Cosmetic Surgery and Beauty Magazine #65

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ody The procedure Patients presenting for brachioplasty understandably would like the incision to be placed in the armpit and the skin pulled up to that site and the excess removed, leaving a small hidden scar. Unfortunately the reality is that only the smallest amount of skin can be removed this way and that skin has to be located close to the armpit. Candidates for brachioplasty have skin/fat excess at least half-way down the arm and in many it extends as far as the elbow, and the only effective way to treat this is by making the incision and therefore the scar down the inner aspect of the arm, often all the way to the elbow. Body contouring surgery creates a more shapely body after significant weight loss If the skin excess extends past the armpit and onto the chest wall then the excision is extended to incorporate this. If the patient has excess fat in the arms – usually on the back of the arm up towards the shoulder – liposuction will be also be performed. Suction drains may be used. Compression sleeves are fitted at the end of the procedure and are worn for four weeks. The patient is typically discharged on the second post-operative day. After the surgery, moving the arms as pain permits is encouraged. Fluid may collect, especially just above the elbow, due to the interruption of lymphatic channels. This is called a ‘lymphocoele’. The fluid is drained painlessly in the rooms, usually on two or three occasions before it resolves. Unlike the scar in the tummy tuck procedure, the brachioplasty scar is not in a favourable anatomical location and often six to 12 months are required for the scars to fade. Occasionally the scar becomes tight, producing discomfort on stretching the arm above the head. In this case a scar revision is performed. The arm reduction procedure may need to be revised after a number of years due to recurrence of skin laxity due to ageing. INNER THIGH LIFT (REDUCTION) Excess tissue between the thighs rubs together, causing discomfort when walking. The inner thigh lift, in most cases assisted by liposuction, produces smoother, shapelier and much younger looking thighs which no longer cause friction. The procedure The general conception amongst patients is that the inner thigh lift is a simple, quick procedure, but in fact for the surgeon it is technically demanding due to the awkward site and the difficulty of access. The inner thigh lift for many years was performed through an incision from the groin through to the buttock fold. As in brachioplasty, patients understandably expected the lift to be done though this incision alone, but the reality was that this was suitable only for a few patients, and the incision was invariably extended down the inner aspect of the thigh, often as far as the knee, producing a T-shaped scar. The horizontal resection represents a true lift, but gravity gradually drags the scar down so that the scar, initially hidden within the underpant line, becomes visible below this. More recently a vertical resection alone has become the procedure of choice, with the excision extended up alongside the pubic area when required. The three big advantages of the vertical excision are: 1. Much of the excess is located down the inner thigh; 2. The tightening is across gravity, rather than opposing it; 3. There is no T-junction in the groin region where tissue breakdown with delayed healing was very common with the older technique. Suction drains may be used, and the patient is encouraged to mobilise on the first post-operative day and is ready for discharge home the following day. A compression garment is worn for about four weeks (six weeks if a significant amount of liposuction has been performed). After an inner thigh lift, patients are encouraged to walk following discharge home. Jogging may be resumed after six weeks but upper body gym work can be resumed after about three weeks. Fluid may collect, especially just above the knee, due to the interruption of lymphatic channels, which is drained in the clinic until it resolves. The vertical scar down the thigh is not in a ‘favourable’ skin line and therefore may remain pink and visible for some months but then settles down into a pale scar which is hard to see. GYNAECOMASTIA Gynaecomastia refers to a condition in which men have enlarged breasts, also known rather unkindly as ‘man boobs’. Men who have developed enlarged breasts may feel embarrassed and may be hesitant to be seen in T-shirts or to take their shirts off in public such as at the beach. In the massive weight loss setting, the breast enlargement is due to an accumulation of fat and there may be little or no actual breast tissue. This is called ‘pseudogynaecomastia’ and may respond to liposuction alone. The skin excess usually necessitates skin resection with transposition of the nipple or removal of the nipple at the start of the procedure and replacement of it as a graft at the end of the procedure. Removal of skin necessarily means scars on the male chest, which are avoided wherever possible. Suction drains are used in this procedure. A compression garment is then applied for four weeks. The patient is discharged on the second post-operative day. Arm motion is encouraged. As mentioned in relation to other body-contouring procedures, some fluid may collect in the subcutaneous space (a ‘seroma’), requiring aspiration in the clinic. 66 www.cosbeauty.com.au
MR RICHARD MAXWELL MELBOURNE PLASTIC SURGEON FRACS (Plast) High quality care, beautiful results Mr Richard Maxwell is a widely respected plastic surgeon in the Melbourne, Victoria area. For 20 years, Dr Maxwell has used his plastic surgery skills to help patients enhance their appearance and improve their self-confi dence. He and his staff ensure safe and effective treatments for cosmetic enhancement and rejuvenation, with a particular interest in body contouring after massive weight loss. PLASTIC SURGEON SPECIALISING IN: Body surgery – contouring after massive weight loss, liposuction, tummy tuck, body lift, gynaecomastia Breast surgery – augmentation, lift, reduction Face surgery – facelift, blepharoplasty, rhinoplasty, otoplasty Non-surgical – anti-wrinkle injections, fi llers, fat transfer CABRINI MEDICAL CENTRE MITCHAM PRIVATE CONSULTING SUITES WILLIAMSTOWN DERMATOLOGY info@maxwellplasticsurgery.com.au www.maxwellplasticsurgery.com.au 03 9509 9699
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