Plastic, Reconstructive & Cosmetic Surgery - Vital Aesthetic Surgical Enhancement

Pressure Ulcers

2011-12-08T21:02:00.006+10:00

Pressure Ulcers or Decubitus Ulcers arise as a result of prolonged period of lying down on a bed as in paraplegics or sitting on wheelchairs. They arise in prominent, bony areas. The severity is staged, depending on the depth of the ulcer:

Stage 1 - Redness of the overlying skin

Stage 2 - Subcutaneous fat layer (fat layer under the skin)

Stage 3 - Muscle sheet & muscle

Stage 4 - Bone

The causes can be:

1. Direct damage to the skin surface

a/ Friction to the skin surface

b/ Chemical burns

2. Interference with blood supply to the skin from below

a/ Local factors

-Pressure (compression of tissue, to cut off blood supply)

-Shear force (pulling of the muscle &/or subcutaneous fat tissue away from the skin above, to cut off blood supply)

b/ Systemic factors

-Endothelial (blood vessel) damage (e.g. diabetes, smoking, artherosclerosis)

-Clotting tendencies

3. Aggravating Factors

a/ Metabolic disorders (genetic diseases that interfere with the assimilation & use of biological raw materials or components of food substances that are absorbed from

the guts & the elimination of by products mainly via the kidneys & lungs)

b/ Malnutrition (not enough raw materials taken in for repair)

c/ Moisture (high moisture predisposes)

d/ Temperature (high temperature predisposes)

Prevention (regular turning of the patient) is a very demanding job. In Papua New Guinea (PNG), there is a shortage of nursing staff and materials such as water beds etc. The usual surgical treatment is extensive surgical debridement without the proper use of a flap (chunk of nearby normal skin with intact blood supply) for coverage. This only worsens the condition, by extending the size of the wound.

Furthermore, the usual wound dressing method in PNG is hydrogen peroxide cleansing, followed by saline-gauze packing of the wound. The problems with this dressing method, are:

1. Destruction of normal granulation tissue (newly formed vessels) by the hydrogen peroxide

& the adherence of the gauze

2. Poor removal of exudates

3. No antisepsis

3. Painful during change of dressing

4. Bleeding during change of dressing

As a result, the wound healing process is very slow with a lot of complications. In PNG, the mortality rate (death from such cases) is very high.

In Goroka, we have introduced a new dressing method for pressure ulcers, trying as much as possible to avoid surgery. The steps are:

1. Use of absolute or 99.9% ethanol for wound cleansing & antisepsis, especially to treat bursas (tunnel under the skin)

2. Careful use of hydrogen peroxide to clean only the dirty portion of the ulcer without

disturbing the granulating areas

3. Hydrocolloid with antiseptic dressing until the wound is clean

4. When the wound is clean, only the hydrocolloid is used, until complete healing

Below is a photo of a patient who underwent such dressing method. This patient is diabetic and had osteomyelitis and developed septicemia, before commencement of the above wound dressing method. The patient recovered fully & was discharged home.

Hemorrhoids

2011-11-20T15:12:00.004+10:00

Hemorrhoids are swellings around the anal area. These swellings arise as a result of interference with the normal return of venous blood into the main branches. There is pooling of excess venous blood causing the skin or mucosa to swell, corresponding with the venous dilatation. The cause is chronic (happening over a long period of time; months to years) constipation & straining during defecation. With modern diet (processed food), there is less fibers that contributes stool bulkiness resulting in excessive straining during defecation.

There is external & internal types:

External: composing of skin & the base may be easily visualized, therefore surgical excision may be easy

Internal: composing of mucosa (pinkish part of rectum or gut wall). The base may not be visible & it may be difficult to excise

There are 4 grades of hemorrhoids, that indicates severity, using the criteria of prolapse:

Grade 1 - No prolapse

Grade 2 - Prolapse upon defecation but spontaneously reduce

Grade 3 - Prolapse upon defecation and must be manually reduced

Grade 4 - Prolapse and cannot be manually reduced

Surgical excision has many complications associated:

1. Bleeding

2. Sores which may not heal

3. Pain

4. Recurrence

Surgical excision is also very expensive despite the many complications stated above. Recently Dr. Mol introduced sclerotherapy (injection of medicine to shrink the veins) for hemorrhoids at Goroka General Hospital. With sclerotherapy there is not much complication & the patient can go home on the same day (no need for admission to the wards), thereby cutting down the costs of treatment, making it easier & convenient for both the patient & the healthcare workers.

The steps taken for this new treatment strategy are as follows:

1. Insertion of medicine that numbs the skin & prevents swelling afterwards & a 1 hour waiting period is given

2. After 1 hour, the sclerosants (medicine that causes veins to shrink) are injected into the swelling without much pain

3. Regular insertion of medicine that prevents swelling & pain for 3 days

as well as ingesting of medicine that softens stool, to prevent straining during defecation

4. Review after 1 week to asses state of swelling & to assess & advice on diet changes to prevent constipation (straining during defecation)

5. Review after 1 month to check on the state of the swelling as well as the diet & to decide wether further injections of sclerosants are required or not

With a good diet adjustment, there shouldn't be any recurrences. With the injection of sclerosants, the only complication is excessive swelling, which will maximize after 3 days & then slowly regress. If the right sclerosants are injected & into the right sites, then the swelling should completely disappear within 3 months time. Otherwise, it may be needed to repeat the injections 2-3 times or repeated once a month until complete resolution occurs.

Below is a photo of a patient who initially had excision of external hemorrhoids Grade 4, however he suffered persistent bleeding & worsening of internal hemorrhoids. There was improvement (cessation of bleeding & regression of the swelling) after just 1 session of sclerotherpy, throughout a 1 month period.

