Newsletter 2019

newsletter 2019
  • A Brow Lift Can Really Open Up Your Face
  • A Letter from Dr. Hodgkinson
  • Male and Female Facelifts: How are they different?
  • ALCL and Breast Augmentation
  • Rhinoplasty: A Good Result Also Improves Your Breathing
  • Operation Restore Hope (ORH): Ongoing Commitments
  • A Brow Lift Can Really Open Up Your Face

    Before and After Facial Rejuvenation by Dr Hodgkinson
    Before and After Facial Rejuvenation by Dr Hodgkinson

    The brow represents 80% of human expression and a sagging brow or asymmetrical brow gives the appearance of tiredness, disinterest and sometimes even distress. These features can be reversed to a modest extent by non-surgical techniques and to a large extent by the latest, improved surgical techniques of brow lifting.

    The non-surgical techniques include injections to modulate the muscular activity, and especially of the central muscles called the glabellar muscles, the depressor muscles of the eyebrow. The most common injection used is Botox and has been used for 25 years.

    “The results are much appreciated, opening up the upper third of the face, giving a much brighter communicative appearance….”

    Brow lifting as a surgical procedure initially involved an incision across the top of the head and then rolling down the scalp and pulling it up into a better position. Although highly effective in the results, the problem was the long scar and the loss of hair and scalp sensation.

    Endoscopic surgery

    The development of the endoscopic surgery, which I began performing in 1995, and was probably the first to do so in Australia, was a huge improvement but required a large investment of training as well as equipment to produce a bandaid operation where only small incisions were made in the hair.

    The hair line and the scalp were elevated and the muscles could be manipulated via these endoscopic techniques.

    Techniques have improved

    Over the years the techniques of fixation have improved and we have used an Endotine suture for the last 10 years. An Endotine is an absorbable small plate which holds the brow in place until the plate absorbs and the brow is held in its new elevated position.

    Much brighter appearance

    The results are much appreciated, opening up the upper third of the face and giving a much brighter communicative appearance to the overall countenance of the patient.

    A Letter from Dr. Hodgkinson

    Dr Hodgkinson with “Super Neck” surgeon Andre Auersvald from Curitiba, Brazil
    Dr Hodgkinson with “Super Neck” surgeon Andre Auersvald from Curitiba, Brazil

    More Meetings in 2019

    I have had the wonderful opportunity in 2019 to attend and lecture at a number of International meetings throughout the world.

    This began with a North American Alpine Workshop which was held in Zermatt, Switzerland, and where I gave two papers and was exposed to some of the brightest minds in plastic surgery from the United States and around the globe.

    There is only one Australian representative and I am
    fortunate to be that surgeon in this elite group.

    Naples lectures

    From this I went in May to Naples, Italy and gave lectures there to another International group, which gave me a flavour of the European plastic surgery scene.

    As the year progressed, I had the opportunity to be invited to Curitiba, Brazil, where I observed a very famous neck lift surgeon and was able to lecture at the Brazilian Society of Plastic Surgeons on rhinoplasty and neck surgery.

    Global approach needed

    So I have had a continued global exposure this year to the trends in plastic surgery, also attending a small meeting in Brisbane to enjoy Dr Bryan Mendelson’s anatomy dissection course.

    I would say that to keep up with the latest trends in surgery it requires a global approach; I am associated with an exclusive WhatsApp group of International Cosmetic Facial Plastic Surgeons where we discuss the trends.

    We are very active on a day to day basis and our work allows us all to continue to grow and develop as surgeons.

    Male and Female Facelifts: How are they different?

    mid lower facelift surgery
    Before and After Male Facial Rejuvenation by Dr Hodgkinson

    People want to know how facelifts differ between men and women. They differ in many ways.

    Men do not want such a glamorised appearance but are more satisfied with a good jaw and
    neckline. Women, on the other hand, think it more important to establish not only the neck and jaw but also the cheek area, more specifically the sagging around the nasolabial fold.

    In men, there is slightly higher risk of bleeding because the skin is more vascular from shaving and we are cognisant of that in the postoperative period. The rate is less than 2% of cases.

    Women have an advantage

    Women have the advantage of being able to use makeup in the postoperative period to reduce any noticeable bruising, but men have their own camouflage too, that is growing a stubble or beard,
    which they can do for 10 to 12 days in the postoperative period, again limiting any noticeable bruising.

    The “Net” speeds recovery

    One of the new procedures I have introduced, thanks to my exposure this year to International surgeons and into South America, is the “Net.” This looks a little frightening in that the skin is sewn with stitches down to the underlying tissues and this is a temporary stitching that lasts for two to three days and seems to reduce swelling, bruising and bleeding, and also tends to cause the skin to adhere much more reliably to the underlying tissues.

