Cosmetic Surgery & Medicine by Dr John Flynn

Cosmetic Surgery & Medicine 

Dr John Flynn

XXX 

Dr John Flynn 

MBBS, Dip RACOG, FRACGP, 

Dip.P.Derm (UK), FACCS 

Cosmedic and Skin Clinic 

1300 88 13 88 

www.cosmedic.com.au

about the ACCS 

The overriding aim of the College is easily summarised: 

raising standards… protecting patients. 

The Australasian 

College of 

Cosmetic Surgery 

(ACCS) 

Dedicated to quality, ethical 

and responsible practice. 

WHO WE ARE 

The ACCS is a multi-disciplinary 

body including general surgeons, 

dermatologists, ear nose and throat 

surgeons, ophthalmologists and 

other doctors who specialise in 

cosmetic surgery. 

The factor that unifies this divergent 

group is that they all need to obtain 

additional specialised education, training 

and experience beyond their original area 

of postgraduate specialisation before 

becoming competent in cosmetic 

medical practice. 

our vision 

To have Cosmetic Medical Practice 

recognised as a new Medical 

Specialty, performed only by certified 

cosmetic practitioners. 

our mission 

To ensure the safe provision of cosmetic 

surgery and non-surgical procedures 

(such as laser and light treatments, dermal 

fillers and wrinkle relaxant injections) to 

the Australian general community through 

supply of appropriately trained and 

certified medical practitioners. 

In the interests of patient protection, the Australasian College 

of Cosmetic Surgery (ACCS) was established in 1999 to bring 

regulation and accountability into the practice of cosmetic 

surgery and cosmetic medicine. 

The goal of the ACCS is to ensure the safe provision of 

cosmetic surgery and non-surgical procedures to the Australian 

general community through supply of appropriately trained and 

certified medical practitioners. 

Cosmetic medical practice is a well defined and unique 

medical branch, currently performed by medical practitioners 

from various specialties including dermatology, general 

surgery, general practice, plastic and reconstructive surgery, 

oral and maxillofacial surgery, ophthalmology, otolaryngology 

and gynaecology. 

The ACCS is the only group in Australia with a single 

focus on cosmetic surgery and medicine and is the only 

one that offers formal training and accreditation in cosmetic 

medicine and surgery. It has a medical faculty that accredits 

cosmetic physicians and a surgical faculty that accredits 

cosmetic surgeons. 

Another important initiative undertaken by the College was 

the introduction of a Code of Practice in 2009. It was authorised 

by the Australian Competition and Consumer Commission 

(ACCC). The Code covers, among other things, advertising 

and other promotional conduct, informed consent guidelines, 

monitoring of the code and has an extensive governance 

regime including independent compliance audits and reports 

to the ACCC. 

How qualified is your cosmetic doctor? 

Are they a Fellow of the Australasian College of Cosmetic 

Surgery? Do they have the right to display the symbols below? 

These symbols denote that not only is the doctor a Fellow of 

the Australasian College of Cosmetic Surgery but also they 

have successfully participated in a continuing education and 

recertification programme. This, unlike that of other Colleges, 

is specific for cosmetic medicine and surgery. 

CERTIFIED 

IN COSMETIC 

SURGERY 

c o s m e t i c s u r g e ry & m e d i c i n e w w w. a c c s . o r g . a u / / 3

Male hair loss 


MBBS, Dip RACOG, FRACGP, Dip.P.Derm (UK), FACCS

profile 

ABOUT 

DR Flynn 

Dr John Flynn is an internationally recognised cosmetic doctor with more 

than 20 years of experience. Specialising in facial cosmetic surgery and 

non-invasive facial rejuvenation techniques, Dr Flynn also has significant 

experience in breast augmentation, liposculpture and laser surgery, as well as 

a special interest in the treatment of skin cancer. 

As a Foundation Fellow and Chief Censor of the Australasian College 

of Cosmetic Surgery, as well as former President of the College, Dr Flynn 

participates in the yearly re-certification programme to ensure he stays up-todate 

with the latest cosmetic surgery and medicine advances. He has studied 

extensively and holds qualifications from Australia and overseas. 

Dr Flynn is committed to enhancing the natural beauty of his patients, helping 

to boost their confidence and help them feel good about themselves. From his 

clinic on the Gold Coast, Dr Flynn offers each of his patients individual, expert 

advice on the best treatment options available to them. 

In addition to his thriving practice, Dr Flynn is regularly invited to present 

at academic meetings around the world, and conducts training courses in 

cosmetic surgery, laser and cosmetic medicine. He is proud to consult for 

a number of product companies, helping them formulate protocols for the 

avoidance and management of complications. As well as publishing the Journal 

of Cosmetic Surgery and Medicine, he has authored many articles. 

Dr Flynn and his team acknowledge that one of the most pressing concerns 

faced by patients considering any cosmetic procedure is whether they are 

going to look ‘too’ different. ‘It is very important to us that after a procedure 

is performed the patient looks “natural” and not “over-done”,’ he says. ‘We 

appreciate the confidence our patients have in the doctors at our practice 

and we do our best to respect that confidence. Cosmetic surgery is a very 

personal issue and everyone’s needs are different. We recognise this and strive 

to individualise treatments to suit each patient’s requirements.’ 

Dr Flynn’s personal approach, commitment to natural-looking results and 

dedication to continued training and education has resulted in an ever-growing 

list of satisfied patients. 

John and his wife Narelle John and Narelle’s son Sean John and Narelle, with their son Sean and his fiancée Philippa 

C o s m e t i c s u r g e ry & m e d i c i n e w w w. a c c s . o r g . a u / / 5

DR JOHN FLYNN 

LESS IS MORE 

DR JOHN FLYNN EXPLAINS A FULL FACELIFT 

IS NOT ALWAYS NECESSARY. EXCELLENT 

RESULTS MAY ALSO BE ACHIEVED WITH 

LESS INVASIVE TREATMENTS. 

According to Dr John Flynn, more and more patients at his Cosmedic & 

Skin Clinic on the Gold Coast are asking how to achieve the best cosmetic 

outcomes with the least amount of surgery. ‘With advances in both 

technology and techniques, it seems the current thinking in cosmetic surgery is 

less is more,’ he says. 

While facelift surgery is still the best option for sagging features, too much 

skin or reversing gravity, patients are now showing a clear preference for having 

6 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U . A C C S . O R G . A U

Dr john flynn 

‘There is a lot 

that can be done 

before we need 

to go as far as a 

facelift’ 

smaller procedures earlier to postpone the need for more radical surgery. ‘There 

is a lot that can be done before we need to go as far as a facelift,’ Dr Flynn says. 

Dr Flynn says a series of less dramatic procedures at regular intervals is 

attractive to patients. ‘Not only is it less obvious that someone has had something 

done but the results are more natural looking. This concept of maintenance rather 

than radical rescue is really the leading edge of cosmetic practice,’ he says. 

By taking cosmetic surgery gradually – over a period of months or even 

years – a patient is more likely to be satisfied with the outcomes. ‘For instance, 

a patient may have a combination of eyelid surgery and a peel. Some time later, 

when she is accustomed to her rejuvenated look, she might decide to have 

something further and perhaps a laser photo rejuvenation may be in order. Then, 

of course, there are the fillers and other anti-wrinkle treatments.’ 

Non-surgical options can be combined with minor facelifts (such as the minilift 

or S-lift), neck lifts, brow lifts, eyelid surgery, laser resurfacing, cheek implants, 

facial fat transfers and facial liposculpture, all of which are becoming less invasive 

with quicker recovery times. 

Finding the best combination for each patient requires a thorough assessment 

of their individual issues. ‘We are all unique and a good doctor’s skill lies in 

retaining the elements that make us who we are,’ Dr Flynn says. 

Soft skin program 

Dr Flynn’s Soft Skin Program combines a series of short treatments that are 

effective whether used in conjunction with surgery or as stand-alone treatments. 

It is designed to put back the glow factor. 

Skin 

For skin texture and complexion, peels and non-ablative laser treatments target 

brown pigment problems and red vascular issues like broken capillaries and red 

blemishes. Stronger lasers for skin rejuvenation can also help tremendously. 

Facial balance 

The full range of dermal fillers can be used to correct lines and wrinkles: soft 

fillers for fine lines and firmer fillers for facial contouring. Longer lasting fillers 

should be considered as an option. 

Sagging skin 

This is where lifting techniques are best employed. In good hands a facelift is the 

best procedure to lift sagging skin. But there are alternatives. 

Thread lifts 

Threads require no surgery and leave no scars. Well placed and anchored 

threads provide an alternative to a facelift for suitable patients. Dr Flynn has 

pioneered the use of thread lifts in Australia and internationally and also teaches 

surgeons how to use the threads. 

‘Whatever procedures you decide to proceed with, don’t forget that skin care, 

complexion and glow factor are essential for looking your best,’ says Dr Flynn. 

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 7

DR JOHN FLYNN 

MAKE ME OVER 

COMBINING DIFFERENT TREATMENT OPTIONS IS 

THE BEST WAY TO ACHIEVE A COMPLETE NON- 

SURGICAL FACIAL MAKEOVER, SAYS QUEENSLAND 

COSMETIC DOCTOR DR JOHN FLYNN. 

The telltale signs of ageing can manifest in many ways and at different 

stages in a person’s life. Whereas one person may succumb to fi ne 

lines and wrinkles relatively late in life, another may develop deep folds 

and sagging skin in their early years. The key to restoring youth to someone’s 

appearance, therefore, is to combine a number of techniques and procedures 

to address the specifi c concerns of each individual patient. 

By using a combination of laser resurfacing, dermal fi llers and other 

minimally invasive techniques, surgical intervention often can be postponed 

or even avoided. ‘Today, a “facelift” is no longer a purely surgical experience,’ 

says Dr John Flynn from Queensland. Dr Flynn prefers to combine conservative 

surgery with facial rejuvenation procedures such as laser resurfacing, 

thread lifting, dermal fi llers and muscle relaxants depending on the needs 

of each patient. 

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‘Often a face 

cannot be fully 

rejuvenated 

without 

restoring the 

volume lost in 

the cheeks and 

other areas of 

the face’ 

Typically, the patients Dr Flynn sees fall into two different age groups. ‘In 

younger patients, it is possible to use minimally invasive techniques to enhance 

a particular feature, or to create a desired shape. In older patients, it is more likely 

we need to replace lost volume, using dermal fillers, for example,’ he explains. 

A youthful face is usually fuller, with well-supported fat, full-cheeks and 

smooth contours. With age, this volume dissipates, often leaving sunken cheeks 

and harsher angles, which combine to leave an aged appearance. Although antiwrinkle 

injections can be used to smooth the lines and wrinkles that develop on 

the face over time, often a face cannot be fully rejuvenated without restoring the 

volume lost in the cheeks and other areas of the face. 

‘Where facial volume has been depleted with age, augmenting techniques 

such as dermal fillers and fat transfer can be used in combination with anti-wrinkle 

injections to achieve an overall, non-surgical facial rejuvenation,’ says Dr Flynn. 

A number of different fillers are available, all of which vary in their longevity, 

composition and viscosity. Depending on the individual circumstances of each 

patient, Dr Flynn uses a combination of ‘superficial’ and ‘deeper’ fillers to both 

address skin issues and reshape and remodel the face. 

‘Dermal fillers can be injected into different areas of the face to smooth 

superficial lines, wrinkles and deeper folds,’ explains Dr Flynn. ‘However, more 

permanent fillers can be used to reshape and remodel the face, in order to create 

a more balanced and harmonious face shape.’ 

Complementary procedures such as anti-wrinkle injections to tackle fine lines 

and laser skin treatments to improve the tone and texture of the skin can be 

administered at the same time, or as part of a program spread over several 

weeks, in order to fully refresh a patient’s appearance. 

‘In order to completely refresh and rejuvenate a patient’s appearance it is 

important to address the texture and tone of the skin,’ says Dr Flynn. ‘The skin is 

the fabric that covers the entire face, so when looking to perform a combination of 

procedures on the face we have to look at how to correct the quality of the fabric 

as well.’ 

Dr Flynn prefers to use the SmartXide Dot Fractional laser. ‘We call it the “Hot 

Dot”, he says. ‘As a CO 2 

, fractionated laser, I believe it offers optimal recovery 

and is versatile enough to treat various issues ranging from age-related concerns 

to acne scarring.’ 

The procedure works by imparting a high energy burst of laser light in 

microscopic ‘dots’ across the skin’s surface. Because it is ‘fractionated’, the 

laser leaves the skin surrounding each impact point in tact. The healthy skin can 

then heal the thermal injuries by stimulating the production of new collagen. 

‘The body’s natural healing process creates new, healthy tissue which replaces 

skin imperfections,’ Dr Flynn explains. ‘Collagen shrinkage as a result of thermal 

damage results in some immediate skin tightening, with further improvements in 

skin tightness and collagen density occurring more gradually over time.’ 

It is important that the methods used to refresh and restore youth to the 

face are tailored to each patient. The key to non-surgical facial rejuvenation is 

a thorough consultation, during which the surgeon can explain what can be 

achieved and decide upon the optimal treatment plan for each patient. 