Dermabrasion

2011-06-05T20:00:00.004+10:00

Dermabrasion is a physical method whereby the top layer of the skin (epidermis) is lightly & gently scratched off. Only the superficial layer is scratched off. The whole component that regenerates new skin, remains below (basal layer of the dermis). Thus, allowing the regrowth of new, normal skin.

In the tropics, the application of sunscreen after a session of dermabrasion is of utmost importance. Sunscreen of 'Sun Protective Factor (SPF)' 30 or more may be appropriate and make sure it is from a reliable brand. A simple & more reliable method may be to avoid exposure to the sun by staying in doors or to use a large, black umbrella everytime one goes out.

The benefits of dermabrasion are as follows:

1. Removal of dark areas of skin (acquired nevus) allowing or stimulating newer, normal skin to grow from below

2. Removal of small, finer wrinkles

3. It has been found that dermabrasion stimulates, collagen formation in the skin, giving it a tighter & glossier appearance

4. Removal of depressed scars of acne

5. Removal of tattoos

Pinna/Auricular (Ear) Reconstruction

2011-01-05T15:54:00.004+10:00

Reconstruction of the external ear is very challenging. A satisfactory result may not be achieved in a single staged operation. Depending on the size & extend of the defect, we may decide to use a cartilage graft or to use skin alone for reconstruction. Several procedures may be needed to perfect the reconstructed external ear.

Varicose Veins

2010-10-09T12:58:00.018+10:00

Varicose Veins Treated by 'Slow-Acting Sclerosants'

Superficial Veins and their tributaries (branches) that usually give rise to Varicose Veins.

Varicose Veins Treated by 'Slow-Acting Sclerosants'.

Varicose Veins, compared to normal side (leg).

Varicose Veins involving the tributaries that drain into the Long Saphenous Vein.

Before treatment.

Immediately after the injection of Slow-Acting Sclerosants & application of plaster.

Varicose Veins are abnormally, dilated Superficial Veins of the lower limbs (legs). In the lower limbs there are 3 kinds of Veins:

1. Superficial Veins (situated just under the skin)

2. Communicating Veins (connects Superficial to Deep Veins)

3. Deep Veins (situated below the leg muscles)

All Superficial Vein tributaries drain into the Short Saphenous Vein (Popliteal area or behind the knee) and the Long Saphenous Vein (groin area or inner aspect of the thigh)

Communicating Veins drain from the Superficial Veins into the Deep Veins. Deep Veins are situated below the leg muscles. Muscle contraction aids in pushing the blood towards the heart.

Superficial Veins rely mainly on Valves, to ensure a one way flow of blood, against gravity, towards the heart. Defects within this Valves may cause backflow and pooling of blood, within the Superficial Vein tributaries (branches), causing them to dilate (Varicose Veins).

The usual treatment is Surgical Stripping (surgically pulling out the veins through several skin incisions) of the involved veins. Other nearby, competent veins, may eventually take over the function of drainning the blood. However, the main complications are bleeding, bruising and pain. Despite this agressive surgery and the associated agonies, there may be recurrence.

Nowadays, substances that destroy the veins (irritants or sclerosants) are injected into the veins or laser ablation is carried out through a tiny skin incision. However, there is a risk of thrombo-embolism (clot/thrombus formation and dislodging to the lungs) resulting in life threatening complications. Other newer techniques use heat, to seal-up the veins. However, heat is associated with alot of pain & swelling after the procedure. In large varicose veins, large quantities of sclerosants may be used for injection. The commonly used sclerosant is Foam Polidocanol (mixed with air to cause bubble formation, to increase the surface area of contact between the endothelium & the sclerosant/polidocanol). However, it has a risk of systemic absorption leading to cardiac arrest as well as air embolism. Some surgeons attempt surgeries on these incompetent vein valves. However, the surgery is meticulous, time consuming & the outcome may not be good. There is also a risk of thrombo-embolism because of disturbed (turbulant) flow through these repaired valves.

'Slow-Acting Sclerosants' do not destroy the veins immediately but induces a slow (chronic) inflammatory process/response that allows the body's own defence system to destroy the veins, over a long period of time (several weeks to months). This method is associated with very minimal complications. It is almost painless and the patient may go home the same day (day surgery procedure). Furthermore, 'Slow-Acting Sclerosants' do not cause thrombo-embolism and has only a local effect (chronic inflammation), without any other systemic complications.

The procedure requires the application of a topical anaesthetic cream an hour prior to the injection, therefore, it is almost painless upon injection. A light plaster is applied around the area of injection for 3 days. With this plaster on the leg, the patient is adviced not to engage in strenuous activities (exercise and/or sports etc.) for at least 3 days. After removal of the plaster, the patient can return to his/her normal activities.

Nature's Manifestations

2010-10-03T03:07:00.008+10:00

Breast Surgery

2010-05-23T00:33:00.018+10:00

Breast Surgery involves surgical procedures to remove lesions (breast cancer or benign lesions) and procedures to modify the shape and contour or to reconstruct it after removal due to cancer.

Breast lesions should be first investigated by a general surgeon and a radiologist, followed by a histopathologist, once a biopsy specimen of the breast lesion is taken.

The treatment of breast cancer is best done by a general surgeon, specializing in breast oncology. The treatment of breast cancer involves the combination of 3 modalities: surgery, chemotherapy & radiotherapy.

After the completion of breast cancer treatment, follows breast reconstructive surgery. The reconstruction is best done by a Plastic & Reconstructive surgeon specializing in breast reconstructive surgery. The reconstruction is done in 2 ways:

1. Implants

-preformed silicone implants are used now days. Modern silicone implants have a thick capsule & roughened surface to prevent rupture & migration or displacement. Despite rumours, large statistical analyses have shown no association between silicone and cancer and/or connective tissue diseases.

