Cosmetic Surgery & Medicine by Dr John Flynn


Dr John Flynn is an internationally recognised cosmetic doctor with more
than 20 years of experience. Specialising in facial cosmetic surgery and
non-invasive facial rejuvenation techniques, Dr Flynn also has significant
experience in breast augmentation, liposculpture and laser surgery, as well as
a special interest in the treatment of skin cancer.

Cosmetic Surgery & Medicine

Dr John Flynn


Dr John Flynn


Dip.P.Derm (UK), FACCS

Cosmedic and Skin Clinic

1300 88 13 88

about the ACCS

The overriding aim of the College is easily summarised:

raising standards… protecting patients.

The Australasian

College of

Cosmetic Surgery


Dedicated to quality, ethical

and responsible practice.


The ACCS is a multi-disciplinary

body including general surgeons,

dermatologists, ear nose and throat

surgeons, ophthalmologists and

other doctors who specialise in

cosmetic surgery.

The factor that unifies this divergent

group is that they all need to obtain

additional specialised education, training

and experience beyond their original area

of postgraduate specialisation before

becoming competent in cosmetic

medical practice.

our vision

To have Cosmetic Medical Practice

recognised as a new Medical

Specialty, performed only by certified

cosmetic practitioners.

our mission

To ensure the safe provision of cosmetic

surgery and non-surgical procedures

(such as laser and light treatments, dermal

fillers and wrinkle relaxant injections) to

the Australian general community through

supply of appropriately trained and

certified medical practitioners.

In the interests of patient protection, the Australasian College

of Cosmetic Surgery (ACCS) was established in 1999 to bring

regulation and accountability into the practice of cosmetic

surgery and cosmetic medicine.

The goal of the ACCS is to ensure the safe provision of

cosmetic surgery and non-surgical procedures to the Australian

general community through supply of appropriately trained and

certified medical practitioners.

Cosmetic medical practice is a well defined and unique

medical branch, currently performed by medical practitioners

from various specialties including dermatology, general

surgery, general practice, plastic and reconstructive surgery,

oral and maxillofacial surgery, ophthalmology, otolaryngology

and gynaecology.

The ACCS is the only group in Australia with a single

focus on cosmetic surgery and medicine and is the only

one that offers formal training and accreditation in cosmetic

medicine and surgery. It has a medical faculty that accredits

cosmetic physicians and a surgical faculty that accredits

cosmetic surgeons.

Another important initiative undertaken by the College was

the introduction of a Code of Practice in 2009. It was authorised

by the Australian Competition and Consumer Commission

(ACCC). The Code covers, among other things, advertising

and other promotional conduct, informed consent guidelines,

monitoring of the code and has an extensive governance

regime including independent compliance audits and reports

to the ACCC.

How qualified is your cosmetic doctor?

Are they a Fellow of the Australasian College of Cosmetic

Surgery? Do they have the right to display the symbols below?

These symbols denote that not only is the doctor a Fellow of

the Australasian College of Cosmetic Surgery but also they

have successfully participated in a continuing education and

recertification programme. This, unlike that of other Colleges,

is specific for cosmetic medicine and surgery.




c o s m e t i c s u r g e ry & m e d i c i n e w w w. a c c s . o r g . a u / / 3

Male hair loss

Dr John Flynn




DR Flynn

Dr John Flynn is an internationally recognised cosmetic doctor with more

than 20 years of experience. Specialising in facial cosmetic surgery and

non-invasive facial rejuvenation techniques, Dr Flynn also has significant

experience in breast augmentation, liposculpture and laser surgery, as well as

a special interest in the treatment of skin cancer.

As a Foundation Fellow and Chief Censor of the Australasian College

of Cosmetic Surgery, as well as former President of the College, Dr Flynn

participates in the yearly re-certification programme to ensure he stays up-todate

with the latest cosmetic surgery and medicine advances. He has studied

extensively and holds qualifications from Australia and overseas.

Dr Flynn is committed to enhancing the natural beauty of his patients, helping

to boost their confidence and help them feel good about themselves. From his

clinic on the Gold Coast, Dr Flynn offers each of his patients individual, expert

advice on the best treatment options available to them.

In addition to his thriving practice, Dr Flynn is regularly invited to present

at academic meetings around the world, and conducts training courses in

cosmetic surgery, laser and cosmetic medicine. He is proud to consult for

a number of product companies, helping them formulate protocols for the

avoidance and management of complications. As well as publishing the Journal

of Cosmetic Surgery and Medicine, he has authored many articles.

Dr Flynn and his team acknowledge that one of the most pressing concerns

faced by patients considering any cosmetic procedure is whether they are

going to look ‘too’ different. ‘It is very important to us that after a procedure

is performed the patient looks “natural” and not “over-done”,’ he says. ‘We

appreciate the confidence our patients have in the doctors at our practice

and we do our best to respect that confidence. Cosmetic surgery is a very

personal issue and everyone’s needs are different. We recognise this and strive

to individualise treatments to suit each patient’s requirements.’

Dr Flynn’s personal approach, commitment to natural-looking results and

dedication to continued training and education has resulted in an ever-growing

list of satisfied patients.

John and his wife Narelle John and Narelle’s son Sean John and Narelle, with their son Sean and his fiancée Philippa

C o s m e t i c s u r g e ry & m e d i c i n e w w w. a c c s . o r g . a u / / 5







According to Dr John Flynn, more and more patients at his Cosmedic &

Skin Clinic on the Gold Coast are asking how to achieve the best cosmetic

outcomes with the least amount of surgery. ‘With advances in both

technology and techniques, it seems the current thinking in cosmetic surgery is

less is more,’ he says.

While facelift surgery is still the best option for sagging features, too much

skin or reversing gravity, patients are now showing a clear preference for having

6 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U . A C C S . O R G . A U

Dr john flynn

‘There is a lot

that can be done

before we need

to go as far as a


smaller procedures earlier to postpone the need for more radical surgery. ‘There

is a lot that can be done before we need to go as far as a facelift,’ Dr Flynn says.

Dr Flynn says a series of less dramatic procedures at regular intervals is

attractive to patients. ‘Not only is it less obvious that someone has had something

done but the results are more natural looking. This concept of maintenance rather

than radical rescue is really the leading edge of cosmetic practice,’ he says.

By taking cosmetic surgery gradually – over a period of months or even

years – a patient is more likely to be satisfied with the outcomes. ‘For instance,

a patient may have a combination of eyelid surgery and a peel. Some time later,

when she is accustomed to her rejuvenated look, she might decide to have

something further and perhaps a laser photo rejuvenation may be in order. Then,

of course, there are the fillers and other anti-wrinkle treatments.’

Non-surgical options can be combined with minor facelifts (such as the minilift

or S-lift), neck lifts, brow lifts, eyelid surgery, laser resurfacing, cheek implants,

facial fat transfers and facial liposculpture, all of which are becoming less invasive

with quicker recovery times.

Finding the best combination for each patient requires a thorough assessment

of their individual issues. ‘We are all unique and a good doctor’s skill lies in

retaining the elements that make us who we are,’ Dr Flynn says.

Soft skin program

Dr Flynn’s Soft Skin Program combines a series of short treatments that are

effective whether used in conjunction with surgery or as stand-alone treatments.

It is designed to put back the glow factor.


For skin texture and complexion, peels and non-ablative laser treatments target

brown pigment problems and red vascular issues like broken capillaries and red

blemishes. Stronger lasers for skin rejuvenation can also help tremendously.

Facial balance

The full range of dermal fillers can be used to correct lines and wrinkles: soft

fillers for fine lines and firmer fillers for facial contouring. Longer lasting fillers

should be considered as an option.

Sagging skin

This is where lifting techniques are best employed. In good hands a facelift is the

best procedure to lift sagging skin. But there are alternatives.

Thread lifts

Threads require no surgery and leave no scars. Well placed and anchored

threads provide an alternative to a facelift for suitable patients. Dr Flynn has

pioneered the use of thread lifts in Australia and internationally and also teaches

surgeons how to use the threads.

‘Whatever procedures you decide to proceed with, don’t forget that skin care,

complexion and glow factor are essential for looking your best,’ says Dr Flynn.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 7







The telltale signs of ageing can manifest in many ways and at different

stages in a person’s life. Whereas one person may succumb to fi ne

lines and wrinkles relatively late in life, another may develop deep folds

and sagging skin in their early years. The key to restoring youth to someone’s

appearance, therefore, is to combine a number of techniques and procedures

to address the specifi c concerns of each individual patient.

By using a combination of laser resurfacing, dermal fi llers and other

minimally invasive techniques, surgical intervention often can be postponed

or even avoided. ‘Today, a “facelift” is no longer a purely surgical experience,’

says Dr John Flynn from Queensland. Dr Flynn prefers to combine conservative

surgery with facial rejuvenation procedures such as laser resurfacing,

thread lifting, dermal fi llers and muscle relaxants depending on the needs

of each patient.

8 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

Dr john flynn

‘Often a face

cannot be fully



restoring the

volume lost in

the cheeks and

other areas of

the face’

Typically, the patients Dr Flynn sees fall into two different age groups. ‘In

younger patients, it is possible to use minimally invasive techniques to enhance

a particular feature, or to create a desired shape. In older patients, it is more likely

we need to replace lost volume, using dermal fillers, for example,’ he explains.

A youthful face is usually fuller, with well-supported fat, full-cheeks and

smooth contours. With age, this volume dissipates, often leaving sunken cheeks

and harsher angles, which combine to leave an aged appearance. Although antiwrinkle

injections can be used to smooth the lines and wrinkles that develop on

the face over time, often a face cannot be fully rejuvenated without restoring the

volume lost in the cheeks and other areas of the face.

‘Where facial volume has been depleted with age, augmenting techniques

such as dermal fillers and fat transfer can be used in combination with anti-wrinkle

injections to achieve an overall, non-surgical facial rejuvenation,’ says Dr Flynn.

A number of different fillers are available, all of which vary in their longevity,

composition and viscosity. Depending on the individual circumstances of each

patient, Dr Flynn uses a combination of ‘superficial’ and ‘deeper’ fillers to both

address skin issues and reshape and remodel the face.

‘Dermal fillers can be injected into different areas of the face to smooth

superficial lines, wrinkles and deeper folds,’ explains Dr Flynn. ‘However, more

permanent fillers can be used to reshape and remodel the face, in order to create

a more balanced and harmonious face shape.’

Complementary procedures such as anti-wrinkle injections to tackle fine lines

and laser skin treatments to improve the tone and texture of the skin can be

administered at the same time, or as part of a program spread over several

weeks, in order to fully refresh a patient’s appearance.

‘In order to completely refresh and rejuvenate a patient’s appearance it is

important to address the texture and tone of the skin,’ says Dr Flynn. ‘The skin is

the fabric that covers the entire face, so when looking to perform a combination of

procedures on the face we have to look at how to correct the quality of the fabric

as well.’

Dr Flynn prefers to use the SmartXide Dot Fractional laser. ‘We call it the “Hot

Dot”, he says. ‘As a CO 2

, fractionated laser, I believe it offers optimal recovery

and is versatile enough to treat various issues ranging from age-related concerns

to acne scarring.’

The procedure works by imparting a high energy burst of laser light in

microscopic ‘dots’ across the skin’s surface. Because it is ‘fractionated’, the

laser leaves the skin surrounding each impact point in tact. The healthy skin can

then heal the thermal injuries by stimulating the production of new collagen.

‘The body’s natural healing process creates new, healthy tissue which replaces

skin imperfections,’ Dr Flynn explains. ‘Collagen shrinkage as a result of thermal

damage results in some immediate skin tightening, with further improvements in

skin tightness and collagen density occurring more gradually over time.’

It is important that the methods used to refresh and restore youth to the

face are tailored to each patient. The key to non-surgical facial rejuvenation is

a thorough consultation, during which the surgeon can explain what can be

achieved and decide upon the optimal treatment plan for each patient.

By restoring lost volume, addressing the tone and texture of the skin,

and by smoothing fine lines and wrinkles, patients can look forward to

a refreshed, rejuvenated appearance. ‘Using a combination of different

minimally-invasive non-surgical techniques can restore a youthful

appearance whilst preserving individuality.’

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 9






Many people have dieted, exercised and are at their optimum healthy

weight and yet still feel self-conscious in a swimsuit because some

fat simply refuses to budge, especially on their hips and lower tummy.

Similarly, many other women are unhappy with their smaller breasts compared

with their curvy hips.

‘A lot of women are concerned about their disproportionate body shape –

lack of projection on top or too much projection at the bottom,’ says Dr John

Flynn from Queensland.

According to Dr Flynn, changing body shape is a matter of balance. ‘Breast

augmentation can fi rm up the top end, while liposuction can trim down the

bottom half of the body so the patient feels more comfortable with her body.’

In his initial consultation with each patient, Dr Flynn tries to ensure a

1 0 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

Dr john flynn



can firm up the

top end, while

liposuction can

trim down the

bottom half of

the body’

balance between what is possible, appropriate and aesthetically pleasing and

the patient’s own desires. This means first a careful assessment of her body

shape – including height, build and proportions. Length of bones, distribution of

body fat and skin elasticity are also all taken into consideration.

