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Description: Dr Vlad Milovic specialises in Plastic, Reconstructive and Cosmetic Surgery. He has spent the last 20 years training and working in this area and finds his job as a Plastic Surgeon incredibly rewarding. Hi is a Fellow of the Royal Australasian Society of Plastic Surgeons (FRACS) in the specialty of Plastic Surgery.

PLASTIC & COSMETIC SURGEON RECONSTRUCTIVE MICROSURGERY ACTUAL PATIENT OF DR VLAD MILOVIC Dr VlaDimir miloVic Dr Vladimir Milovic FRACS (Plast.) Specialist Plastic & Cosmetic Surgeon Specialist Reconstructive Microsurgeon 2 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u Dr VlaDimir miloVic the values of asPs Surgicalexcellenceand ethicalpractice Honesty integrityandrespect Compassion Accountability Scholarshipandcollegiality other Professional membershiPs AustralasianSocietyof AestheticPlasticSurgeons (asaPs) AmericanSocietyofPlastic Surgeons(ASPS) International Member InternationalConfederation forPlastic Reconstructive& AestheticSurgery(IPRAS) RoyalSocietyofMedicine UK he decision to have plastic surgery can be a daunting one and this is why i tell my patients i will be with you all the way on this journey ... from your first consultation until your last postoperative appointment. my specialty is Plastic reconstructive and cosmetic Surgery. i have spent the last 20 years training and working in this area and i am passionate about what I do. The joy I get when watching my patients faces following a life-changing surgical procedure the joy the tears of happiness and the comments You ve changed my life My self-esteem has gone through the roof all of this makes my job as a Plastic Surgeon incredibly rewarding. i am a Fellow of the royal australasian Society of Plastic Surgeons (FracS) in the specialty of Plastic Surgery. i cannot stress enough that before you make any decision to have plastic or cosmetic surgery you do your homework. FracS is an important acronym to remember. This means a doctor has achieved formal qualifications in surgery and these five letters take eight to 10 years to earn through detailed training and rigorous assessment. Plastic Surgery is a general term that covers both reconstructive and cosmetic surgery. And it s interesting to note that cosmetic surgery developed from reconstructive surgery. i am therefore able to use a number of titles such as Specialist Plastic Surgeon Specialist Plastic & Cosmetic Surgeon or Specialist Reconstructive & Cosmetic Surgeon for example. I choose however to go by the colloquial title of Plastic & Cosmetic Surgeon . in australia the national medical Board has stated that the Specialist Plastic Surgeon title can only be used by FRACS approved specialist surgeons in the recognised specialty of Plastic Surgery and this includes reconstructive and cosmetic surgery. This is quite complicated but essential information to have about your surgeon before you seek any plastic or cosmetic surgery. i am also a member of the australian Society of Plastic Surgeons (aSPS) and i therefore abide by the aSPS code of Practice. The aSPS code of Practice provides specific guidance on the professional ethics and behaviour required of members of this Society. It reflects the professional standards expected of Specialist Plastic Surgeons by aSPS and the communities we serve. i constantly keep abreast of all the latest techniques available worldwide and I can therefore confidently offer my patients the most upto-date and innovative surgical procedures in all areas of Plastic and cosmetic Surgery. and my team is as committed as i am to providing our patients with the highest quality surgical procedures in the most agreeable and relaxed environment. i look forward to discussing with you in detail the Plastic or cosmetic procedure you ve decided to undertake whether it is facial or body surgery and remember I will be with you all the way on this journey from your first consultation until your last postoperative appointment. From Dr Milovic T Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 3 Breasts all about breast augmentation Learn more about what to expect when it comes to surgery and the choices invoLved in breast augmentation. 4 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u Breasts B reast augmentation is a surgical procedure to increase the volume of the breasts through the placement of saline or silicone gel-filled implants. Whilst the end goal might be to enhance the size of the bust women s motivations for breast augmentation are many and varied. They might want to correct asymmetrical breasts restore breast volume after dramatic weight loss or breastfeeding reconstruct breasts after trauma or mastectomy or simply enlarge their breasts so as to be more in proportion with the rest of their body. Whatever the motivation breast augmentation can have a real impact on a woman s sense of wellbeing and when entered into with the right level of understanding has one of the highest rates of satisfaction of any cosmetic procedure. No two breast augmentations will be the same and today the range of implants and techniques available to surgeons means the procedure can be truly tailored capable of achieving personalised breasts designed to suit you and your unique body type. During any patient s journey there will be a number of decisions to make from the type of implant to its shape and projection the incision site and where the implant will be placed. Whilst it s your surgeon s job to guide you understanding the options and the decisions you need to make will help you enjoy your breast augmentation journey. Implants Today the range of implants and techniques available to surgeons means breast augmentation can be truly tailored When considering implant shape texture and size a decision is made with reference to a woman s individual body type and aesthetic goals. It s down to the surgeon to guide each patient through an individual assessment process where measurements are taken to determine the anatomical limitations and allowances of the breasts chest and soft tissue and where patients are encouraged to express what they like and dislike. The choice of projection is a very personal one. A woman who is happy with her shape and has sufficient breast tissue may opt for a low profile implant that will simply increase the size of her breasts. Another patient may favour a highprofile implant to reduce sag and generate cleavage. Ultimately a thorough understanding of the implants their shapes fills and placement will help ensure a satisfactory outcome. Breast implants can either have a silicone or saline fill. Designed to mimic natural breast tissue silicone gel-filled implants are the most commonly used implants in Australia. They have an outer silicone shell encasing a firm cohesive gel that offers a more natural feel. Their cohesive consistency means gel-filled implants retain their shape better than saline-filled implants. If ruptured the risk of dispersal is lessened in gel-filled implants than with saline though some doctors are wary as ruptures can be left undetected for longer periods of time. reassuringly silicone is regularly used in medical devices and is regarded as one of the most compatible materials for implanting into the body. Because silicone gel is manufactured into the implant before surgery the incision sites must be slightly longer than those required for saline implants which can be filled through valves once inside the breast pocket. The length of incision will depend on the size of the implant. With an outer shell of silicone saline implants are filled with a medical grade saltwater solution to create a waterbed-like feel. This feel can be moderately adjusted by changing the volume of fill but saline implants will remain firmer to touch than their silicone filled counterparts. If implant rupture occurs the body will absorb the saline solution a rupture will be immediately noticeable and a slow leak will be evident within days. Saline implants have a higher risk of visible folds and ripples compared to silicone filled implants. Saline implants can be filled through a valve during surgery after the implant Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 5 Breasts Dr Milovic uses both textured and smooth shells depending on the circumstances of each patient is situated in the breast pocket. Because of this the incision site is generally smaller than that needed for silicone implants. the valve also means the amount of fill can be adjusted after surgery which is not possible with silicone gel implants. Alternatively saline implants can be pre-filled to a fixed volume during manufacture which eliminates the need for a valve and filling during surgery. As well as different fills Dr Milovic will guide you through the different shapes and textures available during pre-operative consultation in order to agree upon which implant is best suited to your procedure. Patients can choose from round implants which usually lend more upper pole fullness or anatomical which more closely resemble the natural shape of the breast. A precise degree of accuracy is needed when positioning anatomical implants and if they shift after surgery the shape of the breast may be noticeably distorted. To reduce this risk anatomical implants will always have a textured surface to enable adherence to surrounding tissue. All implants have a thick outer shell made of silicone-rubber which will either have a smooth polished surface or a rough textured surface. Whilst there are pros and cons to each type typically smooth-shelled implants are thought to allow the breast to move and feel more natural than a textured breast whilst textured implants can grip on to the surrounding tissue and therefore reduce the risk of capsular contracture by creating less friction between the implant and breast pocket. Since 2008 polyurethane coated implants have been used in Australia which have a coating of polyurethane foam over the silicone shell. These implants were designed specifically to further reduce the incidence of capsular contracture which is the most common complication of breast augmentation. Dr Milovic uses both textured and smooth shells and will typically use round implants depending on the circumstances of each patient. If the implant is placed under the muscle it doesn t matter whether it is textured or smooth he explains. If we need to put the implant over the muscle I always use textured. Similar to choosing texture and shape deciding upon implant placement is a balancing act with benefits and drawbacks for each option. Typically there are three placement possibilities subglandular submuscular and dual plane. Depending on the patient their body shape and desired outcome one might be better suited than another. The incision site will determine the visibility of scars and is generally decided based upon personal preference. Understandably the patient will have her own ideas about the positioning of scars and a surgery she is comfortable with. Also the surgeon will usually have a preference based on visibility offered amount of control possible and experience using a particular incision site. Is breast augmentation right for me Not everyone is suited to breast augmentation and it s important to enter into the decision with realistic expectations as to what cosmetic surgery can do for you. Before deciding on breast augmentation Dr Milovic recommends keeping the following points in mind. Breast augmentation does not correct droopy breasts. A breast lift (mastopexy) may be required in this instance Breast implants may affect your ability to breastfeed (individuals may vary) Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants smokers are at increased risk of complications from any surgery. If you are 6 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u Breasts serious about undergoing cosmetic surgery you should try to quit smoking If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence there are alternatives to cosmetic surgery. these may include other treatments wearing padded bras or accepting yourself the way you are. Breast augmentation is typically performed under general anaesthesia or twilight sedation both of which will be discussed at your pre-surgery consultation. Whilst modern anaesthesia is generally accepted as safe and effective it carries with it some risks. Fortunately the more serious complications such as aspiration allergicreaction nausea vomitingandincreasedbloodpressureand heart rate are rare. Your personal risk profile depends on the type of anaesthesia used your overallhealthandhowyourespondtothechosenanaestheticsandDrMilovic oryouranaesthetistwillaskyouaboutallthemedicationsyouaretakingorhave taken andanyallergiesyoumayhavebeforesurgery.Forthisreason makesure youhaveanuptodatelistbeforethesurgery. Therisksofconscioussedationincludeheadache nausea vomitingand or unpleasant memories of your surgery. Local anaesthesia is considered extremely safe. the surgery itself typically takes two hours. Aswithanyinvasivesurgery somelevelofscarringisinevitable althoughDr Milovicwillendeavourtominimisescarringandkeepanyscarsasinconspicuous as possible by locating them in easily hidden sites. scars will be positioned in the natural skin lines and creases and will fade with time. Should scarring become a post-operative concern Dr Milovic can provide a treatment plan designed to expedite their healing. this might include laser treatment or silicone gel. Surgery Complications Breast augmentation is not guaranteed to last a lifetime and future surgery is often required to replace one or both implants. Nor is the practice of medicine an exact science. although good results are expected there is no guarantee. In somesituations itmaynotbepossibletoachieveoptimalresultswithasingle procedure and another surgery may be necessary. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 7 BREASTS how will i look after breast surgery Visualising the expected outcome with the help of 3d imaging might help patients enter into breast augmentation with more confidence. 8 Dr VlaDimir miloVic R ather than wanting an obvious increase in the size of their breasts most Australian women seeking breast augmentation want to achieve naturallooking contours according to Canberra plastic surgeon Dr Vlad Milovic. Whilst breast augmentation can increase the size of the breasts considerably in his experience women are much more driven to achieve breasts that are not overly large and that are in proportion with the rest of their body. It s my experience that most women in Australia are very careful and conservative when proceeding with breast augmentation he says. We don t see the same trend as in some other countries where the tendency is to emphasise fullness. Rather women want to balance their curves and complement their overall body shape. In 90 per cent of patients I see women want an improvement in the shape and firmness of their breasts and a modest increase in size that doesn t look unnatural or draw glaring attention to the fact they have had an augmentation. As well as achieving a subtle enhancement Dr Milovic says women want to ensure the breasts move naturally and feel soft to the touch. To ensure his patients are comfortable with the changes that will take place Dr Milovic uses 3D scanning technology during consultation with his patients. This allows them to see a detailed image of what they might look like following their breast w w w. D r m i l o V i c . c o m . a u BREASTS 3D visualisation helps alleviate much of the anxiety surrounding the outcome of surgery augmentation and helps them select an implant that they are comfortable with. No matter how much a patient may want a procedure cosmetic surgery can have a profound psychological as well as physical impact says Dr Milovic. Indeed proposed changes to the breasts and face for example can lead to some level of anxiety surrounding the outcome even when in the hands of the most trusted and experienced surgeon. In my experience 3D visualisation helps alleviate much of the anxiety surrounding the outcome of surgery he says. It is particularly beneficial for breast surgery where patients might be unsure about the size of implant they want. In my clinic patients are scanned with a bra or bikini top and try on different sizes shapes and placements of implants to see how they would complement their figure and lifestyle before proceeding with surgery. It allows me to tailor the operation to their needs. According to Dr Milovic 3D scanning is particularly helpful when performing breast reconstruction after a mastectomy or other surgeries where tissue has been removed. 3D scanning technology uses clinical data to generate a series of anatomically accurate images of a patient s body in a three-dimensional matrix. This allows the surgeon and patient to view the patient s body as a figure in space. The surgeon then alters those views to simulate the effect of various surgical interventions to show patients how they could look post-surgery. By visualising the desired outcome the patient can be assured becoming more confident in what the results will physically look like. Although there are a number of technologies Dr Milovic has invested in Axis Three 3D and he offers each breast augmentation patient a complimentary preoperative breast scan using the device at their pre-surgery consultation. Axis Three 3D helps patients visualise their new look in a matter of seconds helping them to make their decision with greater confidence Dr Milovic says. During the breast scan Dr Milovic uses Axis Three 3D to capture the patient s 3D form drawing on the device s anatomical and photorealistic accuracy. He can then select and position implants directly from a manufacturer s catalogue which incorporates the specific parameter and profile of that implant in order to accurately show the patient what her own body will look like after surgery. Because the implant profile is known and stored in the software Dr Milovic then has the ability to control position and rotation. Unlike other available methods this technique uniquely utilises the patient s own physiological characteristics to accurately portray postoperative 3D images of their body incorporating these changes. Algorithms calculate the effect of the implant on each patient s body based on their particular physiological characteristics and adjust the outcome resulting in an anatomically accurate photorealistic simulation. With any breast procedure he performs Dr Milovic says achieving balance of the breasts is essential for an aesthetically and emotionally satisfying result. The introduction of 3D technology has allowed me to more accurately test the volumetric difference between each breast for greater symmetry and a better result overall he concludes. In turn seeing how they are likely to look means patients can enter into surgery fully prepared and more confident in the results they are going to achieve. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 9 Breasts Other types of breast surgery Breast augmentatiOn isn t fOr everyOne. fOr sOme patients a Breast Lift reductiOn Or recOnstructiOn might Be required. ver time and because of life events such as pregnancy and breastfeeding the breasts can lose volume and droop. In this instance a breast augmentation will not be able to restore the breasts to their former elevation and a mastopexy more commonly referred to as a breast lift might be needed either alone or in addition to implants where greater volume is desired. For some women a lumpectomy or mastectomy may have left them needing reconstruction surgery whilst still more may suffer from large weighty breasts in need of reduction. today surgeons are equipped with a variety of techniques to help enhance the appearance of the breast whether that means reconstructing reducing lifting or augmenting. O Breast Lift a natural part of the female ageing process is sagging of the breasts. Breast feeding and extreme weight loss can also compound breast droop. If it causes concern mastopexy or a breast lift can help restore height volume and shape. Breast implants may also be used in conjunction with this procedure to achieve the result desired by the patient. Mastopexy is designed to lift the breasts by removing excess skin creating a more youthful contour. 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 ways Aroundtheareola Aroundtheareolaandthenverticallydownthebreast 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 repositioned to create a more pert and youthful looking shape. During a breast lift the nipple always 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. the procedure generally takes 2 to 3 hours under general anaesthetic or intravenous sedation and is usually performed on an outpatient basis. a surgical support bra or elastic bandage is worn post surgery to minimise swelling and stabilise the new breast shape during the healing period. It is 10 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u Breasts common for some patients to lose sensation and some feeling in the nipple or breast. Most patients are advised to take a week off work and not engage in strenuous activities for 3 to 4 weeks. Over time post-surgical swelling will resolve and incision lines will fade. some incision lines resulting from breast lift are concealed in the natural breast contours however others are visible on the breast surface. Incision lines are permanent but in most cases will fade and significantly improve over time. Breast Reduction Breast reduction (or reduction mammoplasty) is a surgical procedure that reduces lifts and reshapes the breast. the procedure is aimed at removing excessive breast and fatty tissue leaving you with an overall smaller and better-shaped breast. It seeks to relieve symptoms caused by very large breasts including back and neck pain breast tenderness shoulder grooving (from bra straps) intertrigo (rash between folds of skin) and overall 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 pertly 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 and you should expect to spend 1 to 3 nights in hospital following the 2 to 4 hour operation depending on the amount of tissue removed. However it can also be performed on an outpatient basis depending on the individual. The breasts will be bandaged for support and can be removed a day or two after surgery but you will have to continue wearing a surgical bra 24 hours a day for at least 1 to 2 weeks while the swelling and bruising subside. You should expect to be off work 1 to 2 weeks and avoid strenuous activity for 4 to 6 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. This scar generally takes longer than other types 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. A natural part of the female ageing process is the sagging of the breasts Breast Reconstruction there are a number of options available for breast reconstruction patients and today it s possible for many women to undergo their mastectomy and reconstruction on the same day. The surgery rebuilds the breast mound so that it is about the same size and shape as it was before. the nipple and the darker area around the nipple (areola) can also be added. Most women who have had a mastectomy can have reconstruction. Women who have had only the part of the breast around the cancer removed may not need reconstruction. Nipple Correction & Reconstruction Many breast cancer patients will have their nipple removed at the time of their mastectomy. Some time after breast reconstruction the nipple areolar mound can be reconstructed using tissue taken from elsewhere on the body. The pigmented areola is typically reconstructed with the help of cosmetic tattooing to result in a natural-looking nipple. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 11 BODY Tuck iT in Tummy Tuck surgery can remove excess skin and faT To reveal a more hourglass conTour. 