2. Autologus tissue

-a person's own fatty tissue is harvested to reconstruct a breast mound. It is only for the shape or looks and there is no functional significance of this reconstructed breast. The surgery may take a longer time than when inserting an implant. Donor site morbidity may be unacceptable to some patients.

Other surgical procedures on the breast incudes:

1. Lumpectomy (removal of a lump within the breast)

2. Mastectomy (removal of the entire breast tissue)

3. Radical Mastectomy (extensive removal of breast as well as other nearby tissues and all the lymphnodes drainning the breast)

4. Breast reduction (reducing the size of the breast by partial mastectomy)

5. Mastopexy (breast lift or lifting a ptotic or dropping breast to make it pointed))

Dr. Mol has learnt the art of breast surgery from Japan's number one breast reconstructive surgeon, Dr. Nohira Kunihiko (Director, Soshundo Plastic Surgery Clinic, Sapporo, Japan).

Further Notes on Silicon, Silicone & Autologus tissue

Let me clear some aspects of the above topic. Silicones are widely used medically. In the field of plastic surgery (cosmetic or aesthetic or esthetic surgery), they are used as:
1. Breast implant
2. Facial implants (chin, nasal etc.)
3. Fillers (injected straight under the skin to modify the contour)
4. Dressing (compression sheets applied straight onto scars to prevent
and/or treat hypertrophic scars & keloids)

Before going further, lets define some terms:

Silicon:
Silicon (Si) is a metal in the same column as carbon in the periodic table. It is the most abundant element on earth and does not occur naturally in its pure metallic state.

Silica:
Silica (SiO2) in its crystalline form is common sand or quartz.

Silicate:
Negatively charged (anionic) form of silica eg. [Si2O7]6" or other compunds of Silicon eg. fluorosilicate (SiF6)2-. In one form it attracts water molecules (hydroscopic) so it is placed in containers of dried food as a white, small packet, labelled 'do not eat' to keep them dry.

Silicone: (R2SiO)n, where R=organic groups such as methyl, ethyl, and phenyl.The class of substances known as silicones are polymers of silicon and oxygen. There are as many forms of silicone. Dimethylsiloxane=(C2H6OSi)n where n is typically >4, is the building block for most medical-grade silicone products, including breast implants. It can be made extremely pure and modified into products with a multitude of characteristics (various viscosities to hardness).

Why use silicone?

Because it is easier for the surgeon. They come in ready-made sizes, shapes & textures so it is easy & quick to apply or insert.

What are the problems?

It is a common rumor that silicone is associated with certain illnesses, including breast cancer and connective tissue disorders (also referred to as autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis).

Large scientific trials have disproved such rumors:

1. Eherenfeld M., Shoenfeld Y, Bar-Meir E. Silicone gel breast implants and connective tissue disease--a comprehensive review. Autoimmunity, June 2003, vol.36 no.4, pp.193-197(5)

2. http://www.lookingyourbest.com/info/breastimplant-swhatis.php

However, there are a group of few, unfortunate individuals who display some kind of unfavourable results. The causes could be divided into 3 groups:

1. The surgeon (not skilled enough or human error during placement)
-assymetry
-protrusion
-hematoma, Infection, skin necrosis etc.

2. The material: (modern versions of silicone are tough, well textured, shaped & easily integrates with surrounding tissue).
-rupture (when they rupture, the fluid silicone escapes the firm capsule into the surrounding tissue & may calcify & become as hard as a rock)
-migration (moves around & may lodge in an undesired location/position) etc.

3. The individual
-Chronic inflammatory reaction which leads to 'capsular contracture', displacement of the implant to nearby structure or protrusion through the skin. Not only this but it may be associated with other symptoms such as pain, irritation etc. The individual tends to blame all other medical problems, at that time to the silicone (personally, I think it is a kind physical & psychological rejection of the foreign substance).

Individuals who suffer from such problems are really shocked & they make alot of 'noise' using the media, such as this website:
http://www.siliconeholocaust.org/

If there are no 'rejection' then the silicone implant may last/stay 20 or more years some say a life time. But it is hard to predict which patient will undergo 'rejection' & which will not.

Autologus tissue can be used to replaced all such procedures done using silicone implants, however the problems are:

1. Time consuming (takes too long & may be tiresome to harvest the tissue eg. when using autologus abdominal fat & skin as a 'flap' to reconstruct the breast, it takes about 6-7 hours for 1 breast)

2. Donor site morbidity (pain, scar, loss of muscle function etc.)

3. General anaesthetic problems (most silicone implants are inserted with mild sedation & local anaesthesia in the form of 'tumescent' meaning diluted local anaesthesia to increase the volume or coverage and minimize systemic complications).

4. Surgical complications (blood loss, wound infection, hernia formation at donor site etc.)

For the time being, the use of silicone is increasing, especially in the developed world.

I hope I've cleared some doubts regarding silicone implants.

Microsurgery

2010-05-21T11:53:00.004+10:00

Microsurgery is the art of surgery involving an operating microscope & microscopic instruments & sutures. The sutures (threads) are smaller than a person's hair. The techniques are used for:

1. microvascular & 'free flap' surgery

2. nerve surgery (eg. facial nerve palsy/paralysis)

3. lymphoedema (tissue swelling secondary to lymph vessel obstruction) surgery

4. eyelid surgery

5. precision skin closure to minimize scaring

Therapeutic Massage & Acupuncture

2010-05-10T16:43:00.010+10:00

Therapeutic massage (massage as a form of treatment), may be used for treatment, rehabillitation & prevention of:

1. Muscle cramps & pains (myalgias)

2. Dysuse, muscule bulk wasting (Atrophy/Dystrophy/Degeneration)

3. Motor nerve disorders & lesions

4. Deep vein thrombosis (DVT) in bed ridden patients

5. Stress, anxiety & depression

6. Transient blood pressure & heart rate lowering

There is no human body contact in our technique. We use a 'Transcutaneous Electric Nerve Stimulation (TENS)'. This machine works by the usage of 2 tiny batteries, to produce just enough current to stimulate the motor nerves, to induce muscle contraction. Therefore, there is no risk of electric shock.