Dr Flynn says he often finds himself asking, ‘Do you realise?’. For example, to

a woman with a short torso: ‘Do you realise that a much bigger breast implant

might make you look shorter?’ Or to a patient contemplating liposuction: ‘Do you

realise if I take too much off the bulge on the inner side of your thighs then the

outer side won’t look right?’

Trying on a crop top with different-sized implants can give the patient an idea of

how her breasts might look when enhanced. Dr Flynn can then advise her on how

a boosted cup size would harmonise with her hips, height and overall silhouette.

‘Determining the extent of liposuction (removal via a cannula of stubborn

fat deposits that don’t normally respond to diet and exercise) around the hip,

bottom and thighs to achieve the right balance takes a significant deal of skill

and experience,’ he says.

Dr Flynn measures the patient’s hip and thigh circumference, and seeks

practical feedback from them. He asks her to show where her jeans are too

tight or why she can’t wear a particular item of clothing. ‘This helps me decide

the best treatment option to achieve the best results possible for each patient.’

Balance is also important when determining how much fat to remove. ‘I

remove enough to give a nicer shape and contour. Too much may lead to an

undesirable hollow effect or loose skin, which can then lead to an additional

cosmetic problem,’ he says.

While liposuction on the lower body tends to concentrate on the bottom,

hips and thighs, Dr Flynn also performs liposculpture using very fine cannulae to

access knees, calves and ankles. ‘Calves and ankles are more challenging, and

involves making a straight calf more shapely or a chunkier calf finer.’

Dr Flynn says it is vital that patients have realistic expectations of body

reshaping. ‘This means that improvement, not perfection, is the goal. Fatty

bulges should be localised to a few areas and the individual should be near their

ideal body weight. Liposuction will not replace good eating and exercise habits

or counter obesity.’

Dr Flynn points out that there is no set formula for balancing body shape

using cosmetic surgery techniques. ‘It’s not like the tide tables or engineering

formulas where the answer is constant or predictable. It comes with experience

and an innate eye, and is different for each individual patient.’

The patient also needs to think about balance in the way she perceives

herself. ‘It’s important for her to balance the “me” she sees in the mirror and her

feelings about her appearance with the total sum of her life,’ he adds.

Balance also comes into play with the way the doctor allocates their time. ‘It’s

important to maintain a balance of pre-operative consultation and post-operative

care with the operation itself,’ he says.

Dr Flynn finds that many of his patients have such a psychological boost from

the results of their cosmetic surgery it gives them the incentive to exercise even

more than before to improve other parts of their physique.

When considering surgery to either augment or reduce certain parts of the

body, patients need to be aware that all surgery involves some element of

risk. The practitioner must have proper training and credentials, and extensive

experience in the procedure.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 1 1

cosmetic medicine



1 2 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic medicine

The ACCS has, as Fellows, doctors of many

disciplines, and not all practice surgery. The Faculty

of Medicine represents these doctors who have

trained specifically, and are recognised fully, in the

field of Cosmetic Medicine.

Cosmetic medicine can improve some of the most common signs of ageing

such as facial lines and wrinkles; a gaunt and hollowed appearance;

sun-damaged skin; acne and acne scars; a dull and uneven complexion;

and sagging facial structures.

Whether by using wrinkle injections, fillers, medical-grade peels or advanced

light therapies, the array of choices available can treat just about any appearancerelated

concern. Maintenance is the key and earlier, less-invasive procedures can

actually delay the effects of ageing on the face, sometimes even negating the

need for more invasive procedures at all.

It is important, however, for prospective patients to thoroughly understand

the procedure (or combination of procedures) they wish to undergo, regardless

of whether it does not involve surgery. A skilled and accredited cosmetic doctor

will help navigate each patient through the myriad of options, select the most

appropriate course of action for the patient’s specific concerns and ultimately

achieve the best possible, natural-looking results for the individual.

Any cosmetic enhancement should be chosen for the right reasons and not in

the impossible pursuit of perfection. Non-surgical cosmetic enhancement offers

patients with realistic expectations the chance to look younger and rejuvenated,

no matter what their age.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 1 3





Facial hollows and gauntness due to loss of volume, shrinkage of the bone

structures, loss of collagen and elasticity and the effects of gravity are all

manifestations of the ageing face. While some of the skin-related factors can

be reined in with healthy lifestyle choices and a good skincare regime, many of

the characteristics of ageing are a matter of genetics.


Cutaneous ageing is caused by two distinct processes – intrinsic and extrinsic

factors. Intrinsic, or chronological ageing, is the inevitable genetically determined

process that naturally occurs. Intrinsic ageing is determined by each person’s

genetic clock and is affected by the degenerative effects of free radicals and the

body’s inability to perfectly repair their damage.

Over time, cells, tissues and vital organs deteriorate. These internal changes

to the muscle, fat and bones are not as visible as the signs of ageing on the

external organ – the skin. Skin shows the wear and tear of extrinsic ageing,

which is environmentally induced and manifests in age-associated skin changes

including thinning, laxity, fragility and wrinkles. In addition, sun-exposure leads to

dyspigmentation, premature wrinkling, telangiectasia and actinic elastosis.

Intrinsic ageing is a continuous process that usually begins in the mid-20s but

may not become evident for decades. At this time collagen production slows and

elastin loses its ‘spring’. Dead skin cells do not shed as quickly and turnover of

new skin cells decreases.

The apparent signs of intrinsic ageing include the loss and descent of underlying

fat leading to hollowed cheeks and eye sockets, as well as loss of fi rmness and

sagging skin as the bones shrink away from the skin due to bone loss.

Genes control how quickly the normal ageing process unfolds. At a cellular

level, ageing is thought to be related to the shortening of telomeres (the terminal

portions of chromosomes) with each cell cycle, resulting in cell-cycle arrest or

apoptosis once a critical length is reached.

The extrinsic, or preventable environmental factors that magnify intrinsic

ageing, often act together with the normal ageing process to prematurely age

skin. Most premature ageing is caused by sun exposure, though others are

repetitive facial expressions, gravity, sleeping positions and smoking.

Lines and creases form over major and minor joints as a result of skin

contractions that lie perpendicular to the underlying muscular vector force.

However, relaxed skin tension lines (RSTL) are formed during relaxation and are

created by the natural tension on the skin from the underlying structures.

1 4 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic medicine

Structural changes

Shrinking of facial bones also plays a role in ageing the face. Evidently, facial

bones remodel their three-dimensional shape with age, showing the most

pronounced difference measured in the T-zone. In women, the area between the

brows and top of the nose (the glabellar angle) is shown to decrease as the area

under the rim of the eyebrows retreats, resulting in sagging brows and deflated

eyelid skin. In men, the glabellar angle decreases and the area supporting the

cheeks (maxillary angle) is also shown to decrease.

Additionally, the malar fat pad, which is responsible for cheek fullness, slides

down and forward, pushing against the nasolabial fold and making the maxillary

angle appear more pronounced. Bones can also recede in the pyriform angle

(the opening of the nose), causing the appearance of an elongated nose and a

drooping nasal tip.

‘Extrinsic factors

often act

together with

the normal

ageing process

to prematurely

age skin’

loss of volume

Facial ageing is reflective of dynamic and cumulative effects of time on the skin,

soft tissues and deep structural components of the face. It is a complex synergy of

skin textural changes and loss of facial volume. Many of the facial manifestations

of ageing combine the effects of gravity, progressive bone resorption, decrease

in tissue elasticity and redistribution of subcutaneous fullness.

With age, facial fat descends and causes the shape of the face to change.

The youthful face is typified by full, well-supported fat, and surrounding ligaments

serve to fixate this volume of fat to underlying structure. Together with the

volumetric fullness of the upper cheek region are well-defined contours such as

a smooth S-shaped curve (commonly called the Ogee curve) of the cheeks when

seen from an oblique angle and a clean neck/chin angle and jaw line. It is this

pairing of both fullness and facial definition that accounts for the more tapered

appearance of the youthful face.

As this ligament support reduces, facial fat volumetrically comes forward and

descends in the cheek, producing a squarer facial contour with less distinction

between upper cheek volume and mid-facial fat. This lowering of the facial fat

means that over time the face appears vertically longer than young faces.

Facial fat also deflates with age and this is most apparent in regions with a

high density of retaining ligaments, which are typically volumetrically full in youth

(malar, preparotid, lateral and infraorbital rim, and lateral chin). Along with facial

deflation comes a laxity in soft tissue caused by diminished support.

Radial expression

Facial ageing is not all vertical – the soft tissue that occurs along specific areas

of the mid-face also undergoes radial expansion. The skin and underlying

subcutaneous fat are densely attached to the deep facial fascia by retinacular

fibres that weave in the skin, subcutaneous fat, superficial and deep fascia

and muscle.

For example, over time facial expressions cause the skin along the nasolabial

line to disrupt the subcutaneous fat, disengaging these attachments and

developing lines of differentiation on the face. This forces the skin and fat

alongside the nasolabial fold to expand radially and fall out from the skeleton,

explaining some of the nasolabial fold prominence in the ageing face.

Radial expansion lateral to the marionette lines extending from the corners

of the mouth downwards also accounts for some of the jowling that becomes

apparent with age.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 1 5





Anti-wrinkle injections can smooth the lines and wrinkles that develop on the

face over time, resulting in a more youthful-looking appearance. However,

as natural fat dissipates with age, often a face cannot be fully rejuvenated

without restoring volume lost in the cheeks and other areas of the face.

Where facial volume has been depleted with age, augmenting techniques

such as dermal fi llers and fat transfer can be used in combination with antiwrinkle

injections to achieve an overall, non-surgical facial rejuvenation.

A number of different fi llers are available, all of which vary in their longevity,

composition and viscosity. Depending on their individual circumstances, patients

may benefi t from superfi cial fi llers used to tighten the skin, in combination with

deeper, longer-lasting fi llers designed to tackle deeper issues and reshape and

remodel the face.

Complementary procedures such as anti-wrinkle injections to tackle fi ne lines

and laser skin treatments to improve the tone and texture of the skin can be

administered at the same time, or as part of a program spread over several

weeks, in order to fully refresh a patient’s appearance.

It is important that the methods used to refresh and restore youth to the

face are tailored to each patient. The key to non-surgical facial rejuvenation is

a thorough consultation, during which the surgeon can explain what can be

achieved and decide upon the optimal treatment plan for each patient.

1 6 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U


‘It is important

that the methods

used to refresh

and restore youth

to the face are

tailored to each





he appearance of deep frown lines and wrinkles can result in a prematurely

aged appearance. Wrinkle injections are a popular facial rejuvenation

treatment and are an effective non-invasive treatment for reducing lines and

revitalising the appearance.

Wrinkle injections contain a protein produced by the bacterium Clostridium

botulinum. It is a muscle relaxant that is commonly used for cosmetic facial

enhancement, particularly to treat crow’s feet around the eyes, the frown lines

between the eyebrows (glabellar lines) and the worry lines across the forehead.

The treatment works by blocking nerve stimulation to wrinkle-causing

muscles, which prevents the muscle from contracting and signifi cantly reduces

wrinkles and fi ne lines and can also help prevent the formation of new ones.

A few tiny injections are administered just under the skin, reducing nerve

stimulation to the targeted muscles. The procedure usually takes about 10

minutes but this can vary depending on the number of areas being treated.

Because men tend to have larger and stronger muscles, they often require more

injections to achieve satisfactory results.

Generally, no anaesthetic is required. The needles are very fi ne and only a small

volume of the product is needed, so the procedure is typically only associated

with mild discomfort. If the patient is particularly concerned, the practitioner can

numb the skin over the area before administering the injection.

After treatment for lines on the forehead, ultimately patients are physically

unable to frown. Over the fi rst few days, the muscles gradually relax, and it often

takes three to six days for results to become visible. The effects gradually wear

off, so in order to maintain results repeat injections are necessary every three to

fi ve months.

Common side effects are generally restricted to minor temporary redness

or bruising at the injection site. There is a very slight risk that it can cause a

temporary weakness in nearby muscles, which may result in a slight drooping of

an eyelid or eyebrow which may last from one to six weeks. Occasionally patients

may experience a slight headache or nausea.

Wrinkle treatments are not recommended for women who are pregnant or

breastfeeding. All patients are advised to avoid the use aspirin, anti-infl ammatory

drugs or blood-thinning agents, unless they are medically required, for two weeks

prior to treatment to minimise bruising.

With careful placement, a more youthful appearance can be achieved while

maintaining natural expression and character.

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 1 7



Used to restore lost volume and smooth lines, fi llers are an increasingly

popular way to rejuvenate the face. They are gel-like substances injected

into different areas of the face to smooth lines, wrinkles and deeper folds.

Fillers are also used to restore volume to the face where tissue has degenerated

with age or where lipoatrophy (fat loss caused by disease) has caused the cheeks

to collapse. They can also be used to fi ll in pockmarks and acne scars and

to contour or reshape facial features, adding volume to lips and cheeks. More

permanent fi llers can even be used to reshape the nose and jawline.