By restoring lost volume, addressing the tone and texture of the skin, 

and by smoothing fine lines and wrinkles, patients can look forward to 

a refreshed, rejuvenated appearance. ‘Using a combination of different 

minimally-invasive non-surgical techniques can restore a youthful 

appearance whilst preserving individuality.’ 

C o s m e t i c s u r g e ry & m e d i c i n e w w w. A C C S . o r g . a u / / 9

DR JOHN FLYNN 

A BALANCING ACT 

DR JOHN FLYNN DISCUSSES COMBINATION 

SURGERIES THAT HELP TO CORRECT 

DISPROPORTIONATE BODY SHAPES. 

Many people have dieted, exercised and are at their optimum healthy 

weight and yet still feel self-conscious in a swimsuit because some 

fat simply refuses to budge, especially on their hips and lower tummy. 

Similarly, many other women are unhappy with their smaller breasts compared 

with their curvy hips. 

‘A lot of women are concerned about their disproportionate body shape – 

lack of projection on top or too much projection at the bottom,’ says Dr John 

Flynn from Queensland. 

According to Dr Flynn, changing body shape is a matter of balance. ‘Breast 

augmentation can fi rm up the top end, while liposuction can trim down the 

bottom half of the body so the patient feels more comfortable with her body.’ 

In his initial consultation with each patient, Dr Flynn tries to ensure a 

1 0 / / C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U


‘Breast 

augmentation 

can firm up the 

top end, while 

liposuction can 

trim down the 

bottom half of 

the body’ 

balance between what is possible, appropriate and aesthetically pleasing and 

the patient’s own desires. This means first a careful assessment of her body 

shape – including height, build and proportions. Length of bones, distribution of 

body fat and skin elasticity are also all taken into consideration. 

Dr Flynn says he often finds himself asking, ‘Do you realise?’. For example, to 

a woman with a short torso: ‘Do you realise that a much bigger breast implant 

might make you look shorter?’ Or to a patient contemplating liposuction: ‘Do you 

realise if I take too much off the bulge on the inner side of your thighs then the 

outer side won’t look right?’ 

Trying on a crop top with different-sized implants can give the patient an idea of 

how her breasts might look when enhanced. Dr Flynn can then advise her on how 

a boosted cup size would harmonise with her hips, height and overall silhouette. 

‘Determining the extent of liposuction (removal via a cannula of stubborn 

fat deposits that don’t normally respond to diet and exercise) around the hip, 

bottom and thighs to achieve the right balance takes a significant deal of skill 

and experience,’ he says. 

Dr Flynn measures the patient’s hip and thigh circumference, and seeks 

practical feedback from them. He asks her to show where her jeans are too 

tight or why she can’t wear a particular item of clothing. ‘This helps me decide 

the best treatment option to achieve the best results possible for each patient.’ 

Balance is also important when determining how much fat to remove. ‘I 

remove enough to give a nicer shape and contour. Too much may lead to an 

undesirable hollow effect or loose skin, which can then lead to an additional 

cosmetic problem,’ he says. 

While liposuction on the lower body tends to concentrate on the bottom, 

hips and thighs, Dr Flynn also performs liposculpture using very fine cannulae to 

access knees, calves and ankles. ‘Calves and ankles are more challenging, and 

involves making a straight calf more shapely or a chunkier calf finer.’ 

Dr Flynn says it is vital that patients have realistic expectations of body 

reshaping. ‘This means that improvement, not perfection, is the goal. Fatty 

bulges should be localised to a few areas and the individual should be near their 

ideal body weight. Liposuction will not replace good eating and exercise habits 

or counter obesity.’ 

Dr Flynn points out that there is no set formula for balancing body shape 

using cosmetic surgery techniques. ‘It’s not like the tide tables or engineering 

formulas where the answer is constant or predictable. It comes with experience 

and an innate eye, and is different for each individual patient.’ 

The patient also needs to think about balance in the way she perceives 

herself. ‘It’s important for her to balance the “me” she sees in the mirror and her 

feelings about her appearance with the total sum of her life,’ he adds. 

Balance also comes into play with the way the doctor allocates their time. ‘It’s 

important to maintain a balance of pre-operative consultation and post-operative 

care with the operation itself,’ he says. 

Dr Flynn finds that many of his patients have such a psychological boost from 

the results of their cosmetic surgery it gives them the incentive to exercise even 

more than before to improve other parts of their physique. 

When considering surgery to either augment or reduce certain parts of the 

body, patients need to be aware that all surgery involves some element of 

risk. The practitioner must have proper training and credentials, and extensive 

experience in the procedure. 

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The ACCS has, as Fellows, doctors of many 

disciplines, and not all practice surgery. The Faculty 

of Medicine represents these doctors who have 

trained specifically, and are recognised fully, in the 

field of Cosmetic Medicine. 

Cosmetic medicine can improve some of the most common signs of ageing 

such as facial lines and wrinkles; a gaunt and hollowed appearance; 

sun-damaged skin; acne and acne scars; a dull and uneven complexion; 

and sagging facial structures. 

Whether by using wrinkle injections, fillers, medical-grade peels or advanced 

light therapies, the array of choices available can treat just about any appearancerelated 

concern. Maintenance is the key and earlier, less-invasive procedures can 

actually delay the effects of ageing on the face, sometimes even negating the 

need for more invasive procedures at all. 

It is important, however, for prospective patients to thoroughly understand 

the procedure (or combination of procedures) they wish to undergo, regardless 

of whether it does not involve surgery. A skilled and accredited cosmetic doctor 

will help navigate each patient through the myriad of options, select the most 

appropriate course of action for the patient’s specific concerns and ultimately 

achieve the best possible, natural-looking results for the individual. 

Any cosmetic enhancement should be chosen for the right reasons and not in 

the impossible pursuit of perfection. Non-surgical cosmetic enhancement offers 

patients with realistic expectations the chance to look younger and rejuvenated, 

no matter what their age. 


COSMETIC MEDICINE 

THE 

AGEING 

FACE 

Facial hollows and gauntness due to loss of volume, shrinkage of the bone 

structures, loss of collagen and elasticity and the effects of gravity are all 

manifestations of the ageing face. While some of the skin-related factors can 

be reined in with healthy lifestyle choices and a good skincare regime, many of 

the characteristics of ageing are a matter of genetics. 

INTRINSIC & EXTRINSIC AGEING 

Cutaneous ageing is caused by two distinct processes – intrinsic and extrinsic 

factors. Intrinsic, or chronological ageing, is the inevitable genetically determined 

process that naturally occurs. Intrinsic ageing is determined by each person’s 

genetic clock and is affected by the degenerative effects of free radicals and the 

body’s inability to perfectly repair their damage. 

Over time, cells, tissues and vital organs deteriorate. These internal changes 

to the muscle, fat and bones are not as visible as the signs of ageing on the 

external organ – the skin. Skin shows the wear and tear of extrinsic ageing, 

which is environmentally induced and manifests in age-associated skin changes 

including thinning, laxity, fragility and wrinkles. In addition, sun-exposure leads to 

dyspigmentation, premature wrinkling, telangiectasia and actinic elastosis. 

Intrinsic ageing is a continuous process that usually begins in the mid-20s but 

may not become evident for decades. At this time collagen production slows and 

elastin loses its ‘spring’. Dead skin cells do not shed as quickly and turnover of 

new skin cells decreases. 

The apparent signs of intrinsic ageing include the loss and descent of underlying 

fat leading to hollowed cheeks and eye sockets, as well as loss of fi rmness and 

sagging skin as the bones shrink away from the skin due to bone loss. 

Genes control how quickly the normal ageing process unfolds. At a cellular 

level, ageing is thought to be related to the shortening of telomeres (the terminal 

portions of chromosomes) with each cell cycle, resulting in cell-cycle arrest or 

apoptosis once a critical length is reached. 

The extrinsic, or preventable environmental factors that magnify intrinsic 

ageing, often act together with the normal ageing process to prematurely age 

skin. Most premature ageing is caused by sun exposure, though others are 

repetitive facial expressions, gravity, sleeping positions and smoking. 

Lines and creases form over major and minor joints as a result of skin 

contractions that lie perpendicular to the underlying muscular vector force. 

However, relaxed skin tension lines (RSTL) are formed during relaxation and are 

created by the natural tension on the skin from the underlying structures. 



Structural changes 

Shrinking of facial bones also plays a role in ageing the face. Evidently, facial 

bones remodel their three-dimensional shape with age, showing the most 

pronounced difference measured in the T-zone. In women, the area between the 

brows and top of the nose (the glabellar angle) is shown to decrease as the area 

under the rim of the eyebrows retreats, resulting in sagging brows and deflated 

eyelid skin. In men, the glabellar angle decreases and the area supporting the 

cheeks (maxillary angle) is also shown to decrease. 

Additionally, the malar fat pad, which is responsible for cheek fullness, slides 

down and forward, pushing against the nasolabial fold and making the maxillary 

angle appear more pronounced. Bones can also recede in the pyriform angle 

(the opening of the nose), causing the appearance of an elongated nose and a 

drooping nasal tip. 

‘Extrinsic factors 

often act 

together with 

the normal 

ageing process 

to prematurely 

age skin’ 

loss of volume 

Facial ageing is reflective of dynamic and cumulative effects of time on the skin, 

soft tissues and deep structural components of the face. It is a complex synergy of 

skin textural changes and loss of facial volume. Many of the facial manifestations 

of ageing combine the effects of gravity, progressive bone resorption, decrease 

in tissue elasticity and redistribution of subcutaneous fullness. 

With age, facial fat descends and causes the shape of the face to change. 

The youthful face is typified by full, well-supported fat, and surrounding ligaments 

serve to fixate this volume of fat to underlying structure. Together with the 

volumetric fullness of the upper cheek region are well-defined contours such as 

a smooth S-shaped curve (commonly called the Ogee curve) of the cheeks when 

seen from an oblique angle and a clean neck/chin angle and jaw line. It is this 

pairing of both fullness and facial definition that accounts for the more tapered 

appearance of the youthful face. 

As this ligament support reduces, facial fat volumetrically comes forward and 

descends in the cheek, producing a squarer facial contour with less distinction 

between upper cheek volume and mid-facial fat. This lowering of the facial fat 

means that over time the face appears vertically longer than young faces. 

Facial fat also deflates with age and this is most apparent in regions with a 

high density of retaining ligaments, which are typically volumetrically full in youth 

(malar, preparotid, lateral and infraorbital rim, and lateral chin). Along with facial 

deflation comes a laxity in soft tissue caused by diminished support. 

Radial expression 

Facial ageing is not all vertical – the soft tissue that occurs along specific areas 

of the mid-face also undergoes radial expansion. The skin and underlying 

subcutaneous fat are densely attached to the deep facial fascia by retinacular 

fibres that weave in the skin, subcutaneous fat, superficial and deep fascia 

and muscle. 

For example, over time facial expressions cause the skin along the nasolabial 

line to disrupt the subcutaneous fat, disengaging these attachments and 

developing lines of differentiation on the face. This forces the skin and fat 

alongside the nasolabial fold to expand radially and fall out from the skeleton, 

explaining some of the nasolabial fold prominence in the ageing face. 

Radial expansion lateral to the marionette lines extending from the corners 

of the mouth downwards also accounts for some of the jowling that becomes 

apparent with age. 



FACIAL 

REJUVENATION 

A COMBINATION APPROACH 

Anti-wrinkle injections can smooth the lines and wrinkles that develop on the 

face over time, resulting in a more youthful-looking appearance. However, 

as natural fat dissipates with age, often a face cannot be fully rejuvenated 

without restoring volume lost in the cheeks and other areas of the face. 

Where facial volume has been depleted with age, augmenting techniques 

such as dermal fi llers and fat transfer can be used in combination with antiwrinkle 

injections to achieve an overall, non-surgical facial rejuvenation. 

A number of different fi llers are available, all of which vary in their longevity, 

composition and viscosity. Depending on their individual circumstances, patients 

may benefi t from superfi cial fi llers used to tighten the skin, in combination with 

deeper, longer-lasting fi llers designed to tackle deeper issues and reshape and 

remodel the face. 

Complementary procedures such as anti-wrinkle injections to tackle fi ne lines 

and laser skin treatments to improve the tone and texture of the skin can be 

administered at the same time, or as part of a program spread over several 

weeks, in order to fully refresh a patient’s appearance. 

It is important that the methods used to refresh and restore youth to the 

face are tailored to each patient. The key to non-surgical facial rejuvenation is 

a thorough consultation, during which the surgeon can explain what can be 

achieved and decide upon the optimal treatment plan for each patient. 



‘It is important 

that the methods 

used to refresh 

and restore youth 

to the face are 

tailored to each 

patient’ 

WRINKLE 

INJECTIONS 

T 

he appearance of deep frown lines and wrinkles can result in a prematurely 

aged appearance. Wrinkle injections are a popular facial rejuvenation 

treatment and are an effective non-invasive treatment for reducing lines and 

revitalising the appearance. 

