'Plastic Surgery'

In the first of a two-part series, Sydney plastic surgeon Dr Kourosh Tavakoli explains the key elements of a natural-looking breast augmentation.

The number of breast enlargement operations is on the increase, and the demand for natural-looking results is even more apparent. As a plastic surgeon specialising in breast augmentation and lifting procedures, I have been privileged to treat a large number of patients every year in my Sydney clinics. Therefore, I have drawn from this wide experience to develop the formula for successful and attractive breast augmentation.

Telltale signs

There are three main telltale signs of unnatural-looking breast augmentation to be avoided:

1. Breast implant margin:

This should be soft and imperceptible, as obvious implant edge visibility, especially in the midline, will resemble the look of Tori Spelling or Posh Spice’s implants.

2. Breast implant size:

An implant that is too large for a small frame is usually an obvious giveaway that a patient has had a breast augmentation. The best example of this is Pamela Anderson-style breasts. Women wanting to go from an A cup to a full D cup need to understand this point.

3. Perkiness:

An augmented breast that is too perky will tend to look fake, as a small amount of droop is natural. When a patient lies on her back, the breast implants should roll to the side like natural breast tissue and not sit up in rigid peaks.

Before undergoing surgery, it is beneficial for the patient to review photographic examples of the breasts they would like and to convey their wants to the surgeon so there is a clear, visual understanding of the desired result.

Clinical parameters and key considerations

There are six main clinical parameters for breast implants on initial consultation:

• Patient’s body build and height
• Natural breast size, shape and symmetry
• Nipple position in relation to the breast
• The quality of breast skin
• Chest wall shape and dimension
• Patient’s desire for new cup size and shape

After establishing the crucial parameters in the clinical examination, the process of tailor-making the right breast augmentation begins.

I believe there are six key considerations for a surgeon when customising a breast augmentation to gain a naturallooking result:

1. Incision placement

There are three choices about where to make the skin incisions for breast enlargement. They can be in the breast fold (inframammary), around the nipple (periareolar) or underneath the arm (transaxillary). These incisions can all produce scarring. Although patients may voice some initial concerns about the location of their scars, they are ultimately far more concerned with the final shape and size of their breasts.

2. Breast implant shape

The choice of implant varies from round to teardrop shapes. The round implant comes in both low and highprofile varieties. The shape variation is in the width and projection of the implant for any given size. The spectrum of breast implants available to the surgeon can therefore provide great versatility in achieving a more natural look.

Use of the teardrop (anatomical) shape depends on the patient’s desired outcome, as well as her breast shape. In general, there are two groups of women who benefit from teardrop-shaped breast implants. It can be the ideal choice for women who have droopy or tuberous breasts. Mild elevation of the nipple in relation to the breast mound can be achieved without the need for extra scars on the actual
breast (unlike breast lift scars). In these cases, the implants will be inserted in a subglandular or subfascial pocket (under the breast tissue). In severe cases of droopiness, breast lift must be performed to restore aesthetic shape.

Secondly, some patients specifically want less fullness in the upper quadrant. Teardrop breast implants certainly offer less fullness in these particular situations. It should be noted, however, that this request tends to be very personal, as most women are seeking breast augmentations in order to obtain upper pole fullness.

It should be noted that teardrop or anatomical implants do have tendency, estimated at about 5 percent, to rotate. Unfortunately, this problem can only be corrected by secondary surgery.

3. Breast implant fill

I use both the cohesive silicone-gel and saline-filled breast implants. The new generation silicone-gel breast implant is very safe and generally feels and looks more like a natural breast. The gel is always my first preference.

The gel usually comes in low and high cohesiveness (soft or firm), and patients should ask their plastic surgeon for different samples at the time of the consultation so that they can make the most informed choice possible.

Welcome to the next generation of cosmetic treatments. Subtle changes that equal major impact, courtesy of groundbreaking technology and these doctors.

