Plastic & Reconstructive Surgery

+ CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome often causes numbness and tingling of the hand and fingers, but may also cause pain in the hand and forearm. Digits usually affected are the thumb, index, middle and ring fingers. Symptoms are variable but may wake you from sleep, or be brought on by common activities like driving or prolonged use of a computer mouse.

It is caused by pressure on the Median nerve in the wrist. The reasons for it developing are multiple, but may be more common in people suffering with thyroid problems, rheumatoid arthritis or diabetes.

Successful treatment first requires the correct diagnosis and exclusion of other conditions that may be causing the symptoms. This may require further investigations before treatment is recommended.

Depending on the severity of the Median nerve compression, carpal tunnel syndrome may be treated non-operatively. However, surgery is often required.

+ CUBITAL TUNNEL SYNDROME

Cubital tunnel syndrome is caused by pressure on the Ulnar nerve at the elbow. It often causes numbness and tingling involving the little and ring fingers, and the little finger side of the hand. More severe forms of cubital tunnel syndrome may also have weakness of pinch grip and clumsiness of the affected hand.

Symptoms may be worsened by holding the arm in certain positions for a prolonged periods (for example while sleeping).

Successful treatment first requires thorough examination of the entire upper limb. Further investigations may be required before treatment is recommended. Treatment of this condition is often surgical. Severe cubital tunnel syndrome symptoms may not be fully resolved even after successful surgery due to permanent nerve injury.

+ DEQUERVAIN'S

DeQuervain’s tenosynovitis, also known as first dorsal compartment tendonitis, is a condition due to irritation of the thumb extensor tendons at the wrist.

Any repetitive activity may initiate these symptoms in susceptible people, but is often found in new mothers for a variety of reasons, not least of which is picking up the new baby.

This condition is characterised by pain at the wrist (on the thumb side), made worse by certain activities such as lifting and twisting.

Treatment of deQuervain’s tenosynovitis includes both surgical and non-surgical methods. The best for you will be considered before treatment starts.

+ DUPUYTRENS CONTRACTURE

Dupuytrens contracture is a common hand condition. It has a genetic basis and is more frequent in people of Celtic origin. It may first be seen as “pits” or nodules in the palm, but slowly develops cords running in the palm and into the fingers. These cords are not tendons, but can pull the finger down into a bent posture.

When the bend in the fingers cause functional problems, surgery may be required. Other less invasive procedures may be of benefit in circumstances where surgery is contraindicated.

Depending on the severity of the bend in the finger before treatment, a full-thickness skin graft may be required as well as post-operative splinting and Hand therapy. Full correction may not always be possible, but the best treatment option and likely outcome will be discussed with you before treatment starts.

+ GANGLIONS

Ganglions are common, benign, fluid filled lumps that may be found throughout the wrist, hand and fingers.

They are associated with joints, tendons and tendon sheaths. The most common sites are the back (dorsum) of the wrist, the front of the wrist, the fingers and the palm.

Ganglions tend to slowly increase in size, but the size may fluctuate. Wrist ganglions that cannot be seen on the surface may still cause symptoms such as ache and pain.

Even though ganglions are benign, they may require surgical removal if they become symptomatic.

+ THUMB ARTHRITIS

The joint at the base of the thumb is prone to developing arthritis. This joint is very specialised and is required for most activities. Unfortunately, because of this, it is also prone to developing arthritis. The reasons for arthritis are multi-factorial. However, base of thumb arthritis is most common in middle-aged to elderly women.

Pain at the base of the thumb is the most common symptom and is often aggravated by activities that involve pinching and gripping. The alignment of the joint also may be affected and result in a lump on the back of the hand at the base of the thumb.

Only when non-surgical treatment has proven to be unsuccessful is surgery for base of thumb arthritis considered. Hand therapy plays an important role in this stage of treatment. There are multiple surgical options for treatment of this condition at different stages. Optimal treatment for each individual must be considered to ensure the best outcome.

+ HAND TRAUMA

Whether it is through work or play, accidents happen.

Dr Wong has been well trained to treat all forms of hand trauma from fractures of the wrist and hand to lacerations of the tendons, blood vessels and nerves.

Dr Wong is regularly involved in the management of all forms of trauma from major mutilating injuries to minor lacerations through his position at the Royal Perth Hospital and he is happy to be consulted for non-acute trauma privately.

+ EYELID LIFT (BLEPHAROPLASTY)

While excess eyelid skin may contribute to a baggy appearance, loss of elasticity of the support structures within the eyelid also can lead to fat bulge. This can cause functional problems due to obstruction of vision or a feeling of heaviness.

Surgery to the upper eyelids may address these functional problems with the benefit of giving the face a well-rested appearance. However, not all cases of “heavy eyelids” can be addressed by a blepharoplasty procedure. The problem may not even be your eyelids, and you may require an eyebrow lift instead.

An upper eyelid lift is not always a “cosmetic” procedure. You will need to have a visual field test completed by your Optometrist or Opthalmologist to demonstrate a visual field loss for this procedure to be considered "non-cosmetic".

Bruising and swelling following this procedure should be expected. Cold compresses to your eyes are recommended for the first few days after surgery, and you should sleep with extra head eleveation on at least two pillows until your first post-op visit.

Risks specific to a blepharoplasty include: Over or under-correction (overcorrection being a much more serious problem); Asymmetry; Chemosis (swelling of the eyeball lining); Injury to the cornea; Dry or watery eyes; The rarest complication is bleeding behind the eyeball that could result in blindness.

+ EAR CORRECTION (OTOPLASTY)

Otoplasty is surgery to correct prominent ears. This usually occurs due to a lack of sufficient folding of the cartilage that supports the ear. The incisions are usually behind the ear to access the cartilage, which then can be reshaped to give the desired effect.

