This procedure involves removing excess skin and fat from the stomach (abdomen) and tightening the muscles of the abdominal wall. Cuts (incisions) are made across the lower abdomen above the pubic area and around the umbilicus (tummy button/navel) and the muscles underneath are pulled together and stitched. The tummy skin is stretched down and the excess skin removed. A new hole is made for the umbilicus. A variation on this operation is to detach the umbilicus off the abdominal muscles and allow it to come down a few centimetres as the tummy skin is tightened downwards. (It is re attached deeply). This avoids a scar around the navel. This is only possible in people without too much excess skin. If it looks as if the navel would come down too far and look 'out of place' it is better to do the method mentioned above. Liposuction is usually used as an adjunctive procedure. It helps to smooth the contour of the abdomen and can be used to get rid of hip and loin fat pads at the same time. Extra procedures add cost, however. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-4 hours for an average case. You will probably have to stay in hospital for 1-2 days and will need to arrange for someone else to drive you home. Your tummy skin will be swollen and tender at first and you will need to take medication for pain relief for several days. You will need to wear a special support garment for 6 weeks after surgery, to help prevent seroma and haematoma. (We tell you where to get this, custom made ones are also available). You will probably be able to return to work after about 2 weeks. It may take 3-4 months for lower abdominal swelling to go completely and it will take 9-12 months for the scar to fade to a white line.

Surgery to increase breast size involves inserting silicone bags (implants) filled with silicone gel or salt water (saline) under the chest muscle or breast gland. The procedure involves making a cut (incision) either in the armpit (for saline filled implants), under the breast or in the lower half of the areola (the dark area around the nipple) through which the implant is inserted. The surgery is usually performed under general anaesthesia (you will sleep through it) and it will take about 2 hours. We usually like you to stay in hospital overnight to ensure you get the right amount of painkiller, antibiotics, anti-nausea medications etc. however we do many augmentations on an outpatient basis now. We put in nerve blocks between the ribs before you wake up so this keeps you numb for many hours after surgery, allowing you to go home and rest there. We give a prescription for suitable painkillers, antibiotics and anti-inflammatory agents to keep you comfortable. In these cost conscious times avoiding an overnight stay will save many hundreds of dollars! You will need to arrange for someone else to drive you for the first week after surgery. You will need to take medication for pain relief for 2-3 days and you should rest for the first week after surgery. You will probably be able to return to work after 7-10 days. We like you to wear a non-underwire bra for 3 months after surgery as wired bras are rigid and tend to make the newly healing scars uncomfortable. It will take several months for the scars to fade. At your pre-op consultation we encourage you to try out implants or 'sizers' in a suitable bra to assess the size you wish to be. Putting a t-shirt on over the bra and implant will give you a good idea of what you will look like to other people.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours for the simplest type and up to 4 hours for the most complex type that may also involve placement of a breast implant. Options are carefully discussed with you prior to surgery. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day. Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later. There are two methods of breast reconstruction: one involves using an implant, either alone or in combination with a flap of tissue taken from another part of your body; the other uses tissue taken from another part of your body such as the abdomen or back without using an implant. There may be medical reasons why one of these methods is more suitable for you. There are usually several options from which you can choose. Implants A silicone bag filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag (called a tissue expander) where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will take about 1.5 hours under general anaesthesia. Reconstruction by implant or tissue expander followed by implant is often done on an outpatient day stay basis. Flap Reconstruction A skin flap taken from another part of the body such as your back (latissimus dorsi flap), abdomen (rectus abdominus flap) or buttocks (gluteal flap), is used to reconstruct the breast. If taken from the back or abdomen the skin flap is left attached to the muscle through which the blood supply comes. Abdominal and buttock tissue can also be transferred as a 'free flap' (detached from the body) and then reattached by joining up the main artery and veins using an operating microscope. This is a much more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital. The most common type of breast reconstruction is the "TRAM flap" (Transverse Rectus Abdominus Musculo-cutaneous flap). The skin, fat and muscle from the lower abdomen is freed then tunnelled up under the skin to lie where the breast used to be. The 'flap' of tissue is then shaped to look like a breast and sutured into position. A nipple is usually reconstructed 3-6 months later and at the same time the other breast can be reduced or uplifted to match if needed. For the unfortunate woman who has lost a breast to cancer, having either an immediate or delayed reconstruction can give a huge psychological boost to improve self esteem and quality of life, as well as a big improvement in appearance!

