Face Procedures

Face and Neck

Blepharoplasty

Rhinoplasty

Otoplasty

FACE AND NECK

FACIAL AND NECK

Face And Neck Lift

Face and neck lifts can dramatically improve neck and jowl shape. As the face ages, the skin and underlying muscles become lax with loss of skin tone and elasticity. This combined with the effects of the sun results in drooping of the facial tissues. There is also a loss of fat volume and descent of fat in the face. A facelift can partly reverse these changes, particularly the neck and jawline. This procedure can sometimes be done with the removal of neck fat, a blepharoplasty (eye-lid procedure), fat injections to help fill out the middle of the face, and a forehead lift.

Full-Facelift

This entails lifting the skin and fat layer away from the underlying muscles. This is done in the cheek, jaw-line, and down into the neck. An incision from above the ear in the hair than runs in front of and finally behind the ear. Sometimes the incision is placed along the sideburn hairline instead of up into the hair itself. These options will be discussed during the consultation. The underlying muscle layer (SMAS layer) is then tightened. This is an important stage in the operation as this layer takes up much of the ‘lift’. The excess skin from the face and neck is then removed and carefully stitched in its new elevated and tightened position.

Short Scar Facelift

This involves a smaller incision that is in front of and not behind the ear. Although working on similar principles as the full-facelift, the extent of skin elevation is less and it treats predominantly the jaw-line and less so the neck.

Scars

Scars on the face tend to heal very well. Although a little pink initially in the first few months they then fade to white. Most patients form very good quality scars over time. The length of time will vary in each individual patient and some patients may form raised or stretched scars.

Smoking

If you are a smoker, try and stop for eight weeks before and one week after surgery as it can reduce the chances of complications. A facelift is very prone to smoking-related problems.

Length Of Surgery

The operation takes 2.30 - 4 hours depending on the type of technique used.

Length Of Stay In Hospital

Usually one night, occasionally two.

Dressings And Stitches

You will wake up with dressings on the wounds and wearing a head compression garment. Any stitches will be removed at your appointment on day 5 or 7.

Drains

The use of a small surgical drain under the face skin is common to remove any unwanted blood/fluid. This is usually removed the day after surgery.

Bruises and Swelling

People vary in recovery, but normally bruises can be visible for 2-3 weeks depending on the cases. Most patients are very comfortable at one week and although feel able to return to work, we would recommend waiting. It is normal to be swollen in the first week, but this tends to be less severe than patients usually expect. Most of the bruising and swelling would have settled by the end of the second-third week. A real definitive result is then normally obtained in 3 months after the procedure.

Time To Exercise

Patients usually feel able to walk a distance at 5-7 days. Strenuous exercise (aerobics etc) should be avoided for 6 weeks.

Post-Operative Instructions

Day 1-4 You should be taking it very easy!

Day 5-14 You will be feeling much better from here onwards. The swelling will be settling and much of the bruising will subside progressively. You can start exercising gently and build it up over the next 10 days.

Follow Up

We will check your wound and change the dressing on day 5. You will then have an appointment at 1 and 3 months.

Potential Complications With Face and Neck Lifts

This is a routine operation that is a great success for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below.

• Skin loss: This is extremely uncommon and occurs if the blood supply to the skin is insufficient. The risks are if the skin is pulled too tight (therefore always avoided) and in patients that are heavy smokers.

• Altered skin sensation: This is common initially after surgery, but for the vast majority all sensation returns.

• Altered ear sensation: This is very uncommon, but can occur if a nerve to the ear is damaged.

• Small areas of asymmetry: Small areas of asymmetry: The same operation will be performed on both sides. There is a small risk of minor irregularities in the skin surface on either side. Similarly, the lobe of the ear can subtly change position.

• Scars: The quality of scars varies between patients.

• Wound breakdown: Although uncommon this can result in a delay of wound healing and poorer scar quality.

• Bleeding: A blood clot can collect under the skin flaps, which would result in going back to the theatre for its removal. However, if a blood clot is to form it will be within the first 24 hours post-surgery. This occurs in approximately 1% of patients.

• Infection: Quite uncommon but if occurs you will need a course of antibiotics.

