Cosmetic Surgery of the face has become increasingly common. However the most important things to consider are safety and achieving a natural look.
To get a better idea of what to expect and to ensure you have realistic expectations, it is recommended that the patient looks at before and after photographs of similar patients operated on by your surgeon. Also, ask to speak to previous patients (your surgeon should be happy to oblige).
By the end of the consultation with your cosmetic surgeon, you should have clear answers to the following 10 questions:
1. Do I have realistic expectations of the outcome of treatment?
2. How is the procedure performed and how long will it take?
3. Which technique(s) will help me to achieve the result I want?
4. What kind of anaesthesia (local anaesthetic, sedation or general anaesthetic) would you recommend for my cosmetic surgery?
5. How much does the procedure cost and what other factors affect the overall cost (i.e. hospital fee, anaesthesia, etc)?
6. What are the surgeon’s professional qualifications, training and level of experience in performing the operation?
7. What percentage of patients experience complications with this operation?
8. What is the surgeon’s policy for repeating or adjusting the operation if the outcome does not meet agreed upon goals?
9. How many times will I see you after surgery to ensure good aftercare?
10. What can I expect after surgery in terms of discomfort, scarring, recovery and return to normal activities?
These questions should be the minimum you should ask before proceeding.
Facial Sculpting enhances the balance of facial features as these have as much relevance as the harmonious appearance of each individual part, and contributes greatly to a face that we find beautiful. Facial Sculpting has developed from a deeper understanding over time of what constitutes our ideal of beauty and this does not mean that a “beautiful” face is completely without imperfection.
Facial balance is related to the relationship between the nose and the chin. When the chin is relatively small (retrogaenia or microgaenia) it makes the nose appear more prominent. Correcting the shape of the nose can be successful in creating a beautiful nose but not necessarily in creating a beautiful profile. A combination of nose reshaping and chin enhancement can lead to a more balanced and pleasing profile.
Buccal Fat Reduction
Buccal (pronounced BUCK-ull) fat reduction surgery removes excess fat from the cheeks to produce a more contoured and refined appearance.
About buccal fat reduction
A face with some fullness looks healthy and youthful. Excessive fullness may however give you a “chipmunk” effect. Buccal fat reduction addresses this problem by removing excess fat from the cheeks to produce a more delicate, chiseled appearance. As with all surgical procedures, before you make a decision, give it some careful thought.
Most people’s faces start to thin as they reach their 30s, so any fullness now may disappear as you age. If you choose to have buccal fat reduction performed before this natural slimming of the face occurs, you may find your face becoming too thin over time.
One of the best approaches is to look at your genetics. Did your parents have overly plump faces when they were young? Did this plumpness persist once they reached their 30s and 40s? If so, you may have inherited their more rounded facial appearance. If not, having buccal fat reduction surgery while you are still young may leave you looking gaunt as you get older.
During your consultation, your surgeon should take a complete medical history and enquire about any medications you are currently taking and whether you smoke. He should ask about your goals for the procedure, explain what you can expect and describe how the procedure will be performed.
What to expect from your operation
Buccal fat reduction is most often performed as a day case using local anaesthesia coupled with sedation or a general anaesthetic.
A small (2-4 cm) incision should be made between your cheek and gums, near your second molar from the back. Your surgeon will then press on the outside of your cheek to make the buccal fat protrude through the incision. When the correct amount has been removed he should close the incision, most often with dissolvable sutures.
After your surgery
For 2 weeks after your surgery it is advisable for you to sleep on 2 pillows, so as to keep your head elevated. It is also advisable to rest for around 3 weeks.
During your recovery period there are several things you should expect:
• You will have some discomfort, but this should be controlled by pain medication prescribed for you. If you experience excessive pain, redness or any other symptoms that seem abnormal you should contact your surgeon immediately, as you may have an infection.
• Bruising and swelling are normal after surgery and should subside within 2 weeks.
• Due to the incision being inside your mouth you will probably have to eat a restricted diet for a while. Your surgeon should tell you what foods to avoid. You should also be advised to rinse your mouth several times a day with an antibacterial mouthwash.
• Normally dissolvable sutures are used, therefore it should not be necessary to have them removed. Please resist the temptation to chew on the stitches you feel inside your cheek.
• Your first follow-up appointment should be around 1 week after surgery, when your surgeon can assess the progress your wounds have made. It is important to take it easy, avoid bending over and lifting heavy objects. Contact sports should be avoided for at least 6 to 8 weeks.
• Your swelling will continue to subside over several weeks.