Acupuncture is the Chinese art of inserting needles into predetermined points to control pain. Our needles are sterilized using the standard technique & our staff was trained in China.

Gradual Peel

2010-04-30T09:41:00.004+10:00

Chemical peeling is a method of peeling off the top, dead skin layer, thus allowing new skin to grow from below. Strong peels may cause scar formation & skin pigmentation in the Melanesian skin, especially in the tropics where the sun is strong. We have designed a gradual peeling procedure, specially for the Melanesian skin. This procedure can be used to treat:
1. Acne/Pimples
2. Uneven skin pigmentations
3. Small wrinkles
4. Very oily skin & for
5. General skin lightening

Since it is a mild form of chemical peeling, the pack can be supplied for self-administration at home.

'CLAP'

2010-04-12T15:40:00.015+10:00

'CLAP' stands for: Cleft, Lip, Alveolus & Palate. 'Hare lip' is the visible part. However the bones that hold the teeth (alveolus) and the 'wall' that separates the mouth from the nose (palate), may also be involved. There may also be asymmetries of the nose. The proper treatment involves multiple stages and expert services of various specialist Drs. If your child has such a problem, then you should come in for a consultation with Dr. Mol at Goroka General Hospital. The consultation days are Mondays & Wednesday 11am-12pm.

Audit

2010-03-19T10:10:00.021+10:00

Plastic & Reconstructive Surgery services at Goroka General Hospital commenced in April 2008. In August 2009 (after 16 months) the operation theatre was closed for all electives due to the break down of scavenging & air-conditioning systems. The following are statistics for all the procedures done within that period. Within a 16 months period, 488 cases were operated on. More than 60% of these cases were done as day cases. Most of them were cystic lesions which received sclerotherapy followed by keloids & scar revisions. The major reconstructive surgeries followed head & neck cancer ablative surgeries with the Ear-Nose-Throat & Head & Neck surgeon and Facio-Maxillary surgeon as 'team surgery'.

Projects

2010-03-10T11:50:00.016+10:00

Sample pages from the book, 'Goroka General Hospital Basic Statistics, 1998 - 2008'

Compiling of a manual containing the basic hospital statistics from 1998-2008
-Basic hospital statistics can help us to make decisions as to how best to use our limited resources. From 1969 when the hospital opened, until the present time, there has been no such statistics manual. This will be the first attempt to publish such data in the form of a manual.

Dr. Mol has recently completed publishing 'Goroka General Hospital Basic Statistics, 1998 - 2008'. This project was completed on the 9th of July 2010 & published recently.

The features of this manual includes:

Section A - Outpatient Services (Pages 1 - 92)

Section B - Inpatient Services (Pages 93 - 376)

Section C - Support Services (Pages 377 - 439)

Section D - Appendix (Pages 440 - 483)

It has a total of 496 pages and they are all in color. One single graph (figure) occupies 1 page. The appendix contains provincial demographic data, hospital staff data, maps etc.

Joint Operation With 'Interplast' Australia & New Zealand

2010-02-10T10:15:00.006+10:00

'Interplast' is a volunteer group of plastic surgeons from Australia & New Zealand, aiming to help provide services to the developing nations. They visit PNG once a year. This year's visit comprises of 2 groups. One group that went to Port Moresby concentrated on hand surgery. The other group that went to Alotau & then Mt. Hagen, was headed by Professor Donahoe & Dr. Savundra. Dr. Mol joined this team in Mt Hagen from 1st to 5th February 2010. Also with the team was surgeon, Dr. Morath Maire who is trainning to specialize in Head & Neck & Plastic surgery under Dr. George Gende. Dr. Mol & the team operated on more than 15 patients with scar contractures, cleft lip and palate and vascular malformations.

Publications (Scientific Papers/Write-ups)

2009-12-21T13:51:00.016+10:00

Dr. Mol has been an author to 13 papers regarding sclerotherapy and various other aspects of Plastic & Reconstructive Surgery. The references are as follows:

1. 2009: Efficacy of polidocanol sclerotherapy for capillary malformation with masked venous malformation. Dermatologic surgery 2009; 35(1):161-4.

2. 2008: Merkel cell carcinoma of the face: an analysis of 16 cases in the Japanese. Journal of plastic, reconstructive & aesthetic surgery. 2008, Aug 1 (Epub ahead of print) PMID: 18676193.

3. 2008: Simvastatin inhibits growth via apoptosis and the induction of cell cycle arrest in human melanoma cells. Melanoma research 2008; 18(2):85-94.

4. 2008. Salvage of cartilage framework exposure in microtia reconstruction using a mastoid fascial flap. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2008; 61 Suppl 1: s110-3. E-pub 2007 March 9.

5. 2008: Double innervation occurs in the facial mimetic muscles after facial-hypoglossal end-to-side neural repair: rat model for neural supercharge concept. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2008; 61(3):257-64.

6. 2007: Evaluation of the sclerotherapeutic efficacy of ethanol, polidocanol, and OK-432 using an in vitro model. Dermatologic surgery 2007; 33(12):1452-9.

7. 2007: Use of absolute ethanol & 1% polidocanol for the treatment of vascular malformations at our institute. Papua New Guinea journal of science, technology and engineering 2007; 1 (Epub only).