The best breasts

For many women, our breasts symbolise our most feminine physical characteristic. But for various reasons — lack of development, postpregnancy changes resulting from breastfeeding, radical weight loss, ageing — you may be considering breast augmentation.

A successful breast augmentation shouldn’t necessarily look obviously different… in fact, the success hinges on the doctor’s surgical technique and attention to detail. Renowned Sydney plastic surgeon Dr Kourash Tavakoli has developed a specialised breast practice and his reputation is based on understanding the essentials of natural breast augmentation.

Dr Tavakoli uses his extensive experience to treat not only poorly developed or shaped breasts, but also sagging breasts, common in women after breastfeeding and/or weight loss.

The Australian-trained plastic surgeon also promises minimal scarring and ensures his patients feel comfortable with what is an intimate procedure. Further reason why Dr Tavakoli has one of this country’s busiest breast implant practices.

A patient with a disfiguring condition went to Sydney plastic surgeon Dr Kourosh Tavakoli to have her breasts transformed. Lauren Alexander reports.

Sydney plastic surgeon Dr Kourosh Tavakoli’s patient approached him for surgery to correct her abnormally shaped breasts. He assessed her as having grade three to four tuberous breasts, an unusual condition that affects the way breasts develop.

The patient says she was concerned about the shape of her breasts and felt they didn’t look normal. She says their condition prevented her from wearing v-necked styles of clothing and that she didn’t feel comfortable wearing a swimsuit and avoided going to the beach.

She had an initial consultation with another doctor who told her what needed to be done but, she says, ‘I didn’t feel comfortable with him so I started looking on the internet. Dr Tavakoli was the only doctor who had before and after surgery photos of tuberous breasts like mine.’

She says when she met Dr Tavakoli he immediately put her at ease and she was impressed by his friendly manner and felt confident about his ability to help her. Dr Tavakoli took her through two consultations. During the first he assessed her breasts and explained what would be needed to correct the tuberous condition and talked her through the whole procedure.

Then she says he showed her with the implants in her bra what the final result would look like. She could see that they would provide a solution to her problem and decided to have the surgery.

During the second consultation Dr Tavakoli talked her through the procedure again, asking her if she had any questions about the surgery before going ahead with the procedure.

The procedure took place at a private hospital and required an overnight stay. Dr Tavakoli’s patient says her recovery was very straightforward. ‘I was fine; there were no side effects. The first thing I did when I regained consciousness was to ask for food!’

She says she only needed to take painkillers at night for three days and after that experienced minor discomfort. ‘I thought it was going to be a lot worse.’

Dr Tavalkoli’s clinic recommended some gel patches to assist with healing and she is now using a specially formulated oil to help the scars disappear completely.

She says her new breasts have helped her to feel much more confident and that she immediately went shopping for new clothes. ‘I’d recommend the procedure to anyone with a condition like mine. They look so natural that no one beyond my immediate family and boyfriend can tell that I’ve had it done.’

A key aspect of rhinoplasty is simply making the decision to have the procedure, says Sydney plastic surgeon Dr Kourosh Tavakoli.

Brenda McCormick reports.

Rhinoplasty is one of the most common cosmetic surgery procedures performed in Australia, although many people take a long time to actually decide to have the surgery, according to Sydney plastic surgeon Dr Kourosh Tavakoli. He says prospective patients often postpone the decision because of self-consciousness, anxiety or a lack of confidence. However, once they have taken the plunge and had the procedure done, many admit they wish they had done it sooner.

One of Dr Tavakoli’s patients is a typical case; she considered rhinoplasty for many years before finally deciding to undergo the procedure. ‘I’ve just always hated my nose’ she says, ‘I was going get a rhinoplasty done when I was 21 and then decided to go overseas instead, so when I was turning 30 I thought, well, I’ve always wanted it done so I started to really look into it.’

