Dr John Kippen Plastic Surgeon


  Contact : 1300 KIPPEN (1300 547 736)

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Under your skin.

With time, sun exposure, ageing and genetic changes, our skin becomes less compliant, thinner, more wrinkled and sagging. There are, however, numerous treatment types we can choose from to help reduce or reverse these changes.

With these treatments, the skin is essentially subjected to a controlled, limited depth, mild injury that stimulates it to heal and recover. Part of the recovery is to deposit collagen, resurface the upper layers and tighten the skin. Benefits, when combined with good skin care and sun protection, may be long-lasting.

There is a balance between outcome, recovery and depth of treatment. The deeper or more severe the treatment, the more significant the result but this is at the expense of a longer recovery and more downtime. More superficial treatments may need to be repeated to obtain similar results but each treatment has little or reduced downtime and recovery.

Treatments can be chemical (chemical peels), physical (needling, dermabrasion, microhydrabrasion), light-based (laser, IPL, Fraxel) or radiofrequency (thermage).

 

Skin Peels
Skin peels can be superficial, medium or deep. Modern superficial and medium depth peels are very popular and slough away and peel the upper skin layers. Rejuvenated skin is smoother and less wrinkled. Pore size and pigmentation may also be improved.

Pretreatment requires skin preparation to optimize the results. An anaesthetic is not usually needed with these peels (deep peels usually need an anaesthetic). Face, neck and chest are usually combined in a single treatment. Hands may also be treated. Examples are alphahydroxy acids (superficial), tricholoroacetic acid (medium) and phenol (deep) peels.

 

Skin Needling
Skin needling uses a roller containing fine, medical grade needles that is rolled over the skin surface. Multiple small holes are pierced in the skin, stimulating new collagen growth and improving texture. Needle length varies from shorter more superficial rollers, used at home, to longer, deeper penetrating needles used by practitioners. Fibrous scar tissue may be softened.

The results are progressive and improve over months. Care must be taken with poor scar tendencies and keloid scarring. Repeat treatments or ongoing home treatments maintain the results.

 

Microhydrabrasion and dermabrasion
Microhydrabrasion is a superficial exfoliation technique. Dermabrasion is deeper and removes the upper skin layers. Either a rotating burr or brush is used. Small or large areas can be treated. Again the healing process stimulates collagen and the new skin surface is smoother, fresher and finer textured. Scar tissue and pigmentation can be removed.

 

Intense Pulsed Light 
IPL or Intense Pulsed Light uses light energy to cause a recoverable, mild skin injury. It is very useful in treating pigmented areas, small red blood vessels and broken capillaries because the darker- coloured tissue preferentially absorbs more light energy. Adjacent lighter areas absorb less. Increasing the wavelength of IPL allows deeper penetration in the skin. Healing then tightens the skin as collagen is deposited.

 

Other Treatments
Fraxel uses individual columns of light that penetrate the skin. Collagen in the surrounding skin is stimulated to heal these columns. Columns are replaced and collagen is deposited in the skin, improving its appearance. Treatments can be repeated and downtime is proportionate to the density of treatment.

 

Thermage uses radiofrequency to impart heat to the deeper, collagen-rich skin layers. Healing stimulates this collagen which tightens and may lift the skin. All skin types can be treated as skin colour is less important in the procedure. Some immediate results are visible but the changes usually progress gradually up to six months.

 

All these treatments should be supplemented with ongoing skin care and sun avoidance. Good Quality cosmeceutical products, used daily, will maintain and prolong theses changes and results. They also increase the interval between any subsequent treatments.

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Taking years off your eyes.

The area around our eyes often reveals the first sign of ageing. Discover how a simple procedure on your eyelids can help turn back the clock.

Our eyes are the windows to our soul, showing expression and emotion. But as we grow older, the area around our eyes can make us look tired, angry, wrinkled or puffy. Bulges, skin excess and fullness are also common.

Natural ageing process
Changes of ageing involve skin, muscle and fat layers. In the lower eyelids – a structural, supportive layer – the orbital septum also bulges with time. This allows the deeper fatty pouches to protrude forward, resulting in puffiness or bulging of the lower eyelids. Each of these layers need to be addressed in the correction.

A thorough examination determines the contribution of each layer and correction may involve each or all of these layers. It is also important to balance both the upper and lower eyelids. Correcting only the upper lids may make the lower eyelids appear worse.

Drooping or ptosis of the eyebrows may contribute extra skin to the upper eyelids. Eyebrow position, in resting state, must be assessed.

Lazy eyelids or low upper eyelid position may overlap the colour portion of the eye. This can also be corrected.

Planning the surgery
After a full medical history, a complete examination of each of the eyelid layers is performed. Upper, middle and lower divisions of the face are also assessed. Any abnormal findings may prompt further investigation. Multiple photographs document the eyelids from frontal, oblique and side views. These also help with planning of surgery.

