Dr. Raymond Goh Plastic And Cosmetic Surgery: 2016

Wednesday, 9 November 2016

REVISION RHINOPLASTY

Why is Revision Rhinoplasty Tougher?

Revision rhinoplasty, also commonly referred to as secondary rhinoplasty, is any time the nose has surgery performed on it after the first surgery. Revision rhinoplasty is more often than not more difficult to perform than a primary (first time) procedure. It takes more time to complete, will often require materials gained from other parts of the body, and requires more knowledge, experience, and technical skills on the surgeon’s side.

So why is secondary rhinoplasty much tougher to perform? Well, to begin with, the anatomy is no longer pristine, but rather, there will often be an abundance of thick, hard scar tissue from the previous operation. Scar tissue obscures the natural tissue planes that separate the various cartilages, bone, and soft tissue within the nose. Precise and careful dissection is often painstakingly necessary to separate the scar tissue from normal structures of the nose.

Defining the normal existing anatomy of the nose is only the beginning and this alone can take hours. Once the existing anatomy of the nose has been clearly defined, the surgeon then has to assess what’s present, what’s absent, what’s normal, and what’s abnormal. This assessment is followed by correlation with the current clinical picture and what is the desired final outcome. To achieve this desired result, the surgeon then has to begin formulating a plan to “re-build” the nose.

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The nose is like a tent, supported by its poles. Underneath the skin of the nose, there are inter-related cartilage structures that give shape to the nose. More importantly, these cartilages also keep the nostrils open and allows a patent airway to breathe through. Not uncommonly, a revision rhinoplasty case will present a nose that lacks structural support. Imagine a tent which has weak tent poles. A nose like this will lack strength and is at risk of collapse. One of the reasons why this type of nose may lack support may be due to over-removal of tissue from the previous operation.

To restore structural support to the nose, one has to find material (usually cartilage) to build and also support the construct of the nose. The cartilage that is used is often taken from the septum (the structure that runs down the middle of the nose), the ear, or the rib. “Harvesting” this cartilage material is another factor which adds to the complexity and time required for a revision rhinoplasty. It also adds to another scar on the patient.

At the outset at any rhinoplasty, one has to devise a plan together with the patient that aims to achieve the ideal outcome through one, first, and final, procedure. That been said, as with any other surgery, there is always the chance that the outcome achieved may not be 100% in line with what the patient expects. Complications can occur, and revision surgery is always a possibility. With nose surgery, both surgeon and patient need to be extra patient before they evaluate the final result. Swelling in the nose can persist for many months after surgery, especially in men and in thick skinned people.

One must be careful not to rush into performing a revision before the final shape of the nose is realised. The shape and function of the nose will continue to change and often improve as swelling subsides and the scar mature. Regular follow up between the patient and surgeon is therefore crucial to ensure that the patient is progressing in the right direction.

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Thursday, 6 October 2016

WHICH INCISION?

WHICH INCISION?

Effect of Incision Choice on Outcomes in Primary Breast Augmentation

If you are thinking about having breast augmentation, one of the factors that needs consideration is the site of the incision (where the cut in the skin will be created to place the implant through).

The options for the incision in breast augmentation are:

1. inframammary (in the fold underneath the breast)

2. peri-areolar (around the nipple)

3. trans-axillary (arm-pit)

4. trans-umbilical

The trans-umbilical approach has many drawbacks and is seldom performed. The trans-axillary approach has a scar that’s well hidden; however, this approach does not allow the surgeon as good an access to the breast when compared with the inframammary or peri-areolar approach.

In my practice, the inframammary and peri-areolar incisions are the most commonly used approaches for breast augmentation. They each have their pros and cons, and I would discuss these with the patient during our consultation, taking into consideration the patient’s personal preference. Both incisions give good access to the breast, both for primary as well as secondary procedures if they are ever required. Both incisions can heal up to become almost indistinguishable.

A study conducted in 2011 by Professor Scott Spears showed that the incidence of capsular contracture, which is scarring around an implant that can contract and cause symptoms, is highest with the transaxillary approach and lowest with the inframammary approach. One theory behind the cause of capsular contracture is bacterial contamination. The lower rate of capsular contracture with the inframammary approach may be related to the possible reduction in contamination by bacteria (theoretically, the the nipple or armpit can be a source of bacteria). The occurrence of capsular contracture can be unpredictable, and further studies on this condition are been carried out to determine ways of minimising their occurrence.

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Thursday, 8 September 2016

Consult Dr. Raymond Goh to Experience the Great Effects of Plastic Surgery

If you are thinking about going for a plastic or cosmetic surgery, then you must consult with Dr Raymond Goh the Best cosmetic surgeon in Brisbane. He is the highly qualified Australia based specialist plastic surgeon in Brisbane. He will answer all your queries and doubts related to the all surgical procedures. They make sure the client is fully satisfied with their services and client’s safety is always their first priority. Dr. Goh performs both reconstructive and cosmetic plastic surgery. His practical and clear cut approach to revive and improve the body parts gives natural, satisfying and enduring results.

