Neck Lift Surgery (Platysmaplasty)

Performed either alone or as part of a face lift, a neck lift can remove excess skin, fatty tissue and banding, and restore a smooth appearance to the neck.

For people with loose, sagging skin under the chin, vertical bands and wrinkles or necks that are too heavy. Neck lift surgery can be performed either alone or in combination with other cosmetic procedures and different procedures are used for each of these problems:

• Sagging skin - this may be tightened or removed entirely, using a procedure called cervicoplasty.

• Vertical bands - a technique called platysmaplasty can be used to tighten the muscles of the neck.

• Fat deposits - these can be removed directly or by liposuction.

The end result of all these procedures will depend upon the elasticity of the neck skin and degree of sun damage to the area. It is also important to have realistic expectations.

Genetics can play a large part, so that people whose relatives have a well defined jaw line, or chin may likewise keep this definition in their own features as they age.

For those who have inherited a relatively small chin, a combination of neck lift and chin augmentation can give improvements to facial balance and neck contours.

A relatively small group of people tend to have poor definition in the neck very early in life, without ever being overweight. If the elasticity of the skin allows, it is possible to do extensive contouring with an anterior neck lift. This is usually done with a small incision (3 cm) under the chin. Through this it is possible to reduce the fatty tissue situated below the skin, as well as deeper tissue of the platysma muscles; trim the lower pole of the submandibular glands (if necessary) and; adjust the position and tension of the platysma muscles, so that the neck contour is improved.

Your consultation

During your consultation your surgeon should take a general medical history and ask about any other facial surgery you may have had. You should then discuss your goals and your surgeon will explain what results you can reasonably expect.

Often, in particular for patients after their mid-40s, the lower part of the submandibular glands is palpable below the jaw line. It is possible during the neck lift procedure to address both the superficial and deep seated fatty tissue in the neck, as well as trim the lower poles of the submandibular glands, for a more detailed neck contouring.

A neck lift can be done in conjunction with a face lift or other cosmetic procedures.

What to expect from surgery

Neck lift surgery usually takes between two and three hours, longer if it is being performed in conjunction with a face lift or other procedure. If it is being performed alone, neck lift surgery is usually done as a day case.

• Platysmaplasty for vertical banding - small incisions will be made under your chin or behind your ears to reach your neck muscles and move them as required.

• Cervicoplasty for correction of loose and sagging skin - your surgeon should use similar incisions to a platysmaplasty, trim the skin, move it into place and secure it using stitches or tissue glue. Your surgeon may also fit you with a compression bandage and instruct you to wear it continuously for at least a week.

• Liposuction is normally used if you wish to get rid of excess fat. This is a process whereby fat is vacuumed away through thin cannulas (or tubes). If this is the only procedure you are having it should take an hour or less. If more extensive contouring is required, reduction of fatty tissue is normally done through an incision under the chin.

After your surgery

In the days after your surgery there are several things you should expect:

• Depending on how extensive your procedure was, you may have some swelling and bruising. Both should settle in 4 to 10 days.

• You may also experience feelings of tightness, burning, pulling and numbness. These are normal in the first few weeks and should resolve on their own.

• If you have sutures that need removing they should be taken out within 7 to 10 days after surgery.

• Any discomfort you experience can be controlled by taking paracetamol or medication provided by your surgeon. Do not take aspirin or other anti-inflammatory medication as these can promote bleeding.

• If you smoke, you should be advised to stop entirely for 2 weeks before and 2 to 3 weeks after your surgery to give your body the best opportunity to heal.

• You should be able to return to work in 1 to 2 weeks, however you will need to avoid sporting activities for at least 3 weeks, possibly longer, as advised by your surgeon.

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.

Cheek Implants

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.

Your consultation

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.

After surgery

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.

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.

Your consultation

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.