Dr Mark Vucak has been specialising in Plastic and Reconstructive Surgery for over 20 years and during that time has just about seen it all. He chats to us not only about popular procedures, but has some really relevant and important information and insights on men’s overall health and well-being. This is a definite must read for every male (and the women!).

Dr Mark Vucak

Dr Mark Vucak

Trish Hammond: What do you think are some of the important issues to highlight during Men’s Health Week. What do the guys need to know?

Dr Mark Vucak: When you’re in the business of anything, whether it’s in engineering or whatever business you’re in, you have some insights that other people don’t have, which is kind of interesting. There’s a few things that I do myself. And I was just thinking about how I might answer some of these questions that you’re posing, and I just had a look at myself and see what I do and see whether I can improve my activity and my outlook and things.

So I thought I’d briefly just run though, just for a minute or two, some of the things which I think are important and some of the things I try to adhere to and live my life by. And I think the first thing for men’s health altogether, especially as you get older, it’s a pretty good idea to stay married if you can, because it’s good for your mental health, and if you can surround yourself with family, it’s so important. And to work in a position where you can help other people, as well. Because it’s okay just working at a bank or something like that, but you really need give back to the community, and that giving back gives you a sense of mental health and well being. When I was younger I used to be on the Australian canoe team so my whole life I’ve trained a lot, and I think regular exercise is key, as well as diet. The regular things you hear.

But when it comes down to exercise, it’s really important to, if you’re going to do weights for example, you need to max out with all these exercises, because when you push really heavy weights it releases a growth hormone, and that’s going to help your strength and muscle and bones as well. There’s a lot written about how much one should exercise on a weekly basis, and this week for example, I’ve gone for three paddles and two walks for over an hour. So I think you need to try and keep up your exercise so that you can face things as you get a bit older.

I do a lot of dietary supplements, and I’ve looked to … In plastics, we get involved a lot with longevity and I’ve found that the Life Extension Foundation, which is a not-for-profit organisation, pretty handy, because they can give you a lot of things which aren’t in the mainstream. And I have a lot of dietary supplements through these guys. Of course, every five years I have a colonoscopy, and then every second year I have blood tests for looking at my prostrate and liver functions, so PSAs. You need that every couple of years, and certainly need a colonoscopy every five years.

So they’re the basic things. Getting the diet right, having the right dietary supplements. But in relation to our job in plastics, there’s a few things I do. Every six to eight weeks I have a protégé, which is skin tightening on my face. And now I’m nearly sixty, my skin is as tight as it was when I was twenty. And it’s a machine that we have in the office. It’s handy, I’ve got it so I can use it.

Trish Hammond: Which one is it?

Dr Mark Vucak: That’s the Protégé machine. It’s a radio frequency skin tightening. It’s handy, it’s not invasive. And for nearly 60, my skin’s just great and tight. Every year, about in January, I have my break, I either have a laser resurfacing or a peel, and that sort of gets rid of all the sun damage across the top of your skin, and I just keep up my injectables to my glabella and crow’s feet, and that helps with facial ageing.

And of course every day I have a skin care programme, so I have the peel once a year, or the laser once a year. And then pretty much every day I use a combination of Retin-A, salicylic acid or lactic acid peels. So it’s an ongoing programme where we’re building up the skin and exfoliating the skin all at same time. So turning over the skin, and that gives you a fresher, more youthful appearance. It’s one of these things whereas doctors you should really prescribe stuff that you should try apply it to yourself, because most people don’t do that and that’s a good place to start.

As far as men’s health altogether, I think first of all it’s a good idea to have a week dedicated to men’s health, bit like Movember, there’s a movement to making people aware of what’s possible. I think most men just don’t understand the disease, and I certainly don’t understand some diseases as much as I should, but we’re pretty clear on most things. And because they don’t understand the disease they don’t know what symptoms to look for, they don’t know what to put together so they might actually have something, so if they’re concerned they pretty much need to go and get somebody with knowledge to sort that out for you. I mean, you could have symptoms and not know about it.

