Surgery

Many people assume that a cosmetic surgeon performs cosmetic surgery and that a plastic surgeon performs reconstructive surgery, but this is quite incorrect. No matter what industry you come from, there are certifications, degrees, etc that must be abided by. If you don’t have the correct level of qualification then you cannot perform the job legally. Unfortunately this is not the case in the medical world. As long as you have a basic doctors degree, as you can read here, you can perform brain surgery! Your surgeon’s training and qualifications are absolutely fundamental to his ability to accomplish your goals. A plastic surgeon’s training and qualifications are the gold standard in cosmetic surgery, whilst a cosmetic surgeon’s training and qualifications are often non-existent.

• Assistant Fees
• Smoking and Surgery
• Your Weight and Surgery
• Vitamins and Surgery
• Medications and Surgery

Assistant Fees

When a specialist performs surgery for you, he will charge a surgeons fee accordingly. This fee often reflects the length of time the surgery takes as well as other factors such as the technical difficulty of the procedure.Many surgeons use an assistant to reduce operating time. The less time spent on each operation means more operations can be performed in an operating list, and therefore more income can be generated. Most plastic and reconstructive surgeon use GP’s (General Practitioners) to assist them in some or all of their surgery. When a GP is used as an assistant, Medicare has ruled that an “assistant’s fee” is charged to compensate the GP for his time. This “assistants fee” is a set 20% of the surgeon’s fee and is billed to you either directly by the GP, or indirectly by your surgeon. Cosmetic procedure are generally bilateral (two sided)procedures for example breast enlargement or reduction , eyelid surgery, facial surgery and so on. When a GP assists a surgeon, he often performs half of the procedure, and will invariably do half of the wound closure or suturing. Your surgeon does not use an assistant in surgery. He believes that you pay a plastic surgeon to perform your surgery – all of it. If you have any questions regarding your operation or surgical assistants etc, our friendly staff will be able to assist you with your enquiry. Please call our free Call number on 18000 80001 Back to top

Smoking & Surgery

Cigarette smoke contains many toxic chemicals. This fact is well known and is in fact written on each and every packet of cigarettes. Cigarette smoke, whether inhaled directly or through inhaling the smoke of others (passive smoking), will seriously increase the risks of problems associated with surgery. As most people will be aware, smoking is the greatest preventable cause of death in Western society. Approximately 90% of all drug-related deaths are due to smoking. Statistics show that every cigarettes smoked reduces your life expectancy by about 15 minutes. Post surgical problems directly related to smoking included the following:

1. Delayed and impaired wound healing
2. Reduction in scar quality
3. Increased risk of hypertrophic and keloid (raised and lumpy) scars
4. Fat necrosis (death of some subcutaneous fat lying under the skin)
5. Skin necrosis (death of overlying skin also)
6. Need for secondary or corrective surgery with additional expense
7. Profound reduction in cosmetic outcome

Smoking will also increase the risk of problems relating to anaesthesia, particularly if general anaesthesia is used. Such problems include:

1. Atelectasis (collapse in the lower parts of the lungs)
2. Pneumonia (lung infection)
3. Myocardial infarction (heart-attack)
4. Stroke (especially if on the oral contraceptive pill)
5. Deep vein thrombosis (blood clots in leg and pelvic veins)
6. Pulmonary embolism (such blood clots travelling to the lungs)
7. Death or severe debility as a consequence of these problems

Your planned surgery is an elective procedure. You have chosen to see a plastic surgeon to get the very best possible results. We certainly do not want to increase the risk of problems to you, and it makes no sense that you would voluntarily choose to do so. Prior to any elective surgical procedure, you must avoid all cigarette smoke and all nicotine containing products for at least three weeks before and three weeks after your surgery, regardless of the type of procedure you are having performed. If you anticipate difficulty in doing this please plan a visit to your GP well in advance of your surgery date. This will allow you to take the necessary steps to reduce your levels of nicotine and therefore aid you to stop smoking prior to surgery. If you are still using nicotine of any sort (cigarettes, patches or creams) 21 days prior to surgery you must contact our rooms to reschedule the date of your surgery. Back to top