• Nerve injury: Injury to the facial nerve is very uncommon but can result in palsy of the facial muscles. The most common areas affected are to the eyebrow and corner of the mouth. If this does happen it will correct itself for the vast majority of patients over 2-3 months. However, there have been some cases of permanent injury, and this should be considered before proceeding with surgery.

• General operation risks: Chest infections, Blood clots in the leg or lung (DVT or PE). Although rare it is important to avoid these by not smoking, not being excessively overweight, and moving about after surgery as soon as possible.

EYELID SURGERY

EYELID SURGERY (Blepharoplasty)

Eyelid surgery (blepharoplasty)

Eyelid surgery (blepharoplasty) is a form of treatment for upper and lower eyelid bags. Eyelid bags are a combination of excess skin on the lid, with or without bulging fat from under the eyelid. This can make the eye look older, tired, or ‘puffy’. The eye-lid bags can be composed of both skin and fat, and this varies between people. Older people usually have extra skin with variable amounts of fat, while younger

people tend to have prominent fat.

The Procedure

The standard blepharoplasty consists of removing the unwanted extra skin and then removing or occasionally re-distributing the bulging fat into the upper cheek. The incisions are just below the lid margin on the lower lid and in the lid crease on the upper lid. (In some younger patients the incision can be made inside the lid to remove fat only Trans-conjunctival blepharoplasty). This is a very effective procedure for both men and women.

Incisions

The incisions on the eye-lids heal extremely well and can be very difficult to see, particularly in the upper lid. The use of eye shadow and mascara makes it easier to hide the scars in the early days of recovery.

Scars

Scars on the eyes tend to heal very well. Although a little pink initially in the first few weeks

they then fade to white. Most patients form very good quality scars over time. The length of

time will vary in each individual patient. A very small number produces red or raised scars

although this is very rare on the eyelids.

Smoking

If you are a smoker, ideally try and stop for six weeks before and two weeks after surgery

as it can reduce the chances of complications.

Length Of Surgery

The operation takes 60 minutes for the upper eyelids and 30-90 minutes for the lower lids. The upper lids can be done under local anesthesia as a day-case, but if all four lids are to be treated a Sedation/general anesthesia and an overnight stay would be recommended.

Length Of Stay In Hospital

Patients may be seen as a day case or may require a one night stay.

Dressings And Stitches

One long stitch or thinly separated stitches will be placed on each eyelid that is treated. The suture/s are usually removed at your appointment on day 4 or 5.

People vary in recovery, but patients should allow at least 1-2 weeks of recovery. Most patients are very comfortable after a few days, and it will only be the bruising and swelling that may make you feel uncomfortable about returning to work. Most of the evident bruising will have gone by the second week.

Time To Exercise

Strenuous exercise (aerobics etc) should be avoided for 4 weeks.

Post-Operative Instructions

Day 1-2 You should be taking it very easy! Either relax in the hospital or at home.

Day 2-5 You can be up and about but your eyes will be swollen and have stitches that are visible.

Sunglasses will be useful if going outside.

Day 5-14 Your stitches will be removed and most of the swelling and bruising will settle over this time. You will be feeling much better from here onwards and will be able to start building up your exercise over the next 10 days. Week 3 onwards you will be nearly back to normal.

Follow Up

The stitches are removed usually at days 4- 5. You will then have a follow-up checkup at 2 weeks and 1 month.

Final Outcome

Although your result will be noticeable early it will continue to improve over the first three months.

Potential Complications With Eyelid Surgery (Blepharoplasty)

• Ectropion: This is very uncommon. It is where the eyelid gets pulled down and does not rest on the eyeball. It occurs in the lower lid if it is weak or the skin closed too tight. Great care is taken in the lower lid to avoid this and checks will be made to ensure you are not at risk.

• Small degrees of asymmetry: The same operation will be performed on both sides. There is a small risk of minor irregularities in the skin surfaces on either side.

• Scars: The quality of scars varies between patients.

• Wound breakdown: Although very uncommon this can result in a delay in wound healing and scar quality.