A lot of people have head in the sand type of approach with men, especially. My cosmetics consultant, I was talking to her this morning, her husband’s’ father died from bowel cancer at 44 and generally hasn’t had any tests at all so far, so that’s kind of like … You want to do something about that. Most men don’t know what their options are when it comes to … Especially plastic surgery, they don’t realise that there’s non-surgical options like laser and CoolSculpt, where you don’t have to go in for an operation. You can have CoolSculpt and remove fat in the office, and that can be done during lunchtime. It’s a non-invasive type procedure.

And finally, your hair, people, and even I hear things on the radio and promotions about aesthetic surgery, and somehow we think that it doesn’t apply to us, it applies to somebody else. So it’s really a matter of getting perspective.

Trish Hammond: That’s so true. And it’s so funny because of course we’re on a Skype video so I can actually see you now, and I must be like the general public, you just have a presumption that older guys aren’t going to do anything, and I just thought, “Yeah, yeah, he looks good for a 60-year-old.” So you have stuff done too, I love that.

Dr Mark Vucak: Yeah, almost every … I’m having some this afternoon, actually, it’s more skincare this afternoon. It’s so important, especially in our business because you want to present well, and you need to practise what you preach. It’s the same old adage, if you look as good as you can then people will think, “Well, you’re going to do a good operation for me.”

Trish Hammond: Yeah.

Dr Mark Vucak: If you come in a daggy T-shirt and you don’t comb your hair and you don’t polish your shoes, well, I probably wouldn’t have surgery with that person.

Trish Hammond: Yeah, that’s so true. You know what I’m going to do, when I transcribe this back I’m going to actually make this up as a bit of a checklist because I think it’s a really good idea, everything you went through, like the colonoscopy every five years. Because it’s true, sometimes we just don’t look after ourselves because we don’t really realise what we should actually have done to maintain our health. Because it’s not that you just eat healthy, you kind of have to do extra stuff to maintain a level of health. Like you said this morning, you’ve gone out for an hour exercise, it’s just because that part of your health maintenance, isn’t it?

Dr Mark Vucak: Yeah, I think it’s part of the health maintenance. And I think we’re kind of lucky being in medicine, we know what we need to do. The things that you’re going to get, either cardiac disease, so you need to exercise, bowel cancer, so you need colonoscopies, or prostate cancer, so you need your PSAs. Now, if you cover off those big bases then … I mean, common things are common, so if you can get that sorted then you’re okay. I think a really interesting test is CT calcium scores, so you can have a cat scan and they can have a look how much calcium is in your coronary artery. I think by the time you get to 50, and certainly 60, you should probably have a calcium score done just to see where you stand and make sure you’re not going to have and infarct any time soon. They can have a good look at your coronary artery with the calcium score, see what you’re up to.

Trish Hammond: I’m going to make myself a list myself after hearing that. Just going back to the bloke thing, do you think that men find it harder than women to discuss their health issues? Because I do. And if you think that, why is this the case?

Dr Mark Vucak: I think, personally, men are just less articulate, by and large, and this is a common thing I find in the operating together. You’re working doing a case and most of the time you have to ask the women to be quiet because … Apparently, women talk about eight times as much as men, or even more than that. So for every word I have they’ve got eight words to describe the same thing. That’s one of the big differences between men and women, men are just less articulate. So first of all, they don’t know to ask for things, they’ve got a brave front that they have to keep up, and it’s all part of this toughness. And the expectation from when they’re little is because they’re tougher that they won’t get sick. I mean, everybody thinks they’re pretty bullet-proof, including me.

But a lot of these being quiet and not asking things, a lot of the time it’s tied up with some sort of depression, in some way. I was just reading an article on Friday in The Financial Review about why your 40s is the most unhappiest time of your life, because in your 30s you’re striving, in your 40s you become more depressed, and in your 50s and 60s you get insight and you begin to understand a lot more about the world and relate to it in a different way.

So I think there’s a depth of depression that happens in your 40s you don’t really appreciate, because you’re sort of transitioning from trying to achieve things in your workplace and trying to build a business and get a house and do as well as you can to the second half of your life where it’s more about think about other people and making sure that they’re happy, and being able to provide for everybody. So there’s a transition of depression, I think, in middle age, especially in men. And that depression goes along with being unable to articulate ait properly with this toughness, and that combination of those three things, I think, makes it harder for men to discuss their issues, and their health issues.

