A FIFTH plastic surgeon will start work in Northern Tasmania within the next 18 months, to help cope with increasing demand.

Plastic surgery, especially cosmetic, has been on the rise across Australia for the past decade and Tasmania is not missing out on the trend.

Four plastic surgeons operate in Launceston and split their time between cosmetic and reconstructive surgery.

The surgeons all own private clinics and also work at the Launceston General Hospital, where they perform public works, especially following trauma incidents.

A fifth surgeon from Western Europe, who specialises in microsurgery, is expected to start work in Launceston within 18 months.

Launceston's current plastic surgeons are Gary Kode, Maria Popa, Michael Thomson and Robert Boyle.

Mr Kode, who is the head of the Launceston General Hospital plastic surgery department, said the workload for cosmetic and reconstructive surgeons across the state had "picked up big time" in the past year.

Not only are surgeons fixing injuries after trauma and reconstructing breasts following cancer, they are also enlarging breast for cosmetic reasons and injecting Tasmanians with botox and fillers.

Tasmanian men are also requesting facelifts, nose jobs, liposuction and brow and eye lifts.

Mr Kode said in terms of operation numbers, he did more reconstructive surgeries due to skin cancers.

In terms of time, he does more cosmetic surgeries.

"Each skin cancer only takes me half an hour to 45 minutes, whereas a facelift might take me four hours," Mr Kode said.

One in four of Ms Popa's clients sees her for cosmetic reasons.

Ms Popa said the growth in cosmetic procedures could be because there was a better understanding of plastic surgery.

She said it could also be because people saw others who looked good as being more confident.

Mr Kode added "it is empowering to feel good about yourself"'.

The common surgeries:

Mr Kode said breast augmentation continued to be the most popular kind of plastic surgery in Tasmania.

Mr Kode, who owns Launceston Plastic and Cosmetic Surgery Unit, said he saw 100 people a year on average in regard to breast enlargements.

"But not all of them have surgery," he said.

That figure does not include those needing reconstructive surgery following breast cancer.

Mr Kode said people wanting breast surgery had to see him at least twice before going under the knife.

"There is the initial consultation and then the pre-op, where we go through all the complications and decide implant sizes," he said.

Implants have become more reliable and were less likely to break than they once were, Mr Kode said.

Plastic surgeon Maria Popa, who moved to Northern Tasmania from France 12 years ago, said the increase in the number of women in their 20s getting breast augmentation, could be due to Australia's culture of showing off your body.

"Now the young girls, they travel," she said.

"They go to Queensland, they go overseas and they have their body shown, so that is why they are more concerned about the size of their breasts.

"From my experience, I've done more breast augmentations in the past year than I have done in the past."

Breast augmentation is also common for women in their 30s, who have had children and want to get their breasts back to what they were like before their pregnancies.

Many Tasmanians are also getting breast reductions, which are often classified as reconstructive surgery, as large breasts can cause severe back pain.

Mr Kode said the second-biggest cosmetic surgery at his practice was liposuction on the bottom.

"They are just too big," Mr Kode said.

"That is really to change shape and change proportion."

Brow lifts are commonly requested by males.

That procedure is said to not only improve appearance, but is also functional as itimproves field of vision.

The rise of non-surgical treatment:

Like any industry, plastic surgery is changing with the times.

It has become more common in the past few years for patients to want non-surgical operations, rather than going under the knife.

Non-surgical operations can include botox, fillers and even non-surgical body shaping.

Victoria's Cosmetic Medical Clinic owner and manager Anne Talbot said the High Street clinic had offered botox since 1998.

She said the numbers of people wanting botox outweighed that of fillers, and had grown rapidly since the 90s.

"It plateaued about four, five years ago and it has stayed at that level," Ms Talbot said.

The registered nurse said fillers in the lower face were popular, with main filler areas including the lines around the mouth and cheek enhancements.

"These things (lines around the mouth) can be fixed quite easily and it can last up to 12 months or even more in some cases, so they find it very cost-effective," Ms Talbot said.

Mr Kode said the philosophy of botox had changed dramatically over the years.

"We are not following the American way nowhere near as much where, thankfully, we have come to realise that tight does not mean young," Dr Kode said.

"It is much more of a European philosophy.

"It is more about beauty and aesthetics and understanding ageing.

"We are not doing as much surgical intervention. It is a lot more non-surgical and I am doing a lot more with fat injections than I used to. "

There are two kinds of fat injections, synthetic and autologous.

In an autologous fat transfer, surgeons take fat cells from the patient's own body and inject it elsewhere.

Mr Kode also has an Exilis machine, which uses radiofrequency to burn fat and tighten the skin in a non-surgical way.

"Patients don't mind if it is not a dramatic change because complication rates are low and convenience is high," he said.

"It's not as drastic and there's not the same cost (with the Exilis machine), so it's very convenient."

The added expense of overseas surgery:

Tasmanian surgeons say not too many Tasmanians are travelling overseas for plastic and cosmetic surgery, but they do often see patients after things have gone wrong.