• During this time you may notice a change in your smile or odd sensations like tingling, pulling, burning, hollowness, cold or sudden sharp pain. These feelings, are related to the healing of the nerve branches and should subside within the first few weeks.
• Numbness is also possible and, whilst it normally settles within the first few weeks, it may occasionally become a permanent issue. Other possible complications of buccal fat reduction include asymmetry, haematoma, seroma and infraorbital nerve and facial nerve buccal branch dysfunction.
Cheek implants, or malar augmentation, makes cheekbones more prominent and this can give the face better definition. The implants are usually made of synthetic material and are semi rigid. Once these are implanted they can feel as natural as the bones of your face.
Bone harvested from yourself can also be used to create an implant. In some people the mid face area is not fully developed and this can lead to:
• A downward slant to the eyelids with a lower position of the lid margin
• Eyes that are more rounded than normal
• Lower lid eye bags that develop earlier than usual
• An overall flatter, poorly defined appearance to the face
• An early appearance of lines on either side of the nose leading to the mouth (naso-labial folds)
Occasionally the problem is more extensive, involving the upper jawbone and affecting the way the upper and lower jaw fits together and will require more extensive surgery.
At your consultation your surgeon should take your medical history and ask about any previous surgery or sinus infections. He should also discuss your goals for the procedure and how much increased prominence of the cheek you require. He should determine whether your facial structure makes you a good candidate for malar augmentation surgery and should explain that over-emphasis of the cheekbones would result in an artificial, unsatisfactory appearance.
He should also explain about the types of implant available and together you should decide what is appropriate for you.
What to expect from your surgery
Although malar augmentation is usually performed under a general anaesthetic, it may also be done as a day case. Incisions are made on the inside of the mouth so there are no external scars. The implants are then fixed in position and the wounds closed.
A more limited malar augmentation can be done using your own fat. It is also possible to correct a significant asymmetry between the two cheekbones by using implants complemented by fat transfer.
For the first 4 or 5 days after your procedure you will need a soft diet to protect the wounds inside your mouth. You should also be aware that:
• You will need someone to drive you home and stay with you the first night after your procedure.
• If you experience discomfort this can be eased by taking a mild painkiller such as paracetamol. Aspirin must be avoided as it can promote bleeding.
• You should have your first follow up appointment 1 week after your operation. At that visit the surgeon should inspect your wounds to ensure that everything is settling down well.
• You should avoid returning to exercise for 2 to 3 weeks after the operation, as it can trigger swelling in your face.
• After surgery, it is possible to brush your teeth with a soft toothbrush from the first day onwards. It is advisable to use an antiseptic mouthwash 4 times daily for the first week.
• Swelling can be moderate to significant, but gentle massage can help relieve this.
• Sleeping with 2 pillows for the 2 weeks following surgery should help speed your recovery.
Chins may be augmented or reduced.
Chin remodelling can help bring your features into proportion with other features, giving a more balanced appearance.
• Chin augmentation - increases the size of the chin either through the use of an implant, or by moving a section of bone forward (sliding genioplasty) and fixing it into position.
Your surgeon should carefully consider whether chin remodelling is appropriate depending on whether your teeth meet correctly. If they do not, then a much longer process of orthognathic surgery supported by orthodontic preparation may be needed and can take up to 2 years to complete.
At your consultation, your surgeon should take a general medical history and ask you about your goals for your procedure. He should also describe the various options available, and help you determine which will be right for you.
What to expect from your operation
Both chin reduction and chin augmentation are usually performed under general anaesthesia. Typically these procedures are done as day cases. Both procedures may be performed either through an incision inside the mouth or one placed under the chin. If the procedure is being done at the same time as a face lift or neck lift, the incision will most likely be placed under the chin and also used as access for neck lifting.
In the case of chin augmentation, an implant may be used or the bone may be reshaped.
• When an implant is used, chin tissues are first freed from the bone. The implant is then placed, adjusted as needed and fixed to the bone with two titanium screws. The chin tissues are then reattached over the implant and your wounds are closed with absorbable stitches.
• If the bones are to be reshaped, a horizontal wedge of bone is removed from the lower part of the chin, moved forward and fixed into its new position. In the case of chin reduction the bone may be filed down or actually cut. Alternatively, your surgeon may remove a wedge of bone just over the chin point. The chin is then repositioned slightly back and higher up.
After your surgery
As mentioned above, this surgery is usually done under local anaesthetic, however if you opted for general anaesthetic, you should arrange for an adult to accompany you home and stay with you through the first night.
• If your surgery was done through incisions inside your mouth you should eat soft foods for the first week so that your wounds can heal properly, as vigorous chewing can cause your stitches to break down and infection may occur.