8. 2007: New grading system for patients with Treacher Collins syndrome. The journal of craniofacial surgery 2007; 18(1):113-9.

9. 2007: Modification of thoracoscopy in pectus excavatum: insertion of both thoracoscope and introducer through a single incision to maximise visualisation. Scandinavian journal of plastic and reconstructive surgery and hand surgery. 2007; 41(4):189-92.

10. 2006: Percutaneous sclerotherapy using polidocanol for haemangioma and vascular malformations. Japanese journal of interventional radiology 2006; 21(4): 403-407.

11. 2006: Surgical management of ischial and perineal pressure ulcers with urethrocutaneous fistulae. Journal of wound care 2006: 15(2); 55-7.

12. 2006: P6: A study on blood flow in pedicled jejunum after supercharge using a dog model - which is more important for survival of distal (oral) end of pedicle jejunum, artery or vein? Plastic and reconstructive surgery: September 15, 2006 - volume 118 - issue 4 - pg89-90 posters: scientific posters: pdf only.

13. 2004: A new technique of microvascular suturing: the chopstick rest technique. British journal of plastic surgery 2004; 57: 567-571

Permanent Removal of Facial Hair or Body Hair

2009-12-09T10:40:00.005+10:00

There are 2 methods for hair removal:
1.Temporary
-Shaving
-Trimming
-Plucking
-Waxing
-'Veet' (cream) etc.

Plucking and waxing removes hair from closer to the follicle or root, thereby stimulating more & thicker hair growth. Removal with cream such as 'Veet', dissolves hair at the shaft above the skin. Over time the hair may become thin.

2. Permanent
-Electrolysis
-Laser

Needle electrolysis is the most common and reliable method in the world today. After numbing & cleaning the skin, a tiny needle is passed alongside the hair shaft, down to the follicle and then the switch is put on to pass a tiny current to the follicle. If done properly it is painless, safe and reliable. There is a newer tweezers type of electrolysis, where no needle is used instead, the current is passed down to the follicle using a highly conductive gel. This is a new machine & may not be reliable.

Laser is concentrated light, once absorbed the energy is converted to heat to destroy the follicle. Darker materials absorb more heat. It works better for light skin people with darker hair. The light energy is only absorbed by the hair shaft, preserving the skin. Dark skin people will have burns. Laser is associated with a lot of pain, redness & swelling following the procedure.

Up until now, there is no reliable cream or lotion for permanent hair removal designed yet.

Body Piercing

2009-12-02T11:08:00.007+10:00

Body piercing has been a tradition and a culture among our Melanesian tribes. They have used sharp bamboos, turtle shells etc.. for piercing. Even, nowadays, improper techniques can lead to infections and hypertrophic scars and keloids, especially on the ear lobes. The piercing gun provided by many pharmacies around the country, can cause problems. This is because the pierce is blunt, therefore, it can cause a lot of pain, bleeding and swelling. Because of the bluntness, the skin edges where the pierce penetrates is very irregular. This irregular skin edges has a high tendency for hypertrophic scars and keloid formation. It is better to do piercing under sterile (clean) conditions and to use an anaesthetic cream to numb the skin, as well as to use a sharp instrument to create an opening prior to the insertion of the blunt pierce. These precautions may prevent the formation of keloids.

Lip Reduction

2009-12-02T10:55:00.007+10:00

In Melanesians, the size of the upper and lower lips are naturally large. Sometimes they are large because of some trauma or growth below it. In Caucasians the lips are usually thin or small, so they usually request for lip enlargement. Fillers (substances that are injected below the skin) are injected for lip enlargement. For lip reduction in the Melanesian, a small incision is done on the oral side to remove the excess lip skin. The scar is well hidden on the oral side. There is minimal blood loss and the patient can go home the same day. Slight swelling may last for 2-3 days. The patient is allowed to eat soft foods and rinse the mouth with warm salt water, immediately after the operation. Normal feeding can resume after 3 days. The thread or sutures will stay and resolve or disappear into the skin after 2-3 weeks. The risk of infection is low for any minor wounds within the oral mucosa.

Sclerotherapy (Scarless, Bloodless & Painless Surgery)

2009-12-01T10:01:00.015+10:00

Sclerotherapy is a method whereby agents that irritate the vessel walls are injected to cause the vessels to harden & obliterate over time. Thus, cutting off the blood supply to the diseased part to cure it. This technique is done through an injection needle, therefore no scar is left on the skin & there is less complications such as blood loss & the recovery time is short.

Sclerotherapy is used to treat:
1. cystic lesions (fluid filled swellings)
2. vascular malformations & hemangiomas (swellings that are composed of blood vessels)
3. uncontrollable bleeding sites after trauma or surgery
4. cancers (to cut off blood supply to tumours)
5. to cut off nerve supply to control abnormal muscle movements or excessive pain
6. hemorrhoids (anal swellings that are composed of veins)

Dr. Mol is the only person in PNG specialising in the art & technique of sclerotherapy. He has obtained a PhD on sclerotherapy while studying plastic surgery at Hokkaido University, Japan. He has elucidated the mechanism of action (how they work or induce sclerosis) of 3 commonly used sclerosants (agents that induce sclerosis or hardening of vessels).

Health, Beauty & Relaxation Haven (Aesthetic Salon)

2009-11-18T10:58:00.010+10:00

Dr. Mol has introduced an aesthetic salon to Goroka Town (We are relocating from Gouna Center to a new setting, please call us to find out about our new location: Ph-715 43676. The services provided are:

1. Deep facial cleansing & light chemical peeling for lighter, smoother & youthful skin
2. Permanent hair removal using the 'Vector' system
3. Electronic massage for muscle cramps & aches & physiotherapy
4. Acupuncture for pains that are not responsive to medications
5. Removal of facial birth marks
6. Long term control of excessive sweating & body smell
7. Removal of facial scars & keloids
8. Removal of facial wrinkles
9. Treatment of pimples & acne

2011 PNG Medical Symposium in Kimbe

2009-02-18T12:32:00.025+10:00

The 2011 (47th) Annual PNG Medical Symposium was held at 'Liamo Reef Resort', Kimbe from 4th-9th September 2011. The theme was 'Pandemics, Epidemics & Disasters'.