Trish Hammond: Yeah, that’s true actually, because even my partner he would like to get a bleph done, an upper and lower bleph, because he’s like, “Oh my God, I just can’t believe it. I can’t believe that’s me in the mirror.” But he’s just so paranoid about talking with anyone about it because he’s a man, it’s not really something that you talk about. But when I show him stories and say, “Look, apparently, I think one in four people have this done”, he’s becoming more open to it and sort of thinking, “Oh, yeah.” But I know that he thinks of it totally different to what I think of it, because you don’t have that … Not communication, I don’t know, just that general conversation about the way we look aesthetically. It’s a bit vain, I guess, for a guy.

Dr Mark Vucak: Yeah, I think that’s the case. When people come in I think it’s important when you’re talking to them, I don’t like to have my desk between myself and my patients, I like to sit facing my patients directly, and I like to … Even though I wear a tie, and occasionally a suit, I try and make the least distances I can between people, so I don’t talk to them in medical terms, I just find out what they want and try to understand where we’re going together so that they feel more comfortable. That being approachable I think it helps in medicine as you go on.

Trish Hammond: Totally. And do you reckon that our society and culture is changing when it comes to what’s acceptable for men with regards to looking after their appearance? Do you reckon that the expectations of a male’s appearance are kind of changing as well?

Dr Mark Vucak: The thing in the 80s and 90s when the gay community started having their voice heard and becoming a lot more prominent things changed quite a lot, not only for the gay community … And my son’s gay so I’m very familiar with everything to do with that. I understand what the issues are. And I think previously everybody was being a bit blokey, but now with … Especially young men, because there’s so much social media, they’re always taking selfies, there’s rated and people likes and dislikes each other. Everybody’s going to the gym, and gym memberships are growing exponentially. So people are a lot more concerned about their body image, I think probably as a result of social media, and certainly in their 20s. In the 30s and 40s it’s much more stayed because people haven’t really grasped that progression.

But before, perhaps you might be able to suggest in your own mind that somebody might be gay and the other guy is different you might go, “Well, everybody is so much the same now.” You can’t use that as a blanket statement anymore, and I think that’s a good thing. The area that interests us, from a surgical point of view especially, is educated senior people because they’re more interested in skin care, they’re prepared to have procedures. There may be issues with job promotion, they might feel like they’re working in an environment with a lot of younger people and they want to stay up with everybody. Being divorced is a terrible time in life, and I think a lot of people, whether they like it or not, like to have a restart after they divorce or separate. And a lot of divorcees, men, are coming to have things done to try and improve their appearance. And that comes back to self-esteem and improving body image.

Trish Hammond: Yeah. And I think you’re totally right, because last week I did a Facebook Live with a guy who just had some surgery. He’d lost a heap of weight, so he had body surgery, but he’d also had a facelift. It must be because I’m old or whatever, no matter what you still have this mindset on what sort of men might have surgery and stuff like that, so it still is, like you said, you sort of think someone who’s quite effeminate and whatever. But this guy, just by looking, I would never have picked him as someone who would even consider or think of plastic surgery, or let alone the facelift that he had done. I mean, you can’t tell, but I keep getting blown away every day, it’s so much more accepted, amongst guys as well. They’re definitely becoming more caring about their appearance, I guess.

Dr Mark Vucak: Yeah. There’s functional and cosmetic things to be concerned about. For example, you’re right, with a body lift type surgery or massive weight loss surgery, that’s maybe slightly in a different bracket from somebody’s having facial rejuvenation surgery. I mean, one’s more functional, one’s more aesthetic, so people have got different motivations for doing those two different things.

Probably in terms of the most popular procedures, I think for me anyway, gynecomastia surgery, which is male breast enlargement, that leads the field by far. That’s our commonest operation for men. And I can see why people might want to have that surgery, from the time they were teenagers their breasts have been enlarged, they look effeminate, they don’t want to go to the pool with their shirts off. Probably the most common would be gynecomastia, a very small periareolar incision, so we don’t have any incision going out into the normal skin, and we can take out 20 grammes through that small incision, and then liposuction and contour the rest. That surgery can be done with very little scarring, very hard to see.

