World Tour

World Tour

So the New York itinerary has me leaving late November and back six days thereafter.

Now that’s the wrong time of year for New York and definitely too short a trip to go that far. But it looks like being a landmark conference on rhinoplasty (nose reshaping) with outstanding faculty from the far flung corners of the world.

If plastic surgery is the pursuit of perfection then nowhere is this more evident than with rhinoplasty. Whilst acknowledging from the start that the surgical results are never perfect these obsession crazed surgeons continue to push the envelope for how close to perfection we can get.

One of the guest speakers is a Professor Gubisch from Stuttgart in Germany. I spent a very intensive few days with him in April this year as a participant at his advanced rhinoplasty course. He probably has the single largest experience in this operation in the world, having performed over 10 000 procedures. The course is indeed intensive with an anatomical workshop, extensive lecture sessions and live surgery beamed into the lecture hall.

So for a rhinoplasty enthusiast the trip from Gold Coast to Stuttgart was not too high a price to pay with such a feast of education on offer.

Rhinoplasty is an operation that combines art and science. The science is based around sound grasp of the anatomical structure of the nose and the mechanics of how shape is achieved and breathing facilitated.

Coupled with this is careful delineation of what the artistic objectives are; what looks good in a nose, the variations in shape that suit different faces and different ethnicities, and how the structural changes will age as the years go by.

Then you go a step further. Recognition has to be made of the fact that the overlying skin will to some extent mask the changes to the scaffolding of the nose that surgery achieves. There is very little that can be done to the skin of the nose without occasioning further scarring. Therefore one has to work within the confines of the overlying skin’s capacity to shrink and reshape. Trying to make a nose too small can end up with redundant skin that has no support or shape. Here one wisely opts for a slightly bigger nose with attractive form rather than a smaller but ill-defined nasal shape.

The Vectra 3D imaging system is of great assistance in explaining this operation to patients. It is difficult enough to be objective about your own facial appearance but much more difficult to understand how structural changes to the nose can interact with the rest of the facial proportions. The Vectra imaging system allows one to display a before and after with proposed changes to the nose and takes away a lot of the apprehension about surgery and the uncertainty of the final results.

So in the same way that advances in the surgical procedure are designed to make the results more predictable, durable and natural, use of the Vectra 3D imaging system lets the surgeon communicate those aims. A clear line of communication between patient and surgeon is a great comfort when embarking upon what can be a very complex and demanding procedure.

The other arena in which the Vectra has made a major contribution is with breast augmentations. Again use of this technology allows one to image a given patient with a proposed implant type and size in the breasts prior to the actual operation. The technology for “morphing” has been around for quite some years but only just recently has it reached this stage of sophistication. And it is an ongoing process with further software improvements expected for the device later this month based to a large extent on the contribution of Australian plastic surgeons who are very familiar with the anatomically-shaped implants that are becoming increasingly popular.

A trip to Sweden is certainly longer still than one to New York but the meeting in this case was in the first week of June and there are few places that wear their summer coat better than the lovely old city of Stockholm. Those who have been there will tell you the only thing more attractive than the city itself is the inhabitants, with tall slim blond Swedes at every turn. Stockholm is a collection of interlinked small islands so the water is never far away and it was spared the ravages of World War II so it has retained its old world charm.

Per Heden  who is based in Stockholm has been a driving force in advances in breast augmentation surgery. Although the anatomically shaped implants were an American invention their sales were stopped in the USA in 1991 shortly after their introduction, as the American FDA grappled with the implant crisis. In many ways these implants had corrected the very problems that the FDA has taken almost twenty years to grapple with. The implant is known as the “Turkish delight” implant, due to its dense and durable gel. The implants can even be cut in half and no leakage occurs from their surface. Use of a denser more stable gel has enabled predictable shape alterations to be made to the breast and experience with the implants have shown them to be more durable than their previous counterparts.

This is not to say that other implants are obsolete or inferior. Quite the contrary. The modern breast augmentation procedure is about taking advantage of the wide range of available implants to match the patient shape and their aspirations to the device that is most likely to produce that outcome. Textured or smooth, round or tear-dropped, with or without polyurethane coating- all these implants have their specific roles and indications.

In general one is inclined to opt for implants where the accumulated data is most extensive. The fiasco with PIP implants, where it appears inferior industrial grade silicone gel was deliberately substituted as a cost-cutting measure, has emphasized the necessity for ongoing monitoring of outcomes with any medical device. Whilst the polyurethane coated devices (known as the “furry Brazilian”) are not a new device, and in fact date back to the eighties, they disappeared from usage in most countries throughout the world in the early nineties. Only in South America did surgeons continue with their usage and thus they have acquired the name of the Brazilian implant despite not being originally made in that country. Recent experience with them would suggest they have some advantages in specific circumstances and thus they add to the overall armamentarium of implants that are available when striving to achieve an ideal outcome for any individual patient. However at this point there is perhaps less data on them than other implants.

Because for some of us too much information is never enough we coaxed Professor Per Heden out from Stockholm to Sydney late last year for yet another intensive workshop and his energy experience and clinical acumen were greatly appreciated by the attendees.

When you hear someone described as a “rockstar of face lifting” one has to sit up and take notice.

Timothy Marten is a plastic surgeon from San Francisco who worked extensively with Bruce Connell one of the fathers of modern face lifting. Timothy has built on this legacy and further refined the face lift procedure, combining it as many of us have done, with the use of structural fat grafting. The face doesn’t just age by acquiring skin laxity. A large part of what we see as facial aging is also brought about by “deflation” of the face. The full round cheek and lips of the teenage face empty and become grooves or thin lines. Lifting the face helps to re-contour the laxity around the neck and jawline and the brow, but “refilling” the depleted highlights of facial shape adds an enormous amount of the perception of youth in that face. This is a technique pioneered by Dr Sydney Colman a plastic surgeon from New York. The technique had been in use for some years and some remarkable results were obtained before the possibility of transfer of stem cells and rejuvenate effects were even considered. Now to be realistic the scientific grasp of stem cells and their uses is still largely in its infancy. They would seem to hold enormous potential but it is true at this stage that really very little is known about their effects and how to harness them. However it may be that some of the rejuvenation we see from fat grafting a face is due to the positive effects of these cells.

So as you can see to stay at the forefront of modern cosmetic plastic surgery one has to really make the world your oyster and become very familiar with the long haul that is any trip from Australia. It’s not all hard work however, Dr Timothy Martens most recent performance that I enjoyed was at a villa on the shores of Lake Como in northern Italy. A more idyllic surrounding could scarcely be found and one could delight after the meeting each day in the ambience of these beautiful surroundings made none the worse by fine Italian food and wine.

Bon Voyage!

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