There are a multitude of different fi llers on the market, ranging in longevity,

composition and viscosity, depending on the individual patient’s needs.

Fillers can be used in conjunction with wrinkle injections for a cumulative and

complementary result.

More permanent fi llers can even be used to reshape the nose and jaw line in

order to create a more balanced and harmonious face shape.

The vast majority of contemporary fi llers available are formulated with a

humectant that occurs naturally in the human body throughout connective,

epithelial and neural tissues and is particularly abundant in the dermis. These

types of fi llers are biocompatible and biodegradable, and range in longevity,

composition and viscosity.

The humectant used in modern-day fi llers can attract up to 1,000 times its

weight in water and is one of the main agents in maintaining hydration and a

fresh, youthful appearance, as well a major component of tissue repair.


Filling superfi cial fi ne lines and moderate facial wrinkles, and for treating those

with fi ne skin, calls for fi llers with lighter textures. Greater volumes of these fi ner

fi llers may also be injected into the mid or deep dermis for subtle contouring of

larger areas of the face such as the lips, cheeks and chin. Treatments can last

around nine months, depending on the patient.

Where a stronger and longer-lasting result is required, practitioners may opt

1 8 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic medicine

‘Fillers are used to

restore volume to

the face where tissue

has degenerated

with age’

for medium volume fillers. These are intended for deeper injection to restore lost

volume in areas like cheeks, under-eye hollows, nasolabial (nose to lip) folds and

marionette lines (drooping mouth corners). They are also used to correct deeper

facial wrinkles and folds and augment the lips. Results last for at around six

months to a year, again depending on the patient.

More robust and longer lasting fillers are used to revolumise larger areas such

as the cheeks and mid-face, or fill out facial depressions, deep contours and

hollows. Results can last around 12 months or more in some patients, and do

not tend to migrate from the injection site.

There is also a ‘permanent’ filler which can be used to fill nasolabial

folds, enhance cheekbones, lips or the nose, and to smooth wrinkles or folds

in the skin. This long-lasting filler does not migrate from the injection site, is

biocompatible, non-toxic and non-absorbable, which means results last for a

number of years – as many as 10 in some cases.


Some volume injectables stimulate the patient’s skin to produce more of its

own collagen and elastin over a period of weeks or months, to gradually restore

more youthful and pleasing facial contours. They stimulate the fibroblasts (the

key cells in connective tissue that produce collagen) to fill wrinkles and sunken

areas as well as help tighten the skin.

The amount injected at each session and the number of treatments

required varies for each patient depending on volume loss and specific concerns.

Results are subtle and progressive over a number of months and can last

around two to three years. It is also designed to improve the skin’s overall texture

and luminosity.

Some ‘bio-stimulating’ injectables have a two-fold effect: on injection it

immediately restores volume in addition to stimulating the growth of new

collagen (neocollagenesis) over time. It is not suitable for the lips. Results

generally last 12 to 18 months.

fat transfer

Another modality to smooth lines and plump facial hollows is fat grafting. Fat

is harvested from the patient’s own body, usually from the thighs or buttocks,

cleaned thoroughly and prepared for injection into the face.

The grafted fat is used to fill nasolabial folds, enhance lips and restore

lost volume to the cheeks. Some of the injected fat is reabsorbed by the body

over time and results last an average of three to five years, depending on the

individual patient.

As the patient’s own body tissue is used there is no risk of allergic

reaction or rejection. Patients have also noted an improvement in skin texture

and colour.

Traditional fat transfer techniques often led to the ‘overfilling’ of treatment

areas, as practitioners weren’t able to accurately predict how much fat would

survive the graft. However, with the technological advancements, results are

much more consistent and predictable than in the past.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 1 9





Peels are solutions applied to the surface of the skin to strip away the outermost

layers, revealing the fresh new skin beneath. Used to treat a variety of skin

conditions, peels can improve problems from dryness or skin dullness to acne,

rosacea and pigmentation.

Ingredients range from naturally occurring chemicals and herbal extracts

to synthetic chemicals, and their effects range from mildly brightening to

aggressive resurfacing. Depending on the strength, peels can be administered

by dermatologists, cosmetic practitioners and skincare professionals, and are

recommended as a course of treatments.

2 0 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic medicine

Natural peels

Alpha hydroxy acid (AHA) peels are the mildest option, available in salon

treatments and can be used on most skin types. They use lactic, fruit or glycolic

acids to treat dryness and improve skin texture. Beta hydroxy acid (BHA)

peels use salicylic acid to speed the skin cell shedding process and improve

blemished skin.


therapy targets

the bacteria

that cause acne


whilst also

improving the

appearance of

acne scarring’

Chemical peels

Chemical peels are higher strength solutions that use different grades of acid

to strip the skin of dead skin cells and promote the production of collagen and

elastin in the skin. These chemicals – ranging from alpha hydroxy and salicylic

acids to trichloroacetic acid and phenol – also vary in their depth of penetration,

causing them to directly target specific concerns. Typically, the stronger the

strength of the peel the deeper the penetration and the more severe the posttreatment

side effects.

The treatments typically cause stinging during application and various degrees

of flaking after treatment, from fine flaking to sheeting, as the new layers of skin

start to form. Chemical peels can be quite aggressive, so skin analysis during

consultation is required to find out which peel is most suitable, and whether any

allergic reactions will occur.

Dryness, redness and peeling can be expected for up to a week after most

peels, which feels similar to sunburn. It is imperative the peeling skin is not picked

at or rubbed as it may cause scarring. Makeup may be worn to cover this,

depending on the practitioner’s instructions. Using an unscented moisturiser can

help relieve the tight sensation of treated skin, and a mild topical steroid cream

or ointment can be used to soothe temporary swelling or redness. Sunscreen

should be worn at all times while outside.


Acne typically affects areas of skin where there is an over production of sebum

(oil). Pustules and papules develop as a result of blockages in follicles caused by

sebum and dead skin cells. This is often compounded by bacterium, which leads

to inflammation and can result in scarring.

Over-the-counter and prescription acne treatments work to speed up skin cell

turnover, slough dead skin calls, reduce oil production, fight bacterial infection,

limit inflammation and ultimately improve the appearance of acne. Medications

may be applied to the skin (topical) or ingested (oral). Side effects such as

stinging, burning or redness may occur, and results may not be seen for up to

eight weeks.

Moderate to severe acne is sometimes treated with antibiotic medication in

order to reduce bacteria and fight infection. Women may also see an improvement

in acne after taking oral contraceptives.

Laser and other light-based therapies are often used to treat acne and acne

scarring. Light therapy targets the bacteria that cause acne inflammation whilst

also improving skin texture and lessening the appearance of acne scarring.

Similarly, laser treatment works by damaging the sebaceous glands, lessening

the amount of oil they produce. Certain cosmetic procedures including chemical

peels and microdermabrasion are considered effective acne management when

used in combination with other treatments.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 2 1

cosmetic medicine

The appearance of acne scarring can be improved with the use of fillers;

chemical peels, which remove the top layer of skin; microdermabrasion, which

‘polishes’ the skin; and laser, light-based and radiofrequency treatments, all of

which heat the dermis and promote the formation of new skin.

‘Checking skin

each month can

help identify

changes to be

reported to the



As with many other cancers, screening can be the first line of defence, identifying

abnormal skin tissue before a person has any symptoms. Regular exams of the

skin by both the individual and their doctor increase the chances of detecting

skin cancer early on, therefore providing an improved chance of survival. Most

melanomas can be seen by the naked eye, typically growing on the surface of

the skin before spreading to the dermis. Therefore, checking skin each month

can help identify changes to be reported to the doctor.

When skin is identified as abnormal, a biopsy may be performed. The doctor

will remove as much of the suspicious tissue as possible with a local excision.

The tissue will then be inspected beneath a microscope to check for cancerous

cells. Identifying cancerous cells can prove difficult, and sometimes a falsepositive

or false-negative indication may be given. Patients may therefore choose

to seek the opinion of two pathologists.

Surgery may be used in the management of skin cancers. Once the cancer

has been surgically excised, pathological examination will determine whether all

cancerous cells have been removed. If the skin cancer is large, the neighbouring

skin may be moved to cover the wound, reducing the scarring and providing a

better tone and colour match than a skin graft.

Other techniques may be adopted to manage pre-cancerous conditions

such as actinic keratoses, or non-melanoma skin cancers such as basal cell

carninomas. Cryotherapy, for example, can be used to freeze tumour cells. Most

commonly used for the treatment of actinic keratoses, a cryogen is applied to

the growths in order to freeze them. The growths then form a dry crust that

falls off within three weeks. Basal cell carcinomas may also be treated with

electrosurgery. Once the top of the lesion has been removed, the underlying cells

and bleeding points are cauterised with an electrocautery needle. A curette is

then used to remove the base of the lesion. Photodynamic therapy is also often

used to treat large area actinic keratosis lesions or non-melanoma skin cancers

such as basal cell carcinomas.

Thread lifting

Thread lifting is a minimally invasive technique that elevates the soft tissues of the

face using specially designed internal sutures and can deliver subtle yet effective

results. The procedure involves the use of multiple fine biocompatible threads

to lift and support sagging skin on the face and neck. Tiny ‘nicks’ are made to

the skin, which are hidden in the sideburn area. Threads are then looped to the

sagging soft tissues that support the face and neck, lifting and anchoring the

facial tissue in an elevated, more youthful position.

This process allows the threads to have a firm hold on the underlying tissues,

without causing trauma to the outer layers. Acting as a kind of scaffolding, the

soft barbs gently hold to the tissue as they lift the skin, complementing the natural

line of the face or neck. Once in position, the body generates new collagen that

surrounds each thread to maintain the lifting effect.

2 2 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic medicine

New-generation threads are completely absorbable and dissolvable. This

means the threads dissolve within around none to 12 months, yet still maintaining

the revitalising and lift effect for several years to come.

The procedure is typically performed under local anaesthetic and usually

takes around one hour to perform. Patients can usually return home within one

to two hours after the procedure, however patients should be aware the threads

take a few weeks to settle and integrate properly with the skin.

This procedure does not replace a conventional facelift; rather it offers patients

a minimally invasive approach to address the early signs of facial ageing. Results

tend to last around two to four years.


Microdermabrasion removes the outer layer of the stratum corneum (outermost

layer of the skin) to aid the skin’s natural process of sloughing off dead skin cells,

improving the appearance of fine lines, sun damage and scars, and creates a

more even tone and texture on the skin.

There are a number of different types of microdermabrasion. Generally the

procedure is carried out via jets that blast fine particles onto the face to dislodge

hardened skin cells, although a wand can also be used on the skin’s surface to

create the same effect. Crystal dermabrasion works by blasting the skin with

microscopic crystal particles; diamond microdermabrasion uses a diamond

head to lightly abrade the skin’s surface; and organic microdermabrasion uses

medical-grade baking soda or milled grains that are gentler than crystals and

more suitable for sensitive skins. A handpiece is used to vacuum up the stripping

agent and skin particles during and after treatment.

The treatment is generally well tolerated and can be compared to a more

intense exfoliation. After treatment, the skin can feel hot and appear slightly

red but this usually settles over a few hours. It’s generally recommended that

a course of six treatments is carried out to improve problems such as age

spots, but it can also be effective to treat blocked pores and blemishes with two

to three treatments.


Sclerotherapy offers an effective, less invasive alternative to diathermy and laser

treatments to improve the appearance of broken capillaries and spider veins that

occur as a result of ageing.

The treatment involves injecting the unwanted blood vessels with a sclerosing

solution (saline solution which induces the hardening of tissue) that causes the

target capillary to shrink and eventually dissolve as the body naturally absorbs

the vein. This process occurs over a number of weeks.

Sclerotherapy is typically preferred to laser for eliminating large spider veins

(telangiectasiae) as well as smaller varicose leg veins. Unlike a laser, the sclerosing

solution additionally closes the ‘feeder’ veins under the skin that cause the spider

vein to form, making any recurrence of the spider veins in the treated area less

likely. Having said this, sometimes a single blood vessel may have to be injected

more than once, some weeks or months apart, depending on its size. A number

of vessels can be injected in any one-treatment session.

While sclerotherapy is a relatively simple treatment, injecting the veins requires

a high degree of skill and accuracy. Because of this, it is important to seek

treatment from a properly qualified practitioner.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 2 3

cosmetic medicine



2 4 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic medicine

The healing power of light has been recognised and used for thousands of

years, dating back to the Ancient Greeks and Romans. Over the millennia,

our understanding and use of light-based therapies have continually evolved

to optimise results, reduce downtime and treat a wide range of skin conditions

and ageing concerns.

For cosmetic indications, light-based treatments can be broadly categorised

as intense pulsed light therapy, photodynamic therapy and laser therapies.

Intense pulsed light therapy

Intense pulsed light (IPL) in cosmetic therapy uses light wavelengths that safely

target either melanin or haemoglobin in the skin. It can be used to permanently

reduce unwanted hair growth, fade brown spots and cauterise enlarged or

broken capillaries and port wine stain birthmarks. Some treatments have been

developed specifically to treat rosacea.

