Cosmetic Procedures

Currently, we classify non skin cancer procedures as 'cosmetic procedures'.  These include removal of skin tags, harmless moles, epidermoid cysts and more. 

Circumcision

Circumcision is a personal choice made for various reasons - cultural, religious or just personal preference. Our clinic is located in the north eastern suburbs of Adelaide.

Our SA circumcision service is for males of all ages - from infants 3 months old through to adults of any age. 

Our doctor has over 30 years of experience with these procedures.  Simply contact the friendly staff at our clinic and a consultation appointment will be made for you to see our doctor.  Our clinic has consulting rooms and a surgical theatre and theatre staff at the one convenient location.

We can usually offer you a procedure appointment within a few weeks of your initial consultation.

                                                          

1. The Procedure

2. Methods

3. Preferred Age

4. Infants and Boys up to 9 years

    4a    Post Operative

    4b    Possible Complications

    4c    Instructions to Parents

5. Boys 10 years through to Adults of any age.

   5a    Post Operative

   5b   Possible Complications

6.  Benefits to Health

7.  Fees and Medicare Item Numbers

 Circumcision consent form attached as pdf at bottom of page.

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1.  The Procedure
This operation is the surgical removal of the foreskin of males - infants, children and adults.  This procedure is not reversible.

2.  Methods

We use two different methods depending on age -

For infants and children we use the plastibell or circumplast method (ligature tied around a grooved plastic tube).  The freehand adult method is an option in some boys aged 8 or 9 who are able to tolerate the longer time this procedure takes. 

For children 10 years and above through to adults, doctor uses the free-form surgery method involving hand stitching. 

The patient  is required to have an initial consultation with our doctor to discuss the procedure (patients under 16 require parental consent).  Following the consultation, the procedure appointment can be booked.

3. Preferred Age

Circumcision at any age is not a difficult procedure at our clinic. After performing well over a thousand circumcisions over many years, using local anaesthetic, our doctor considers that 3 - 4 months of age is optimal.

4. Infants and boys to 10 years old

Local anaesthetic is used for this procedure, however Emla local anaesthetic cream is applied at the Clinic half an hour to one hour prior to the procedure (depending on age of the child) and is held in contact with the skin using plastic wrap.  This numbs the skin for administration of the local anaesthetic injections at the commencement of the procedure. 

We may also offer a sedative such as Diazepam or Valium just prior to the procedure.

Ineffective anaesthetic – the practice keeps up to date with effective anaesthetic techniques for circumcision but in a small percentage of cases the anaesthetic is not totally effective. When possible, further anaesthetic will be given to the child.

Distress – your infant may become distressed during the process. Babies can become distressed for various reasons even with effective analgesic. We will attempt to minimise distress as much as possible during the procedure. If your infant appears in pain, it may be possible to give more local anaesthetic.  

We allow 30 minutes for the plastibell/circumplast method, or an hour if using the stitching method in the older boys.

In 95% of patients the local anaesthetic works fully and the patient feels no pain whatsoever, however 5% may feel the anaesthetic needle slightly and may feel some discomfort as the string is tied.

We supply parents with chloromycetin eye ointment to use on the healing skin 3 times per day applied using a finger or a cotton bud.  Although infection is uncommon, use of this ointment reduces the liklihood of infection even more so.

4a Post Operative
The plastibell/circumplast, ligature (string) and remnant of foreskin should all come off by itself in about 7 to 14 days.   

Bathing - the patient can be bathed once daily as usual with a small amount of liquid soap.  More frequent bathing is associated with increased risk of infection.

Pain Relief - the majority of babies/children need no pain relief whatsoever as the local anaesthetic takes a few hours to wear off.  Occasionally, the patient will cry or be unsettled for a short while at this time and usual analgesia as appropriate for the age of the child may help.

 4b Possible Complications

Generally, circumcision at a young age is a straight forward trouble free procedure within minimal interference in baby's routine but there are a few uncommon problems that parents should know about.

Infection - Some redness near the string is expected about one week following the operation.  Should swelling or redness move down the shaft of the penis then this should be reported to the clinic or your local doctor.  There may be a need for the doctor to remove the plastibell/circumplast early to reduce the inflammation.

Bleeding - This offurs in about one in 300 circumcisions.  Should this occur parents must contact the clinic promptly.  We provide after hours phone contacts for our doctor.