    Before and After Female Facial Rejuvenation by Dr Hodgkinson
    Before and After Female Facial Rejuvenation by Dr Hodgkinson

    ALCL and Breast Augmentation

    Smooth gel and saline implants are the safe option

    Before and After Breast Augmentation with smooth walled saline implants
    Before and After Breast Augmentation with smooth walled saline implants

    Much has been seen in the media and in my newsletters and blogs regarding ALCL. Fortunately for my patients, none of the implants that I use for primary breast augmentation have been withdrawn from the market because I have used mainly smooth implants.

    The only time in the last 14 years that I have used a textured implant was in breast reconstruction. This is only a very small group of my patients that have breast reconstruction as these cases are usually referred by the oncological surgeons to other surgeons who work in larger public hospitals.

    Only Smooth Gel and Saline Implants

    For the vast majority of the hundreds of patients that I do perform breast augmentation surgery, they need not worry as I have in the last 14 years only used smooth gel and saline implants.

    Yearly Check up a Good Idea Saying that, I wish all patients to follow our advice and have a yearly check up of the implant. Even though there are likely no problems, it is also reassuring to know that that there are no problems and it is worth following up.

    A Moving Target

    The breast is a moving target, with patient’s breasts sagging, aging, pregnancy and with menopause, changes in the consistency of the breast tissue occurs, so I encourage all patients who had a breast augmentation to make an appointment for a check up and to discuss the status of their implants, cf.

    Rhinoplasty: A Good Result Also Improves Your Breathing

    Rhinoplasty is one of the most popular procedures that I perform, two or three times a week, or sometimes more. Perhaps 50% of the cases are a secondary procedure from elsewhere and these are more challenging cases.


    nose surgery rhinoplasty
    Before and after cosmetic and functional rhinoplasty by Dr Hodgkinson

    “A good result must also improve the breathing.”

    I concentrate on the breathing aspects and not only the appearance. I have seen patients
    who have been very satisfied with the appearance from other surgeons but can hardly breathe. That is not what I regard a good result.

    Improving breathing vital

    A good result must improve the breathing also. Patients, when they come for consultation have breathing testing performed. Sometimes a CAT scan of the nasal passages is carried out, and we always do medical imaging to try and ascertain what the patient is trying to
    achieve aesthetically.

    The rhinoplasty is an outpatient surgical procedure, is not particularly painful surgery, and requires the patient to have approximately one week off work.

    Bruising usually minimal

    Bruising is usually quite minimal and patients have to realise however, depending on the type of procedure performed, the patient may need to have follow up visits and also taping of their nose because swelling is unpredictable, as is the thickness of the skin.

    Operation Restore Hope (ORH): Ongoing Commitments

    ORH is celebrating twenty-six years commitment to children with cleft lip and palate and cranio-facial disorders in the Philippines. Most of my readers know that we have been performing missions for over 25 years in the Philippines, but they may not know about our major commitment to children with serious cranio-facial deformities.

    Screening day for ORH’s little craniofacial patients
    Screening day for ORH’s little craniofacial patients

    Although I personally do not do these surgeries, the local members of our team Dr Gurango and the cranio-facial surgeons, neurosurgeons and anaesthetists at the Philippine Children’s Medical Center (PCMC) are supported for performing extremely difficult procedures on these children born with rare facial deformities.

    Sai Sai 2015
    Sai Sai 2015 – age 5 – No legs Tracheostomy Nasogastric feeding

    It is not a one-time operation; it requires multiple operations over a long period of time. Dr Gurango has outstanding experience and wonderful training and produces wonderful results. But the biggest problem is these operations require considerable amount of funding, costing thousands and not hundreds of dollars

    Gratifying and life-saving

    The results are gratifying for the parents and life saving for the children. We have long term
    follow-ups and you can see a photo of one of the children born with a rare disorder in which she is without hands, lower legs and a mandible/jawbone.

    operation restore hope
    Sai Sai in 2019 – age 9
    Confident with prosthetic legs
    No Tracheostomy
    Normal feeding (loves Jollibee burger steak)
    Top of her class & winning med

    And now here she is today

    She has been supported by our group through multiple procedures and buying multiple prosthetic limbs. Here she is top of her class, proudly displaying her medals.

    Operation Restore Hope functions every day of the year supporting and following up with these children providing the needed funds and equipment to enable these children to receive their life saving operations at the PCMC.