Plastic Reconstructive & Aesthetic Surgery

Guide to Cosmetic Plastic Surgery

2 3

Table of Contents

Welcome .....................................................................3

Introduction .................................................................4

Deciding to have surgery .............................................5

What are your expectations? .......................................6

General Risks & Complications ....................................7

Additional Information ...................................................8

Anaesthesia – Information for Patients .........................9

Risks of Smoking .......................................................10

Patient Consent Form ................................................11

Checklist ...................................................................12

Surgical Procedure Information

Breast Enlargement / Mammaplasty .................... 13-16

Breast Lift / Mastopexy ........................................ 17-18

Breast Reduction / Mammaplasty ........................ 19-20

Brow Lift / Forehead Lift ...................................... 21-23

Chin & Cheek Augmentation / Facial Contouring .......24

Ear Surgery / Otoplasty ....................................... 25-26

Eyelid Surgery / Blepharoplasty ........................... 27-28

Face & Neck Lift / Rhytidectomy .......................... 29-31

Portrait / Laser Resurfacing ................................. 32-33

Lipostructure / Fat Grafting ........................................34

Liposuction / Lipoplasty ....................................... 35-36

Nose Reshaping / Rhinoplasty ............................. 37-38

Tummy Tuck / Abdominoplasty ............................ 39-41

Non-Surgical Procedure Information

Gentle Skin Treatments – C & E Skin Care, Retin-A ....42

Gentle Skin Treatments – Microdermabrasion ............43

Laser Hair Removal ...................................................44

Lip Enhancement & Quick Wrinkle Treatments

– Injection Therapy .............................................. 45-46

Specialised Surgery

Breast Reconstruction – after Mastectomy .......... 47-52

Your Next Step ..........................................................53

Notes .........................................................................54

2 3

Thank you for choosing to visit my practice. Over my

twenty years as a Plastic Surgeon, I have seen the life

changing, positive results that can come of it, and I look

forward to working with you to achieve your goals.

The decision to undergo any surgery is not to be taken

lightly. Information and knowledge is essential for any

patient, so their expectations are well-informed.

This book has been designed to help inform patients

that may be considering Plastic Cosmetic surgery. The

information includes descriptions of procedures, expected

results, general surgery risks, and specific procedure risks

and complications.

Prior to any surgery, I have a minimum of two consultations

with each patient. This is my preferred method so I may

discuss at length the best option for you.

Should you have any questions at all, please do not

hesitate to call the surgery on 07 5539 1000.

I look forward to seeing you again,

DR TERRENCE SCAMP

One of the most important factors in the success of

aesthetic (plastic/cosmetic) surgery is the surgeon

you select. That is why you need to know about

the qualifications and experience of your Aesthetic

Plastic Surgeon.

Dr Scamp is a graduate of the University of Queensland

and underwent his internship at Princess Alexandra

Hospital in Brisbane. Two years after graduation he

moved into surgical training and obtained experience in

vascular, orthopedic, neurosurgery and general surgery.

He commenced his specialized training Plastic and

Reconstruction Surgery in 1986 at the Royal Brisbane

Hospital, returning to Princess Alexandra Hospital in

1987 for further training in Plastic Surgery. In 1988, he

commenced three and a half years of international training

in Scotland, Bristol, Harley Street London, Belgium,

Slovenia, Germany and USA. Dr Scamp received specific

training in a Cosmetic Fellowship in Harley Street from

Europe’s leading aesthetic surgeon, Mr. Frederick V.

Nicolle. Dr Scamp obtained his specialist qualifications as

a member of the Royal Australasian College of Surgeons in

the division of Plastic and Reconstructive Surgery in 1990.

Dr Scamp is invited regularly to give lectures on

cosmetic and reconstructive procedures within Australia

and overseas.

QUALIFICATIONS AND ACCREDITATIONS

Fellow Royal Australasian College of Surgeons

Member Australian Society of Plastic Surgeons

Member Australasian Society for Aesthetic Plastic

Surgery

Member American Society for Laser medicine and

Surgery Corresponding International

Member American Society of Plastic and

Reconstructive Surgeons

Welcome To Our Practice

4 5

Making A Change

The term Plastic Surgeon comes from the Greek plastikos,

which means to mould or give form. Plastic Surgery

enables us to mould or re-form the human body. The Plastic

Surgery specialty encompasses both reconstructive and

aesthetic (cosmetic) surgery.

Statistics show that each year, millions of people undergo

aesthetic procedures to enhance a particular feature of

reduce visible signs of aging. In recent years, aesthetic

surgery has grown in popularity among both women and

men.

Many people choose aesthetic surgery to give themselves

added confidence in social or work situations, a

psychological boost or simply to help them look as young

as they feel. Often, improving a feature of your face or

body will enhance self-image, and that can help you to

make positive changes in many areas of your life. Having

realistic expectations about aesthetic surgery increases

the likelihood that you will be happy with the results.

If you recognize a specific area in which your appearance

could be improved and you have a strong personal desire

to make a change, then you may be an ideal candidate for

aesthetic plastic surgery.

CHOOSING A QUALIFIED SURGEON

One of the most important factors in the success of your

plastic surgery is the surgeon you select. Many people are

surprised to learn that some doctors performing plastic/

cosmetic surgery today have had no formal surgical

training. That is why you need to ask the right questions

before you schedule a consultation.

Don’t be confused by other official-sounding certifications.

A Plastic Surgeon is a ‘specialist’ like a Cardiologist is

for the heart or a Neurosurgeon is for the brain. A Plastic

Surgeon will have a fellowship of the Royal Australasian

College of Surgeons and be a member of the Australian

Society of Plastic Surgeons.

You can ring the Australian Society of Plastic Surgeons to

confirm qualification on: 02 9437 9200. Remember to look

for this symbol.

4 5

If you are well motivated, have realistic expectations

and select a qualified Plastic Surgeon, chances

are you will be happy with your decision to have

aesthetic plastic surgery. Here are some things you

should know before going ahead.

FEES

Fees for Plastic Surgery generally are paid two weeks

prior to your surgery. Cost varies and depends on factors

including the complexity of the operation, where the

surgery is performed and what type of anaesthetic is

administered.

PRIVATE HEALTH INSURANCE

Some Plastic Surgery is not covered by insurance; however

this depends on your Health Fund and type of coverage.

There are certain procedures, such as rhinoplasty,

otoplasty, breast reduction and abdominoplasty that may

address functional problems as well as improve your

appearance. In such cases, Medicare will rebate a small

amount and your Health Fund may also pay your hospital

costs. For other Cosmetic Procedures please contact your

Health Fund to see if they cover cosmetic surgery.

SURGICAL FACILITY

Dr Scamp operates at Accredited Hospital Facilities. This

could be Pacific Private, Pindara Hospital or another

accredited facility. These facilities will only allow accredited

Specialists to operate.

ANAESTHESIA

Most larger procedures are done under general

anaesthesia. Sedation and local anaesthesia may be an

option. Appropriate anaesthesia type will be recommended

to allow you minimal discomfort.

RISKS OF SURGERY

Please refer to risks and complications in this book.

however, Plastic Surgery moulds and reshapes living

tissue, and the results are not absolutely predictable.

No surgeon can offer risk-free surgery or guarantee a

perfect result.

BEFORE AND AFTER SURGERY

Dr Scamp will give you all the information you need to

prepare for surgery and recovery. You will be asked to

avoid smoking for six weeks prior to surgery. Certain

other medications and supplements are to be avoided

two weeks prior to surgery, such as aspirin, red wine

and vitamin E. Following your procedure, there may be

restrictions to your activities for several days to several

weeks. Plan your business and social activities to allow

sufficient time for recovery. All patients are provided with

our after hours phone number so you may be in contact at

all times through your recovery.

Deciding To Have Surgery

6 7

• To perform any cosmetic surgical procedure an

anaesthetic will be necessary, which will be a general

anaesthetic or local anaesthesia and sedation if

appropriate.

• There can be no absolute guarantee with any surgery.

The real aim of surgery is improvement. It is important

you realize the limitations of what is possible with

cosmetic surgery. Further operations may occasionally

be needed after surgery to correct complications that

have occurred.

• It is important that you read all of the risks and

complications outlined in this book and discuss these

with Dr Scamp.

• NO SURGERY IS GUARANTEED. Cosmetic surgery

is unique in that you, the patient, request the surgery.

Misunderstandings may result if you do not explain

precisely to the surgeon what is desired. You must

be quite specific as to exactly what you want the

surgeon to perform. It is important that you realize the

limitations of what is possible with cosmetic surgery. It

is also important that you realize that there may not be

a successful result after the surgery is performed.

What Are Your Expectations

6 7

“PATIENT MUST READ PRIOR TO ANY SURGERY

OR SIGNING OF CONSENT FORM”

It is important that Dr Scamp and the Anaesthetist are

made aware before the operation of any medical problems

or drugs you are taking. If you are allergic to any drugs you

must also make that known before surgery.

The operation will result in a scar. Make sure you are fully

aware before the surgery as to the nature, extent and

position of the scar. Occasionally scars can become very

thickened, red and painful (keloid). Fortunately this is not

common.

Any unwanted bleeding can result in a collection of

blood below the tissues. This is called a haematoma. A

haematoma can occur after an operation. It increases

the appearance of bruising. There will be swelling and

the healing of the wound may be slow and it may spoil

final results. Re-operation may be required to drain the

haematoma.

Infection can occur with any surgery. If the wound becomes

red and/or painful after discharge it is important that you

inform Dr Scamp immediately.

If you are on any drugs that thin the blood (Aspirin,

Warfarin) you must make sure that your surgeon is aware

of this so that they con inform you as to whether you need

to stop taking them prior to surgery.

Smoking before or after surgery can increase the risk

of complications. These range from increased bruising

to major would breakdown, skin loss and failure of flap

surgery. Smoking must be ceased six weeks (at least) prior

to surgery. This includes nicotine patches.

Dr Scamp may have specific requirements that you may

need to undergo before your surgery. This may include

exercise, weight loss and cessation of smoking. Should

you not adhere to Dr Scamp’s advice then the final result

may be impaired.

GENERAL RISKS

1. Would infection (treatment with antibiotics may be

needed)

2. Pain and discomfort around the incisions

3. Haematoma (an accumulation of blood around the

surgical site that may require drainage)

4. If blood loss during surgery has been large, a

transfusion may be needed: this is uncommon

5. A blood clot in a leg or the chest (deep vein thrombosis)

that will require further treatment; rarely, a clot can

move to the lungs and become life threatening. Gentle

exercise and stopping smoking reduce the risk of

blood clots.

6. Nausea (typically from the anaesthetic, usually settles

down quickly)

7. Heavy bleeding from the incision

8. Keloid or thickened scars (most scars fade or flatten,

but some may become “keloid” and remain raised,

itchy, thick and red. A keloid can be annoying but it

is not a threat to health. Additional surgery or injection

treatment may be needed to try to improve the scar)

9. Slow healing (more likely to occur in smokers)

10. Separation of wound edges

11. Chest infection (more likely to occur in smokers)

12. Complications due to the anaesthesia and allergies

to anaesthetic agents, antiseptic solutions, suture

material or dressings. Anaesthetic risks are best

discussed with your anaesthetist before your surgical

procedure.

General Risks & Complications

8 9

SCARS

Every wound in the body heals with a scar formation. It is

not always possible to predict the outcome and the quality

of the scar. The quality of the scar will depend on the

patient’s age, healing ability and the site on which the scar

is located. However, some scars may take many years to

mature. Occasionally further surgery may be required to

improve the appearance of scars.

PAIN

Different patients and different operations will produce

differing amounts of pain. Occasionally pain and sensory

change may persist for a considerable time. The techniques

used are designed to minimize pain.

Dr Scamp will discuss with you prior to your operation

the amount of pain expected and medication, which will

be given. Increase in post-operative pain may be a sign

of impending complications and the surgeon must be

notified immediately.

RESTRICTION OF ACTIVITY

Wound healing is aided by some restriction in activities.

This will minimize discomfort and reduce the risk of

complications.

COMPLICATIONS

Complications can arise as a result of the anaesthetic or

indeed the surgery itself. All of these complications are

discussed previously.

Additional Information

8 9

Dr Scamp likes his patients to have optimal comfort when

having surgery. Therefore, he prefers to use General

Anaesthetic for most larger procedures; sedation and local

anaesthesia may be an option for your procedure.

An Anaesthetist is a highly trained specialist who after

graduation as a doctor spends at least six more years

training in anaesthesia, pain control and the management

of medical emergencies.

Your Anaesthetist will assess you before the operation,

select the most appropriate anaesthetic for you and

monitor you throughout the surgery. He is also in charge

of pain relief.

YOUR ROLE BEFORE SURGERY

There are some things you can do to make your surgery

safer:

• Get fitter – regular walks will do wonders

• DO NOT SMOKE – ideally for at least six weeks prior

to surgery. Patients are at a higher risk if they are

smokers. Smoking can also cause wound breakdown

• Drink less alcohol

• Tell your surgeon and Anaesthetist of any drugs you

may be taking

• Do not take any aspirin or aspirin based drugs two

weeks prior to surgery

• Tell your surgeon if you have any cold or flu

Ask your Anaesthetist if you have any more questions or

you are anxious about anaesthetics.

YOUR ROLE AFTER SURGERY

When you wake up you will feel drowsy. You may have

a sore throat, you may feel sick or have a headache.

You may also feel dizziness, blurred vision or short-term

memory loss. This should all pass soon.

If you are having day surgery, make sure someone

accompanies you home and stays with you for the first

night. Do not drive or use dangerous equipment, drink

alcohol or sign any documents for at least 24 hours.

DO NOT EAT OR DRINK ANYTHING SIX HOURS

PRIOR TO SURGERY

If you have any further questions or concerns please

contact the Southport Anaesthetist Group on 07 5532

3667. The staff will be able to assist you further.

Anaesthesia - Information For Patients

10 11

All procedures in plastic surgery are performed to improve

form and, in some cases, function. Our goal as Plastic

Surgeons is to have a perfect form and scar. Unfortunately,

smoking and secondary smoke affect wound healing in

potentially a very devastating way. Any exposure to

smoke either directly or indirectly can result in poor wound

healing, delayed wound healing, skin loss necessitating

skin grafting, increased risk in wound infection and loss

of skin and deeper tissues, all resulting from decreased

blood supply to those areas. The diminished blood flow to

skin wound edges can cause the breakdown of skin and

scabbing.

FACELIFT OPERATIONS

There can be actual skin loss of the face in front and

behind the ear.

BREAST REDUCTION AND MASTOPEXY

OPERATIONS

There can be delayed wound healing, resulting in

unsightly scarring and skin loss and potential nipple loss

necessitating skin graft. In all cases of patients exposed

to smoke or directly smoking, wounds do not heal in a

normal length of time. Wound healing can be prolonged,

as long as three - four months.