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-5 hours depending on size and surgical method needed to get a pleasing result. Women with breast cup sizes DD to G or H can be reduced to B or C cup in size. It is important to have the breasts in proportion to the rest of your body. Often liposuction of the fat pads on the sides of the breasts under the armpit is done to reduce these fat rolls at the same time if the patient so desires. This adds extra time and cost. You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home. You may need to take some medication for pain relief for several days. We apply waterproof dressings to enable you to have a quick wash in the shower each day in the week after surgery. We can also supply a special support bra to be worn for 3 months after surgery. This has no underwire so the wire does not dig into the new scars thus being much more comfortable. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade. There are several different methods of breast reduction. For moderately large breasts often a 'short scar' technique can be used. We use the shortest scars possible to get the required result.

The appearance of ears that are mis-shaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children. Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts about 2 hours and can be performed under local anaesthetic for teenagers and adults (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure is performed under general anaesthetic (they sleep through it). Usually the children are treated as day cases. A head bandage is worn for about 1 week. A return to normal daily routines is usually possible after that. Contact body sports should be avoided for 3 months. Several techniques of setting back prominent ears are available. We use the one most suitable to a persons particular needs. Extra procedures such as reducing the size of excessively large ears can be done at the same time.

Excess skin and/or fat can be surgically removed from your upper and/or lower eyelids to give your skin a less wrinkled and puffy appearance. The procedure typically involves making a cut (incision) in the fold of the eyelid (for the upper lid) or just below the eyelashes (for the lower lid) and removing any excess skin and/or fat. The surgery will take about 1.5 to 2 hours for the upper lids alone and 2 to 2.5 hours for the lower lids alone. Doing uppers and lowers together takes about 3.5 to 4 hours depending on complexity. In patients with big fat bags in the lower lids and deep grooves or 'tear troughs' below them we use a fat redistribution technique to fill in the grooves with fat from underneath the lower lid. Blepharoplasty is usually performed under local anaesthetic (the area being treated is numbed by injections) together with a sedative to make you feel drowsy (this can be by tablet or intravenously). General anaesthetic is available but this adds more cost. You will be able to go home the same day. It is recommended that you have complete rest and keep cold eye pads on for a couple of days after surgery. You should be able to return to work within 1 week, but be prepared to wear dark glasses for 2 weeks! (until the bruising settles).

Problems with the appearance or function of the hand can be the result of injury, birth defects or degenerative conditions. Re-implantation Fingers or hands that have been accidentally cut off can be reattached by very detailed surgery that is performed under a microscope (microsurgery) and involves reconnecting blood vessels, tendons, bones and nerves. Arthritis Arthritis is a condition in which a joint and the surrounding tissue become swollen and painful and the joint surfaces can become eroded due to rheumatoid or osteo-arthritis. If surgery is necessary, it may involve replacement of the joint with an artificial joint or removal or repair of swollen or damaged synovial tissue. Birth Abnormalities Surgery may sometimes be required for hand abnormalities that are present at birth such as too many or too few fingers, webbed fingers or joints that won’t bend. Carpal Tunnel Syndrome A pinched nerve in the wrist that causes tingling, numbness and pain in your hand may require surgery to make more room for the nerve. This operation is usually performed under local anaesthetic (the area being treated is numb but you are awake). Injuries Damage to tendons, nerves, joints and bones in the hand may require surgical repair. In some cases, tissue may be transferred from a healthy part of your body to the injured site (grafting). Fractures These can sometimes be treated as closed injuries by manipulation and setting the position of the broken bones. Often internal fixation with K-wires or plates and screws is needed. With open reduction and internal fixation earlier and quicker mobilisation can usually be done. Dupuytren's Contracture This is a common condition (often of a familial inheritance pattern) usually involving the formation of dense scar-like fibrous tissue in the palm of the hand extending into the ring and little fingers and to a lesser extent the thumb and other two digits. The fibrous tissue with time contracts pulling the fingers down towards the palm. Surgery is needed to release the fibrous bands once the fingers begin to bend down. If surgery is delayed it is much harder to get the fingers out straight again and there is more risk to the arteries and nerves during surgery. Sometimes skin flaps and grafts are needed or in extreme cases (often involving the little finger) amputation is necessary as a last resort.

