Pittwater Life April 2020 Issue

Health & Wellbeing
Health & Wellbeing
Surgery ‘about face’:
so what is reversible?
There may be a few reasons
to reverse surgery:
too much surgery has
been done, or the effect that
was gained has been lost.
Rather than reversing surgery
it is probably best to prevent
this situation. Most surgeons
will adopt a more conservative
approach in being able to
perform a bit more surgery
rather than having to reverse
it. Hence the term a “nip” or
“tuck”. It is far easier to take
a little more skin or tighten a
little more than having to perform
reversal of the surgery.
Unfortunately, surgeons work
with living, unequal, mobile,
unpredictable tissue so setting
anatomic measurements will be
different with each person and
even less predictable within the
same person. This tissue also
varies in response to surgery.
At times the surgery lasts many
years and yet the same procedure
in another person may last
much shorter. It is not possible
to predict this before surgery.
Scars are an inevitable result
of surgery. This is the way the
body heals and it is not predictable.
The role of a plastic surgeon
is to try to optimise the
scar, or hide them. Scars can
be revised, moved, changed
in orientation or lightened.
Scars themselves may migrate,
stretch, become elevated and
pigment. They cannot be
removed and poor scars (keloid
or hypertrophic) may recur. If
wounds take longer than two
weeks to heal or if there are
other complications of healing,
then the scars may be worse.
Certain areas of the body are
prone to poor scars. Scars may
also cause a recurrence of the
need for surgery, badly scarred
noses after trauma have a
higher recurrence rate.
Cosmetic surgery usually
tries to improve the signs of
ageing. Patients ask: “How
many years younger will I look?”
It is important to realise that
the ageing process continues,
so in several years there may
be a recurrence of the signs of
ageing. Surgery may need to be
repeated. Certain procedures
have a higher risk of recurrence.
Breast lift surgery may
need to be repeated as the loss
of tissue elasticity may contribute
to subsequent droop.
After liposuction, breast
reduction or tummy tuck,
weight gain or repeat pregnancy
my reverse the effects
of the surgery. Heavy upper
eyelids may be compensated
with Dr John Kippen
for by unconsciously lifting the
eyebrows. Once the reason for
this compensation is removed
(eyelid surgery), the brows may
drop and cause an apparent
recurrence or reversal of the
surgery. Usually this is unequal
between the sides.
True reversal of surgery can
be achieved in certain procedures.
If too much tissue is
removed then tissue must be
replaced and conversely if not
enough is removed, then more
need to be taken. The most
obvious of these are breast
augmentation, the implants can
be removed and breast reduction
where breast implants may
be required to add volume back
to the breasts. Nose surgery is
reversed at times if too much
“bump” is removed or it is made
too narrow. All revision surgery
has similar risks and complications
to the original surgery
and in some cases those risks
are often higher. This should be
considered.
Our columnist Dr John
Kippen is a qualified, fully
certified consultant specialist
in Cosmetic, Plastic and
Reconstructive surgery.
Australian trained, he also
has additional Australian and
International Fellowships.
He welcomes enquiries; email
doctor@johnkippen.com.au
46 APRIL 2020
The Local Voice Since 1991