Dr Mark Gianoutsos is an extensively trained plastic surgeon based in Randwick, Sydney. Dr Gianoutsos has a broad range of experience across a variety of aspects of plastic surgery. Not only is he Head of Department at Sydney’s Children’s Hospital, he is also Director of The Craniofacial and Plastic Surgery Research Unit at The Prince of Wales and University of New South Wales, and has a busy private practice where he applies his skills to patients needing aesthetic plastic surgery work. Meet Dr Mark Gianoutsos.
Dr Gianoutsos is highly respected for his work and we chatted to him about his approach, his patients and some insights into his career. To learn more about him you can also visit his website. To read the transcript of the podcast see below.
Trish Hammond: Hello listeners. It’s Trish Hammond here again from Transforming Bodies. And today I’ve got the absolute delightful joy to be speaking to Dr. Mark Gianoutsos, and he’s actually based in Sydney around Randwick, actually at Prince of Wales Private hospital in Randwick, and today we’re going to have a bit of a chat about the treatments that he does and how he started, and what brought him about to be a plastic surgeon and why he loves what he does. Welcome Dr. Gianoutsos.
Mark Gianoutsos: Thank you, Trish.
Trish Hammond: Thank you so much for taking the time to talk to me today.
Mark Gianoutsos: It’s a pleasure.
Trish Hammond: Lovely. So tell me, you’ve obviously been doing this for a few years now. How did you pick plastic surgery, or did plastic surgery pick you? How did you know, and when?
Mark Gianoutsos: I think like a lot of these things, they pick you a little bit in that the sort of medical specialty that one enters into is largely dictated I think by your personality, and to a degree your experience with them. I was very surgically focused from relatively early on, but had a few options of what to pursue. I was initially going to undertake orthopaedic surgery, but then did a plastic surgical term and was captivated by the intricacy of the procedures, particularly with micro surgery, but also the fact that not all of your procedures, or all of your procedures aren’t just a cookie cutter type approach where you’ve got to have an individual approach for each of your patients.
There’s not a formula necessarily as there are in lots of other surgical procedures. So, for the one problem you might have a number of different potential solutions that you’ve got to establish is what is the best for your individual patient. That goes for both reconstructed, but also for cosmetic surgical procedures. That was what captivated me really about the specialty early on.
Trish Hammond: And I guess that’s so true, because plastic surgery is not just one thing. You actually have a whole plethora of things that you can actually treat, ranging from what we were talking about before, craniofacial stuff for babies, and hand surgery and aesthetic surgery. It’s a whole like broad … You can’t get bored.
Mark Gianoutsos: Yeah, it’s a very wide ranging sort of specialty and it’s more a technique which is applied to lots of different things. So yeah, as you say, in the paediatric or child population, I run the Craniofacial Unit at Sydney Children’s Hospital, and in that we treat children with … Largely with misshapen heads and faces with premature fusion of the bones of the skull, which can give children both an unusual appearing skull, but can also have implications with regard to the development of pressure within the brain. There are functional aspects of it, but also the aesthetics of that in children is in a sense a functional matter as well, because it’s how they interact with their peers, and it’s a really important matter to address for them.
It encompasses a lot of the things that we do within plastic surgery, and as you say, there’s lots of different other specialties within plastic surgery. Hand surgeries, both paediatric and adult, aesthetic surgery, general reconstructive surgery, skin cancer surgery is a big part of most people’s practise and part of mine. So yeah, it’s a widely ranging field, but uses the same sort of principles in all of those.
Trish Hammond: Yeah, and on that as well … I’m having a look at all of the awards that you’ve actually got. You’ve got a million different awards and they’re all for completely different things. Am I right in that your career started in 1985?
Mark Gianoutsos: Oh, well look, I graduated from medical school in the late ’80s, and I went into basic training, so an intern, and then you’re a resident. I was lucky enough to get onto a surgical training programme fairly early on, did some general surgery and then entered into the plastic surgical training programme. Went to Melbourne to start that out, and was lucky enough to work with some terrific people down there. I guess most of my work down there was with a fellow called Ian Taylor, who’s one of the real giants of plastic surgery in this country, but also internationally, both from his clinical but also… He’s a real giant of plastic surgery worldwide, and I feel very fortunate to have been able to work with him, but also lots of other people in Melbourne in my training.