Your Weight & Surgery

Did you know that being somewhat over what might be regarded as an ideal weight for your height, can affect the success of your cosmetic surgery? Statistics demonstrate conclusively that an index of your weight and height, called the body mass index (BMI), does indeed predict accurately the risk to you of various post-surgical problems. Some of these problems relate to the use of general anaesthesia, whilst others relate to the specific operation undertaken. In general, anaesthesia related complications related to obesity (and being merely overweight) include:

1. Difficulty with gaining intravenous access
2. Difficulty keeping the airway passages clear to keep oxygen going into the lungs
3. Difficulty inflating the lungs
4. High risk of lung collapse
5. Increased risk of heart attack, heart failure and stroke.
6. Higher risk of abnormal blood clots (which can be fatal) and pneumonia after surgery.

In general, surgery related complications include elevated risks of wound healing problems such as infection, wound dehiscence (separation of wound edges) and adverse scar formation (hypertrophic and keloid scars). In particular problems are frequently experienced with the blood supply of elevated flaps of tissue, resulting in necrosis (black death) of tissues in those surgical procedures requiring flap elevation. Procedures at maximal risk appear to be abdominoplasty (tummy tuck) and breast reduction. Your surgeon realises you may be self-conscious about your weight, and seeking a speedy solution. Nonetheless the surgery we are contemplating is purely elective, and it behoves both of us to minimise risk and maximise the quality of our results. It is very much in your best interest to attain your ideal or desired weight (or alternatively a maximum BMI of 28) prior to surgery. This will help to ensure predictably excellent results. NB . The list of anaesthetic risks has been provided by our anaesthetist Back to top

Vitamin Intake Before and After Surgery

Traditionally, vitamins were thought to merely prevent specific vitamin deficiency syndromes or disease, in the manner that a modest amount of vitamin C prevents scurvy and vitamin D prevents rickets. Recommended daily allowances (RDA’s) were formulated by government bodies solely with this in mind. Nowadays, there is broad agreement that higher vitamin dosages will optimise health and prevent many diseases common in modern society, such as cancer, heart disease, arthritis and osteoporosis. In 2002, the prestigious Journal of the American Medical Association wrote that ” It appears prudent for all adults to take vitamin supplements. Most people do not consume an optimal amount of vitamins by diet alone.” ⁽¹⁾The British Medical Journal agreed, saying “…popping a multivitamin a day can keep disease at bay”.⁽²⁾ Surgery is unavoidably a time of emotional stress and physical stress on your body, as well as tissue damage and free radical formation. It is also a time when the body turns from anabolic (building tissues up) to catabolic (breaking tissues down), for an extended period. Several interventions will help to minimise these changes. As is the case in anti-ageing medicine, these interventions compromise diet, exercise, supplementation and hormonal modulation. Before surgery your diet should be very low in sugar ( and other high-glycaemic index carbohydrates) and very high in protein. Gentle exercise such as walking should be resumed as soon as possible after surgery. Aim to resume all usual activities within one month. Supplements which reduce inflammation, accelerate resolution of bruising and swelling, and provide strong anti-oxidant effects will prove valuable. There are no supplements designed specifically for peri-operative use available in Australia, so we have finally designed our own programme. We now stock a number of supplements by NutritionCare, a respected “health practitioner-only” range formulated by the eminent Professor Ian Brighthope of Melbourne. We have specifically selected four supplements to provide maximal support for your body during and after surgery, whilst avoiding ingredients which might cause bleeding problems due to thinning the blood. We recommend commencement a week or two prior to surgery and continuation for two to three months afterward. Details of these supplements are included. With respect to hormonal modulation, there is excellent evidence that anabolic and immune stimulant hormones will also help, particularly human growth hormone, DHEA and 7-keto DHEA. We are currently researching such interventions.