12 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u BODY A tummy tuck can address the appearance of sagging skin and excess fat as well as any laxity of the abdominal wall muscles lso known as an abdominoplasty tummy tuck surgery is commonly performed on women whose bodies have changed post-pregnancy or who have undergone extreme weight loss leaving behind folds of loose skin. The procedure is designed to improve the appearance of excess sagging skin which is often impervious to exercise. In my experience the changes seen post-pregnancy or weight loss can impact on a woman s body image and selfconfidence says Canberra plastic surgeon Dr Vlad Milovic. During pregnancy the abdominal skin and muscles become stretched which can result in a loose and sagging tummy region that diet and exercise cannot rectify. At the same time ageing can result in the thickening of the torso. An abdominoplasty can address the appearance of sagging skin and excess fat as well as any laxity of the abdominal wall muscles. Performed in combination with liposuction Dr Milovic believes women can recapture a more youthful hourglass figure. During an abdominoplasty excess skin and fat are removed from the stomach area and the abdominal muscles are tightened and repaired. An incision is made across the lower abdomen the excess fat is removed and the slack muscles repositioned explains Dr Milovic. This not only helps flatten the tummy but also tightens and narrows the waist. Because the skin is stretched and tightened during the procedure the navel may need to be repositioned. However this can be done without detaching it from its position beneath the skin. Any fatty deposits that might exist can be removed at the same time as abdominoplasty by performing liposuction as an adjunct procedure. Whilst the abdominoplasty flattens the stomach by tightening the muscles and removing loose skin it s liposuction that sculpts the abdomen by removing pockets of fat. Where suitable a patient will experience optimal results when liposuction is performed in combination with an abdominoplasty says Dr Milovic. Abdominoplasty is a major operation and typically results in a hospital stay of between two and five days so the patient can be closely monitored. Stitches are removed after between one and two weeks and Dr Milovic recommends his patients wear a compression garment for a further four to six weeks in order to support the abdomen. Whilst the length of time patients need to take off work varies from person to person Dr Milovic typically advises his patients take around three to four weeks off work following surgery. Scarring is an unavoidable part of tummy tuck surgery and patients will be left with a low scar that runs from hip to hip following their procedure. Although the scar will be positioned below the bikini line and is therefore hidden when wearing underwear or swimwear Dr Milovic works with his patients to manage the improvement of the scar over time. The results of tummy tuck surgery are long-lasting so long as patients commit to a healthy way of life and for women who have struggled to regain their pre-baby bodies or who are disappointed by excess skin following weight loss Dr Milovic says it can leave patients with a renewed sense of motivation. Abdominoplasty often acts as an impetus for patients to adopt a healthier diet and exercise regime. By supplementing the results of surgery with this holistic approach results can be long-lasting. A Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 13 FACE Facelift surgery As Ageing tAkes its toll FAceliFt surgery cAn turn bAck the yeArs And Achieve A younger nAturAl-looking you. 14 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE W e are all affected by ageing. As time goes by tissue degeneration results in a loss of elasticity and stretching of the skin its supporting suspensory ligaments and the underlying soft tissues. Volume is also lost from areas such as the cheeks and around the eyes. The result is a timeworn appearance that might be at odds with our true age or with how young and vital we may feel on the inside. Facelift surgery seeks to address these concerns to create a firmer more youthful looking appearance and one that is more in line with your sense of youth. What is facelift surgery First performed more than 100 years ago surgical facelift techniques have continued to evolve and today can enhance virtually any part of the ageing face. Predominantly used by women to restore the contours of youth a facelift or rhytidectomy can correct sagging loose skin and reposition fat and tissues to add volume back to the face. Over time the effects of gravity sun damage and the stresses of everyday life appear on the face altering the way people appear to the outside world. Deep lines may appear around the eyes and mouth sagging skin may fall from the cheek jawline and neck and fat deposits that were once full and firm deplete leaving hollow and sunken areas of the face. As people are living increasingly lengthy lives a facelift is designed to address these age-related changes and help both men and women look as young as they feel inside. By repositioning both the skin and the layer of muscle and tissue beneath (known as the superficial musculoaponeurotic system or SMAS) the modern approach to facelifting restores facial elements to a more desirable position to create a younger looking appearance while avoiding the tell-tale signs of surgery. While the modern approach to facelifting predominantly addresses volume replacement and vectors of lift the procedure also helps smooth lines and folds. A facelift does not however address overall skin texture skin thickness or wrinkling and creases around the nose and mouth. Most facelifts are performed on people aged between 40 and 65 although facelifts can still achieve good results in older patients. Today there are a number of facelift techniques and Dr Milovic draws on a variety of advanced techniques to achieve a natural more youthful look. Depending on the patient their circumstances end-goal and condition of their skin he might recommend the MACS lift S-Lift or Composite Facelift. Facelift techniques The goal of facelift surgery is to achieve a more youthful natural-looking and rejuvenated appearance not one where the surgery is evident or where the skin has a pulled appearance. Traditional or conventional facelifting techniques don t necessarily take into account the fact the face ages as a single dynamic unit rather than as a series of static independent parts. Over time traditional facelifts can therefore lead to a tight unnatural-looking appearance. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 15 FACE Facelift surgery seeks to create a firmer more youthful looking appearance Recent advances in facelift techniques have helped surgeons like Dr Milovic achieve more natural-looking results for their patients. One of these techniques is the Composite Facelift. The composite facelift is similar to a deep plane lift which 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. The dissection is made deeper than with a more superficial lift below the SMAS so the flap is thicker. The lift therefore comes from tightening the underlying structures of the face rather than simply repositioning and tightening the skin. By using the deep plane technique surgeons can restore the neck jawline and mid face together therefore delivering more natural results. The Composite Facelift involves 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 the 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 superficial lifts. Dr Milovic also often draws on the S-Lift technique. The S-Lift is a type of facelift named after the S-shaped 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 significant skin laxity of the neck and jowls. It is most suited to patients beginning to show signs of facial ageing and who want some tightening of the lower face without longer incisions. Dr Milovic will discuss each of the techniques in detail during a pre-surgery consultation outlining the advantages and risks of each technique. Depending on the patient s individual circumstances he will then devise the best surgical plan designed to achieve optimal results. Regardless of the technique employed by the surgeon facelift surgery will require anaesthesia. Whilst modern anaesthesia is largely considered safe and effective it does have some risks which are largely dependent on the patient and their level of fitness pre-surgery. During pre-surgery consultation Dr Milovic and or the anaesthetist will ask about all the medications you are taking or have taken and any allergies you may have. Your facelift surgery will take place in an accredited hospital (ACHS or ISO accredited) and will usually involve an overnight stay to ensure you can be monitored effectively post-operation. Risks Scars are an inevitable part of any invasive surgery but it s natural to be concerned about the appearance of scars around the face area. Dr Milovic will endeavour to minimise scarring and to keep your scars as inconspicuous as possible by locating the incisions in easily hidden sites. That way scars will be positioned along natural skin lines and creases. Scars may fade with time and become barely noticeable. Some patients form raised keloid scars or suffer hair loss around the incisions. Hair transplant surgery may be needed to correct this and men may find they will need to shave extra areas 16 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE because skin has been moved. If scarring is a concern to you after surgery Dr Milovic will help you with a scar treatment plan to help optimise the appearance of your scars. If you are prone to scarring you should advise Dr Milovic during your pre-surgery consult. The risks specific to facial surgery include injury to the nerves that control facial muscles problems with healing which is more frequent in patients who smoke scarring crust on the incisions and numbness or tingling around the incisions. Skin loss or discolouration is rare but can occur and continue for several months. Recovery Post-surgery most patients can expect to experience some pain bruising and swelling most of which will subside within a few weeks. If a surgical drain was used it will usually be removed within a day and non-absorbable sutures may be removed in around seven to 10 days. Any discomfort experienced can be controlled with pain medication as needed. Keeping the head elevated by sitting up or propping it up on pillows is beneficial in reducing post-operative swelling. Surgeons may also recommend the use of a cold compress. The specific length of recovery is dependent on factors such as age preoperative activity level as well as the number and type of procedures that have been performed. However most patients can usually return to everyday activities after between two and three weeks. Final results may not be evident until several months after surgery. During the recovery period it is important that surgical incisions are not subjected to excessive force abrasion or motion during healing. Patients should refrain from wearing any clothing that has to be pulled down over the head as well as avoiding excessive sun exposure and cigarette smoke. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 17 FACE The composiTe facelifT can help give paTienTs a naTural-looking long-lasTing resulT. The composite facelift T raditional or conventional facelifting techniques don t necessarily take into account the fact the face ages as a single dynamic unit rather than as a series of static independent parts. Over time traditional facelifts can therefore lead to a tight unnatural-looking appearance. Recent advances in facelifting techniques have helped surgeons achieve more natural-looking results for their patients. Canberra plastic surgeon Dr Vladimir Milovic has adapted his approach to facelifting to achieve results that stand the test of time. He believes the composite facelift technique when combined with adjunct procedures such as neck lifting and advanced upper blepharoplasty where required can achieve the most natural-looking long-lasting results. The composite facelift is a next-generation alternative to standard procedures says Dr Milovic. It is a sophisticated technique that requires experience to perform but it can successfully restore a youthful appearance. While other procedures only reposition facial tissue horizontally the composite lift counters the natural descent of the face with a vertical lift. The composite facelift is similar to a deep plane lift with the addition of an extra step to include the muscle around the eyelid. A deep plane lift is designed 18 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE The whole face can be lifted to achieve more youthful contours without that telltale pulled appearance 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. The dissection is deep and goes below the superficial musculoaponeurotic system (SMAS) releasing strategic face and neck muscles and reattaching them at higher anchor points. The fat remains attached to the overlying tissues. The deep plane facelift was developed as a modification to standard facelifting techniques in order to better address characteristics of ageing in the mid-face. As well as restoring volume to the mid-face with the deep plane lift improvements to deep nasolabial folds can also be achieved. Like the deep plane lift the composite lift involves the elevation and resection of the SMAS layer as well as the orbicularis muscle and cheek fat pad. During the lift 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 whole face can be lifted to achieve more youthful contours without that telltale pulled appearance that people might experience with conventional procedures says Dr Milovic. Dr Milovic explains that as well as creating a smoother neck and more defined jawline the composite lift can recreate the full plump cheeks of youth something that can t be achieved with other facelifting techniques alone. An added advantage is that the composite lift also helps blend the dividing line between the lower eyelid and cheek which can appear with age. In traditional facelifting techniques the surgeon pulls the skin outward to gain access to the underlying muscle and connective tissue. The tissue is then repositioned and tightened. Some fat may also be removed or repositioned at this point. Composite facelifting provides balance between vertical and horizontal lifting thus providing a more holistic result. Dr Milovic believes that patients between the ages of 45 and 65 are typically the most suitable candidates for the procedure. Depending on the patient Dr Milovic will therefore commonly perform a neck lift in conjunction with the composite lift in order to achieve an overall rejuvenated and youthful appearance. You can t separate the face from the neck there must be unity for balance he explains. In some patients Dr Milovic may also perform an endoscopic brow lift although in most cases the desired effect can be achieved with injections of botulinum toxin. In order to achieve the most natural-looking results for his patients Dr Milovic has embraced a more advanced upper blepharoplasty (eye lift) technique pioneered by Melbourne plastic surgeon Dr Bryan Mendelson. Using the technique he has experienced some outstanding results. Whereas many people believe the problem with drooping upper eyelids is excess skin Dr Milovic explains this is often not the case. What has actually occurred is that the skin has detached from its former position deep within the eyelid where it used to appear as a neat fold of skin he explains. When detachment occurs the neat clean contour above they eye can be obscured by the drooping skin. This procedure requires only a short incision in the eye fold which heals so that it is undetectable within four months even with the eyes closed. Dr Milovic believes this technique avoids the risks associated with traditional blepharoplasty. When excess skin is cut away from the upper eyelids there is always the risk of taking too much giving the patient a taut surprised look leaving them unable to close their eyes properly. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 19 FACE Other facial surgery a facelift is just One Of the surgical techniques that can Be used tO refresh and rejuvenate the appearance Of the face. BlepharOplasty As the window to the soul the eyes offer an indication of someone s age level of fatigue and even overall state of health. Studies have shown that factors such as the degree of wrinkling skin texture and upper eyelid hooding can indicate poor health and lifestyle to others. As the effects of ageing take their toll a blepharoplasty procedure which addresses the upper and or lower eyelids can help not only recapture a sense of youth but also express an overall sense of health and happiness to others. From skin laxity to thinning and fat depletion and descent ageing can take its toll on the eye region resulting in delicate changes. With age the muscle layer beneath the skin starts to lose its tone the fat of the eyelid can protrude forward to cause a dark shadow the cheeks begin to shrink leaving a groove-like valley known as a tear trough and the brows 20 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE descend. The result is a tired-looking aged appearance. The effects of ageing can also be exacerbated by sun-exposure and smokedamage both of which lead to the emergence of crow s feet and fine lines and wrinkles under the eyes. Despite the largely uniform ageing process however the variety of ways in which these effects present themselves on each individual means that blepharoplasty is not suitable for everyone. Even when someone is convinced an upper or lower blepharoplasty procedure is right for them this may not be the case and it is the surgeon s job to identify where the real opportunity for improvement lies. A thorough consultation including a review of past photos can help determine whether someone will benefit from blepharoplasty. The approach to eyelid surgery will be individualised to each patient. Skin quality ethnic features as well as anatomical differences will dictate the ideal approach for each patient. Surgeons will typically consider the aesthetics and function of both the upper and lower eyelid and consider whether altering one or both is the appropriate surgical approach. An extensive understanding of the anatomy of the upper and lower lids is vital in undertaking the correct rejuvenation procedure. Often an upper eyelid blepharoplasty is sufficient in rejuvenating the appearance of younger patients whereas a lower lid blepharoplasty may be needed to remove redundant skin and bags in older patients. In others a brow lift or fat sculpturing may be the best option to address specific concerns. Considered a more straightforward procedure than lower eyelid surgery upper blepharoplasty is well suited for those with excess skin that creates a hooded effect over the eyes. Typically the procedure involves removing excess skin to create a more open appearance in the eye area revealing the contour of the brow and inner eyelid crease. Upper eyelid surgery is usually approached from the skin crease in the outer surface of the eyelid. The incision is typically made in the lid crease and is made with either a scalpel or CO2 laser that seals the blood vessels as it incises. Skin and muscle are removed to reduce hooding in the upper eyelid. In some cases fat pockets may need to be repositioned during surgery but this is dependent on the patient. For suitable patients upper blepharoplasty can produce dramatic results and is a minimally invasive surgical procedure when no fat transfer is required. Upper blepharoplasty Lower blepharoplasty Approaches to the lower lid are more likely to require a combination approach which may involve surgery filler and laser to give the best result. 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 heaviness 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 supporting muscles and structures surrounding the lower lids play an important role in the appearance of the eyes and therefore lower blepharoplasty requires an intimate understanding of the periocular anatomy. Damage to any of Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 21 FACE the surrounding structures can lead to complications such as scarring and droopy lids. The preservation of the blinking mechanism is also of critical importance in order to avoid problems with eye irritation post-surgery. The results of eyelid surgery become apparent gradually with swelling and bruising usually subsiding after around two weeks to reveal a smoother better defined eye region and a more alert and rejuvenated appearance. Results typically last around seven to 10 years. Some patients may also elect to have their eyelid surgery combined with a facelift or brow lift to maximise the rejuvenating effect and further enhance results. Rhinoplasty Rhinoplasty is the surgical procedure to improve the shape and or function of the nose and might be approached in one of two ways depending on the circumstances of the patient. Open Rhinoplasty During open rhinoplasty an incision is made at the base of the columella the tissue and skin that separate the nostrils at the base of the nose. The nasal skin is then carefully lifted back allowing the surgeon to work on the cartilage and tissue inside the nose. Because the inner cartilage network and underlying structure of the nose is exposed the surgeon has greater visibility than with closed rhinoplasty and is able to work on the inner structure of the nose with more precision and freedom. Open rhinoplasty is therefore often chosen for more complicated cases where considerable work may be required in order to achieve the desired outcome. The open technique for example can be helpful when performing cleft lip operations or during revision rhinoplasty when an earlier procedure has left a nose pulled too high and structural grafts are required. In these scenarios surgeons will tend to favour open rhinoplasty due to the extra visibility given by revealing the internal structure of the nose. The open technique also helps ensure the basic foundation of the nasal structure is kept strong facilitating a natural-looking outcome. It also leads to a more stable shape post-surgery helping to safeguard against collapse. Because an incision is made at the base of the columella the open technique will leave a small scar on the underside of the nose. This will fade over time and in most cases become barely noticeable. The patient may also experience swelling bruising and numbness for a more drawn out period of time than with the closed approach to rhinoplasty. Closed rhinoplasty During the closed technique all incisions are made inside the nostrils. The procedure does not result in visible scarring and is therefore considered less invasive than open rhinoplasty. Whereas the open technique may be used to tackle complex cases closed rhinoplasty is generally used to address minor defects. The operation is much quicker typically taking between one and two hours around half the time taken to perform closed rhinoplasty. Given the minimally invasive approach healing and recovery time is also less as are swelling bruising and numbness of the nasal tip post-surgery. 22 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE As the brow descends it can cast an aged tired and often angry expression across the face Often the type of surgery selected will come down to the preference of the surgeon. Where some prefer open surgery because it unveils the underlying structure of the nose others prefer the closed approach because it offers better ability to judge the final shape and contour of the nose. This is because there are no external incisions compromising the appearance of the nose. The closed technique offers surgeons considerable freedom to reshape the nose. Bone and cartilage can both be removed using this technique or in some cases taken from other parts of the body and used to better shape and support the nose. However despite offering plenty of scope to address minor modifications the main disadvantage of the closed technique is its limited use. Although suitable for reshaping the contours of the nose complex cases cannot be tackled as effectively with closed rhinoplasty. Brow lift The eyebrow area can be especially influential in the appearance of ageing eyes as the brow can descend and cast an aged tired and often angry expression across the face. The brow and the forehead can be the first part of the face to show early signs of facial ageing. Deep creases across the forehead and between the eyebrows can appear 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 more recent 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 five short incisions above the hairline each about 2cm long. An endoscope 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 first 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 final results apparent within around two months. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 23 FACE A brow lift is often combined with a facelift or blepharoplasty to provide a harmonious rejuvenation. OtOplasty Affecting around one in 20 people overly large ears often result in a significant aesthetic and psychological handicap. Indeed prominent or protruding ears can wreak havoc in young lives causing many to seek out a surgical solution often when still a child. Ears that are out of proportion with the rest of the face can draw too much attention marring the appearance of other 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 (or ear correction) is a surgical procedure that reduces the appearance of prominent ears pulling them back closer to the head and making them less noticeable. An otoplasty is a relatively simple operation to correct protruding ears and can result in a pleasing and long-lasting outcome. 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 scar at the back of the ear which fades over time. Swelling and bruising post-surgery is usually minimal. Neck aNd chiN lifts Performed either in conjunction with a facelift or as a stand alone procedure a neck lift is designed to reduce excess skin and fatty tissue of the neck and correct poor definition of the chin neck angle and jaw line. The technique used will depend on several factors such as the degree of excess skin the level of skin 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. 