Skin lesions can be divided into two groups: benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance. malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended. Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

If the scar to be revised or skin lesion being removed is particularly large, a skin graft may be performed. This involves transferring skin from another, healthy part of the body (donor site) to the injured site (recipient site). While skin grafting can improve the function of a damaged area, some scarring will be left at both the donor and recipient sites. Skin grafting is likely to be performed under general anaesthesia (you will be asleep during the procedure) in a hospital. The wound may take weeks or months to heal and you may need to wear a support bandage for a similar period.

Scar appearance can be improved by various methods including a surgical procedure known as scar revision. This usually involves cutting out the old scar, closing the wound with stitches and, in some cases, moving the scar so that it is hidden by natural features of the body. Scar revision is usually performed under local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic). Sometimes you may also be given steroid injections at the time of surgery. Immediately following the procedure, you will need to remain at the clinic for about an hour, during which you will be encouraged to walk around. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

Problems with the appearance or function of the hand can be the result of injury, birth defects or degenerative conditions. Injuries Damage to tendons, nerves, joints and bones in the hand may require surgical repair. In some cases, tissue may be transferred from a healthy part of your body to the injured site (grafting). Carpal Tunnel Syndrome A pinched nerve in the wrist that causes tingling, numbness and pain in your hand may require surgery to make more room for the nerve. This operation is usually performed under local anaesthetic (the area being treated is numb but you are awake). Dupuytren’s Contracture This condition occurs when there is abnormal thickening of the deep tissue between the palm of your hand and your fingers. This thickening occurs very gradually and will start to make your fingers curl toward your palm. If this condition gets to the stage where it significantly limits your hand function, surgery may be recommended. This usually involves removal of the thickened tissue, allowing you to straighten your fingers again. Transplantation Fingers or hands that have been accidentally cut off can be reattached by very detailed surgery that is performed under a microscope (microsurgery) and involves reconnecting tendons, blood vessels and nerves. Arthritis Arthritis is a condition in which a joint and the surrounding tissue become swollen and painful. If surgery is necessary, it may involve replacement of the joint with an artificial joint or removal or repair of swollen or damaged tissue. Birth Abnormalities Surgery may sometimes be required for hand abnormalities that are present at birth such as too many or too few fingers, webbed fingers or joints that won’t bend.

A cleft lip occurs when there is a failure of normal structures to join together during formation of the lip, resulting in a gap in the lip. A cleft lip often occurs together with a cleft palate which is the result of the failure of the two sides of the roof of the mouth to join together. A cleft palate can affect a child’s ability to feed, rate of weight gain, middle ear function, speech and facial growth. Cleft lip and palate are usually repaired by surgery at about 9 months of age. In some cases, the lip is strapped with tape for some time before surgery to help prepare for the procedure. Further surgery is usually carried out at about 7 or 8 years of age. During this time, the child’s hearing and speech development will be monitored. Sometimes speech therapy and/or grommets (drainage tubes inserted into the ear drums) may be necessary. Mr Kenton-Smith spent 15 years doing all the cleft lip and palate surgery for the South Island. He is absolutely passionate about this branch of surgery and now only does these operations privately in New Zealand. He also travels to the developing world each year to do cleft lip and palate operations with the charity - Operation Smile.

The appearance of ears that are misshaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children. Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts 1-2 hours and can be performed under local anaesthetic (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure would be performed under general anaesthetic (they sleep through it) and they will remain in hospital overnight. You will need to wear head bandages for about 1 week and will probably be able to return to normal daily routines after that.

Excess skin and/or fat can be surgically removed from your upper and/or lower eyelids to give your skin a less wrinkled and puffy appearance. The procedure typically involves making a small cut (incision) in the fold of the eyelid (for the upper lid) or just below the eyelashes (for the lower lid) and removing any excess skin and/or fat. The surgery will take 1-3 hours and is performed under local anaesthetic (the area being treated is numb) together with a sedative to make you feel drowsy. You will be able to go home the same day. It is recommended that you have complete rest and keep eye pads on for a couple of days after surgery. You should be able to return to work within 1 week.