After doing a lot of research online, she narrowed her choice of surgeons down to a shortlist of three, but she says that after meeting with Dr Tavakoli her mind was made up. ‘During my first consultation with him he showed me computerised before and after pictures of what a rhinoplasty could do for my nose.’ She also felt comfortable with Dr Tavakoli and his staff, which sealed her decision. ‘They had an opening available so I said, “book me in!”‘

The surgery took about two hours and altogether she spent only six hours in the clinic. She says she felt ‘completely fine’ when she woke up after surgery and suffered minimal swelling. ‘For about three days I had really bad black eyes and some swelling, but I was back at work two weeks later and no one even knew.’

Dr Tavakoli’s patient says she feels very lucky to have had such a positive experience and straightforward procedure. She says having the opportunity to see the digital ‘after’ shots at the consultation stage meant she had realistic expectations of what the surgery could achieve and that she is very happy with the result.

Sydney plastic surgeon Dr Kourosh Tavakoli outlines the options available to get your pre-pregnancy body back. Francis Herron reports.

For many women, having a baby takes a toll on their body and the shape they are left with post-pregnancy can be a cause of concern, affecting self-esteem and confidence levels. In a study by United Kingdom Mother & Baby magazine, 86 percent of women surveyed said they felt less attractive post-pregnancy, while a similar number were unhappy with their weight and shocked by the changes to their body after having a baby.

“Yummy mummy” celebrities such as Katie Holmes, Heidi Klum and Jennifer Garner seem to regain their postbaby figures in double-quick time, and now it appears that here in Australia women are equally determined to take steps to restore both their pre-baby body and confidence. In fact a large number are choosing cosmetic surgery to help restore their shape and are taking the opportunity to correct long-standing problem areas, which may have become more prominent during pregnancy.

Sydney plastic surgeon Dr Kourosh Tavakoli estimates up to 30 percent of his female patients have come to see him because they want to improve their bodies after childbirth. All of these women, he says, have a specific goal in mind and, somewhat surprisingly, it is not one that involves an idealised ‘new’ body or perfect physique. Their aim is restoration, not transformation. ‘These women are not wanting to create something new, they want to restore what they had previously,’ Dr Tavakoli explains. ‘They have 50 or 60 years ahead of them and want to keep looking their best.’

There are numerous options available to women who want to tackle post-pregnancy problems such as excess fat and skin around the abdomen and drooping, sagging breasts. Troublesome areas that have caused some concern before pregnancy, such as love handles, can be exacerbated after giving birth. However, these issues can be addressed with surgery, and according to Dr Tavakoli,

the top three procedures requested by mothers who come to see him are breast enhancement, abdominoplasty and
liposculpture.

Breast enhancement

The degree of change experienced in the breasts depends on whether patients have breastfed and, if so, for how long. ‘The more a woman has breastfed, the more dramatic the changes that occur in her breasts usually are,’ says Dr Tavakoli. Most women opt for a breast augmentation procedure but if there is no change to the volume of the breast, a breast lift might be enough to achieve the result they want. However other woman may require both a breast reduction and lift procedure to obtain their desired shape, he says.

Abdominoplasty

According to Dr Tavakoli, the abdomen is the area most affected by pregnancy as the abdominal wall becomes lax due to stretching. An abdominoplasty procedure, also known as a tummy tuck, can restore a woman’s post pregnancy tummy and the procedure can be combined with liposculpture to offer an even better result. ‘Abdominoplasty, when combined with liposculpture, can remove excess skin and fat from the abdomen, repair any underlying damage to the abdominal muscles and reposition the umbilicus,’ says Dr Tavakoli.

Liposculpture

As well as being effective when combined with abdomnioplasty, liposculpture can be used alone to treat common problem areas such as love handles and inner and outer thighs. As Dr Tavakoli explains, ‘These could be areas that troubled the patient prior to pregnancy but they may have become more prominent postpregnancy.’ The most important thing, according to him, is that the treated area remains in proportion with the rest of the patient’s body.