24 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u FACE Neck & chiN liposuctioN Two of the defining features of a youthful face are a well-defined jaw line and a pleasing angle where the neck and chin meet. Chin and neck fullness or a poorly defined 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 fluid 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. Facial implaNts Available in a wide range of sizes suitable for the cheek jaw nose and chin facial implants are designed to restore the contours and proportion of the face which may be left depleted by the natural ageing process. By adding volume to these features surgeons can create more defined and harmonious facial contours. Facial implants are used to correct sunken cheeks a receding chin or enhance the jaw and also to create structural balance in the face. Chin augmentation for example can build up a weak chin and contribute to an overall balanced profile. Facial implants are often inserted in conjunction with rhinoplasty to achieve facial proportion. It is also possible to add balance to the face by building up and enhancing the cheekbones using implants. Placed through a small incision in the mouth they give the high cheekbone look. Incisions for cheek implants can also be made through the hairline or lower eyelids. Chin and jaw implant incisions are usually hidden in the mouth. The implants themselves are specially formed from solid biocompatible materials and are designed to augment the physical structures of the face and create more defined contours and angles. The incisions are normally closed with absorbable sutures that dissolve over the next seven to 10 days. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 25 men Popular procedures for men Men are increasingly seeking ways to tweak the Parts of their bodies they wish to iMProve. luckily there s an ever-increasing range of oPtions. 26 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u men osmetic enhancement is no longer just a woman s domain. An increasing number of men are turning to elective procedures in order to enhance their appearance. Whilst many of the same procedures that women undergo are available to men abdominoplasty nose reshaping and eyelid surgery for example there are some technical anomalies given the anatomical and structural differences between the genders. men tend to have thicker skin than women and have a greater blood supply meaning the risk of bleeding during surgery is increased and healing may take longer. The tendency to wear their hair shorter than women also means that special attention needs to be given to the length and position of the scar during facelift surgery. It is well established that women generally have a higher percentage of body fat than men. The scientific explanations for the dramatic difference in body fat distribution between men and women are largely unknown although differences in hormones hormone receptors and enzyme concentrations play a part. Given their anatomical differences there are a number of cosmetic procedures designed specifically for men. Gynaecomastia (male breast enlargement) penile surgery and hair transplants for example are some of the most common cosmetic surgeries requested by men. C Gynaecomastia The enlargement of the male breast is a relatively common condition that can cause considerable embarrassment and psychological distress. Whilst many overweight men develop abnormal amounts of fat in the chest area sometimes unkindly referred to as man boobs others develop actual breast tissue. This is a medical condition known as male gynaecomastia and can be addressed with cosmetic surgery. men can also suffer from lipomastia where they develop a degree of lipodystrophy a disturbance in the way the body produces uses and stores fat. Additionally there are men with lipogynaecomastia who develop a combination of excess fat and breast tissue in the chest. Whilst being overweight can lead to all these conditions they are also commonly caused by a hormonal imbalance or abnormality which has to be checked for prior to surgery. Another known cause is steroid use in bodybuilders. However there are cases that are non-specific and idiopathic meaning there is no known cause. This is commonly the situation with males who develop breast tissue around puberty. Fortunately the correction of male breasts is relatively straightforward and can be very successful. The technique used depends on the age of the patient the volume of tissue that needs to be reduced and also the type of tissue that is predominant within the breast. male breast volume is typically composed of a combination of ductal and stromal tissue commonly referred to as glandular tissue as well as fatty tissue. Gynaecomastia refers to the abnormal development of mammary glands in men which leads to breast enlargement. Because the condition can occur during adolescence it is often a source of distress. The actual term Gynaecomastia is derived from the Greek terms gynec (feminine) and mastos (breast). The literal translation male breasts relates to any condition that results in excessive development of breast tissue in males. Where patients have severe gynaecomastia excess skin may result in significant drooping of the breast. If the breast is predominantly made up of firm dense tissue a combination of Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 27 men liposuction and tissue excision can be used to remove the excess tissue. If the composition is mainly fatty tissue liposuction alone may be sufficient. If there is an excess of skin as well as breast tissue surgery may be required. Before proceeding with treatment it s important to rule out any underlying medical conditions. many cancers have the potential to cause hormonal changes which can result in gynaecomastia. Once it has been established the patient is otherwise healthy the breast tissue and fat from the chest can be removed. During surgery it s not uncommon for incisions to be made within the areola and there may be some loss of sensation in this area post-procedure. The results are usually long-lasting and only a small number of patients will go on to develop breast tissue again once it has been excised. Reverse vasectomy Although a vasectomy is considered a permanent method of birth control it is possible to reverse the procedure reconnecting the tubes that were originally cut. The success of the procedure largely depends on the length of time between the vasectomy and the reversal as with time blockages can occur and some men even develop antibodies to their own sperm. The procedure typically takes around two to four hours and patients can return to their normal activities after around three weeks. Other popular procedures for men Abdominoplasty (tummy tuck) This type of surgery can help create a flatter stomach with repaired abdominal muscles and can also be used to sculpt better muscle definition. An incision is made across the lower abdomen then excess skin and fat is removed and the stomach muscles are tightened. The navel is repositioned when the skin is re-stretched over the stomach and a large scar is created across the lower abdomen. A firm strap and drain are normally worn for a day afterwards then replaced with a compression garment for several weeks. most patients need around three weeks off work. Liposuction Liposuction can be used to remove excess fat from the body or to remove a double chin or jowls in areas usually unaffected by diet and exercise. Fatty deposits are suctioned out through small incisions. Liposuction can be performed as day surgery and patients can usually return to work after about one week 28 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u men although bruising may last for several weeks and swelling for up to a few months. Liposuction techniques can also be used to sculpt areas of the body to add definition for example around the abdomen. Nose surgery (rhinoplasty) Rhinoplasty is particularly popular with Australian men and is used to change the size of the nose remove a hump narrow the nostrils change the angle or refine the tip. The procedure is performed by either the open technique when the incision is made at the base of the nose or the closed technique when the incisions are made inside the nose. Swelling and bruising usually subsides within seven to 10 days but final results may not be evident until after a year. The results are permanent. Facelift (rhytidectomy) In men a facelift can be used to tighten the skin and the muscles of the face chin and neck with results lasting around seven to 10 years. Incisions are made behind the hairline and around the ear then excess facial fat is removed and muscles are tightened. Swelling and bruising may last a few weeks and full recovery may take up to three months. Body Implants Body implants can be used to enhance the appearance of the buttocks biceps calves face pectorals penis and triceps. They are also used on patients who have had previous surgery injury or disease. The implant is inserted either above or below the muscle through an incision. Implants can also be used to correct facial imperfections such as sunken cheeks or a receding chin and can improve facial balance when combined with a facelift rhinoplasty or eyelid surgery. Implant surgery can create numbness but this usually subsides. Facial implant surgery can result in swelling and bruising for several days making talking and eating difficult. Normal activities can usually be resumed after around four to seven days and the results are permanent unless the implant is removed. Ear correction (otoplasty) Otoplasty is used to correct prominent ears and is a common procedure in men. A thin strip of skin is removed behind the ear and the middle cartilage layer is folded back and secured in position for permanent results. The ears are wrapped for a week and are swollen for a few weeks. normal activities can be resumed in around one to two weeks. Facial rejuvenation Wrinkle relaxant (botulinum toxin) injections are used to treat dynamic wrinkles those formed by repeated muscle contraction from facial expressions such as frown lines crow s feet and marionette lines and are growing in popularity amongst men. These injections can also be effective for chin creases and the horizontal wrinkles in the lower part of the front of the neck. There is no down time and results are seen after around four days. Repeat treatment is necessary after about three to five months in most cases. Dermal fillers can be used to treat static wrinkles which are caused by ageing and repetitive muscle movement and loss of facial volume. The range of dermal fillers available are designed for use near the surface of the skin to treat wrinkles as well as at deeper levels to restore volume. Their duration depends on the mobility of the treated area and the formulation. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 29 body all about lipoSuction Say goodbye to Stubborn pocketS of fat thankS to Surgical body Sculpting with lipoSuction. iposuction can be an effective option if a patient is looking to significantly reshape a part of the body or reduce fatty bulges resistant to diet and exercise. Typically the procedure is used to target areas of fat on the thighs hips and around the abdomen but liposuction can also be used to remove fat from more delicate areas such as around the neck knees and ankles. Liposuction involves the judicious removal of fat through suction-assisted cannulae. While the procedure can be used to remove large volumes of fat it is also commonly used to fine-tune and streamline body contours. It is commonly performed under general anaesthetic or twilight sedation as a day surgery procedure usually with no need to stay overnight in hospital however this is dependent on each patient. As with any kind of surgical procedure it s very important for patients to have realistic expectations and be fully aware as to the limitations of liposuction. For example while traditional liposuction can stimulate minor skin tightening the procedure cannot correct very loose skin and nor is it designed to improve the appearance of cellulite. Techniques in liposuction have developed over time and today surgeons can choose from a variety of liposuction approaches depending on the patient and their end-goal. All methods use a traditional liposuction cannula with suction to remove the fatty tissue. The most recent advances 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- L 30 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u body assisted liposuction power-assisted liposuction and laser-assisted liposuction. The role of the energy is to dislodge and break up the fat so it can be removed more 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 surgeon. There is no consensus among doctors as to which liposuction technique is superior. There may be slightly less blood loss and a greater ability to remove fat in difficult areas with for example ultrasound-assisted liposuction but it can be associated with greater complications than the traditional suction-assisted liposuction. because there are only small differences between the procedures the technique the doctor is most skilled in will cause the least complications and achieve the most effective results. dr Milovic uses suction-assisted and waterassisted liposuction techniques depending on the patient and treatment area being targeted. What happens during liposuction during suction-assisted liposuction dr Milovic makes tiny incisions in the areas to be suctioned and a cannula is inserted. Using the cannula dr Milovic moves in a specific pattern through the fat layer to break up fatty deposits which are then suctioned 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. Instead of removing the fat cells manually with a cannula or using laser technology to melt and dislodge the fat water jet assisted liposuction uses a slightly pressurised stream of saline to dislodge fat and simultaneously remove the fat cells. Instead of destroying fat cells this type of liposuction loosens the fat cells to facilitate more gentle removal. 