• Bleeding: A blood clot can collect under the skin, which would result in going back to the theatre for its removal.

• Infection: Also very uncommon but if occurs you will need a course of antibiotics.

• Eye injury: The eye will be protected during the procedure, but the injury can occasionally occur. The most common is a small abrasion to the cornea (front of eye-ball), although painful it heals without detriment in a few days.

• Epiphora: This is watering of the eye following a temporary or rarely permanent change to the tear drainage of the eyelids

RHINOPLASTY

The Procedure

The operation will depend on the area being treated but will involve re-shaping of the cartilage and bones of the nasal bridge (dorsum) and /or the cartilages of the tip. When most of the work is being done to the bridge for removal of the hump the surgery is usually performed from inside the nostrils (known as Closed Rhinoplasty). When the tip cartilages are being changed then an Open Rhinoplasty is performed involving a cut made on the columella (skin between the nostrils).

Nose – Bridge

Cartilage and bone will be removed from the bridge of the nose, which is then fractured to allow the remaining bone to be moved closer together. This results in both removal of the hump and narrowing the nose.

Nose – Tip

When the tip of the nose is to be treated the cartilage that supports it will need to be partly removed or reshaped. This will sometimes be done through the nostril (Closed Rhinoplasty) or through a small cut in the Columella (Open Rhinoplasty).

Scars

Both Closed and Open Rhinoplasty will result in very little/no visible scarring. Closed Rhinoplasty is carried out inside the nostril and the scars inside the nose almost vanish after a period of time. For patients who have Open Rhinoplasty, the Columella incision heals very well and also becomes very difficult to see.

Smoking

If you are a smoker, try and stop for a minimum of five days before and after surgery as it can reduce the chances of complications.

Length Of Surgery

The operation takes approximately 1.30 - 3 hours depending

upon the technique.

Nights In Hospital

Usually, a one night stay. In selected cases, a day surgery

procedure can be feasible.

Dressings And Stitches

A splint will be placed on the nose and held in place with tape.

A pad will be placed underneath the nose. This will be

removed after 12 hours, but the splint will stay on for 7-8 days.

Most patients are comfortable after 3-5 days but will be bruised and find it difficult to breathe through the nose for up to 2 weeks.

Strenuous exercise (aerobics etc) should be avoided for 4-6 weeks.

Post-Operative Instructions

Day 1 You should be taking it very easy! Either relax in the hospital or at home.

Day 2-7 You can be up and about but you will still feel discomfort and will need to be protective of your nose and splint. 7-14 Your stitches will be removed and most of the swelling and bruising will settle over this time. You will be feeling much better from here onwards. You can start exercising gently and build it up over the next 10 days. Day 7-14 You will be feeling much better, starting to return to your normal routine with gentle activity. Although your dressing and splint will be removed after 7-8 days, you will need to be protective of your nose for a further 1-2 weeks. Some patients can get back to the most gentle activity. The dressing will be off after 7 days.

Follow Up

We will check your wound and change the dressing on day 7-8. Normally the next appointment is at day 14 and then again at 3 months

Final Outcome

It is common to experience some bruising and this will take 2-4 weeks to disappear. The final result will improve over the first 8-12 months.

Potential Complications With Rhinoplasty

This is a routine operation that is a great success for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below.

Bleeding: Minor bleeding is common and stops in the first 24 hours. In a small number of cases, the bleeding can be heavy and can result in having to return to the theatre to control it.

Scars: Both Closed and Open Rhinoplasty will result in very little/no visible scarring.

Infection: Very uncommon but if occurs you may need a course of antibiotics.

Skin irregularity: Although uncommon, if the bridge of the nose is treated to remove a 'hump' the bone and cartilage left behind can have small irregularities that may show through the skin.

Change in skin color: Skin on the nose can become pink, but this tends to only affect patients who undergo repeat Rhinoplasty procedures.

Asymmetry: There can be subtle differences between the two sides of the nose from differing bone or cartilage position.

Pain: A small number of patients experience some pain for a number of weeks after the surgery.

Loss of smell and taste: This is usually temporary, but for some patients, their senses can be altered long-term.