While these procedures can offer great results for women who want to restore their pre-pregnancy body, Dr Tavakoli stresses that those who undergo an abdominoplasty or liposculpture procedure need to commit to a healthy lifestyle, involving a sensible diet and exercise regime, to maintain the results.

He screens prospective patients to ensure they are not suffering from post-natal depression and has a policy of not operating on recently pregnant women until the mother’s last child is at least 18 months old. ‘I usually advise patients to complete all their pregnancies before commencing surgery,’ he says. ‘As long as the expectations are realistic I find the overall satisfaction rate in this group of patients is very high.’

It’s clear that for some women who are unhappy with their post-pregnancy appearance, a cosmetic surgery procedure could offer the ideal way to restore their figure and confidence levels.

One of the most commonly performed cosmetic surgery procedures is the rhinoplasty. This procedure represents the greatest fusions between art and science. Sculpting a new nose requires an in depth knowledge of nasal anatomy and function as well as a true sense of the patient’s sense of beauty and ethnicity. The nose you end up with should fit
easily into the shape of your face and in fact should not be distinguishable from any other feature.

A well recognized successful rhinoplasty is that of Ashley Simpson, American Pop star. Her new nose was so right for her face that it really accentuates its true beauty.

Rhinoplasty can improve the tip of the nose and its projection and the removal of the hump on a nose can change the length as well as the shape of that nose. Most Rhinoplasty procedures can be performed as day only cases requiring a week off work.

Successful rhinoplasty is a combination of careful patient selection and planning, accurate operative technique and thorough postoperative care.

Sydney plastic surgeon Dr Kourosh Tavakoli’s case study shows how cosmetic procedures can be combined to reduce costs, anaesthesia and recovery times. Gillian Samuel reports.

Sydney plastic surgeon Dr Kourosh Tavakoli’s patient says she had a bump high on the bridge of her nose that, while it didn’t bother her unduly, always caught her eye when she saw herself in a mirror.

She says the bump is a family feature shared by her father and aunt and as she found herself noticing it more and more in her mid-twenties, she began to think about having it corrected. When she consulted Dr Tavakoli about a rhinoplasty, she mentioned during their discussion that she had always wanted a breast augmentation. At more than 180cm tall, she says she has always felt she was completely flat-chested.

Dr Tavakoli explained she could have both procedures at the same time and the convenience strongly appealed to
her, so she made arrangements to take two weeks off work in August this year.

‘The breast augmentation is something I’d always thought about. I used to talk about it with my mum and we’d joke that we’d do it together,’ she says, adding with a laugh that her mother is jealous of her now she has gone from an A to a D cup.

She said that Dr Tavakoli reassured her there wasn’t any extra risk involved with undergoing the two procedures simultaneously. Her rhinoplasty and breast augmentation operations took about three hours and she says she went into day surgery at 7am and was at home by 2pm.

Dr Tavakoli removed the bump from the bridge of her nose and also performed a septoplasty to narrow it. She says she is very happy with the result.

He also inserted high profile, round silicone-filled implants behind the pectoral muscle to provide some forward projection and to give her fullness in the upper pole of her breasts, giving her the bustline she had always dreamed of having.

She says that even Dr Tavakoli has been impressed by the speed of her recovery. ‘From the moment I woke up and he was holding my hand and telling me that everything had gone very well until now, which is five weeks later, I’ve had no pain at all, just a little tenderness with my nose.’

She says she took a prescription painkiller for a week and a half after the surgery and that although all the work on her nose was internal, she did have bruises over her upper eyelids, which faded in a week.

Her breast augmentation incisions were relatively small and are healing very nicely. Overall she is extremely pleased with the outcomes of both procedures.

‘I don’t think it’s changed me as a person, I just feel so much more comfortable when I look in the mirror and the breast augmentation has given me a lot more confidence about wearing summer clothes,’ she says. ‘I haven’t needed to buy more clothes, the ones I have still fit, they just look better!’