Sometimes a small amount of cartilage is removed. Bulky bandages are required for about a week after surgery, but these are soon replaced by a headband that is only worn at night (for six weeks).

Risks specific to Otoplasty include: Over or under-correction; Asymmetry; Erosion of the (permanent) sutures through the skin; Altered sensation; Haematoma.

+ TUMMY TUCK (ABDOMINOPLASTY)

Significant weight loss often results in excess abdominal skin. The abdominoplasty, or “tummy tuck” procedure involves removal of excess skin and fat, possibly with repositioning of the umbilicus (belly button) and repairing the weakened, separated underlying muscles. Occasionally liposuction may also be used to improve the overall outcome.

This cannot be achieved without scars, but these are usually located in a position that can be covered by underwear or swimwear. If the umbilicus is repositioned there will be a scar around the belly button. It is not uncommon to have altered sensation around the lower abdomen after surgery. Bruising is common, and wound healing issues are possible. Drains are commonly used to reduce the risk of haematoma or seroma, but are usually removed before you are discharged from hospital.

Following surgery you will need to wear a support garment for six weeks. During this time you should not be planning to be able to perform your normal activities.

+ LIPOSUCTION

Liposuction is useful in the treatment of localised fat deposits that don’t respond to a good diet and exercise. It aims to favourably alter body contours with minimal scarring, and is often used as part of breast reduction and abdominoplasty procedures. However, not everyone is a good candidate for liposuction and this would be discussed during a consultation with your Specialist Plastic Surgeon.

The procedure involves detailed pre-operative mapping followed by injection of the treatment area with fluid. The fluid improves the ability to remove fat using a small, hollow metal tube attached to a suction device, as well as containing an anaesthetic agent that helps with post-operative pain.

Compression garments are required for up to six weeks after the procedure.

Specific risks of liposuction include: Insufficient or excessive removal of fat; Asymmetry; Injury to nerves and blood vessels resulting in altered sensation or bruising.

+ BRACHIOPLASTY

Brachioplasty (also known as an Arm Lift) is a procedure to change the contour of the upper arms. It involves the removal of excess skin from the inner part of the upper arms and therefore will always have scars.

The risks and benefits of the procedure as well as the expected outcome will be discussed with you before surgery. Some of the risks of brachioplasty include restricted movement from the scars, altered sensation and rarely fat necrosis causing firm lumps beneath the skin.

+ BREAST LIFT (MASTOPEXY)

A mastopexy aims to lift and reshape the breast. There are multiple techniques that all involve elevating the nipple areola complex, repositioning the breast tissue to achieve adequate filling and removing any excess skin.

The breast lift procedure does not significantly change the volume of the breast and occasionally breast augmentation may be a better procedure, or used in combination to achieve your best result. The size of the areola can be potentially reduced during this procedure if desired.

+ BREAST REDUCTION (MAMMOPLASTY)

Bilateral Breast Reduction (also known as Reduction Mammoplasty) is one of the most frequently performed plastic surgical procedures.  This procedures aims to reduce the size of the breast which otherwise may be causing headaches, neck and back pain as well as skin problems. 

Breast reduction can not be achieved without scars, but Dr Wysun Wong will endeavour to keep these as small and inconspicuous as possible whilst still working safely and giving the desired result.

At the end of the procedure you will be fitted with a surgical support garment, and this will need to be worn for the first four weeks. During this time, although gentle movement is encouraged, you should not be performing any strenuous exercise, you should not be massaging your breasts, and you need to be very cautious wearing a seat belt in the car.

Some of the complications specific to Breast reduction include: Over or under-correction; Asymmetry; Vascular compromise to the nipple areola complex; Altered sensation; Haematoma; Interruption to the inframammary fold (where the breast meets the chest wall); Fat necrosis resulting in new lumps in the breast tissue.

+ SKIN CANCER

Dr Wong continues to have an interest in the best-practice management of skin cancers. Occasionaly these skin malignancies require reconstruction with local flaps or skin grafts after the tumour has been removed.

+ SCAR REVISION

Scar revision surgery may be required for particularly conspicuous or painful and/ or itchy scars.  No surgery can erase a scar, but it may be re-orientated to a less noticeable position or to improve function.

+ GENERAL SURGICAL RISKS

All surgery carries risks and complications. Risks specific to each procedure can be seen under the individual procedures. However, some risks are common to most surgery.

Anaesthetic: Respiratory or cardiac problems; Aspiration; Unexpected allergic reactions. Any specific questions about these risks are best directed to your anaesthetist. Please contact the office to find out who your anaesthetist will be.

Haematoma / Seroma: Excessive accumulation of blood (haematoma) or other fluid (seroma) at the operative site. Usually no action is required, but rarely may need a return to the operating theature for drainage.

Infection: Bacteria at the operative site causing infection is rare. Not all procedures require antibiotic at the time of the operation. However, if required antibiotics may be prescribed during or after your procedure. Allergies to antibiotic are relatively common and if you have an allergy, you need to make sure that you tell Dr Wong.

Injury to adjacent structures: It is rare that structures such as nerves, blood vessels, tendons and muscles would be accidentally injured during your surgery. Nerve injury may result in altered sensation (pins and needles) or numbness.

Would healing complications: Infection is the usual culprit, but sometimes wounds break open. This may mean dressings for a longer period than expected, or even further (corrective) surgery. You can reduce the chance of this by not smoking.

Excessive scarring: All surgery will have scars. Rarely, scars can by complicated by either Keloid or Hypertrophic scarring that may require additional treatment.