A Letter from Dr Hodgkinson

What is the difference between a rhinoplasty and a nose job?

A more youthful look with minimal scars.

Many people don’t realise that even when our surgical teams aren’t operating in the Philippines clinics are still being run by our volunteers.

Cosmetic Surgery Update

I recently was a guest Lecturer at the Anti-Aging World Conference held in Paris where 2000 attendees heard 3 days of lectures and saw demonstrations of the latest techniques in anti-aging medicine and cosmetic facial surgery. My lecture of mid-face rejuvenation was very well received by my European colleagues, many of who plan to visit our Double Bay Clinic later this year.

Although ‘anti-aging medicine’ is a poorly understood term encompassing hormonal replacement and lifestyle enhancement, cosmetic surgery is well established as the primary way to enhance one’s self-image. The misintegration of body and cognizance that occurs when one is fit and healthy but looks old and tired can be reversed with cosmetic procedures.

Besides operative procedures, the greatest advances have been with injectables: anti-wrinkle and non-permanent injectible fillers. Dr. Patrick Trevedic from Paris expressed great caution when “permanent” fillers were to be used due to the lack of knowledge of long-term results, although Aquamid had a >95% satisfaction for both physician and patient in Dr. Trevedic’s short follow-up study of 200 of his patients.

A general consensus from our European colleagues is that injectables, while they have a low rate of unpleasant side effects, they should still be taken seriously enough as to be performed only by qualified medical practitioners.

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If you look at facial rejuvenation over the last 20 years, one of the first things we established was rejuvenation of the neck by working with the submental fat pad and the SMAS (superficial musculoaponeurotic system)," recounts Dr Darryl Hodgkinson. "But no matter how you controlled the SMAS, you couldn’t do anything about the naso labial folds. Then the brow lift became popular, but still the area between the eyes and the mouth couldn’t be addressed."

Soft tissues from the cheek start to fall down with age and create deeper naso labial folds, a flattening of the mid face and a square appearance to the shape of the face. "Sometimes when you critically looked at the patient’s before and after photos after a facelift, yes they may look better but the midface is often still falling down." explains Dr Hodgkinson.

By the early 90s facial implants were helping fill and lift the mid third of the face quite successfully, then when endoscopes were developed for cosmetic surgery purposes there became an opportunity of accessing this area and being able to lift it.

"The problem has always been the technical difficulty of moving from the upper third of the face into the mid third – there are facial nerves between the two," says Dr Hodgkinson. "The use of the endoscope didn’t eliminate this technicality." However, what it did do is allow for smaller incisions to be made in the temporal area. "Now we use a procedure where we use an incision inside the mouth and identify the structures from inside the mouth and cheek," explains Dr Hodgkinson. "Then sutures are directed up and suspended into the temporal region, accessed through small incisions hidden in the hairline."

This gives the cheek area a lift deep underneath the skin. At the same time, a cheek implant can be placed if the patient wants more volume.

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Before and After a Midface Lift

"The surgery is similar for both because you free up the area just the same as if you are putting an implant in but then you put sutures underneath to suspend the cheek up," says Dr Hodgkinson. "No skin is removed and the tissues, over time, attach to the bone and are permanent and you don’t see or feel the sutures because they are at the bone level."

" There are very few risks with this technique. The main complication is that the suturing might break, but to minimise this it is held into place for 7-10 days with tape," says Dr Hodgkinson. "There’s always a risk of partial damage to the facial nerves but this is rare and I’ve never seen permanent damage to a nerve."

This technique of giving the mid face a lift re-establishes the inverted cone appearance of the face rather than the square appearance that develops through mid face sagging from age. It also smoothes nasal labial folds that have been created through this sagging. Elevated cheeks shorten the junction between the lower eyelid and the cheek, which result in a more youthful appearance.

(Reprinted from Australian Cosmetic Surgery Magazine)

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Operation Restore Hope at work year round

“ One of Operation Restore Hope’s children before and 1 and 3 years after surgery. Because Operation Restore Hope commits itself to its communities it is able to monitor not only the quality of its results but can be a part of these children’s lives.”

Many people don’t realise that even when our surgical teams aren’t operating in the Philippines that clinics are still being run by our volunteers. These clinics which are held at the hospitals in which we work are to screen the children for surgery, to educate their families on the special needs of their children (how to care for them both before and after surgery) as well as programs to medicate children with chronic problems like asthma or tuberculosis so that they will be fit for surgery. While all this is taking place in the Philippines, our teams of volunteers here need the whole year working and planning to amass the medical supplies, equipment and personnel as well as to have the children ready so that we can do over a hundred of operations in the few weeks we are operating.

We have a Filipino Ladies Fundraising Committee as well as a medical supply committee and our medical volunteers who are constantly planning not only to ‘keep up the good work’ but to expand and improve it with each mission.

Membership renewals are now due, so if you are already a member you should be receiving a reminder in the mail. If not, why not show your support and become a member. It only costs $10 per year with a one time $10 application fee. If you are interested, please contact us at Operation Restore Hope on 02 9362 7480.