Location of Kimbe (West New Britain Province) on New Britain island.

The main cash crop of the province is Oil Palm. Here the older palms are destroyed and replaced with newer palms.
View of sunset from Liamo Reef Resort.
Hoskins airport, out of Kimbe town.
Newer 'Air Niugini' aircrafts, servicing the province.
Walindi Plantation Resort. A perfect haven for dives in nearby reefs.
View of Kimbe peninsula.
Cultural show in Kimbe.

Dr. Mol submitted 3 papers for presentation at the symposium:

1. 'Handling 10 Years of Basic Health statistics at Goroka General Hospital'

2. 'State-of-Art Management of Chronic Renal Failure in PNG - How Far Are We?'

3. 'Scarless Treatment for Benign Cystic Lesions at Goroka General Hospital'

The 2 papers for the main session were not accepted. However, the third one was accepted for the ENT, Head & Neck Surgery specialists' meeting. At this specialty meeting, the following were discussed:

1. Future trends and build up of ENT, Head & Neck Surgery services in PNG incorporating Plastic, reconstructive & Cosmetic Surgery services (funding, training etc.)

2. Newer techniques in ENT, Head & Neck Surgery (eg. modifications of 'maxillary swing method')

3. Support & recognition of Plastic, Reconstructive & Cosmetic Surgery services in PNG

The 2010 (46th) Annual PNG Medical Symposium was hosted in Wewak from the 29th August (Sunday) to the 3rd September (Friday) 2010. The theme was ´Lifestyle Related Diseases & Cancers´. Our team presented 2 papers:

1. 'Team Surgery' the Way to Go for Head & Neck Cancer Surgery in PNG

2. Plastic & Reconstructive Surgery Services at Goroka General Hospital (16 Months)

2010 PNG Medical Symposium in Wewak - August 29th to September 3rd 2010 Team effort to try & withstand the force of a wave.

´Noni´ Fruit (traditional, medicinal plant)
Traditional method of cooking fish, wrapped in ´Noni´ Leaf. ´Noni´ oil is a traditional medicine used in the South Pacific Region.

The team from Goroka. From Left to Right, Dr. Endican (ENT/ Head & Neck Surgeon, Alex (Anaesthetic Scientific Officer), Roaipa (Senior Radiographer), Dr. Mol (Plastic Surgeon), Dr. Karu (Anaesthetist) & Dr. Dala (Sexual Health Physician, currently studying for Masters at University of Sydney, Australia).
Departing Wewak by boat to Madang (Lutheran shiping, takes about 14 hours).

Sunrise, early morning, on the way to Madang.

Arrival in Madang....

Conference in Japan.

Dr. Mol has visited Japan from 21st February to 7th March. He attended the Japanese Foot Care Society meeting (http://fc2009.jtbcom.co.jp/index.html) and has presented on a new, simple & painless technique of preventing ingrown nail. Before that he has spent a few days at Japan's oldest & largest private hospital that specializes in cancer treatment & research (http://www.jfcr.%20or.jp/english/). There, he studied the techniques of breast and orthopaedic reconstructive surgery.

Conference in Japan.

Pacific International Hospital

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Dr. Mol often visits the Pacific International Hospital. He will see patients with any kinds of swelling in the head & neck region as well as facial hair in the female, scars, wrinkles, breast reduction etc. Call to the reception to make appointments.

2011 PNG Medical Symposium at Liamo Reef Resort, Kimbe

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Liamo Reef Resort Main Entrance
Chinese cuisine
Night view of bridge

Lawn & Beach

The 2011 PNG Medical Symposium was held in Kimbe, at Liamo Reef Resort from 4th-9th September. The theme was, 'Pandemics, Epidemics & Disasters'.

Liamo Reef Resort is a beautiful beach resort, locally famous for its delicious Chinese cuisine.

Dr. Mol presented a paper at the ENT, Head & Neck specialty meeting regarding, 'Scarless Surgery for Benign Cystic Lesions at Goroka General Hospital'.

Visit to PIH

Dr Mol has visited the Pacific International Hospital (PIH) from 20th April to 1st May 2011. He will be visiting regularly from Goroka. Appointments can be made at the reception.

One of the only 2 dialysis machine in PNG. PIH is the first & only hospital to acquire the machines & to provide the service.
During hemodialysis, the patient is connected via a central-venous catheter to the hemodialysis machine. However, the problems associated with such catheters are:

1. Low flow, therefore, the process of hemodialysis is very slow

2. Formation of clot & thrombo-embolism

3. Infection

4. Pain & Discomfort

5. Re-insertion after 3-5 months

Connection via an artificially created Arterio-Venous Fistula (AVF) is more superior to the catheters. Up until now, patients have been refered to Singapore to have the AVF created, at a cost of over K20, 000.oo (twenty thousand kina). Recently, Dr Mol has created the first AVF at PIH. The cost savings of localising the service, is over K10, 000.00 (ten thousand kina).

Dr Mol, performing the first creation of an Arterio-Venous Fistula at PIH.

Visit by Dr. Munetomo Nagao (MD, PhD) from Iwate Medical University, Department of Plastic & Reconstructive Surgery.

Dr. Nagao Munetomo visited our Department of Plastic & Reconstructive Surgery here at Goroka General Hospital from 6th to 9th March 2011.

