fullybooked200We are currently booking routine (non-urgent) new patient appointments for February 2020 and beyond. We always do our best to accommodate emergency and urgent referrals upon receipt of your doctor's referral, and we have a number of "emergency" slots available in the weeks ahead. We also have an appointment waiting list so that wait listed patients can receive offers of earlier appointments if and when they become available. However, due to strong demand, limited appointment availability and only a few weeks to go before the Holiday Season commences, we do not anticipate being able to accommodate further routine (non-urgent) patient appointments in 2019. Thank you for your understanding.

Broken noses (Nasal fractures)

Written by Dr Jill Tomlinson on .

One of the most common types of fractures is a broken nose, or nasal fracture. Nasal fractures may occur in a variety of situations including from sporting injuries, motor vehicle accidents and interpersonal violence.

The upper part of the nose is made of bone, and the lower part is cartilage. When a nose is broken it is generally the upper part that breaks although the cartilage can break or warp as well. It the broken parts of the nose haven’t moved from their original position then the break does not require treatment and will usually heal without any problems. However, if the broken parts of the nose have shifted then the nose will look abnormal and there may be problems with breathing through the nose.

My nose is broken, what should I do?

If you have a broken nose it is advisable to seek prompt medical attention so contact us to arrange an urgent appointment. X-rays and CT scans are usually unnecessary unless there are concerns about other facial fractures or injuries. When you see Dr Tomlinson she will ask you questions about your breathing and the appearance of your nose, and together you will determine if surgery is necessary to restore your nose. If there is a visible deformity most individuals choose to undergo surgery to correct the nose position.

Surgery for a broken nose

Ernst-Joubert-broken-nose-260x298Surgery for a broken nose should be performed within 2 weeks in adults and within 10 days in children. If the nasal bones are broken but the cartilage part of the nose (the ‘septum’) is unbroken then nasal fracture surgery is relatively straightforward. An anaesthetic is administered and then Dr Tomlinson manipulates the bones back into their normal position and ensures that the nasal airway is open. A simple cast or splint is then applied to prevent the bones moving out of place over the following week.

If the surgery is performed more than 2-3 weeks after the time of the injury then it is not possible to simply manipulate the nose back into position. In these circumstances if the nose is to be fixed it must be re-broken to move it from where it has set in position. If the nose has set in position then a full “septorhinoplasty” may be required to restore the nose to its former position (or a new position, should you wish to change the shape of your nose from its original appearance). A septorhinoplasty involves surgically repositioning the cartilage and bones of the nose.

Recovery

It is wise to take a couple of days off work after having a broken nose fixed. After three weeks no restrictions are required, as the nose heals relatively quickly.

Are there Medicare or private health insurance rebates for nasal fracture surgery?

Surgery to repair a broken nose and to correct nasal deformities after trauma is eligible for Medicare and health insurance rebates. Correcting pre-existing deformities including nasal humps and nasal tip work is not eligible for Medicare and health insurance rebates.

 Image from Larry Brown Sports

Facelift & Facial Rejuvenation Surgery

Written by Dr Jill Tomlinson on .

There are many different types of facelifts, so how do you know which type is right for you? A facelift should be tailored to your individual needs and preferences. It may involve an eyelift (upper and/or lower blepharoplasty), a browlift, fat grafting, fat removal, a malar lift, a SMAS lift, a neck lift, chin augmentation, a nose job (rhinoplasty), cheek implants, a lip lift, lowering of the hairline and resection of the corrugator (frown) muscles.

A facelift can subtly or dramatically change your appearance so it's important to ensure that you are on the same page as your surgeon about your desired outcome. It is very sensible to see more than one surgeon when considering a facelift, as each individual surgeon is likely to have their own opinion about what your face "needs" and what they can do to help you. Do you want to look like yourself, but younger? Do you have a specific area of concern - perhaps your eye area, or your jowls, or your cheeks? Are you seeking a dramatic change or a subtle change? A surgeon will be able to guide you and make recommendations about what treatments and surgery will produce the best results for you, but it is very important that you understand and agree with the surgeon's recommendations.

Non Surgical Options

There are a variety of non-surgical treatments that many people have already tried before they decide to investigate a facelift. These non-surgical treatments include injectables (botulinum toxin and dermal fillers), skin treatments (including retinol, alpha hydroxy acids, antioxidants vitamin C and E, niacinamide, tea extracts, coenzyme Q10 and grape seed extract) and chemical peels. Laser treatments can also be used to treat wrinkles, pigmentation, sunspots and visible blood vessels (telangiectasia). Great skin care is beneficial prior to facelift surgery as healthy skin not only looks better but heals better. 

