerve injury– This is rare and permanent nerve injury even more so. Recovery time from nerve injury varies greatly from very brief, have you ever hurt your funny bone, others can take quite some time.
A longer term nerve injury “neuropraxia” can take takes days or weeks to recover and some nerve injuries are permanent. However rare, nerve injuries around the face can in rare circumstances have serious consequences- they could result in numbness in the ear or inability to move some muscles in the face. Extreme vigilance on your surgeon’s part is imperative.
A Neck-lift often done in concert with a face-lift and can range from a simple liposuction proceedure to a more complex operations involving muscles and the removal of tissue.
Simple neck lift– this is for those that have some excess fat below the chin. A liposuction is done to improve the contour without any incision.
Neck-lift with skin incision– This involves a combination of an initial liposuction after which extra skin is addressed with incisions hidden around the ear.
Comprehensive neck-lift– This combines the above above techniques with additional small transverse skin incision below the chin to smooth out the so called “turkey neck”. This turkey neck happens because the muscles fiber in your neck called platysma becomes stretched and forms two lines or bands.
The operation consists of bringing these muscles back together again at the midline.
Potential complication of a neck lift is similar to the facelift discussed above.
Rhinoplasty may be for functional and/or aesthetic reasons.
Functional issues often arise due to sinus or a previous broken nose and maybe require a more in depth functional nasal surgery in conjunction with an Ear Nose and Throat surgeon.
Aesthetic concerns are usually about a bump or kink on the nose, or a bulbous tip that a patients wants refined. Issues like a deviated nose may have both aesthetic and functional which can be remedied by surgery.
Different methods of rhinoplasty are employed depending upon the issue and areas that need to be addressed.
How is Rhinoplasty Performed?
Depending upon your unique anatomy and circumstance there may be one of more of the below procedures required to achieve the desired result.
Incision– Usually an “open” approach where a small one centimetre incision is made between the nostrils to gain access into the nasal structures.
If the concern is just the bump it may only require a small hidden incision along the line of the nostril. The bump is then gently shaved down to give you a more pleasing profile.
Inside work– Operations such as straightening a deviated septum not only have a great impact on appearance but can also include functional nasal surgery at the same time to improve breathing. Interestingly, the septum, which is the middle partition between right and left nasal cavity, is a common source of extra cartilage material used for altering the shape of the nose.
Nasal bone work– Where a person desires to reduce the width of their nose to give a more balanced appearance it can require shaving the actual bone structure to give that balance.
Tip work– Using different suture techniques relocating cartilage from the septum or elsewhere the tip is re-defined and any imbalance or tilt of the nose can be corrected. For more complex cases such as reconstruction after severe trauma a small part of rib may be borrowed to create a better contoured nose.
Following Rhinoplasty – You will experience some discomfort the worst is usually passed in 24-48 hours. Swelling and bruising is normal and the time it takes to subside largely depends upon the type of rhinoplasty performed.
The final result usually be seen in around two months.
Inside Work – If you have had inside work done you may also have internal and external splints to guide the healing.
The internal ones will need to come out a day or two after the initial surgery. The outside splint will stay on for another week and tapes to help reduce swelling will remain for a couple of weeks after that.
You will be given nasal washes, antibiotics and pain relief to ensure your recovery is smooth.
What Are The Risks in Rhinoplasty?
Infection– Though relatively infection is possible so you will be provided with prophylactic antibiotics to further minimise this risk after the surgery.
Bleeding– Bleeding can occur and while a little light bleeding is no concern, excessive nose bleed that may require a return to operating theatre. Fortunately this is also very rare.
Failure to achieve the desired result-Perfect symmetry can be difficult to achieve depending on what you start with.
Dr Kim will see you at least twice before the surgery to fully assess your needs and make sure you are both understand and agree on the desired result and what is possible.
Risk of poor wound healing– This is very rare in rhinoplasty where the incision made is very small.
Face-lift & Neck-lift Surgery
Face-lift and Neck-lift surgery may be required for cosmetic reasons or functional reasons such as after a stroke that affects facial muscles.
Cosmetically these procedures can smooth out facial lines and reduce the signs of aging. A facelift can also reduce the apearance of a stroke and even restore more natural function by tightening the affected facial muscles.
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British Medical Association House
Level 6 Suite 603
135-137 Macquarie St
7 Ashley Lane
Westmead NSW 2145
Phone 1300 911 151
Fax (02) 9475-1370
© 2019 Dr Leo Kim firstname.lastname@example.org