Safety Issues in Cosmetic Surgery
Safety in Cosmetic Surgery
Dr. Hodgkinson with some of the surgical team at the DBDS
Recent media coverage of tragic deaths from cosmetic surgery procedures in Australia emphasises how important patient selectivity is for the surgeon and how serious the decision is when you are considering to have a surgical solution to cosmetic issues that are causing you distress.
If you have a small area of unwanted fat, minimal wrinkles or skin discolouration and sun damage we do use non-surgical techniques such as injectable fillers, anti-wrinkle injections, lasers and ultrasonic treatments. However, after a certain point, usually about 45-50 years of age, the treatments become less effective and so, surgery will be the only solution. Remember, although injectables often achieve good results there is no replacement for the power and precision of a surgical approach for most aesthetic problems.
Many nurse injectors or non-operating cosmetic physicians over use these non-surgical treatments on patients even when they know that it is unlikely to achieve the results the patient desires. In turn this creates a dissatisfied client who has wasted their money. So there comes a point when surgery is the only option for a noticeable improvement. But the risks/benefits ratio has to be weighed up.
There are many things to consider:
Your general health
- Surgery is invasive, requiring anaesthetics and will be accompanied by bruising and swelling and a period of healing. Patients who are on blood thinning medicines, heart medicines, respiratory medicines will all need to have an important work up prior to considering whether they might have surgery. Referral to their general practitioner or specialist is necessary and at the Double Bay Day Surgery we only operate on very low risk patients called ASA 1 patients, hence reducing the risk that some unexpected event may occur during the surgery.
We also only use qualified anaesthetists to monitor the patients during the procedure so that if there are problems the anaesthetist can deal with these. By operating on only ASA 1 patients, risks of something untoward happening to the patient are very, very low.
- Nothing is more critical to the success of your operation than the surgeon you choose. Their experience and expertise is paramount.
Expertise means the surgeon is regarded highly in the profession as a plastic or cosmetic surgeon, evidenced by their publishing articles in scientific journals or giving lectures at meetings and attending local and international high level plastic and cosmetic surgical conferences.
And as important as expertise is experience, because nothing substitutes for years of experience.
The support staff
- After surgery you need nursing and technical staff to assist in your management. It is important that you have a seamless journey through the surgery and the postoperative recovery period. With his/her experience in cosmetic procedures your anaesthetist will be critical to the process to provide you with adequate pain medicine or anti-nausea medicine in the postoperative period.
The operating room
- Day surgeries dedicated to one particular type of surgery have been shown to be the safest delivery site for cosmetic surgery. But the facility must be licensed and accredited. Such a facility will be regulated on an annual basis and you should check that it has the appropriate licensure to perform the surgery.
In New South Wales it is mandatory that surgical procedures are conducted in licensed day surgery facilities; however some surgeons cut costs and increase profits by operating outside of these guidelines.
Fees can deceive
- Do not be fooled by a cheap price. A cheap price generally means that at some point there has been shortcuts and these shortcuts may be putting you at risk. A high price is also no guarantee either as many high profile advertising surgeons with little experience charge highly, the cost covering their expensive marketing budget.
Safety is paramount
- With over 30 years experience as a senior plastic surgeon with an onsite dedicated licensed and accredited facility, at the Double Bay Day Surgery at 20 Manning Road in Double Bay, we take safety as your number one issue when you are considering cosmetic surgery.
Letter from Dr. Hodgkinson
Every two years Dr Enrico Robotti conducts a major rhinoplasty course in Bergamo Italy.This is the sixth course. It is attended by the most elite rhinoplastic surgeons in the world and is limited to 500 participants.
Dr Robotti asked me to give a paper on body dysmorphic disorder. I have previously published on this disorder which is very common. Approximately 15% of patients who are undergoing rhinoplasty are likely to suffer from this disorder.
Simple Psychological Test
In my practice I utilise a simple psychological test as part of my evaluation of patient suitability to undergo cosmetic surgery, especially rhinoplasty.