Facelift Surgery: Procedural Details

Facelift surgery is performed in a hospital operating theatre under anaesthetic and requires an overnight stay. The recovery period varies according to the precise nature of the treatment performed. You should plan to take two weeks off work and you will have two post surgical reviews during this time.

You must not smoke for the three weeks before surgery or after surgery. Smoking not only ages your skin but also increases the risks of poor wound healing, wound breakdown, bad scarring and skin necrosis (skin death) with facelift surgery.

Possible complications

Possible complications of facelift surgery include bleeding (haematoma), skin necrosis, visible scarring, nerve injury with temporary or permanent numbness, nerve injury with temporary or permanent reduction or loss of facial movement, infection, earlobe deformity, facial asymmetry, contour deformities, hair loss in the area of incisions or distortion of the hairline and anaesthetic risks.

Maintaining the results of surgery

Facelift surgery can turn back the clock and make you look younger, but it does not stop the clock! To maintain the results of facial rejuvenation surgery I recommend using good quality skin care products, protecting your face from the sun and definitely no smoking. Strict avoidance of UVA and UVB dramatically reduces photoageing which is a major contributor to facial ageing in Australia.

To schedule an appointment to see Dr Tomlinson about facelift surgery please phone (03) 9427 9596. You do not need a referral from your general practitioner; facial rejuvenation surgery is not covered by Medicare or private health insurance.

Any surgical or invasive procedure carries risks.
Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.

Blepharoplasty / eyelid surgery

Written by Dr Jill Tomlinson on .

eyesglabellaEyelid surgery ("blepharoplasty") is used to treat the upper and/or lower eyelids. Delicate surgery removes excess or overhanging skin, giving a more youthful look to baggy upper eyelids and even improving vision in individuals whose eyelid skin obscures their vision by resting on their upper eyelashes. Asian blepharoplasty eyelid surgery ("double eyelid" surgery) is performed to create a crease in the upper eyelid, giving the appearance of a larger eye and making it easier to apply eye makeup.

Bags and wrinkles under the eyes can also be treated with specialist techniques including facial fat grafting to address the hollowing that occurs around the eyes with ageing.

When you see Dr Tomlinson to discuss eyelid surgery she will assess the function of your eyelid muscles. If you have a weakness of one or both upper eyelids you may require surgery to the muscles. This "ptosis repair" is performed on droopy eyelids, where a muscle in the upper eyelid ("the levator muscle") has stretched or detached from its usual position within the eyelid. Ptosis repair adjusts the resting height of the upper eyelid, whereas blepharoplasty removes excess skin - with or without fat and muscle. It is important to individualise your surgery in order to achieve optimal results; in blepharoplasty surgery there is no "one size fits all" operation.

Eyelid / Blepharoplasty Surgery

Blepharoplasty is performed as day surgery under local anaesthetic, or sedation and local anaesthetic, or general anaesthetic.

You must not take aspirin, warfarin, clopidogrel or any blood thinning medications prior to surgery as this will increase the risks of surgery, especially the amount of bruising after the surgery. You must disclose to Dr Tomlinson if you have existing eye conditions, such as dry eyes, glaucoma or wear contact lenses as these conditions can affect the surgical risks and recovery. The surgery should not be performed if you have uncontrolled blood pressure or uncontrolled thyroid problems, and if you smoke it is recommended that you give up at least 2 weeks prior to surgery.

Asian Eyelid Surgery

Asian blepharoplasty eyelid surgery (also called "double eyelid" surgery) is performed to create a crease in the upper eyelid, giving the appearance of a larger eye. It is the most frequently performed cosmetic surgery in Asia. In this video US surgeon Dr Amiya Prasad shows before and after images, and demonstrates how the surgery is done (note: video contains medical procedures).

Recovery After Blepharoplasty Surgery

After the surgery you will need to spend 2-3 days resting quietly at home to reduce post operative swelling. Cold packs should be applied gently to the eye area in the first 48 hours to minimise swelling and bruising. Do not rub at your eyes. You will be prescribed pain medications and an ointment to apply to the wounds twice a day. You can wash your face and shower on the night of surgery.

You will return to see Dr Tomlinson at approximately 1 week after the surgery to check your wounds and progress. You should plan to take 1-2 weeks off work; over this time the bruising and swelling will gradually resolve. You can apply eye makeup to the wounds and resume exercise after 2 weeks. You should expect to have visible bruising around the eyes for 7-10 days. More severe bruising can take longer to resolve and you should allow at least 6 weeks before any important social events or photographs.