Unlike lasers, IPL devices produce a broad spectrum of light in a range of

wavelengths. The emitted light is further adjustable through the use of filters,

allowing any skin colour to be treated. The range of light is typically between

500-1500nm, depending on the machine and filter used. This versatility allows

the characteristics of the light energy to be adjusted according to each patient’s

skin type, specific condition and location of the area to be treated.

In terms of safety, the two types are similar, but with both IPL and laser

facial rejuvenation treatments the practitioner and patient each need to use eye

protection, and treatment needs to occur in a controlled area where people

cannot wander in and be exposed to the light.

While lasers and IPL treat many of the same conditions, IPL is a single

technology for a multitude of applications – from unsightly veins and birthmarks

to ageing and sun-damaged skin, unwanted hair and rosacea.

During the procedure pulses of intense light are fired at the skin through

varying filters which isolate specific wavelengths of light. Various targets (such

as haemoglobin in the blood to remove vascular lesions, or melanin to treat

hyperpigmentation) are preferentially absorbed, heated and selectively destroyed

by certain light wavelengths (called selective photothermolysis) without damaging

surrounding tissues.

IPL treatment cannot typically address extensive sun damage and skin

discolourations but it can reduce surfaced capillaries and brown spots, as

well as help revitalise and even out the overall complexion. Typically four to six

treatments are required for optimal results.

The usual downtime with IPL modalities is minimal to none, depending on the

intensity of treatment, however full recovery can take around two weeks in some

cases. Immediately after IPL a slight burning sensation can occur for a few hours

but there is generally little discomfort.

Temporary discolouration can occur for around three to four days after the

procedure and this skin will flake off slowly. Short-term side effects include

reddening of the skin (erythema), temporary bruising and oedema. Reactions

such as scabbing and blistering are possible though rare. It is important to

protect skin from UV light with daily sunscreen application.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 2 5

cosmetic medicine

Which laser

and why?

Most resurfacing lasers work by

removing microscopic quantities of

skin and stimulating the production

of new collagen. Non-ablative lasers

use wavelengths which do not burn

away skin and are suitable for the

treatment of melasma, scarring, fine

lines and wrinkles and typically do

not require any downtime.

The most common ablative

lasers include carbon dioxide (CO 2


and Erbium:YAG lasers. These

use a process where the upper

layers of aged or damaged skin are

vaporised by the controlled laser.

More recently, laser is applied using

fractionated technology.

It is this damage that stimulates

the healing and restructuring of

the skin, resulting in a more even

complexion and a significant

reduction in lines and wrinkles.

Carbon dioxide lasers can

dramatically reduce wrinkles but

downtime and side effects such as

redness and peeling are extended,

usually taking many weeks to heal.

Erbium lasers have a great accuracy

with fewer side effects but cannot

treat deep wrinkles as successfully.

Photodynamic therapy

Photodynamic therapy uses a chemical reaction activated by light energy to

selectively destroy specific tissues and can be used to treat sunspots, certain

types of skin cancer, rosacea, acne and sun-damaged skin. A photosensitising

medication is applied topically on the skin and a narrow band of light (red or blue

light) is administered to cause a moderately deep exfoliation and target damaged

tissue and sebaceous glands.

When skin is exposed to a light source of an appropriate wavelength, its

photosensitiser molecules are activated to produce oxygen intermediates

that destroy the targeted cells. Recovery time is around two weeks after each

treatment and usually one to three sessions are required.

Laser therapy

Laser is an acronym for Light Amplification for the Stimulated Emission of

Radiation. Laser light is different to normal light for many reasons: it travels in a

synchronised fashion; retains its intensity over a long distance; is monochromatic

(of the same wavelength or colour) and can be pulsed.

Laser therapies work by targeting tissue and can be used for a number of

treatments, including pigmentation, scarring, unwanted hair, spider veins, sundamaged

skin, wrinkle reduction and overall complexion rejuvenation.

The principle behind lasers is light absorption. The same as a black car will

be hotter than a white car because it absorbs more wavelengths of light, certain

target tissues will absorb certain wavelengths of light more effectively. As the

laser light is monochromatic the target tissue will take on maximum absorption

while the surrounding tissues won’t. This allows the target to be isolated and

treated. In other words, the laser emits a single frequency of light with all the

light waves going in the same direction, allowing the target tissue to absorb the

maximum amount of heat.

The target tissue is all-important when treating skin problems with a laser.

For pigmentation it is melanin; for spider veins and other vascular conditions it

is haemoglobin (blood); and for wrinkles it is water. Each of these target tissues

absorbs a different wavelength of light, meaning a different laser is needed for

each specific problem.

Recent advances in laser technology mean that laser skin resurfacing, once

reserved for the treatment of severe conditions such as acne scarring due to the

extensive downtime involved, has become an effective option for many people

seeking reduction of lines and wrinkles and uneven skin colour, tone and texture.

2 6 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic medicine

Fractional laser therapy

The advent of fractionated laser, where microscopic columns of skin are treated

while surrounding skin is left intact, has made it possible to achieve results

comparable to traditional laser resurfacing with fewer side effects and profoundly

less downtime.

Fractional skin resurfacing can utilise both non-ablative and ablative lasers

– the breakthrough difference of this technology is the fractionated delivery

system of light.

Fractional laser technologies break up light beams to allow columns of

untreated tissue to activate healing mechanisms beneath the skin’s surface,

treating skin conditions ranging from scars and birthmarks to wrinkles.

These lasers work by creating microscopic thermal injuries that trigger

collagen production, stimulating cell renewal and plumping out the tissues. In

other words, the laser works by creating tiny holes, or ‘dots’, in the skin’s surface,

penetrating deep into the dermis which triggers the body’s natural healing

responses. It leaves the skin around each dot intact, enabling the surrounding

tissue to heal these microscopic thermal injuries by stimulating the production

of new collagen.

The anti-ageing benefits of fractional laser technology include improving

evenness of skin tone and texture, reducing pore size and the appearance of

lines and wrinkles, and helping to reverse the effects of sun damage. A more mild

treatment may take several sessions, while one procedure is usually sufficient for

a more aggressive treatment.

Because laser treatments use heat, a mild to moderate burning sensation

is experienced during treatment and slight swelling, redness and bronzing

afterwards. This can be covered with makeup and normally subsides after a few

days, however full healing can take several weeks, depending on the intensity of

treatment and the areas targeted.

Results of light-based therapies vary, depending on the technique and

experience of the practitioner and the individual patient. Patients should always

ask their practitioner how new the laser or IPL machine is and when it was

purchased. Recent models are far superior to earlier ones in terms of achieving

predictable and precise results.

What is a target tissue?

Different wavelengths allow delivery of energy to different structures. These

structures are target tissues known as chromophores and for cutaneous laser

therapy these are: haemoglobin (blood both oxygenated and de-oxygenated),

water, melanin (pigment in hair and brown spots) and ink (tattoos).

As each chromophore absorbs different wavelengths of light, different lasers

are used for different treatments. The treatments usually fall into four categories:

1. Resurfacing the skin, minimising wrinkles and scars (chromophore is water)

2. Vascular lesions such as spider veins (chromophore is haemoglobin)

3. Pigmented lesions such as brown spots and unwanted hair (chromophore

is melanin)

4. tattoos (chromophore is protein).

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 2 7

cosmetic surgery



2 8 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic surgery

All Fellows of the Australasian College of Cosmetic

Surgery are specifically trained in cosmetic medicine

and surgery and are required by the College to

maintain their skills through a Continuing Professional

Development program.

There is a wide range of cosmetic surgery options available to target

specific areas of the face and body. Whether facial surgery (such as a

facelift, rhinoplasty and blepharoplasty) or body surgery (such as breast

enhancement, liposuction and abdominoplasty), the modern approach to

cosmetic surgery involves tailoring a procedure or combination of procedures

to each patient’s individual requirements and goals.

As with any surgery, there are risks and limitations associated with all

cosmetic procedures. It is important the patient is well informed about the

realistic outcomes, the potential complications as well as the procedure itself.

This is where managing expectations becomes imperative for achieving a

successful outcome.

The doctor’s training and certification should be appropriate to the chosen

procedure. Certification by the appropriate medical board or body shows that

the doctor has met additional requirements for continuing education and

experience in cosmetic surgery.

The decision to have cosmetic surgery should never be made in a rush or

to please anyone else. The best results are always achieved through effective

patient-doctor communication and having realistic expectations of what cosmetic

surgery can achieve for each individual patient.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 2 9




The face, more than any other part of the body, defi nes an individual to

the outside world. With age, the effects of gravity, sun damage and the

stresses of everyday life become apparent and can alter the appearance of

a person’s face. As such, these age-related changes can make people feel as if

their identity has changed over time. As people are living longer and more active

lives, many seek facial cosmetic surgery to help them look as young as they feel.

Changes can occur in the upper, mid and lower portions of the face due to the

downward descent of facial fat and skin, resulting in deep lines around the eyes

and mouth, sagging skin in the cheeks, jaw line and neck, as well as banding

around the neck.

Facial tissues weaken over time, losing their resiliency and ability to maintain

a fi rm, youthful position. In addition, facial muscles weaken and stretch, and fat

deposits which normally give the face a soft, rounded appearance deplete and

descend to create hollow areas. A facelift, or rhytidectomy, is designed to address

these age-related changes and can restore a fi rmer, more youthful appearance.

Facelifting has continued to evolve over the past 30 years by adding and

developing various methods and techniques that treat particular areas of the face.

What began as a skin-only lift in the early 1900s has become a comprehensive

procedure which takes into account virtually every structure of the ageing face.

By repositioning both the skin and the Superfi cial Musculoaponeurotic System

(SMAS), the modern approach to face lifting restores the facial structures to a

more desirable position to create a younger looking appearance while avoiding

the telltale signs of surgery.

While a modern facelift predominantly addresses volume replacement and

vectors (directions) of lift, the procedure also helps smooth wrinkles and folds.

A typical full facelift today begins with incisions that are concealed within the

hairline. From these incisions, the skin is separated from the muscles and tissue

beneath. The SMAS layer is then tightened in the lower face, mid-face and neck,

after which the skin is pulled back to reduce lines and wrinkles. Excess skin and

fat is removed and the incisions are closed.

Recovery from modern facelifts is typically much less extensive and lengthy

compared with facelifts of the past, with less swelling, bruising, pain and recovery

3 0 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic surgery

At a glance

Procedure Improving sagging

facial skin, jowls and loose neck

skin by removing excess fat,

tightening muscles, redraping

skin. Most often done on men and

women over 40.

Length Several hours.

Anaesthesia Local with sedation,

or general.

In/Outpatient Usually outpatient.

Some patients may require short

inpatient stay.

Side Effects Temporary

bruising, swelling, numbness and

tenderness of skin; tight feeling,

dry skin.

Risks Injury to the nerves that

control facial muscles or feeling

(usually temporary but may be

permanent). Infection, bleeding.

Poor healing; excessive scarring.

Asymmetry or change in hairline.

Recovery Back to work: 10 to

14 days. More strenuous activity:

2 weeks or more. Bruising: 2 to 3

weeks. Must limit exposure to sun

for several months.

Duration Usually 5 to 10 years.

time. There are also different procedures, such as mini-lifts that use smaller and

fewer incisions, offering less recovery and down time.

There are different types of face lifting surgery, with each tailored to correct

different regions of the face. For example, a lower facelift is performed to

rejuvenate the lower portion of the face, while a brow lift or mid-facelift can

typically correct age-related changes in the upper and mid-face, respectively.

In addition, sagging and puffy eyelids can be addressed with eyelid surgery,

or blepharoplasty.

It is important to note that facelifts do not address overall skin texture, skin

thickness, or wrinkling and creases around the nose and mouth. Instead, modern

face lifting techniques are designed to correct sagging, loose skin and reposition

fat and tissues to add volume back to the face.

Lower facelift

A lower facelift can be performed using different types of incisions, depending on

the patient’s individual needs and wishes. A single incision is commonly made

within the hairline that extends downward around the perimeter of the ear and

into the hairline on the back side of the head.

Through these hairline incisions, the skin is lifted from the underlying tissue

of the lower face, jaw line and neck to expose the SMAS, a layer of tissue

composed of muscle and fibrous connective tissue.

The SMAS is then repositioned to elevate and tighten the underlying facial

structures to a more youthful and aesthetically pleasing position. There are

a variety of methods that can be used to lift the SMAS, such as excision or

plication in which the tissue is augmented and suspended in a higher position

with sutures.

After the necessary adjustments, the skin is then repositioned over the face

and any excess skin is removed. In some cases, the surgeon may place a

surgical drain beneath the skin to prevent fluid build-up during healing, although

this is not usually necessary. The incision is then closed with sutures. A lower

facelift procedure typically takes around three hours, depending on the extent

of surgery.


During a mid-facelift, the underlying tissues are tightened, and fat pads that

give the face shape and volume are lifted to restore a firmer, younger looking

appearance. A mid-facelift cannot correct loose skin in the neck or along the jaw

line, nor can it address fine lines or uneven skin tone and texture.

