Facial aesthetics

In this episode of PodMD, accredited plastic and reconstructive surgeon Dr Katie-Beth Webster will be discussing the topic of facial aesthetics, including what type of patients are asking for cosmetic surgery, the main risks with this type of surgery, the red flags GPs should be aware of with patients asking for this surgery, when a GP should refer and more


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  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Dr Katie-Beth Webster

    Dr Webster is a specialist Plastic and Reconstructive surgeon and completed her medical degree (MBBS) at the University of Queensland, graduating in 2010. She then entered specialist plastic surgical training at major centres in Queensland and NSW and was awarded a Fellowship of the Royal Australasian College of Surgeons in 2020.

    Katie-Beth has undergone additional training in craniofacial trauma and aesthetics and has also undertaken research in several areas including microsurgical breast reconstruction, flap reconstruction, head and neck surgery, skin grafting, hand injuries, and outcomes following surgery. She has presented this research at national and international conferences.

    Today, we’ll be discussing the topic of facial aesthetics

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Katie, thanks for talking with us on PodMD today.

    Katie : Thank you for having me

    Question 1
    The topic of today’s discussion is facial aesthetics. Katie, Can you give us a brief overview about facial aesthetics?

    Katie: Yeah. So procedures to improve the aesthetics or the appearance of the face have been done for a very, very long time. Initially, like the original plastic surgery back in India thousands of years ago was for people that had had trauma, nose amputations, burns and then that sort of the skills that we attain from reconstructive surgery have then over the time morphed to be able to cosmetically alter the appearance of the face.

    I think the initial cosmetic procedures that were performed were around 1800s like things like rhinoplasty and otoplasty, so surgery on the nose or the ears, but they were kind of very brutish with large scars and I like to think that we have tailored things a lot more since then.

    Broadly speaking, facial aesthetics are also includes non surgical procedures that you can use to alter the appearance of the outward face, and that would be things like Botox or fillers and these can be done to improve facial symmetry, facial balance or reduce the signs of aging.

    Question 2
    How would a patient wanting facial cosmetic surgery typically present?

    Katie: So I find these patients tend that come to see me tend to fit into two major groups. Often many have a facial feature that has bothered them for a large percentage of their life, and they have been thinking about coming to speak to someone about cosmetic surgery for a really long time. And they just want to know what things can be done to change or improve that particular feature, whether it be their nose, their chin, their eyelids.

    Others were happy with their appearance, but have noticed signs of aging and would like to look rejuvenated and have sort of their previous features restored and come to see me to see what we could do to help that. I occasionally see people that have had trauma cancer, things like that, or weight loss or medication related facial atrophy that need facial cosmetic surgery to correct those as well. But yeah, that’s tends to be the patient cohort that come to see me.

    Question 3
    What are the risks of aesthetic procedures?

    Katie: Yeah. So, aesthetic procedures all come with risks. Same as non-aesthetics procedures. There’s things like bleeding and infection, scarring. For injectables, there’s a lot of risks that a lot of people aren’t aware of like if you Botox the wrong area, you can cause problems with your eyelid opening and closing if you put filler in the wrong area, you can cause blindness or areas of skin loss, so those are things that are important to be aware of.

    For surgical procedures for aesthetics, I guess the main risk that we worry about. Are making sure that as a clinician, my expectation of the result the patient is going to achieve matches for patients and I spent a lot of time making sure that the image I have in my head of what is achievable and what I can attain for this patient is the same as what the patient desires and just making sure that expectation is matching up is one of the main sort of post operative things that I want to make sure it’s the case.

    Other unique risks that patients should be aware of if they’re having facial aesthetic procedures are specific to the procedure. So, if you’re having a blepharoplasty or upper eyelid surgery, there’s always concerns about blindness or issues with closure, closure of the eyelids.

    Rhinoplasty, a lot of patients aren’t aware that by reshaping the size of the nose and the shape of the nose are less common risk is they could have issues with breathing long term, often with swelling and edema there’s initial issues with breathing out of the nose, but that should improve with time. But in some patients becomes an issue.