Dr. Nagao is a senior staff surgeon at Iwate Medical University, Department of Plastic, Reconstructive & Aesthetic Surgery. Dr. Nagao is specialised in General Plastic Surgery as well as the treatment of Hemangiomas & Vascular Malformations. Dr. Mol & Dr. Nagao studied minimally invasive treatment for Hemangiomas & Vascular Malformations, together, under Professor Satoru Sasaki at Hokkaido University, Department of Plastic & Reconstructive Surgery.

Dr. Nagao educated our Drs here at Goroka General Hospital about the general aspects of medical technology in Japan as well as the latest developements in Plastic, Reconstructive & Cosmetic/Aesthetic Surgery.

The devastating earthquake/tsunami happened 2 days after he returned. Himself & his family are lucky to be alive without any injuries. However, we symphatize with the consequences of the disaster that are ongoing and the hardships many families are going through. We pray that God will aleviate their sufferings & hardships.

2010 PNG Medical Symposium in Wewak, in pictures

The 2010 PNG Medical Sympsium in Wewak, from 29th August to the 3rd September went very well, however there were a few set backs.

1. The hall for the main venue (Kaindi Divine Word University) was too small & hot
2. Accommodation shortage for participants
3. Most of us from the highlands were not used to the hot weather

Transportation was very efficient & the food & cultural entertainments were great. There were many interesting papers discussed regarding the theme, ´Lifestyle Related Disease & Cancers´. Our team presented on Tuesday morning & afternoon. The topics were:
1. Team Surgery the Way to Go For Head & Neck Cancer Surgery
2. Plastic & Reconstructive Surgery Audit at Goroka General Hospital (16 Months)

Wewak is a beautiful small town with beautiful beaches & friendly people. There is also the Wom War Memorial near the Wom beach.

Apart from the famous Sepik Carvings, there is also Sepik baskets, ´bilums´ & the cane chairs. The Sepik ´bilums´ are made of pure traditional materials & are very stylish & durable & may be suitable for modern PNG fashion.

Scar & Keloid Removal

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-Scars are unsightly end result of wound healing
-Hypertrophic scar & keloids are common among dark skin people
-Routine treatment by general practitioners or surgeons have a high chances for recurrence
-Our salon offers the latest treatment modalities to prevent recurrence & healing with almost no visible scars.

Your Safety, Comfort, Privacy & Satisfaction is our Number 1 priority!

Tattoo & Birthmark Removal

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-Tattoos are artificially induced coloured spots on the skin while birthmarks are naturally occurring

-Laser removal is unsafe for dark skin people as it may cause burns to the normal surrounding skin.

-Precise surgical procedures may be done for Melanesians to minimise the scars

Your Safety, Comfort, Privacy & Satisfaction is our Number 1 priority!

Wrinkle Removal

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-Wrinkles are baggy, skin lines and depressions occurring as a result of collagen damage that holds the skin tightly together or as a result of pull by over-reactive underlying muscles or as a result of fat atrophy (disappearance of fatty tissue) & excessive dehydration.

-The collagen is damaged mainly by the process of aging & prolonged exposure to sunlight. Fat tissue may disappear as a result of aging, malnutrition or any other systemic disease.

-Modern techniques to compensate the collagen loss & also to stimulate the production of collagen as well as relaxing of the underlying muscles may help to restore youthfulness.

-Apart from fat transfers, we emphasise the importance of nutritional rehabilitation. This is a holistic approach.

A Story of Someone Who Defied Death & Has Renewed Life Itself

'An Inspiration to Appreciate Life & to Live it to the Fullest'

It is usual to have 1 or 2 life-threatening illnesses throughout our life time. With a strong heart and passion for life, we may conquer these illnesses & live on. Here is a story of someone who fought so many wars with many major life threatening conditions and situations but refused to give in to all these adverse circumstances. She had conquered all battles & then took a big leap forward to undergo the first facelift surgery in PNG at the hands of Dr. Mol, at 55 years of age. The following is a summary of her story:

1. Had tuberculosis of the neck glands (TB lymphadenitis) in childhood and has completed TB treatment daily, for 6 months
2. Had marriage related problems; the first husband committed suicide, she also attempted suicide; overdosed herself with a prescribed medication; she had dilated pupils and had cardiac arrest; she was resuscitated successfully at the PMGH, emergency department in 1978
3. Right ovarian cyst; had it removed (oophorocystectomy)
4. Left ovarian cyst & twisted fallopian tube; had part of the ovary removed
5. Inflammation of the appendix (appendicitis); had it removed (appendectomy)
6. Inflammation of the gal bladder (cholecystitis); had it removed (cholecystectomy)
7. Had the abdomen opened up (laparatomy) for severe abdominal pains & adhesive bowel obstruction
8. Had her last 2 children on whatever was left of her left ovary
9. During her job as a flight attendant, she wrestled with someone twice her body size, who deliberately tried to opened the aircraft door during flight; she successfully overpowered the man & closed the door, saving her own life as well as the life of all others on board
10. Had a cyst in the uterus; had total removal of the uterus (abdominal hysterectomy)
11. Had left breast cancer in 2004; completed chemotherapy & radiotherapy in Australia by the end of 2005
12. Had endoscopy for peptic ulcer disease & inflammation of the duodenum during the breast cancer treatment; completed treatment & was cured completely
13. Had severe depression & attempted suicide; took 50 tablets of valium (250mg in total) and went into respiratory arrest & was resuscitated at the PMGH, emergency department
14. Underwent plastic (cosmetic/aesthetic) surgery in May 2011 at Goroka General Hospital at the hands of Dr. Mol
-had mid, lower face & neck lift
-had skin resurfacing (chemical peeling &
dermabrassion ) for acquired nevus & melasma(hyperpigmented/dark areas of the skin) & small wrinkles around the lip
15. Currently undergoing major change of lifestyle
-diet, exercise, making new friends etc.

