Aesthetic Surgery: Facelift, Rhinoplasty and Body Contouring

Plastic surgery was originally developed for reconstruction, so any wound that hasn't healed in three weeks, whether traumatic, burn, or post-cancer resection, needs plastic surgery intervention and can be referred directly. Any congenital defect, a hand anomaly, cleft, or other soft tissue deformity, should also be sent directly. Cancerous skin lesions, where excision and reconstruction go together, are handled by plastic surgery too. And any leg oedema that doesn't resolve with elevation and conservative management is a specific trigger for lymphoedema referral. These are the practical trigger points to know.

Costs are considerably lower than in the Western world. Microvascular reconstructions range from roughly $6,000 to $9,000-10,000 depending on the number of procedures required and typically a 4-5 day hospital stay. Purely cosmetic procedures range from $2,000 to $7,000; a bundled "mommy makeover" package (breast reduction, liposuction and tummy tuck) is offered at a fixed $7,000.

Over the last two years, microsurgical success rate has been about 99%, with only two procedures not meeting expectations. For cosmetic procedures, outcomes depend heavily on patient expectations being realistic to begin with; when they are, success runs around 90-95%.

As with any surgery, there is a roughly 4-5% complication rate per case, managed through department protocols designed to minimise it. Patients prone to keloid scarring can develop keloid formation after cosmetic procedures. Patients with comorbidities like diabetes, hypertension or thyroid disease carry a higher chance of wound dehiscence, infection, haematoma or seroma formation, these are best thought of as expected side effects to plan around rather than true complications in most cases.

Yes, it varies significantly. For the arm, the golden period is 4 hours. For the forearm, 6 hours. For fingers, replantation can be attempted even at 8-10 hours. Early in his practice, proximal replantation was attempted at 10-12 hours, but the post-operative course was unpredictable enough that the lesson learned was not to attempt proximal replantation beyond 4, at most 6, hours.

For facial procedures, around 15-16 years with parental consent, since facial growth is considered complete by then. For body procedures, 17-18 is considered the appropriate minimum age, reflecting the maturity needed to weigh the decision properly.

Patient expectations being realistic from the outset is the single biggest factor; when expectations are well-calibrated, reported success runs 90-95%. Comorbidities like diabetes or a tendency toward keloid scarring also need to be factored into pre-surgical counselling.