FOREHEAD LIFT

There can be hair loss, poor wound healing and scarring.

ABDOMINOPLASTY

Smoking or exposure to smoke again will decrease the

ability of the skin to heal properly resulting in unsightly

scarring and higher risk for infection and more importantly,

skin loss sometimes requiring a skin graft.

For any surgery requiring flaps (Facelift, Forehead Lift,

Abdominoplasty, Breast Reduction, Mastopexy, TRAM

Flap) you need to stop smoking (and patches) six to eight

weeks before surgery.

Slow wound healing (months instead of weeks); skin loss

resulting in scabbing; and prolonged need for dressing

changes and infection, usually involving the need for

antibiotics (but sometimes another surgery to drain the

infection), all are complications that can occur if you smoke

or are exposed to smoke. (Instead of less than 5%, it can

be as high as 100% risk).

Smoking is not as critical for Liposuction, Blepharoplasty,

Breast Augmentation or Rhinoplasty as these operations

do not involve skin flaps. Ceasing two - four weeks prior to

surgery is advised.

Smoking/Secondary Smoke & Would Healing

10 11

Please read the information provided in this book about the specific procedure you are having and the risks and

complications that can occur prior to signing the consent form.

Please make sure prior to signing this form, or having the operation performed, that any questions you have are fully discussed

with Dr Terrence Scamp. Please also ensure you have read the general complications and risks and those that apply to your

specific procedure/s set out in this booklet.

Dr Scamp has discussed all specific complications and risks for my procedure/s with me personally. Knowing the risks and

complications, I have requested to undergo the following cosmetic surgery:

Procedure

Name

Address

Dr Scamp has explained to me that sometimes during surgery it is discovered that additional or other surgery is needed. Life

threatening occurrences will be treated at Dr Scamp’s discretion. I However, if the additional surgery is not immediately life

threatening:

I authorize Dr Scamp to proceed

I do not authorize Dr Scamp to proceed

I acknowledge that Dr Scamp has provided me with information concerning the procedure and available alternative treatments,

and has answered my specific queries and concerns to my satisfaction.

I acknowledge that no guarantee has been made that the surgery will improve the condition.

Signature of Patient/parent/guardian:

Date:

I declare that I have personally explained the nature of the patient’s condition, the need for treatment, the operation to be

performed and the risks and alternatives outlined in this book.

To the patient or

To the patient’s parent/guardian

Signature of Doctor:

Date:

CANCELATION POLICY FOR SURGERY

All surgery bookings must be paid for two weeks in advance of the surgery date. If surgery is cancelled with less than five

working days notice 20% of the total fee is retained by Dr Terrence Scamp which will be credited to your next surgical booking.

These monies will not be refunded in the event you choose not to go ahead with surgery. If less than 24 hours notice is given,

50% of the total fee is retained which will be credited to your next surgical booking. These monies will not be refunded in the

event you choose not to go ahead with surgery.

I have read and understand the Cancellation Policy

Signature of Patient/parent/guardian:

Date:

Consent Form

12 13

QUESTIONS YOU MAY WISH TO ASK (Please tick)

What are the surgeon’s qualifications and experience?

Does he have a FRACS in Plastic & Reconstructive

Surgery?

Are they a member of ASPS?

Do they perform the procedure on a regular basis?

Are hospital costs included?

Do they have a special technique relating to the

procedure?

If yes, how does this differ from other surgeons and

what is the benefit to me?

Are there any complications associated with the

procedure?

If complications do occur or the procedure is not

successful, how will the surgeon deal with these?

Where will the surgery be performed?

Will a qualified Anaesthetist administer the anaesthetic

and/or sedative medication?

Are these fees included in the treatment cost?

Do they have a consent form outlining the procedure for

your review?

Will there be any bleeding, swelling or bruising? How will

these be managed?

Will there be any discomfort following the procedure?

How will this be managed?

Will I need time off work?

Are there other post-operative side effects?

Will there be any visible scarring following the

procedure? How can this be minimized?

What aftercare will be provided and will this be included

in the treatment costs?

Do I have any options other than surgery?

Will Medicare cover any of the procedure costs?

MEDICATIONS TO CEASE TWO WEEKS PRIOR TO

SURGERY

Unless prescribed by Dr Terrence Scamp do not take the

following medications two weeks before or after surgery.

• Anti-inflamitories

• Alka Seltzer, Arthrexin, Astrix

• Aspirin, Aspalgin, Aspro-clear

• Brufen (Ibuprofen)

• Cardiprin

• Cartia, Celebrex, Clinoril

• Cialis

• Clexane

• Codis

• Codral, Coumadin

• Diclofenac

• Disprin, Dipyridamole

• Dolobid (Diflusinal)

• Ecotrin

• Feldene

• Heparin

• Indocid, Indomethacin

• Naproxen, Naprosyn, Naprogesic

• Nonsteroidal antifalammatories

• Nurofen, Mobic

• Orudis

• Ponstan, Plavix

• Persantin

• Repro

• Solcode, Sulindac, Solprin

• Sildenafil

• Tagamet, Tadalafil

• Ticlid

• Toradol

• Voltaren, Veganin

• Viagra

• Warfarin

If pain relief is required, you may take paracetamol

or codeine such as Panadol, Panamax, Dymadon or

Panedine.

Patient Checklist – For Cosmetic Surgery

12 13

BREAST ENLARGEMENT

Breast enlargement, also called augmentation

mammaplasty, is designed to increase the size of small

or underdeveloped breasts. Surgery can also restore and

enhance your breast volume if it has decreased as a result

of having children.

The incision for placement of your implants can be made

underneath your breast, just above the crease; around the

lower edge of your areola (the pigmented skin surrounding

your nipple); or in your armpit. A pocket is created for the

implant either behind your breast tissue of behind the

muscle between your breast and your chest wall.

Following surgery, you may wear a dressing. There will

be some swelling and discolouration that will gradually

disappear. You should not engage in vigorous activities,

especially using your arms, for up to three weeks. You

should be able to return to work within a week or two.

There is a great deal of scientific evidence supporting

the long-term safety of breast implants. During your

consultation, Dr Scamp will discuss with you the known

risks associated with implants.

If you are in the appropriate age group for mammographic

screening, having breast implants will not change your

recommended exam schedule. Following surgery,

be sure to select a technician who has experience in

mammography of augmented breasts. The presence

of breast implants requires modified mammographic

techniques and additional X-ray views.

Breast augmentation enlarges small or underdeveloped breasts. If your breasts have decreased in size, implants

can restore and enhance your breast volume.

The incision can be made underneath your breast, just above the crease; around the lower edge of your areola (the pigmented area surrounding your nipple); or in your armpit

The implant is placed in a ‘pocket’ that is created directly under your breast tissue or underneath your chest muscle.

Following surgery, your breasts will be fuller and you may feel more self confident about your appearance.

Breast Enlargement

14 15

BLEEDING

Some blood loss during and after surgery is to be expected.

This may be drained away by a small drain inserted in each

breast. In general these drains stay for one or two days,

although this does not mean that confinement to hospital is

required for this period. In fact, most commonly surgery is

performed as a day patient and you will be discharged with

a dressing on your chest and sometimes a drain from one

or both sides. If sudden severe bleeding occurs, returning to

the operating theatre may be required for control of bleeding

and removal of the blood clot. If the blood clot is left, it may

result in infection or increased risk of Capsular Contracture

(see below).

Bleeding is most common where aspirin has been taken

recently. This should be avoided for at least two weeks

prior to surgery. High doses of vitamin E may also lead to

bleeding and this should be avoided for a similar period.

Bleeding is more common in smokers and can even occur

with increased frequency in people who drink red wine, as

this also has a mild aspirin like effect.

INFECTION

Infection can be serious in breast augmentation. A

prosthesis (the breast implant) is a foreign body and does

not have your natural immunity to infection. Severe infection

may result in removal of the prosthesis and this may have to

be left out for three months until the tissues have settled and

the infection controlled. If the infection is very severe, the

wound may open and the prosthesis may start to come out

(extrusion). With some types of prosthesis, a new prosthesis

will be required at the second operation. This undoubtedly

creates great inconvenience and of course further expense.

Every care is taken to carefully clean and disinfect the

wound prior to surgery. Antibiotics are given at surgery

intravenously and are to be taken as capsules after surgery.

Despite this, infection may still occur in approximately 2%

to 4% of operations. The signs of infection are increasing

pain, redness and swelling in the breast. It is rare for this

to occur before two to three days after surgery, but may

occur many years after surgery through mechanisms

which are not clear.

LOSS OF SENSATION

Some loss of sensation after breast augmentation surgery

is common. Usually it is at the lower portion of the breast.

The site of the incision, be it in the armpit, around the

edge of the nipple or below the breast is not related to

sensory loss. It is dissection of a “large pocket” to allow

the prosthesis to move naturally that tends to stretch and

disturb the nerves. In general, sensation recovers well three

to six months after surgery. When the sensation to a nipple

is lost, this may well take over a year or more to recover.

However, most cases recover in the time mentioned above.

It is possible to lose sensation permanently to one or both

nipples after breast augmentation surgery. Fortunately this

is extremely rare.

SCARRING

To insert the implants, the operative incisions may be made

in the armpit, around the edge of the pigmented skin near

the nipple (areola) or in the fold below the breast (infra-

mammary fold). Most commonly the incision around the

nipple is used. This incision usually heals well to leave a fine

scar on the border of the pale and pigmented skin which is

not cosmetically obvious. It is also the easiest hidden of all

the incisions and permits access if re-operation is required.

Rarely scars may remain red for extended periods of time

or thicken markedly (keloid).

ROTATION OF IMPLANTS

Where anatomical form-stable implants are used there is

about a 2% risk of rotation which may require re-opertaion.

MALPOSITION OR MIGRATION OF THE IMPLANT

Malposition or migration of a prosthesis, contraction of the

chest muscle or shrinking of the scar capsule can push a

prosthesis and make it sit in an inappropriate position. This

is usually corrected several months after the initial surgery

when the scar is matured by reopening the original incision

and relocating the prosthesis. In some people there is

a natural difference in the two breasts and therefore the

prostheses tend to lie in slightly different positions. If this is

a natural and not unattractive feature, it is best left. However,

if it is troublesome and can be corrected, it may be possible

through the original incision.

Possible complications of mammaplasty

14 15

CAPSULAR CONTRACTURE

Capsular Contracture refers to the shrinkage of the scar lining

wall in the large pocket that is dissected during surgery. The

prosthesis lies within this pocket and moves within it, as the

breast moves on the chest wall. If this scar capsule shrinks

and forms a ‘contracture’, it may push the prosthesis in an

inappropriate position or make it feel firm or hard. It is hoped to

prevent this complication by regular massage of the prosthesis

within the pocket after surgery where smooth implants are

used. If the massage is done properly, a large space should

be maintained and the prosthesis should feel soft. Textured

implants have a wall that is designed to interact with the scar

tissue and generally requires little or no massage. Where the

scar capsule shrinks, re-operation may be advised to maintain

the new pocket. Capsular Contracture is the most frequent of

complications after breast augmentation surgery and occurs in

approximately 10% - 20% of patients. It may be subtle and of

no particular note, but it can also be quite severe and make

the prosthesis feel very hard. Fortunately, this is a rare outcome.

Some patients will repeatedly form hard scar tissue, even when

scar release has been done. This may lead one to the position

where either removal of the prosthesis is advised or one is forced

to live with a firm breast. Again, fortunately this situation is a rare

outcome.

BREAST SAG

The presence of a breast prosthesis may contribute to sag as

years go by. In general however, the scar capsule lends some

support to the prosthesis and the breast, and sag is not a

remarkable feature. It is more common to occur if pregnancy

also occurs. If sag of a breast occurs, a repositioning procedure

(mastopexy) can be performed. This will entail more scarring

than the original breast augmentation incision.

AUTO IMMUNE DISEASE

This is a broad group of diseases which affect the bones, joints,

skin and soft tissues. They have no known cause and breast

prostheses were accused of causing these also. In fact, scientific

research has shown that patients with breast prostheses have

no increased risk of these conditions.

RUPTURE OR LEAKAGE OF A PROSTHESIS

Saline salt water filled prostheses have a leak rate of

approximately 1% per year. Leaking prostheses will need to

be replaced. Saline-filled prosthesis have the same wall as

silicone gel-filled prostheses. This wall is made of plasticized

silicone (silastic). Modern silicone gel-filled prostheses are more

viscous and less prone to spread if rupture occurs. In general

these prostheses are strong and rupture requires a substantial

force. An estimate of leak rate for the modern silicone prosthesis

is not yet available. It is known to be substantially reduced on

the silicone prostheses of the late seventies about which much

adverse publicity has been heard.

If a prosthesis is to rupture and silicone leaks into the breast-

tissue usually there is little to detect. A firm lump may develop

which is usually pain-free. Just like any breast-lump, it would

need to be investigated and most likely excised. If the prosthesis

becomes infected then the breast would certainly become

painful and red and further surgery would be required.

PALPABLE RIPPLING OR RIDGING

Saline prostheses have a tendency to fold when placed in the

human body. This may create ripples or ridges that can be felt or

seen in certain positions. This is particularly true where there is

little overlying covering fat or breast tissue and is therefore more

of a risk in the slim patient. Whilst silicone gel-filled prostheses

also show folds, these are very soft and it is much less common

for them to be visible or felt. As well as being more prone to this

complication, saline-filled prostheses are in general firmer to touch

than gel-filled prostheses. Saline-filled prostheses are best used in

people with sufficient fat or breast tissue to mask this.

RISK OF BREAST CANCER

Breast prostheses were accused at one stage of leading to

an increased risk of breast cancer. In fact, scientific research

based on many thousands of patients with or without breast

prostheses has shown that patients with breast prostheses have

a reduced rate of breast cancer. The reason for this is not clear,

but the reduction is quite substantial (over 30%).

MAMMOGRAPHY AFTER BREAST AUGMENTATION

After breast augmentation, mammography can still be

performed. The examination has to be more thorough than in

people without prostheses. Even allowing for this, there is still

approximately 10% of the breast tissue that cannot be seen on a

mammogram when a prosthesis is present. However, combined

with careful examination of the breast by the hand, this will

hopefully not result in any delay in diagnosis of a breast lump.

The occurrence of any complication after breast augmentation can

result in further discomfort, inconvenience and expense. Every care

is taken to reduce the risks of these complications. Please ask if you

require any further information on any of these topics.

Possible complications of mammaplasty

16 17

MAMMOGRAPHY

Implants may interfere with the detection of breast cancer

using mammography, a type of X-ray examination. If you have

had breast cancer, a family history of breast cancer, or may

have other risk factors for breast cancer, tell your surgeon.

As implants could possibly rupture from squeezing of the

breast during mammography, always tell the radiography

technician that you have implants.