You will get the knowledge of various procedures from their website, such as:

Breast Procedures: The Shape and size of women breasts can play important role in women body. Women who are not satisfied with their breast size or its appearance, they offer many procedures. Talk to Dr. Goh and consult about the available Breast Reconstruction Procedures in Brisbane.
Hand surgery: Your hands are very important part of your body to do the day to day activities. Dr. Goh has a great experience in treating a wide variety of common hand issues.
Facial Procedures: If you want any kind of facial procedures to enhance its appearance and improve your natural beauty and looking for the best nose surgery or facelift cosmetic surgery in Brisbane. Have a discussion with Dr Goh today about your goals for facial renewal and enhancement.
Body Procedures: Dr. Goh helps you and guide about what body procedure and will guide about which body procedure is right for you. They also offer various safe, effectual procedures that will help you out in achieving a perfect body shape.
Skin Cancer: Surgical treatment of skin cancer can result in ugly scars which can only be treated by a plastic surgeon. Their team is high experienced in these treatments.

Don’t wait just consult Dr. Raymond Goh, he and his team are devoted to providing specialized and personalized cosmetic care services in stress free surroundings. They completely understand that the decision of plastic and cosmetic surgery is an important and life changing task. That is why it is imperative for you to be entirely informed about the specific procedure you are thinking to go for.

Thursday, 1 September 2016

BREAST AUGMENTATION COMPLICATIONS

Breast Augmentation Surgery: Potential Risks

Breast augmentation and breast lift (mastopexy) procedures can dramatically improve the femininity and self confidence of women seeking enhancement of their breasts. The majority of women having breast augmentation will travel through their procedure uneventfully. There are certain things after the operation that should be expected, such as swelling, mild to moderate discomfort, and temporary numbness – these should be communicated to the patient prior to surgery. The benefits of having a breast augmentation or lift should also be balanced with comprehensive discussion on the potential risks and complications of undergoing the procedure.

As common as it is, and as much as it is promoted, discussed, and popularised in social and popular media, the potential risks of breast augmentation and lift should never be trivialised. It is still a surgical procedure, and all surgical procedures carry potential risks. The list of possible complications of breast augmentation and lift is exhaustive, but the important ones include:

1. Bleeding. If bleeding is significant enough, this may warrant a return to the operating theatre, and evacuation of the haematoma (collection of blood) and identification and cessation of the source of bleeding. The signs of bleeding include an increase in pain and swelling/size of the breast. If this occurs, you should immediately contact your surgeon or hospital emergency department.

2. Infection. This is rare. However, if an infection develops around the implant becomes severe enough, it may be necessary to remove the implant and clean out the wound.

3. Numbness. This usually recovers after several weeks, but may persist for longer in some women.

4. Capsular Contracture. This is scarring around the implant which may be severe enough to cause symptoms. It can occur in the short term or many years after placement of the silicone implants. The body will naturally form a layer of scar tissue around the silicone implant – this is expected, normal, and is called a capsule. A capsular contracture occurs when the scar tissue becomes thick and firm enough to cause discomfort, palpable hardness, and visible deformity. A surgical procedure may be required (capsulectomy) to remove the capsule if symptoms are severe enough.

5. Asymmetry. There can be many reasons why breast may appear not exactly symmetrical after an augmentation or lift procedure. It may be related swelling, capsular contracture, or due to technical aspects of the pocket creation, pectorals muscle release, nipple positioning, degree of skin adjustment, and establishing the inframammary fold. The implants may take several weeks to settle into their final position whilst the swelling dissipates, and it is important during this time that you diligently wear the supportive garment provided.

6. Complications related to the general anaesthesia. These include blood clots, chemical imbalances, and heart and lung related issues.

Whilst complications after breast augmentation and lift surgery are not common, when they do occur, they can impact upon the patient’s physical and emotional wellbeing, and cause a significant setback in their overall expectation. It is important at this time that the patient is fully informed of and understands what is occurring and the possible reasons behind it. Sometimes, however, a complication can occur without any clear reason and even after the most perfectly executed surgery. Whatever may be the case, it is important that the surgeon communicates to the patient how the problem can be fixed (if a secondary procedure is indicated) and what is to be expected.

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Friday, 26 August 2016

Best Cosmetic Surgeon in Brisbane

Welcome to Dr Ray Goh’s Plastic and Cosmetic Surgery practice. Dr Goh and his staff are committed to delivering professional and personalized care in a relaxed setting. We understand that the decision to embark upon plastic and cosmetic surgery can be a major and life-changing undertaking. It is therefore important for you to be fully informed about any procedure you may be considering.

This website provides a wealth of information on the most common cosmetic and plastic surgery procedures performed by Dr Goh. We are here to answer all your questions and concerns regarding surgical procedures, what to expect, and the risks involved. Your ultimate satisfaction and safety are our priorities.

Dr Raymond Goh is a fully qualified Australia-trained specialist Plastic Surgeon (FRACS, ASPS, ASAPS), who performs both reconstructive and cosmetic plastic surgery. His time tested and straightforward approach to rejuvenating and enhancing the human form aims to produce natural, pleasing, and lsting results.

If you are considering plastic or cosmetic surgery in Brisbane, we invite you to visit our office for a personal consultation with Dr Goh. We look forward to meeting you in person.