A mid-facelift can be performed using a variety of different incisions and surgical

techniques. For example, when combined with eyelid surgery (blepharoplasty),

the surgeon may choose to make incisions in the lower eyelid. When performed

in conjunction with a lower facelift, the physician may make additional incisions

inside the mouth along the gum line to help release the mid-face tissues.

Another approach is the endoscopic technique, whereby small incisions are

usually made just above the hairline, above the ear or by the temple. Additional

incisions are made inside the mouth over the cheekbone. With the aid of an

endoscope, a thin tube-like instrument with a tiny camera on the end, the

surgeon can gently manipulate the facial tissues and lift them to a more youthful

position. The tissues are typically suspended by use of sutures or absorbable

medical-grade material that dissolves over the course of a few months. Once

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 3 1


the underlying tissues are tightened and the fat pads are lifted, the incisions

are closed using sutures. A mid-facelift procedure takes around one and a half

hours, depending on the extent of treatment.


Advances in surgical procedures and technology mean there are several different

facelifting techniques available today. They are designed to address each

patient’s individual needs more specifi cally, helping to ensure optimal results.

SMAS lift

The SMAS (Superfi cial Musculoaponeurotic System) technique concentrates

on the thin underlying connective tissue and muscle layer called the superfi cial

musculoaponeurotic system, as well as repositioning and removing excess skin.

Tightening this foundational tissue gives a smoother and improved shape without

noticeable tension in the skin.

Deep plane lift

A deep plane facelift is designed to reshape the entire face, including the upper

and lower eyelids, the brow and the neck, by lifting facial tissues, fat, muscle and

skin in one continuous section. Because the dissection is deep, the fl ap is thicker

than in the SMAS method. Some surgeons prefer this technique as they believe

restoring the neck, jawline and mid-face together delivers more natural results.

Endoscopic lift

Commonly performed with the aid of an endoscope, this lift is designed to

reposition skin, fat and muscle simultaneously since the tissues tend to sag

together, not individually and is often performed partially in the subperiosteal

plane. This type of facelift releases tissues off the bony layer, separating the bone

from all of the tissues covering it.

There is more swelling with the endoscopic lift than with more superfi cial

lifts due to the depth of the dissection. It also usually causes more swelling and

takes longer to recover.

Composite or SOOF lift

The sub-orbicularis oculi fat (or SOOF) lift is similar to a deep plane lift, with the

addition of an extra step to include the muscle around the lower eyelid. The

orbicularis oculi muscle (around the eye) is separated from its attachment to the

cheekbone through an incision in the lower eyelid and then lifted and sutured

into place.

The composite facelift essentially involves elevation and resection of the SMAS

layer, orbicularis muscle and cheek fat pad. There is typically more swelling with

the composite lift than with more superfi cial lifts.

3 2 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U



The S-Lift is a type of facelift named after the S-shaped incision or short incision

made in the hairline at the temple and in front of the ear. The SMAS and attaching

skin is usually elevated as one unit and only excess skin is removed. The best

candidates for an S-Lift are those who do not have signifi cant skin laxity of the

neck and jowls. It is most suited to patients beginning to show signs of facial

ageing and want some tightening of the lower face without longer incisions.


This type of facelift typically refers to any limited-incision facelift, usually with

a quicker recovery time compared with other more invasive techniques. Also

referred to as a MACS Lift (Minimal Access Cranial Suspension) and the shortscar

facelift, it is typically suited for patients with early signs of ageing, usually

aged in their 30s and 40s, to achieve a natural-looking facial rejuvenation. During

a mini-lift, the surgeon usually makes a short incision on the front side of the ear.

Via this incision, deep plicating sutures lift the deep tissues and the extra skin

is then removed. Due to its less invasive approach, this type of facelift typically

offers less recovery time and a lower risk of complications.



Two of the defi ning features of a

youthful face are a well-defi ned jaw

line and a pleasing angle where the

neck and chin meet. Chin and neck

fullness or a poorly defi ned jaw line

can create the appearance of excess

weight and premature ageing.

Facial liposuction is a relatively

minimally invasive surgical procedure

and is best suited to patients

presenting with excess fatty tissue

but minimal excess neck skin.

Through several tiny incisions, the

fatty tissue is removed by way of

a specialised suction device. The

procedure is most often performed

with a microcannula using a

tumescent technique that involves

injecting fl uid into the targeted area

while suctioning the fat out.

Swelling and bruising should

typically subside in around seven to

10 days, after which most patients

can return to normal everyday

activities. Final results can take

several months to become evident.


Performed in conjunction with a facelift or as a stand alone procedure, a neck

lift is designed to correct excess skin and fatty tissue of the neck (the so-called

‘turkey gobbler neck’), platysmal bands which run from beneath the chin to the

lower neck, as well as a poorly defi ned chin/neck angle and jaw line.

The type of technique used for a neck lift procedure depends on several

factors, such as the degree of skin excess and laxity and the presence of

fatty tissue.

The traditional neck lift incision begins in front of the ear lobe and loops

under and behind the ear, ending in the scalp towards the back of the neck. An

additional small incision under the chin may be made to tighten the platysma

muscles. Other techniques may involve an incision only inside the hairline at the

back of the neck (known as a posterior neck lift), or behind the ear only (for some

suspension techniques), depending on the techniques used and the degree of

lifting required.

During a typical neck lift procedure, the platysma muscles of the neck, which

weaken and separate with age, are tightened and sewn back together in the

centre. In some cases the surgeon may choose to remove a small part of the

muscle to further reduce the appearance of skin laxity and neck banding. Tissue

and skin can also be elevated to a more youthful position during the procedure.

A small amount of skin trimming is performed as needed and the incisions are

closed, followed by a support bandage.

Liposuction of the chin and/or neck area may be required to remove excess

fatty deposits and help create a more defi ned chin/neck angle and jaw line. In

younger people with good skin tone, unwanted fat in the neck and jowls area can

be removed with liposuction alone.

In most cases recovery time is around two to four weeks and healing is usually

complete within a few months.

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 3 3



Procedure Correct drooping

upper eyelids and puffy bags below

the eyes by removing excess fat,

skin and muscle. (Upper-eyelid

surgery may be eligible for a

Medicare rebate)

Length 1 to 2 hours.

Anaesthesia Usually local with

sedation, or general.

In/Outpatient Usually outpatient.

Side Effects Temporary

discomfort, tightness of lids,

swelling, bruising. Temporary

dryness, burning, itching of eyes.

Excessive tearing, sensitivity to

light for fi rst few weeks.

Risks Temporary blurred or double

vision. Infection, bleeding. Swelling

at the corners of the eyelids. Dry

eyes. Formation of whiteheads.

Slight asymmetry in healing or

scarring. Diffi culty in closing eyes

completely (rarely permanent).

Pulling down of lower lids (may

require further surgery). Blindness

(extremely rare).

Recovery Reading: 2 to 3 days.

Back to work: 7 to 10 days.

Contact lenses: 2 weeks or more.

Strenuous activities, alcohol: about

3 weeks. Bruising and swelling

gone: several weeks.

Duration Several years.

Sometimes permanent.



Blepharoplasty is a surgical procedure to improve the appearance of the

upper and/or lower eyelids, to give a more refreshed appearance to the

surrounding area of the eyes. The loose fold of skin that droops over the

upper eyelid can be removed to make the eyes appear bigger, and the ‘bags’

below the eye can also be reduced.

The incision lines for eyelid surgery are made within the natural structures of

the eyelid region, allowing any resultant scars to be well concealed.

The incision for an upper lid blepharoplasty is in the lid crease and is made

with either a scalpel or CO 2

laser that seals the blood vessels as it incises. Skin,

muscle and fat are removed to reduce hooding in the upper eyelid.

Incisions for the lower lid blepharoplasty can be made either inside the eyelid

or just below the lower lash line. Excess skin in the lower eyelids is removed

through these incisions to correct under-eye bags or sagging.

Eyelid bulging caused primarily by excess fat may be corrected by a

transconjunctival blepharoplasty. The incision in this case is made inside the

lower eyelid, and excess fatty material is removed.

The results of eyelid surgery become apparent gradually, with swelling and

bruising usually subsiding after around two weeks to reveal a smoother, better

defi ned eye region and a more alert and rejuvenated appearance. Results

typically last around seven to 10 years.

Some patients elect to have their eyelid surgery combined with a facelift or

brow lift to maximise the rejuvenating effect and further enhance results.

3 4 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U



Procedure Raise the position of

the eyebrow and make the eyes

look more open. Can be done

using short scars (endoscopic) or

traditional (coronal). Other variants

possible (direct, temporal, hairline).

Length 1 to 2 hours.

Anaesthesia Local with sedation,

or general.

In/Outpatient Usually outpatient.

Side Effects Temporary swelling,

numbness, headaches, bruising.

Traditional method: Possible itching

and hair loss.

Risks Injury to facial nerve,

causing loss of motion, muscle

weakness, or asymmetrical look.

Infection. Broad or excessive


Recovery Back to work: 7

to 10 days, usually sooner for

endoscopic forehead lift. More

strenuous activity: several weeks.

Full recovery from bruising: 2 to

3 weeks. Limit sun exposure for

several months.

Duration Usually 5 to 10 years.


Often the brow and forehead area can show the fi rst signs of facial

ageing. Deep creases across the forehead and between the eyebrows

can become evident, even when the face remains in a static position.

The effects of gravity, sun damage and the natural ageing process all contribute

to a gradual descent of the brow, giving a ‘heavy’ or ‘hooded’ look to the upper

face, which can make a person appear angry, sad or older than their years.

Also known as a forehead lift, a brow lift elevates a low or sagging brow to a

more youthful position, minimises the creases and wrinkles that develop across

the forehead, and improves frown lines that develop high on the bridge of the

nose. It can also rejuvenate the upper eye area, reducing heaviness and sagging

over the eyelid and at the outer edges of the eye.

Brow lift surgery can be performed using several different techniques,

depending on the patient’s individual requirements and the surgeon’s preferred

method. Generally there are two commonly used methods of performing a

brow lift: the traditional coronal open incision brow lift and the newer endoscopic

brow lift.

The traditional brow lift procedure involves an incision made behind the

hairline across the top of the head from temple to temple. The forehead skin

is lifted from the underlying tissue and tightened along with the muscle using

sutures under the skin. The incision is then closed with stitches. Surgery typically

takes around one to two hours.

Instead of one long incision, the endoscopic approach to lifting the brow

involves three to fi ve short incisions above the hairline, each about 2cm long. An

endoscope, a thin instrument with a tiny camera at one end, is passed through

an incision and positioned near the brow. From there, surgical instruments are

inserted through another incision to allow the tissue and muscle beneath the skin

to be repositioned.

Gauze is placed over the closed incision and an elastic bandage may be

wrapped over the area to reduce swelling for the fi rst few days. Most patients

can resume everyday activities within a week, although rigorous activity should

be avoided for several weeks. Bruising and swelling typically subsides after

around three to four weeks and some numbness of the scalp is normal. Healing

is usually complete and the fi nal results apparent within around two months.

New techniques in threadlifting have also been applied with some success in

brow lifting.

A brow lift is often combined with a facelift or blepharoplasty to provide a

harmonious rejuvenation.

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 3 5


‘What you

want to see is


proof that the

product has

been tested in

clinical trials and

approved by

the FDA’


Procedure Set prominent ears

back closer to the head, or reduce

the size of large ears. Most often

done on children between the ages

of 4 and 14 years. (May be eligible

for a Medicare rebate)

Length 2 to 3 hours.

Anaesthesia Young children:

usually a general. Older children

or adults: general or local with


In/Outpatient Usually outpatient.

Side Effects Temporary

throbbing, aching, swelling,

redness, numbness.

Risks Infection of cartilage.

Excessive scarring. Blood clot

that may need to be drained.

Mismatched or artifi cial looking

ears. Recurrence of the protrusion

requiring repeat surgery.

Recovery Back to work/school:

5 to 7 days. Strenuous activity,

contact sports: 1 to 2 months.

Duration Usually permanent.




Prominent or protruding ears are one of the most common congenital

deformities in the head and neck region, affecting around one in 20 people.

An otoplasty is a relatively simple operation to correct protruding ears, and

can result in a signifi cant aesthetic and psychological boost.

Ears that are out of proportion with the rest of the face can draw too much

attention, marring the appearance of other, more attractive facial features. Many

people with protruding ears often learn to hide them from a young age, be it with

a hat or hairstyles, to avoid unkind remarks.

Otoplasty is a surgical procedure that reduces the appearance of prominent

ears, pulling them back closer to the head and making them less noticeable.

Suitable for both adults and children, the procedure usually takes around two

hours. The surgeon makes a small incision, using either a scalpel or laser, at the

back of the ear so that the cartilage is exposed. The cartilage is then sculpted

and bent back toward the head. In cases where only one ear may protrude, the

surgery is usually still performed on both ears for better balance.

After the surgery, a bandage is wrapped around the patient’s head to help with

moulding and healing. This stays on for approximately one week, after which a

lighter and smaller headband is usually worn during sleep for the next two to

three weeks. In most cases the incision leaves a faint scare at the back of the

ear, which fades over time. Swelling and bruising post-surgery is usually minimal.