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 up 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 see the final effect. Although different surgeons may favour certain modalities and techniques it is important to remember that all liposuction is surgery requiring incisions sedation and diligent post-operative care. It is also important to note that fat removal procedures are not a substitute for a healthy diet and exercise regimen. Fat is an important tissue and removing too much can cause loose skin and surface irregularities Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 31 body genital rejuvenation Procedures such as labioPlasty and vaginoPlasty can alleviate discomfort and enhance self-esteem. ynaecological and urinary problems are very common among women yet many remain unaware of the surgical options available to address them and suffer unnecessary discomfort because of this. Problems can be both aesthetic and functional and include vaginal prolapse and muscle laxity incontinence menstrual dysfunction and overly large or misshapen labia either naturally occurring or as a result of childbirth or ageing. Each of these issues can not only result in physical distress but can also impact on a woman s self esteem and relationships. because the function and form of the different parts of the vagina are closely linked to the female psyche by correcting these issues women can experience an overwhelming increase in their sense of confidence and self-esteem. Plastic surgeons can draw on a number of minimally invasive techniques in order to alleviate many of these problems. one such procedure is vaginoplasty which aims to tighten a vagina that s become loose from vaginal childbirth or as a natural consequence of ageing. Whilst vaginoplasty can enhance vaginal muscle tone strength and control it is not designed to enhance sexual response. A labioplasty is designed to correct oversized elongated or asymmetrical labia minora the inner vaginal lips that surround the entrance to the vagina that can cause irritation and discomfort when wearing certain clothes during exercise or sex. Whilst there is considerable variation in the appearance of the external genitalia the vulva structures (including the labia minora labia majora mons pubis perineum entrance to the vagina and hymen) can be surgically enhanced both functionally and aesthetically. Genital rejuvenation should always be performed in a fully accredited hospital to monitor any discomfort. After the procedure the amount of downtime needed will depend on the individual circumstances of each patient but most patients will be able to return to their work two weeks after surgery. Any mild discomfort experienced after the procedure can be controlled by analgesics and cold packs to the area during the first week after the operation. As with any surgery prior to the operation there should be a thorough discussion between the surgeon and the patient about the operation techniques and likely outcomes. during the consultation the patient should also be informed about any risks associated with the surgery. G 32 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u PATIENT JOURNAL PATIENT JOURNAL breast reduction DR MILOVIC S PATIENT DISCUSSES HER BREAST REDUCTION H aving suffered years of back pain and low self-esteem due to her oversized breasts one 55-year-old patient explains her decision to seek a breast reduction with Dr Milovic. Why did you decide to have breast reduction surgery My breasts were causing me to suffer from back pain as well as a sore neck and shoulders. They also left me with low self-esteem and restricted my participation in sports. Why did you choose Dr Milovic Dr Milovic was recommended to me by a friend. They knew a number of people who had been to him for breast reconstruction and facial surgery. I was nervous about the prospect of surgery but was also happy that I was doing something for myself. It also made me more positive and comfortable knowing I was in the hands of an experienced surgeon I could trust. Before surgery I had a consultation with Dr Milovic during which he gave me plenty of information. It also helped knowing I had the support of my husband. Tell us about the day of your surgery On the day of surgery I woke early went to hospital and was admitted. This was a strange feeling for me as I am usually there checking my son in and going through the motions of his care. I was happy as I felt this was something I should have done for myself years ago. After waiting for the time to come I was taken to surgery where all the staff were fantastic. Dr Milovic drew all over me and I remember saying a couple of things and then I was asleep. Dr Milovic s care was great caring and supportive and it has been nice to receive phone calls from the staff in his clinic since the procedure. It s actions such as these that ensure you feel like a person not a number. The support from everyone at the clinic before surgery was excellent. How did you feel after surgery I woke up in recovery and was then taken to my room. I wasn t the best company I just slept The care was great and I felt strange as I felt different. It s hard to express how I felt. It s only now I realise how large my breasts were I no longer have to worry about the impact they have on my appearance or having to buy clothes that fit my chest rather than anything else. I don t have back pain a sore neck or grooves in my shoulders any more. My surgery has been a very positive experience and since then I have recommended others visit Dr Milovic to experience the same. DR VLADIMIR MILOVIC W W W. D R M I L O V I C . C O M . A U 33 PATIENT jourNAl Patient journal breast augmentation one Patient oPenS uP about her breaSt augMentation With Dr Milovic A s a 34 year old single mum to two small children this patient hoped breast augmentation would be an important step in re-establishing her self confidence. Here she talks about her decision to have breast augmentation and the results. Why did you decide to have a breast augmentation I have always felt very self conscious about having very small breasts (less than an A cup) and feel I have spent my life buying padded bras to look like I have feminine shape. In the back of my mind I have always been fascinated with the possibility of surgery but initially ruled it out based on health risks and because I thought others might perceive me as being too vain. Over the course of 12 months I left an abusive marriage and found myself raising two young children alone. In reflecting on my life choices I realised that I had perhaps settled on the wrong man because I didn t have confidence that I was attractive and womanly enough to have more options. I ultimately chose to have surgery to increase my self esteem and to be able to better fit into all the clothes that I own. I wanted to feel like a real woman and I wanted to do this while I was still young to enjoy the benefits of the new look. Why did you choose Dr Milovic Two GPs recommended Dr Milovic to me for mole removal based on his experience and his reputation for not up-selling cosmetic procedures. Having had several consultations with Dr Milovic about my face I took the opportunity to ask about breast surgery. The fact that he pointed me in the direction of medical information about the risks involved he suggested a new breast size based on my exact proportions and that he suggested I get my mother s support before making a decision all built my trust. It took me another five months to consider the prospect of surgery secure the support of my mother and become 100% confident with the decision to proceed. Before surgery I had researched what I may or may not be physically 34 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u PATIENT jourNAl capable of doing so organised my mother to stay with me for two weeks after the operation. I arranged to take one week off work as I didn t have much sick leave. I had heard that I wouldn t be able to drive or lift anything so I arranged for my children to spend some time with other family members. I had heard that you can t lift your arms so remembered to pack a button front shirt to leave the hospital in. Tell us about your surgery day Immediately after surgery I couldn t stop looking down my hospital gown at my new breasts I was a bit concerned I hadn t heard from the anaesthetist and met him when he was prepping me for theatre. The anaesthetist had a reassuring manner and I was so glad that putting the cannula in my arm was successful first go unlike in other situations I have had. I wore a t-shirt to hospital without a bra rather than my usual padded kind revealing to the world that I was actually very flat chested. It felt good to know that at 34 I was about to hit puberty and have breasts. By chatting to the anaesthetist and his assistant I felt reassured there would be five people in the operating theatre helping to ensure that I was in the best possible care. I didn t feel worried just elated that I was going to have surgery that I believed would have a profound impact on the way I perceive myself. How did you feel after surgery Immediately after surgery I just couldn t stop looking down the front of my hospital gown and looking at my new breasts marvelling that they were there and the surgery had gone so well. The pain and nausea were there and continued for 10 days after surgery. By day 10 however I was driving and able to lift my arms up high enough to brush my hair for the first time since surgery. I hadn t realised how dependant I would be on my mum even having to ask her to wash my hair as it hurt to lift my arms. With young children (aged 2 and 4) I really needed her help with bathing them and getting meals ready etc. It worked well that I also had minor facial surgery at the same time so that the kids could visually understand that mummy is sore rather than actually pointing out about the augmentation. Although I didn t tell my work colleagues about my surgery I did tell family and friends. That was a wise decision as they have all been very supportive and interested (and are now considering procedures themselves ). Actually I think they can see that I am really happy. Since the surgery I have had an exciting time buying swimmers for the first time where I have filled the tankini top (I am now a C cup). It has been amazing to feel that I am now an average woman. My self confidence has soared and I would now not be embarrassed if anyone saw me naked Making the decision to have the surgery ranks in my top 5 ever life decisions up there with having children and going to university. This will change the quality of my life as I now feel more normal and in fact look fabulous. I am no longer ashamed that I don t look womanly. I would definitely choose Dr Milovic again and have already recommended him to others. He built my trust with his manner and he worked magic on how I look. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 35 PATIENT jourNAl patiENt jOurNal breast implant revision & lift ONE patiENt talks OpENly abOut hEr brEast implaNt rEvisiON aNd lift I first had silicone implants in 1996 with a surgeon I had researched well before the procedure. looking at the patient portfolio beforehand I could see before and after glamour shots and was definitely influenced by these photos. The procedure was very straight forward and had no complications. A few years later I noticed the right implant had started to drop or slip down resulting in a double bubble in the right breast. I also noticed a bulge in the upper region of my left breast which made my breasts look awkward and uneven. I was most unhappy and spent a great deal of time researching other plastic surgeons going as far as Melbourne for a second opinion. I settled on a high profile surgeon in Sydney. I believed this time I could have another operation that would give me the desired result. It was difficult to decide 36 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u H ere a 53-year-old woman shares her journey to seek revision surgery with Dr Milovic following a number of disappointing augmentation procedures. PATIENT jourNAl I cannot emphasise enough the importance of finding a surgeon experienced enough to correct postoperative problems what size implants due to the fact I had implants already. I chose saline implants that were ultimately larger than I should have decided on. I was assured by the surgeon that the implants would be placed in a different position to avoid the same problem occurring. He seemed a little concerned at the time but not overly nor did he offer any other suggestions or ways that might offer a better outcome. unfortunately and to my huge disappointment and distress I noticed the exact same problem had occurred again and over the next few years my breasts got worse. The right implant had bottomed out and the left breast was so high it seemed like it was almost under my chin. I couldn t believe that I was going to have to face yet another breast operation. In December 2009 my right implant failed and I spent the Christmas break researching plastic surgeons. The stress of not knowing what to do actually made me very depressed over the next month. I spent several weeks intensely researching photos of breast implants surgeons both in Australia and overseas websites looking at photos of women s breasts with and without implants older women with revision surgery the effects of the breast after implant removal mastopexy (breast lift). I really could not make a decision. I had three doctors appointments looking for referrals before I chose Dr Milovic. Two of the doctors I spoke to knew of Dr Milovic s reputation particularly with breast reconstruction and microsurgery procedures. At 52 I did not want to take another risk. I made the appointment with Dr Milovic and was pleasantly surprised to notice there were no glamour photos anywhere in the room just authentic patient reviews detailing positive results. I was also very happy with the way the staff handled my concerns they were most obliging and considerate. Nothing was too much trouble. I spent a long time with Dr Milovic who was very sympathetic and extremely honest. He assured me that he could manage the procedure even though I could not give him accurate details of the previous implants or their correct position or size. unfortunately both previous surgeons had retired and I had been unable to obtain my records. We then discussed the various options thoroughly. I left it up to Dr Milovic to examine both my breasts and the history I gave him and make the best decision for me based on my age chest wall dimensions skin and breast condition and my desire to have natural-looking breasts with no droop. I wanted lower pole fullness as opposed to high profile round breasts. I wanted the best outcome possible Dr Milovic decided to give me a breast lift with 375cc silicone implants with the assurance of a new procedure that would minimise implant failure and contracture or deformity. What I didn t know until I saw Dr Milovic post-surgery was just how difficult this operation had been due to the limited information I had given him. In this respect I fully praise Dr Milovic for his experience and knowledge as without that I may have been in the same position all over again. Dr Milovic was easy to talk to with a wonderful sense of humour to complement his expertise and knowledge and I recommend him to anyone in a situation similar to mine. I cannot emphasise enough the importance of finding a surgeon who not only performs breast implant operations but who is experienced enough to correct post-operative problems such as in my case in the event of an unknown complication. I would like to make this information available to women like myself who have had disappointing or multiple breast surgeries (with other surgeons) and are not sure what to do. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 37 Patient information true or false 38 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u Dr Milovic answers soMe of the Most coMMon questions surrounDing cosMetic surgery to help Dispel soMe of the Myths. PATIENT INFoRMATIoN True or false In Australia it is legal for any doctor (without specialist qualifications) to perform cosmetic surgery. True. Currently it is legal for a doctor with a basic medical degree to perform surgery. A doctor with only an MBBS (Bachelor of Medicine and Bachelor of Surgery) degree is not trained for invasive surgical procedures. These days many general surgeons Ear Nose and Throat (ENT) specialists opthamologists General Practitioners (GPs) and other medical professionals offer cosmetic procedures. Specialist Plastic Surgeons however are Commonwealth Government accredited plastic surgeons trained and qualified to perform invasive cosmetic and reconstructive surgery in public and private hospitals and accredited day surgeries. True or false All plastic and cosmetic procedures are performed in accredited hospitals or day surgeries False. In Australia it is legal to conduct surgical procedures in unaccredited facilities such as an office space or day procedure centre. In these settings there is sometimes no quality assurance and no way for authorities to monitor that the surgery is being performed safely and expertly. True or false Specialist Plastic Surgeons only perform reconstructive surgery False. Cosmetic surgery was developed out of reconstructive surgery which only Specialist Plastic Surgeons are accredited to perform. Therefore cosmetic surgery falls well and truly within a Specialist Plastic Surgeon s specialty. The medical specialty of Plastic Surgery encompasses both cosmetic (aesthetic) and reconstructive surgery. Cosmetic surgery is currently not a recognised or accredited medical specialty on its own. A trainee Specialist Plastic Surgeon (someone trained by the Royal Australasian College of Surgeons) completes an average of 3 000 procedures over the course of his her training of which almost two-thirds have a cosmetic application. The Royal Australasian College of Surgeons (RACS) is the only accredited and nationally recognised training college for specialist surgeons including Plastic Surgeons. In fact Specialist Plastic Surgeons draw from both their reconstructive and cosmetic skills and training in order to deliver the optimal result for each patient no matter the circumstance. True or false There is limited regulation on the use of titles to describe medical qualifications in plastic and cosmetic surgery. True. Patients can feel confused by the various medical titles and what they represent as well as those that are sometimes misrepresented. A fully trained and accredited surgeon in the specialty of Plastic Surgery is known as a Specialist Plastic Surgeon . The title of Specialist Plastic Surgeon is protected by the Medical Board of Australia and can only be used by FRACS approved specialist surgeons. In Australia the Guidelines for Advertising of Regulated Health Services including the use of medical titles is provided by the Medical Board. Patients are encouraged to conduct their own research to ensure the doctor performing their plastic or cosmetic surgery is properly trained and qualified. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 39 PATIENT INformATIoN preparation risks & recovery Knowing what to expect and preparing for your surgery can maKe all the difference when it comes to your recovery 40 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u PATIENT INformATIoN ven before making the decision to undergo cosmetic surgery there are steps you can take to help achieve an optimal physical and psychological outcome. Preparing yourself now will pay dividends when it comes to your recovery. This includes understanding what your procedure will involve setting realistic expectations learning about and acknowledging possible risks and complications as well as planning for a period of downtime as you recover. It s just as important to explore any underlying motivations for seeking change with your friends and family and your surgeon and to prepare the body physically for surgery by ensuring it s in its best possible health. None of this can be rushed but taking the time prior to surgery will help alleviate much of the anxiety that can surround cosmetic changes. E Choosing your surgeon Choosing a surgeon is one of the most important decisions facing someone thinking of undergoing a cosmetic procedure and one of the first to be faced. The surgeon s experience training and judgment will all impact on the physical outcomes of surgery as will their openness to discuss concerns and question the patient s motivation during the consultation prior to surgery. When it comes to selecting a surgeon prospective patients should ensure their surgeon s training and certification is appropriate to the specific procedure they will be performing be it facelift surgery breast augmentation or a less invasive procedure. Certification from the relevant medical board or body reassures a patient the doctor has completed additional requirements surrounding continuing education and experience in cosmetic surgery. Trusted sources of information include the Australasian Society of Aesthetic Plastic Surgery (ASAPS and the Australasian Academy of facial Plastic Surgery (AAfPS) and Dr milovic encourages all his patients to reference these sites. Be realistic about the outcome for the right individual cosmetic surgery can have a real impact on a person s wellbeing and self-esteem. It can be highly successful for people who are both physically healthy and psychologically sound. However having a clear and realistic understanding of what a procedure can and can t achieve is important prior to committing to surgery. Age and body shape will both influence surgical outcomes so individuals interested in having cosmetic surgery should meet with a qualified surgeon to discuss individual expectations. By communicating which features of their face or body they are unhappy with initially patients can look forward to a better postsurgery outcome. Similarly if the motivation behind seeking surgery is to achieve a more youthful appearance it s important to acknowledge that although this can be achieved in the short term both the face and body will continue to age and change over time. Cosmetic procedures remain popular because of the long-lasting and noticeable results they can achieve. However it s important to acknowledge the limitations of any procedure. A facelift for example will not eliminate wrinkles or skin imperfections such as acne scars and hollows and nor will it alter the shape of the face. Similarly significantly older people with less elastic skin may not obtain the same cosmetic result that can be achieved in those with younger Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 41 PATIENT INformATIoN more supple skin. Nor will breast implants last a lifetime and patients need to have realistic expectations as to the outcome of their elective procedure. Importance of the consultation When it comes to preparing for surgery research is a fundamental aspect of patient safety and prospective patients are encouraged to learn as much as possible about the procedure they are seeking ahead of selecting and meeting with their surgeon. It s equally important for the surgeon to conduct his or her own research which will take place during the consultation. The consultation provides the surgeon with the opportunity to discuss the chosen procedure in detail with the patient. The surgeon will relay the type of anaesthesia to be used the risks limitations and costs involved and will outline the steps that need to be taken both leading up to and after surgery. Importantly the surgeon will also be able to ask the patient about their expectations goals and reasons for pursuing surgery. A full medical history will be taken during the consultation and the surgeon will take any measurements required for the individual procedure. Lab testing or a medical evaluation may be required in order to establish a patient s level of health and fitness and alterations to any existing medication plan may be recommended. Aspirin and other blood thinning drugs for example should not be taken in the lead up to surgery and smokers will need to stop well in advance of surgery due to the increase in surgical and anaesthetic complications caused by smoking tobacco. Along with the physical aspect of preparing for surgery it s also important patients are mentally prepared for the change that will take place in their appearance. Not only are there physical complications associated with surgery but there can also be psychological reactions. Part of preparing for surgery means coming to terms with the fact that there will be differences in the person reflected in the mirror post-surgery. Being aware of this and accepting a new and improved look will help patients return to normal everyday life more readily. Understand the risks involved In skilled hands cosmetic procedures have an excellent safety profile Every surgical procedure involves some risk. In skilled hands cosmetic procedures have an excellent safety profile. But despite the highest standards of surgical practice complications can still occur. The most effective way to minimise the risks is to have a thorough physical examination prior to surgery and to follow the surgeon s advice and guidance. With many cosmetic procedures some scarring can be expected but an experienced surgeon can take steps to minimise or hide these scars. for these reasons it is important to choose a qualified and experienced surgeon. Complications following a procedure often prove to be temporary. These may include blood or fluid retention under the skin crusting of scars and numbness. There is a minimal risk of nerve damage or infection. Complications vary from procedure to procedure for example a less invasive procedure will typically carry fewer risks and involve less pain than a more invasive time consuming procedure. Whilst surgery itself carries its own inherent risks there will be additional risks and complications unique to each procedure and these should be discussed in depth with your surgeon beforehand. 