To achieve a better examination of breast tissue, some

women may need to have additional tests such as

specialized mammography, ultrasound or MRI (magnetic

resonance imaging). Specialised mammography will require

more exposure to X-rays, but the benefits in better cancer

screening are greater than the risks of the extra X-rays.

There is no evidence that breast implants increase the

risk of breast cancer, although the question has been

considered. It is important that women learn how to perform

breast self examination. They should examine themselves

monthly for lumps, in addition to having any regular tests as

recommended by their doctor. Your surgeon may suggest a

follow-up appointment for an examination of the breast for

lumps and to asses the implants.

BREASTFEEDING

Intact implants do not normally interfere with lactation. Many

women with implants have successfully breastfed their

babies. Not all women can breastfeed successfully, including

those who have not had breast enlargement surgery. If

complications occur, lactation and breastfeeding may be

adversely affected.

Questions have been raised about whether the health of

babies of breastfeeding women could be affected in some

way. Indeed, many children’s medicines contain silicone,

as do many other food and drinks. No evidence has been

produced to show that babies develop or are vulnerable to

any illness because their mothers have breast implants.

OUTCOME IN THE LONG TERM:

Breast size and shape will change due to pregnancy, weight

loss and gain, and as a normal process of aging. Breast

implants will not stop the effects on breast size and shape

caused by these situations.

Report to Dr Scamp at once if you have any of these

unexpected side effects:

• Fever (more than 38oC) or chills

• Heavy bleeding from the incision

• Drainage of blood or body fluid from the incision that

persists beyond the first day after surgery

• Increasing pain in the breast

• Redness around the incision that is spreading

• Tenderness and marked enlargement of either breast

• Any other concerns regarding your surgery

Other Issues about Implants

16 17

A breast lift, also called mastopexy, raises and re-contours

loose, sagging breasts. You may decide you would like a

breast lift because you have lost tone in your breasts after

having children. Another frequent reason for having this

procedure is the loss of a significant amount of weight.

A breast lift improves the appearance of your breasts in

several ways. It elevates your breast tissue, removes excess

skin from the lower portion of your breast and then reshapes

your remaining breast skin. At the same time, it relocates

your nipple and areola (the pigmented skin surrounding your

nipple) to a higher position. If your areolae have stretched over

time, they can be reduced in size. Women who have their

breasts lifted often may decide to also have them enlarged. If

this is the case, an implant is placed behind the chest muscle.

A commonly performed breast lift technique (see illustrations)

uses incisions that follow your breast’s natural contour. The

resulting scar, which is permanent but will fade to some extent

over time, encircles the areola and then extends vertically

down the breast and horizontally along the crease underneath

the breast. There are other breast lift techniques that may

eliminate the horizontal incision, the vertical incision, or both.

The use of any particular pattern of incisions depends on

individual patient factors and Dr Scamp’s recommendation.

Following surgery, your breasts will be wrapped in a dressing.

Swelling and discolouration are to be expected but will

gradually subside. You may experience decreased breast or

nipple sensation, which is usually temporary. You should be

able to return to work within one of two weeks.

When breast augmentation and lift are performed

simultaneously, there is a raised risk of revisional surgery

being required. It may be recommended in an individual case

that these procedures be performed six months apart.

A breast lift elevates and reshapes loose, sagging breasts

Using this common technique, incisions follow your breast’s natural contour, defining the area of excision and the new location for the nipple. Skin in the shaded area is removed, and your nipple is moved higher. Variations

in the placement of incisions may be used, depending on individual patient factors and surgeon recommendation.

Skin formerly located above and to the sides of your nipple area is brought down and together to reshape your

breast.

After surgery, your breasts will be positioned higher and feel firmer. The resulting scars are permanent but will fade

to some extent over time.

Breast Lift

18 19

The operation will keep the patient in hospital for only a day or

two. Sometimes it can be done as a day patient.

Although every effort will be taken to make sure that the

breasts are made the same size and contour, a small degree

of difference may occur. This is common amongst all un-

operated breasts also.

There will be significant and obvious scars in the early months

after the surgery. The prominence of these scars will gradually

reduce with time. Usually the shape of the scar will involve a

circular scar around the nipple; a vertical scar passing below

the nipple line down to meet a curved horizontal scar, which

may be long, and passes from near the midline in front to

outside the breast near the armpit. The horizontal part of the

scar is long, following large reductions, and would normally be

visible at each end but usually only on close inspection. The

vertical scar usually fades and has a tendency to be slightly

stretched. Sometimes the scar may be more thickened than

normal and this may be associated with them becoming red,

thick and itchy. This is called a keloid change. The scars can

usually be improved by a second operation if desired.

Sensation of the nipple may be affected. This can range from

complete loss through to mild reduction in sensation.

Very occasionally there may be a breakdown in the wound

edges, particularly near the junctions of the vertical and

horizontal scars. This is a temporary nuisance and requires

regular dressings but rarely makes any difference to the overall

final results.

Post-operative haematoma (unwanted blood collecting under

the skin and breast tissue) and infection may occur. This can

lead to delay or complete failure of the healing process. This

may require an operation to drain either the infection or the

collected blood. This may have an adverse outcome on the

final quality of the result of the operation.

The operation is planned in such a way as to try and ensure an

adequate blood supply is maintained to all the remaining parts

of the breast (skin, fat, breast tissue and nipple). On some

rare occasions the circulation is inadequate and some of the

tissues may die. Although this is uncommon it is more likely to

occur in patients with very large breasts and patients with very

poor circulation. This may mean that the surgeon may have to

compromise and alter the size and shape from that which is

desired in order to maintain an adequate circulation.

Patients who have had a mastopexy (lift) may not be able

to breast feed. Part of the breast tissue may be separated

from the normal anatomy of the ducts and the nipple. On

other occasions circulation may be too limited in reduction

operations on enormous breasts. In order to stop the nipple

from dying, it may be essential to graft its attached nipple

high up on the breast tissue. This will make breast feeding

impossible. Often the tip of the nipple can take up to one

month to heal after this special operation.

Post-operative pain is difficult to assess. Sometimes patients

have differing amounts of pain in each breast. There should

be no great discomfort and there may be some tender spots

but these are usually temporary. Increasing or severe post-

operative pain is usually a sign of complications and your

surgeon should be notified immediately.

Report to Dr Scamp at once if you have any of these

problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding from the incision

• Leakage of blood or body fluid beyond the first day after

surgery

• Increasing pain in either breast

• Redness around the incision lines that is spreading

• Tenderness and marked enlargement of either breast

• Any other concern regarding your surgery

Specific Risk of Mastopexy

18 19

Breast reduction, also called reduction mammaplasty,

enhances your overall appearance by making your breasts

more proportional to the rest of your body.

Large, sagging breasts often interfere with normal physical

activities. They can cause back pain, postural problems,

deformities of the back and shoulders, skin rashes and

breast pain. For these reasons, breast reduction generally

is considered a reconstructive plastic surgery procedure.

In addition to alleviating physical problems, however, it

improves the shape of your breasts and nipple areas.

The operation is performed under general anaesthesia

and may be done as a day patient or during hospital

stay. During the procedure, excess breast tissue and

skin is removed, your nibbles and areolae (the pigmented

skin surrounding the nipple) are repositioned, and your

remaining breast tissue is reshaped.

A commonly performed breast reduction technique (see

illustrations) uses incisions that encircle the areola and

then extend vertically down the breast and horizontally

along the crease underneath the breast.

After surgery, your breast will be wrapped in a dressing.

Loss of breast or nipple sensation is possible, but usually

is not permanent. You should be able to return to work

within two weeks.

A breast lift elevates and reshapes loose, sagging breasts

Using this common technique, incisions follow your breast’s natural contour, defining the area of excision and the new location for the nipple. Skin in the shaded area is removed, and your nipple is moved higher. Variations

in the placement of incisions may be used, depending on individual patient factors and surgeon recommendation.

Skin formerly located above and to the sides of your nipple area is brought down and together to reshape your breast.

After surgery, your breasts will be positioned higher and feel firmer. The resulting scars are permanent but will fade

to some extent over time.

Breast Reduction

20 21

The operation will keep the patient in hospital for only a

day or two. Sometimes it can be done as a day patient.

Although every effort will be taken to ensure that the breasts

are made the same size and contour, a small degree of

difference may occur. This is common amongst all un-

operated breasts also.

There will be significant and obvious scars in the early

months after the surgery. The prominence of these scars

will gradually reduce with time. Usually the shape of the

scar will involve a circular scar around the nipple; a vertical

scar passing below the nipple line down to meet a curved

horizontal scar, which may be long, and passes from near

the midline in front to outside the breast near the armpit. The

horizontal part of the scar is long following large reductions,

and would normally be visible at each end but usually only

on close inspection. The vertical scar usually fades and

has a tendency to be slightly stretched. Sometimes the

scars may be more thickened than normal and this may be

associated with them becoming red, thick and itchy. This

is called a keloid change. The scars may be improved by a

second operation if desired.

Sensation of the nipple may be affected. This can range

from complete loss through to mild reduction in sensation.

Very occasionally there may be a breakdown in the wound

edges, particularly near the junctions of the vertical and

horizontal scars. This is a temporary nuisance and requires

regular dressings but rarely makes any difference to the

overall final results.

Post-operative haematoma (unwanted blood collecting

under the skin and breast tissue) and infection may occur.

This can lead to delay or complete failure of the healing

process. This may require an operation to drain either the

infection or the collected blood. This may have an adverse

outcome on the final quality of the result of the operation.

The operation is planned in such a way as to try and ensure

an adequate blood supply is maintained to all the remaining

parts of the breast (skin, fat, breast tissue and nipple). On

some rare occasions the circulation is inadequate and

some of the tissues may die. Although this is uncommon

it is more likely to occur in patients with very large breasts

and patients with very poor circulation. This may mean that

the surgeon may have to compromise and alter the size

and shape from that which is desired in order to maintain an

adequate circulation.

Patients who have had a reduction mammoplasty may not

be able to breastfeed. Part of the breast tissue may be

separated from the normal anatomy of the ducts and the

nipple. On other occasions circulation may be too limited in

reduction operations on enormous breasts. In order to stop

the nipple from dying, it may be essential to graft its attached

nipple high up on the breast tissue. This will make breast

feeding impossible. Often the tip of the nipple can take up

to one month to heal after this special operation.

There is no documented risk that this operation will produce

breast cancer in any way. If anything it actually lessens the

chances of this danger because breast tissue is removed.

The operation does not make normal breast examinations

more difficult once the healing process has settled down.

If anything, a smaller tumor would be easier to detect

because its relative size is bigger in a smaller breast.

Post-operative pain is difficult to assess. Sometimes

patients have differing amounts of pain in each breast. There

should be no great discomfort and there may be some

tender spots but these are usually temporary. Increasing or

severe post-operative pain is usually a sign of complications

and your surgeon should be notified immediately.

Contact Dr Scamp if you have any of these problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding from the incision

• Leakage of blood of fluid beyond the first day after

surgery

• Increasing pain in either breast

• Redness around incision lines that is spreading

• Tenderness and marked enlargement of either breast

• Any other concerns you have regarding your surgery

Specific Risks of Breast Reduction

20 21

A brow lift, also called a forehead lift, corrects the loss of tone

that causes sagging of your eyebrows and hooding of your

upper eyelids. A brow lift usually softens the deep creases

across your forehead. It reduces the horizontal frown lines at

the top of your nose and the vertical lines between your brows.

The result is a more relaxed and refreshed appearance.

A brow lift is often performed along with a facelift or other

facial rejuvenation procedures. Some people have inherited

traits that cause them to have a brow lift as early as early as

their 20s or 30s.

One technique for performing a brow lift requires an incision

across the top of the scalp, beginning above your ears. The

incision may be placed toward the middle of the scalp where

it is hidden within your hair or at the front of the hairline.

Through this incision, you plastic surgeon can modify or

remove parts of the muscles that cause wrinkling or grown

lines, remove excess skin and lift your eyebrows to a more

pleasing position.

Most patients are good candidates for an endoscopic brow

lift. The endoscopic brow lift is a minimally invasive technique

that requires several very small incisions into the scalp. The

endoscope, inserted through these tiny incisions, allow your

plastic surgeon to see and work on the various internal

structures of the forehead.

After surgery, you will have temporary puffiness and

discolouration that may involve your eyelid and cheek areas

as well. You may experience numbness and itchiness of your

scalp. You may experience some loss of hair around the scar

region. You should be able to wash your hair in a few days

and be back to work within 10 days.

A brow lift corrects droppingor drooping eyebrows and eyelid tissues, forehead creases and frown lines that can

make you look worried or angry.

One common approach to a brow lift involves an incision across your scalp, a few inches behind your hairline

or along the hairline. An alternative for some patients, the endoscopic brow lift, uses several small incisions (indicated by ovals) within the hairline. The number of

incisions and their placement may vary.

After surgery, your eyebrows will be elevated, your forehead will be smoothed and you will look relaxed and refreshed.

Brow Lift

22 23

SCARRING

The incision will obviously result in a scar formation. The

scars are usually pink to start with, generally fade and

become white, soft and supple over the next three -12

months. The scar is in the hairline but may become visible

with parting of the hair. Keloid scars are rare and are a

thickening, inflammatory process which occurs in scar

tissue. These are not due to a surgical fault but due to a

peculiarity of the patient’s healing process. Small hairless

areas can sometimes be found adjacent to the scar but

these can usually be hidden with the hair. Hair growth will

recommence after three months.

INFECTION

Infection may occur and will be treated by the usual

techniques. This may involve being admitted to hospital for

intravenous antibiotics and further drainage procedures.

Further surgery may also be required.

NUMBNESS

It is usual to have some temporary numbness around the

forehead and scalp. This is due to surgery coming close to

the nerves in this region while the skin tightening is being

carried out. The numbness is usually fully recovered within

six to 12 months and is rarely troublesome. Post-operatively

there is normally discomfort because of the tightening

rather than pain. Post-operative pain should be brought to

the attention of your surgeon as this may be an indication

that complications are developing.

NERVE INJURY

One of the worst complications as a result of this operation

is damage to the facial nerve. This is the nerve that supplies

all the muscles of expression to the face. This results in

weakness of the facial muscles, causing drooping brows. It

is uncommon but it can occur. Fortunately most cases that

do occur correct themselves spontaneously within a period

of sic months. As with all cosmetic surgery the problems

have to be weighed against the benefits.

HAEMATOMA

A haematoma is a collection of blood under the skin. This

is due to bleeding in the post-operative period. This may be

severe and may cause loss of some of the skin on the face.

It normally requires further surgery to drain and remove the

clot as it forms. Every step should be taken to reduce this

including the patient stopping treatment with drugs with

aspirin or other blood thinning agents prior to surgery.

ALOPOECIA

Hair loss may occur following brow lift around the suture

lines. Patients with thinning hair and those having a tendency

to Alopoecia are prone to great hair loss. Most hair loss is

corrected by a new growth within six - eight months.