(1) Fletcher RH & Fairfield KM (2002) “Vitamins for chronic disease prevention in adults : scientific review” JAMA 287 (23) – 3116 – 26 (2) Josefson D (2002). “Popping a multivitamin daily can keep disease at bay” BMJ (29 June) 324:1544

Before Surgery

Some medication must be avoided completely for two weeks prior to surgery. Please find a comprehensive list of these medications on the next page. Vitamin C in high doses is beneficial prior to surgery as it is an anti-oxidant and it has anti-inflammatory properties. It is essential in the healing of wounds, bruises, fractures and capillary damage, and for the formation of bones, cartilage and teeth. Anti-oxidants before surgery will assist your general level of health. Having increased anti-oxidant levels in your system will aid your bodies healing process, aiding your fight against free radicals. A good multi-purpose anti-oxidant tablet should contain some or all of the following: milk thistle, grape seed, Beta carotene, vitamin C, selenium, vitamin B1, B5, B6, B12, folic acid and zinc. (Beware of anti-oxidants with high levels of vitamin E, as this is one of the vitamins to be avoided for two weeks before surgery. Daily levels of vitamin E prior to surgery should not exceed 200 IU daily).)

After Surgery

As for pre-operative use, vitamin C is essential for healing and has many anti-inflammatory and anti-oxidant effects. Quercetin and Bromelian are powerful anti-inflammatory agents, reducing swelling and oedema and promoting faster healing Zinc is believed to accelerate wound healing, and is therefore useful before and after surgery. Most multivitamins contain zinc, and this is usually sufficient. However, if you are a particularly poor healer, suffer infections easily, or are prone to stretch marks etc, then you may wish to take an additional zinc tablet daily just prior to and after surgery. Arnica is credited with anti-inflammatory, anticoagulant, circulation stimulating, healing and antiseptic properties. It has been shown to aid in the reduction of bruising post operatively. Some people are sensitive to arnica, so we suggest only low doses if you are not familiar with arnica. For optimal results, commence Arnica the day prior to your surgery. After surgery continue treatment for four days. Back to top

Medications & Surgery

Medication and Vitamin Supplements to be Avoided Prior to Surgery

The following is a list of vitamin supplements that we recommend you stop taking two weeks prior to any surgery. Some of these have the effect of thinning the blood, whilst others react adversely with anaesthetic agents. If you have any queries regarding any medication or vitamin supplements you are currently taking, please contact the nursing staff in our rooms.

Vitamin Supliments

Aloe Bilberry Cayenne Cod Liver Oil Echinacea Evening Primrose Oil (Omega 6) Feverfew Flaxseed Oil (Linseed Oil) Garlic Ginger Ginko Biloba Ginseng Goldenseal Licorice Root Omega 3, EPA (Fish Oil) St. John’s Wort Vitamin E ( < 200 iu is OK) Valerian Yohimeed

Medications

Actifed, Addaprin, Advil, Alka Seltzer ASA (Arthritis Strength Aspirin) Aspalgin, Aspro, Aspro Clear, Aspirin Asantin Astrix Bex & Vincent’s Powders Calciparin, Calcihep Cardiprin, Cartia Clexane, Clinoril Codral Blue Tablets Codiphen, Codis, Codox Coumadin Decrin Powders, Dindeva Disprin, Ecotrin Effexor, Fiorinal Fragmin, Heparin Fraxiparine Iscover Marevan Morphalgino Orgaran Persantin Plavix Reopro Revasc Solcode, Solprin, Spren SRA Thrombotrol Ticlohexal Ukiden Veganin Proxen Winsprin

NSAIDS Amitriptyline, Aclin ACT-3 Actiprofen Anaprox Arava Arthroxin Arthrexin Arthtotec Brufen Butazolidin Candyl Clinoril Crysanal DBL Piroxicam Diclohexal Dinac Dolobid Feldene Indocid Inza Mefic Mobilis Naprogesic Naprosyn Nurofen Orudis Oruvail Pirohexal-D Ponstan Rafen Rosig Surgam Tilcotil Toradol Voltaren