Wrinkle injections contain a protein produced by the bacterium Clostridium 

botulinum. It is a muscle relaxant that is commonly used for cosmetic facial 

enhancement, particularly to treat crow’s feet around the eyes, the frown lines 

between the eyebrows (glabellar lines) and the worry lines across the forehead. 

The treatment works by blocking nerve stimulation to wrinkle-causing 

muscles, which prevents the muscle from contracting and signifi cantly reduces 

wrinkles and fi ne lines and can also help prevent the formation of new ones. 

A few tiny injections are administered just under the skin, reducing nerve 

stimulation to the targeted muscles. The procedure usually takes about 10 

minutes but this can vary depending on the number of areas being treated. 

Because men tend to have larger and stronger muscles, they often require more 

injections to achieve satisfactory results. 

Generally, no anaesthetic is required. The needles are very fi ne and only a small 

volume of the product is needed, so the procedure is typically only associated 

with mild discomfort. If the patient is particularly concerned, the practitioner can 

numb the skin over the area before administering the injection. 

After treatment for lines on the forehead, ultimately patients are physically 

unable to frown. Over the fi rst few days, the muscles gradually relax, and it often 

takes three to six days for results to become visible. The effects gradually wear 

off, so in order to maintain results repeat injections are necessary every three to 

fi ve months. 

Common side effects are generally restricted to minor temporary redness 

or bruising at the injection site. There is a very slight risk that it can cause a 

temporary weakness in nearby muscles, which may result in a slight drooping of 

an eyelid or eyebrow which may last from one to six weeks. Occasionally patients 

may experience a slight headache or nausea. 

Wrinkle treatments are not recommended for women who are pregnant or 

breastfeeding. All patients are advised to avoid the use aspirin, anti-infl ammatory 

drugs or blood-thinning agents, unless they are medically required, for two weeks 

prior to treatment to minimise bruising. 

With careful placement, a more youthful appearance can be achieved while 

maintaining natural expression and character. 

C O S M E T I C S U R G E RY & M E D I C I N E W W W. A C C S . O R G . A U / / 1 7


FILLERS 

Used to restore lost volume and smooth lines, fi llers are an increasingly 

popular way to rejuvenate the face. They are gel-like substances injected 

into different areas of the face to smooth lines, wrinkles and deeper folds. 

Fillers are also used to restore volume to the face where tissue has degenerated 

with age or where lipoatrophy (fat loss caused by disease) has caused the cheeks 

to collapse. They can also be used to fi ll in pockmarks and acne scars and 

to contour or reshape facial features, adding volume to lips and cheeks. More 

permanent fi llers can even be used to reshape the nose and jawline. 

There are a multitude of different fi llers on the market, ranging in longevity, 

composition and viscosity, depending on the individual patient’s needs. 

Fillers can be used in conjunction with wrinkle injections for a cumulative and 

complementary result. 

More permanent fi llers can even be used to reshape the nose and jaw line in 

order to create a more balanced and harmonious face shape. 

The vast majority of contemporary fi llers available are formulated with a 

humectant that occurs naturally in the human body throughout connective, 

epithelial and neural tissues and is particularly abundant in the dermis. These 

types of fi llers are biocompatible and biodegradable, and range in longevity, 

composition and viscosity. 

The humectant used in modern-day fi llers can attract up to 1,000 times its 

weight in water and is one of the main agents in maintaining hydration and a 

fresh, youthful appearance, as well a major component of tissue repair. 

COMPOSITION & LONGEVITY 

Filling superfi cial fi ne lines and moderate facial wrinkles, and for treating those 

with fi ne skin, calls for fi llers with lighter textures. Greater volumes of these fi ner 

fi llers may also be injected into the mid or deep dermis for subtle contouring of 

larger areas of the face such as the lips, cheeks and chin. Treatments can last 

around nine months, depending on the patient. 

Where a stronger and longer-lasting result is required, practitioners may opt 



‘Fillers are used to 

restore volume to 

the face where tissue 

has degenerated 

with age’ 

for medium volume fillers. These are intended for deeper injection to restore lost 

volume in areas like cheeks, under-eye hollows, nasolabial (nose to lip) folds and 

marionette lines (drooping mouth corners). They are also used to correct deeper 

facial wrinkles and folds and augment the lips. Results last for at around six 

months to a year, again depending on the patient. 

More robust and longer lasting fillers are used to revolumise larger areas such 

as the cheeks and mid-face, or fill out facial depressions, deep contours and 

hollows. Results can last around 12 months or more in some patients, and do 

not tend to migrate from the injection site. 

There is also a ‘permanent’ filler which can be used to fill nasolabial 

folds, enhance cheekbones, lips or the nose, and to smooth wrinkles or folds 

in the skin. This long-lasting filler does not migrate from the injection site, is 

biocompatible, non-toxic and non-absorbable, which means results last for a 

number of years – as many as 10 in some cases. 

Biostimulators 

Some volume injectables stimulate the patient’s skin to produce more of its 

own collagen and elastin over a period of weeks or months, to gradually restore 

more youthful and pleasing facial contours. They stimulate the fibroblasts (the 

key cells in connective tissue that produce collagen) to fill wrinkles and sunken 

areas as well as help tighten the skin. 

The amount injected at each session and the number of treatments 

required varies for each patient depending on volume loss and specific concerns. 

Results are subtle and progressive over a number of months and can last 

around two to three years. It is also designed to improve the skin’s overall texture 

and luminosity. 

Some ‘bio-stimulating’ injectables have a two-fold effect: on injection it 

immediately restores volume in addition to stimulating the growth of new 

collagen (neocollagenesis) over time. It is not suitable for the lips. Results 

generally last 12 to 18 months. 

fat transfer 

Another modality to smooth lines and plump facial hollows is fat grafting. Fat 

is harvested from the patient’s own body, usually from the thighs or buttocks, 

cleaned thoroughly and prepared for injection into the face. 

The grafted fat is used to fill nasolabial folds, enhance lips and restore 

lost volume to the cheeks. Some of the injected fat is reabsorbed by the body 

over time and results last an average of three to five years, depending on the 

individual patient. 

As the patient’s own body tissue is used there is no risk of allergic 

reaction or rejection. Patients have also noted an improvement in skin texture 

and colour. 

Traditional fat transfer techniques often led to the ‘overfilling’ of treatment 

areas, as practitioners weren’t able to accurately predict how much fat would 

survive the graft. However, with the technological advancements, results are 

much more consistent and predictable than in the past. 



SKIN REVISION 

TECHNIQUES 

PEELS 

Peels are solutions applied to the surface of the skin to strip away the outermost 

layers, revealing the fresh new skin beneath. Used to treat a variety of skin 

conditions, peels can improve problems from dryness or skin dullness to acne, 

rosacea and pigmentation. 

Ingredients range from naturally occurring chemicals and herbal extracts 

to synthetic chemicals, and their effects range from mildly brightening to 

aggressive resurfacing. Depending on the strength, peels can be administered 

by dermatologists, cosmetic practitioners and skincare professionals, and are 

recommended as a course of treatments. 



Natural peels 

Alpha hydroxy acid (AHA) peels are the mildest option, available in salon 

treatments and can be used on most skin types. They use lactic, fruit or glycolic 

acids to treat dryness and improve skin texture. Beta hydroxy acid (BHA) 

peels use salicylic acid to speed the skin cell shedding process and improve 

blemished skin. 

‘Light-based 

therapy targets 

the bacteria 

that cause acne 

inflammation 

whilst also 

improving the 

appearance of 

acne scarring’ 

Chemical peels 

Chemical peels are higher strength solutions that use different grades of acid 

to strip the skin of dead skin cells and promote the production of collagen and 

elastin in the skin. These chemicals – ranging from alpha hydroxy and salicylic 

acids to trichloroacetic acid and phenol – also vary in their depth of penetration, 

causing them to directly target specific concerns. Typically, the stronger the 

strength of the peel the deeper the penetration and the more severe the posttreatment 

side effects. 

The treatments typically cause stinging during application and various degrees 

of flaking after treatment, from fine flaking to sheeting, as the new layers of skin 

start to form. Chemical peels can be quite aggressive, so skin analysis during 

consultation is required to find out which peel is most suitable, and whether any 

allergic reactions will occur. 

Dryness, redness and peeling can be expected for up to a week after most 

peels, which feels similar to sunburn. It is imperative the peeling skin is not picked 

at or rubbed as it may cause scarring. Makeup may be worn to cover this, 

depending on the practitioner’s instructions. Using an unscented moisturiser can 

help relieve the tight sensation of treated skin, and a mild topical steroid cream 

or ointment can be used to soothe temporary swelling or redness. Sunscreen 

should be worn at all times while outside. 

ACNE 

Acne typically affects areas of skin where there is an over production of sebum 

(oil). Pustules and papules develop as a result of blockages in follicles caused by 

sebum and dead skin cells. This is often compounded by bacterium, which leads 

to inflammation and can result in scarring. 

Over-the-counter and prescription acne treatments work to speed up skin cell 

turnover, slough dead skin calls, reduce oil production, fight bacterial infection, 

limit inflammation and ultimately improve the appearance of acne. Medications 

may be applied to the skin (topical) or ingested (oral). Side effects such as 

stinging, burning or redness may occur, and results may not be seen for up to 

eight weeks. 

Moderate to severe acne is sometimes treated with antibiotic medication in 

order to reduce bacteria and fight infection. Women may also see an improvement 

in acne after taking oral contraceptives. 

Laser and other light-based therapies are often used to treat acne and acne 

scarring. Light therapy targets the bacteria that cause acne inflammation whilst 

also improving skin texture and lessening the appearance of acne scarring. 

Similarly, laser treatment works by damaging the sebaceous glands, lessening 

the amount of oil they produce. Certain cosmetic procedures including chemical 

peels and microdermabrasion are considered effective acne management when 

used in combination with other treatments. 



The appearance of acne scarring can be improved with the use of fillers; 

chemical peels, which remove the top layer of skin; microdermabrasion, which 

‘polishes’ the skin; and laser, light-based and radiofrequency treatments, all of 

which heat the dermis and promote the formation of new skin. 

‘Checking skin 

each month can 

help identify 

changes to be 

reported to the 

doctor’ 

SKIN CANCER MANAGEMENT 

As with many other cancers, screening can be the first line of defence, identifying 

abnormal skin tissue before a person has any symptoms. Regular exams of the 

skin by both the individual and their doctor increase the chances of detecting 

skin cancer early on, therefore providing an improved chance of survival. Most 

melanomas can be seen by the naked eye, typically growing on the surface of 

the skin before spreading to the dermis. Therefore, checking skin each month 

can help identify changes to be reported to the doctor. 

When skin is identified as abnormal, a biopsy may be performed. The doctor 

will remove as much of the suspicious tissue as possible with a local excision. 

The tissue will then be inspected beneath a microscope to check for cancerous 

cells. Identifying cancerous cells can prove difficult, and sometimes a falsepositive 

or false-negative indication may be given. Patients may therefore choose 

to seek the opinion of two pathologists. 

Surgery may be used in the management of skin cancers. Once the cancer 

has been surgically excised, pathological examination will determine whether all 

cancerous cells have been removed. If the skin cancer is large, the neighbouring 

skin may be moved to cover the wound, reducing the scarring and providing a 

better tone and colour match than a skin graft. 

Other techniques may be adopted to manage pre-cancerous conditions 

such as actinic keratoses, or non-melanoma skin cancers such as basal cell 

carninomas. Cryotherapy, for example, can be used to freeze tumour cells. Most 

commonly used for the treatment of actinic keratoses, a cryogen is applied to 

the growths in order to freeze them. The growths then form a dry crust that 

falls off within three weeks. Basal cell carcinomas may also be treated with 

electrosurgery. Once the top of the lesion has been removed, the underlying cells 

and bleeding points are cauterised with an electrocautery needle. A curette is 

then used to remove the base of the lesion. Photodynamic therapy is also often 

used to treat large area actinic keratosis lesions or non-melanoma skin cancers 

such as basal cell carcinomas. 

Thread lifting 

Thread lifting is a minimally invasive technique that elevates the soft tissues of the 

face using specially designed internal sutures and can deliver subtle yet effective 

results. The procedure involves the use of multiple fine biocompatible threads 

to lift and support sagging skin on the face and neck. Tiny ‘nicks’ are made to 

the skin, which are hidden in the sideburn area. Threads are then looped to the 

sagging soft tissues that support the face and neck, lifting and anchoring the 

facial tissue in an elevated, more youthful position. 

This process allows the threads to have a firm hold on the underlying tissues, 

without causing trauma to the outer layers. Acting as a kind of scaffolding, the 

soft barbs gently hold to the tissue as they lift the skin, complementing the natural 

line of the face or neck. Once in position, the body generates new collagen that 

surrounds each thread to maintain the lifting effect. 



New-generation threads are completely absorbable and dissolvable. This 

means the threads dissolve within around none to 12 months, yet still maintaining 

the revitalising and lift effect for several years to come. 

The procedure is typically performed under local anaesthetic and usually 

takes around one hour to perform. Patients can usually return home within one 

to two hours after the procedure, however patients should be aware the threads 

take a few weeks to settle and integrate properly with the skin. 