BRUISING

Black eyes are usual in the post-operative period and

may last up to two - three weeks. This bruising may be

minor or severe. In some instances, a collection of blood

or fluid may accumulate underneath the skin necessitating

drainage. A second anaesthetic may be required if this

accumulation is large.

After the surgery, the aging process continues at its natural

rate. Some patients do request a repeat operation years

later. It is usually no more difficult than before.

It is not usual at the operation to get as much tightening

as can be obtained with fingers in front of a mirror. It is,

however, possible to produce a significant degree of

improvement.

The operation lifts the skin off the deeper tissues and thus

compromises its blood supply. In most people the normal

healthy reserve of skin copes well with this. In the smoker,

the pre-existent damage done to the blood vessels in the

skin may result in an area of the skin dying leaving a scar.

This can also happen in the non-smoker but it is much

more rare. For this reason smoking must cease six weeks

prior to surgery. In general this allows the tissues to recover

although the risk of skin loss still persists and is probably

higher than it is for the person who has never smoked.

Specific Risks of a Forehead Lift

22 23

ASYMMETRY

Asymmetry may occur in the final result. Each person has

a unique facial structure, which is different from the left to

the right side of the face. This may result in some difficulty

in achieving complete symmetry of the final result. Many

attractive faces are naturally asymmetric.

WOUND BREAKDOWN

Infection may lead to wound breakdown of part or all

of the brow lift suture line. Wound breakdown may

require treatment conservatively through dressings and

debridement, or surgical treatment, utilizing skin graft and

similar techniques.

PIGMENTATION

Patients who bruise easily have a greater tendency

to hyperpigmentation. Patients who have multiple

telangiectasis (broken capillaries) frequently have an

increase in the number of telangiectasis in the areas of

undermined skin.

NEED FOR FURTHER SURGERY

This is uncommon, but may take the form of scar revision,

drainage of haematoma or treatment of infection. This may

also include treatment of unforeseeable complications as

mentioned before. If this occurs, there may be an additional

cost incurred for which you are responsible.

Contact Dr Scamp if you have any of these problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding from the incision

• Leakage of blood or fluid beyond the first day after

surgery

• Redness around incision lines that is spreading

• Any other concerns you have regarding your surgery

Specific Risks of a Forehead Lift

24 25

The contours of your face may be enhanced by a variety of

techniques. Chin augmentation (also called genioplasty or

mentoplasty) strengthens the appearance of a receding chin

by increasing its projection. Similarly, the cheekbones can be

made fuller, creating a more sculpted look, using implants.

Facial implants provide a permanent and predictable result.

Sometimes fat may be injected into specific areas to restore a

more youthful fullness to your face. Treatment with fat injections

may need to be repeated to maintain improvement.

The goal of chin augmentation is to improve your profile by

creating a better balance between your chin and other facial

features. Increasing the projection of your chin will not affect

your bite of jaw function.

There are several techniques for adding prominence and

contour to your chin. One, performed through an incision inside

the mouth, requires moving the chinbone. A more common

approach involves insertion of a chin implant. The implant

is inserted through incisions inside your mouth or on the

underside of your chin. In the latter case, surgery usually leaves

only a faint scar that is barely visible underneath the chin.

To permit proper healing following the chin augmentation, you

may be placed on a liquid diet for a day or two. Your chin may

be taped or bandaged.

Augmentation of your cheekbones is achieved by placing a

specially designed implant over them. The procedure usually is

performed through an incision inside the mouth, but it may be

done through a lower eyelid or a brow lift incision.

After a chin or cheek augmentation, you will most likely be up

and about the same day, but your activities will be restricted.

You should be able to return to work within one to two weeks.

A third technique involves insertion of your own fat into the soft

tissues of the chin to build it out. This technique is very safe but

survival of the fat can be unpredictable and a repeat procedure

may be required (see Lipostructure on Page 29).

Chin augmentation strengthens the appearance of a receding chin.

In one approach, the lower section of bone is moved forward and wired into position.

An alternative approach involves inserting an implant between the bone and chin tissue through a short

external incision under your chin or through an incision made inside your mouth between the lower lip and gum. Similarly, your cheekbones may be built up by placing an

implant over them.

After surgery, you will have a more balanced profile and pleasing facial contour.

Chin and Cheek Augmentation

24 25

Otoplasty can improve the shape of positioning of your

ears. It also can reduce the size of your ears if they are

large in proportion to your other features. If your ears

protrude more than normal, surgery can reposition them

closer to your head.

Ear surgery often is recommended for children of six years

or older as they near total ear development at age five of

six. Correction of the ears prior to the child entering school

helps to eliminate potential psychological trauma from the

teasing of classmates. Adults may also have their ears

reshaped. As long as you are in good health, there is no

upper age limit for the surgery.

The supporting tissue of the ears, called cartilage, is

reshaped in order to position your ears closer to your head.

This usually is accomplished through incisions placed

behind your ears. Subsequent scars will be concealed in

the natural skin crease.

After surgery, you will need to wear a bandage for seven

days to ensure that your ears heal in their new, corrected

position. You will need to avoid strenuous exercise and

contact sports for several weeks. You can resume most

non-strenuous activities within a week. You will need to

wear a head band at night for four weeks.

Otoplasty to correct large or protruding ears may be performed as early as age 5 or 6, when the ears are near

full development.

Surgery seen from the back of the ear, left to right. (a) Incisions are made and a small portion of skin,

sometimes with underlying fat, is removed. (b) Cartilage is recontoured to bring your ear into it’s correct position and supported with sutures. (c) Stitches close the incisions,

leaving a faint scar.

Surgery seen from the front of the ear. Reshaped cartilage restores the ear fold, making your ear lie flatter

against your head.

After surgery, ears have a normal appearance.

Ear Surgery

26 27

The appearance of the will depend upon its initial size and

shape. The healing process after the operation will also

be a factor and will largely dictate the degree of normality

of the operation. Perfect symmetry between the two ears

cannot be guaranteed.

The post-operative pain is normally minimal after 24 - 48

hours. If pain persists, Dr Scamp should be consulted as

this may be an early sign of complications developing.

To be able to reduce the risk of fluid accumulating under

the skin, a fairly bulky and tight bandage will commonly be

used, which needs to be kept in place for one week. This

may cause some discomfort particularly in hot weather.

A haematoma is due to unwanted bleeding occurring

between the skin and the cartilage of the ear. Immediate

post-operative bleeding is a potential but an unusual

complication; which may require urgent return to the

operating theatre, in order to evacuate any clot that has

formed and prevent further bleeding.

Any trauma to the ear after the bandages are removed

may also cause bleeding and this may necessitate further

surgery. However, some oozing can occur following the

surgery and may be visible on the outside of the bandage.

Provided this does not persist it should not cause any

problems.

The ears will look a little swollen and bruised when

the bandages are first removed. Patients commonly

experience some numbness and abnormality in the feeling

of touch over the skin of the ear. It should generally return

over the next few months.

Infection is a rare complication but can cause severe

damage and deformity to the ear cartilage. This may

prevent adequate wound healing which may require further

surgery and may also reduce the quality of the final result.

The incision normally heals with only a minimal scar

behind the ear. Usually the result is excellent and because

of its location the scar is unnoticeable. Some patients,

unfortunately, may develop a very thickened, red, itchy,

swollen scar (a keloid) which may require subsequent

treatment.

Even in the hands of very experienced surgeons, a second

operation to correct residual asymmetry or a minor

irregularity may also be needed.

The operation is usually performed at a patient’s request.

If possible, the surgery should not be performed until the

child is aware of the deformity and will cooperate with the

surgery. This is usually age six or older.

The length of hospital stay may vary with individual cases.

Almost always the surgery is performed as a day patient.

Contact Dr Scamp if you have any of these problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding

• Increased swelling around surgery site

• Increasing pain

• Redness around incision lines that is spreading

• Any other concerns regarding your surgery

Specific Risks of Otoplasty

26 27

Cosmetic Eyelid surgery removes the excess fat and

wrinkled, drooping skin of the upper eyelids that can make

you look constantly tired or sad. It also eliminates bags

under your eyes and tightens your lower eyelid skin. The

result is a more alert and rested appearance.

Eyelid surgery is often performed along with a facelift or

other facial rejuvenation procedures. Some people have

inherited traits that cause them to have eyelid surgery as

early as their 20s or 30s.

Fat and loose skin are removed from your upper eyelid

area through and incision that is hidden within the natural

eyelid fold. The incision extends slightly beyond the

outside of your eye where it easily blends into existing

laugh lines or other creases. If your upper eyelid problem is

aggravated by sagging of your eyebrows, then Dr Scamp

may recommend a brow lift.

Treatment of the lower eyelids often requires an incision

that is hidden just below your lower lashes. Through

this incision, excess skin, muscle and fat are removed

or adjusted. Sometimes fat may be repositioned to

eliminate puffiness or bulges. If your lower eyelid skin is

not excessive, Dr Scamp may decide to use a different

technique that removes fat through an incision placed

inside the lid. A laser is sometimes used, if necessary,

to resurface the lower eyelid skin and to achieve a small

degree of skin tightening.

After surgery, expect some swelling that may persist for a

week or longer. Your vision may be somewhat blurry for a

few days, and you will want to wear dark glasses to protect

your eyes from the wind and sun. Within a week, you can

wear makeup to conceal any remaining discolouration.

You should be back to work within ten days, but bruising

can last longer.

eyelid surgery removes puffy bags under your eyes and wrinkled folds of skin hooding your eyelashes on the

upper lids.

Incisions follow natural contour lines in your upper and lower lids. In some cases, lower eyelid fat may be

removed without an external incision; instead an incision is placed inside your lower eyelid.

Stitches close the incisions. Incision lines fade and blend into natural creases.

After surgery, your appearance is brighter, more alert and rested.

Eyelid Surgery

28 29

Usually this type of surgery results in minimal scars.

However, in the first few weeks after surgery, the scar may

be pink and slightly thickened. This can be more prominent

in the lower eyelid, particularly if the scar needs to be

extended past the outer edge of the eyelid by more than 1

cm. This may require some sort of makeup camouflage until

this settles down over the first few months.

Bruising almost invariable occurs around the eyelids due

to the nature of the operation. It may even spread on to

the white part of the eye where it lasts for longer than the

normal week to ten days. However, in order to minimize

the bruising and swelling, drugs such as aspirin or other

drugs which thin the blood should be stopped prior to

the operation. Immediately after the operation, the patient

should avoid over-activity and bending over for up to three

weeks. Dark glasses are also helpful in the immediate post-

operative period.

Swelling may make closure of the upper lid difficult initially.

This may result in the upper eyelid becoming slightly opened

when asleep. This may persist for some weeks. Should this

occur, it is vital that the patient uses lubricating eye ointment

during this phase in order to prevent the eye from drying

out and becoming sore. If this is not undertaken then the

tissues at the front of the eye can dry out and result in a

scar which will reduce the quality of vision. Occasionally,

prolonged reduction in tear formation or dry eye may result.

This requires the use of artificial tears.

Another potential complication is ‘ectropion’. This is where

the lower eyelid appears pulled down too far. The lower

eyelid is a very weak structure and in order to avoid this

potential problem, surgeons are careful not to pull down the

eyelid too hard or too far. For this reason, the skin below

the eyelid may not be as smooth as desired. This surgery

will not remove the fine wrinkling lines on the outer edges of

the eyelids nor will it raise the eyelid itself. Any weakness of

the lower lid which is present will normally last for up to two

weeks. This is due to the need to penetrate the muscle of

the lid in order to take away the fat from the lid. The situation

can normally recover without treatment, but if permanent,

may be improved by further surgery. Few patients notice the

formation of small lumps in the lower eyelid. These generally

disappear over a few months. Unfortunately, during this

time, temporary irritation and abrasions may occur.

Blindness is fortunately an extremely remote and rare

possibility. It is more likely to occur if patients have pervious

eye conditions, e.g. glaucoma or any other ocular problems

that may impede vision or tear formation. It is important the

surgeon is aware of these conditions before surgery.

Every operation will produce a degree of pain. This is not

a particularly painful operation. If any post-operative pain

develops, it is important that the surgeon is notified, as this

may be an indication of early complications developing.

However, there is discomfort because of the tightness of

swelling and the ointment. There may be excessive tear

formation and sensitivity to bright light for the first few days.

The post- operative pain is normally minimal after 24 - 48

hours. If pain persists, the surgeon should be consulted, as

this may be an early sign of complications developing.

Another symptom of the operation is blurring of vision.

This normally occurs in the very early post-operative

phase and is due to swelling and the use of ointment

in the eye. However, there is a temporary impression

of double vision which lasts for a day or two after the

operation. This usually recovers spontaneously and is a

result of the bruising. It is not normally the result of any

serious complication of the operation.

Very rarely do wounds become infected. This may require

drainage of any tissue fluid that is infected or accumulated

under the skin. This is more likely to occur in a fairly significant

degree of bruising. Bruising, fluid collecting under the skin

and infection may delay the speed of wound healing and

may also produce an undesired cosmetic result.

Report to Dr Scamp at once if you develop any of the

following:

• Temperature higher than 38oC or chills

• Heavy bleeding from the incisions

• Severe pain or tenderness

• Redness around the incisions that is spreading

• Loss of feeling in any area of the face

Specific Risks of Blepharoplasty

28 29

A facelift smoothes loose skin on your face and neck,

tightens underlying tissues and removes excess fat. Your

bone structure, heredity and skin texture all play a role in

how many ‘years’ a facelift can ‘remove’ and, to some

extent, influence how long it will last.

There are many variations to the facelift procedure and

placement of incisions. The goal of every facelift technique

is to keep the incisions hidden as much as possible.

Following surgery, scars will be concealed by your hair or

with makeup.

Your facial skin is lifted from its underlying tissue and

the excess is trimmed off. The deeper tissues are also

repositioned to restore a more youthful contour to your

face. If necessary, a small incision beneath your chin

permits the removal of fat and smoothing of the cord-like

structures in your neck.

When facial sagging in the cheek area is pronounced,

a procedure called a mid-facelift may be performed.

Incisions are often made inside the lower eyelid or may be

placed in another area that provides superior access to the

central cheek region.

After facelift surgery, you will experience temporary skin

discolouration and some tightness or numbness in your

face and neck. Since your skin will remain somewhat

sensitive for a few months, protection from the sun

including daily use of a sun block is essential. You can

wear cosmetics a few days following surgery and patients

often are back to work within two weeks.

REDEFINING FACIAL FEATURES

Achieving harmony of your facial features is one of the

most important goals of aesthetic plastic surgery.

Facial aesthetic surgery can help you shape your nose,

reduce prominent ears, increase the projection of your chin

and create a more pleasing contour in your cheek areas.