    And with a facelift surgery, the scariest risk that is very uncommon is facial weakness or basically injuring the nerves that control the muscles of the. Face and that’s something that I always take a long time to discuss with my patients and I’m very careful to avoid during surgery.

    Question 4
    What are the treatment options?

    Katie: So. There’s lots of options out there to alter the appearance of the face outwardly. Some options for non-surgical are things like everyone would most people would be aware of Botox to reduce your wrinkles, filler to replace loss volume in either your cheeks jawline, tear through or can be used to actually change the shape or augment the nose or the chin. Sometimes I might choose to do this in patients that are thinking about possibly having a genioplasty or a jaw surgery. Which is a bigger procedure, and occasionally patients aren’t really quite sure then I’ll put a bit of filler in see if they like it and if they do then they progress to a more permanent option.

    Surgical options for changing the shape of the face. Some of them are specifically related to aging and other are just related to facial symmetry. Things like lifting the eyebrows, lifting the lips, obviously lifting the face to give a younger, more rejuvenated appearance. Neck lifts or platysmaplasty are when we reshape the neck and also obviously as a previously discussed a rhinoplasty or genioplasty, our options for altering the nose or the chin to allow patient to have a bit more symmetry or a different appearance.

    Question 5
    Have there been any developments in treatment in recent years?

    Katie: So. There’s been a lot of changes in facial aesthetics. Obviously 10-15 years ago, without social media being such a big thing that it is now. Now and injectables were a little bit more done, but not really spoken about. With certain celebrities being very heavy in the media and influencer culture, certainly injectables of fillers, Botox, those sort of things, had a huge sort of resurgence or surgence. So that’s sort of very big in this sector at the moment.

    And then coming on from that, it’s become a lot more normalized to have facial aesthetic surgery to augment the face and that may be things like a like fat grafting instead of filler to have a more permanent volume replacement. Or to change your cheek implants, chin implants, rhinoplasty to change the shape of the face has all become a little bit more acceptable and discussed in the community.

    The other sort of recent developments, I guess there’s always new techniques being described for things like face lift. Deep pain plain face lifters has been popularised for a number of years now as a way to sort of reposition the fat pads that have dropped with age to be in a more appropriate position. Obviously there’s always new developments with rhinoplasty, we used to only have the option of using the patient’s own rib if they needed a lot of structural support, and now we have cadaveric rib grafts that can be used if a patient doesn’t want a second donor site. And we now can do 3D custom implants using CT scans. To give the patient cheek or chin implant that is tailored to their face specifically.

    Question 6
    Are there any red flags gps should be aware of in patients requesting cosmetic surgery referrals?

    Katie: Yeah. So one of the recent changes in our field, I guess, is that AHPRA has sort of cracked down on cosmetic surgery clinicians and that is for patient safety. There were a reasonable number of clinicians that were practicing without appropriate cosmetic surgery training, and now there is that stop gap that when a patient used to be able to just Google find someone’s name, make an appointment and go and see them, and then have a cosmetic operation, now GP referral is required for any cosmetic procedures, so GP’s should be aware that that’s something that patients will be asking for.

    It’s also there’s some safety guidelines that have changed, such as you need to have two consultations with a patient prior to even considering offering them an operative date, which I think is good because it gives them the opportunity to go home and think about it, come back and ask more questions and it sort of stops the seeing a patient and then operating on them the next day before they’ve had time to really sink in that this is a permanent life changing body changing procedure that they’re going to undergo.

    The other thing I guess that AHPRA has updated with the new guidelines are a body dysmorphia screening survey, which they recommend a clinician to ask the patient questions regarding body dysmorphia. And that’s a condition where patients have an unrealistic expectation of their outward appearance. There are a lot of conditions that fall within that definition, I guess, which aren’t necessarily related to aesthetic surgery, but I think it’s important to do those screening tools because those are the patients that tend to have surgery and I very rarely happy with the result because they’re sort of chasing an idea which is unattainable or unrealistic.