Then I returned to complete my training here in Sydney at Prince of Wales and at the Children’s Hospital, fellowship training at North Shore – lots of plastic surgery really in Joe McCarthy. I gained a lot out of that, both clinically and also from a research viewpoint working in craniofacial, but also in cosmetic surgery there. Then I returned and took up positions at Prince of Wales, the Children’s Hospital and the Royal Hospital for Women, and started up my busy private practise as well, and also led the research lab and have done until now. The Craniofacial and Plastic Surgery Research Lab, which is associated with the University of New South Wales, both the Prince of Wales and Sydney Children’s. A broad ranging training and also career and practise.
Trish Hammond: Just having that chat before, with the work that you do with children, and I guess because you go from children … It must be really crazy, you go from treating a child who’s got some sort of fusion, and then maybe the next day you’re treating a cosmetic person who wants a nose job or something like that. It’s just like, there’s many different hats.
Mark Gianoutsos: Yeah, well you know, there are different aspects and there’s sort of different hats you wear, but as I said, you’re really wearing the same hat and applying those skills and techniques to different procedures. And a familiarity in craniofacial surgery certainly gives you a familiarity in the anatomy and applied surgery. I’m doing all sorts of procedures on those areas. It’s not just cosmetic rhinoplasty that I would be doing, but having a deep knowledge of craniofacial surgery certainly makes approaches to these things I think more rounded and there’s greater facility for doing those sorts of things with that sort of knowledge in that field. There’s a bit of cross pollination between them and so those skills can be applied to both things that I think makes you better at both of them.
Trish Hammond: Yeah. I totally agree with you and on that as well, I’ve been reading the story about one of your patients who’s also your close friend now, who’s a young artist called Stella Jackson and she was inspired to paint you. Can you tell us a little bit about Stella’s story and like … Because you’ve obviously known her since she was like three weeks old and how old is she now?
Mark Gianoutsos: Stella is now 15 and yeah, I’ve known her since she was … Really since she was born and she was significantly affected by a craniofacial malformation in which one side of her face did not develop as the other side had. It affected her jaw, both upper and lower jaw, but also affected her cheek and her eye and her face in entirety on that side, as well as her ear. And she had a number of other things which were associated with that. And she is really a remarkable young lady and with her parents who are equally remarkable has turned into a very fine young lady. And she has had a number of procedures over the years. And probably the biggest of those was when we reconstructed her jaw on that side using the bone from the hip as what we call a free tissue transfer or a free flap.
Mark Gianoutsos: And what that means is that the body part that is the hip, which mimics the jaw very closely in its anatomical form, can be raised, that is lifted from the body, but with the blood supply to that. So there is an artery which runs to that bone and a vein that comes from it and that can then be a rejoined or anastomosed as we say, to blood vessels in the neck. Which means that that bone is immediately alive and stays alive and will grow with her. And that’s what has happened. And that made a very big difference to her. Both from a functional but also importantly from an aesthetic viewpoint. She still has a facial difference, and she really is a great ambassador for that and is leading a very full life. And as you said, is quite a talented young artist. And I was very touched when she asked whether she could paint me for the young Archibald award, and I’d actually put her in contact with a friend of mine who is a very fine portrait painter, and he’d helped her really formulate her ideas and get her thoughts on canvas.
Trish Hammond: Great. We had a little bit of a hiccup in the audio there. It didn’t quite capture all of that so, if I ask you some questions, forgive me.
Mark Gianoutsos: Okay.
Trish Hammond: The last bit I caught was the fact that you put her in touch with a friend of yours who was a portrait painter and they kind of taught her a bit more as well. Is that right?
Mark Gianoutsos: Yeah. What really helped … Yeah, this friend of mine who’s a very accomplished portrait artist and has been in the Archibald for many years, amongst a lots of other artistic endeavours really helped her to formulate her ideas. And to develop some of them and gave her tips and spent a fair bit of time with her. Just helping her get what she wanted to in the sense of it onto canvas, which she did in a very accomplished way.