Sometimes enhancing a single facial feature brings your

whole face in balance, enhancing your overall appearance

and increasing your self-confidence. Looking your best

can give you an important ‘edge’ in both your personal

and professional life.

A facelift corrects visible signs of aging such as deep cheek folds, jowls and loose skin on the front and sides

of your neck.

Your plastic surgeon will design incisions to suit your particular needs. Your facelift incisions may be placed

within the hairline and within natural contours in front of and behind your ears, as shown. Modified incisions may be used if, for example, you need correction of only your

neck and lower face, or to preserve hair.

Loose skin is pulled up and back, and the excess is removed.

After surgery, the skin on your face and neck will look smoother, firmer and fresher.

Face & Neck Lift

30 31

SCARRINGThe incision will obviously result in a scar. The scars are usually pink to start with, generally fade and become white, soft and supple over the next three -12 months. The scar in the hairline may become visible with parting of the hair. The scar behind the ear may be the most noticeable and it is helpful to have a hairstyle which can cover this area. Keloid scars are rare and are a thickening, inflammatory process which occurs in normal scar tissue. These are not due to a surgical fault but due to a peculiarity of the patient’s healing process. Small hairless areas can sometimes be fund adjacent to the scar but these can usually be hidden with the hair. Hair growth will recommence after three months.

INFECTIONInfection may occur and will be treated by the usual techniques. This may involve being admitted hospital for intravenous antibiotics and further drainage procedures. Further surgery may be required.

BRUISINGBruising of the face and neck is usual in the post-operative period and may last up to two - three weeks. This bruising may be minor or severe. In some instances, a collection of blood or fluid may accumulate underneath the skin necessitating drainage. A second anaesthetic may be required if this accumulation is large.

NUMBNESSIt is usual to have some temporary numbness around the cheeks and sometimes the ears. This is due to surgery coming close to the nerves in these regions while the skin tightening is being carried out. The numbness is usually fully recovered within six to 12 months and is rarely troublesome. Post-operatively there is normally discomfort because of the tightening rather than pain. There may be tender areas, more commonly below the ears and on the side of the neck. Post-operative pain should be brought to the attention of your surgeon as this may be an indication that complications are developing.

NERVE INJURYOne of the worst complications as a result of this operation is damage to the facial nerve. This is the nerve that supplies all the muscles of expression to the face. This results in weakness of the facial muscles. It is uncommon but it can occur and the danger is greater when the underlying muscles and fascia are tightened, and when fat is removed from the neck. Fortunately most cases that do occur correct themselves spontaneously within a period of six months. As with all cosmetic surgery the problems have to be weighed against the benefits.

HAEMATOMAA haematoma is a collection of blood under the skin. This is due to bleeding in the post-operative period. This may be severe and may cause loss of some of the skin on the face. It normally requires further surgery to drain and remove the clot. Every step should be taken to reduce this including the patient stopping treatment with such drugs as aspirin or other blood thinning agents prior to surgery.

Usually a fine strip of hair is trimmed immediately before the operation and it is this skin, clipped of hair, which is removed during the operation so that afterwards there is little evidence of shaving or baldness along the operation line. Bruising and swelling is usual and varies with each patient; from being virtually invisible to being so severe that a blood clot collects, which may need to be removed back in the operating theatre. Most of the severely swollen cases have settled by the third week.

Varying forms of anaesthesia can be used and a day or two in hospital after the operation is usual. In some cases day surgery is possible. The first night is usually spent with the face bandaged but a day or so later the bandages are removed and the operation inspected and redressed. The hair is commonly washed before the patient goes home. Many wear dark glasses if the eyelids are bruised. The hair hides most of the sutures, but a scarf can be helpful.

If your surgeon has also agreed to remove some tissue from your eyelids, please read the particular consent form regarding blepharoplasty.

Unfortunately the wrinkles on the lips and those ingrained in the corners of the mouth and eyes are not helped by this operation. Fat grafts and/or laser resurfacing may be of benefit. The forehead is not treated by a facelift, it can be improved by a brow lift.

In the neck region, improvement will be a reduction in the amount of loose skin but it will not remove the creases in the neck which are normal and present from childhood. Occasionally an extra scar is placed immediately below the chin in order to remove excess fat in this area.

A few weeks after the operation when the final swelling from the operation is gradually settling, it may appear that the face is beginning to ‘fall’. This is an inevitable minor consequence of the face that the skin is stretched by post-operative swelling and is usually complete within about three months. Fine wrinkles may occasionally return during this time. The patient must be prepared to be satisfied with an improvement rather than seeking some ‘perfection’ or ‘total rejuvenation’.

Special Risks of Facelift & Neck Surgery

30 31

No matter what we do to the structure of our face, if the

skin is ‘old’ our look is never entirely rejuvenated. Fine

lines, deep wrinkles, sun spots and skin pigmentations

all contribute to an ‘old skin’ look. The Portrait, is a skin

rejuvenation device which uses plasma (ionized gas) to

rejuvenate the skin in a similar way to a laser but with a

more rapid recovery.

With the Portrait system, the overlying skin stays intact for

three to five days. This gives the deeper layer a chance to

heal so that when the top layer flakes off there is already

healthy healed skin beneath it. This reduces the time taken

to heal, reduces the discomfort and minimizes the overall

risk (particularly that of infections).

Portrait can be performed as an in office procedure with

the use of topical anesthetic cream and local anesthetic

blocks, rather than being done in the operating theatre

under a general anesthetic, as is common with lasers.

And, as the overlying skin stays in act the dressing regime

for after care is also much more simple. Only a heavy

moisturizer is usually required.

The Portrait has two effects on the skin. The immediate

effect, visible within a week or so, is that shiny, healthy,

young-looking skin emerges. This is due to loss of

superficial layers of the skin which contain a lot of the

aftermath of sun damage and photo-aging.

The deeper layers of the skin are also affected by the

Portrait. They are strongly stimulated and the cells there

become metabolically very active and lay down new

collagen. This progressively tightens and smoothes the

skin. Even after a year of a single Portrait treatment,

increased activity in the deeper parts of the skin are still

visible.

Healing usually takes less than a week and further continual

improvement is seen in the skin over a year.

Areas other than the face such as the backs of hands,

limbs and décolletage and neck can also be treated with

the portrait device.

Portrait is recommended for treatment of sun damage,

wrinkles, benign skin lesions, superficial pigmentation and

acne scarring.

Portrait will not remove the fine blood vessels which are

commonly seen on the face as we age. These can be later

reduced by use of intense pulse light (IPL).

In certain instances where lines are particularly deeper or

very close to the eye, laser resurfacing may be preferred.

Plasma Skin Resurfacing

32 33

Skin resurfacing provides significant and long lasting

improvement of sum damaged, unevenly pigmented or

coarsely wrinkled facial skin. Usually you will undergo a single

procedure rather than the series of treatments commonly

recommended for milder skin revitalizing techniques.

Laser skin resurfacing is a popular technique. Like other

resurfacing methods, the laser is effective in treating

wrinkles, blotchiness or age spots, and scars from acne or

other causes. It can be used on the entire face of specific

areas. The laser also has a mild tightening effect on the skin,

particularly in the lower eyelid area. There are a variety of

lasers in use today. Dr Scamp can advise you about the

specific treatment that would be most effective in meeting

your goals.

A few days following laser resurfacing, your new skin

emerges. Its bright pink colour will fade over the next few

months and in the meantime, may be covered by makeup.

In most cases, you should be able to return to work within

a week or two.

Like other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars

from acne or other causes. Your plastic surgeon is able to precisely control the amount of energy transmitted to

your skin’s surface by the laser beam

Skin Resurfacing

32 33

There are a number of possible complications, the major ones are listed below:

SENSATION OF TIGHTNESSThis is quite common in the first one to two months after treatment. Use of specific moisturiser creams can help to relieve this and it is generally not something to be concerned about but is expected as part of the process.

MILIAThese are small obstructed oil glands in the skin. They can occur normally or after laser resurfacing. They are usually not a major problem and respond to ‘de-roofing’ with a small needle.

RECURRENCE OF LINESIt is not possible with the laser to remove all lines on the face without inflicting a burn to a depth that has a substantial risk or causing scarring. The philosophy pf treatment is that it is best to accept remaining lines rather than to run the risk of major scarring. In general an 80% improvement is hoped for, but may be less than 50% with acne.

There are lines that are present at rest (static) and lines that appear with muscle action. Strong muscle action lines will not be removed by the laser treatment but may respond to Injection Therapy. Most of the static lines will respond to laser except the very deep ones. Attempts to remove these with laser may inflict new scars.

ACNEBoth the swelling and the use of occlusive dressings and creams may exacerbate acne after treatment. Usually, after approximately 6 weeks of treatment, recommencement of Retin A is possible to help control this.

SYNECCHIAThese are small webs of skin that occur as the skin heals. They are uncommon and are usually not much f a problem. They occasionally require gentle removal.

SKIN ERUPTIONSLaser resurfacing may cause an outbreak of cold sores (herpes). These can affect any area that has been resurfaced and are more common in patients who have a history of cold sores. They can, however, occur with anybody. These outbreaks can result in skin scarring and it is therefore recommended that you take anti-cold sore medications for a period of approximately ten days round the time of resurfacing. These medications are expensive (over $100). Infections may result in the skin after laser resurfacing. These may be fungal or bacterial in origin. Antibiotic or antifungal cream may be required if these arise.

DERMATITISSkin that has been resurfaced is very sensitive and prone to allergic reactions. Dermatitis that results in this way usually responds to topical steroid creams.

PIGMENTATION DISTURBANCES Resurfacing the skin may result in dark patches or a general darkening in the colour of the skin. This is particularly true if sun exposure occurs within the first few months after the resurfacing. Utmost care to prevent sun exposure is required and Retin A is usually recommended six weeks after resurfacing. Subsequently, chemical peels or other topical medications may be required to help fade this pigmentation, but it may be permanent.

Conversely, pale patches (hypo pigmentation) or a general paling of the treated skin may result after laser resurfacing. This is uncommon and it occurs in approximately 1 in 50 patients. Deeper treatments to eradicate resistant lines are more prone to this problem.

OBVIOUS BLOOD VESSELSLaser treatment does not lead to large blood vessels appearing on the face. It can, however, expose the underlying spider veins as the pigmentation fades with treatment. Treatment with a different laser can often improve these vessels.

SCARRINGScarring occurs in less than 1% of patients treated for laser resurfacing. Treatment with steroid injections may be required and it may take a year or more for these scars to fade. Permanent scarring is small but a definite risk.

FADING OF THE LIPThe redness along the lip border may face with treatment from the laser around the mouth. This is generally easy to mask with lipstick.

ECTROPIONTreatment of lower eyelids with laser resurfacing may cause a tightening in the skin below the eyelids in the lower lid being pulled down. This is uncommon and usually settles spontaneously, but it may take up to four months to do so. A support procedure (lateral canthopexy) may be recommended to reduce this risk.

Report to Dr Scamp if you have any of these unexpected side effects or any other concerns regarding a possible side effect from treatment:

• Fever (more than 38oC) or chills• Increasing pain or redness in the treated area• Any other problems or concerns

Specific Risks & Complications of Laser Resurfacing

34 35

FAT GRAFTING

Lipostructure is a technique of fat grafting developed by

a New York Plastic Surgeon, Dr Sydney Coleman. The

technique entails placing a network of fine interwoven fat

grafts into a region to rejuvenate an area or improve the

contour of that region.

This may leave a more youthful fullness and reduce the

lines of a region.

Dr Coleman has successfully used these grafts in the

brow, cheeks and the eyelids to rejuvenate the upper face.

Grafts to the jaw line may create a more attractive contour

and profile. Whilst this surgery to the lips may soften lines

and create a more attractive pout.

The lipostructure technique has also been used in acne,

as substantial thinning of the fat layer may happen in this

condition. Lipostructure may give acne patients better

texture and improved appearance.

The surgery is commonly performed under general

anaesthesia as a day patient. Swelling and bruising to

the face may be quite marked, especially in the first two

weeks, but sometimes as long as four or more weeks. In

general, the final result is visible by eight weeks.

The abdomen is commonly the site the grafts are taken

from. Again bruising, swelling and some numbness are

to be expected at least temporarily. Bruising is worse if

aspirin is taken in the two weeks before surgery.

RISKS

Infections can occur in the grafts, which will result in pain

and swelling. Antibiotics are given at surgery to reduce this

risk. Surgery to the lips or face may result in an outbreak of

cold sores (herpes) even in someone who has no previous

history of these. If cold sores arise, specific medication will

be prescribed. This medication is expensive (over $100).

Please notify us immediately if you believe you are getting

a cold sore or any infection.

Fat grafts, ideally, should give a permanent improvement.

They can, however, melt away. The risks of this are probably

higher in smokers. Please cease smoking six weeks prior

to surgery. In some patients graft shrinkage may be

excessive and repeated grafting will be recommended.

The possibility of additional costs should be kept in mind.

Conversely, there is also a risk that grafts may be too

large or irregular (lumpy). Again, revisional surgery may

be recommended. Removal of grafts is technically difficult

and may entail additional scarring.

Please ask if you have any further questions.

Fat Grafting

34 35

Lipoplasty, also called liposuction or liposculpture, removes localised collections of fatty tissue to give you a smoother and slimmer body contour. For the best results, you should be of relatively normal weight with extra fat localised in specific areas such as the hips, buttocks and abdomen. Lipoplasty is also effective in removing fat deposits from the back, legs, arms, face and neck.

Lipoplasty is neither a substitute for proper diet and exercise nor a method for overall weight loss. It cannot eliminate cellulite or correct loose, hanging skin. In fact, the best results from lipoplasty are achieved when you have health, elastic skin with the capacity to shrink evenly after surgery. If your skin has lost much of its elasticity, you may need a skin tightening procedure such as a tummy tuck, thigh lift, buttock lift or arm lift.

General anaesthesia is used for this procedure for maximum patient comfort. Lipoplasty is usually performed using a suction pump device to vacuum away excess fatty deposits. In some cases, hand-held syringe may be used instead of a pump. There are a number of variations to conventional lipoplasty. Ultrasound-assisted lipoplasty, for example, uses energy from sound waves to liquefy the fat before it is removed. The technique chosen for your specific case depends on individual factors that Dr Scamp will discuss with you.

Following surgery, you will need to wear a snug pressure garment for 6-12 weeks, to promote skin shrinkage and to minimise swelling and bruising as you gradually resume normal activities. You can expect to return to work within one or two weeks.

Lipoplasty helps to eliminate, unsightly bulges by removing localised fat deposits

Collections of fatty tissue in the shaded areas are removed through short incisions that are discreetly placed

A long, hollow tube, called a cannula, with an opening at one end, is inserted through a small incision. At the tube’s opposite end, a vaccum pressure unit suctions away the fat. Ultrasonic energy sometimes may be used to liquefy

the fat before it is removed.

After surgery, your body contour will appear smoother and slimmer.

