A Facelift With A Natural Look
A Letter from Dr Hodgkinson
The Doctor is in!
Breast Enhancement Update
More patients considering Liposculpture & Body Contouring
A more refined approach to nose surgery
“...a final result which complements the appearance ”
With Rhinoplasty, we want a final result which complements the appearance, giving proportion to the profile, so that the other features of the face, the eyes, brow and the mouth, the expressive parts of the face are then emphasized.
Rhinoplasty or a “nose job” is one of the most technically demanding of all aesthetic surgical procedures. This is so because of the nose’s position in the face, central and most easily observed, so any irregularity can be spotted at once. Rhinoplasty requires a great deal of experience and technical Know-how to manipulate the bones and cartilage underneath the skin, so that the final shape of the nose is complementary to the patient’s face.
Before and after Rhinoplasty by Dr Hodgkinson at the Double Bay Day Surgery.
Selecting the “right” nose for the patient
Each patient has a particular idea of what they want their nose to look like, although they might not be able to verbalise this or show us photographs. Our imaging system, Alter-Image, operated by Naomi Berns who has over 15 years of imaging experience, is able in most cases to show you a 90% likelihood of the result that you can achieve with Rhinoplasty.
Your input is essential. So patients are encouraged to bring in photographs of noses they like and view them together with a huge array of visual images which may or may not suit them. Only by communicating with them and using the imaging system can we come up with a design that not only looks natural, but is the right nose for their face.
Too small a nose may not be the answer. We are more concerned with shape than size. A nicely shaped nose which fits in, balancing the mid third of the face, is not noticeable because it is proportionate to the remainder of the face.
Noses also need to be ethnically appropriate so, for example, a Mediterranean patient will receive quite a different nose to that desired by an Asian patient.
Breathing can be Improved
“...we come up with a design that not only looks natural, but is the right nose for their face...”
We investigate the nasal function, not only by inspection but also radiographically to determine the cause of any nasal obstruction if it exists. In most cases. I can fix the nasal obstruction at the same time as I give the desired external appearance to the nose.
There are two basic groups of patients that we deal with: Caucasians who often have a large bump to their nose or their nose is too broad, and Asians, who often have flat or broad noses.
Operations are essentially quite different; in the Caucasian, removing the bump, refining the nasal tip and narrowing the nose; in the Asian, it is usually augmenting or increasing the projection of the roof of the nose and refining the nasal tip, or the flare of the nostrils.
Both procedures are carried out under a light general anaesthetic, taking usually approximately 1 to 1½ hours. A small splint is in place for just over one week.
A subgroup of the patients that we deal with are called secondary rhinoplasties, and in these cases, frequently too much tissue has been removed and we have to reconstruct the nose, often with bone and cartilage grafts. These are more complex procedures, taking more time to heal and also procedures which have more swelling in the post-operative period.
We advise patients to take at least one week to 10 days off work and we suggest that they abstain from very vigorous physical activity for 4 to 6 weeks, especially that which may involve the possibility of their nose being traumatised.
Before and after Rhinoplasty by Dr Hodgkinson
Cosmetic Surgery in China I have just returned from being on the Faculty of the First International Conference on Aesthetic Plastic Surgery, put on by ISAPS (International Society of Aesthetic Plastic Surgeons).
Together with one other eminent Australian surgeon, I myself and 20 more surgeons from the United States, France, South America, Singapore, Korea and Japan, along with our Chinese colleagues, gave numerous talks to approximately 400 plastic surgeons in China. What is astounding is that the 1.3 billion people in China are now discovering cosmetic surgery and they as a population have the same kinds of concerns that we face. There are ethnically unique issues for their cultural aesthetic such as the flatness of the nose and the heavy upper eyelids.
What is interesting is that all people age in a similar way with regard to laxity and droop of ageing musculature and degradation of facial fat, despite the different quality of Asian skin which is less subject to wrinkling. Therefore amongst our peers we found a certain universality of topics and areas of interest that were relevant to all of us.
This was also very relevant to me because of the multi-national nature of Sydney and the fact that, a growing percentage of my patients are Asian. I always enjoy working with Asian patients as over the years I have learned a great deal through them about their concerns, their aesthetics, their goals and their culture
This was a highly educational conference, definitely from the Chinese point of view as well as for me. I was honoured and privileged to be a part of the Faculty in China. I will be returning in a few weeks, to give a course on Rhinoplastic surgery, which many of our readers already know, is definitely one of my subspecialties.
Q: “I know I need a facelift but I don’t want my face to be left blank & expressionless”
r Hodgkinson comments:
Pan Facial Rejuvenation, which assesses all areas of the face simultaneously: face/ jaw, neck, eyes and brow, allows for a balanced, more youthful and expressive visage to be created.
Pan Facial Rejuvenation by Dr Hodgkinson
Before and after Breast Augmentation by Dr Hodgkinson
We see many patients who have had previous breast enhancement and are dissatisfied with the results. Why is this so? There are many reasons, but one is that some surgeons still believe just using one type of implant will give the desired result.
However, as with the fillers, so many implants have come and gone. The saline implant has been around for 30 years without ever having been taken off the market; for 50% of my patients, this is the ideal implant with a very low rate of going hard and the same rate of breakage as the silicone implant.
The new silicone gel implant certainly does offer a vast improvement but the key issue is not to put too large an implant in, bigger is not necessarily better.
Through tiny incisions either under the breast or through the armpit, we can give a patient a result which is appropriate but not too large. If the implant extends further than a patient’s natural breast tissue or is too big for a chest wall, the implant will show and the result will look unnatural. We take into account a patient’s activities and they must understand that an implant does not last forever; a very small percentage, approximately 3% to 5% of implants will need replacing in 5 to 10 years. This does not mean a change in 10 years is inevitable, but means it may be required in the future. The saline implant is the easiest implant to exchange should this become necessary. Conditions which tend to cause implant change include pregnancies, menopause, weight gain or hormonal therapy. Most patients undergoing breast augmentation understand it is not forever.
We still perform an enormous amount of liposuction in the practice and have done so since its inception in the early 1980s, both for men and women.
The reason is that as the temperature rises and we seek out our briefer clothes and swimwear, many people feel that a few kilos have been added or their shape is not flattering when wearing a swimsuit. I recently performed liposuction on a 25 year old female who wanted a trip to a beach holiday resort with her husband.
Unfortunately, the problem of her genetically heavy hips, saddlebags and thighs meant that she felt embarrassed and reticent to take the vacation. You can see her before and after photographs here which really show an excellent improvement in her body shape.
Liposculpture performed by Dr Hodgkinson
Recently, at the meeting of leading plastic surgeons in China, it was endorsed that while temporary injectable fillers are perfectly safe that permanent injectable fillers are a ‘no-go’!
We have known for many years, that many of the new fillers that came on to the market, eventually drifted off the market, due to complications and this is true of some of the permanent injectible fillers that have been introduced in the last few years.
‘Permanent’ can mean ‘problems’
Do not be sucked in by the hope that you may get a permanent correction from a permanent product. Over years, these permanent products can become inflamed, infected and form what we call granulomas. Granulomas are hard lumps and are very difficult to remove and cause great angst for both the patient and the surgeon.
Results without complications
The temporary injectable fillers have stood the test of time, providing the result without complications, short or long-term. Old and new products allow for longer lasting results, up to 18 months, but the advantage is the product goes away with no clinical reaction to cause inflammation, infections or granulomas.