There was a vogue for only doing it by liposuction, initially, with the last 10 years with more aggressive cannula, but you still have to make a cut somewhere to get the liposuction cannula in. And I was seeing a lot of people with incisions down across their ribs trying to get the cannula up to suction the breast tissue out, because the breast tissue is very hard to suction out, you have to grasp it out. And so we abandoned that and just went back to the very small periareolar incision, and that produces a great result.

Trish Hammond: So on that, apart from that one, what are the popular procedures and treatments do you do for men?

Dr Mark Vucak: I think pretty much the same as woman, but I think there’s a little bit of a different priority. We have a lot of massive weight loss patients in north Queensland. For example, in January, there was 32 gastric sleeves, so about half of those were men, and half woman. So a lot of those people come to us for tummy tucks, weight loss surgery, where we’re going to remove a lot of skin where the body lifts. I was just having a look at my … For example, in the last two weeks, if I just think back in a very short period of time, did a otoplasty last week on a guy who’s in his 40s, so ear pinning. He was having a hernia done with another surgeon so he thought, “I’ll just do that at the same time”, and worked out pretty good.

A lot of people have, especially in Queensland, a lot of sun damage. And I just love a erbium laser resurfacing to 100µ. It was something taught to us by the guys from Texas. We started first with lasers in 1993 and 1994 when they first came out, CO2, and now we’ve gone to … We went through CO2 to erbium, and then went from erbium to Fraxel, and then from Fraxel back to erbium. For skin cancer resurfacing erbium at 100µ produces a very nice even result. So you get rid of your skin cancers, but as a byproduct it tightens all the lines up on your face so you get a really good aesthetic result. And then we can tidy that up with some Fraxel or some DOT Therapy to the neck, so overall you get quite a good cosmetic result without even going for cosmetic surgery. You’re having skin cancer surgery but you get the side effect of having a good aesthetic result, and can look many years younger just by doing that.

In the last week I’ve done a couple of rhinoplasties on men. The first rhinoplasty I did was where another surgeon had over resected, they took too much tissue out and so we had some nasal collapse. And as it turns out, I needed to do, what we call, a cantilever bone graft. So what that means, is I took his rib and the cartilage joined to the rib … So if you just take rib to make a new nose it’ll fracture and absorb, if you just take cartilage it’ll bend. So, basically we get the end of the rib and the cartilage. I like to do about 50-50 or 60% rib and 40% cartilage, so then we can do rhinoplasty and get the shape right, and then we can do a cantilever bone graft, which means then we screw the bone onto the nasal dorsum up the top of there. So we can use the cartilage as the tip of the nose so it’s not so rigid, and we can support it with some other [inaudible 00:19:24].

So this guy needed nasal reconstruction because his tissue had been over resected. But I do get quite a lot of rhinoplasties for men just trying to change the shape. I think that’s a big thing. But we do so many rhinoplasties, and a lot of these rhinoplasties have underestimated … They thought it would be cosmetic, but most of mine are functional because we can do a septoplasty at the same time, we can put in cartilage grafts, we can improve nasal airway, and so they get a secondary aesthetic benefit just from doing a reconstruction.

Trish Hammond: Right.

Dr Mark Vucak: There’s a couple other things we do, liposuction. It’s quite handy, but … A lot of men come to see me for liposuction and they’re not good candidates because their fat is inter-abdominal. So they’ve got visceral fat, so the inside of their tummy is very full and tight and they’ve got a tight rotund abdomen. And that fatty layer on the outside, there’s not much of it, so they’re not good candidates. The best candidate is when you’re thin on the inside and just wearing a big overcoat of fat, that’s when you get a good liposuction result.

I just do liposuction in my rooms, for some bodybuilders just to tone them a little bit to get areas they can’t get out. And of course, same with your partner, blepharoplasty is common, and facelift. Facelift is not common in my practise. What happens as you get older is you get a lot of neck laxity at the front with the platysma bands hanging down. And so when men think about doing a facelift, not really concerned about their face, they’re more concerned about their neck. So it’s really kind of like a neck lift for most men.