Liposuction

36 37

The capacity of the skin to contract (shrink) determines the

maximal advisable amount of fat to be removed. There is

no guarantee that it will be possible to remove just the right

amount. As a result, too much or too little may be removed.

This may result in a contour defect such s rippling or

dimpling if the skin fails to shrink. This may require a second

operation. Patients who are overweight or over the age of

35 must be willing to accept a greater possibility of these

contour irregularities and poor skin redraping in exchange

for looking better in clothing.

Post-operative pain is experienced by most patients. This

is usually just discomfort and lasts for several days to one

week after surgery. The amount of pain will be based on

the size of the procedure and each patient’s individual

tolerance. Numbness may also occur but this usually

disappears after some months. Bruising is characterised

by skin discolouration, blue and black areas, and texture

irregularity. This can last for up to three weeks and longer

in many cases. In some cases lumpy areas may last longer

and may be improved by massage.

Infection is an infrequent occurrence. It may produce altered

cosmetic results or delay healing of the wound.

A collection of blood (a haematoma) or a watery fluid

(seroma) may arise but occurs infrequently. These two will

produce the worst cosmetic result and may delay wound

healing. A second operation may be necessary in order to

evacuate the blood or serum which has accumulated.

An area of skin loss can occur and this has been reported in

the literature. This is a very infrequent occurrence. Swelling

occurs when the knees and inner thighs are treated. In

particular, ankle swelling can occur and may last longer

than a week. It may take up to six to eight weeks before

the benefits of the procedure are visible. Patients can be

expected to wait up to six months to see the final results.

The procedure tends to use very minimal incisions. Areas of

contour defect can be improved by liposuction of the face,

the neck, breasts, fatty areas above the breast near the arm

crease, fullness lateral to the breasts, breast enlargement

in men, the waist area in both sexes, the buttocks, the

outer thighs (jodhpur deformity), the inner thighs, knees,

calves, ankles and also the arms. The abdomen can also

be recontoured using this technique. Post-surgical or post-

traumatic fat deposits can also be suction contoured.

Using liposuction alone, the skin is not tightened surgically.

Therefore, it is best suited to people who are in good

physical shape and who have skin quality which has youthful

characteristics. This is best performed for people under the

age of 35. There are specific cases in which excess skin

may present following this procedure and surgical removal

of the skin may be necessary to achieve a good cosmetic

result.

The procedure is usually performed under a general

anaesthetic. Local anaesthesia is usually limited for small

areas. Out patient liposuction may be able to be performed,

but admission to hospital may be required for more

extensive liposuction.

Following the surgery the patient is normally in hospital

resting in bed for up to 24 hours. The average stay is

between one to three days.

When a lengthy procedure is performed on multiple

extensive areas, a blood transfusion may exceptionally be

required.

Post-operatively, a snug garment will be placed on the

wound. Where possible a commercially made support

garment such as a long-legged pantigirdle, support tights,

abdominal binder or surgical bra will be used. Some form

of support dressing will normally be utilized for up to six

-12 weeks. Normal bathing and shower facilities can be

resumed within a few days. Ask your surgeon prior to the

surgery, regarding the massage program to use in the post-

operative period. After six weeks, strenuous activities can

usually be resumed though more reasonable activities can

normally be carried out in an earlier period, usually two to

three weeks.

Contact Dr Scamp if you have any of these problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding or oozing from any incision

• Increased swelling around the surgery sites

• Increasing pain

• Redness around incision lines that is spreading

• Any other concerns regarding your surgery

Specific Risks of Liposuction

36 37

The goal of rhinoplasty is to reshape your nose so that it complements your other facial features. The earliest recommended age for rehinoplasty is the mid-teens when the nose is near full development. As long as you are in good health, there is no upper age limit for nose reshaping.

Reshaping, generally, is done through incisions inside your nose. In some instances, there may also be an incision on the underside of your nose between your nostrils. The resulting scars fade and ultimately should be barely visible.

Your nose can be reduced, or built up, by adjusting its supporting structures. This is done either by removing or adding bone cartilage. Your skin and soft tissues will assume their new shape over this ‘scaffolding’.

If you have breathing problems because of irregularity in the internal structures of your nose, adjustments can be made to improve your nasal airway. This can be done at the same time as alterations to the external appearance of your nose. Dr Scamp will operate with another specialist (ENT) surgeon if required.

After surgery, some discomfort, swelling and bruising can be expected. You will need to wear a nasal splint for a week. You can begin wearing cosmetics as soon as it is removed. Your routine will be severely restricted for only a day or two, but it will be a few weeks before you can resume bending, lifting and exercise. As long as your job does not involve activities that raise your blood pressure, you should be able to return to work within 10 days. Minor swelling of your nose may persist for up to a year, but most likely this will not be noticeable to others. The final results of rhinoplasty are permanent and well worth the wait.

Rhinoplasty can reshape your nose to remove nasal hump and reduce an enlarged tip. It can also improve the

angle between your nose and upper lip.

Incisions usually are made inside your nose to provide access to cartilage and bone which can be cut and reshaped to alter the external appearance. the nasal bridge can be narrowed by moving the bone inward, as shown by the arrow. In some instance, an open

technique, which requires an incision on the underside of your nose between the nostrils, may be used.

Areas where cartilage and bone have been readjusted to improve the shape of the nose are shown.

Following surgery, your nose will complement your other facial features.

Nose Reshaping

38 39

Infection may occur and will be treated by the usual

techniques.

Swelling of the lining of the nose occurs along with the

general swelling of the region and produces a mild

temporary obstruction of the air passage. Do not blow the

nose for one month after the operation as this may cause

troublesome bleeding.

The tip of the nose often feels numb for some months but

this is quite normal and usually recovers completely.

Minor irregularities along the bridge-line may be felt by a

discerning finger. These should not be regarded as serious

because they are seldom visible. However, persistent

irregularities of contour in the bridge-line do occasionally

follow this reconstructive surgery. If still present one year

after the operation they may be removed by a further

operation but this is necessary in only 10%.

There may be a feeling of stiffness or numbness in the

upper lip which may be persistent in the first few weeks

due to the swelling in the nose, which can affect the

movement of the lip. The lip or a front tooth may also be

temporarily numb.

Smoking is known to interfere with the quality of blood

being supplied to the skin. Smoking markedly increases

the risk of skin loss, although this is rare in rhinoplasty.

Severe bleeding requiring re-operation occurs in 1%.

The length of hospital stay may vary with individual cases.

Almost always the surgery is performed as a day patient.

Contact Dr Scamp if you have any of these problems:

• Fever (with a temperature of more than 38oC) or chills

• Heavy bleeding

• Increased swelling around surgery site

• Increasing pain

• Redness around incision lines that is spreading

• Any other concerns regarding your surgery

Specific Risks of Rhinoplasty

38 39

A tummy tuck, also called Abdominoplasty, is designed to give you a smoother, flatter abdomen. The procedure removes excess abdominal skin and usually reduces fat and tightens the muscles of your abdominal wall. Often performed to correct the muscle weakness and loose skin that can occur following multiple pregnancies, significant weight loss or abdominal surgery.

Abdominoplasty will be performed as an in-patient in hospital. Usually you will stay for 3 days. General, a horizontal incision is made just within or above your pubic area. The contour of this incision may vary. The resulting scar is permanent, but your plastic surgeon will try to place it within the lines of a bathing suit or undergarments that you typically wear.

To correct loose skin above your navel (belly button), your surgeon will make a second incision around your navel so that the skin can be pulled down and the excess removed. The position of your navel will not change. If there are stretch marks on your lower abdomen, these may be removed. Any remaining stretch marks may be somewhat flattened, but don’t expect a dramatic improvement.

Abdominoplasty sometimes may be combined with liposuction to achieve the best results, but this may need to be done at a second stage. If your skin laxity and muscle weakness are limited to the area below the navel, you may be a good candidate for a modified abdominoplasty that leaves a shorter scar and requires no incision around the navel (‘Minituck’). Another technique for minimizing scars uses an endoscope; this procedure may be an option if you have only a minimal amount of excess skin and muscle laxity.

The day after surgery, you will be encouraged to get out of bed and walk for short periods to promote blood circulation. You will be instructed to wear a support garment for several weeks. You will need to avoid strenuous activity for a while but should be able to return to work within two - four weeks.

An abdominoplasty incision usually is made just within or above the pubic area and around the navel. Skin in the

shaded area is separated from your abdominal wall.

To tighten your abdominal wall, your plastic surgeon will bring loose underlying tissue and muscle together with

sutures.

Abdominal skin is drawn downward and the excess is removed. A small opening is made for your navel so that

it’s position remains unchanged.

After surgery, you will have a firmer, flatter abdomen. The resulting scars are permanent but will fade to some

extent over time.

Tummy Tuck

40 41

SCARS

There will be a long, horizontal scar which is usually placed

low enough to be hidden by most moderate two-piece

bathing costumes. It is usually quite noticeable but will

generally fade. No surgeon can guarantee that such scars

will be hidden by all swimming garments. The desired

result is to improve the shape and contour of the abdomen.

Sometimes the scar can be keloid in nature. This means

there is a red, thick and itchy scar. The final scar may

still remain thickened after a period of time. Patients can

reduce the risk of this occurring and aiding the healing of

the scars by avoiding over-activity and straining for three

to four weeks.

Because the redundant tissue is taken out vertically, there

is a small tendency for the pubic hair to be pulled up

approximately 2cm. This may counteract the descent that

occurred with pregnancy.

A bulge may be present above or below the suture line.

This may occur when thicker, fatty upper abdominal tissue

is sutured to thinner pubic tissue after removal of the

abdominal excess tissue. Follow-up liposuction may be

required. This may necessitate additional surgical, hospital

and anaesthetic costs.

FAILURE OF THE PROCEDURE

Sometimes it is impossible to ring down the skin below

the navel to meet the pubis in a horizontal scar. On these

occasions, a vertical segment of the scar is included in the

reconstruction of the abdominal wall. This tends to leave a

scar like an upside down T, though occasionally there may

be two scars, a horizontal one and a vertical scar.

Where previous surgery has been performed on the

abdomen (e.g. Caesarean section, hysterectomy or

gallbladder operation) it is more likely these scars will

end up in this configuration. Previous scars from other

operations also reduce the amount of blood flowing into

the skin and fat of the stomach wall. This means that

circulation to the remaining skin is not as good as in regions

where there are no scars. Because of this, the remaining

skin is at risk of ‘necrosis’ or dying. A recognized, although

rare complication of this operation, is for necrosis (death of

skin) to occur adjacent to previous surgical scars.

POSITION OF UMBILICUS

Position of the umbilicus may be difficult to calculate pre-

operatively. This is particularly true in a patient who has

lost a lot of weight. Occasionally ‘normal’ navels are not

central. There is also the possibility of loss of the navel.

However, the scar may provide a reasonable substitute.

ABDOMINAL WALL MUSCLES

The operation will also involve the repair of stretched or

separated abdominal wall muscles. This can produce a

muscle soreness immediately after the operation.

SENSORY CHANGES

The area of skin that has been pulled down below the

umbilicus may sell be numb for up to a year or so. This is

because the operation will disturb the nerves present within

the skin and the fat. Sometimes this loss of sensation is

permanent. Occasionally there may just be numbness on

each side. This may extend well on down to the thigh.

WOUND BREAKDOWN

Infection may lead to wound breakdown of part or all of

the Abdominoplasty suture line. Wound breakdown may

require treatment conservatively, through dressings and

debridement or surgical treatment, utilizing skin graft and

similar techniques.

SKIN NECROSIS OR SKIN LOSS

May occur post-operatively and is caused by poor blood

supply to the skin. This complication is much more

common in smokers, as smoking has been proven to

cause a decrease in superficial blood supply. Necrosis

may vary from a mild lever, which will create minimal or no

scarring, to severe, which could result in permanent and

disfiguring scarring.

NERVE INJURY

Transient numbness of the abdomen may occur for the first

two to six months following Abdominoplasty, as a result of

interuption of the small sensory nerves during surgery, and

to some extent this is unavoidable. Liposuction can further

cause damage to sensory nerves. This sensory loss may

be permanent.

Specific Risks & Complications of Abdominoplasty

40 41

ASYMMETRY

May occur due to small anatomical differences in underlying

structures on the left and right sides of the abdomen as

well as muscle tension and tone. Small skin dimples are

possible from deep sutures.

PAIN

Pain after an Abdominoplasty procedure may vary from

mild to severe. Discomfort and tightness in the abdomen

may be more widespread, covering those areas treated.

SUCTION

Liposuction is used in some Abdominoplasties; however

Abdominoplasty does not involve treatment of the hips

or fatty deposits on the side of the waist or back. If this

is required and can be performed at the same time as

the abdominoplasty, additional complications specific to

suction include the following:

• Dimpling of the skin due to uneven fatty deposits

• Skin laxity if skin elasticity does not allow for retraction

• Further scarring from insertion of suction catheters in

other areas including the back and loins, if treated

• These complications may produce permanent

disfigurement in the form of thick scarring, asymmetry

and skin laxity

• Further revisionary surgery may be required as a result

of these complications

• Compression garments may be required in the post-

operative period to minimize the risk of developing

complications

Report to Dr Scamp or ring our after hours number if

you develop any of the following:

• Temperature higher than 38oC or chills

• Heavy bleeding from the incisions

• Severe pain or tenderness

• Redness around the incisions that is spreading

• Any concerns you have regarding your surgery

Specific Risks & Complications of Abdominoplasty

42 43

Many people would like to improve their appearance, but

are not ready yet for cosmetic surgery. For those people

we can offer a range of non-surgical treatment to give them

that little lift.

Skin care and conditioning programs, utilizing clinically

proven ingredients such as retinoids, fruit acids, vitamin C

and other antioxidants.

We have a special product range designed to reduce the

excessive facial pigmentation that is commonly seen after

pregnancy or just too much sunshine.

C & E SKIN CARE

Everyday, environmental elements like sunlight, smoke and

air pollution cause free radicals to form in the skin. These

free radicals attack your skin’s collagen, causing lines and

wrinkles to appear. This process is called photo-aging.

Antioxidants (like vitamin C and vitamin E) fight free radicals,

helping to prevent premature environmental damage, and

improving the appearance of fine lines and wrinkles.

We have a number of skin care and conditioning programs,

utilizing clinically proven ingredients such as vitamin C,

vitamin E, retinoids, fruit acids and other antioxidants.

One such highly effective antioxidant product combines,

for the first time, vitamin C (L-ascorbic acid) and vitamin E

(alpha-tocopherol).

The antioxidant benefits of vitamin C and vitamin E are well-

established medical facts. Recent studies show that using a

combination of vitamin C and vitamin E provide even greater

benefits for the skin than using vitamin C or vitamin E alone.

This combination of C + E provides better protection from

UVB damage than vitamin C and vitamin E alone. When

used with a sunscreen a combination of vitamins C + E

provides enhanced protection against UVA damage.

