Fat Transfer
This is a procedure, whereby a small quantity of fat is removed from the buttock, thigh or abdomen and injected into deep lines in the face. It is most commonly used for the deep creases between the mouth and nose (naso-labial folds) but can also be used to plump lips and depressed scars.
The advantage of a fat transfer procedure is that the fat is naturally occurring within the body and therefore will not result in any untoward reactions. It is particularly good for people who are allergic to other injectables e.g. collagen, or who don't like the idea of having a foreign substance used on them.
A percentage of the fat transferred will be reabsorbed by the body, therefore, to achieve a good result the doctor has to over-correct the area. This will result in obvious swelling for a few weeks and quite possibly some bruising. The patient will requires some down time, in terms of work or social commitments, until the area has settled.
30% of the fat will disappear in the first 2 - 3 days, another 30-40% will disappear in the next few months and about 30% will stay permanently. The other factor to take into consideration is that the area from where the fat is taken (the donor site) will be tender and bruised for several days.
Fat injected into the upper lip will certainly plump up the lip, but will not result in a clearly defined border. If this is the look you want then you may have to consider another form of injectable, such as collagen.
The fat transfer procedure may need to be repeated several times to achieve the desired result. It will not work for everybody and there is no way of predicting this ahead of time.
Skin Conditions
Vascular Conditions
This is a broad group of conditions include vascular birth marks such as port wine stains, facial telangiectasias, acne rosacea, poikiloderma of civatte and leg veins.
At Adelaide Plastic Surgery Associates, we have a Copper Bromide Laser (Dual Yellow - Norseld) and a Flash Pumped Pulsed Dye Laser (V-Beam - Candela). Your doctor will advise which laser will suit the condition you have. We also have an Intense Pulsed Light/Radio-frequency machine (Aurora - Incision) and a Diode/Radio-frequency machine (Polaris - Incision)
Vascular Birthmarks
There are many types of vascular birthmarks but most are treatable with the V-Beam laser. It is usual to require several treatments with approximately 6 weeks between treatments. In most cases, a Medicare rebate applies for this treatment.
There may be some bruising and swelling after a treatment with the V-Beam laser but this usually only lasts a few days. Treatment is quickly and easily performed with minimal discomfit.
Visible blood vessels on the face are unsightly and easily treated with the Copper Bromide Laser. These are often caused by genetics, sun exposure, trauma such as skin cancers surgery and acne and conditions such as rosacea.
They may become more apparent with triggers such as alcohol, heat, caffeine and emotion. They are often unsightly and associated with the stigma of being a "drinker". Usually, only a couple of treatments will clear these blood vessels. With time they do recur and maintenance treatment may be necessary. In some cases, a medical rebate may apply to this treatment.
Acne Rosacea
This is a condition that causes redness, flushing and often facial rash. It is socially disabling for many people. In most cases, treatment with the V-Beam laser reduced redness and flushing significantly. Some people also require topical or oral antibiotics. Several treatments are usually required and in most cases, a medical rebate applies.
Poikiloderma of Civatte
This is discoloration of the neck and chest due to sun damage. It is usually demarcated from normal skin along the neckline of clothing. It may consist of redness, brown pigmentation and textural change of the skin. The red component is treatable with the V-beam laser. If there is also brown pigment, Intense Pulsed Light may treat both the red and brown pigmentation. The textural change is difficult to reverse with any treatment.
Leg Veins
Pigmentation Disorders
Disorders of pigmentation include brown (melanocytic) birthmarks, melasma and chloasma, post-inflammatory hyper-pigmentation, solar and actinic lentigines and freckles. The common feature with all of these conditions is an excess of the skin pigment melanin.
In many cases, the excess pigmentation may be treatable with the Nd:YAG (Neodynium:Yttrium Aluminium Garnet) Laser. In some cases, a medical rebate applies.
Other treatments for excess pigmentation include bleaching creams, chemical peels and intense pulsed light treatments.