The two most common types are 'port wine stains' and 'strawberry ' haemangiomas, these are non-cancerous, vascular skin lesions. The 'strawberry' type usually appears in the first month after birth and can grow very quickly for about 8 months. Haemangiomas generally start to fade and become smaller after 2 years continuing to decrease in bulk and fade in colour to 8-10 years of age but usually do not disappear completely. Treatment is not usually recommended unless the haemangioma is causing problems such as bleeding, feeding or breathing difficulties or impairing vision. Recommended treatments depend on the type and location of the haemangioma and include beta blockers such as Propanolol in early childhood, steroid medication, laser treatment and surgery. If surgery is required, it usually does not require an overnight stay in hospital.

Reduction of excessively large labia minora (the inner ‘lips’ or folds) is becoming popular now that women realise this can be done relatively easily with a good cosmetic appearance. With a practice nurse present, the woman needs to show the surgeon which parts really bother her and discuss how much tissue needs to be removed to give a neat and tidy appearance. It is best to have the operation clearly explained with the help of anatomy diagrams and photos of the actual procedure. Different amounts of excess tissue can be removed depending on individual variation. A general anaesthetic is advised. More women are opting for local anaesthetic alone (so they are fit to drive their cars post-op) or LA plus sleeping tablet sedation, both being much cheaper than a general anaesthetic. You must not drive a car after either sedation or general anaesthesia! It takes about one hour to do the procedure neatly and carefully and thus get a good result. You can go home soon afterwards with a prescription for painkillers, antibiotics and soothing ointment. Other procedures available for the female genital area include liposuction of the mons pubis fat pad. If this is embarrassingly large/bulky, a neat appearance can usually be obtained. It can be done under local anaesthetic with sedation or under general anaesthetic on its own or as part of a more extensive abdominoplasty or liposuction procedure. Vaginoplasty or vaginal tightening (posterior colporrhaphy) is becoming more popular once women have completed their families and can be done on its own or in conjunction with reduction labiaplasty. General anaesthetic is required.

Lips can be augmented by either injecting temporary or permanent fillers into the tissues just under the skin. Some people develop inflammatory reactions to the particle containing permanent injectable fillers so it is safer to avoid these. The 'gel' type fillers which contain either hyaluronate (short acting 6 months) or a polyvinyl compound (long acting 2-10 years) are much safer. They do not contain any animal protein such as bovine collagen therefore allergy testing is not needed to use products such as 'Restylane', 'Esthelis', 'Teosyal' (6 months) or 'Aquamid' (2-10 years). Temporary fillers can last 6 to 18 months depending on the type used. Injectable fillers cannot be removed, you have to wait for them to be slowly absorbed. Another option is to have a surgical procedure performed to make your lips appear fuller without having foreign material injected into them. In this operation, small cuts (incisions) are made on the inside of the lip to allow the mucosa to be lowered to bulk up the pink part of the lip, the 'vermillion'. The surgery takes about 1 hour for the upper or lower lip and it is performed under local anaesthetic (the area is numb but you are awake). It will take 1-2 weeks for the swelling to disappear.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach (abdomen), hips and thighs, inner knees and calves/ankles. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body. A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours. Small areas are treated under local anaesthetic (the area being treated is numb but you are awake). Big areas like the whole abdomen are done under general anaesthetic taking 1.5 to 2 hours. You will probably be able to go home the same day after a small area but an overnight stay in hospital is best after doing large areas. This is to ensure you get plenty of intravenous fluids and the appropriate antibiotics and painkillers. The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will need an elastic dressing or support garment (we tell you where to get this) that you may have to wear continuously for up to 6 weeks. You will probably be able to return to work after 1-2 weeks. Liposuction takes out cores of fat by tunnelling but leaves the fascia, nerves and blood vessels behind. Some bruising occurs and you will have a variable amount of prickly 'pins and needles' effect for some months after surgery. There may be patches of numbness and patches of increased sensitivity. This 'dysaesthesia' may last for 6-9 months or more but usually resolves in 3-6 months.