Trish Hammond: Oh look, I love it. I love it and I love what she says. You’ve obviously become very good friends with her, which is just absolutely beautiful. Makes my heart sing. But she says that you can see that he’s a good person, his hands are magic, but what you don’t see is his kind and generous heart. And that’s what she sees. I love that. I love Stella.
Mark Gianoutsos: Yeah look, she’s a very special young lady. Yeah.
Trish Hammond: Yeah. You know what, and what I really like is I love the fact that, because like over the last however many years people aligned plastic surgery with big lips, big breasts and just aesthetic stuff and really true plastic surgery, nothing could be further from the truth because that is really the cosmetic surgery. But the real plastic surgery is this stuff that kind of … I mean it all changes lives, but people could not live a normal life without the magic I guess that guys like you create really. Guys, and men and women actually, not guys like you, but men and women can create.
Mark Gianoutsos: Yeah, no I think that’s … I’ll do so, I think that all these sort of procedures done in the right manner and for the right reasons do change people’s lives to a greater or lesser degree. And I think that probably Stella’s a very dramatic example of that sort of thing. But it can be equally personally important and dramatic for a young person having a rhinoplasty or having a breast reduction because those are very significant, or can be very significant impediments for that person themselves. So they’re not completely different. They’re on different parts of that spectrum of a surgical approach, if you like.
Trish Hammond: That’s so true because I mean, I was just talking to a lady today and I myself have had a rhinoplasty and a breast reduction. I sound like a operation junkie, but I know how much they both did change my life in totally different ways. One was for the breathing and one’s for the fact of not carrying around an extra 10 kilos of breast tissue around your chest and your shoulders and all that. So you’re absolutely right when you say that.
Mark Gianoutsos: Yeah, that’s so, but it’s also importantly about how you feel about yourself, and I think that’s the key to all of these things. Yeah. And that’s what drives a lot of these things as well.
Trish Hammond: Well, that’s true. I wanted to ask you, so I know that you do lots of work with children, so can you give us a little bit of a run down of the procedures that you do like in your clinic? I know you do the range of face procedures. Can you tell us a little bit about the face procedures that you offer?
Mark Gianoutsos: Yeah look, I do a lot of facial cosmetic sort of procedures. We’ll do blepharoplasty or eyelid surgery, brow lift surgery. And as I said, rhinoplasty is one of my particular interests, which I do a lot of. I do a lot of face and neck lift and facial rejuvenation surgery, and as they sort of marry in with my craniofacial background in particular. In children, we also do otoplasty or battier type procedures to set ears back, which are overly prominent. And the source of teasing for a lot of children as well. So broad range of facial sort of procedures. I also do a lot of skin cancers and skin cancers are most commonly seen in the face, so I do a lot of that as well.
Trish Hammond: I noticed as well you do structural fat grafting. Can you explain what that’s about, because like …
Mark Gianoutsos: Well, structural fat grafting is something that’s around for quite some time. I guess it’s becoming into Vogue a little more of recent times. What it entails is taking fat basically from another part of the body, using a type of liposuction. Often used with a small syringe rather than a large liposuction equipment and that fat is then treated and separated, so it is just the fat. And then the fat is carefully injected into the face, generally speaking, to augment areas which are deficient either through age or potentially sometimes through trauma or sometimes through congenital reasons. That is someone doesn’t have a particularly prominent cheekbone. It can be augmented, using structural fat grafting. And so it’s injected in very fine little threads in a matrix in different planes so that the fat which is injected has its best chance of being retained.
And the advantage of the structural fat grafting is that it’s your own tissue. It’s not like some of the synthetic fillers which need to be redone. Generally speaking, where the fat grafting takes that will be retained in the long term. Now it doesn’t all take, and it can mean that on occasion it needs to be redone. There needs to be a little touch up to get the volume that you’re really after. But it is the natural tissue which is in the plane into which it is injected. And it is your own tissue. It is a bit more of an undertaking than a simple filler injection. But for lots of people, that equation rings true and it works well for them.