Scars
Hypertrophic and Keloid Scars
These scars are difficult to remove completely but improvement can be achieved with a combination of treatments including vascular lasers for colour and intra-lesional steroid and 5-fluorouracil (5-FU) injections. Compression therapy with tapes or silicon gel may also be used.
Acne Scars
Scars from acne can present in many ways with some being raised and red (see Hypertrophic/Keloid Scars) and others and pitted or indented. They are often broad based or narrow and deep (ice-pick scars) and cover large areas of the face, chest and back.
Usually a combination of treatments will be required including laser skin resurfacing, facelift, subcision, excision, punch grafting as well as chemical peels, injectable fillers, laser and light based treatments. A program will be tailored to your particular type of scarring.
Tattoos
Traumatic, medical, amateur and body art tattoos can be treated with lasers to reduce or remove the inks or particles in the skin. At Adelaide Plastic Surgery Associates, we use both the Nd:YAG laser and the ruby laser for treating tattoos.
Some inks are better treated than others with black ink being the most successful. Green and light blue inks are difficult to remove completely and may leave some residual pigmentation or colour. Tattoos require several treatments over 1-2 years. Further information will be provided at your consultation.
Sun Damage and Skin Cancers
There is a broad spectrum of sun damaged skin and skin cancers. Some require surgical treatment (see skin tumours in reconstructive surgery section) and others are suitable for non-surgical treatment. Topical agents, photodynamic therapy (PDT), laser ablation and cryotherapy are just some of the treatments that can be used. Your doctor will advise you of the best treatment method for you.
Birthmarks
Birthmarks may be vascular (red) or melanocytic (brown). Some contain hair or other features. Your doctor will advise you of the most appropriate treatment. Most can be improved with laser therapy but some birthmarks require surgical treatment.
Wrinkles and Rejuvenation
There are many non-surgical treatments available for the reduction of lines and wrinkles and for an overall improval in appearance.
Dermal filling agents and muscle relaxing injections are available at Adelaide Plastic Surgery Associates as well as intense pulsed light, non-ablative wrinkle reduction, chemical peels and skin
care products as well as the full range of plastic and cosmetic surgery.
Dermal fillers include Collagen, Hylaform, Sculptra (formerly New-Fill) and Restylane Muscle relaxing injections are also used to treat frown-lines, smile-lines, crows-feet, forehead-lines, nasal-scrunch lines as well as manipulating eyebrow height and shape.
Acne
Adelaide Acne Clinic
Acne is a problem that plagues so many, from early teens to ongoing adult-acne. There are many treatments available from creams and cleansers to prescription medications. Unfortunately these treatments have varying results and some have serious side effects. Some of these have been highlighted in the media (Roaccutane)
This DRUG FREE treatment is a complete program to treat active acne on many different fronts. There are: products to cleanse the skin; Laser treatments to reduce the size of over-active sebaceous glands and Phototherapy for the elimination of the bacterial component. The treatment requires commitment, but in approximately one month, it can effectively eliminate up to 70% of inflammatory skin pimples. You will be receiving treatment to both the cause and the condition.
Skin management and maintenance is required to obtain the maximum benefit. It is necessary for you to follow the program regime between sessions and after the treatment is completed, to reduce the possibility of new acne occurring.
Your first visit will be with an Acne Consultant who will assess your acne and include a history and assessment of your skin. They will then go through and explain the program in detail and demonstrate the treatment machines. You will have all your questions answered so that you can make an informed decision to progress with the treatment.
The treatment cycle is generally completed in 4 to 6 weeks using a combination of therapies. This thorough, comprehensive acne treatment reduces the chance of acne related scaring and long-term skin damage. The treatments are comfortable and cause no collateral skin damage and are well tolerated by sensitive skin types.