This procedure does not replace a conventional facelift; rather it offers patients 

a minimally invasive approach to address the early signs of facial ageing. Results 

tend to last around two to four years. 

Microdermabrasion 

Microdermabrasion removes the outer layer of the stratum corneum (outermost 

layer of the skin) to aid the skin’s natural process of sloughing off dead skin cells, 

improving the appearance of fine lines, sun damage and scars, and creates a 

more even tone and texture on the skin. 

There are a number of different types of microdermabrasion. Generally the 

procedure is carried out via jets that blast fine particles onto the face to dislodge 

hardened skin cells, although a wand can also be used on the skin’s surface to 

create the same effect. Crystal dermabrasion works by blasting the skin with 

microscopic crystal particles; diamond microdermabrasion uses a diamond 

head to lightly abrade the skin’s surface; and organic microdermabrasion uses 

medical-grade baking soda or milled grains that are gentler than crystals and 

more suitable for sensitive skins. A handpiece is used to vacuum up the stripping 

agent and skin particles during and after treatment. 

The treatment is generally well tolerated and can be compared to a more 

intense exfoliation. After treatment, the skin can feel hot and appear slightly 

red but this usually settles over a few hours. It’s generally recommended that 

a course of six treatments is carried out to improve problems such as age 

spots, but it can also be effective to treat blocked pores and blemishes with two 

to three treatments. 

Sclerotherapy 

Sclerotherapy offers an effective, less invasive alternative to diathermy and laser 

treatments to improve the appearance of broken capillaries and spider veins that 

occur as a result of ageing. 

The treatment involves injecting the unwanted blood vessels with a sclerosing 

solution (saline solution which induces the hardening of tissue) that causes the 

target capillary to shrink and eventually dissolve as the body naturally absorbs 

the vein. This process occurs over a number of weeks. 

Sclerotherapy is typically preferred to laser for eliminating large spider veins 

(telangiectasiae) as well as smaller varicose leg veins. Unlike a laser, the sclerosing 

solution additionally closes the ‘feeder’ veins under the skin that cause the spider 

vein to form, making any recurrence of the spider veins in the treated area less 

likely. Having said this, sometimes a single blood vessel may have to be injected 

more than once, some weeks or months apart, depending on its size. A number 

of vessels can be injected in any one-treatment session. 

While sclerotherapy is a relatively simple treatment, injecting the veins requires 

a high degree of skill and accuracy. Because of this, it is important to seek 

treatment from a properly qualified practitioner. 



light 

therapy 



The healing power of light has been recognised and used for thousands of 

years, dating back to the Ancient Greeks and Romans. Over the millennia, 

our understanding and use of light-based therapies have continually evolved 

to optimise results, reduce downtime and treat a wide range of skin conditions 

and ageing concerns. 

For cosmetic indications, light-based treatments can be broadly categorised 

as intense pulsed light therapy, photodynamic therapy and laser therapies. 

Intense pulsed light therapy 

Intense pulsed light (IPL) in cosmetic therapy uses light wavelengths that safely 

target either melanin or haemoglobin in the skin. It can be used to permanently 

reduce unwanted hair growth, fade brown spots and cauterise enlarged or 

broken capillaries and port wine stain birthmarks. Some treatments have been 

developed specifically to treat rosacea. 

Unlike lasers, IPL devices produce a broad spectrum of light in a range of 

wavelengths. The emitted light is further adjustable through the use of filters, 

allowing any skin colour to be treated. The range of light is typically between 

500-1500nm, depending on the machine and filter used. This versatility allows 

the characteristics of the light energy to be adjusted according to each patient’s 

skin type, specific condition and location of the area to be treated. 

In terms of safety, the two types are similar, but with both IPL and laser 

facial rejuvenation treatments the practitioner and patient each need to use eye 

protection, and treatment needs to occur in a controlled area where people 

cannot wander in and be exposed to the light. 

While lasers and IPL treat many of the same conditions, IPL is a single 

technology for a multitude of applications – from unsightly veins and birthmarks 

to ageing and sun-damaged skin, unwanted hair and rosacea. 

During the procedure pulses of intense light are fired at the skin through 

varying filters which isolate specific wavelengths of light. Various targets (such 

as haemoglobin in the blood to remove vascular lesions, or melanin to treat 

hyperpigmentation) are preferentially absorbed, heated and selectively destroyed 

by certain light wavelengths (called selective photothermolysis) without damaging 

surrounding tissues. 

IPL treatment cannot typically address extensive sun damage and skin 

discolourations but it can reduce surfaced capillaries and brown spots, as 

well as help revitalise and even out the overall complexion. Typically four to six 

treatments are required for optimal results. 

The usual downtime with IPL modalities is minimal to none, depending on the 

intensity of treatment, however full recovery can take around two weeks in some 

cases. Immediately after IPL a slight burning sensation can occur for a few hours 

but there is generally little discomfort. 

Temporary discolouration can occur for around three to four days after the 

procedure and this skin will flake off slowly. Short-term side effects include 

reddening of the skin (erythema), temporary bruising and oedema. Reactions 

such as scabbing and blistering are possible though rare. It is important to 

protect skin from UV light with daily sunscreen application. 



Which laser 

and why? 

Most resurfacing lasers work by 

removing microscopic quantities of 

skin and stimulating the production 

of new collagen. Non-ablative lasers 

use wavelengths which do not burn 

away skin and are suitable for the 

treatment of melasma, scarring, fine 

lines and wrinkles and typically do 

not require any downtime. 

The most common ablative 

lasers include carbon dioxide (CO 2 

) 

and Erbium:YAG lasers. These 

use a process where the upper 

layers of aged or damaged skin are 

vaporised by the controlled laser. 

More recently, laser is applied using 

fractionated technology. 

It is this damage that stimulates 

the healing and restructuring of 

the skin, resulting in a more even 

complexion and a significant 

reduction in lines and wrinkles. 

Carbon dioxide lasers can 

dramatically reduce wrinkles but 

downtime and side effects such as 

redness and peeling are extended, 

usually taking many weeks to heal. 

Erbium lasers have a great accuracy 

with fewer side effects but cannot 

treat deep wrinkles as successfully. 

Photodynamic therapy 

Photodynamic therapy uses a chemical reaction activated by light energy to 

selectively destroy specific tissues and can be used to treat sunspots, certain 

types of skin cancer, rosacea, acne and sun-damaged skin. A photosensitising 

medication is applied topically on the skin and a narrow band of light (red or blue 

light) is administered to cause a moderately deep exfoliation and target damaged 

tissue and sebaceous glands. 

When skin is exposed to a light source of an appropriate wavelength, its 

photosensitiser molecules are activated to produce oxygen intermediates 

that destroy the targeted cells. Recovery time is around two weeks after each 

treatment and usually one to three sessions are required. 

Laser therapy 

Laser is an acronym for Light Amplification for the Stimulated Emission of 

Radiation. Laser light is different to normal light for many reasons: it travels in a 

synchronised fashion; retains its intensity over a long distance; is monochromatic 

(of the same wavelength or colour) and can be pulsed. 

Laser therapies work by targeting tissue and can be used for a number of 

treatments, including pigmentation, scarring, unwanted hair, spider veins, sundamaged 

skin, wrinkle reduction and overall complexion rejuvenation. 

The principle behind lasers is light absorption. The same as a black car will 

be hotter than a white car because it absorbs more wavelengths of light, certain 

target tissues will absorb certain wavelengths of light more effectively. As the 

laser light is monochromatic the target tissue will take on maximum absorption 

while the surrounding tissues won’t. This allows the target to be isolated and 

treated. In other words, the laser emits a single frequency of light with all the 

light waves going in the same direction, allowing the target tissue to absorb the 

maximum amount of heat. 

The target tissue is all-important when treating skin problems with a laser. 

For pigmentation it is melanin; for spider veins and other vascular conditions it 

is haemoglobin (blood); and for wrinkles it is water. Each of these target tissues 

absorbs a different wavelength of light, meaning a different laser is needed for 

each specific problem. 

Recent advances in laser technology mean that laser skin resurfacing, once 

reserved for the treatment of severe conditions such as acne scarring due to the 

extensive downtime involved, has become an effective option for many people 

seeking reduction of lines and wrinkles and uneven skin colour, tone and texture. 



Fractional laser therapy 

The advent of fractionated laser, where microscopic columns of skin are treated 

while surrounding skin is left intact, has made it possible to achieve results 

comparable to traditional laser resurfacing with fewer side effects and profoundly 

less downtime. 

Fractional skin resurfacing can utilise both non-ablative and ablative lasers 

– the breakthrough difference of this technology is the fractionated delivery 

system of light. 

Fractional laser technologies break up light beams to allow columns of 

untreated tissue to activate healing mechanisms beneath the skin’s surface, 

treating skin conditions ranging from scars and birthmarks to wrinkles. 

These lasers work by creating microscopic thermal injuries that trigger 

collagen production, stimulating cell renewal and plumping out the tissues. In 

other words, the laser works by creating tiny holes, or ‘dots’, in the skin’s surface, 

penetrating deep into the dermis which triggers the body’s natural healing 

responses. It leaves the skin around each dot intact, enabling the surrounding 

tissue to heal these microscopic thermal injuries by stimulating the production 

of new collagen. 

The anti-ageing benefits of fractional laser technology include improving 

evenness of skin tone and texture, reducing pore size and the appearance of 

lines and wrinkles, and helping to reverse the effects of sun damage. A more mild 

treatment may take several sessions, while one procedure is usually sufficient for 

a more aggressive treatment. 

Because laser treatments use heat, a mild to moderate burning sensation 

is experienced during treatment and slight swelling, redness and bronzing 

afterwards. This can be covered with makeup and normally subsides after a few 

days, however full healing can take several weeks, depending on the intensity of 

treatment and the areas targeted. 

Results of light-based therapies vary, depending on the technique and 

experience of the practitioner and the individual patient. Patients should always 

ask their practitioner how new the laser or IPL machine is and when it was 

purchased. Recent models are far superior to earlier ones in terms of achieving 

predictable and precise results. 

What is a target tissue? 

Different wavelengths allow delivery of energy to different structures. These 

structures are target tissues known as chromophores and for cutaneous laser 

therapy these are: haemoglobin (blood both oxygenated and de-oxygenated), 

water, melanin (pigment in hair and brown spots) and ink (tattoos). 

As each chromophore absorbs different wavelengths of light, different lasers 

are used for different treatments. The treatments usually fall into four categories: 

1. Resurfacing the skin, minimising wrinkles and scars (chromophore is water) 

2. Vascular lesions such as spider veins (chromophore is haemoglobin) 

3. Pigmented lesions such as brown spots and unwanted hair (chromophore 

is melanin) 

4. tattoos (chromophore is protein). 


cosmetic surgery 

cosmetic 

surgery 



All Fellows of the Australasian College of Cosmetic 

Surgery are specifically trained in cosmetic medicine 

and surgery and are required by the College to 

maintain their skills through a Continuing Professional 

Development program. 

There is a wide range of cosmetic surgery options available to target 

specific areas of the face and body. Whether facial surgery (such as a 

facelift, rhinoplasty and blepharoplasty) or body surgery (such as breast 

enhancement, liposuction and abdominoplasty), the modern approach to 

cosmetic surgery involves tailoring a procedure or combination of procedures 

to each patient’s individual requirements and goals. 

As with any surgery, there are risks and limitations associated with all 

cosmetic procedures. It is important the patient is well informed about the 

realistic outcomes, the potential complications as well as the procedure itself. 

This is where managing expectations becomes imperative for achieving a 

successful outcome. 

The doctor’s training and certification should be appropriate to the chosen 

procedure. Certification by the appropriate medical board or body shows that 

the doctor has met additional requirements for continuing education and 

experience in cosmetic surgery. 

The decision to have cosmetic surgery should never be made in a rush or 

to please anyone else. The best results are always achieved through effective 

patient-doctor communication and having realistic expectations of what cosmetic 

surgery can achieve for each individual patient. 


COSMETIC SURGERY 

FACELIFT 

(RHYTIDECTOMY) 

The face, more than any other part of the body, defi nes an individual to 

the outside world. With age, the effects of gravity, sun damage and the 

stresses of everyday life become apparent and can alter the appearance of 

a person’s face. As such, these age-related changes can make people feel as if 

their identity has changed over time. As people are living longer and more active 

lives, many seek facial cosmetic surgery to help them look as young as they feel. 

Changes can occur in the upper, mid and lower portions of the face due to the 

downward descent of facial fat and skin, resulting in deep lines around the eyes 

and mouth, sagging skin in the cheeks, jaw line and neck, as well as banding 

around the neck. 

Facial tissues weaken over time, losing their resiliency and ability to maintain 

a fi rm, youthful position. In addition, facial muscles weaken and stretch, and fat 

deposits which normally give the face a soft, rounded appearance deplete and 

descend to create hollow areas. A facelift, or rhytidectomy, is designed to address 

these age-related changes and can restore a fi rmer, more youthful appearance. 

Facelifting has continued to evolve over the past 30 years by adding and 

developing various methods and techniques that treat particular areas of the face. 