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size. Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear. Mr Kenton-Smith spent 15 years doing all of the cleft lip and palate operations in the South Island (whilst serving in the public hospital) and also corrected the cleft noses of the same children. Jesse is passionate about correcting noses and has done a great many over the years. He now only operates privately.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later. There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice. Implants A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days. Flap Reconstruction A skin flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 2-4 hours. You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home. You may need to take some medication for pain relief for several days and you must wear a special support bra continuously for 2 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day. Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

Surgery to increase breast size involves inserting silicone pouches (implants) filled with silicone gel or salt water (saline) under the chest muscle and skin. The procedure involves making a cut (incision) in the armpit, under the breast or around the areola (the dark area around the nipple) from where the implant is inserted. The surgery is usually performed under general anaesthesia (you will sleep through it) and it will probably take about 1 hour. You may be able to go home on the day of the operation, but you will need to arrange for someone else to drive you. You may need to take some medication for pain relief for 2-3 days and you should rest for a few days after the surgery. You will probably be able to return to work after 7-10 days. It will take several months for the scars to fade.

This procedure involves removing excess skin and fat from the stomach and tightening the muscles of the stomach wall. Cuts (incisions) are made across the lower stomach and around the tummy button and the muscles underneath are pulled together and stitched. The skin flap is stretched down and the excess skin removed. A new hole is made and the tummy button replaced. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-4 hours. You will probably have to stay in hospital for 2 days and will need to arrange for someone else to drive you home. Your stomach will be swollen and painful at first and you may need to take medication for pain relief for several days. You will possibly have to wear a special support garment for 2-3 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take 9-12 months for the scar to lighten.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach, hips and thighs. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body. A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours and is carried out under local anaesthetic (the area being treated is numb but you are awake). You will probably be able to go home the same day but will need someone to drive you. However, if the procedure is more extensive and numerous areas are being treated at the same time, it may require general anaesthesia (you will sleep through it) and you may have to remain overnight in hospital. The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will be given an elastic dressing or support garment that you may have to wear continuously for 2-3 weeks. You will probably be able to return to work after 1-2 weeks.

A number of plastic surgical procedures have been developed in order to address body contour issues after massive weight loss. Often after massive weight loss the body does not return to the nice, tight skin envelope that was present prior to weight gain. Procedures available to address the issues that arise include: body lift, abdominoplasty, mastopexy, brachioplasty, medial thigh lift, upper body lift and face lift. These procedures may be combined with liposuction to optimise body contour. Liposuction alone is rarely suitable for people who have lost a significant amount of weight, since this only increases skin laxity rather than improving it. Body Lift Most people who have undergone significant weight loss will require a body lift to rejuvenate the lower abdomen. A body lift is essentially an extended tummy tuck (abdominoplasty) which meets in the middle of the back. This not only tightens the front of the abdomen but also removes excess skin at the sides and back. It has some effect on tightening the outer thigh laxity which may be present. Mr Kenton-Smith will advise you of the advantages and disadvantages of an abdominoplasty versus a body lift during a consultation. An abdominoplasty tightens up the loose skin at the front of the tummy and also recontours the abdominal wall, removing of the folds of loose skin at the front of the abdomen. A body lift achieves this along with tightening the sides and the back of the lower trunk as well. An abdominoplasty usually takes 2 hours and a body lift takes about 5 hours in theatre. Patients generally stay in hospital for 1-2 days after an abdominoplasty and 2-3 days after a body lift. Most people are able to return to sedentary/office type work after 2 weeks for an abdominoplasty and after 3 weeks for a body lift. Breast Lift/Mastopexy/Upper Body Lift Following massive weight loss the skin envelope is often loose and empty. The looseness may extend around the sides of the body towards the back. If the looseness is just isolated to the breast a mastopexy, or breast lift, will lift and reshape the breast. If the looseness extends around to the sides, the incisions will be extended in the form of an upper body lift to tighten this. It is possible to use any excess tissue under the arms to enlarge/augment the breast and avoid the need for a breast implant, this is called autoaugmentation. These possibilities will be discussed with you in full during a consultation. It can be surprising how much larger breasts can appear after having a breast lift or after using autoaugmentation technique. Thigh Lift A thigh lift has an effect on the outside of the thighs. This, combined with liposuction of the outer thigh, lifts and tightens the outer thigh skin. The outer thigh is lifted as part of the lower body lift procedure. This, however, does not address the inner thigh. The inner thigh can be treated with a medial thigh lift. Inner Thigh Lift - Liposuction versus Medial Thigh Lift. Liposuction to the inner aspect of the thigh must be performed very carefully in order to reduce the chance of subsequently requiring an inner thigh lift. A consultation with Mr Kenton-Smith will assess your suitability for liposuction to the inner thigh, and advise you if you would be better served with an inner thigh lift. Young, tight skin with no stretch marks is most suitable for liposuction on its own. Following significant weight loss an inner thigh lift is generally required. Both liposuction and an inner thigh lift help to improve the contour of the inside of the thigh and prevent rubbing and chafing. An inner thigh lift is performed under a general anaesthetic at St Georges or Southern Cross Hospital. Mr Kenton-Smith will see you on the ward and perform preoperative markings prior to theatre. Whilst in theatre, liposuction will be performed to the inner thigh to remove any excessive volume of fat. Following this, an incision will be made in the crease of the groin and the inner thigh will be lifted. Extensive stitching is performed under the skin in order to re-suspend the inner thigh into a tighter position. The skin is then closed. After this operation patients can expect a scar within the groin crease. Most patients can expect to spend one night in hospital after this operation. They are advised to part their legs no further than shoulder width apart for the next two weeks, and avoid vigorous exercise for three weeks.