Trish Hammond: And so for example, if someone was to have a facelift and part of that was to fill in certain parts of the face with that, that’s kind of where you’d put it.
Mark Gianoutsos: Yeah, we often do it in concert with a face lift as well, where we can add some volume with the fat injection at the same time as that surgical procedure. And it’s also used quite commonly in the lower eyelid area in place of an open surgical procedure or in concert with that. So it can be used either on its own or in concert with other sorts of operations.
Trish Hammond: Awesome. So you kind of do everything with the face. You also do breast work?
Mark Gianoutsos: Yeah, no, I do a lot of breast work, I do a lot of breast reduction, a lot of breast lift, breast augmentation and breast reconstruction. So you know, I have a big practise in those things and familiarity for some time in those. Yeah. And they’re similarly sorts of things that make big difference to people’s lives on a daily basis.
Trish Hammond: Yeah.
Mark Gianoutsos: For different reasons.
Trish Hammond: Absolutely. And do you do explant surgery as well? Implants removal?
Mark Gianoutsos: Yes, I do. And yeah I think we’re seeing a lot more of that in relatively recent times, with the discussions around a typical large cell lymphoma and its link to textured implants, and so I think that that is going to be something that is probably going to be more of a surgical endeavour.
Trish Hammond: That’s so true, we’re finding-
Mark Gianoutsos: Yeah. Going forward.
Trish Hammond: Yeah, we’re finding as well people are asking more about who does explants and also some do a complete Capsulectomy where they remove the capsule and some doctors believe that may not necessarily be the best thing for that person. So I guess it’s an individual …
Mark Gianoutsos: It is very individual. You’ve got to work out why the patient is having it done. You’ve got to work out what the clinical situation and scenario is. Sometimes there is a very limited capsule there. Sometimes that capsule is very thick and it just depends on the individual situation and see how much of that capsule is appropriate to be removed. But the other matter is that as I say to my patients, it’s not always the actual risk of a problem such as a typical large cell lymphoma, which is numerically very small for most types of implants, particularly the micro-textured implants. So it’s not so much always the actual risk, but it’s the perceived risk in the mind of the patient. And I think for some people a very small risk is inconsequential, but for others it’s intolerable. And so your approach will be a little different in those different patients. They both get exactly the same information about the science behind what’s going on as best we know it at this point. But different people will act upon that in different ways and need to be guided through that process.
Trish Hammond: Yeah. I think that’s absolutely true because people will, someone said to them, you absolutely have to have and block and it’s not necessarily true in each case. So I think it’s really important for people wanting to do that, to actually listen to both, to why you should or why they would with you, or why they wouldn’t. And actually go with the surgeon that you trust and actually take their advice. I think that’s always the best way.
Mark Gianoutsos: Yeah, that’s right. But I think it’s always important to listen to the patient and what their real concerns are.
Trish Hammond: Yeah, that’s absolutely true too. Well look, I’ve got to say, I know you do a bunch of other procedures. You’ve got your body work, the men as well and skin and paediatric and the general surgery. How many years have you actually been a plastic surgeon?
Mark Gianoutsos: I’ve been a practising plastic surgeon for over 20 years. I was lucky enough to graduate fairly early on. So at the age of 30 I was a practising , fully qualified plastic surgeon, so-
Trish Hammond: Yeah, because it’s about 40 normally, isn’t it?
Mark Gianoutsos: Yeah look, these days it tends to be a little bit later. But yeah no, I was fortunate enough to be able to sign up fairly early in that and so I’ve been doing it for a long time.
Trish Hammond: Yeah. Awesome. And look, it’s so good. It’s been so great to speak with you today. Thank you so much for your time to talk to us.
Mark Gianoutsos: It’s a pleasure. Thank you for yours.
Trish Hammond: Lovely. And this is, look, if you’d like to have a consultation with Dr Mark Gianoutsos, as I said, he’s actually in Randwick at the Prince of Wales Private Hospital. You can check them out on our website, just type his name into the search bar, or you can also send us an email to [email protected] or you can even email us. Thank you so much.
Mark Gianoutsos: Thank you, thank you.
Trish Hammond: Have a great day. Bye.
Mark Gianoutsos: Bye.