What began as a skin-only lift in the early 1900s has become a comprehensive 

procedure which takes into account virtually every structure of the ageing face. 

By repositioning both the skin and the Superfi cial Musculoaponeurotic System 

(SMAS), the modern approach to face lifting restores the facial structures to a 

more desirable position to create a younger looking appearance while avoiding 

the telltale signs of surgery. 

While a modern facelift predominantly addresses volume replacement and 

vectors (directions) of lift, the procedure also helps smooth wrinkles and folds. 

A typical full facelift today begins with incisions that are concealed within the 

hairline. From these incisions, the skin is separated from the muscles and tissue 

beneath. The SMAS layer is then tightened in the lower face, mid-face and neck, 

after which the skin is pulled back to reduce lines and wrinkles. Excess skin and 

fat is removed and the incisions are closed. 

Recovery from modern facelifts is typically much less extensive and lengthy 

compared with facelifts of the past, with less swelling, bruising, pain and recovery 



At a glance 

Procedure Improving sagging 

facial skin, jowls and loose neck 

skin by removing excess fat, 

tightening muscles, redraping 

skin. Most often done on men and 

women over 40. 

Length Several hours. 

Anaesthesia Local with sedation, 

or general. 

In/Outpatient Usually outpatient. 

Some patients may require short 

inpatient stay. 

Side Effects Temporary 

bruising, swelling, numbness and 

tenderness of skin; tight feeling, 

dry skin. 

Risks Injury to the nerves that 

control facial muscles or feeling 

(usually temporary but may be 

permanent). Infection, bleeding. 

Poor healing; excessive scarring. 

Asymmetry or change in hairline. 

Recovery Back to work: 10 to 

14 days. More strenuous activity: 

2 weeks or more. Bruising: 2 to 3 

weeks. Must limit exposure to sun 

for several months. 

Duration Usually 5 to 10 years. 

time. There are also different procedures, such as mini-lifts that use smaller and 

fewer incisions, offering less recovery and down time. 

There are different types of face lifting surgery, with each tailored to correct 

different regions of the face. For example, a lower facelift is performed to 

rejuvenate the lower portion of the face, while a brow lift or mid-facelift can 

typically correct age-related changes in the upper and mid-face, respectively. 

In addition, sagging and puffy eyelids can be addressed with eyelid surgery, 

or blepharoplasty. 

It is important to note that facelifts do not address overall skin texture, skin 

thickness, or wrinkling and creases around the nose and mouth. Instead, modern 

face lifting techniques are designed to correct sagging, loose skin and reposition 

fat and tissues to add volume back to the face. 

Lower facelift 

A lower facelift can be performed using different types of incisions, depending on 

the patient’s individual needs and wishes. A single incision is commonly made 

within the hairline that extends downward around the perimeter of the ear and 

into the hairline on the back side of the head. 

Through these hairline incisions, the skin is lifted from the underlying tissue 

of the lower face, jaw line and neck to expose the SMAS, a layer of tissue 

composed of muscle and fibrous connective tissue. 

The SMAS is then repositioned to elevate and tighten the underlying facial 

structures to a more youthful and aesthetically pleasing position. There are 

a variety of methods that can be used to lift the SMAS, such as excision or 

plication in which the tissue is augmented and suspended in a higher position 

with sutures. 

After the necessary adjustments, the skin is then repositioned over the face 

and any excess skin is removed. In some cases, the surgeon may place a 

surgical drain beneath the skin to prevent fluid build-up during healing, although 

this is not usually necessary. The incision is then closed with sutures. A lower 

facelift procedure typically takes around three hours, depending on the extent 

of surgery. 

Mid-facelift 

During a mid-facelift, the underlying tissues are tightened, and fat pads that 

give the face shape and volume are lifted to restore a firmer, younger looking 

appearance. A mid-facelift cannot correct loose skin in the neck or along the jaw 

line, nor can it address fine lines or uneven skin tone and texture. 

A mid-facelift can be performed using a variety of different incisions and surgical 

techniques. For example, when combined with eyelid surgery (blepharoplasty), 

the surgeon may choose to make incisions in the lower eyelid. When performed 

in conjunction with a lower facelift, the physician may make additional incisions 

inside the mouth along the gum line to help release the mid-face tissues. 

Another approach is the endoscopic technique, whereby small incisions are 

usually made just above the hairline, above the ear or by the temple. Additional 

incisions are made inside the mouth over the cheekbone. With the aid of an 

endoscope, a thin tube-like instrument with a tiny camera on the end, the 

surgeon can gently manipulate the facial tissues and lift them to a more youthful 

position. The tissues are typically suspended by use of sutures or absorbable 

medical-grade material that dissolves over the course of a few months. Once 



the underlying tissues are tightened and the fat pads are lifted, the incisions 

are closed using sutures. A mid-facelift procedure takes around one and a half 

hours, depending on the extent of treatment. 

FACELIFTING TECHNIQUES 

Advances in surgical procedures and technology mean there are several different 

facelifting techniques available today. They are designed to address each 

patient’s individual needs more specifi cally, helping to ensure optimal results. 

SMAS lift 

The SMAS (Superfi cial Musculoaponeurotic System) technique concentrates 

on the thin underlying connective tissue and muscle layer called the superfi cial 

musculoaponeurotic system, as well as repositioning and removing excess skin. 

Tightening this foundational tissue gives a smoother and improved shape without 

noticeable tension in the skin. 

Deep plane lift 

A deep plane facelift 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. Because the dissection is deep, the fl ap is thicker 

than in the SMAS method. Some surgeons prefer this technique as they believe 

restoring the neck, jawline and mid-face together delivers more natural results. 

Endoscopic lift 

Commonly performed with the aid of an endoscope, this lift is designed to 

reposition skin, fat and muscle simultaneously since the tissues tend to sag 

together, not individually and is often performed partially in the subperiosteal 

plane. This type of facelift releases tissues off the bony layer, separating the bone 

from all of the tissues covering it. 

There is more swelling with the endoscopic lift than with more superfi cial 

lifts due to the depth of the dissection. It also usually causes more swelling and 

takes longer to recover. 

Composite or SOOF lift 

The sub-orbicularis oculi fat (or SOOF) lift is similar to a deep plane lift, with the 

addition of 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 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 superfi cial lifts. 



S-Lift 

The S-Lift is a type of facelift named after the S-shaped incision or short 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 signifi cant skin laxity of the 

neck and jowls. It is most suited to patients beginning to show signs of facial 

ageing and want some tightening of the lower face without longer incisions. 

Mini-lift 

This type of facelift typically refers to any limited-incision facelift, usually with 

a quicker recovery time compared with other more invasive techniques. Also 

referred to as a MACS Lift (Minimal Access Cranial Suspension) and the shortscar 

facelift, it is typically suited for patients with early signs of ageing, usually 

aged in their 30s and 40s, to achieve a natural-looking facial rejuvenation. During 

a mini-lift, the surgeon usually makes a short incision on the front side of the ear. 

Via this incision, deep plicating sutures lift the deep tissues and the extra skin 

is then removed. Due to its less invasive approach, this type of facelift typically 

offers less recovery time and a lower risk of complications. 

NECK & CHIN 

LIPOSUCTION 

Two of the defi ning features of a 

youthful face are a well-defi ned jaw 

line and a pleasing angle where the 

neck and chin meet. Chin and neck 

fullness or a poorly defi ned 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 fl uid 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. 

NECK LIFT 

Performed in conjunction with a facelift or as a stand alone procedure, a neck 

lift is designed to correct excess skin and fatty tissue of the neck (the so-called 

‘turkey gobbler neck’), platysmal bands which run from beneath the chin to the 

lower neck, as well as a poorly defi ned chin/neck angle and jaw line. 

The type of technique used for a neck lift procedure depends on several 

factors, such as the degree of skin excess and 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. 

Liposuction of the chin and/or neck area may be required to remove excess 

fatty deposits and help create a more defi ned chin/neck angle and jaw line. In 

younger people with good skin tone, unwanted fat in the neck and jowls area can 

be removed with liposuction alone. 

In most cases recovery time is around two to four weeks and healing is usually 

complete within a few months. 



AT A GLANCE 

Procedure Correct drooping 

upper eyelids and puffy bags below 

the eyes by removing excess fat, 

skin and muscle. (Upper-eyelid 

surgery may be eligible for a 

Medicare rebate) 

Length 1 to 2 hours. 

Anaesthesia Usually local with 

sedation, or general. 



discomfort, tightness of lids, 

swelling, bruising. Temporary 

dryness, burning, itching of eyes. 

Excessive tearing, sensitivity to 

light for fi rst few weeks. 

Risks Temporary blurred or double 

vision. Infection, bleeding. Swelling 

at the corners of the eyelids. Dry 

eyes. Formation of whiteheads. 

Slight asymmetry in healing or 

scarring. Diffi culty in closing eyes 

completely (rarely permanent). 

Pulling down of lower lids (may 

require further surgery). Blindness 

(extremely rare). 

Recovery Reading: 2 to 3 days. 

Back to work: 7 to 10 days. 

Contact lenses: 2 weeks or more. 

Strenuous activities, alcohol: about 

3 weeks. Bruising and swelling 

gone: several weeks. 

Duration Several years. 

Sometimes permanent. 

EYELID SURGERY 

(BLEPHAROPLASTY) 

Blepharoplasty is a surgical procedure to improve the appearance of the 

upper and/or lower eyelids, to give a more refreshed appearance to the 

surrounding area of the eyes. The loose fold of skin that droops over the 

upper eyelid can be removed to make the eyes appear bigger, and the ‘bags’ 

below the eye can also be reduced. 

The incision lines for eyelid surgery are made within the natural structures of 

the eyelid region, allowing any resultant scars to be well concealed. 

The incision for an upper lid blepharoplasty is in the lid crease and is made 

with either a scalpel or CO 2 

laser that seals the blood vessels as it incises. Skin, 

muscle and fat are removed to reduce hooding in the upper eyelid. 

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 bulging 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 results of eyelid surgery become apparent gradually, with swelling and 

bruising usually subsiding after around two weeks to reveal a smoother, better 

defi ned eye region and a more alert and rejuvenated appearance. Results 

typically last around seven to 10 years. 

Some patients elect to have their eyelid surgery combined with a facelift or 

brow lift to maximise the rejuvenating effect and further enhance results. 



AT A GLANCE 

Procedure Raise the position of 

the eyebrow and make the eyes 

look more open. Can be done 

using short scars (endoscopic) or 

traditional (coronal). Other variants 

possible (direct, temporal, hairline). 



or general. 


Side Effects Temporary swelling, 

numbness, headaches, bruising. 

Traditional method: Possible itching 

and hair loss. 

Risks Injury to facial nerve, 

causing loss of motion, muscle 

weakness, or asymmetrical look. 

Infection. Broad or excessive 

scarring. 

Recovery Back to work: 7 

to 10 days, usually sooner for 

endoscopic forehead lift. More 

strenuous activity: several weeks. 

Full recovery from bruising: 2 to 

3 weeks. Limit sun exposure for 

several months. 

Duration Usually 5 to 10 years. 

BROW LIFT 

Often the brow and forehead area can show the fi rst signs of facial 

ageing. Deep creases across the forehead and between the eyebrows 

can become evident, 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 newer 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 fi ve short incisions above the hairline, each about 2cm long. An 

endoscope, a thin instrument with a tiny camera at one end, 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 fi rst 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 fi nal results apparent within around two months. 

New techniques in threadlifting have also been applied with some success in 

brow lifting. 

A brow lift is often combined with a facelift or blepharoplasty to provide a 

harmonious rejuvenation. 



‘What you 

want to see is 

documented 

proof that the 

product has 

been tested in 

clinical trials and 

approved by 

the FDA’ 

AT A GLANCE 

Procedure Set prominent ears 

back closer to the head, or reduce 

the size of large ears. Most often 

done on children between the ages 

of 4 and 14 years. (May be eligible 

for a Medicare rebate) 


Anaesthesia Young children: 

usually a general. Older children 

or adults: general or local with 

sedation. 



throbbing, aching, swelling, 

redness, numbness. 

Risks Infection of cartilage. 

Excessive scarring. Blood clot 

that may need to be drained. 

Mismatched or artifi cial looking 

ears. Recurrence of the protrusion 

requiring repeat surgery. 

Recovery Back to work/school: 

5 to 7 days. Strenuous activity, 

contact sports: 1 to 2 months. 

Duration Usually permanent. 

PROMINENT 

EAR SURGERY 

(OTOPLASTY) 

Prominent or protruding ears are one of the most common congenital 

deformities in the head and neck region, affecting around one in 20 people. 

An otoplasty is a relatively simple operation to correct protruding ears, and 

can result in a signifi cant aesthetic and psychological boost. 

Ears that are out of proportion with the rest of the face can draw too much 

attention, marring the appearance of other, more attractive facial 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 is a surgical procedure that reduces the appearance of prominent 

ears, pulling them back closer to the head and making them less noticeable. 

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 scare at the back of the 

ear, which fades over time. Swelling and bruising post-surgery is usually minimal. 



AT A GLANCE 

Procedure Reduction of excess 

tissue of the inner (labia minora) or 

outer (labia majora) vaginal lips. 