3 6 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U



Procedure Reduction of excess

tissue of the inner (labia minora) or

outer (labia majora) vaginal lips.

Length 1 to 2 hours

Anaesthesia Local with sedation,

or general.

In/Outpatient Outpatient.

Side Effects Temporary bruising,

swelling, soreness.

Risks Infection, collection of blood

(haematoma), scarring, asymmetry.

Recovery Patient may go back

to work after 3 to 7 days. More

strenuous activity may be resumed

after two to three weeks. Can

usually resume sexual activity after

3 to 6 weeks.

Duration Permanent. Should not

affect pregnancy/childbirth.


Labioplasty is a surgical procedure that alters the size of the labia folds in

the vagina. It’s most commonly performed for labial reduction, but can

also be performed for labial augmentation. Reduction is usually, though

not exclusively, carried out on the labia minora, the ‘inner lips’ on either side of

the entrance to the vagina. Labial augmentation is commonly used on the labia

majora, the ‘outer lips’ on either side of the labia minora.

Functional reasons for seeking labial reduction centre on discomfort or pain

that is often experienced when wearing tight underwear or trousers. The labia

become uncomfortable as they rub against each other, or against clothing.

Labial discomfort can prevent women from taking part in sporting activities, such

as horse riding or cycling. Additionally, some women fi nd that the labia fold into

the vagina during sexual intercourse, resulting in friction and pain.

To avoid any clitoral injury and ensure an aesthetically pleasing result, surgery

takes place under general anaesthetic. Labioplasty is typically scheduled as a

one-day procedure and patients usually require pain relief for around three to

seven days after surgery. Bruising may also result from the procedure.

After surgery, patients should anticipate to be off work for a minimum of

three to four days to allow tissues to heal properly. Patients should wear loose,

comfortable clothing during this time to reduce any labial discomfort and swelling.

Sexual or sporting activities can be resumed after two to three weeks; however,

this should be discussed with your surgeon prior to surgery.

The main risk of labioplasty is wound infection. To assist healing, cleanse with

water, avoid astringents and dry by dabbing rather than rubbing. It is best to use

an infl atable donut cushion to make sitting more comfortable during recovery.

Scarring after the surgery is usually minimal although there may be some

tenderness. The scars are fi ne and typically hidden well within the natural skin

creases. Some patients may fi nd that sexual sensations are improved, as excess

skin no longer interferes.P

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 3 7




Breast augmentation is a surgical procedure that increases the volume of

the breasts through the insertion of prosthetic implants. Implants typically

range in volume from 90 to 900 millilitres and also come in different

shapes. They have either saline or silicone fi lling and smooth or textured silicone

or textured polyurethane foam covered envelopes.

As every woman’s physiology and presenting conditions are different, a

skilled surgeon will choose from a range of procedural options to suit the

patient and her desired outcome. In some cases augmentation surgery is

accompanied by a mastopexy, or breast lift, which involves more scarring but

may be needed to ensure an optimal outcome in patients with sagging breasts.

When considering breast augmentation there are a number of choices to

consider, including the location of the incision, the type of breast implant and

where it will be located.

Prior to the procedure, decisions will be made about the size and type of

implant, depending on the patient’s anatomy, body size, chest measurements

and desired fi nal result. Almost all patients who request a breast augmentation

desire some degree of cleavage.

Cleavage is defi ned by the distance between the breasts and it can be

enhanced by narrowing the gap between them breasts as well as increasing

the fullness of the breast at the inner edge of the breast. In most cases, the

appropriate type, size and placement of the implant can enhance cleavage.

However, in some women, particularly those who are extremely thin with minimal

soft tissue and with widely separated breasts, a well-defi ned cleavage will

not be possible without causing the risk of implant visibility and, worse, being

able to feel the implant. In these patients, cleavage can only be further enhanced

by a suitable bra.

Choosing the right implant is more complex than choosing a certain cup size

or wanting to emulate a look from a celebrity or a friend who has previously

undergone breast augmentation. It is important for the patient to choose a breast

implant size that suits her individual body shape and size. This will help ensure

natural-looking results that will enhance her existing shape.

The fi nal outcome depends on the patient’s existing breast volume, the

3 8 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic surgery

At a glance

Procedure Enhance the size of

breasts using silicone or saline

(water) implants.

Length 1 to 2 hours.

Anaesthesia Local with sedation,

or general.

In/Outpatient Usually outpatient.

Side Effects Temporary

soreness, swelling, change in

nipple sensation, bruising. Breast

sensitive to stimulation for a

few weeks.

Risks Formation of scar tissue

around the implant (capsular

contracture), which may cause the

breast to feel tight or hard; bleeding

or infection. Increase or decrease

in sensitivity of nipples or breast

skin, occasionally permanent.

Movement of implants, rupture of

the implant shell, being able to see

or feel the implant. Pronounced

scarring. Mammography requires a

special technique.

Recovery Back to work: 3 to

7 days. Physical contact with

breasts: 3 to 4 weeks. Fading of

scars: several months to a year

or more.

Duration The majority of

women with implants never

require further surgery.

thickness of the soft tissue that covers the breast, the bulk of the muscle

and the tightness of the skin envelope. While these factors should be

considered case by case, there are some general characteristics of an attractive

breast, including:

• A gentle slope from the shoulder to the peak of the breast at the nipple;

roundness at the top of the breast is an implant giveaway

• The nipple is located on the centre of the breast mound and tilted slightly

outwards and upwards

• A gentle arc from the nipple to underneath the breast (not too big and full

which can make the breast appear saggy)

• A good cleavage

• A silhouette line so that when standing front-on, a gentle bulge is apparent on

the side of the chest wall.

The procedure

The breast augmentation procedure involves the surgical placement of an

implant in each breast to push the breast tissue forward. It may be performed on

a day-surgery basis and always takes place in a surgical environment.

During the procedure, the patient is anaesthetised, either with general

anaesthetic or twilight sedation, and the chest area is cleaned and marked up

with guidelines by the surgeon. The surgeon makes an incision that enables

them to lift the breast tissue, creating a pocket within which the implant is placed.

Incision site

The location of the incisions will depend on the patient’s anatomy, breast

condition as well as the surgeon’s recommendations. There are four possible

incision sites:

Inframammary: The incision is made in the crease under the breast close to

the inframammary fold. This is the most common incision site and allows the

doctor to work with good visibility. The scar is hidden in the crease under the

breast and is not normally visible when wearing a bikini top.

Areolar/Periareolar: The incision is made across or around the bottom or

outer edge of the areola. The periareolar incision allows the surgeon to work

close to the breast. It is possible for the surgeon to easily and precisely place

the breast implants in various positions in relation to the chest muscle. However,

this is the only incision that involves cutting through breast tissue and ducts,

and sensitivity in the nipple may be reduced.

Transaxillary: The incision is made in the lower portion of the armpit, next

to the chest. The greatest advantage of an underarm breast augmentation

incision is that no scar is left on the breasts. The scar is virtually invisible in the

armpit fold and lack of tension generally makes for straightforward healing.

Transumbilical: Transumbilical or navel (TUBA) incision is made on the rim

of the navel and can only be used for saline implants as the filling is added after

the implants are placed.

C o s m e T I C s u r g e ry & m e d I C I n e w w w. A C C S . o r g . a u / / 3 9

cosmetic surgery

Implant position

The implant will be placed in one of three positions:

‘The way breast


surgery is carried

out varies with

each individual’


The subglandular pocket is created in front of the muscle, between the breast

tissue and the pectoral muscle. This position resembles the plane of normal

breast tissue and the implant is placed in front of the muscle. Sometimes the

implant is covered by a thin membrane, the fascia, which lies on top of the

muscle. This is called subfascial placement.


The submuscular implant is placed under the pectoralis major muscle after some

release of the inferior muscular attachments. Most of the implant is positioned

under the muscle. This position can create a natural-looking contour at the top

of the breast in thin patients and those with very little breast tissue. The implant

is fully covered, which helps to camouflage the edges of the implant, as well

as rippling. With this placement, there is reportedly less chance of capsular

contracture occurring.

Dual plane

The dual plane implant is placed partially beneath the pectoral muscle in the

upper pole, where the implant edges tend to be most visible, while the lower

half of the implant is in the subglandular plane. This placement is best suited to

patients who have insufficient tissue to cover the implant at the top of the breast

but who need the bottom of the implant to fully expand the lower half of the

breast due to sag or a tight crease under the breast.

Finally, the incision is closed with sutures or surgical glue and covered with

tape, which helps the tissues adhere. In some cases additional dressings

may be applied or a surgical bra may need to be worn, but advances in

surgical techniques mean that a sports bra may be sufficient or no bra at all

may be needed. After surgery the patient is moved to a recovery area and, in

straightforward procedures, may be able to go home a few hours after surgery. In

the case of more complex surgery, an overnight hospital stay may be necessary

or longer if there are any complications.

The way breast augmentation surgery is carried out varies with each individual.

Ultimately, it depends on the woman’s existing shape and her desired outcome.

Which implant?

The design and manufacture of breast implants have been progressively refined

and improved to reduce risks such as capsular contracture, gel diffusion and

implant rupture.

The choices of both saline and silicone gel implants now available in Australia

typically come from a handful of manufacturers. They are produced in round and

teardrop (anatomical) shapes, with a smooth, textured or polyurethane foamcovered

silicone elastomer envelope.

Regardless of the type of implant women choose, the shape, texture and size

can be customised to reflect her individual body type and aesthetic goals.

The choice of projection is to a large extent a personal one. For example, a

woman with adequate breast tissue and a shape she is happy with may opt for

a low-profile implant that will simply increase the size of her breasts. Another

patient seeking to create cleavage, or a patient with some degree of sag, may

prefer a high-profile implant that can help achieve these results.

4 0 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic surgery


Silicone gel-filled implants

The most commonly used implants in Australia are silicone gel-filled implants.

They have an outer silicone shell and all contain a cohesive gel, designed to

mimic the feel of real breast tissue. It has a slightly firm, non-runny consistency,

which can give a more natural feel. As the gel is not liquid, the risk of dispersal if

the implant ruptures is minimised. It also typically maintains its shape better than

a saline implant, especially in the upper part of the implant.

Saline-filled implants

These have an outer silicone shell containing a medical grade saltwater solution,

which makes the implant feel like a waterbed. This can be controlled to an extent

by the volume of fill in the implant. If implant rupture occurs, the saline is absorbed

by the body. Saline implants feel firmer than silicone implants and have a higher

risk of visible folds and ripples.


Round implants

Depending on their fill, round implants can achieve a defined round shape or

assume more of a teardrop form when the patient is upright. They tend to provide

more upper pole fullness than anatomical implants, which are fuller in the lower

pole. Round implants come in smooth and textured shells.

Anatomical (teardrop) implants

These more closely resemble the natural shape of a breast. However, they

demand a greater degree of accuracy in positioning and if they shift after surgery,

the shape of the breast may be distorted. Anatomical implants can also provide

greater projection in proportion to the size of the base, making them particularly

suitable for women with little natural breast tissue. These implants have textured

surfaces to allow for better integration with the surrounding breast tissue. The

implant may still move and distort the appearance of the breast so the surgeon

must be experienced with this type of implant.

‘It is important for

the patient

to choose a

breast implant

that suits her

individual body

shape and size’


Smooth-shelled implants

These are relatively easy to insert and are said to make the breast move and

feel more natural than a textured shell. However, they have increased risk of

capsular contracture (hardening of the breast), which is a common reason for


Textured implants

These implants have a thicker shell and the very nature of their surface means

they can grab onto and adhere to the surrounding tissue, causing less friction

between the implant and breast pocket and therefore helping to reduce the risk

of capsular contracture. Many surgeons also believe it offers them greater control

over the ultimate shape of the breast.

Polyurethane implants

These implants have a medical-grade polyurethane coating. The surface of the

implant comprises a 3D matrix of polyurethane foam cells. Some studies have

shown that the implants lower the risk of capsular-contracture.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 4 1



Procedure This operation removes

excess skin from the breast

that has been stretched during

pregnancy or weight fl uctuations.

Breast implants may also be used

in conjunction with this procedure

to achieve the desired result.

Length Approximately 2 to

3 hours.

Anaesthesia Usually general.

In/Outpatient Usually outpatient.

Side Effects Temporary bruising,

swelling, some mild discomfort,

numbness, and dry/tender breast


Risks Unfavourable scarring

with keloid formation is possible.

In addition skin loss, infection,

unevenly positioned nipples

(asymmetry), and the possibility

of permanent loss of feeling in the

nipples and/or the breasts.

Recovery One week for work, 3

to 4 weeks for strenuous activities.

The fading of scars may take

several months to one year.

Duration The outcome varies from

patient-to-patient. Other factors

that may infl uence results are:

gravity, pregnancy, ageing, and

weight changes which may cause

new sagging.




natural part of the female ageing process is the sagging or drooping of the

breasts. Women who have breastfed or have experienced extreme weight

loss often seek breast enhancement surgery to restore volume and shape

to their breasts, which often involves mastopexy (breast lift). It is also suitable for

women who, although satisfi ed with the size of their breasts, are unhappy with

the sagging and loss of fi rmness.