NB. Zoloft has anti-coagulant properties. If you are taking this medication, please advise the anaesthetist on the day of surgery. Back to top

• Ensure Your Plastic Surgeon is
• Reasons Not To Have Your Surgery Performed Overseas
• Your Surgeon’s qualifications
• Related Articles and News Stories
• Plastic Surgeon Training
• Cosmetic Surgeon’s Training
• What does this mean to you
• Choosing a Qualified Surgeon

Deciding that you would like cosmetic surgery is not always easy, and requires a lot of thought; however, this is the easiest step of your journey.

Your next step is choosing a surgeon to perform your surgery. This is the single most important step you will take.

You have one body, and you want to make sure that you achieve the results that you are aiming for. You certainly don’t want problems! Though problems are possible with any surgical procedure, you can reduce your risk of problems occurring (to you!) by thoroughly researching your surgeon.

The points you should research are:

1. Ensure that the surgeon you choose is a specialist plastic surgeon. Cosmetic Surgery is their specialty; they started it and continue to perfect this specialty. See the article, “The Difference Between a Cosmetic Surgeon and a Plastic Surgeon”. This article explains qualifications in detail. You will be very surprised to see how many doctors have no surgical qualifications at all! All plastic surgeons are members of the Australian Society of Plastic & Reconstructive Surgeons. You will find a list of plastic and reconstructive surgeons at www.plasticsurgery.org.au . If a surgeon is not on this list they are not qualified to perform cosmetic surgery!!
2. Look at how many years the surgeon has been practicing. You want to choose a surgeon who has been doing this surgery for many years, so they have a wealth of experience to draw on. Check that they are keeping abreast with the times however, you don’t want a surgeon who is doing exactly the same thing he did 30 years ago!
3. Look at the surgeon’s website. This technology has been around now since the early 1990s and when most people start their research. Your surgeon should have an up-to-date and informative website with lots of photographic examples of their work, not just a couple of examples. You want to see lots of the surgeon’s work, not just his 2 or 3 best examples.
4. Have your surgery performed in Australia. Australian plastic surgeons are amongst the most respected in the world. The quality of training they receive is second to none, and our surgeons are asked to teach and operate all over the world. Your post-operative care and follow-up are an important part of your surgery. Having surgery in your local area ensures that your surgeon is available to you as often as you need to see them.
   They can help you if you have problems and will do so at either no cost or at as little cost to you as possible.

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Ensure Your Plastic Surgeon is;

• A registered specialist plastic surgeon ie has the letters FRACS behind their name.
• Is a member of ASPS – the Australian Society of Plastic Surgeons?
• Operates only in accredited hospitals with specialist anaesthetists.
• Is personally accredited with a major hospital and not just day facilities.
• Is insured through a leading Medical Defence Organisation.
• Will personally participate in your follow-up care after surgery.
• Is available to you until the final result has been achieved.
• Is able to be contacted before, and after surgery.
• Is up to date with their Continuing Professional Development.
• Will help you financially if you have a complication or need revisional surgery.
• Uses only the world’s best-quality breast implants.

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Reasons Not To Have Your Surgery Performed Overseas

If you or someone you love has been considering having cosmetic surgery performed overseas, do yourself a favour and have a read of the following – information the travel agents DON’T share with you!

You may know people that have been overseas and appear happy with their surgery, this is not unusual. However, problems DO OCCUR and this is also not unusual.

You don’t want to be that statistic! Take a minute to think about the following points before making any decisions.

Holiday-type activities can compromise your health when you should be recovering.

Although combining your surgery with a holiday sound perfect, in reality, the 2 have nothing in common.