Tumours
Benign tumours
The majority of skin moles and growths are harmless, hence being mainly of cosmetic concern. Nevertheless, the public awareness campaign about skin cancer risk motivates people to have many such moles removed for peace of mind. Thin or early growths may be removed by laser without causing a scar. Larger, more advanced growths may need to be surgically excised, consequently leaving a fine scar. We use the Sciton (Erbium YAG) laser for ablation of benign (and selected superficial skin cancers).
The Sciton is an extremely accurate ablative laser, that produces very little collateral tissue injury, hence minimizing complications such as scarring and hyper or hypo-pigmentation. We do not use chemical or electrical cautery, as these procedures give less control to the operator; consequently they have a higher complication risk profile.
Malignant Tumors
Skin Cancers
Australians have one of the highest rates of skin cancer in the world. This is due to our warm climate and the fact that many of us have fair skin, which is not suited to Australian conditions. Adding to this is our love of the great outdoors, where many of our activities are based. Ultraviolet radiation causes skin cancer by not only damaging cells in the skin, but also by depressing our immune system so that it is less able to destroy cancerous cells. We accumulate damage to our cells throughout our lifetime. It is never too late to start protecting our skin with a 30+ broad spectrum sunscreen, protective clothing and hats. Most skin cancers are curable, however early detection is important. Basal cell carcinomas (BCCs) are the most common skin cancer.
They usually occur on sun-exposed areas and grow slowly over time. They almost never spread elsewhere, but left untreated they will continue to grow, potentially making treatment more difficult. Squamous cell carcinomas (SCCs) are also very common in Australia. They can grow quickly and need to be detected early as they can occasionally spread if treated too late. Melanomas are another form of skin cancer that arise from our pigment producing cells (melanocytes). They are not as common as BCCs or SCCs, however they are potentially fatal and early detection is crucial. They can arise from moles, but often develop on normal skin. Melanomas, unlike BCCs and SCCs, occur not infrequently in younger people. The risk factors for developing melanomas include a family history of melanoma, excessive sun exposure, sunburn (particularly when young) and having many moles. Change in a mole is an important clue as is an irregular outline or colour. It is important for Australians to have regular skin checks to improve the chances of detecting early skin cancers. We have doctors that offer full skin examinations for skin cancers and are experienced in treating them. Depending on the type of skin cancer, we offer topical treatments (creams), photodynamic (cream followed by intense red light), laser therapy and surgery. We also have treatments for other sun-induced skin problems, such as sun spots, increased pigmentation, prominent capillaries and wrinkles.
Photodynamic Therapy
(A new treatment modality)
The treatment of skin cancer and pre-malignant skin lesions has traditionally relied on surgical excision. This remains the mainstay of treatment. The benefits are that the lesion is completely excised and there is histological confirmation of that fact. The benefits of a non-surgical solution are obvious, avoiding surgery, scarring and possible disfigurement. However one must always remember that when you are dealing with a malignancy these goals must always be secondary to the primary aim of cure. There are many non-surgical options for the treatment of skin cancer and pre-malignant skin lesions. These include
- Cryotherapy
- Laser ablation
- Topical 5-fluorouracil
- Imiqamod
- Intralesional interferon
Photodynamic therapy has a number of advantages in the treatment of skin cancer and pre-malignant skin lesions. It is a one-stage treatment with proven efficacy and may be used to treat a large area in a single setting. The process is as follows.
- Aminolevulinic acid (an anti-neoplastic agent) is applied to the lesion. This is absorbed by the
neoplastic (cancerous) cells.
- The aminolevelinic acid cream is covered and left in contact with the lesion for 2-4 hours.
- The lesion is then uncovered and excess cream wiped away.
- Red light is then applied to the lesion for 20 minutes.
- This results in cell damage that specifically targets the neoplastic cells, leaving the normal healthy cells unharmed.
The treatment period when the light is applied may be uncomfortable. Following the treatment there will be redness, inflammation, and crusting of the area for 1-2 weeks. Photodynamic therapy is only appropriate for selected skin cancer and pre-malignant skin lesions.
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