You are able to drive after the surgery providing it is 24 hours after your anaesthetic and your vision is clear. You must not wear contact lenses until the incision lines are completely healed. If you experience a sensation of dry eyes after the surgery you should not wear contact lenses until this has resolved. It often takes until 6 weeks after the surgery until the puffiness around your eyes has fully resolved.

Possible Complications of Blepharoplasty Surgery

Possible complications of blepharoplasty include:

  • Risks of anaesthesia
  • Bleeding
  • Infection
  • Temporarily blurred or impaired vision
  • Dry or watery eyes
  • Difficulty closing your eyes - this can lead to drying of the eye surface and cause corneal scarring, but the risks of this occurring are minimised through careful assessment and measurements
  • Asymmetry of the eyelid position or fold
  • Ectropion (rolling down of the lower eyelid)
  • Unnatural-looking eyes (although great care is taken to ensure that you and Dr Tomlinson are "on the same page" if you desire surgery that may change the shape or appearance of your eyes)
  • Inflamed, itchy scars
  • Bleeding behind the eye
  • Vision loss, including complete blindness; this risk is said to be 1 in 40,000 procedures and you are at greater risk if you smoke, have pre-existing eye disease, if your blood does not clot properly and if you cough, strain or lift excessively soon after surgery
  • Further surgery to treat complications.

Blepharoplasty surgery in itself does not remove dark circles from under the eyes, does not lift the eyebrows and does not remove crows feet. If your eyebrows are low Dr Tomlinson will discuss with you the pros and cons of browlift surgery and whether this would be suitable or desirable for you.

What are the costs of Blepharoplasty Surgery?

The surgical quotation that you will be provided at your consultation includes, where applicable:

  • the surgeon's fee
  • the anaesthetist's fee
  • the hospital or day surgery fee
  • the cost of your post surgical appointments for one year

A Medicare and/or private health insurance rebate may be applicable for upper eyelid surgery including ptosis surgery - Dr Tomlinson will discuss this with you at your appointment. Medicare and/or private health insurance rebates are generally not available for the parts of the surgery performed on the lower eyelids, or for fat grafting.

Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.

Fat grafting

Written by Dr Jill Tomlinson on .

enquiringwomandecolletagefaceFat grafting can provide a long-lasting enhancement to lips, hands, eyes, cheeks, temporal hollows, areas of contour deformity and more.

What does the procedure involve?

Fat is harvested from another body area with gentle liposuction through a very small cannula. Most commonly the fat is taken from the abdomen or thighs. The fat is immediately processed to remove excess oil and fluid. The fat is then placed in the treatment area with many passes through tiny incisions (1-2mm), using a blunt cannula in a weaving pattern to separate tissue without damaging underlying structures.

Can dermal fillers be used instead?

Absolutely, hyaluronic acid, poly-L-lactic acid and calcium hyroxylapatite fillers can be used instead of fat and these do have good temporary results (3-15 months). However, using fillers can be expensive in areas where a volume of 1mL or greater is required. A benefit of using fat is that it is a natural product that comes from your own body and can achieve long-lasting results - although the extent to which a fat transfer maintains long term results is variable.

What is the recovery period?

The treatment area is initially swollen. It is important to avoid touching, massaging or compressing the treatment area during the first week. Cold compresses are recommended to reduce swelling.

Dressings will be applied to your treatment and your fat graft donor sites. These and any sutures will be removed at one week after surgery. At this time you will be instructed how to perform regular massage and other techniques to maximise your outcome.

The swelling will reduce gradually, with the majority of swelling resolving in the first 2-3 weeks.  If less fat is transferred this will minimise the trauma of transfer and minimise the swelling, but the long term outcome will also be less successful. There will still be mild swelling for many weeks; the eventual outcome of surgery can be judged at the 6 month stage.

What are the possible complications?

The main post operative issue is that of swelling, which resolves over time. Some patients may notice small lumps or irregularitites as the swelling resolves, perhaps caused by uneven fat distribution or migration. Other possible complications include infection, cyst formation and temporary alteration in sensation (numbness, burning or tingling). Multiple treatments are commonly required to achieve a long term, sustained outcome.

To schedule an appointment to see Dr Tomlinson about fat grafting please phone (03) 9427-9596.

Any surgical or invasive procedure carries risks.
Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.

Website Disclaimer

This website is authored by Dr Jillian Tomlinson, a fully qualified plastic, reconstructive and hand surgeon who practices in Melbourne, Australia. This website aims to inform patients and health professionals about hand surgery, illness prevention and the practice philosophy of Dr Jill Tomlinson. This website's content is designed to complement, not replace, the relationship between a patient and his/her own doctor. The information is not intended to replace the advice of a health professional. This website does not host or receive funding from advertising or from the display of commercial content.