1. Drinking alcohol is not recommended following surgery
2. Your diet should be controlled and healthy for an uncomplicated recovery. New cuisines should be avoided, and Bangkok belly or the like will more than likely interfere considerably with your body’s healing process!
3. Rest is imperative after any surgery. It is required to help the healing process and to reduce the possibility of complications. Lying around a pool or on the beach in bandages is not only unattractive but also not true rest.
4. Following surgery you are not terribly mobile, and you have some level of pain. In general, for the first 5 days following surgery, most people don’t want to move off their couch, let alone gad about some exotic tourist spot of questionable hygiene with thousands of strangers.
5. Hygiene is paramount to preventing infections. This cannot be guaranteed in most Asian countries, and even in some European countries.

Australia has exceptionally highly recognised standards of hygiene.

Cosmetic surgery is still surgery. Don’t be misled to believe it is something less.

All surgery carries some risks, cosmetic surgery is no different.

Infections are the most common complication of any surgical procedure.

This is no different in patients that go abroad for cosmetic surgery.

If your infection occurs while you’re overseas, you may end up in hospital with IV antibiotics, or like an enquiry we got from Bangkok recently – on your fourth full blood transfusion!!!!! 

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Your Surgeon’s qualifications

You would not pay a gynaecologist to do your heart surgery, or your gardener to build your house. So have you researched the qualifications of the person that is going to operate on you?

Do you understand the system of surgical qualifications for the country you are booked in to have your surgery?

No, most people haven’t thought of this point.

Have you researched the qualifications of your anaesthetist?

Do you know who will be looking after your life while you’re under anaesthetic?

If the answer to this is “no”, then you should be thinking twice about your decision.

Cosmetic tourism destinations often have formal medical accreditation boards to certify physicians or their facilities.

Many facilities are privately owned and operated by entrepreneurs – not medical boards or personnel. They may look like 5-star hotels, but are they medically able to handle problems?

These facilities make it difficult to check the credentials of surgeons, anaesthetists, and other medical personnel.

– Air travel is not recommended for some time after larger procedures and significantly increases the risk of complications following any cosmetic procedure.
– Individually, long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots or DVT’s .
– Your risk of developing these potentially fatal complications as well as lesser complications or swelling and infection are extremely high.
– Quality critical care facilities are not always available.
– In the event that an unanticipated complication should occur, you may require admission to a critical care facility.
– Australian standards are very high. This cannot be said for all countries and may not be readily available.
– Such facilities are costly to operate and are frequently unavailable in locations that offer heavily discounted plastic surgery.
– Follow-up care is limited. Follow-up care is an important part of your surgery.
– Choosing to have your surgery performed overseas means that you have deliberately opted for limited follow-up care if any.
– Patients returning to Australia suffering complications following cosmetic surgery procedures performed overseas may find it hard to find a qualified plastic surgeon prepared to treat their problems or to provide revisional surgeries.
– It is impossible for your Australian surgeon to know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible.
– Revisional surgery is always more complicated than the initial operation and patients rarely get the desired results.
– What seems like a bargain turns out to be far more than double the cost of surgery in Australia.
– In Australia, surgeons follow their surgical patients through until they are completely healed, and generally charge nothing for follow-up visits, including in the event of a complication.
– Any revisional surgery will be performed at no cost by your surgeon, or at a small fee.
– If you have a complication following surgery overseas and IF you can find a surgeon to take on your problems, you can expect to be out of pocket considerably.
– Revisional surgery being more complicated than the initial procedure carries higher fees. If you have private health insurance, you may find that your insurer refuses to refund any monies Implants used and other prostheses may not be up to Australian standards.
– In Australia, we are lucky to have a very high standard of medical care.
– Do you know what type of implant you will have implanted? Is it the best on the market? Not likely! These devices may not have been tested or proven to be safe and effective.
– There have been many cases where cheap implants have been used and initially appear fine, only to cause major problems a year or more down the track.