Length 1 to 2 hours 


or general. 

In/Outpatient Outpatient. 

Side Effects Temporary bruising, 

swelling, soreness. 

Risks Infection, collection of blood 

(haematoma), scarring, asymmetry. 

Recovery Patient may go back 

to work after 3 to 7 days. More 

strenuous activity may be resumed 

after two to three weeks. Can 

usually resume sexual activity after 

3 to 6 weeks. 

Duration Permanent. Should not 

affect pregnancy/childbirth. 

LABIOPLASTY 

Labioplasty is a surgical procedure that alters the size of the labia folds in 

the vagina. It’s most commonly performed for labial reduction, but can 

also be performed for labial augmentation. Reduction is usually, though 

not exclusively, carried out on the labia minora, the ‘inner lips’ on either side of 

the entrance to the vagina. Labial augmentation is commonly used on the labia 

majora, the ‘outer lips’ on either side of the labia minora. 

Functional reasons for seeking labial reduction centre on discomfort or pain 

that is often experienced when wearing tight underwear or trousers. The labia 

become uncomfortable as they rub against each other, or against clothing. 

Labial discomfort can prevent women from taking part in sporting activities, such 

as horse riding or cycling. Additionally, some women fi nd that the labia fold into 

the vagina during sexual intercourse, resulting in friction and pain. 

To avoid any clitoral injury and ensure an aesthetically pleasing result, surgery 

takes place under general anaesthetic. Labioplasty is typically scheduled as a 

one-day procedure and patients usually require pain relief for around three to 

seven days after surgery. Bruising may also result from the procedure. 

After surgery, patients should anticipate to be off work for a minimum of 

three to four days to allow tissues to heal properly. Patients should wear loose, 

comfortable clothing during this time to reduce any labial discomfort and swelling. 

Sexual or sporting activities can be resumed after two to three weeks; however, 

this should be discussed with your surgeon prior to surgery. 

The main risk of labioplasty is wound infection. To assist healing, cleanse with 

water, avoid astringents and dry by dabbing rather than rubbing. It is best to use 

an infl atable donut cushion to make sitting more comfortable during recovery. 

Scarring after the surgery is usually minimal although there may be some 

tenderness. The scars are fi ne and typically hidden well within the natural skin 

creases. Some patients may fi nd that sexual sensations are improved, as excess 

skin no longer interferes.P 



BREAST 

AUGMENTATION 

Breast augmentation is a surgical procedure that increases the volume of 

the breasts through the insertion of prosthetic implants. Implants typically 

range in volume from 90 to 900 millilitres and also come in different 

shapes. They have either saline or silicone fi lling and smooth or textured silicone 

or textured polyurethane foam covered envelopes. 

As every woman’s physiology and presenting conditions are different, a 

skilled surgeon will choose from a range of procedural options to suit the 

patient and her desired outcome. In some cases augmentation surgery is 

accompanied by a mastopexy, or breast lift, which involves more scarring but 

may be needed to ensure an optimal outcome in patients with sagging breasts. 

When considering breast augmentation there are a number of choices to 

consider, including the location of the incision, the type of breast implant and 

where it will be located. 

Prior to the procedure, decisions will be made about the size and type of 

implant, depending on the patient’s anatomy, body size, chest measurements 

and desired fi nal result. Almost all patients who request a breast augmentation 

desire some degree of cleavage. 

Cleavage is defi ned by the distance between the breasts and it can be 

enhanced by narrowing the gap between them breasts as well as increasing 

the fullness of the breast at the inner edge of the breast. In most cases, the 

appropriate type, size and placement of the implant can enhance cleavage. 

However, in some women, particularly those who are extremely thin with minimal 

soft tissue and with widely separated breasts, a well-defi ned cleavage will 

not be possible without causing the risk of implant visibility and, worse, being 

able to feel the implant. In these patients, cleavage can only be further enhanced 

by a suitable bra. 

Choosing the right implant is more complex than choosing a certain cup size 

or wanting to emulate a look from a celebrity or a friend who has previously 

undergone breast augmentation. It is important for the patient to choose a breast 

implant size that suits her individual body shape and size. This will help ensure 

natural-looking results that will enhance her existing shape. 

The fi nal outcome depends on the patient’s existing breast volume, the 



At a glance 

Procedure Enhance the size of 

breasts using silicone or saline 

(water) implants. 



or general. 



soreness, swelling, change in 

nipple sensation, bruising. Breast 

sensitive to stimulation for a 

few weeks. 

Risks Formation of scar tissue 

around the implant (capsular 

contracture), which may cause the 

breast to feel tight or hard; bleeding 

or infection. Increase or decrease 

in sensitivity of nipples or breast 

skin, occasionally permanent. 

Movement of implants, rupture of 

the implant shell, being able to see 

or feel the implant. Pronounced 

scarring. Mammography requires a 

special technique. 

Recovery Back to work: 3 to 

7 days. Physical contact with 

breasts: 3 to 4 weeks. Fading of 

scars: several months to a year 

or more. 

Duration The majority of 

women with implants never 

require further surgery. 

thickness of the soft tissue that covers the breast, the bulk of the muscle 

and the tightness of the skin envelope. While these factors should be 

considered case by case, there are some general characteristics of an attractive 

breast, including: 

• A gentle slope from the shoulder to the peak of the breast at the nipple; 

roundness at the top of the breast is an implant giveaway 

• The nipple is located on the centre of the breast mound and tilted slightly 

outwards and upwards 

• A gentle arc from the nipple to underneath the breast (not too big and full 

which can make the breast appear saggy) 

• A good cleavage 

• A silhouette line so that when standing front-on, a gentle bulge is apparent on 

the side of the chest wall. 

The procedure 

The breast augmentation procedure involves the surgical placement of an 

implant in each breast to push the breast tissue forward. It may be performed on 

a day-surgery basis and always takes place in a surgical environment. 

During the procedure, the patient is anaesthetised, either with general 

anaesthetic or twilight sedation, and the chest area is cleaned and marked up 

with guidelines by the surgeon. The surgeon makes an incision that enables 

them to lift the breast tissue, creating a pocket within which the implant is placed. 

Incision site 

The location of the incisions will depend on the patient’s anatomy, breast 

condition as well as the surgeon’s recommendations. There are four possible 

incision sites: 

Inframammary: The incision is made in the crease under the breast close to 

the inframammary fold. This is the most common incision site and allows the 

doctor to work with good visibility. The scar is hidden in the crease under the 

breast and is not normally visible when wearing a bikini top. 

Areolar/Periareolar: The incision is made across or around the bottom or 

outer edge of the areola. The periareolar incision allows the surgeon to work 

close to the breast. It is possible for the surgeon to easily and precisely place 

the breast implants in various positions in relation to the chest muscle. However, 

this is the only incision that involves cutting through breast tissue and ducts, 

and sensitivity in the nipple may be reduced. 

Transaxillary: The incision is made in the lower portion of the armpit, next 

to the chest. The greatest advantage of an underarm breast augmentation 

incision is that no scar is left on the breasts. The scar is virtually invisible in the 

armpit fold and lack of tension generally makes for straightforward healing. 

Transumbilical: Transumbilical or navel (TUBA) incision is made on the rim 

of the navel and can only be used for saline implants as the filling is added after 

the implants are placed. 

C o s m e T I C s u r g e ry & m e d I C I n e w w w. A C C S . o r g . a u / / 3 9


Implant position 

The implant will be placed in one of three positions: 

‘The way breast 

augmentation 

surgery is carried 

out varies with 

each individual’ 

Subglandular 

The subglandular pocket is created in front of the muscle, between the breast 

tissue and the pectoral muscle. This position resembles the plane of normal 

breast tissue and the implant is placed in front of the muscle. Sometimes the 

implant is covered by a thin membrane, the fascia, which lies on top of the 

muscle. This is called subfascial placement. 

Submuscular 

The submuscular implant is placed under the pectoralis major muscle after some 

release of the inferior muscular attachments. Most of the implant is positioned 

under the muscle. This position can create a natural-looking contour at the top 

of the breast in thin patients and those with very little breast tissue. The implant 

is fully covered, which helps to camouflage the edges of the implant, as well 

as rippling. With this placement, there is reportedly less chance of capsular 

contracture occurring. 

Dual plane 

The dual plane implant is placed partially beneath the pectoral muscle in the 

upper pole, where the implant edges tend to be most visible, while the lower 

half of the implant is in the subglandular plane. This placement is best suited to 

patients who have insufficient tissue to cover the implant at the top of the breast 

but who need the bottom of the implant to fully expand the lower half of the 

breast due to sag or a tight crease under the breast. 

Finally, the incision is closed with sutures or surgical glue and covered with 

tape, which helps the tissues adhere. In some cases additional dressings 

may be applied or a surgical bra may need to be worn, but advances in 

surgical techniques mean that a sports bra may be sufficient or no bra at all 

may be needed. After surgery the patient is moved to a recovery area and, in 

straightforward procedures, may be able to go home a few hours after surgery. In 

the case of more complex surgery, an overnight hospital stay may be necessary 

or longer if there are any complications. 

The way breast augmentation surgery is carried out varies with each individual. 

Ultimately, it depends on the woman’s existing shape and her desired outcome. 

Which implant? 

The design and manufacture of breast implants have been progressively refined 

and improved to reduce risks such as capsular contracture, gel diffusion and 

implant rupture. 

The choices of both saline and silicone gel implants now available in Australia 

typically come from a handful of manufacturers. They are produced in round and 

teardrop (anatomical) shapes, with a smooth, textured or polyurethane foamcovered 

silicone elastomer envelope. 

Regardless of the type of implant women choose, the shape, texture and size 

can be customised to reflect her individual body type and aesthetic goals. 

The choice of projection is to a large extent a personal one. For example, a 

woman with adequate breast tissue and a shape she is happy with may opt for 

a low-profile implant that will simply increase the size of her breasts. Another 

patient seeking to create cleavage, or a patient with some degree of sag, may 

prefer a high-profile implant that can help achieve these results. 



Fills 

Silicone gel-filled implants 

The most commonly used implants in Australia are silicone gel-filled implants. 

They have an outer silicone shell and all contain a cohesive gel, designed to 

mimic the feel of real breast tissue. It has a slightly firm, non-runny consistency, 

which can give a more natural feel. As the gel is not liquid, the risk of dispersal if 

the implant ruptures is minimised. It also typically maintains its shape better than 

a saline implant, especially in the upper part of the implant. 

Saline-filled implants 

These have an outer silicone shell containing a medical grade saltwater solution, 

which makes the implant feel like a waterbed. This can be controlled to an extent 

by the volume of fill in the implant. If implant rupture occurs, the saline is absorbed 

by the body. Saline implants feel firmer than silicone implants and have a higher 

risk of visible folds and ripples. 

Shapes 

Round implants 

Depending on their fill, round implants can achieve a defined round shape or 

assume more of a teardrop form when the patient is upright. They tend to provide 

more upper pole fullness than anatomical implants, which are fuller in the lower 

pole. Round implants come in smooth and textured shells. 

Anatomical (teardrop) implants 

These more closely resemble the natural shape of a breast. However, they 

demand a greater degree of accuracy in positioning and if they shift after surgery, 

the shape of the breast may be distorted. Anatomical implants can also provide 

greater projection in proportion to the size of the base, making them particularly 

suitable for women with little natural breast tissue. These implants have textured 

surfaces to allow for better integration with the surrounding breast tissue. The 

implant may still move and distort the appearance of the breast so the surgeon 

must be experienced with this type of implant. 

‘It is important for 

the patient 

to choose a 

breast implant 

that suits her 

individual body 

shape and size’ 

Shells 

Smooth-shelled implants 

These are relatively easy to insert and are said to make the breast move and 

feel more natural than a textured shell. However, they have increased risk of 

capsular contracture (hardening of the breast), which is a common reason for 

re-operation. 

Textured implants 

These implants have a thicker shell and the very nature of their surface means 

they can grab onto and adhere to the surrounding tissue, causing less friction 

between the implant and breast pocket and therefore helping to reduce the risk 

of capsular contracture. Many surgeons also believe it offers them greater control 

over the ultimate shape of the breast. 

Polyurethane implants 

These implants have a medical-grade polyurethane coating. The surface of the 

implant comprises a 3D matrix of polyurethane foam cells. Some studies have 

shown that the implants lower the risk of capsular-contracture. 



AT A GLANCE 

Procedure This operation removes 

excess skin from the breast 

that has been stretched during 

pregnancy or weight fl uctuations. 

Breast implants may also be used 

in conjunction with this procedure 

to achieve the desired result. 

Length Approximately 2 to 

3 hours. 

Anaesthesia Usually general. 



swelling, some mild discomfort, 

numbness, and dry/tender breast 

skin. 

Risks Unfavourable scarring 

with keloid formation is possible. 

In addition skin loss, infection, 

unevenly positioned nipples 

(asymmetry), and the possibility 

of permanent loss of feeling in the 

nipples and/or the breasts. 

Recovery One week for work, 3 

to 4 weeks for strenuous activities. 

The fading of scars may take 

several months to one year. 