    So now it’s our responsibility as a clinician to ask these questions of a patient to figure out if they do have body dysmorphia. And then direct those patients to get appropriate help for that. But it’s something that GP should be aware of as well. Now that these patients used to probably just be able to book an appointment with the clinician, they’ll now be coming to you and asking for a referral for cosmetic surgery.

    Question 7
    What sort of longevity do you get from aesthetic surgery?

    Katie: Yeah. So it’s varied, very dependent on genetics, lifestyle factors, how they do post operatively. Some patients will get a facelift in their 50s. And they’ll come knocking on your door in their 80s and go I’m ready for my touch up. And others have a rhinoplasty in their 20s and they never need another revision or aesthetic procedure done for the rest of their life. Same thing with prominent ears. If you’re doing an ear pinning procedure that tends to be lifelong as well, so it sort of is a bit dependent on that from a anti-aging perspective and from people that have had a rejuvenating facial aesthetic surgery, I generally recommend they get enough sleep, drink enough water, look after their skin, and they’re all things to keys to having a really good lasting result.

    Question 8
    When should a GP refer?

    Katie: Yeah. So anytime a patient’s wishing to discuss cosmetic surgery referring to an ASPS accredited RACS plastic surgeon is a good start. That way you know that your patients in safe hands with someone that’s had appropriate surgical training. And even if a patient has had non-surgical procedures like injectables at a GP clinic and the GP that does the injectables feels that they’ve kind of hit their limit of what they can do to help the patient and then they need to take the next step then that’s a good time to have that discussion with the patient and see if that’s something that they want to undergo.

    There’s certain aesthetic procedures that. Medicare rebatable things like blepharoplasty or upper eyelid surgery for people that have dermatochalasis, a which is a condition when where the upper eyelid skin is in excess, there are actually Medicare item numbers associated with that. So, there is coverage for the private health fund for patients that want to have those surgeries. And there may also be medicare items associated with things like rhinoplasty if a patient has issues with breathing or bimaxillary surgery, if their facial balance is out and they need a jaw surgery related to that.

    Question 9
    What role does the GP play in the management of patients requesting cosmetic surgery?

    Katie: I guess the main thing is. Being supportive, being understanding a lot of patients that are coming to ask for this surgery are a bit anxious about it. Helping to pick up any red flags so things like body dysmorphia, eating disorders, anxiety disorders. Things like that don’t necessarily negate a patient from having treatment, but it’s important to be aware of it and make sure they’ve got the appropriate support prior to undergoing any cosmetic surgery.

    I think it’s important for GP’s to be a port of call for these patients postoperatively as well. I’m always there for them, but I guess you see them along longer than I do. And if you do notice anything or they notice anything that they need more help with or want discussion on, then I always encourage GP’s to send them back to me, even if it’s 10-20 years later.

    And yeah, making sure that it’s my responsibility to make sure they have realistic, attainable expectations. And if a GP refers a patient to me for an aesthetic procedure and after discussion with the patient, I don’t think that that’s right for them or I don’t feel it’s attainable then I’m always communicating with the GP that that’s the case.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on facial aesthetics.

    Katie: Yeah. So the three key things I guess would be everybody ages, it can be done gracefully and that’s with or without surgery. But if surgery is something that a patients are looking into, there is support out there for them, making sure that you refer to a board registered. Plastic surgeon that’s accredited with RACS, ASPS, I think it’s important that way you know your patients in safe hands because there are a lot of cosmetic physicians out there without the same level of training. And sometimes it is difficult to ascertain who belongs where, so just making sure that you do your research when you’re referring people.

    And the third factor I guess would be making sure that patients are aware that these things are permanent and that there are non-permanent solutions out there, like injectables, if it’s something that they’d like a change, but they’re not really 100% certain that’s something that is out there for patients as well.

    Thanks for your time and the insights you’ve provided.

    Katie: Thank you

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.