And there’s a chap in New York called [Gradinger 00:21:04] who made an incision … He’s taking the incision down the front of the neck. I don’t like doing that because I don’t like the scar at the front of the neck, so we use a small submental incision. And we’ve managed probably in the last five years, the best way that I’ve done that is just make a very small incision in front of the ear, not extending into the posterior hair, no extending into the temple, so it’s a very short … It’s like a mini [inaudible 00:21:26] incision, but if you combine that with a submental incision you can really get that platysma up quite a lot. It’s kind of magical really, you can do so much through such small incisions. Because one of the things with men, we don’t want to have long facelift incisions because we don’t want to see the scar. And a lot of men can be balding, so endoscopic brow surgery is not so good because they’ll see the scar at the end of the day.

Trish Hammond: Yeah, valid point.

Dr Mark Vucak: And the very last thing probably in this list is transgender surgery. I’ve actually been doing quite a lot of female to male and male to female surgery. The last person I did where we were going female to male, when you think about removing the breast tissue most people end up with a massive scar right across their chest. I don’t like that. So we adopted a very old technique, it was just a small periareolar [inaudible 00:22:32], an incision, and then take out the breast tissue through the inside, through the lower part of the areola, do a mastectomy through the lower part of the areola, and then stitch it all together. So at the end of the surgery all it is is one incision around the nipple, and that’s it. No transverse incision across the chest. And I couldn’t believe how good that surgery was in terms of keeping the scarring to absolute minimum and getting a good male contour across the chest wall. [crosstalk 00:23:04].

Trish Hammond: Yeah, right. So tell me, is there a common concern or complaint that you hear from men when it comes to their health and/or ageing issues? Is there something that is really common that guys might … If I was a guy, like an old guy, probably feel comfortable, or even younger, coming to you for some rejuvenation because you are a man. Is there something that is really kind of common amongst everyone about a complaint, an ageing complaint? Apart from the fact that I’m getting older, I don’t know what to do. How can you help me?

Dr Mark Vucak: I think it’s very difficult to work out what actually triggers men to decide to have the surgery. For example, my otoplasty guy last week, he’s in a stable relationship, he’s 42, I’m not quite sure why he waited 30 years to have his otoplasty. But he’s having a hernia repair, so he did that together, so maybe convenience helped him there. And with the rhinoplasty guy, he couldn’t breathe so we needed to do something about that. So there’s a lot of functional issues. And my facelift guy the other day, he was recently singled and he worked in an environment with younger staff and he thought that would improve his job chances.

I think for men it’s quite a big barrier, big hurdle, to jump across to decide to actually do this sort of stuff. But with social media and the selfies and the promotion, eventually it all seeps through, so gradually things will change around. But it’s like trying to shift a big boat which is steering in a different direction because there’s so much weight going in a certain direction. There’s certainly a lot of information on men’s health about diet and exercise and contacting your GP and treating depression, I think those things are heading in the right direction.

Trish Hammond: Yeah, I think it’s great. I seriously am going to do up a little checklist, because it just makes sense. Like some people just need to say, “Okay, this is what you need to check, this, this, this, this, this, and just do it every couple of years.” Just go through your checklist and think, “Yup, no worries, I’m all sorted.” Because sometimes guys don’t tend to go to the doctors as much as women.

Dr Mark Vucak: Yeah, I think so. I’ve got a younger family now and I want to be there for them so I’m pretty vigilant about all these issues. My parents are 85 so hopefully the genetics will get me through.

Trish Hammond: Yeah.

Dr Mark Vucak: But I do all these other things, diet and exercise, and then take care of my skin, and don’t become overweight, surround myself with family, and help people as much as I can. And that’s a good thing about my job, I come to work every day and help people so I kind of love that.

Trish Hammond: Yeah, so true. That’s been so good. Really appreciate you taking the time today … Although you’re working today, we have a public holiday here in New South Wales, but Queensland has to work. So thanks so much for taking the time today, much appreciated.

Dr Mark Vucak: Okay, thanks.

Trish Hammond: No worries. So, guys, if you’re out there I’ll definitely do up a checklist, take heed of what Dr. Vucak’s had to say because it’s all really valid information. Pay attention to your health always, but especially during National Men’s Health Week this week. Thank you so much, Dr. Vucak.

Dr Mark Vucak: Thank you.

Trish Hammond: Bye.

Dr Mark Vucak: Bye.

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