Duration The outcome varies from 

patient-to-patient. Other factors 

that may infl uence results are: 

gravity, pregnancy, ageing, and 

weight changes which may cause 

new sagging. 

BREAST LIFT 

(MASTOPEXY) 

A 

natural part of the female ageing process is the sagging or drooping of the 

breasts. Women who have breastfed or have experienced extreme weight 

loss often seek breast enhancement surgery to restore volume and shape 

to their breasts, which often involves mastopexy (breast lift). It is also suitable for 

women who, although satisfi ed with the size of their breasts, are unhappy with 

the sagging and loss of fi rmness. 

A mastopexy is designed to lift the breast by removing excess skin, and 

sometimes re-positioning the nipple to create more youthful looking breasts. 

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 areas: 

• Around the areola 

• Around the areola and then vertically down the breast 

• 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 then repositioned to create a more pert and youthful looking 

breast shape. During a breast lift the nipple 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. 

All breast lift procedures leave permanent scars, which, while red initially, will 

usually fade within six to 12 months. 



AT A GLANCE 

Procedure Reduce the size 

and improve the shape of a 

woman’s breasts. 

Length 2 to 4 hours depending 

upon the technique 

Anaesthesia Usually general 

anaesthesia; smaller reductions 

intravenous sedation with local. 


Side Effects Prolonged swelling 

and delayed healing, bruising. 

Risks Unfavourable scarring, loss 

of nipple sensation, loss of ability to 

breastfeed, loss of nipple and breast 

tissue, unsatisfactory shape, and 

failure to achieve aesthetic goals. 

Recovery Work 1 to 2 weeks, most 

normal activities 4 to 6 weeks. 

Duration Usually permanent in that 

it never needs to be done again. 

BREAST 

REDUCTION 

Breast reduction (or reduction mammoplasty) is a surgical procedure that 

reduces, lifts and reshapes the breast. The procedure removes excess 

breast and fatty tissue, leaving the patient with an overall smaller and more 

shapely breast. 

The operation seeks to improve posture and relieve the symptoms caused by 

very large breasts. These may include back pain, neck pain, breast tenderness, 

shoulder grooving (from bra straps), intertrigo (rash between folds of skin), and 

overall breast 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 

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. Women 

undergoing a breast reduction can expect to spend one to three nights in 

hospital. The recuperation period lasts for around three 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 after the procedure. This scar 

generally takes longer than other types of scarring 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. 



LIPOSUCTION 

Liposuction is a surgical procedure to remove deposits of subcutaneous 

fat from specifi c areas of the body such as the thighs, hips, abdomen, 

buttocks, knees, upper arms, neck and chin. 

There have been many advances in liposuction procedures over the past few 

decades, making it one of the most predictable and popular body contouring 

surgeries in the world. The techniques of liposuction have evolved to become 

less invasive, involve less patient downtime and create more precise results. 

There are numerous liposuction techniques available today and each doctor has 

their preferred method, all of which offer effective, predictable results. No single 

technique, piece of equipment or instrument necessarily offers better results. 

Most doctors will adapt the techniques and tools to each individual patient 

according to their specifi c concerns and desired results. 

The basic liposuction procedure involves the insertion of a small tube-like 

instrument, called a cannula, into the layer of subcutaneous fat via tiny incisions 

made by the surgeon. The cannula is most commonly connected to a clear 

plastic hose which leads to a suction source. It breaks up and vacuums away the 

targeted fat deposits beneath the skin. 

There are two main layers of subcutaneous fat: superfi cial and deep. 

Liposuction is primarily focused on the deeper layer of fat, since suctioning is 

thought to be safer and easier there. Suctioning in the superfi cial layer allows 

the surgeon to achieve subtle benefi ts in the procedure but, because of its 

proximity to blood vessels and nerve endings, it can increase the risk of contour 

irregularities and injury to the skin. Some doctors believe superfi cial liposuction 

enhances skin retraction. 

Although the cannula is designed to slide through fat tissue and cause 

minimum damage to blood vessels and nerves, some may be injured during 

the procedure. 



At a glance 

Procedure Improve body shape 

by permanently removing exerciseresistant 

fat deposits with a 

tube and vacuum device. Can 

be performed on most parts of 

the body. The surgeon may use 

additional technology such as 

ultrasound or laser to more easily 

remove the fat. 

Length 1 to 2 hours or more. 

Anaesthesia Local, with or 

without sedation, or general. 


Extensive procedures may require 

short inpatient stay. 


swelling, numbness, soreness, 

burning sensation. Temporary fluid 

drainage from incision sites. 

Risks Asymmetry. Rippling or 

bagginess of skin. Pigmentation 

changes. Skin injury. Fluid 

retention. Excessive fluid loss 

leading to shock. Infection. 

Recovery Back to work 1 to 2 

weeks. More strenuous activity: 

2 to 4 weeks. Full recovery from 

swelling and bruising: 1 to 5 

months or more. 

Duration Permanent, with sensible 

diet and exercise. 

The procedure 

Various types of anaesthesia can be used for liposuction, depending on the 

doctor and the extent of the procedure. If only a small amount of fat and a limited 

number of body sites are involved, liposuction can be performed under local 

anaesthesia, which numbs only the affected areas. 

Local anaesthetic is sometimes used in conjunction with intravenous sedation 

to help relax the patient during the procedure. Some patients prefer general 

anaesthesia, particularly if a large volume of fat is being removed. 

Generally, the doctor makes tiny incisions in the areas to be suctioned and 

a cannula is inserted. Using the cannula, the doctor moves in a specific pattern 

through the fat layer to break up fatty deposits, which are then vacuumed 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. 

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 three 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 achieve the final effect. 

Although different surgeons may favour certain modalities and techniques, 

it is important to remember that all liposuction is surgery, requiring incisions, 

anaesthesia and diligent post-operative care. 

Energy-assisted liposuction 

Recent advancements 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-assisted 

liposuction, power-assisted liposuction, laser-assisted liposuction and waterassisted 

liposuction. 

The role of the energy is to dislodge and break up the fat so that it can be 

removed 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 operator. 

While some of these techniques are potentially more aggressive than others, 

doctors are increasingly using energy-assisted liposuction techniques for their 

reduced recovery time and, in some cases, their ability to target more superficial 



‘There have been 

many advances 

in liposuction 

procedures, 

making it one 

of the most 

popular cosmetic 

surgeries in 

the world’ 

fat layers underneath the skin. Even though the recovery period is signifi cantly 

less than with traditional liposuction methods, patients should still expect to 

experience bruising, swelling and in some cases residual bleeding from the 

incision points post procedure. 

Energy-assisted liposuction can be benefi cial for large-volume liposuction 

surgeries as the length of the procedure is usually reduced and the patient 

typically spends less time under anaesthetic. However, there is also a risk of 

removing too much fat that can result in unevenness, so operators must 

be properly skilled according to the specifi c device they are using. The heat 

generated during ultrasound- or laser-assisted liposuction can also burn the skin 

or damage the tissue under the skin, but instances of this are rare. 

THINGS TO CONSIDER 

Liposuction is not a way of losing weight. However, it may be a viable option 

for men and women who want to reduce bulges of fat that have resisted dieting 

and exercise. 

The ideal liposuction candidate is at or near their ideal weight, with good 

skin elasticity, and is seeking reduction of diet-resistant localised pockets of fat. 

Common sites include the hips, outer and inner thighs, abdomen, lower back, 

knees and neck. 

Overweight individuals can benefi t if they are in the process of exercising and 

losing weight. However, liposuction is not a cure for obesity. Candidates must 

have realistic expectations of what liposuction can and cannot do. 

If a person has loose skin, liposuction can actually make it worse. If this is the 

case, a body lift procedure may be required to remove excess skin and help the 

skin conform to the body’s new contours. 

It should also be noted that liposuction does not improve cellulite (the dimpled 

‘orange peel’ appearance of the skin commonly seen on the buttocks and thighs) 

or stretch marks (caused by pregnancy or rapid weight gain) as these appearance 

concerns are not related to fat accumulation beneath the skin. 

Both men and women can achieve an improved and more contoured body 

shape through liposuction. The most commonly treated areas in women are the 

outer thighs and stomach, where as the most commonly treated areas in men 

are the abdomen and the fl anks, or ‘love handles’. Some men have excess fatty 

tissue in and around the breast, or gynaecomastia, which can also be removed. 

A specifi c area treated by liposuction is less likely to increase to its former size 

because it has fewer fat cells. 



AT A GLANCE 

Procedure Flatten abdomen 

by removing excess fat and 

skin, tightening muscles of 

abdominal wall and repositioning 

the umbilicus. 

Length 2 to 5 hours 

Anaesthesia General 

In/Outpatient Either depending 

on individual circumstances and 

extent of surgery. 

Side Effects Temporary pain. 

Swelling, soreness, numbness, 

bruising, tiredness for several 

weeks/ months. 

Risks Blood clots. Infections. 

Bleeding under the skin fl ap. Poor 

healing resulting in conspicuous 

scarring or skin loss. Need for 

further operations. 

Recovery Back to work: 2 to 4 

weeks. More strenuous activity: 

4 to 6 weeks or more. Fading 

and fl attening of scars: 3 months 

to 2 years. 

TUMMY TUCK 

(ABDOMINOPLASTY) 

Abdominoplasty, commonly known as a ‘tummy tuck’, involves the removal 

of excess skin and fat from the middle and lower abdomen. It addresses 

protruding fat, loose skin and also laxity of the abdominal wall muscles. 

Typical patients have often experienced extreme weight loss or pregnancy and 

wish to create a fl atter stomach area. 

During the abdominoplasty procedure, skin and fat are removed from 

the stomach area and the abdominal muscles may be repaired, tackling a 

number of conditions at once. While liposuction is used only to remove fat, an 

abdominoplasty can fl atten the stomach area by tightening the muscles as well 

as recapturing a more hourglass fi gure. However, some people may think they 

need to have an abdominoplasty when, in fact, liposuction alone may give a 

good result. 

The abdminoplasty incision is made across the lower abdomen, above the 

pubic bone and, where possible, is positioned in such a way as to be invisible 

under swimwear and underwear. A circular incision is then made around the 

navel and the skin is then separated from the muscle, working up toward the 

ribs, stitching the muscles together then tightens the stomach. Liposuction is 

often performed with the tummy tuck, which creates shape and contour. 

During the procedure, excess skin is removed and a new opening is made 

for the belly button. Drainage tubes are placed under the skin to collect any 

excess fl uid that may accumulate over 48 hours. A hospital stay of two nights is 

generally required. 

If the excess skin and fat are mostly located below the navel, a ‘mini-tuck’ may 

be appropriate. This surgery is less complex, and less skin and fat are removed. 

The incision is not as long, and the navel does not have to be repositioned. 

In both, at fi rst some numbness of the skin is to be expected, especially in the 

lower, central areas and sometimes in the upper thighs. 



preparation 

& recovery 

The decision to undergo cosmetic surgery should not be taken lightly. You 

should be well informed about the possible outcomes, potential risks as well 

as the actual procedure. The decision is always yours, and it should not be 

made in a rush. At consultation, your doctor will be able to discuss the benefits 

and risks of the surgery and the likely outcome. 

You can eliminate much of the anxiety associated with surgery by learning the 

basics of the process beforehand and preparing for what lies ahead. 

One of the most important decisions when electing to undergo cosmetic 

surgery is your choice of doctor. The combination of training, experience and 

judgment the doctor brings to your case strongly affects the outcome of your 

procedure. You should also feel comfortable enough with your doctor to openly 

express your concerns and treatment goals. 

Preparation 

To prepare for surgery, your doctor will schedule an in-depth planning session. 

During this consultation, the procedure, the type of anaesthesia to be used, the 

risks and limitations, costs involved, required medications, your expectations and 

goals, as well as the steps to take prior to the operation will be discussed. 

Your doctor will also need to know your medical history to plan the best 

treatment and achieve optimal outcomes. Fully disclose any health problems you 

may have had as some may interfere with surgery, anaesthesia and aftercare. 

Prior to surgery you may be asked to undergo a medical evaluation. Your 

doctor may also make adjustments to the medications you may be taking and 

advise you to stop taking all forms of aspirin, as well as any medication or vitamins 

which could increase the risk of blood clotting. 

The day before surgery you should properly prepare by packing loose and 

comfortable clothing to wear after the procedure, getting adequate sleep the night 

before, and arranging a ride home. If you are undergoing general anaesthesia, 

you will be required to abstain from eating or drinking for at least six hours before 

surgery (this helps prevent an upset stomach while under anaesthesia). 

Preparing for cosmetic surgery therefore isn’t just physical. You must also be 

mentally and emotionally prepared for the changes that are about to take place. 

Recovery 

Recovery will depend on the technique and anaesthetic administered, as well as 

the extent of the surgery and the individual patient. 

If general anaesthesia is used, you will be transferred to a recovery room 

where you will stay until you awake. Nursing staff will observe your recovery and 

monitor your heart rate, blood pressure and breathing, and you should normally 

be able to go home after one to three hours. Ensure that you have an emergency 

telephone number for your doctor and the clinic, in case you need to contact 

them. A responsible adult should stay with you for at least 24 hours after you 

return home. 