• Swelling is to be expected for the first 7 to 10 days. Your surgeon should recommend a compression garment, to encourage the swelling to reduce more quickly.
• A course of antibiotics and painkillers should be prescribed, but it is important you do not take aspirin as it can promote bleeding.
• Even if you have incisions inside your mouth it is advisable to continue brushing your teeth regularly with a soft toothbrush and to use an antiseptic mouthwash four times a day for the first 2 weeks after surgery.
• You should plan on taking two weeks away from work to allow your bruises to clear and your chin to settle sufficiently.
• Infection caused by a breakdown of incisions within the mouth can be problematic, particularly if there is an implant. If this happens, it is often wiser to remove the implant to promote control of the infection, then repeat the procedure 3 to 4 months later.
• The nerves that give feeling to the lower lip travel through the jawbone and emerge on either side of the chin and may be damaged during surgery. This type of damage usually leads to temporary numbness in the lower lip.
Ear Surgery / Otoplasty
What is Cosmetic Ear Surgery?
Otoplasty or Ear plastic surgery (cosmetic ear surgery) is a procedure that has its roots in the nineteenth century, and is a popular and commonly employed technique in the twenty first century. The surgery is performed on children as well as adults and results are often very positive and long lasting.
Why choose ear correction surgery?
Ears can appear highly prominent if they lie at an angle greater than fifteen degrees from the head. Many people are unhappy with the way their ears look, and it can be a deeply personal and embarrassing problem, leading to teasing from an early age, and a lack of confidence and self-esteem. Ear alteration surgery is able to change the appearance of protruding ears and, where necessary, remould ears to a more pleasing shape. It is a relatively straightforward procedure that can often be performed as a day case, and can lead to an increase in confidence.
Is Cosmetic Ear Surgery right for me?
It’s highly important to have a full consultation with an accredited cosmetic surgeon if you are thinking about undergoing ear pinning and reshaping surgery. As with all cosmetic procedures, cosmetic ear surgery has inherent risks and limitations, and it’s vital to be personally assessed. At the consultation, the surgeon will ask you about any previous surgery you may have had, and he or she will also take a full medical history. It’s vital to be honest and open about the changes you wish to see so that your surgeon can help you formulate realistic goals for your ear surgery. Before and after pictures of successful procedures are a great way of helping you visualise the changes that will occur, and can help you communicate your needs more effectively with the surgeon.
Babies who have prominent or ‘bat’ ears may be treated by gently taping their ears to their head, or by wearing a cap. After this early stage, ears can only be treated with surgery, and it’s advisable to wait until after the child is at least four years old when the ears are 80% of their final size.
Children over 6 and adults generally respond well to ear correction, reduction and ear reshaping, and are usually pleased with the results. It’s important to remember that your ears may never be 100% symmetrical.
What happens during the cosmetic ear surgery procedure?
Generally, surgeons will make an incision behind the ear in the fold where your ear meets your head. Skin is then pulled back and the cartilage beneath is reshaped. In some cases cartilage and skin is removed for optimal results, and your surgeon will discuss your best option beforehand.
Sometimes, when local anaesthetic is used, the procedure can be viewed in a mirror. This enables you to guide your surgeon whilst he or she is repositioning and remoulding your ears, often enhancing the accuracy of results.
Ear correction surgery usually takes around an hour, and most children and adults leave the hospital on the same day, although some younger children are advised to stay overnight.
What happens after cosmetic ear surgery?
- After Ear alteration surgery, a dressing is applied and worn for a week in order to keep the ears in position as they heal.
- As the anaesthetic wears off, mild discomfort is normal and can be controlled by painkillers.
- Bruising and swelling can sometimes occur, but should fade within two weeks.
- It’s important to take extra care whilst sleeping—especially on the first night—and it is worth propping your head up on pillows to minimise movement.
- Stitches are removed within five to ten days, and in that time there may be a mild infection. Dissolvable stitches will disappear in their own time.
- Numbness can occur, and should disappear in a few weeks—but you should see your surgeon if the numbness continues.
- Sometimes small blood vessels will leak after surgery. On certain occasions this bleeding can prompt a return to theatre.
- Once the dressing is removed, it’s advisable to wear a headband for eight weeks whilst sleeping or playing contact sports in order to keep the ears in their new position.
- Your ears should ‘set in’ two months after surgery, changing their shape by one or two millimetres.
It’s important to remember that no surgery is one hundred percent safe, and you should undertake thorough research and book a full consultation before you make any final decisions regarding plastic surgery. Elf ears, pierced ears and protruding ears can be effectively dealt with if you choose the right surgeon and set yourself realistic targets.