Facial Cosmetics

Surgical Cosmetic Services

Breast Surgery

Patients seek breast surgery for a number of reasons. They may have always been unhappy with their breasts or because their breasts have altered, often following childbirth or a change in weight.

Breast surgery has developed greatly over the years leading to more predictable results with shorter recovery times.

Every patient has an individual idea of how they expect their breasts to appear following surgery so a detailed consultation is needed to ascertain this prior to surgery. You will be asked what cup size you would like to be following surgery and in the case of a breast enlargement you will be given an experiment to do to find out how large you would like the implants to be. Your surgeon will give you advice to help you but will want you to be the person in charge of making the final decision. It is not possible to guarantee a particular cup size but it is very likely that the result will be the size chosen or at least very close to it.

Patients over the age of forty will be advised to have a mammogram prior to surgery.

Breast Enlargement

Breast enlargement or augmentation is the most frequently performed cosmetic breast operation and carries a very high degree of patient satisfaction. It is obviously performed to make the breast larger but can also be performed to uplift a breast that has become empty and droopy. Only a small amount of “droop” can be lifted by an implant alone, any more will require an uplift, (mastopexy), with or without an implant.

A breast augmentation requires a general anaesthetic and normally a one-night hospital stay. Incisions are normally made in the crease under the breast and a pocket made in which to place the implant. The implant can be placed under the breast tissue or deeper under the muscle and the benefits of each will be discussed before the operation. The only implants commonly in use today are filled with silicone gel or saline, (salt water); both are used extensively without problems but silicone gel implants generally feel more natural. Following surgery you will go home wearing a sports bra and will be seen again 12 days later for a wound check before you will be allowed to shower. You will probably need 1 to 2 weeks off work and be driving at 12 days. Normally patients will be back to full activities at 4 to 6 weeks. You will be seen during this time and again for a final review at a year.

Breast implants do not have a definite life span. The recent generation of implants have a rough textured surface to reduce the chance of scar tissue contracting around the implant making it feel hard. They are thicker walled than previous implants and are expected to last fifteen years or more. They should be regarded as long term rather than life long and so replacement is likely to be required in due course.

Tummies

The Trunk and Limbs

Once surplus skin has developed following pregnancy or fluctuations in weight exercise and dieting will remove fat but not skin so surgery may be appropriate. Sometimes a considerable amount of fat can be removed as well as skin but operations of this nature are primarily designed to remove surplus skin and should not be considered as an alternative to losing weight by diet and exercise.

Abdominoplasty (Tummy Tuck)

Most patients requesting abdominoplasty will have surplus skin and fat on their abdomens following pregnancy. Similar changes sometimes occur in some men and women who have not had children. Surgery can be as little as a limited abdominoplasty leaving an 8 inch transverse scar in the lower abdomen to a complete body lift which will leave a scar which is circumferential around the whole trunk. In a limited procedure the navel is left untouched but in most procedures it is repositioned to allow more skin and fat to be removed. In this case there will be a small scar around the navel as well as a much longer scar lying transversely in the bikini line.

On occasion the rectus muscles, which lie vertically on either side of the mid line, have separated and during the operation they can be stitched back together with a strong nylon suture.

A general anaesthetic will be required and the hospital stay will vary from day case to 3 nights as an in-patient. Similarly recovery will vary from 2 weeks to 2 months depending on the magnitude of the operation.

This operation is a good procedure for removing skin and fat from the anterior abdominal wall but will do nothing, (apart from stitching the rectus muscles together if they have separated), to the muscle wall of the abdomen so if the muscles are not in good shape exercise will be required to achieve the best result.

Face

Surgery of the Ageing Face

With increasing age the connective tissues, which support the soft tissues of your face, collagen and elastin, become less supple and stretch. As a result skin and fat sags in the face causing drooping of eyebrows and upper lids, eye bags, heavy nasolabial folds and jowls and loose wrinkled skin in the neck. These processes are accelerated by sun exposure and cigarette consumption.