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Related Articles and News Stories

Medical Tourism Poses Public Health Danger Readers of the Age newspaper may have come across an article on this subject that refers to the danger of bringing a newly mutated bacterium into Australia from an overseas country. More and more people are choosing to have serious surgery overseas not necessarily because it is cheaper but also to avoid long waiting lists at home. The problem is that there has been a spread in many overseas countries of a multidrug-resistant organism, the so-called superbug MDM-1. Although there is as yet no evidence that it has spread in Australian hospitals experts are alarmed that patients traveling overseas for surgery are putting themselves and the Australian health system at risk The Age quotes the Director of the Infectious Disease Unit at Australian National University as saying that Australian hospitals should be made to isolate return medical tourists until they know they are not carrying superbugs that could contaminate hospitals.

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Plastic Surgeon Training

The term plastic comes from the Greek word plastikos, which means to mould or shape, hence the term “plastic surgeon”. The word cosmetic originally conjured up images of the very vain and so was not used. In Australia, a specialist plastic surgeon must complete :

1. 5 or 6 years of medical school.
2. then complete at least one year of intern training in a teaching hospital,
3. then complete between 2 and 4 years of basic surgical training.
4. After this, they must complete 4 years of advanced surgical training in all aspects of cosmetic and reconstructive surgery.
5. Once through this rigorous training, and two arduous examination processes (each with pass rates of only 30-60%), they are accepted as a Fellow of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery.

Dr. McGovern passed both Part 1 and Part II Examinations at the earliest opportunities allowed by the Royal Australasian College of Surgeons. He then completed 18 months of further post-graduate training in the United Kingdom and the USA, before settling on the Sunshine Coast to begin his private practice in 1994. 

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Cosmetic Surgeon’s Training

Any doctor whatsoever may decide to call themselves a “Cosmetic Surgeon”.

They often have no valid training, qualifications, or experience in cosmetic surgery and their only qualification is as a general practitioners.

Many have never done any surgical training at all, whilst a few are ENT(ear, nose, and throat) or general surgeons, who would normally take out your tonsils or appendix. Many become members of impressively titled colleges and societies, whose members are generally equally unqualified to perform cosmetic surgery.

These groups band together to give the general public an impression of professionalism and qualification.

Foremost amongst these is the so-called Australian College of Cosmetic Surgery, founded by a paediatrician (children’s specialist) who developed an interest in penis enlargement, Dr. Colin Moore. He wished to legitimise his involvement in Cosmetic Surgery prior to the New South Wales Ministerial Inquiry into Cosmetic Surgery and so formed his “College”!

Since that Inquiry, Queensland has legislated to restrict the use of the term “surgeon” to those who are qualified surgeons ie they have completed and passed the rigorous training and exams as set out above and have become Fellows of the Royal Australasian College of Surgeons (FRACS), however, this law is poorly policed. If the doctors you are researching do not have the letters FRACS (Plast.Recon.Surg) behind their name they are not qualified to perform cosmetic surgery.

Caveat emptor! (let the buyer beware!).

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What does this mean to you?

Ask yourself – would you hire a gardener to build your house? Of course not! You want to be; in the hands of an expert and you don’t want complications.

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Choosing a Qualified Surgeon

The very best way to choose a surgeon to perform your intended surgery is to ensure they are properly qualified to perform that procedure.

This means checking that they are members of The Australian Society of Plastic Surgeons, by telephoning ASPS on 02-94379200 or surfing www.plasticsurgery.org.au.

We recommend seeing more than one qualified plastic surgeon, before making your decision. Always ask for qualifications. If the word “surgeon” is not in their qualifications, then they have no surgical qualifications!

Don’t be misled by advertisements talking only of expertise in “cosmetic surgery”. Ask to see credentials, and if the letters FRACS(Plast.ReconSurg) are not behind their name, then find someone who is qualified.

Look for ASPS membership – this ensures that your surgeon is qualified not only in surgery but in cosmetic plastic surgery.