Common questions about plastic surgery

Dr Kourosh Tavakoli

What is the difference between cosmetic and reconstructive surgery?

Plastic surgery is a very specialised field dealing with both cosmetic and reconstructive surgery. Reconstructive surgery may be performed to correct a deformity caused by birth defect, cancer or trauma. Examples of reconstruction include cleft lip, breast cancer reconstruction and microsurgery. Cosmetic plastic surgery provides the opportunity for you to feel better about how you look. Examples of cosmetic surgical procedures are those done to correct prominent ears, a large nose, baggy eyelids, facial wrinkles or breasts that are small and/or sagging.

Describe a good candidate for plastic surgery

A good candidate for cosmetic surgery is one who understands the procedure, is realistic about expectations of the surgery and is motivated primarily to please oneself. A less likely candidate is one who does not really understand the procedure, has unrealistic expectations or is motivated to please someone else.

At the initial consultation with your plastic surgeon, you should explain your concerns and what you would like to have done. Your situation will be evaluated and you will be advised as to what can be accomplished. You should have some understanding about what will be done so that you can appreciate the magnitude of the procedure. You also should be aware of the risks and potential complications associated with the procedure. Since cosmetic surgery is elective in nature, you should be well-informed and certain that it is what you want. You should carefully weigh the "benefits" that you will receive from the surgery and the "cost" of the procedure which includes risks, inconvenience, discomfort and expense. Should you have doubts about proceeding with the surgery, you should seek and have a full explanation of the procedure and defer surgery until your doubts are resolved.

What questions should I ask before choosing a plastic surgeon to make sure he/she is qualified to operate on me?

Choosing the right plastic surgeon is not an easy task. It is imperative in your research that you find a bona fide surgeon, trained by and meeting the stringent criteria and high standards of the Royal Australasian College of Surgeons. Many "cosmetic surgeons" are in fact just General Practitioners who learned procedures by watching others. Plastic surgeons are fully qualified surgeons and Fellows of the Royal Australasian College of Surgeons (FRACS) who have completed a rigorous training program much as Heart Surgeons, Brain Surgeons, Eye Surgeons and Orthopaedic Surgeons.

Look for the FRACS qualification to confirm this. Plastic surgeons are also members of the Australian Society of Plastic Surgeons (ASPS).

Once you have identified genuine plastic surgeons, you will need to choose between them. Plastic surgery and particularly cosmetic plastic surgery is an art form. Different surgeons have varying levels of training, experience and expertise. The "product" you get will be very different from surgeon to surgeon.

How long is the recuperative period? When can I return to work?

The length of time it takes to recuperate after plastic surgery varies depending on the procedure performed and the person operated on. Most patients will require assistance for the first two days. Following these two days, most patients are able to care for themselves but may still need assistance if they have small children to care for. The specific lengths of disability are outlined below by procedure. These are approximations, and do not include return to exercise.

Eyelid surgery: most patients can get around independently by the second day. With the use of sunglasses, you may feel comfortable going to the store by days three to four, and with make-up could return to work in five to seven days.
Facelift surgery: most patients can get around independently by the second day. Usually do not feel comfortable going out in public for five to seven days. Requires 10-14 days before returning to work if in the public eye.
Breast surgery: most patients can get around independently by the second day. You can return to work at seven days if not required to lift more than two kg.
Liposuction/liposculpture: most patients can get around independently by the second day, earlier if smaller number of areas were treated. One can return to work and normal activities in 10 days.
Abdominoplasty: patients may take between two to four days before getting around independently. The recovery is almost identical to a Caesarean section. One can return to a desk job at 10 days, other jobs in two to three weeks.

When can I resume regular exercise?

The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow, walking routine on the second post-operative day. Regular aerobic and more vigorous activities are not allowed during the first two to three weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed after six weeks in most cases.

What are the costs of cosmetic surgery?

The initial consultation is very important because it will help you determine if you are a candidate for cosmetic surgery and if it is something that you are interested in pursuing. More than one visit may be necessary before you feel comfortable with your decision.

In summary the cost breakdown is as follows:

Surgeon's fee
Anaesthetist's fee
Theatre fee
Implants and garments fee

Sometimes after cosmetic surgery, secondary or touch-up surgery is necessary. If this is done within one year of the original surgery, there is usually no additional surgeon's fee. However, other fees such as anaesthesia, operating room, medications or tests will be charged.

What surgery can improve the appearance of body sculpting and breast enhancement?

In the Australian culture more so than ever, looking good is becoming synonymous with being healthy. National obsession is towards lean looking bodies. However, it is a well-known fact that no amount of dieting or exercise can remove fat from certain "difficult" areas of the body. In fact, paradoxically excessive exercise leads to disproportionately large thighs, calves and even smaller breasts.

Body sculpting refers to changes to improve a woman's figure in a curvaceous way and add to the length of her legs in a more shapely way. Figurative representation is a foundation of human artistic endeavour and so with liposculpture and breast augmentation or lift it must always be an artistic endeavour.

Liposuction has been around since the early '80s. Despite the initial success it was only inevitable with our increasing desire for contoured figures that liposuction would need to undergo further advancements. Hence through Professor Marco Gasparotti from Italy and Dr Luiz Toledo of Brazil, superficial liposculpture emerged as the next generation liposuction.

Liposculpture is the technique of removing excess fat from certain areas of the body and injecting the harvested fat into adjacent areas in order to create shape and contour. The best example of this technique would be the sculpting of the buttocks region. Superficial liposculpture is the next generation technique where the traditional liposuction removed the deep fat but the new technique of liposculpture takes the superficial fat. By removing the superficial layer, the skin is allowed to move freely as an independent entity and hence resume the new shape that the surgeon intends to provide.

The current thinking is that liposuction should not be used only for weight reduction but instead as a means of sculpturing the body into a three-dimensional shape comprised of convexity and concavity. We are moving more towards patients who want to have overall changes in body shape. Knowing that there are three areas of fat under the skin and muscle layers — the superficial fat, the middle fat and the deep fat, liposculpture treats all the three layers to varying amount.

Breast enhancement is an integral part of body sculpting. Women's breasts shape must closely match the overall "physique". In order to gain the optimal result the plastic surgeon must foremost improve the shape and volume of the breasts to match the liposculpted body preferably at the same time. Liposculpture to hips, thighs and abdomen will have profound effect on the perceived shape of breasts. Therefore, where indicated a combined body/ breast approach will be dramatically shape altering.

There are generally three procedures that address the breast as part of the sculpting process. Breast augmentation with implants, breast lift (mastopexy) with and without implants. Since fat injection to breasts has been largely abandoned in Australia, the only currently safe means of breast augmentation is to use an implant (silicone gel or saline).

Before having surgery, it is beneficial for the patient to review photographic examples of the breasts they would like, and to convey their wants to the surgeon so there is a clear, visual understanding of the desired result.

There are five crucial clinical parameters in aesthetic assessment of breast:

Patient's body build and height
Breast size, shape and symmetry
Nipple position in relation to the breast
Chest wall shape and dimension
Patient's desire for cup size and shape

Generally speaking, if the breasts are of good shape but lack volume, simple augmentation using an implant will be sufficient. In breasts that are droopy with good volume breast lift can be very powerful in giving the desired shape and perkiness. Finally, breasts that have lost both volume and shape will benefit from a combined breast augmentation and lift procedures.

Salient points about candidates seeking liposculpture and breast enhancement:

Healthy and physically active
Stable weight and balanced diet
Good skin tone
Non-smokers
Realistic expectations
Committed to wearing post-operative elastic garment and sports bra
Compliant with post-operative physiotherapy and massage