RETIN-A

Sun damage in skin has been found to be much more

common that thought. The effect of this exposure is to

cause a low-grade inflammatory reaction in the skin which

results in damage to the fibrous supporting network of the

skin (collagen). The loss of support makes the skin looser

and it becomes wrinkled and saggy. In addition, the out

layer of the skin also becomes thicker which leads to a

dry leathery texture. Also, the skin may become irregularly

pigmented or mottled.

Microscopic examination of the skin treated with Retin-A

shows a range of changes. There is increase in collagen

formation which expands the dermal compartment of the

skin and flattens out wrinkles. The activity of the pigment

producing cells of the skin are reduced which causes the

fading of areas of hyper-pigmentation or mottling. There

is exfoliation (peeling) of the skin resulting in a smoother

surface. Areas of thickened pre-cancerous change in

the skin are obliterated. It is hoped that this latter feature

plus the anti-tumor effects of Retin-A will help prevent

progression to skin cancer.

As Retin-A decreases the activity of the oil glands and

improves their drainage it will usually quieten acne and

may assist in the recovery of skin scarred by acne. Retin-A

used alone or in combination, will usually lighten pigmented

patches by thinning the epidermis and decreasing activity in

the pigmented cells.

Although improvement may be apparent after only a few

weeks, substantial benefit from Retin-A may take four

months to show. Maximum benefit is usually apparent after

a year at which stage treatment is reduced in frequency.

The aim of Retin-A therapy is to progress to maximal

amounts of Retin-A as soon as the skin will allow. This will

cause some redness, itching, peeling, dryness, tightness

and even soreness. These symptoms are more marked in

the first month or so of usage.

Microdermabrasion is a popular technique that uses a stream of micro-crystals and suction to gently ‘polish’

your skin, giving your complexion a healthy looking glow.

Gentle Skin Treatments – non surgical

42 43

MICRODERMABRASIONMicrodermabrasion fills the middle ground between facials and laser resurfacing.

The progression of time, our environment, our lifestyle (especially smoking and sun exposure) and the natural aging process adversely influence our skin. The components of skin aging can be categorised as intrinsic (genetic) or extrinsic (environmental) factors. Physiologically, the skin is affected by both aging influences with profound changes in the dermis (the elastic deep layer of the skin).

During the aging process, fibroblast activity decreases, affecting skin strength and elasticity. The dermal degradation is observed as lines and wrinkles. Meanwhile, there is a decrease in the flood flow to the skin and the growth of new skin cells drop dramatically. The skin loses its ability to spring back to shape.

Microdermabrasion is the holistic option for modern skin care. It complements other health programs without interference. It provides a gentle yet effective mechanical peeling, using micro diamond shaped crystals to slough off dead cells. Microdermabrasion treatment is fast and pain-free, leaving little or no redness. Use it to treat and minimize the most difficult skin conditions, or just to rejuvenate and maintain the health of the skin.

Today, microdermabrasion is the fastest growing application for skin resurfacing technology. As a non-invasive technique, it respects the skin’s integrity, minimises trauma and created health, vital skin. The Diamond Dermabrasion technology features a patented dual control system with an adjustable applicator head that delivers a steady, powerful stream of fine diamond crystals to the skin, leaving it smooth and fresh, while promoting new collagen growth. The crystals themselves have extraordinary qualities. The exquisite hardness, shape, purity and efficiency deliver a more efficient exfoliation.

Microdermabrasion works best when used in a series of treatment. Results and benefits are delivered with each treatment and ongoing revitalized health skin results.

Gentle Skin Treatments – non surgical

44 45

When dark and coarse hair appears in places we don’t like

or expect – like on the face, neck, abdomen, breasts and/

or the backs of arms, it can affect our lifestyle dramatically,

preventing us from wearing clothing or participating in

activities such as swimming etc.

For long-term hair removal, electrolysis is popular and

effective, but can be painful and slow. Hair by hair an electric

current passes through a needle to destroy the hair root’s

ability to grow. It typically takes months or even years of

regular visits – ever for small areas, like the upper lip. Risks

include electrical shock, infection, pitting and scarring.

The Light Sheer Diode Laser is a state-of-the-art system

specially designed to remove unwanted hair faster, less

painfully and more reliably than electrolysis.

A laser produces a beam of highly concentrated light.

Different types of lasers produce different colours of light.

The colour of light produced by a particular laser is the key

to its effect on hair follicles.

The pigment located in hair follicles absorbs the light

emitted by the laser. The laser pulses for a fraction of a

second, just long enough to vaporise the pigment, disabling

many follicles at a time to eliminate or significantly impede

the hair’s regrowth.

The Light Sheer Diode Laser is a 4th generation laser with

a special contact cooling handpiece, designed for sensitive

skin. It directs the laser energy to the hair root while

protecting and cooling the surrounding skin.

At the time of consultation for hair removal, you will be

asked a number of questions in regard to your general

health, ethnic background and expectations. You will also

be offered a test patch of laser so that you know what to

expect if you decide to proceed. This test patch is not a

pre-requisite to treatment; you may simply proceed with

treatment without this test.

For laser to be effective a series of treatments is necessary.

This varies on average between four and six, depending on

the area to be treated, skin type and the amount of hair.

Treatments for those areas above the neck are usually

scheduled for three to five weeks apart, and those below

the neck for eight weeks apart.

All patients are advised to avoid waxing, plucking, depilatory

creams or electrolysis for at least four to six weeks prior to

treatment. Shaving can be continued and you are asked

to shave the day prior to treatment so that the area to be

treated can be easily seen.

You are also asked to avoid tanning the area to be treated

prior to treatment and during the duration of your treatment.

If the area is exposed to the sun following treatment, the risk

of pigment change is greatly increased.

Short-term side effects may include slight reddening of the

skin or local swelling, which typically lasts less than an hour.

In rare instances there may be some grazing or blistering,

which subsides over a relatively short period.

Laser Hair Removal

44 45

Injection Therapy is a popular technique for treating facial

wrinkles. Patients usually are pleased with the results of

these minimally invasive procedure. Injectable wrinkle

treatments, however, cannot achieve the same results as a

facelift, eyelid surgery, brow lift or skin resurfacing.

INJECTION THERAPY

In plastic surgery, Botulinum Toxin has enabled us to

treat several conditions. After injury to the facial nerve, for

example from Bell’s Palsy, a skull fracture, over activity of the

facial nerve may be produced as the nerve recovers. This

can help to control this unpleasant over activity. It has also

been useful for Blepharospasm, a troublesome condition

that impairs the eyesight.

However most commonly now in plastic surgery, injections

are used for treatment of what are called habitual lines.

These are lines on the face commonly due to over activity

of certain expressive muscles. The frown lines between the

eyebrows (glabella) are due to over activity of the frowning

muscle (corrugator). Injecting into this region will cause

relaxation of the muscles with a resulting improvement or

even disappearance of the lines there. In general, the best

results are obtained with younger people whose lines are

not so long standing, but improvement is usually obtained

in any age group.

‘Crows feet’ can also be improved. By injecting above the

bone, beside the eye, the muscles are encouraged to relax

and the lines there frequently soften. Injections may be used

for the transverse creases on the forehead and sometimes

even for stronger lines in the upper lip.

Injections may be just part of the treatment that is required.

Where lines have been long standing, soft tissue fillers or

Laser Resurfacing may be recommended to further enhance

the result.

Injections are inserted as an office procedure. An ice pack is

usually held to the site and several injections are inserted via

a fine needle. The procedure causes some discomfort but it

is very rapid and usually causes little problems. There is little

to be seen after the injection. Usually just the fine prick of a

needle may be apparent or nothing at all may be seen. It is

possible however, to get a bruise.

This is a popular technique for lines and wrinkles. Patients

usually are pleased with the results. It is recommended that

the site of injection not be massaged and when injection

is inserted into the frown lines between the eyebrows, one

should not lie down for four hours after the procedure.

Massage or lying down may cause displacement which can

lead it to migrate into the muscles of the upper lid. This can

cause drooping of one eyelid (ptosis) which is fortunately

uncommon. It may appear three weeks after the injection

and last for one to two weeks.

In the first 48-72 hours after injection, no effect is usually

seen. However, at about three days it will start to work

and one will notice that using those muscles requires and

increased effort. The peak effect is usually seen at about

two weeks. Duration of effect varies from person to person

but three to six months is common. There is a theory that

repeated injections of the muscles over a two year period to

keep them weak will lead to their total inactivity. At this stage

this is just a theory and has not been completely proven.

By weakening the muscle’s action it requires conscious effort

to use the muscle. This means that one does not tend to

absentmindedly reinforce these deep lines by constant over

activity of the muscles, and the lines therefore tend to improve.

Lip Enhancement & Quick Wrinkle Treatments

Injections are best suited for treating expression lines caused by muscle contraction. Common sites for injections include; Horizontal forehead furrows, vertical lines between

the eyebrows and ‘crows feet’ around the eyes

Injectable fillers help to diminish the appearance of facial lines and wrinkles by ‘plumping up’ the soft tissues.

46 47

Allergic reactions re extremely rare and “immunity” to the

Toxin has not been reported. The material is relatively costly

and in our practice we prefer to use higher concentrations

to obtain a better and longer lasting correction of frown

lines. Naturally the higher concentrations used are more

expensive but the improvement is also greater.

If you have any further questions please ask at your next

consultation.

SOFT TISSUE FILLERS

Water is the source of all beauty. Water gives lift and

resilience to your skin, creating the contours of your lips

and chin.

The resilience and youthful contours of your skin – its ability

to counter the effects of time, wind and weather – owes

much to hyaluronic acid. It exists in all life and its most

important function is to bear and bind water.

When injected into the skin the gel binds with water and

generally remains for many months. We use a totally non-

animal product, so there is no risk of transmitting disease

or eliciting allergic reaction in patients who are sensitive to

common foods such as beef, chicken and eggs.

A consultation with one of our paramedical aestheticians

will enable you to choose a product to give you optimal

results.

One of the great advantages of the filler is that it is long

lasting but not permanent. How long a treatment holds its

effect is very individual. This depends on many factors such

as your age, skin type, life style and muscle activity, as well

as on the injection technique.

Gaining the look you desire is as easy as it is quick. And the

results are instantaneous. No pre-testing is needed and a

session often takes less than 30 minutes.

Depending on the effects desired, an initial visit is usually

maintained with occasional follow-up treatments. For wrinkle

treatments no pain relief is generally necessary, however it

can be arranged at your request. When enhancing the lips,

pain relief in the form of a local anaesthetic if often used.

During treatment the crystal-clean gel is injected into the

skin in tiny amounts with a very thin needle. The gel then

gives natural volume and smoothes the wrinkles. The ability

to integrate with adjacent tissues allows the free passage of

vital elements like oxygen and hormones to pass between

fragments of the gel. The result is healthy, natural skin.

After the treatment some common injection-related

reactions may occur, such as swelling, redness, pain,

itching, discolouration and tenderness at the implant site.

These typically resolve spontaneously within one to two

days after injection into the skin and within a week after

injection into the lips.

Lip Enhancement & Quick Wrinkle Treatments

Nasolabial, Periora Lip Line Before

Nasolabial, Periora Lip Line After

Oral Commissures and Perioral Before

Oral Commissures and Perioral After

Lips Before Lips After

Glabellar Before Glabellar After

46 47

There are many techniques available to reconstruct a breast

that has been removed due to cancer, or which has failed to

develop. Your consultation with Dr Scamp, will be to inform

you and help you to select a procedure that will best suit

your body and your wishes.

Remember the aim of Breast Reconstruction is to make two

breasts that match. Naturally these should be two breasts

that you like. One of the most important things to consider

at the very beginning is whether you have a desire to make

any alteration to your normal breast. Some people feel they

are too big, too small, or sag too much. The appropriate

surgery for the opposite breast can be included in the plan

to construct your breast.

In most cases, two operations at separate stages, some

months apart are required. But even after the first operation,

at least a breast ‘mould’ will have been created, which will

make dressing and wearing of normal clothes much easier

for you. In warm climates, one really needs to be able to

wear a swimsuit or a t-shirt to get through normal activities.

The aim of Breast Reconstruction is to make this possible.

Dr Scamp has a special interest in Breast Reconstruction.

He trained in Australia, Britain, Europe and USA in

Breast Reconstruction techniques. Dr Scamp is a trained

Microvascular Surgeon and uses this skill in many of his

Breast Reconstruction techniques.

The following website will answer some of the basic questions

about Breast Reconstruction – www.plasticsurgery-aust.

com. More detailed information can be found in a book

called A Woman’s Decision by Karen Berger and John

Bostwick 111, MD. This is published by Quality Medical

Publishing Incorporated St.Louis, Missouri. This book is

commonly provided for patients to read after consultation

with Dr Scamp. If you are traveling from a distance to see Dr

Scamp, ask his staff to send you the book in advance or get

a copy from a bookstore. It is very readable and contains a

lot of useful information.

WHO CAN HAVE BREAST RECONSTRUCTION?

Any patient who is medically fit for surgery and who desired

Breast Reconstruction is a suitable candidate. Naturally,

it is best if the breast cancer is under good control.

Reconstruction will not increase your risk of the breast

cancer coming back. If you have any doubt, you may ask

the surgeon performing the mastectomy, when he feels the

right time would be.

Naturally you want to be in the best of health for Breast

Reconstruction surgery. Cessation of smoking and attention

to things such as obesity and high blood pressure would be

prudent. Even if you decide to defer Breast Reconstruction,

or not to proceed at all, you may find some comfort in

knowing that these options are open to you.

WHEN CAN I HAVE A BREAST RECONSTRUCTION?

In many cases it is possible to perform Breast Reconstruction

at the same time as the Mastectomy. This requires co-

operation between the surgeon performing the Mastectomy,

and the plastic surgeon who does the reconstruction. If your

Mastectomy surgeon feels that this would be unwise, he will

inform you of this. But feel free to ask him if he thinks that

this might be possible.

If Breast Reconstruction is not performed at the same time, it

can be performed at any later stage, when you are recovered

from the initial surgery. Some of the procedures for Breast

Reconstruction are complex and have a significant recovery

period. It may be that you simply don’t have time to proceed

with Breast Reconstruction at the time of your Mastectomy.

However, knowing that you can proceed at a later date at

your convenience, will give you a bit more hope to see you

through the hard times.

For women where a breast has failed to develop on one

side, Breast Reconstruction can be tailored to be performed

as a teenager and adjusted as they grow.

WHY SHOULD I HAVE A BREAST RECONSTRUCTION?

Although the Breast Reconstruction can look remarkably

life-like and feel quite real, you will never have your true

breast back again. What you will have is something that

helps you dress more easily, and pass unnoticed in most

social situations. A successful procedure will permit you

to wear a swimsuit and the usual casual clothing that you

wear now. It will also save you the bother of worrying abut

an external prosthesis, which may fall out, or feel hot and

uncomfortable.

