Microsurgery is surgery at an ultrafine level in the order of a few millimetres down to fractions of a millimetre. This method of surgery is done with surgical microscopes or high magnification loupes. It is a technique used for repair or connection of small blood vessels and nerves.
The technique is crucial in some surgical procedures such as replantation of amputated parts, and reconstruction involving the transfer of large tissue units from one part of the body to another. It is used in some complex Head & Neck reconstructions. It is also used for complex reconstruction in other parts of the body such as after a large loss of tissue in major accidents and cancer removals.
Facial nerve weakness or paralysis is a debilitating condition affecting many patients from a diverse range of conditions, both congenital and acquired, which affects a person’s ability to move their face. It can range from subtle weakness in eye closure or smiling, undesirable facial twitching or contractions, to a completely droopy face with functional difficulties such as slurred speech and poor ability to hold water in the mouth for drinking.
Depending on the cause and timeline of the nerve injury, there are various treatment options. In some instances, early intervention is necessary in order to try and salvage the function of residual facial muscles. It is important, therefore, that you discuss with your specialist early about whether you should see a facial nerve surgeon. Surgeons who deal with facial nerve injuries are largely Plastic surgeons and ENT surgeons, but only some Plastic and ENT surgeons do this.
Lymphoedema is a chronic condition arising from poorly developed or obstructed lymphatics which then results in soft tissue swelling, and an increased susceptibility to infections. Lymphoedema can arise from any cause of lymphatic damage. Common causes of chronic lymphoedema in Western countries include cancer treatments, trauma, and congenital lymphatic malformations. Parasite infections are responsible for a large portion of chronic lymphoedema in developing countries but rarely seen in Australia.
The mainstay of treatment for lymphoedema is conservative treatment with compression and lymphatic massage. In some instances surgery can be considered if either conservative measures fail to adequately control the condition or the patient’s circumstance precludes them from being able to undergo effective conservative measures.
Maxillofacial trauma encompasses all major soft tissue injuries and fractures of the facial region. Major facial fractures often do not present in isolation but as part of a multi-system trauma seen in high speed motor vehicle collisions, occasional assaults, workplace-related, and other accidental injuries. Not uncommonly these patients are managed by various teams including plastic & maxillofacial surgery, ENT, neurosurgery, ophthalmology, orthopaedic surgery, trauma surgery, and intensive care. The optimal care for these patients is therefore not considered in isolation but as a well-coordinated effort by several teams, and carefully-planned sequence of surgical interventions.
Dr Ngo is Head of the Department of Plastic, Reconstructive, and Maxillofacial Trauma at Liverpool Hospital, one of Australia’s busiest trauma centres. On average approximately 300 facial fracture cases are treated at this centre annually. Dr Ngo has a special interest in 3D model-based planning and treatment for facial fractures, and in endoscopic (key-hole) surgery for jaw fractures.
Complex Facial Cancers
The facial region is arguably one of the most important parts of plastic surgery as it represents a person’s identity. Their self-esteem, identity, recognition, and confidence is often connected to facial appearance to a large degree. It is also a complex area incorporating intricate anatomy and essential functions such as vision, taste, smell, speech, and expression of emotions. Lymphatic and vascular supply of the facial region are amongst the most intricate in the body, giving it exceptional healing potential, while at the same time increasing the risk of spread of any new tumour to critical structures. Removal of tumours in the facial region can therefore be very challenging, with far-reaching consequences on a person’s life.
Australians have some of the highest per capita incidence of skin cancers in the world due to its sun-ridden landscape, harsh summers, and a large proportion of the population having very fair skin with associated low UV tolerance. Approximately two-thirds of Australians are at risk of skin cancers.
Skin cancers are some of the most common conditions dealt with by GPs, dermatologists, and plastic surgeons, with the latter group bearing the brunt of complex skin cancers that require complex reconstructive surgery. GPs are often the first point of contact regarding skin cancer detection, treatment, and surveillance.
Cosmetic surgery is a booming industry in Australia and around the world. With increasing penetration of social media such as Facebook and Instagram into our lives, people are becoming more appearance conscious and feel the pressure to present their physical appearance in certain ways.
Cosmetic work can range from minimally invasive procedures such as laser, botulinum toxin injection, and fillers, to more invasive procedures such as eyelid surgery, facelift, and breast implants etc. All invasive procedures have potential complications. It is important, therefore, that patients considering cosmetic enhancements do thorough research on what they want and the qualifications of the doctor they have entrusted to do this work.
The only well-recognised body to train surgeons in Australia is the Royal Australasian College of Surgeons which was established in 1927. This allows it to train world-class surgeons in different specialties. Those wanting to enter specialty training often spend at least 3-4 years working as resident medical officers after completing medical school, gathering experience and demonstrating surgical aptitude. They then undergo a highly competitive selection process where only a small number of candidates qualify. Once selected for the specialty, they undergo a further 4-6 years of specialty training and graduate with legally-protected titles e.g. Specialist Plastic Surgeon, Specialist ENT surgeon, Specialist Neurosurgeon etc. Cosmetic surgery is a component of Specialist Plastic Surgery training. Outside of the legal titles, however, the terms ‘surgeon’ and ‘cosmetic’ by themselves, however, are not legally protected. A ‘cosmetic surgeon’ is therefore a ‘descriptor’ but not a qualification and can legally be used by any doctor regardless of training or experience.