42 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u PATIENT INformATIoN Take time to recover Immediately after surgery patients will be taken to a recovery area. Depending on the procedure you might be fitted with a compression garment to facilitate healing and reduce swelling by preventing fluid build-up as well as providing comfort and support. Although loose bandages may be removed in several days compression garments are often worn for up to a few weeks. Post-surgery most patients can expect to experience some pain bruising and swelling most of which will subside within a few weeks. If a surgical drain was used it will usually be removed within a day and non-absorbable sutures may be removed in around seven to 10 days. Any discomfort experienced can be controlled with pain medication as needed. Some patients will be allowed to go home after a few hours whereas others may stay overnight in a hospital or surgical facility depending on the extent and type of surgery and incidence of complications. The specific length of recovery is dependent on factors such as age preoperative activity level as well as the number and type of procedures that have been performed. However most patients can usually return to everyday activities after between two and three weeks. final results may not be evident until several months after surgery. During the recovery period it is important that surgical incisions are not subjected to excessive force abrasion or motion. Patients should refrain from wearing any clothing that aggravates the site of surgery as well as avoiding excessive sun exposure and cigarette smoke. It is not uncommon for some patients to struggle with disappointment or depression immediately following surgery as the positive results often take several weeks to become noticeable. only once the swelling has gone down and the healing completed will the results be visible. Knowing what to expect and entering into your journey armed with as much information as possible will ultimately only ease your experience and help you look forward to an optimal outcome. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 43 Patient information care instructions oPtimise your cosmetic surgery results By folloWing these key care instructions. T he following care instructions are meant to promote safe and successful cosmetic surgery and can help make life easier both before and after your surgery. these care instructions are meant as a guide and don t replace circumstances that are specific to you and your procedure. 2 Weeks Prior to surgery Stop taking aspirin ibuprofen Advil or similar anti-inflammatory medication as these medications increase bleeding. other prescription blood thinners must also be discontinued under the guidance of your specialist. Dr milovic will advise you when you may resume taking these medications which may be a few days. Stop herbal medication supplements and teas as these substances may increase bleeding. Herbal supplements with an increased risk of bleeding include but are not limited to Vitamin e garlic ginger ginkgo ginseng kava and St. John s Wort. Daily multivitamins should be okay to take but ensure Dr milovic knows which you are taking. Stop taking any diet medication. Stop smoking at least two weeks before your surgery. Smoking greatly increases the risks associated with anaesthesia surgery wound healing and recovery. the Day Before surgery Stop all alcohol consumption. Set up a home recovery area with lots of pillows books magazines stationery a tV remote control and DVDs. Have a light dinner. Do not eat or drink from midnight prior to the day of surgery. this restriction includes water milk products chewing gum mints lollies coffee and juice. You may take your regular medications with a very small sip of water. Your stomach should be empty for several hours before anaesthesia. 44 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u patIEnt InForMatIon ThE DAY of SuRGERY please bring a list of your current medications as well as the name(s) and phone number(s) of any medical specialists friends and family to contact in case of emergency. Wear loose comfortable clothing. Do not bring jewellery large amounts of cash or other valuables. Do not wear hair spray perfume makeup or nail polish. Do not wear false eyelashes artificial nails or wigs. Do not wear dentures. Do not wear contact lenses. Bring your glasses in a case if applicable. Bring your medicare card and photo ID. Be sure to arrange a lift home after your procedure as you will not be able to take a taxi use public transportation or drive yourself home after having anaesthesia. arrive at least 90 minutes prior to your scheduled surgery time. AfTER ANAESThESIA plan to rest on the day of surgery. advance your diet slowly from liquids to soft food. nausea may last several hours after anaesthesia. Do not smoke or drink alcohol. Do not drive a car or operate machinery (a lawn mower for example) until 24 hours after anaesthesia. Do not make any personal or legal decisions until 24 hours after anaesthesia. apply a warm compress to any redness or swelling at the IV site in your hand or arm You will be prescribed pain medication by Dr Milovic. Do not take any additional medication for pain or headaches. Follow the detailed postoperative instructions specific to your procedure that will be given to you by Dr Milovic. PoST-SuRGERY DIET Do not consume any alcohol. Do not take any anti-inflammatory medication including aspirin ibuprofen and Advil. Do not take any herbal medications supplements or teas. Drink plenty of fluids. IN AN EMERGENCY Call Dr Milovic immediately if any of the following occur or if you have concerns about your recovery Excessive bright red bleeding Severe pain Difficulty breathing Increasing redness or swelling Double vision Fever Decreased levels of alertness WouND CARE remove your gauze dressing after two days. a small amount of blood is normal. Keep clean ice-packs wrapped in a clean cloth over the area for the first 48 hours. try to keep the ice on as much as possible while awake to help reduce swelling. Steri-strip tape bandages may have been applied to your incision. Leave this tape in-place. the tape will gradually peel off in a few days. If your wound does not have a steri-strip bandage then gently clean the incisions as instructed by Dr Milovic two times a day only for first 48 hours after surgery. Keep the incision dry. You may wash the area with a mild soap and luke warm water after 2 days. Do not soak the area in water or leave wet dressing against wound. Gently pat the area dry with a clean towel. Do not rub. avoid direct sun exposure. Generally you may start using sunscreen over the area one week after the sutures are removed. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 45 gallery breast augmentation BEFORE AFTER breast augmentation by Dr Milovic This 45-year-old female patient presented with deflated breasts post-pregnancy. Dr Milovic perfomed a breast augmentation with 325 cc round silicone implants moderate profile dual plane sub pectoral placement. BEFORE AFTER breast augmentation by Dr Milovic This 22-year-old female patient presented with underdeveloped breasts. Dr Milovic performed a breast augmentation with 425cc round extra high profile silicone implants subpectoral dual plane placement. 46 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u BEFORE AFTER breast augmentation by Dr Milovic 23-year-old female patient post partum round high profile silicone implants dual plane sub pectoral implants. Post op results 7 months. BEFORE AFTER breast augmentation by Dr Milovic 18-year-old female patient with underdeveloped breasts 365 cc round extra high profile silicone implants dual plane sub pectoral placement. Post op results 6 weeks. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 47 gallery breast lift BEFORE 6 weeks AFTER breast augmentation and lift in one procedure 24 year old female patient with drooping breasts and lost volume after weight loss. Dr Vlad performed the Le Jour or vertical scar technique and breast augmentation in the one procedure with 370 cc high profile round silicone implants subpectoral dual plane placement. POST OP PHOTOS 6 WEEKS BEFORE 6 weeks AFTER breast augmentation 33 year old female patient with underdeveloped breasts. Dr Vlad performed a breast augmentation with 390cc high profile round silicone implants subpectoral dual plane placement POST OP PHOTOS 6 WEEKS 48 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u breast reduction BEFORE AFTER breast reduction by Dr Milovic This 18 year-old female patient had bilateral breast hypertrophy and was over a G cup. Dr Milovic performed a bilateral breast reduction with vertical scar technique reducing the size of the breasts to a D cup. mummy makeover BEFORE 6 weeks AFTER mummy makeover by Dr Milovic Dr Milovic performed a bilateral breast reduction with short vertical scar technique (modified Le Jour) anterior abdominoplasty (lateral tension) musculoaponeurotic system repair and liposuction on this 46-year-old female patient. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 49 gallery abdominoplasty BEFORE 9 weeks AFTER abdominoplasty by Dr Milovic This 46-year-old female patient was left with excess abdmonial skin and abdominal muscle laxity after the birth of twins. Dr Milovic performed abdominoplasty and musculoaponeurotic system repair. BEFORE 8 weeks AFTER tummy tuck by Dr Milovic This 34-year-old female patient was left with significant expansion of the anterior abdominal wall and stretchmarks after pregnancy. Dr Milovic performed an abdominoplasty and musculoaponeurotic system repair with insertion of mesh support. 50 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u rhinoplasty BEFORE 6 weeks AFTER rhinoplasty by Dr Milovic This 27-year-old female patient had a combined septal reconstruction bilateral inferior turbinectomies and composite open tip Rhinoplasty by Dr Milovic. facelift BEFORE Dr Milovic performed a deep plane composite S Lift rhytidectomy (facelift) lower pinch blepharoplasty (lower eyelid) neck liposuction and microfat grafts to lip and cheek area on this 54-year-old female patient. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 51 7 months AFTER facelift eye lift neck liposuction and micro fat grafts by Dr Milovic gallery Facial surgery BEFORE 5 weeks AFTER facelift by Dr Milovic This patient requested a natural rejuvenated look. Dr Milovic performed a composite S-lift mid-cheek lift lower pinch blepharoplasty and canthoplasty. The results shown are five weeks after surgery with minimal oedema. BEFORE 4 weeks AFTER face and neck lift by Dr Milovic This 67-year-old male patient wanted a natural refreshed look. Dr Milovic performed a deep plane lower rhytidectomy (facelift) and neck lift. 52 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u neck lift BEFORE 3 months AFTER neck lift and liposuctionby Dr Milovic This 29-year-old female patient was concerned about her neck contour. Dr Milovic performed neck lift and liposuction to improve the appearance of the neck. blepharoplasty BEFORE 3 months AFTER blepharoplasty by Dr Milovic This 69-year-old female patient had an upper tarsal fixation blepharoplasty by Dr Milovic. Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 53 DR VLAD MILOVIC & TEAM 14 Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u ACTUAL PATIENT OF DR VLAD MILOVIC Dr VlaDimir miloVic w w w. D r m i l o V i c . c o m . a u 15 ACTUAL PATIENT OF DR VLAD MILOVIC BREAST SURGERY FA C E S U R G E R Y BODY SURGERY SKIN SURGERY HAND SURGERY NON-SURGICAL PHONE 02 6260 4882 SUITE 1 BUILDING 1 EQUINOX 70 KENT ST DEAKIN ACT 2600 WWW.DRMILOVIC.COM.AU