Ms Popa said she occasionally saw patients who had had breast augmentation done overseas and they were devastated with the outcome.

"The ones that I've seen come back are very ashamed that they got it done overseas," she said.

"I don't want to put pressure on people but, if a surgery is done the wrong way, it is really hard for us to fix it."

Mr Kode added his main concern with patients getting work done overseas was there was no initial or follow-up consultation.

"You don't meet the surgeon until you're about to get them done," Mr Kode said.

"You're booked, it's all paid for, you don't really have the option to change your mind and you might not have all your questions answered.

"We don't even have to discuss if the surgeons are any good, because I've got enough worries without that.

"The fact that they show you good implants doesn't mean that is what they put in.

"And if they are going to be doing surgery for that sort of price, they are going to be inclined to cut corners."

Mr Kode asked: "If there is a complication, what happens?

"I see my patients twice a day while they are in hospital. After that I see them at a week, a month and three months, which is all part of the surgical fee, and patients all have my mobile number.

"You try phoning Thailand on somebody's mobile, saying, 'Hey, listen, I'm just a bit worried about this . . .' what's the guy going to do?"

Mr Kode said getting work done overseas was not too much of an issue in Tasmania, but it was on the mainland.

Removing the past: laser tattoo removal:

Victoria's Cosmetic Medical Clinic is the first clinic in Northern Tasmania to offer large laser tattoo removal.

The clinic spent half a million dollars on its new enlighten laser tattoo removal machine, which arrived in October.

Ms Talbot said she received daily calls for tattoo removal and the new machine was keeping her very busy.

"We can remove tattoos in approximately a quarter of the time of all other tattoo removal method . . . and there is a lot less trauma to the tissue with the new technology," Ms Talbot said.

"I can see we are going to be working in conjunction with the tattoo artists to get the skin back to an ideal canvas."

Clients wanting tattoos removed are given a laser test shot before starting treatment.

Ms Talbot said most tattoos were removed with between three and five treatments.

For a tattoo the size of a credit card, it costs about $250 per treatment to remove.

Emma, of Launceston, had her first treatment to remove the Japanese symbol on her ankle this week.

She said she got the tattoo done in Japan about 10 years ago and decided to have it removed two months ago.

"It's not that I don't like it; the tattoo has just gone blurry," Emma said.

It took less than a minute for Ms Talbot to complete the first laser treatment, which works by blasting the ink particles in the tattoo.

"It's like a rubber band flicking the skin," Emma said.

"It's no worse than getting the tattoo."

Clients must wait six weeks between treatments.

Ms Talbot said she did the first round of laser on two full sleeves earlier this week, which took about 20 minutes each.

She said the main reason people wanted tattoos removed was to get rid of their past.

"They might have names of people there that they don't want any more or the style of tattoo might not suit the others that they have, so they might want one removed and another one put on," Ms Talbot said.

Many plastic surgery clinic do small tattoo removal, but not big tattoos like Victoria's.

Calling for more regulations:

Mr Kode said he would like to see tighter restrictions on who was allowed to perform cosmetic and non-surgical procedures.

Currently, medical practitioners, including GPs, are allowed to perform surgery with the patient's consent.

Most specialist plastic surgeons complete at least 12 years in medical and surgical education, including at least two-years' training in all aspects of surgery including emergency, ICU and general surgery, before undertaking at least four years of accredited training in plastic and reconstructive surgery.

"In that time, you had three exams that were externally audited and assessed, that were nothing to do with your training unit," Mr Kode said.

"A cosmetic physician is somebody who may not have done any formal training in surgery at all.

"Anyone that is allowed to, can tuck anything and inject fillers, but are they going to get a good result?

"Are they actually aware of what the ageing process actually is and how to reverse that look?"

The NSW government announced this week that it was considering whether further legislation of the cosmetic industry was required.

The announcement comes after several NSW patients had been transferred to hospital following breast enlargement surgery at private cosmetic surgery clinics in the past two years.

Fairfax Media has reported at least three NSW clinics are being investigated by the Health Care Complaints Commission.

Mr Kode said he would also like to see Medicare and health insurance companies cover more operations, especially for patients who have lost a lot of weight and have excess skin hanging.

"I'm seeing a lot of patients who have lost a massive amount of weight and I think they should be rewarded for their efforts," Mr Kode said.

"But, in some cases, there is just not item numbers for the procedures."

A federal government Department of Health spokesperson said amending the eligibility criteria for current lipectomy items was under consideration.

Lipectomy is surgical procedure carried out to remove unwanted body fat, usually by suction.

"Patients requiring lipectomy services following significant weight loss may be eligible for rebates, currently and under the proposed amendments, if the surgeon deems the surgery clinically necessary," the spokesperson said.

Dr Kode's Launceston Plastic and Cosmetic Surgery Unit took out the Best Aesthetic Practice for Tasmania at the My Face, My Body Australasia Awards last month.

The Examiner