The problem of operating on patients with body dysmorphic disorder is that they are usually quite disappointed with the result even when the result is very satisfactory.
Awareness of body dysmorphic disorder is becoming more common; patients often know that they are obsessed with their appearance and this obsession is interfering with their family, social and occupational life.
My paper was very enthusiastically reviewed and commented on by some of the worlds most prominent rhinoplastic surgeons. I don’t say I have all the answers to patients selectivity but I try my best to pick the best candidates who will benefit physically and emotionally from the surgery.
Latest News from the CRSC
I recently published a chapter in a textbook, Aesthetic Surgery Techniques, by editor Jim Frame on my technique of face and neck lift. This technique has evolved over 30 years to try and give the best and most natural results to patient and avoiding the overdone or tight looking postoperative face lift result. Only by publishing and presenting results at major international meetings can I assess what is the best for my patients and institute continuing improvements to the techniques.
Before and After Facial Rejuvenation by Dr Hodgkinson
Many of my staff have been very loyal over my career. Sue, my technical scrub nurse, has been with me 27 years and Janet and Trish over 10, Deborah for five years. New staff at the front office, Rebekah and Holly, share with Michelle who was my original front office staff 25 years ago.
Our staff are very aware that our patients require concise and accurate information about procedures.
We aren’t salespeople but do try to help you make an informed decision as to the best non-surgical/surgical procedures for you.
Rebekah, Michelle and Holly at the CRSC
Breast Implant Update
Anaplastic large cell lymphoma (ALCL) is a rare cancer associated with textured gel silicone breast implants. I have not seen such a case yet 400 have been reported around the world.
Almost exclusively I use smooth walled saline and gel implants so my patients are most unlikely to contract this rare disease which is estimated at 1 in 30,000 cases.
Even so, I always encourage all my patients with breast implants to be reviewed yearly and to check the status of their breast implants.
IF YOU ARE A PATIENT OF DR HODGKINSON – PLEASE NOTE THAT HE ONLY USES SMOOTH WALLED BREAST IMPLANTS FOR WHICH THERE IS NO KNOWN CONCERN FOR ALCL
Before and After Breast Augmentation with 375cc smooth walled saline implants in a submuscular pocket through a small incision in the inframammary fold.
Operation Restore Hope is on the road again
By the time you read this story we will be in the Philippines for our second mission at Las Pinas City Medical Centre (LPCMC) to repair children and infants with cleft lip and palate deformity. We will also follow up on our patients at the major craniofacial centre in the Philippines Childrenís Medical Center (PCMC).
Operation Restore Hope works throughout the year and every day, not only to complete our missions but also to continually support our Filipino colleagues in their endeavours. These doctors and surgeons follow up our little patients for their ongoing health care.
Dr and Mrs Hodgkinson with Geralyn and her mother
Volunteers and Donors
It is thanks to all our volunteers and our donors that we are able to carry out this work.
With the help of both of you we have been able to operate on over 3000 children in a 25 year commitment to the poor and neglected children of the Philippines.
Before and after craniofacial surgery for nasofrontal encephalocele.
(protusion of the brain through the skull)
Functional Rhinoplasty: the Pathway to Easier Breathing
Having prior breathing difficulties is often associated with nasal deformities and the appearance of the nose is not the only problem.
Before and After Rhinoplasty by Dr Hodgkinson
I believe that the function of the nose should be assessed prior to surgery and is essential that it is improved by the surgery. A nice looking nose that does not breathe well is not satisfactory as far as I am concerned.
After examining the inside of the nose we perform a maximum inspiratory flow rate test (MIFR) which gives me an objective measurement of the nose is functional efficiency.
A cone CAT scan will define the problem preoperatively and breathing issues can be dealt with at the same time as the cosmetic portion of the rhinoplasty.
Preoperative digital imaging
We always perform preoperative digital imaging to see what nasal shape best harmonises with the patients other facial features and their particular desires. Sometimes a chin implant or neck liposuction adds to the final profile result.