The specific length of recovery is dependent on factors such as your age, 

pre-operative activity level as well as the number and type of procedures you 

have had performed. 

Getting ready 

for surgery 

Being well prepared will in turn 

make your recovery faster, easier 

and with less risk of complications. 

• Avoid using medications 

containing aspirin or any antiinflammatory 

agents. Aspirin 

reduces the ability of your blood 

to clot and could increase your 

tendency to bleed during the 

recovery period. 

• Do not smoke for at least two 

weeks before and after surgery 

as this increases the risks of 

complications and inhibits 

wound recovery. 

• Choose a support person (a 

close friend or family member) 

who can drive you to and from 

the operation and be with 

you the first 24 to 72 hours 

after surgery. 

• set up a home recovery area 

with lots of pillows, books, 

magazines, stationery, a TV, 

remote control and DVDs. 

• Fill prescriptions for your 

painkillers and antibiotics before 

surgery and prepare icepacks 

to reduce post-operative 

swelling. 

• Drink plenty of fluids 24 hours 

before surgery and have a 

good sleep the night before. 

Risks & complications 

Every surgical or medical procedure involves a certain amount of risk. Cosmetic 

procedures have a good safety profile but despite the highest standards 

of surgical practice, complications can still occur. The most effective way to 

minimise the risks involved is to undergo a thorough physical examination with 

your doctor prior to surgery. 

Although complications are rare, they can include infection, nerve damage, 

blood clotting, fluid loss and negative reactions to anaesthesia. Less severe 

liposuction risks include scarring, loss of sensation in and near the treated area, 

as well as skin discolouration in the treated area. Diabetes, poor circulation, 

heart, lung or liver disease, smoking or a family history of blood clots may also 

increase the risk of complications. 

Contact your doctor if you experience any concerns or problems following 

liposuction. These may include: 

• Nausea 

• Fever or chills 

• Heavy bleeding or oozing from incision sites 

• Increased swelling around the surgery sites 

• Increasing pain 

• Redness around incision sites that is spreading. 

General dissatisfaction can be minimised by fully understanding the risks and 

benefits associated with your chosen surgery and having realistic expectations. 

To maximise the success of surgery and minimise the potential risk of 

complications, always follow your doctor’s instructions for surgical preparation 

and post-operative care. 

Some questions to ask yourself 

• Why do you want to have a particular procedure? 

• How do you feel about your body image now? 

• Is anyone prompting you to have the surgery? 

• Do you suffer from an emotional or psychological disorder? 

• Did you recently experience a stressful event eg. divorce or loss of a loved one? 

• Are you a perfectionist, and do you find minor flaws with many parts of your 

body and with your life? 

• Would you be prepared to handle a complication if something goes wrong 

after surgery? 

Are you a good candidate? 

The most important decision you will make when considering cosmetic surgery 

is whether the procedure, with its inherent risks and complications as well as its 

benefits, is the right thing for you. 

Once you have weighed it up and decided to proceed, the key to a successful 

outcome is having realistic expectations and understanding the procedure’s 

limitations for your individual case. 

The psychology behind the decision to have cosmetic surgery is one of the 

most important aspects of the procedure. A good candidate is mentally and 

physically stable and understands the reality of what this surgery can achieve. 


Before & after photos 

face & neck lift 

Gallery 

BEFORE 

AFTER facelift, neck lift and laser resurfacing by Dr Flynn 

BEFORE 

AFTER facelift and laser resurfacing by Dr Flynn 


gallery 

Face & Neck lift 

BEFORE 

AFTER neck lift by Dr Flynn 

BEFORE 

AFTER neck lift by Dr Flynn 


thread lift 

Gallery 

BEFORE 

Twelve days AFTER thread lift by Dr Flynn 

laser resurfacing 

BEFORE 

AFTER SmartXide Hot Dot laser treatment by Dr Flynn 


gallery xxx xxx 


BEFORE 

AFTER SmartXide Hot Dot laser treatment by Dr Flynn 


BEFORE 

AFTER combination treatment including fat transfer and laser 

resurfacing by Dr Flynn 


east lift 

Gallery 

BEFORE 

BEFORE 

AFTER breast lift only by Dr Flynn 

AFTER breast lift only by Dr Flynn 

breast reduction 

BEFORE 

Five days AFTER breast reduction surgery by Dr Flynn (Note some 

modest bruising on the left breast and the scar pattern, which is 

healing well at day five) 


gallery 

breast augmentation 

BEFORE 

AFTER breast augmentation by Dr Flynn 

BEFORE AFTER breast augmentation by Dr Flynn 

BEFORE 

AFTER breast augmentation by Dr Flynn 


liposuction 

Gallery 

BEFORE 

liposuction 

AFTER liposuction by Dr Flynn 

BEFORE 

AFTER liposuction by Dr Flynn 


gallery 

Abdominoplasty 

BEFORE 

AFTER abdominoplasty by Dr Flynn 

Abdominoplasty 

BEFORE 

AFTER abdominoplasty by Dr Flynn 


ACCS patient brochure 

Things you should know 

Raising standards, protecting patients. 

Choosing your doctor 

You should choose a doctor based on the doctor’s relevant education, training, 

experience and proven competence with respect to the specific procedure you 

are considering. 

Cosmetic surgery and plastic and reconstructive 

surgery – what is the difference? 

Although cosmetic surgery and plastic surgery are frequently talked of 

interchangeably, they are different. Cosmetic surgery is performed on normal 

healthy structures of the body in order to change or improve the patient’s 

appearance and elevate their self-esteem. Plastic and reconstructive surgery 

is different to cosmetic surgery because it is performed to improve function or 

repair appearance impaired by congenital defects, disease or trauma. 

Cosmetic medicine and cosmetic surgery 

– what is the difference? 

Doctors who are fellows of the ACCS are accredited as either surgical or medical 

fellows. It is important to note that membership of a particular professional group 

does not guarantee the cosmetic surgery provider’s experience in a particular 

procedure. Make sure you ask your doctor whether they are accredited by the 

College for the procedure you are contemplating. 

ACCS Accreditations 

‘FACCS’ means Fellow of the Australasian College of Cosmetic Surgery. 

These doctors are trained in cosmetic surgery and accredited by the college 

to perform invasive cosmetic surgery such as liposuction and breast 

augmentation. To qualify as an FACCS a doctor must have three years’ basic 

surgery training post medical school and a further two years’ specific cosmetic 

surgery training. 

‘FFMACCS’ means Fellow of the Faculty of Medicine of the Australasian 

College of Cosmetic Surgery. The Faculty of Medicine represents trained 

cosmetic physicians who have been accredited by the College in the field of 

cosmetic medicine. 

Fellows of the Faculty of Medicine (FFMACCS) are not accredited by the 

College to perform invasive cosmetic surgery. Some FFMACCS, because of 

special training and experience obtained outside of the College’s accredited 

programs, may have the expertise to perform these procedures competently, 



but you should establish with the doctor their training and experience in the 

procedure you are considering. 

Procedure specific registers 

In addition to the Fellowship qualifications, the College maintains ‘Procedure 

Specific Registers’. These registers, which are available on the College’s 

website, provide reassurance that you are in the hands of a trained, accredited 

and experienced practitioner. 

To be included on a Procedure Specific Register a doctor has to have done 

a minimum of 50 such procedures. In some cases the minimum is 100 cases. 

Getting the most out of your consultation 

When considering a cosmetic procedure you want to be sure that you get all of 

the information you need to make an informed choice. 

Be sure of what it is that you are trying to correct. This is more important 

than concentrating on asking about a specific procedure because there will 

usually be a number of different options to achieve the result you seek. 

Don’t be afraid to ask questions. If you do not understand something, then 

say so. Any competent doctor will want you to understand everything to your 

satisfaction, and it will help your doctor understand what you are trying to 

achieve. It doesn’t matter if you think the questions are minor – if they worry 

you then they are important. 

Risks and complications 

You should consider seeking a second opinion before having any invasive 

elective procedure. 

Every procedure, whether it is an operation or a non-surgical procedure, 

carries an element of risk. This is important to understand and discuss during 

your consultation. 

Some risks are minor, such as redness or bruising after an injection. Some 

risks are more serious, such as severe infection, scarring or unevenness. 

Sometimes a procedure may not turn out the way a patient would like, despite 

the best appropriate efforts. 

Sometimes patients hope for a result that is difficult or sometimes impossible 

to achieve. It is important for both you and your doctor to make sure that 

expectations are realistic and reasonably achievable. 

You need to make sure your doctor discusses risks and complications with 

you to your satisfaction. If you are not sure then you should not proceed. 



Questions you should ask your doctor 

• Are you a Member of the Australasian College of Cosmetic Surgery? 

• How many times have you performed this procedure before and in the last 

year? 

• What are the risks associated with the procedure and what is your own 

complication rate? 

• What are the alternatives to the procedure being considered? 

• Can I see photographs of the results of your own patients who looked similar 

to me before their surgery? 

• Can I see photographs of the kind of result it will be impossible for me to 

achieve? 

The biggest factor determining what you will look like after a 

cosmetic procedure is what you look like now. Seeing both 

types of photos will help you to understand the kind of result 

you should realistically be able to achieve. 

Do not be afraid to ask these questions. No competent 

doctor will mind answering them. 

Questions you should ask yourself 

• Am I happy with all the arrangements which have been made for me? 

• Do I understand that there are risks and potential complications with this 

procedure? 

• Do I feel confident with this doctor? 

• Do I feel confident about having this procedure? 

• Have all my questions been answered satisfactorily? 

Remember that cosmetic procedures are elective. You can and 

should delay procedures until a time that is appropriate, bearing 

in mind other commitments such as family or other social 

activities, work commitments and finance. 

Most importantly, you should not proceed until you are 

satisfied that you have selected the right doctor and have 

received and considered all the necessary information to make 

an informed decision. 



What to do when things go wrong 

If you feel the outcome of your procedure is not appropriate or if there 

has been a complication, first draw your concerns to the attention of your 

doctor. They are usually in the best position to respond and ensure the best 

outcome. 

If you are uncomfortable voicing your concerns with your doctor 

personally, talk to the nurse or other clinic staff and ask them to convey 

your concerns to the doctor. Hopefully with everyone working as a team, 

the problems can be rectified. However, if you feel you cannot approach 

the clinic with your concerns or if you wish to make a complaint about your 

treatment, there are a number of options available to you. All ACCS Fellows 

and Members must adhere to a strict and enforceable Code of Practice. 

Accordingly, you may: 

• lodge a complaint with the College, which will be acknowledged and 

placed before an investigating panel with disciplinary authority. 

Alternatively, you may: 

• lodge a complaint with your state or territory health care complaints 

commission - a government body specially tasked to investigate and 

advise on patients’ health complaints. 

• lodge a complaint with the Medical Registration Board in your State. 

• seek legal redress against the practitioner by engaging a solicitor. 

Please call the ACCS on 

1800 804 781 if you would like 

further information. 

ABN 89 086 383 431 

Registered office: 

Level 2, 96 Phillip Street, 

Parramatta NSW 2150 

All correspondence to: 

PO Box 36, 

Parramatta NSW 2124 

Phone 1800804781 

Facsimile 02 9687 1799 

admin@accs.org.au 

www.accs.org.au 


The Australasian 

College of 

Cosmetic Surgery 

(ACCS) 

PATIENT SATISFACTION ASSURANCE 

The Australasian College of Cosmetic Surgery is fully committed 

to continuous improvement of the standards of Cosmetic 

Medical Practice. 

Its members have committed extensive resources to 

education and professional standards in Cosmetic Medical 

Practice and must comply with a strict Code of Practice. 

The College wishes to hear from patients who have had 

experiences, both beneficial and otherwise, which they believe 

should be brought to the attention of the College’s governing 

Council. In particular, a Patients Complaint System exists to 

allow for full, transparent and confidential examination of the 

circumstances of the conduct of any Member of Associate 

Member of the College. 

Your Satisfaction 

Your complaint will be properly considered in a timely and 

impartial manner. The College will not consider complaints that 

are at the time subject to judicial or insurance processes. 

At all times you may be assured that the Fellows and Council 

of the Australasian College of Cosmetic Surgery are dedicated 

to advance the standards of care and patients’ interests in the 

field of Cosmetic Medical Practice. 

A full copy of the ACCS complaints procedure is contained 

within the ACCS Code of Practice which is available on the 

College website www.accs.org.au 

Any questions arising from the contents of this pamphlet 

should be addressed to the College Administrator in the first 

instance, who can be contacted on 1800 804 781 or PO Box 

36 Parramatta NSW 2124 Australia.




1300 88 13 88 

www.cosmedic.com.au

COSMEDIC AND SKIN CLINIC 

Suite 2, 98 Marine Parade, 

SOUTHPORT, 4215 

Queensland 

1300 88 13 88 

07 5555 7888 

www.cosmedic.com.au 

info@cosmedic.com.au 




1300 88 13 88 

www.cosmedic.com.au

Cosmetic Surgery & Medicine by Dr John Flynn

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