Swelling: Usually patients experience little swelling in the nose. The exception can be in Open Rhinoplasty, in which the nose may be more swollen and take longer to settle.

OTOPLASTY

Otoplasty can be carried out to reshape ears and place protruding ears closer to the head. Prominent or ‘Bat-ears’ can be a cause of embarrassment and stress for both adults and children. This reshaping will make the ear look smaller although it is also possible to reduce the size of the ear.

Surgery remains the most common form of treatment, but should only be considered after the ear has stopped growing at the age of 7 years onwards. Although surgery can take place at any time in life, the best time is in childhood. The surgery is generally more successful and it avoids the associated anxiety throughout childhood. It is still very feasible in adult life although the success rate is a little lower.

It is sometimes difficult for children to decide about surgery and when there is uncertainty it can always be delayed until they are older. However, teasing at school that is affecting a child should be taken seriously and if the child expresses an interest in surgery this should be at least explored by the parent.

The Procedure

Different parts of one or both ears can be treated depending on the problem, and sometimes it can be more than one problem. Common areas treated include the ‘deep bowl’ in the center of the ear known as the ‘Concha’, which can be too large. Another area treated is the rim of the ear known as ‘Helix’ or ‘Antihelix’ depending on the exact part of the ear.

Surgery revolves around either re-shaping or repositioning the cartilage of the ear. Some skin is usually excised behind the ear and the re-shaping done from this incision. There are different types of operations depending upon the exact cause of the prominence. The various options and the most suitable one for you will be discussed during the consultation.

Scars

Scars on the ears tend to heal very well, and depending upon the technique often sit behind the ear. Although a little pink initially in the first few weeks, they will then fade to white. It is very rare for the scar to remain pink and become raised.

Smoking

If you are a smoker, try and stop before and after surgery as it can reduce the chances of complications.

Length Of Surgery

The operation takes approximately 1.30-2 hours for both sides, depending upon the technique. This can be done under local or general anesthesia in adults, but always under general anesthesia when treating children from 7 years onward.

Length Of Stay In Hospital

Patients are usually treated as a day case.

Dressings And Stitches

Stitches and gauze dressings will be applied to the incisions, the stitches will be removed after 7-10 days. A large head bandage will need to be worn for the first 7 days, after which it will be removed. Patients should then wear a bandage or sweatband at night for a further 6 weeks, which will protect the ears from any movement during sleep.

Post-Operative Instructions

Day 1 You should be taking it very easy.

Day 2-5 You can be up and about but you may experience some discomfort. The head bandage needs to stay on during this period.

Day 5-14 Your stitches and a head bandage will be removed and most of the swelling and bruising will settle over this next week. You will be feeling much better from here onwards. You can start exercising gently and build it up over the next 10 days. Any bruising should disappear after 2 weeks.

Strenuous exercise (aerobics etc) should be avoided for 4-6 weeks and contact sports (rugby etc) for 8 weeks.

Follow Up

We will check your wound and remove the bandage at day 5. We will then remove the sutures at day 9-10. You will then have an appointment at 3 months.

Final Outcome

Although most of your results will be noticeable early it will continue to improve over the first three months as all of the swellings disappears.

Potential Complications With Otoplasty

• Recurrence of the problem: This can occur in about 6% of cases and is higher in adults, especially adult men. It results from the ‘memory’ in the cartilage slowly reforming to its old shape. If this does happen it is usually a partial recurrence and not an exact copy of how the ear appeared pre-surgery.

• Small degrees of asymmetry: The operation can be performed on one or both ears depending upon the requirements of the patient. It is important to note that each ear can often be different, and therefore the effects of surgery can be slightly different on each ear. Occasionally the surgery can cause a deformity to the shape of one or both ears from the cartilage having been cut and then buckling.

• Scars: The quality of scars varies between patients. Most patients will form extremely good quality scars over time.

• Wound breakdown: Although very uncommon this can result in a delay in wound healing and scar quality.

• Bleeding: A blood clot can collect under the skin needing you to go back to theatre for its removal.

• Infection: Very uncommon but if occurs you may need a course of antibiotics.

• Altered sensation: This usually recovers after a few weeks.