Bruising - The local anaesthetic needle can cause a little bruising that takes a day or two to disappear and is of no consequence.  Serious bruising is very rare (one per thousand) but has not been detrimental to the final result.

Plastiell slipping down - this is a rare problem an relate to the size of the plastibell used.  We do our best to ensure the correct size is used making this a very unlikely problem. Should the plastibell slip down over the head of the penis it may become like a ring that is too tight. This may be a medical emergency and needs to be corrected.

Foreskin reforming - on rare occasions, it is possible for the skin as it heals to form a miniature foreskin that can scar up and be hard to pull back.  This is a rare problem and the only solution is usually recircumcision.

4c Instructions to Parents

It is preferable to meet the doctor face-to-face well before the procedure but due to distance, we may agree to a pre operative consultation just prior to the procedure. If your son is  2 year olds or older, the consultation should be the day prior to the procedure or earlier. 

Babies should not be hungry at the time of surgery.

There is no obligation for parents to stay in theatre for the operation but parents often choose to stay in theatre to help assist in diverting their child’s attention.

After the procedure parents should check for bleeding every hour for the next 3 hours. There should be no bleeding whatsoever. Folks from afar are asked to remain in the vicinity of the clinic for at least an hour so that it is easier to return should there be any concerns.

Nappies can be used as normal.

Babies/children should be bathed normally once per day. There is an increased risk of infection with bathing more often.

Once the plastibell/circumplast comes off the penis should look like the usual circumcised penis.

When the penis is healed parents are instructed to clean under the residual skin using a cotton bud daily when drying their infant after bathing.

 5. Children 10 years and above, through to Adults

After the initial consultation with our doctor, the procedure appointment can be booked through our clinic reception staff.  We can usually offer an appointment within 2 - 4 weeks. Children under 16 require parental consent. 

Doctor may offer a sedative such as Diazepam or Valium just prior to the procedure.

Doctor uses local anaesthetic.  Once good anaesthesia is attained the amount of excess foreskin is determined and surgically removed and the remaining tissue rejoined by dissolving handstitches.  

We allow an hour and a half for this procedure.

5a Post Operative

The local anaesthetic used in this procedure usually lasts several hours and "over the counter" pain relief, appropriate to the age of the patient, is recommended as required over the next few days.    

As dissolving stitches are used in free form circumcision surgery, patients can expect stitch remnants to come away after 10 - 14 days.

Time away from normal activity is variable but usually 2 to 7 days. 

5b Possible Complications

Most patients do very well but occasional complications can be include:

Bleeding/bruising -Minor bleeding on to the dressing is not uncommon. Significant bleeding should be reported to the clinic.

Infection- this is rare, patients should report any increased redness and tenderness.

Wound breakdown - This is quite uncommon but best managed with dressings.  It may take several weeks for skin to heal across the wound. You should arrange to see our doctor for advice regarding dressings. 

 

Unsatisfactory cosmetic result - should the patient and the doctor agree that the circumcised appearance has not been obtained, further foreskin can be removed. 

6. Benefits to Health

There are certain well recognised health benefits provided by circumcision besides the obvious ease of hygiene.

Urinary tract infection - this is not a common illness in boys but is very rare in circumcised males.

Sexually transmitted diseases -  In third world countries studies suggest that heterosexual transmission of HIV is less common with circumcised men.

Phimosis -  This is scaring of the foreskin to the extent that it can't be pulled back over the glans.  This is a common reason to request circumcision as an adult.

 

7. Fees

The initial consultation fee, regardless of age of the patient,  is  $90.00

After Medicare rebate of $38.20, leaves an out of pocket gap to the patient of $51.80.

Infants under 6 months on day of the procedure -  $400.00.  Medicare rebate is $122.65     

Children 6 months to less than 10 years  -

                Plastibell/circumplast method is   $500.00.    Medicare rebate is  $122.65

                Stitching method  is $850.00        Medicare rebate is  $122.65

Children 10 -12 years old -  Stitching method only -  $900.00  Medicare rebate is $122.65

Teenagers through to any aged adult -   $1250.00. Medicare rebate is $120.70.

 A deposit of $100  is payable at the time of making a procedure appointment.  Should the patient wish to reschedule or cancel their procedure appointment, 2 full working days notice is required or the deposit will be forfeited.

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