A mastopexy is designed to lift the breast by removing excess skin, and

sometimes re-positioning the nipple to create more youthful looking breasts.

The appropriate technique and incision pattern is determined according to

the size, shape and degree of sagging of the breast, as well as the position

and size of the areola (outer nipple). The incision is most commonly made in one of

three areas:

• Around the areola

• Around the areola and then vertically down the breast

• Around the areola, vertically down the breast and horizontally along the

breast crease.

Once the incision has been made, the excess skin is removed and the nipple

and areola are then repositioned to create a more pert and youthful looking

breast shape. During a breast lift the nipple needs to be lifted and reshaped to

appear smaller, rounder and more in proportion with the new breast. The skin

that surrounds the areola is brought together to contour and reshape the breast.

All breast lift procedures leave permanent scars, which, while red initially, will

usually fade within six to 12 months.

4 2 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U



Procedure Reduce the size

and improve the shape of a

woman’s breasts.

Length 2 to 4 hours depending

upon the technique

Anaesthesia Usually general

anaesthesia; smaller reductions

intravenous sedation with local.

In/Outpatient Usually outpatient.

Side Effects Prolonged swelling

and delayed healing, bruising.

Risks Unfavourable scarring, loss

of nipple sensation, loss of ability to

breastfeed, loss of nipple and breast

tissue, unsatisfactory shape, and

failure to achieve aesthetic goals.

Recovery Work 1 to 2 weeks, most

normal activities 4 to 6 weeks.

Duration Usually permanent in that

it never needs to be done again.



Breast reduction (or reduction mammoplasty) is a surgical procedure that

reduces, lifts and reshapes the breast. The procedure removes excess

breast and fatty tissue, leaving the patient with an overall smaller and more

shapely breast.

The operation seeks to improve posture and relieve the symptoms caused by

very large breasts. These may include back pain, neck pain, breast tenderness,

shoulder grooving (from bra straps), intertrigo (rash between folds of skin), and

overall breast discomfort.

Many breast reduction procedures call for just one vertical incision around the

areola down to the breast crease, and in some cases along the crease as well. A

portion of fat and excess tissue is then removed. The nipple and areola are then

repositioned and the skin under the breast is re-sculpted. This results in smaller

breasts that have a more aesthetically pleasing shape and improved support, lift

and overall fullness.

Breast reduction surgery is performed under a general anaesthetic. Women

undergoing a breast reduction can expect to spend one to three nights in

hospital. The recuperation period lasts for around three weeks. The resulting

scar can be seen from around the nipple down to the breast crease in a vertical

line, and gradually fades over 12 to 18 months after the procedure. This scar

generally takes longer than other types of scarring to settle.

It takes approximately three months for the breasts to relax into their new

shape, as gravity takes effect and swelling begins to reduce.

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 4 3



Liposuction is a surgical procedure to remove deposits of subcutaneous

fat from specifi c areas of the body such as the thighs, hips, abdomen,

buttocks, knees, upper arms, neck and chin.

There have been many advances in liposuction procedures over the past few

decades, making it one of the most predictable and popular body contouring

surgeries in the world. The techniques of liposuction have evolved to become

less invasive, involve less patient downtime and create more precise results.

There are numerous liposuction techniques available today and each doctor has

their preferred method, all of which offer effective, predictable results. No single

technique, piece of equipment or instrument necessarily offers better results.

Most doctors will adapt the techniques and tools to each individual patient

according to their specifi c concerns and desired results.

The basic liposuction procedure involves the insertion of a small tube-like

instrument, called a cannula, into the layer of subcutaneous fat via tiny incisions

made by the surgeon. The cannula is most commonly connected to a clear

plastic hose which leads to a suction source. It breaks up and vacuums away the

targeted fat deposits beneath the skin.

There are two main layers of subcutaneous fat: superfi cial and deep.

Liposuction is primarily focused on the deeper layer of fat, since suctioning is

thought to be safer and easier there. Suctioning in the superfi cial layer allows

the surgeon to achieve subtle benefi ts in the procedure but, because of its

proximity to blood vessels and nerve endings, it can increase the risk of contour

irregularities and injury to the skin. Some doctors believe superfi cial liposuction

enhances skin retraction.

Although the cannula is designed to slide through fat tissue and cause

minimum damage to blood vessels and nerves, some may be injured during

the procedure.

4 4 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U

cosmetic surgery

At a glance

Procedure Improve body shape

by permanently removing exerciseresistant

fat deposits with a

tube and vacuum device. Can

be performed on most parts of

the body. The surgeon may use

additional technology such as

ultrasound or laser to more easily

remove the fat.

Length 1 to 2 hours or more.

Anaesthesia Local, with or

without sedation, or general.

In/Outpatient Usually outpatient.

Extensive procedures may require

short inpatient stay.

Side Effects Temporary bruising,

swelling, numbness, soreness,

burning sensation. Temporary fluid

drainage from incision sites.

Risks Asymmetry. Rippling or

bagginess of skin. Pigmentation

changes. Skin injury. Fluid

retention. Excessive fluid loss

leading to shock. Infection.

Recovery Back to work 1 to 2

weeks. More strenuous activity:

2 to 4 weeks. Full recovery from

swelling and bruising: 1 to 5

months or more.

Duration Permanent, with sensible

diet and exercise.

The procedure

Various types of anaesthesia can be used for liposuction, depending on the

doctor and the extent of the procedure. If only a small amount of fat and a limited

number of body sites are involved, liposuction can be performed under local

anaesthesia, which numbs only the affected areas.

Local anaesthetic is sometimes used in conjunction with intravenous sedation

to help relax the patient during the procedure. Some patients prefer general

anaesthesia, particularly if a large volume of fat is being removed.

Generally, the doctor makes tiny incisions in the areas to be suctioned and

a cannula is inserted. Using the cannula, the doctor moves in a specific pattern

through the fat layer to break up fatty deposits, which are then vacuumed out.

The overlying skin remains attached to the connective tissue and underlying

muscles of the skin during the operation. A thin blanket of fat is left under the

skin to help prevent rippling or bumpy skin occurring after the liposuction is over.

The aim of liposuction is to decrease the bulk of fat in a specific area, but

not to remove all the fat. Fat is an important tissue which helps to maintain skin

shape and firmness. Removing too much fat can therefore cause loose skin and

surface irregularities.

Depending on the size and number of the areas being treated, as well as the

technique employed by the doctor, the procedure usually lasts around one to

three hours.

In addition to fat, body fluid is also removed during the procedure. Because of

this, patients may require fluids intravenously during the operation.

After surgery, the patient can expect to be swollen and bruised. Most patients

report feeling sore for a few days. It is also common to experience some

numbness in the treated areas, although this should gradually return to normal

in the first few weeks.

Patients are required to wear a compression garment for three to six weeks,

but should be able to return to their normal everyday routine after around two to

four weeks. Vigorous exercise can normally be resumed in around one month.

Although results can be seen as swelling subsides, it can take from six months

to a year to achieve the final effect.

Although different surgeons may favour certain modalities and techniques,

it is important to remember that all liposuction is surgery, requiring incisions,

anaesthesia and diligent post-operative care.

Energy-assisted liposuction

Recent advancements in liposuction surgery have seen the advent of different

energy sources being used to assist in dissolving and removing fat. These

techniques include ultrasound-assisted liposuction, radiofrequency-assisted

liposuction, power-assisted liposuction, laser-assisted liposuction and waterassisted


The role of the energy is to dislodge and break up the fat so that it can be

removed easily in an almost liquefied form. Reports of additional benefits such

as a degree of skin tightening and reduced recovery time have been associated

with different devices, however each technology can produce effective results in

the hands of a skilled operator.

While some of these techniques are potentially more aggressive than others,

doctors are increasingly using energy-assisted liposuction techniques for their

reduced recovery time and, in some cases, their ability to target more superficial

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 4 5


‘There have been

many advances

in liposuction


making it one

of the most

popular cosmetic

surgeries in

the world’

fat layers underneath the skin. Even though the recovery period is signifi cantly

less than with traditional liposuction methods, patients should still expect to

experience bruising, swelling and in some cases residual bleeding from the

incision points post procedure.

Energy-assisted liposuction can be benefi cial for large-volume liposuction

surgeries as the length of the procedure is usually reduced and the patient

typically spends less time under anaesthetic. However, there is also a risk of

removing too much fat that can result in unevenness, so operators must

be properly skilled according to the specifi c device they are using. The heat

generated during ultrasound- or laser-assisted liposuction can also burn the skin

or damage the tissue under the skin, but instances of this are rare.


Liposuction is not a way of losing weight. However, it may be a viable option

for men and women who want to reduce bulges of fat that have resisted dieting

and exercise.

The ideal liposuction candidate is at or near their ideal weight, with good

skin elasticity, and is seeking reduction of diet-resistant localised pockets of fat.

Common sites include the hips, outer and inner thighs, abdomen, lower back,

knees and neck.

Overweight individuals can benefi t if they are in the process of exercising and

losing weight. However, liposuction is not a cure for obesity. Candidates must

have realistic expectations of what liposuction can and cannot do.

If a person has loose skin, liposuction can actually make it worse. If this is the

case, a body lift procedure may be required to remove excess skin and help the

skin conform to the body’s new contours.

It should also be noted that liposuction does not improve cellulite (the dimpled

‘orange peel’ appearance of the skin commonly seen on the buttocks and thighs)

or stretch marks (caused by pregnancy or rapid weight gain) as these appearance

concerns are not related to fat accumulation beneath the skin.

Both men and women can achieve an improved and more contoured body

shape through liposuction. The most commonly treated areas in women are the

outer thighs and stomach, where as the most commonly treated areas in men

are the abdomen and the fl anks, or ‘love handles’. Some men have excess fatty

tissue in and around the breast, or gynaecomastia, which can also be removed.

A specifi c area treated by liposuction is less likely to increase to its former size

because it has fewer fat cells.

4 6 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U



Procedure Flatten abdomen

by removing excess fat and

skin, tightening muscles of

abdominal wall and repositioning

the umbilicus.

Length 2 to 5 hours

Anaesthesia General

In/Outpatient Either depending

on individual circumstances and

extent of surgery.

Side Effects Temporary pain.

Swelling, soreness, numbness,

bruising, tiredness for several

weeks/ months.

Risks Blood clots. Infections.

Bleeding under the skin fl ap. Poor

healing resulting in conspicuous

scarring or skin loss. Need for

further operations.

Recovery Back to work: 2 to 4

weeks. More strenuous activity:

4 to 6 weeks or more. Fading

and fl attening of scars: 3 months

to 2 years.



Abdominoplasty, commonly known as a ‘tummy tuck’, involves the removal

of excess skin and fat from the middle and lower abdomen. It addresses

protruding fat, loose skin and also laxity of the abdominal wall muscles.

Typical patients have often experienced extreme weight loss or pregnancy and

wish to create a fl atter stomach area.

During the abdominoplasty procedure, skin and fat are removed from

the stomach area and the abdominal muscles may be repaired, tackling a

number of conditions at once. While liposuction is used only to remove fat, an

abdominoplasty can fl atten the stomach area by tightening the muscles as well

as recapturing a more hourglass fi gure. However, some people may think they

need to have an abdominoplasty when, in fact, liposuction alone may give a

good result.

The abdminoplasty incision is made across the lower abdomen, above the

pubic bone and, where possible, is positioned in such a way as to be invisible

under swimwear and underwear. A circular incision is then made around the

navel and the skin is then separated from the muscle, working up toward the

ribs, stitching the muscles together then tightens the stomach. Liposuction is

often performed with the tummy tuck, which creates shape and contour.

During the procedure, excess skin is removed and a new opening is made

for the belly button. Drainage tubes are placed under the skin to collect any

excess fl uid that may accumulate over 48 hours. A hospital stay of two nights is

generally required.

If the excess skin and fat are mostly located below the navel, a ‘mini-tuck’ may

be appropriate. This surgery is less complex, and less skin and fat are removed.

The incision is not as long, and the navel does not have to be repositioned.

In both, at fi rst some numbness of the skin is to be expected, especially in the

lower, central areas and sometimes in the upper thighs.

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 4 7

cosmetic surgery


& recovery

The decision to undergo cosmetic surgery should not be taken lightly. You

should be well informed about the possible outcomes, potential risks as well

as the actual procedure. The decision is always yours, and it should not be

made in a rush. At consultation, your doctor will be able to discuss the benefits

and risks of the surgery and the likely outcome.

You can eliminate much of the anxiety associated with surgery by learning the

basics of the process beforehand and preparing for what lies ahead.

One of the most important decisions when electing to undergo cosmetic

surgery is your choice of doctor. The combination of training, experience and

judgment the doctor brings to your case strongly affects the outcome of your

procedure. You should also feel comfortable enough with your doctor to openly

express your concerns and treatment goals.


To prepare for surgery, your doctor will schedule an in-depth planning session.

During this consultation, the procedure, the type of anaesthesia to be used, the

risks and limitations, costs involved, required medications, your expectations and

goals, as well as the steps to take prior to the operation will be discussed.