Dr Tavakoli says the safety of modern procedures and technologies means patients can combine procedures for two-in-one cosmetic results.

For many women, our breasts symbolise our most feminine physical characteristic. But for various reasons — lack of development, post- pregnancy changes, weight loss — you may be considering breast augmentation.

A successful procedure shouldn’t necessarily look obviously different … in fact the success hinges on the doctor’s surgical technique and attention to detail. Sydney’s Dr Kourosh Tavakoli aims to achieve a natural fullness, with gentle sloping off the chest wall. Natural cleavage is a must, while the right degree of perkiness can make all the difference.

Dr Tavakoli uses both saline-filled and cohesive silicone-gel implants, adding that the new-generation silicone-gel version is very safe and feels and looks more like a natural breast. The Australian-trained plastic surgeon is also obsessed with minimal scarring. Just another reason why Dr Tavakoli has one of this country’s busiest breast implant practices.

Sunday Mail (QLD)

Edition 2 – State – Main CountrySUN 02 APR 2006, Page 040 Unkindest cuts – Why cosmetic surgery complaints are on the rise By JESSICA LAWRENCE

SPECIAL REPORT

BOTCHED cosmetic procedures are on the rise as more and more Queenslanders go under the knife.

The quest for bodily perfection has seen a surge in the number of patients undergoing tummy tucks and breast, lip and nose jobs.

Queensland surgeons performed 32,000 cosmetic operations last year — up 35 per cent from 2004.

Last year, 24 cosmetic-surgery complaints were heard by Queensland Health Rights Commissioner David Kerslake, up from 22 in 2004, and 13 in 2003. Seven have been received so far this year.

Negligence claims against plastic surgeons jumped more than 70 per cent between 1995 and 2004.

Industry experts say a rise in the number of unqualified cosmetic doctors, coupled with a boom in overseas surgery tours, are responsible for the spike.

Australian Society of Plastic Surgeons spokesman Dan Kennedy said he had recently dealt with a nurse who was forced to undergo surgical repairs after a botched liposuction.

“She thought she was going to a qualified Australian plastic surgeon, and afterwards she found out he wasn’t,” said Dr Kennedy, who practises in Brisbane.

“She got her money back because she suffered quite an injury from it.”

Cosmetic Surgery in Thailand

Sydney plastic surgeon Kourosh Tavakoli said an increasing number of young women were willing to travel to Asian countries: “I spoke to a woman recently who had travelled to Thailand for a breast augmentation and lift, only to have the implants left sitting somewhere near her collarbone.

“And I got a phone call from a girl the other day who was part of a group of 11 girls aged between 18 and 25 who were going to Thailand for surgery.

“It’s half price to go over there, but there is the risk of hepatitis and HIV.

“Then you have beauty therapists in Australia using equipment they may not be equipped to deal with.”

Plastic surgeon Norman Olbourne said many clients were risking their health by flying home just days after undergoing operations in Asia, and clients hoping for cut-price medical procedures were often forced to have corrective surgery: “I spoke to one lady from Perth who went to Thailand for a facelift and a neck lift and a breast and tummy-tuck operation. She was told she would be there for 13 days and it would cost $7000, but she was there 35 days and it cost her more than $20,000.”

The woman has had to mortgage her house to pay for corrective surgery.

“You are supposed to spend up to six weeks in hospital after a tummy tuck, but we know of people who are flying back days later.

“These sorts of tours are being promoted by travel agents and doctors, but the ones who are at risk are the patients.”

In August 2002 in Queensland, Sue Kenny had lap-band surgery — which reduces the stomach — to slim down her 145kg frame after failing to lose weight the old-fashioned way.

One week later Ms Kenny, 41, of Ashgrove in Brisbane, who is being represented by Brisbane lawyers Shine Roche McGowan, was rushed back to hospital after her stomach was punctured.