Various operations are available to remove surplus skin and tighten underlying structures. In this way the clock is turned back although it does not stop ticking! How much rejuvenation is achieved will vary because it depends on the quality of the individuals skin and in particular how much elasticity it retains.

Eyelids and Eyebrows

The most common eyelid operation is an Upper Blepharoplasty in which the excess skin of the upper lid is removed. At this operation it is also possible to remove fat if it is bulging into the lid. Upper lids only can be treated under local anaesthetic as a day patient. The patient must be prepared for a little swelling and bruising but this generally settles down quickly in a week or so. A scar is left in the upper lid crease that is usually of excellent quality and not normally noticeable at conversational distance.

Sometimes the eyelid is hooded not only because there is excessive skin in the upper lid but because the eyebrow has drooped down towards the eyelashes. In this case a procedure is required to lift the brow. Various procedures are used but the operation becoming most popular is the limited removal of a crescent of skin at the hairline.

Lower lid surgery, Lower Blepharoplasty, is a more involved operation that requires a general anaesthetic. An incision is made just below the lashes and the skin and muscle lifted forward to allow the removal of fat that may be bulging through. Surplus skin is removed before the wound is stitched. This operation is very good at removing eye bags but is less predictable at removing wrinkles because the amount of skin that can be removed may be limited as too much will cause the lower lid to be dragged down.

Again some bruising and swelling is to be expected which settles in a week or two. Some discomfort may last a little longer because it is normal for some deep stitches to be left in the outer corner of the eye to tighten the lid

Nose and Ears

Rhinoplasty (Altering the ose Shape)

Some patients are born with a nose they dislike, often similar to a parent's, and others have their noses altered by injury. There are many different procedures that can be used to alter various features of the nose and the ones needed to correct your nose will be selected. Together they make up the rhinoplasty operation. Unless a very minor procedure only is needed, the operation will be performed under general anaesthetic and you will need to stay in hospital overnight. When you wake up there will be small packs in each nostril so you will have to breathe through your mouth until the next morning when they will be removed. If the bones in your nose have been moved you will also have a plaster of Paris cast on your nose, which will stay on for a week.

Recovery is quite quick following rhinoplasty but the nose will feel fragile for a month or so and you will need to take things easy. Nasal bones only take 2 to 3 weeks to heal up but swelling is the main effect of surgery that you will notice. The amount of swelling and black eyes a patient gets varies considerably. It starts to go down very quickly at first but the rate slows down and the last little bit of swelling may take up to a year to settle. You should however notice an improvement straight away and you should be presentable after 10 days or so.

It must be appreciated that although a surgeon will normally be confident that he can leave you with the result you want at the end of the operation he is not in control of the healing processes which will influence the final result. Thus in the best of hands a small percentage of patients will wish to have a further surgical adjustment.

Correction of Prominent Ears

A large number of patients who request set back of prominent ears are children who are getting teased at school but a significant number of adults also seek surgery. Ears normally stick out because a fold is missing in the cartilage of the ear, (cartilage is the gristle in the middle of the ear which gives it its shape and support). Surgery is aimed at producing this missing fold and operation can be performed as a day patient under general anaesthetic, (asleep), or local anaesthetic, (awake), if the patient is old enough to tolerate the local anaesthetic injections. In most cases a strip of skin is removed from the back of the ear to get access to the cartilage. This means that there will be a scar tucked in on the back of the ear and at the end of the operation a head bandage will be put on which stays on for about 10 days.

On removal of the bandage the ears should be set well back although they will be a little bruised and swollen for a couple of weeks. Infrequently bleeding or infection occurs under the head bandage. It is very important that if you do experience severe pain you contact the hospital because the bandage will need to be removed for the ears to be checked. Failure to do so may result in damage and then scarring to the skin on the front of the ear.