Most surgeons will show photographs of the surgery, recovery and likely outcomes. Handouts are useful references to keep. There are risks associated all surgery and these should be fully understood.

Surgical procedure
Incisions are planned so the resultant scars are well hidden. An ellipse of skin is removed from the upper lids. This may extend out to the crows feet where many people have extra skin or lateral hooding. Underlying strips of muscle may be removed. Fatty tissue from the medial or middle part of the upper lids may also be removed. Careful control of bleeding points and stitching completes the surgery. Placing the lower incision just below the eyelash line hides the resultant scar.

Muscle is left on the lower eyelid to support the position of the eyelid. Lower down access is gained to the deeper tissues. Close to the junction of the orbital septum and cheekbone, the fatty tissue is conservatively removed. The supporting septum is then repaired. Fatty tissue may be repositioned to prevent hollowness. Very little skin is removed from the lower eyelids. In general, the lower eyelids are under-corrected. During the healing period, temporary dissolving stitches may be used to support the lower lids.

General or local?
Depending on how much tissue needs to be corrected, the surgery can be performed in the rooms under local anaesthetic or in a hospital or day-surgery with general anaesthetic. Local anaesthetic contains adrenaline which causes small blood vessels to contract – this helps limit the bleeding and bruising. It is possible to go home the same day as surgery although some close to stay overnight.

Many surgeons use cool packs to help with swelling and bruising. Using local anaesthetic also means a number of pain-free hours after the surgery. In general the surgery is not considered too painful.

Post-op care
Regular reviews are completed after surgery. Advice on wound care, scar management, lid massage and healing is important. Most swelling and bruising has settled by two weeks. Some swelling and dryness may persist longer. A gradual return to full activities is encouraged. Return to sport and exercise is dependent on recovery rates. Generally the surgery is well tolerated with favourable outcomes.

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Gynaecomastia – You are not alone

Gynaecomastia is the development of male breast tissue. Although the term is not well-known, the condition is very common.

In fact, about 60% of newborn boys will have it due to their monthers’ hormones crossing the placenta. About 60% of adolescent boys will develop breast tissue at puberty; about 60% of men older than 70 will develop the condition; and during mid-life approximately 30% of men will have the condition.

Either side of the chest or both sides can be affected – often to a variable degree. Gynaecomastia is usually asymptomatic and painless. Some people do develop tenderness, soreness and pain, especially if pumped or knocked. This may affect the breast or nipples. Most men or boys complain about the appearance and being self-conscious at the beach or while swimming.

 

Why does it occur?
No cause may be found for the growth of breast tissue. Known causes include physiologic – newborn, teens and older men where the breasts develop due to hormone changes. There are also many medication or drugs that may result in breast tissue growth.
It is important to exclude any treatable causes – which include liver disease, kidney disease, thyroid disease, adrenal gland disease, hormonal changes or imbalance and some cancers. Testicular developments or disease may also play a role.
Pseudo or false gynaecomastia is fatty deposits without obvious glandular breast tissue. Importantly, there is no association between the defeloopment of gynaecomastia and male breast cancers.

 

How is it treated?
Treatment options depend on the cause. Pseudo-gynaecomastia – or fatty changes – may respond to weght loss. Hormone replacement or hormone blocking medication may resolve those due to hormonal changes.
Surgery remains the treatment for others. Liposuction is used for smaller, softer breast tissue removal. An additional incision may be required to remove any remaining fibrous tissue. The  biggest advantage of liposuction is a few small incisions are used. Not all gynaecomastia is suitable for liposuction as the firmer, harder breast tissue may not be easily removed.

 

Surgery
Open or traditional surgery usually places the incision around half of the areola. Through this fairly small cut the surgery is performed. Instruments with fibre-optic lights facilitate the surgery. Liposuction may be combined to blend the edges of the resected tissue to the chest wall. A big advantage of this surgery is that any skin excess can be  addressed and removed. Once the skin has stretched or lost elasticity, it needs to be removed (this does leave additional scars).

 

Complications and risks
Surgery is usually performed in hospital with a combination of local and a light general anaesthetic, depending on the extent of the surgery. The usual risks of surgery apply, including pain, bruising, swelling, infection and scarring.
There is a relatively high risk of bleeding (haematoma) or fluid collection (seroma). Commonly plastic or silicone drainage tubes are used. Compressive dressings may be used to limit these complications.
Occasionally, the skin may tether to the underlying muscles, there may be irregularities in the remaining fatty tissue. A saucer-shaped indentation may occur under the nipple if sufficient tissue is not left in this area.
Most surgeons will send the breast tissue for laboratory analysis to exclude any changes. In general, the surgery is very well tolerated with a high degree of satisfaction. Recovery is usually quite short with a return to activities, work and exercise.

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Wrinkles

John explains the different types of wrinkles, how treatment is assessed and what options are available to someone looking for treatment.

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