Reconstruction of the nipple is commonly performed at a

second stage and this makes the reconstruction look just

that little bit more life-like.

Breast Reconstruction – after Mastectomy

48 49

Breast Reconstruction – after Mastectomy

HOW IS THE BREAST RECONSTRUCTION DONE?

Broadly speaking, Breast Reconstruction can be performed

by use of prostheses, or by use of your own tissue.

Sometimes a combination of both are required. Prostheses

are often used in a two-stage procedure known as tissue

expansion. Tissue expansion involves insertion of the tissue

expander (an inflatable prosthesis) at the first stage. The

wound is closed and over the ensuing months, in the doctors

office, saline (salt water) is injected into a valve within the

tissue expander to ‘blow it up’. The skin gets a gentle but

persistent stretch and is moulded into the shape of a new

breast. When the skin has stabilised and the internal scar

has matured (usually six months after the first operation),

the second stage procedure is performed. In this procedure,

the tissue expander is removed and the final prosthesis is

inserted. This prosthesis may be either made of silicone gel

(especially the new cohesive ‘leak proof’ gel) or salt water

(saline). You will be asked to choose your prosthesis type

after being informed of the alternatives.

Reconstruction of the nipple is usually performed at the

second operation.

Tissue expansion may be performed as a day patient, as

the surgery is less extensive than techniques which use your

own tissues. Insertion of a tissue expander runs much the

same risks as you will see on the ‘Breast Augmentation’

web site – www.plasticsurgery-aust.com. The second stage

of this surgery can also be performed as a day patient.

Tissue expansion therefore suits somebody who has a busy

lifestyle, who would find it difficult to get enough time away

from their activities to recover from a large procedure.

In the long term, tissue expansion suffers from some of the

risks seen in ‘Breast Augmentation’. A tissue expanded

Breast Reconstruction feels less natural than a breast

that has simply been enlarged cosmetically, as there is

less healthy normal tissue overlaying the prosthesis. It is

however a particularly useful technique where two sides

have been removed (for example, as a precaution to prevent

the development of cancer in someone with a string family

history of breast cancer).

Previous radiotherapy does not make tissue expansion

impossible, but it does increase the risk of complications

occurring. Sometimes tissue expansion is combined with

the use of a flap of your own tissue, such as the latissimus

dorsi flap. This provides a bit more healthy tissue in front

of the prosthesis to make it feel a bit more life-like. In most

cases however, this is not usually required.

Reconstruction using your own tissues is most commonly

done these days by means of the Tram Flap (Transverse

Rectus Abdominis Myocutaneous Flap). This ingenious

operation uses your ‘spare tyre’ to create a breast made of

the skin and fat of your abdomen with a small piece of the

muscle attached. In most cases, no prosthesis is required

to reconstruct the breast and these reconstructions are

commonly the softest and most natural to feel.

The added benefit is of course removal of your ‘spare tyre’.

Thus the successful Tram Flap patient gets a trimmer tummy

s well as a new breast. Again, the nipple reconstruction is

commonly performed at a second stage.

If your tummy is small, you may be unsuitable for a Tram

Flap, or you may require insertion of a prosthesis beneath

the flap at a second stage to provide adequate size. Dr

Scamp will advise you on the method the he thinks will best

suit your physique and your wishes.

The Tram Flap procedure is a bigger operation. You will

be asked to give your own blood prior to surgery, in

case transfusion is required. You will be in hospital for

approximately five nights and it will take you three to four

weeks to get your old strength back. We usually start you

on iron and folate pills (FEFOL) prior to surgery, to ‘build up’

your blood level.

Patients who have gone through this procedure, feel

that the benefit of having a reconstruction made from all

their own tissues and getting a trimmer tummy as well,

makes the extended recovery period required worthwhile.

The Tram Flap is often called the ‘Rolls Royce’ of Breast

Augmentations, as it can provide particularly life-like results.

48 49

50 51

There are many techniques available to reconstruct a breast

that has been removed due to cancer, or which has failed to

develop. Your consultation with Dr Scamp, will be to inform

you and help you to select a procedure that will best suit

your body and your wishes.

Remember the aim of Breast Reconstruction is to make two

breasts that match. Naturally these should be two breasts

that you like. One of the most important things to consider

at the very beginning is whether you have a desire to make

any alteration to your normal breast. Some people feel they

are too big, too small, or sag too much. The appropriate

surgery for the opposite breast can be included in the plan

to construct your breast.

In most cases, two operations at separate stages, some

months apart are required. But even after the first operation,

at least a breast ‘mould’ will have been created, which will

make dressing and wearing of normal clothes much easier

for you. In warm climates, one really needs to be able to

wear a swimsuit or a t-shirt to get through normal activities.

The aim of Breast Reconstruction is to make this possible.

Dr Scamp has a special interest in Breast Reconstruction.

He trained in Australia, Britain, Europe and USA in

Breast Reconstruction techniques. Dr Scamp is a trained

Microvascular Surgeon and uses this skill in many of his

Breast Reconstruction techniques.

The following website will answer some of the basic questions

about Breast Reconstruction – www.plasticsurgery-aust.

com. More detailed information can be found in a book

called A Woman’s Decision by Karen Berger and John

Bostwick 111, MD. This is published by Quality Medical

Publishing Incorporated St.Louis, Missouri. This book is

commonly provided for patients to read after consultation

with Dr Scamp. If you are traveling from a distance to see Dr

Scamp, ask his staff to send you the book in advance or get

a copy from a bookstore. It is very readable and contains a

lot of useful information.

WHO CAN HAVE BREAST RECONSTRUCTION?

Any patient who is medically fit for surgery and who desired

Breast Reconstruction is a suitable candidate. Naturally,

it is best if the breast cancer is under good control.

Reconstruction will not increase your risk of the breast

cancer coming back. If you have any doubt, you may ask

the surgeon performing the mastectomy, when he feels the

right time would be.

Naturally you want to be in the best of health for Breast

Reconstruction surgery. Cessation of smoking and attention

to things such as obesity and high blood pressure would be

prudent. Even if you decide to defer Breast Reconstruction,

or not to proceed at all, you may find some comfort in

knowing that these options are open to you.

WHEN CAN I HAVE A BREAST RECONSTRUCTION?

In many cases it is possible to perform Breast Reconstruction

at the same time as the Mastectomy. This requires co-

operation between the surgeon performing the Mastectomy,

and the plastic surgeon who does the reconstruction. If your

Mastectomy surgeon feels that this would be unwise, he will

inform you of this. But feel free to ask him if he thinks that

this might be possible.

If Breast Reconstruction is not performed at the same time, it

can be performed at any later stage, when you are recovered

from the initial surgery. Some of the procedures for Breast

Reconstruction are complex and have a significant recovery

period. It may be that you simply don’t have time to proceed

with Breast Reconstruction at the time of your Mastectomy.

However, knowing that you can proceed at a later date at

your convenience, will give you a bit more hope to see you

through the hard times.

For women where a breast has failed to develop on one

side, Breast Reconstruction can be tailored to be performed

as a teenager and adjusted as they grow.

WHY SHOULD I HAVE A BREAST RECONSTRUCTION?

Although the Breast Reconstruction can look remarkably

life-like and feel quite real, you will never have your true

breast back again. What you will have is something that

helps you dress more easily, and pass unnoticed in most

social situations. A successful procedure will permit you

to wear a swimsuit and the usual casual clothing that you

wear now. It will also save you the bother of worrying abut

an external prosthesis, which may fall out, or feel hot and

uncomfortable.

Reconstruction of the nipple is commonly performed at a

second stage and this makes the reconstruction look just

that little bit more life-like.

Breast Reconstruction – after Mastectomy

50 51

Breast Reconstruction – after Mastectomy

The Tram Flap is moved based on the blood supply that

comes through the muscle beneath it. Dr Scamp uses the

‘free’ Tram Flap procedure, which takes the smallest piece

of muscle possible with the blood vessels attached to it

coming up from your pelvis. These small blood vessels are

divided and re-attached beneath the microscope, to blood

vessels in your breast region. The alternate technique to this,

the ‘pedicled’ Tram Flap uses the more distant blood vessels

that run down the muscle from above. A larger piece of the

muscle is taken to shift the pedicled Tram Flap, and this may

weaken the abdomen more. This can cause a hernia.

The latissimus dorsi was the most popular method of

reconstructing the breast with your own tissues, before

the advent of Tram Flap. It uses a piece of skin and muscle

from your back, which is ‘tunneled’ through your armpit and

brought to the breast. Usually a prosthesis is required with

this flap, as the flap is not sufficiently bulky to reconstruct

an entire breast. However, it may be useful technique for

bringing in healthy blood supply to an area that has had

radiotherapy, so that tissue expansion can proceed more

safely or to cover a prosthesis where the overlying skin and

fat is very thin. The latissimus dorsi muscle is mostly used

in climbing or rowing and it is not missed by most people. It

does leave a scar on the back and we try to design this to fit

into the line of your clothing.

Nipple reconstruction is performed usually by taking a graft

of slightly darker skin high up in your groin crease and

performing a flap on the breast mound to provide projection.

Tattooing can be used to better match the colour. The

reconstruction of the nipple can be remarkably life-like,

and makes the reconstructed breast look more natural and

less ‘surgical’. As said above, the nipple reconstruction is

usually performed at the second stage of either the tissue

expansion or Tram Flap procedure.

If you feel your other breast is too large, a Breast Reduction

can be performed to better match the size. This may be

performed at the first or second stage of your reconstruction.

If the size is good but there is too much sag, a lifting

procedure (Mastopexy) can be offered to better match the

two breasts. Where the size of your other breast is too small,

Breast Augmentation can be offered to achieve the size that

you desire.

Some patients have even said they feel their breasts look

better then before their Mastectomy. This is certainly the aim

of the reconstructive procedure, but cannot be promised in

all cases.

WHERE IS BREAST RECONSTRUCTION PERFORMED?

A Tram Flap is performed as a hospital in-patient. Usually you

will stay for five nights. Tissue expansion can be performed

as a day patient, under general anaesthetic, or in hospital

with an overnight stay, as you prefer. This is particularly

used if surgery to the other breast is done at the same time,

although this can also be performed as a day patient. The

nipple reconstruction at the second stage is usually done as

a day patient.

You will be asked to decide whether you would prefer to

have your surgery performed as an in-hospital patient or as

a day surgery patient. In both cases general anaesthesia is

used for your comfort.

REMEMBER THERE ARE RISKS:

The general risks of surgery such as bleeding, fluid collection,

excessive scarring or anaesthetic difficulties, also apply

to Breast Reconstruction. Fortunately these are relatively

uncommon. Smokers increase their risks of surgery

substantially, and you will be asked to cease smoking

for at least six weeks prior to undertaking this surgery.

Remember, we both want you to have the smoothest

perioperative course and the best possible result. Nicotine

patches also need to be ceased six weeks prior to surgery.

Where complications are severe, secondary surgery may be

required and more expense will result.

Where an implant is employed, the risk associated with

breast prostheses, such as hardening (capsular contracture)

also apply. This is due to shrinkage of the scar tissue around

the prosthesis and may require an operation to divide

this hardened scar tissue. The tissue expanders used are

designed to weaken the scar as much as possible and

reduce the risk of this occurring. Capsular contracture does

not occur where a Tram Flap is employed and no prosthesis

is required.

52 53

Infection can occur around the expander of the final

prosthesis. If it does occur, usually these need to be removed

for at least three months. This is obviously disappointing,

as it will leave you with a flat chest for three months while

your body recovers. Fortunately infection is uncommon (2-

4%). Your reconstructed breast and nipple will never have

normal sensation, but remarkably some sensory recovery

does occur. Minor adjustment to the scar, or to the opposite

breast for a better match may be required. We try to give you

a perfect breast, but realistically our aims are to enable you

to dress comfortably and wear the clothes you like.

On the positive side, research has shown the remarkable

psychological benefit of reconstruction surgery. This is

particularly true when reconstruction is performed at the

same time as the Mastectomy.

PLANNING YOUR SURGERY:

After your consultation with Dr Scamp, you will be given

a book to read on Breast Reconstruction (A Woman’s

Decision). When you have read this book, you will return for

your second consultation with Dr Scamp. At that stage a

firm plan for your surgery will be made. In the interim, Dr

Scamp’s staff will provide you with an idea of costs of each

of the alternative procedures you may be considering.

Plan your time off work to rest at home. Arrange your

surgery for when you can get sufficient support to make

your recovery better. The more warning you give us, the

better we are able to fit in with your timetable.

PREPARING FOR SURGERY:

Apart from ceasing smoking and nicotine patches at least

six weeks prior to surgery, you should try to get yourself in

the best possible condition. Obesity increases your risks of

almost all perioperative complications. It is a substantial risk

to your heart. Getting fitter prior to surgery will hasten your

recovery from surgery.

Avoid aspirin, red wine and high dose Vitamin E for at least

two weeks prior to surgery, as these compounds can make

you bleed.

RECOVERING FROM SURGERY:

As mentioned above, it may take you up to four weeks or

more to get back to feeling your old self, less if a tissue

expander is used. Swelling at the operation site may take

even longer to disappear. The swelling may cause some

difficulty with dressing. Tissue expanders commonly sit a

little high and cause excess fullness at the upper pole of the

breast, in the initial stages of expansion. This may mean that

you will have to adjust the clothes that you wear to mask

this at first, but of course it will be less inconvenient than the

mastectomy was.

Most patients find that this surgery does an enormous

amount for their self-esteem and the quality of their life.

Write down any questions you have and ask Dr Scamp at

the time of your consultation.

Before Mastectomy

Breast Reconstruction – after Mastectomy

52 53

Now that you have read this overview of the most common

aesthetic procedures, you probably have some questions.

If you are considering surgery, your next step is to consult

with Dr Scamp. He will discuss detailed information about

the specific procedure or procedures in which you are

interested.

Dr Scamp may also discuss with you his preferred variations

to the surgical techniques described in this booklet.

Advances are constantly being made in the field of aesthetic

plastic surgery. While ‘new’ procedures do not always prove

to be better than established ones, Dr Scamp may feel

that you can benefit from a recently developed or modified

technique.

If there is an aesthetic procedure that you have hear about

from another source, such as a magazine article or television

program, be sure to ask Fr Scamp about it. He can advise

you whether a specific technique would be beneficial for

you. If there are any problems or safety questions, he will be

able to alert you to them.

Above all, confide in Dr Scamp by thoroughly discussing

your coals, expectations and concerns. His most important

job is to help you safely and comfortably achieve both

physical well-being and satisfaction with your appearance.

After Mastectomy

Your Next Step

54 55

Notes

54 55

T (07) 5539 1000 F (07) 5539 1177W www.esteemdayspa.com

A PO Box 7068, GCMC Bundall Qld 9726