She spent another three months in hospital undergoing several more operations and suffered kidney failure. She now has dialysis four times a week.

“My doctors told me to get it done because I needed to lose weight for medical reasons. They told me this was a safe procedure, and if I didn’t like it I could have it taken out. If I knew now what was going to happen I would never have had the operation.”

A member of the medical negligence team at Shine Roche McGowan, Alison Allysonalker, said there had been a “definite rise in inquiries” regarding botched cosmetic surgery, especially lap-banding: “The more advertising there is about `what a wonderful procedure it is’, the more people are going down that road thinking it’s right for them. But it’s not always the case.”

National head of medical negligence with law firm Slater and Gordon, Bill Madden, said patients seeking compensation could have difficulty proving they had been disfigured.

“People go in and have nose surgery and the outcome to them might seem significant because it is not a good outcome,” he said.

“But it’s not necessarily something which is going to be horrific, and when the time comes to working out financial compensation the amount might be quite modest.”

Last year The Sunday Mail reported that children as young as eight were undergoing procedures such as ear-pinning after discussions with plastic surgeons.

Dr Kennedy urged those considering plastic surgery to check the credentials of the surgeon, and make sure they belonged to an accredited organisation.

“It’s also important to make sure you feel comfortable with your surgeon, and that they understand exactly what you want.”

Dr Tavakoli is an accredited Cosmetic Plastic Surgeon. Contact Dr Tavakoli today to get the right professional advise for your Cosmetic Plastic Surgery

Teenagers who want to have plastic surgery usually have different motivations and goals than adults. They often have plastic surgery to improve physical characteristics they feel are awkward or flawed, that if left uncorrected, may affect them well into adulthood. Teens tend to have plastic surgery to fit in with peers, to look similar. Adults tend to have plastic surgery to standout from others.

THREE GOLDEN RULES:

1. The teenager initiates the request with parental support.

2. The teenager has realistic goals

3. The teenager has sufficient maturity.

QUESTIONS/ANSWERS

1- Is teenage breast augmentation on the rise?

Definitely on the increase compared to a few years ago.

2- Why has the popularity of cosmetic surgery risen among teenage girls?

A few reasons:

• I think its partly because of media exposure from shows like nip’tuck that teenagers think it is OK to have plastic surgery.
• Recognition of psychological benefit of plastic surgery. So their parents, who are funding the procedure, are now more likely to support the ” idea of change”.
• With more information on procedures such as breast augmentation , liposculpture and rhinoplasty on internet, teenagers can now research cosmetic surgery more extensively than ever before.

3- What sort of reasons do your clients give you for wanting cosmetic/plastic surgery? Peer pressure? Unhappy with body image? Medical condition?

Probably more as a result of general increase in awareness, but also peer pressure.

4- Are the procedures of choice generally for cosmetic reasons or genuine medical reasons?

Bye and large cosmetic. Mainly unhappy with big nose or ears, small breasts.

5- What age group is generally having breast augmentation?

16 to 24 those with no babies 25 plus after pregnancy sagginess

6- Would you give a teenager breast implants?

Under what circumstances? What were the circumstances?

Cosmetic: Genuienly small breasts, completely out of proportion with the rest of the body.

Reconstructive: treating conditions such as Polands syndrome where there is an obvious chest wall deformity as a result of birth defect.

7- What are the most common procedures among teenage girls?

Otoplasty, Breast augmentation and rhinoplasty.

8-Would you have any statistics on Teenage Plastic Surgery?

According to American Society of Plastic Surgeons (ASPS) statistics, more than 331,000 cosmetic plastic surgery procedures were performed on people age 18 or younger in 2003.

Dr Tavakoli is an accredited Cosmetic Plastic Surgeon. Contact Dr Tavakoli today to get the right professional advise for your Cosmetic Plastic Surgery