Interesting Qs & As

I’ve guided many tens of thousands of people, both patients and colleagues, over the years, in conferences, during lectures/ tutorials, in clinic/ hospital wards and operating rooms, on radio and television, in educational videos, and, of course, by way of web material, including on RealSelf and Estheticon.  The following are a selection of some of the topics for which I gave counsel:

General Advice

As cosmetic surgery becomes increasingly popular, and especially as chain clinics increase in number, potential customers/ patients should be aware of the following:

Sales tactics:

  • Free consultations.  Nothing is free and the cosmetic clinic doesn’t exist for charitable purposes for you, so they’ll recoup the costs somehow!;
  • Seeing a nurse instead of seeing the surgeon who shall be performing the procedure.  Quite simply, only the doctor who shall perform the procedure shall have the insight to adequately address any concerns;
  • Having a ‘salesperson’ – many of whom work on commission – to close ‘the deal’.  Do you feel that your best interests are the primary focus?

Professional style:

  • The focus being on social media and not on education;
  • Guarantees of surgical outcomes – remember that nothing may be guaranteed in life aside of uncertainty (and also taxes and death, as Benjamin Franklin said);
  • Limited repertoire of services, which means there is a higher chance of being ‘sold’ to (so that you shall fit the service on offer, instead of different services being available to suit you).  For example, somebody who cannot perform tummy tucks may wrongly convince a potential patient to only get non-invasive

Financial strategies:

  • In-house finance;
  • ‘Insistence’ to apply for a loan.

There is no substitute for experience as a doctor AND for relevant experience in the field of practice:

  1. The greater the breadth AND depth of training, it is likelier that you shall be managed more proficiently;
  2. The greater the number of years spent focussing in a particular field, the greater the relevant knowledge and the higher the chance of better outcome.

So, check and confirm about the year of graduation of the clinician, and also how many years they’ve spent ‘specifically’ training in the particular specialty.

This advice comes from my experience around the world (Europe, North America, and Oceania) where I’ve gained experience in the public sector and the private sector (in chain clinics and standalone middle-tier clinics) and, now, as the owner of a high-end, world-first medispa inside a hospital.

About Government-funded services

Government-funded services (Medicare) do not usually cover the treatment of:

  • Asymptomatic scarring (i.e. not affecting physical function);
  • Redundant soft tissues, e.g. abdominoplasty;
  • Cosmetic-only procedures, such as breast augmentation or cosmetic nasal reshaping;
  • Revisions after cosmetic surgery, including replacement of breast implants;
  • Tattoo removal.

Patients are advised to do their own research, and to contact their insurance companies, where applicable, for additional guidance. 

Please also note that a small, but not insignificant number, of surgeons intentionally misrepresent (miscode) procedures in order to access public funds.

Dr. Niro is staunchly opposed to such behaviour, and shall not refer patients under false pretences to offset solely cosmetic costs.  Please note that Dr. Niro does not provide any government-funded/ Medicare services, and therefore no longer treats the following:

  • Acute burns injuries;
  • Hand injuries, such as to the fingertip, tendons, or bone fractures;
  • Peripheral nerve compression syndromes, such as carpal tunnel.

Anti-wrinkle Injections or Soft-tissue Fillers?

This depends upon what is anatomically needed and upon what the patient’s expectations and budget are.  As a rule-of-thumb, young people with good skin elasticity need anti-wrinkle injections.  Those who are older typically need to improve contours/ definition, projection, and volume.  However, all too often, a combination of both, in a considered an strategic way, yields the best results – aesthetically and temporally – and it is absolutely important to ensure that the skin is glowing, hydrated, and looking uniform.

Breast Implant Differences (in America)

I was recently asked why, in America, are saline breast implants approved by FDA (the equivalent of Australia’s TGA) for women over 18 but silicone implants are approved for those over 22.  It’s very simple: a woman at 22 is notably more mature than she would have been four years earlier, and the implication of this has to do with the possibility of implants leaking, though unlikely.  Firstly, both saline-filled implants and silicone-filled implants, have silicone shells.  However, a saline-filled implant clearly deforms when the salty water leaks out, meaning it’d be obvious to see deflation.  In contrast, silicone-filled implants may exhibit ‘silent’ ruptures should a small amount of silicone leak out, and women have to cognizant of this.  Therefore, it was felt that a more mature person would better manage this potential complication.  Please note that only extremely few surgeons still use saline-filled implants, globally – the vast majority use silicone-filled implants.

In summary, the choice of breast implant depends on the aesthetic wish of the patient, the patient’s anatomy and characteristics of soft tissues (e.g. amount of coverage, degree of elasticity of the skin), and considerations about other aspects of the patient’s body’s shape (e.g. shape of hips and buttocks).

What methods are available to clear or treat bruises?

Bruises may take a couple of weeks to clear-up.  The size of the bruise and the skin colour of the person, have an impact on the perception of the bruise, and as time passes, the colour changes.  Easy approaches include:

The patient avoiding certain dietary substances (e.g. alcohol, fish oils, and vitamin tablets) for around one week before a procedure;
Patients avoiding some types of drug (e.g. aspirin, diclofenac, warfarin) for around one week before the procedure.  Any medically prescribed drugs, such as blood thinners, must not be discontinued without formally checking with a doctor (ideally, with the physician who prescribed the drug);
The use of Hirudoid cream (‘topical heparin’) over bruised areas;
The use of a vascular laser in those with light-colour skin, to break the pigment trapped causing the bruise to be visible.  Please note that a light bruise may respond well to just one session of laser treatment, whereas a deep, dark bruise may require around three treatments, with a minimum of one day between each treatment. 

A brief note on the consumption of arnica (a herb that is frequently used in beverages and foods, and in homeopathy): whilst there are a lot of conflicting studies, some patients and physicians swear by the use of arnica in the run up to, and subsequent to, the procedure, in order to minimize bruising and inflammation (swelling).  This ‘might’ be the case, but please note that whilst it may have an anti-inflammatory effect, some studies have also suggested increased bleeding and, therefore, increased bruising.  Indeed, it is important to note that arnica may cause oropharyngeal irritation, vomiting, diarrhoea, and cardiovascular instability, if consumed in large amounts.  Accordingly, if in doubt, ignore this strategy but patients are encouraged to do their own research.

RealSelf Qs and As