A face lift can include several different procedures such as a neck lift and/or a brow lift, all designed to reduce lines and wrinkles and lift sagging skin. In a typical face lift, cuts (incisions) are made within the hairline in front of and around behind the ears. Tissue lying deep below the skin is repositioned, then the skin replaced and any excess is removed. The surgery varies in duration, but can take up to 4 or 6 hours if it is combined with other procedures. General anaesthesia (you sleep through the operation) is usually required, but in some cases you may be given a local anaesthetic and a sedative so the area being treated is numb and you feel drowsy but not asleep. In most cases, you will stay in hospital overnight following the procedure. It may take 2-3 weeks for the worst of the swelling to disappear and up to 1 year for the scars to fade.

Implants can be put into your chin, cheeks or jaw to improve or change the shape and/or size of the bones in these areas. In most cases, small cuts (incisions) are made on the inside of your mouth, through which the implants can be inserted. The length of the operation depends on the type of procedure but is typically 30-60 minutes. In most cases, you will probably receive a general anaesthetic (you will sleep through the procedure) and you will stay in hospital overnight. Your face will be swollen and bruised for several days after the surgery and you will probably need at least 1 week off work.

Labiaplasty is a technique to reduce the size of the labia minora. This technique can also be used to equalise the two labia if one side is larger than the other. Labiaplasty can be helpful for patients who experience pain, or even ulceration, of the labia due to their size. Mr Kenton-Smith will discuss the options and likely outcomes with you during a consultation. When he examines patients he is always chaperoned by a nurse to make you feel more comfortable and at ease. How is this procedure performed? Labiaplasty can be performed under local or general anaesthetic. During the operation the labia minora is reduced and then stitched. Healing is generally rapid and takes approximately 7 days. Does this tighten the vagina? Labiaplasty does not tighten the vaginal muscles. There are techniques available to achieve this, however they are not performed by Mr Kenton-Smith. He is happy to refer you to a gynaecologist should this be required.

A naevus is a common skin growth composed of special pigment-producing cells. Naevi can vary in size, with small naevi requiring only simple surgery for removal, while the removal of larger naevi may require more than one operation and may involve skin grafts.

Botox is used to reduce lines around the face and leave a younger, more youthful appearance. The frown lines, crows feet and many other lines can be treated and results can be expected to last about 3 months.

Juvederm is a synthetic dermal filler used to fill and soften facial lines, to augment/enlarge lips and to create volume in the face as it ages. Juvederm contains lidocain which is an effective anaesthetic and makes treatments signifiantly more comfortable. A treatment of Juvederm can be expected to last up to 18 months in some areas.

An effective dermal filler used to soften and fill lines and to augment lips.

A surgical procedure can be performed to make your lips to appear fuller without having foreign material injected into them. In this procedure, small cuts (incisions) are made on the inside of the lip and the tissue is reshaped. The surgery takes about 1 hour for the upper or lower lip and it is performed under local anaesthetic (the area is numb but you are awake). It will probably take 1-2 weeks for the swelling to disappear.

Cosmecueticals by Aspect Dr and SkinBetter are available at the clinic. These products are very active and must be used with caution, they are only available through doctors. Every skin benefits from a facial cleanser, vitamins A, B and C, a moisturiser and a high quality sunscreen. We also have two eyecreams available, one to treat lines and the other for dark circles/puffy skin. The products are paraben and sodium laryl sulphate free, are perfumed with botanical extracts and are made with organic ingredients whenever possible.