BEYOND FACE VALUE

 When you hear the term “plastic surgery”, images of Hollywood celebrities and reality TV stars often come to mind. In fact, the definition of Plastic Surgery is “the process of reconstructing or repairing parts of the body by the transfer of tissue, either in the treatment of injury or for cosmetic reasons.” So it’s not just all about aesthetics and “cosmetic surgery” is just the tip of the plastic surgery iceberg! This month we talked to Newcastle Plastic Surgeon, Dr Gary Avery about the “non-Hollywood” side of plastic surgery.


What kind of surgery do you do? A very broad range. As you might expect, given Newcastle’s outdoor lifestyle, I see a large number of patients with skin cancer. While general practitioners often manage smaller cancers, I see the most serious cases often involving extensive reconstructions. I’ll work anywhere from the top of the head to the tips of the toes but particularly the cosmetically sensitive areas such as the nose, face, lip and ears.


In terms of cosmetic procedures, I perform a large number of breast reductions and augmentations, abdominoplasty and rhinoplasty. I also offer breast reconstructions for women post-mastectomy or as part of preventative surgery where they have tested positive for the breast cancer gene.


I perform hand surgery for common hand conditions such as carpal tunnel syndrome, in which a large nerve is compressed at the wrist affecting the feeling in the fingers and also emergency surgery at the John Hunter following trauma alongside some of my Orthopaedic colleagues.


What’s your role in emergency cases? I work at the John Hunter Hospital as a Plastic Surgeon and Hand and Microsurgeon. Hand injuries can include broken bones, cut nerves or tendons, serious infections and, of course, the extreme such as complete amputation of a finger, thumb or hand. Most people don’t realise this, but Plastic Surgeons like myself are trained to perform the repair of blood vessels, tendons, bones and nerves required to help people return to work and back to normal life as soon as possible.


As a Plastic Surgeon I am able to help patients with injuries to other areas of the body particularly working with orthopaedic surgeons treating people with skin and muscle loss or nerve injury associated with significant trauma and broken bones. Often this involves skin grafting or even more involved surgery moving one part of the body to another.


Sometimes these cases involve creative solutions so I’ve had to perform surgery to attach a hand to a thigh to get skin to grow over the hand where skin has been lost in an accident and then weeks later separate the areas again. Makes life pretty challenging for the patient during that week as you can imagine!


Why did you go into Plastic Surgery? I have always enjoyed science and helping people – being a surgeon allows me to do both. I worked with burn victims as a medical student and found it very confronting. I could only imagine what this would be like for the patient. Plastic Surgeons were involved in treating burn victims and this set me on the path of plastic surgery training where I have had the opportunity to work with amazing, inspiring people and have the privilege of providing help to so many. Plastic surgery involves restoring form or appearance and function, often the results are clearly on-show, so I’m always aware of the importance of the final appearance of my work.


What are your most challenging cases? Any case on any day can be difficult. I do more than one thousand operations a year but for each of those operations it may be that persons first operation. The challenge is to do my very best to achieve the best possible result in the safest manner possible, and this holds true for emergency surgery, treating cancer and elective surgery.


In emergency surgery, people can feel vulnerable and powerless, and it can turn their life upside down. In elective procedures particularly cosmetic surgery, people may have strong feelings about their appearance and how they are perceived due to this. Plastic surgery can be a powerful tool used to alter our appearance and how we feel about ourselves and how others interact with us. As a Plastic Surgeon, I love that my job allows me to help people be both healthy and happy.


What’s your favourite operation? Breast reductions are very rewarding because they can truly change a woman’s life. So many of my breast reduction patients tell me afterwards that they are back to living the life they haven’t been able to for years, sometimes decades, because the pain and embarrassment of large breasts has stopped them doing so much. Many of these women have suffered in silence with back and neck pain caused by the strain of large breasts, so it is a fantastic operation.


"I also love helping children. I spent a year at the Royal Children’s Hospital in Melbourne working with a fabulous Plastic Surgery Department. It is very rewarding to improve a child’s appearance through surgery and give them a fair shot at life that might otherwise be tough through no fault of their own."
A common operation such as pinning back protruding ears, generally done in the early school years and can help those first years go more smoothly as kids can be pretty harsh to those they see as different. The big smiles we get after surgery make all the hard work worthwhile.


Do you offer public hospital surgery? Yes. Dr Moncrieff and I are the only Plastic Surgeons providing a public service in Newcastle, and we perform a variety of skin cancer and breast reconstruction procedures. I have also recently started offering a “no-gap” breast reconstruction service given the length of the public waiting list.


I think one of the challenges we have in Newcastle is growing the plastic surgery service. We are very proud of the work we can do in the public hospital system, but we know that more could be done. In the longer term, it would be great to see more Plastic Surgeons move to Newcastle so cases such as birth anomalies, significant burns or facial lacerations and many other conditions could be attended to locally by those, like myself, who specialise in the area.


What about the person who wants to look like a celebrity or wants something over the top? I’d have to say that in Newcastle, that isn’t a huge issue, unlike some of the examples my colleagues in capital cities report. Novocastrians tend to be somewhat grounded and realistic. Where I don’t feel a requested procedure would be healthy for the patient or meets their expectations, in the long run, I will offer alternatives but occasionally I’ve had to simply refuse to operate.


How long have you been in Newcastle? I moved here to join Dr Moncrieff at Hunter Plastic Surgery in early 2013. The move has been great not only because I really enjoy the work I do in Newcastle, but the lifestyle is excellent for my family. Where else can you be on the beach and 30 minutes later scrubbed in and ready to operate?!


Have more questions? See Hunter Plastic Surgery’s website www.hunterplasticsurgery.com.au or call their friendly team!

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