Your doctor will also need to know your medical history to plan the best

treatment and achieve optimal outcomes. Fully disclose any health problems you

may have had as some may interfere with surgery, anaesthesia and aftercare.

Prior to surgery you may be asked to undergo a medical evaluation. Your

doctor may also make adjustments to the medications you may be taking and

advise you to stop taking all forms of aspirin, as well as any medication or vitamins

which could increase the risk of blood clotting.

The day before surgery you should properly prepare by packing loose and

comfortable clothing to wear after the procedure, getting adequate sleep the night

before, and arranging a ride home. If you are undergoing general anaesthesia,

you will be required to abstain from eating or drinking for at least six hours before

surgery (this helps prevent an upset stomach while under anaesthesia).

Preparing for cosmetic surgery therefore isn’t just physical. You must also be

mentally and emotionally prepared for the changes that are about to take place.


Recovery will depend on the technique and anaesthetic administered, as well as

the extent of the surgery and the individual patient.

If general anaesthesia is used, you will be transferred to a recovery room

where you will stay until you awake. Nursing staff will observe your recovery and

monitor your heart rate, blood pressure and breathing, and you should normally

be able to go home after one to three hours. Ensure that you have an emergency

telephone number for your doctor and the clinic, in case you need to contact

them. A responsible adult should stay with you for at least 24 hours after you

return home.

4 8 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

cosmetic surgery

The specific length of recovery is dependent on factors such as your age,

pre-operative activity level as well as the number and type of procedures you

have had performed.

Getting ready

for surgery

Being well prepared will in turn

make your recovery faster, easier

and with less risk of complications.

• Avoid using medications

containing aspirin or any antiinflammatory

agents. Aspirin

reduces the ability of your blood

to clot and could increase your

tendency to bleed during the

recovery period.

• Do not smoke for at least two

weeks before and after surgery

as this increases the risks of

complications and inhibits

wound recovery.

• Choose a support person (a

close friend or family member)

who can drive you to and from

the operation and be with

you the first 24 to 72 hours

after surgery.

• set up a home recovery area

with lots of pillows, books,

magazines, stationery, a TV,

remote control and DVDs.

• Fill prescriptions for your

painkillers and antibiotics before

surgery and prepare icepacks

to reduce post-operative


Drink plenty of fluids 24 hours

before surgery and have a

good sleep the night before.

Risks & complications

Every surgical or medical procedure involves a certain amount of risk. Cosmetic

procedures have a good safety profile but despite the highest standards

of surgical practice, complications can still occur. The most effective way to

minimise the risks involved is to undergo a thorough physical examination with

your doctor prior to surgery.

Although complications are rare, they can include infection, nerve damage,

blood clotting, fluid loss and negative reactions to anaesthesia. Less severe

liposuction risks include scarring, loss of sensation in and near the treated area,

as well as skin discolouration in the treated area. Diabetes, poor circulation,

heart, lung or liver disease, smoking or a family history of blood clots may also

increase the risk of complications.

Contact your doctor if you experience any concerns or problems following

liposuction. These may include:

• Nausea

• Fever or chills

• Heavy bleeding or oozing from incision sites

• Increased swelling around the surgery sites

• Increasing pain

• Redness around incision sites that is spreading.

General dissatisfaction can be minimised by fully understanding the risks and

benefits associated with your chosen surgery and having realistic expectations.

To maximise the success of surgery and minimise the potential risk of

complications, always follow your doctor’s instructions for surgical preparation

and post-operative care.

Some questions to ask yourself

• Why do you want to have a particular procedure?

• How do you feel about your body image now?

• Is anyone prompting you to have the surgery?

• Do you suffer from an emotional or psychological disorder?

• Did you recently experience a stressful event eg. divorce or loss of a loved one?

• Are you a perfectionist, and do you find minor flaws with many parts of your

body and with your life?

• Would you be prepared to handle a complication if something goes wrong

after surgery?

Are you a good candidate?

The most important decision you will make when considering cosmetic surgery

is whether the procedure, with its inherent risks and complications as well as its

benefits, is the right thing for you.

Once you have weighed it up and decided to proceed, the key to a successful

outcome is having realistic expectations and understanding the procedure’s

limitations for your individual case.

The psychology behind the decision to have cosmetic surgery is one of the

most important aspects of the procedure. A good candidate is mentally and

physically stable and understands the reality of what this surgery can achieve.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 4 9

Before & after photos

face & neck lift



AFTER facelift, neck lift and laser resurfacing by Dr Flynn


AFTER facelift and laser resurfacing by Dr Flynn

5 0 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u


Face & Neck lift


AFTER neck lift by Dr Flynn


AFTER neck lift by Dr Flynn

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 5 1

thread lift



Twelve days AFTER thread lift by Dr Flynn

laser resurfacing


AFTER SmartXide Hot Dot laser treatment by Dr Flynn

5 2 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

gallery xxx xxx

laser resurfacing


AFTER SmartXide Hot Dot laser treatment by Dr Flynn

laser resurfacing


AFTER combination treatment including fat transfer and laser

resurfacing by Dr Flynn

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 5 3

east lift




AFTER breast lift only by Dr Flynn

AFTER breast lift only by Dr Flynn

breast reduction


Five days AFTER breast reduction surgery by Dr Flynn (Note some

modest bruising on the left breast and the scar pattern, which is

healing well at day five)

5 4 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u


breast augmentation


AFTER breast augmentation by Dr Flynn

BEFORE AFTER breast augmentation by Dr Flynn


AFTER breast augmentation by Dr Flynn

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 5 5





AFTER liposuction by Dr Flynn


AFTER liposuction by Dr Flynn

5 6 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u




AFTER abdominoplasty by Dr Flynn



AFTER abdominoplasty by Dr Flynn

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 5 7

ACCS patient brochure

Things you should know

Raising standards, protecting patients.

Choosing your doctor

You should choose a doctor based on the doctor’s relevant education, training,

experience and proven competence with respect to the specific procedure you

are considering.

Cosmetic surgery and plastic and reconstructive

surgery – what is the difference?

Although cosmetic surgery and plastic surgery are frequently talked of

interchangeably, they are different. Cosmetic surgery is performed on normal

healthy structures of the body in order to change or improve the patient’s

appearance and elevate their self-esteem. Plastic and reconstructive surgery

is different to cosmetic surgery because it is performed to improve function or

repair appearance impaired by congenital defects, disease or trauma.

Cosmetic medicine and cosmetic surgery

– what is the difference?

Doctors who are fellows of the ACCS are accredited as either surgical or medical

fellows. It is important to note that membership of a particular professional group

does not guarantee the cosmetic surgery provider’s experience in a particular

procedure. Make sure you ask your doctor whether they are accredited by the

College for the procedure you are contemplating.

ACCS Accreditations

‘FACCS’ means Fellow of the Australasian College of Cosmetic Surgery.

These doctors are trained in cosmetic surgery and accredited by the college

to perform invasive cosmetic surgery such as liposuction and breast

augmentation. To qualify as an FACCS a doctor must have three years’ basic

surgery training post medical school and a further two years’ specific cosmetic

surgery training.

‘FFMACCS’ means Fellow of the Faculty of Medicine of the Australasian

College of Cosmetic Surgery. The Faculty of Medicine represents trained

cosmetic physicians who have been accredited by the College in the field of

cosmetic medicine.

Fellows of the Faculty of Medicine (FFMACCS) are not accredited by the

College to perform invasive cosmetic surgery. Some FFMACCS, because of

special training and experience obtained outside of the College’s accredited

programs, may have the expertise to perform these procedures competently,

5 8 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

ACCS patient brochure

but you should establish with the doctor their training and experience in the

procedure you are considering.

Procedure specific registers

In addition to the Fellowship qualifications, the College maintains ‘Procedure

Specific Registers’. These registers, which are available on the College’s

website, provide reassurance that you are in the hands of a trained, accredited

and experienced practitioner.

To be included on a Procedure Specific Register a doctor has to have done

a minimum of 50 such procedures. In some cases the minimum is 100 cases.

Getting the most out of your consultation

When considering a cosmetic procedure you want to be sure that you get all of

the information you need to make an informed choice.

Be sure of what it is that you are trying to correct. This is more important

than concentrating on asking about a specific procedure because there will

usually be a number of different options to achieve the result you seek.

Don’t be afraid to ask questions. If you do not understand something, then

say so. Any competent doctor will want you to understand everything to your

satisfaction, and it will help your doctor understand what you are trying to

achieve. It doesn’t matter if you think the questions are minor – if they worry

you then they are important.

Risks and complications

You should consider seeking a second opinion before having any invasive

elective procedure.

Every procedure, whether it is an operation or a non-surgical procedure,

carries an element of risk. This is important to understand and discuss during

your consultation.

Some risks are minor, such as redness or bruising after an injection. Some

risks are more serious, such as severe infection, scarring or unevenness.

Sometimes a procedure may not turn out the way a patient would like, despite

the best appropriate efforts.

Sometimes patients hope for a result that is difficult or sometimes impossible

to achieve. It is important for both you and your doctor to make sure that

expectations are realistic and reasonably achievable.

You need to make sure your doctor discusses risks and complications with

you to your satisfaction. If you are not sure then you should not proceed.

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 5 9

ACCS patient brochure

Questions you should ask your doctor

• Are you a Member of the Australasian College of Cosmetic Surgery?

• How many times have you performed this procedure before and in the last


• What are the risks associated with the procedure and what is your own

complication rate?

• What are the alternatives to the procedure being considered?

• Can I see photographs of the results of your own patients who looked similar

to me before their surgery?

• Can I see photographs of the kind of result it will be impossible for me to


The biggest factor determining what you will look like after a

cosmetic procedure is what you look like now. Seeing both

types of photos will help you to understand the kind of result

you should realistically be able to achieve.

Do not be afraid to ask these questions. No competent

doctor will mind answering them.

Questions you should ask yourself

• Am I happy with all the arrangements which have been made for me?

• Do I understand that there are risks and potential complications with this


• Do I feel confident with this doctor?

• Do I feel confident about having this procedure?

• Have all my questions been answered satisfactorily?

Remember that cosmetic procedures are elective. You can and

should delay procedures until a time that is appropriate, bearing

in mind other commitments such as family or other social

activities, work commitments and finance.

Most importantly, you should not proceed until you are

satisfied that you have selected the right doctor and have

received and considered all the necessary information to make

an informed decision.

6 0 / / C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u

ACCS patient brochure

What to do when things go wrong

If you feel the outcome of your procedure is not appropriate or if there

has been a complication, first draw your concerns to the attention of your

doctor. They are usually in the best position to respond and ensure the best


If you are uncomfortable voicing your concerns with your doctor

personally, talk to the nurse or other clinic staff and ask them to convey

your concerns to the doctor. Hopefully with everyone working as a team,

the problems can be rectified. However, if you feel you cannot approach

the clinic with your concerns or if you wish to make a complaint about your

treatment, there are a number of options available to you. All ACCS Fellows

and Members must adhere to a strict and enforceable Code of Practice.

Accordingly, you may:

• lodge a complaint with the College, which will be acknowledged and

placed before an investigating panel with disciplinary authority.

Alternatively, you may:

• lodge a complaint with your state or territory health care complaints

commission - a government body specially tasked to investigate and

advise on patients’ health complaints.

• lodge a complaint with the Medical Registration Board in your State.

• seek legal redress against the practitioner by engaging a solicitor.

Please call the ACCS on

1800 804 781 if you would like

further information.

ABN 89 086 383 431

Registered office:

Level 2, 96 Phillip Street,

Parramatta NSW 2150

All correspondence to:

PO Box 36,

Parramatta NSW 2124

Phone 1800804781

Facsimile 02 9687 1799

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 6 1

The Australasian

College of

Cosmetic Surgery



The Australasian College of Cosmetic Surgery is fully committed

to continuous improvement of the standards of Cosmetic

Medical Practice.

Its members have committed extensive resources to

education and professional standards in Cosmetic Medical

Practice and must comply with a strict Code of Practice.

The College wishes to hear from patients who have had

experiences, both beneficial and otherwise, which they believe

should be brought to the attention of the College’s governing

Council. In particular, a Patients Complaint System exists to

allow for full, transparent and confidential examination of the

circumstances of the conduct of any Member of Associate

Member of the College.

Your Satisfaction

Your complaint will be properly considered in a timely and

impartial manner. The College will not consider complaints that

are at the time subject to judicial or insurance processes.

At all times you may be assured that the Fellows and Council

of the Australasian College of Cosmetic Surgery are dedicated

to advance the standards of care and patients’ interests in the

field of Cosmetic Medical Practice.

A full copy of the ACCS complaints procedure is contained

within the ACCS Code of Practice which is available on the

College website

Any questions arising from the contents of this pamphlet

should be addressed to the College Administrator in the first

instance, who can be contacted on 1800 804 781 or PO Box

36 Parramatta NSW 2124 Australia.

Dr John Flynn


Dip.P.Derm (UK), FACCS

1300 88 13 88


Suite 2, 98 Marine Parade,



1300 88 13 88

07 5555 7888

Dr John Flynn


Dip.P.Derm (UK), FACCS

1300 88 13 88

More magazines by this user