She is a renewed person now. Her motto is:

'Living Life to the Fullest'

Dr. Mol did the first facelift surgery in PNG on this brave & determined person. Facelift is basically an attempt, to try & restore the youthfulness of the face. The early signs of aging, manifests as follows:
1. Hollowness due to loss of fat (atrophy/dystrophy or migration), collagen loss/damage & severe dehydration
2. Collagen damage & migration of skin resulting in formation of wrinkles & excess/baggy skin

Facelift surgery mainly involves:
1. Repositioning of fat or autologus fat transfers/graft or sometimes fascia/muscle sheet grafting
2. Stretching & repositioning of skin

The overall aim of facelift surgery is to restore the youthful, facial contours of the face, as well as to remove wrinkles. Muscles of the face attach to the skin to create facial expressions. Some wrinkles arise from hyperactive muscles, exerting excessive pull on the skin, even at rest (when not attempting to make a facial expression). In such cases 'botox' may be indicated to relax these muscles. Excessive use of 'botox' may cause 'mask-like' or expressionless face. Furthermore, excessive removal of facial fat & multiple facelift surgeries may cause mask-like or skeletonized face (loss of normal facial contour, resulting in prominent, and show of facial skeletal features).

Your Safety, Comfort, Privacy & Satisfaction is our Number 1 Priority!

Skin Care Consultations

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-In the Melanesian, the skin consists of a thick, oily outer layer, followed by another thick layer of dead skin (keratin) and then the real skin below. The use of soaps only removes the oily part but not the keratin. The keratin layer usually contains hyperpigmented areas embeded within them, that makes the skin looks unevenly coloured. Research has shown that by peeling off this keratin layer using weak acids (chemical peeling), stimulation of the skin's stem cells will occur. Thus, resulting in the growth of new skin from below to replace the dead, top layer. This will make the skin look glossy and very youthful.

-Use of over the counter creams & lotions only mixes with the top oily layer and is washed off during showers or baths. Most of them do not serve their purpose because they do not penetrate the top keratin layer, down to the real skin below. However, the skin's main source of nutritional supply comes from below, upward, through the blood supply. Therefore, it is important to maintain a proper and balanced diet, making sure to maintain an adequate amount of fluid intake. In the tropics, we lose a lot more fluids and salts through the skin, leaving the skin looking floppy, dry and too oily. Furthermore, the sun in the tropics is too strong, therefore damaging the skin & causing, uneven areas of skin pigmentations.

-We can offer you consultation on how to best care for your skin so you may look younger than your actual age

Your Safety, Comfort, Privacy & Satisfaction is our Number 1 Priority!

Who is Dr Mol?

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Dr. Mol William is a graduate of University of Papua New Guinea (UPNG) School of Medicine & Health Sciences.

In December 1997 when he was in his 4th year MBBS (Bachelor of Medicine & Surgery) program, he received a scholarship for 1 month to Royal North Shore Hospital in Sydney, Australia. That is where & when he started studying Plastic Surgery. In April of the following year (1998) he received another scholarship for 2 years to Hokkaido University, Sapporo Japan. He skipped his 5th (final) year to study Plastic Surgery as well as Japanese language and culture at Hokkaido University, Japan.

In April 2000, he returned to University of Papua New Guinea to complete his MBBS program. From January 2001 to December 2002, he did his residency training at Port Moresby General Hospital.

From January to April 2003, he worked part-time with Professor Mathias Sapuri & Dr. Mark Paul at their private clinic (Port Moresby Private Specialists Medical Centre). In April 2003, he return to Hokkaido University, Department of Plastic & Reconstructive Surgery to complete his studies on Plastic & Reconstructive surgery.

On March 25th, 2008 he completed his PhD at Hokkaido University Graduate School of Medicine, Department of Plastic & Reconstructive surgery. His research thesis was on the usage of minimally invasive techniques or sclerotherapy to treat hemangiomas and vascular malformations (birthmarks) of the face, head & neck region. Dr. Mol was also trained in the following areas of Plastic surgery:
1. Head & Neck Reconstructive surgery
2. Microsurgery, including facial nerve surgery
3. Breast reconstructive surgery
4. Cosmetic/aesthetic surgery &
5. General plastic surgery

On April 21st 2008, he was employed by Goroka General Hospital and on November 29th 2008, he was registered with the Papua New Guinea Medical Board as the first specialist in Plastic & Reconstructive Surgery in Papua New Guinea. Dr. Mol is also a visiting Plastic surgeon to Pacific International Hospita l, Port Moresby.

Currently he is working as part of the general surgery and head & neck surgery unit at Goroka General Hospital, engaging in clinical work as well as research in collaboration with the Papua New Guinea Institute of Medical Research. He is also the coordinator of the grand round meetings at the hospital.

What is Plastic & Reconstructive Surgery?

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-Plastic surgery is the surgery of the skin, soft tissues, small bones of the hands, feet and the face & head & neck region for functional purposes as well as to achieve a more natural and younger look or appearance.

-Reconstructive surgery is the branch of plastic surgery that tries to restore function & appearance, after tumour ablative surgery, trauma or birth defects.

-Cosmetic/Aesthetic surgery is the branch that deals with modification of the body shape, size and colour for better appearance & younger looks

-Dermatologic surgery is minor procedures to remove small skin lesions and to enhance the youthfulness of the skin

-In Papua New Guinea, Plastic surgery is needed to try and restore normality after:

1. Hand trauma
2. Burns
3. Tumour ablative surgery
4. Congenital malformation/anomalies etc..