A naevus is a common skin growth composed of special pigment-producing cells. Naevi can vary in size, with small naevi requiring only simple surgery for removal, while the removal of larger naevi may require more than one operation and may involve skin grafts. The common name for a naevus is a 'mole' which usually signifies the dark brown slightly raised compound naevus. The fleshy raised pigmented lesions are intra-dermal naevi. Blue naevi have a dark bluish-black appearance. Junctional naevi are usually 2-3 mm diameter and often very dark brown to black and sometimes look like melanomas. The reason for getting dark moles and spots checked is that 50% of melanomas (pigmented skin cancers) may arise in or from pre-existing pigmented moles. Any change in a dark mole such as blackness, irregular edge, bleeding or ulceration should be reported to your doctor promptly. Excision of any 'suspicious' darkly pigmented lesions is generally recommended.

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size. Small cuts (incisions) are made either on the inside (usually) or outside of the nose (across the central part, the columella). Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2.5 hours for a cosmetic operation and up to 3.5 hours for a post traumatic reconstructive procedure and is performed under general anaesthetic (you sleep through it). If you have any obstructive airway symptoms due to a buckled septum or enlarged turbinates it is best to fix these at the same time. We assess this at the time of consultation. You may be able to go home the same day following a simple nose tip operation but after major bone surgery we prefer you to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. Internal soft packing is used after septoplasty work. This is removed the next day. It will take about two weeks for the 'blackeyes' to go and six weeks for the worst of the swelling to disappear. The nose tip can have numbness(which makes the nose feel bigger than it really is) and minor residual swelling for 6-12 months.

Scar appearance can be improved by various methods including a surgical procedure known as scar revision. This usually involves cutting out the old scar, closing the wound with stitches and, in some cases, moving the scar so that it is hidden by natural features of the body. Z-plasties or W-plasties are methods of breaking up scars so they look less obvious. Revision of small scars is usually performed under local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic). Sometimes you may also be given steroid injections at the time of surgery. These small operations are done on an outpatient basis. Large scars may be treated under general anaesthetic. We usually apply a waterproof dressing which is left on until you return in a week for the first wound check. Stitches may be removed in 1-2 weeks. Sometimes all the sutures are buried biodegradable stitches so there is no risk of stitch marks and with the advantage of no sutures having to be removed. You may need to take a few days off work after the surgery. We like you to keep your new scars taped with flesh tone low allergy tape for 3 weeks on the face and 3 months elsewhere on the body. This improves scar quality.

If the scar to be revised or skin lesion being removed is particularly large, a skin graft may be needed. This involves transferring skin from another, healthy part of the body (donor site) to the injured site (recipient site). On the face and hands, full thickness skin grafts are usually used as they have better contour, colour and texture than split thickness grafts which are usually used elsewhere. Large split skin grafts as used in resurfacing large burned areas, are usually harvested from the thigh or buttocks. While skin grafting can improve the function of a damaged area by releasing a contracture, some scarring will be left at both the donor and recipient sites. Except for small face and hand grafts, skin grafting is likely to be performed under general anaesthesia (you will be asleep during the procedure) in a hospital. The grafted areas may take weeks or months to heal completely and you may need to wear a support bandage or splint for a similar period.

Skin lesions can be divided into two groups: Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance. Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. It is best to remove them before they get too big to avoid a bigger operation or before they damage a vital structure e.g. eyelid. Melanoma is a serious skin cancer that can spread to other parts of the body if allowed to go untreated. Urgent removal is recommended. Even though melanoma has a nasty reputation, if it is removed before it has grown 0.75 mm into the skin from the surface, it is usually completely curable. Hence the need to have early diagnosis and surgical treatment. Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. Small tumours can be excised and closed directly. Large ones will leave big gaps in the skin after removing a safety margin of 4mm around the edges. In this situation a skin graft or skin flap repair is needed. On the face we try and use flaps of adjacent skin to repair cancer defects as the appearance is much better due to good colour and skin texture match. If a suitable flap cannot be devised then a full thickness skin graft is taken from behind the ear or sometimes from in front of the ear or from the lower neck depending where loose /surplus skin is available. With difficult or extensive invasive tumours we often get a pathologist to come along and check the tissue from the margins of the excision at the time of surgery . This is called a 'frozen section' technique as the samples are frozen, sliced, stained and checked for tumour while we wait. Getting clear margins this way is very reassuring. A similar method is Moh's micrographic surgery where the margins and under surface of the tumour are all checked. We apply a waterproof dressing. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.