Getwell Soundarya Cosmetic surgery

Getwell Soundarya

AESTHETIC CENTER

Cosmetic Surgery

ABDOMINAL REDUCTION
ABDOMINOPLASTY OR TUMMY TUCK
BOTULINUM TOXIN INJECTIONS
BREAST AUGMENTATION
BREAST REDUCTION
BREAST UPLIFT
COSMETIC FACIAL INJECTIONS
EYELID SURGERY
FACELIFTS
LIP ENHANCEMENT
LIPOSUCTION
RHINOPLASTY
SETTING BACK PROMINENT EARS

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Abdominal Reduction
Abdominoplasty or Tummy Tuck. In this procedure excess skin and fat can be removed, abdominal contours and scars
improved, and the muscles tightened. Different combinations are combined in the various procedures.
THE STANDARD ABDOMINOPLASTY
The excess skin and fat of the abdominal wall between the pubic area and
the umbilicus (navel) is removed leaving the umbilicus in place. The skin of
the abdominal wall at the level of the umbilicus is then drawn down to
suture it to at the pubic level. The patient is left with a long, usually curved
scar across the lower part of the abdominal wall at the level of the pubic
hair. There is also a scar around the umbilicus. Any looseness of the
muscles of the abdominal wall or hernia is repaired at the same time – see
Figure.
Liposuction may be carried out during this procedure to thin the abdominal wall, or as a separate procedure either
before or after the Abdominoplasty.
MINI-ABDOMINOPLASTY
In the Mini-Abdominoplasty surplus skin below the umbilicus is removed leaving a low abdominal scar at the level of the
pubic hair. The umbilicus is not disturbed but liposuction is usually carried out at the same time as the procedure to
reduce the thickness of fat in the abdominal wall and any laxity or hernia of the abdominal wall is repaired at the same
time.
EXTENDED ABDOMINOPLASTY
In the extended abdominoplasty surplus skin and fat of the loins and back are also removed so that the scar extends
around the flanks onto the lower back.
ENDOSCOPIC ABDOMINOPLASTY
The endoscopic abdominoplasty is used to tighten the muscles of the abdominal wall to give a better contour and is
carried out through a short transverse incision above the pubic hair. Skin is not removed but liposuction can be carried
out at the same time.
APRONECTOMY
The apronectomy is a modification of the mini-abdominoplasty for patients who have a large excess of skin and fat
hanging down over the pubic area. In this procedure only the surplus skin and fat is removed. The scar is long and
transverse extending from one side of the apron to the other.
Modifications to the abdominoplasty skin excision are made when the patient has particular problems associated with
scars from previous operations.
An alternative procedure which should always be considered instead of many of the above is liposuction on its own. This
reduces fat and causes just a little retraction of the skin.

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WHO IS A CANDIDATE ?
Anyone who has abdominal skin and fat may be a candidate. With women the problem is usually caused by pregnancy,
but is greatly aggravated by weight loss. The muscles of the abdominal wall may be weakened by pregnancy and actually
pulled apart in the middle (divarification of recti). Men are similarly affected by weight loss. Stretch marks (striae) are
simply the scars which are left after extreme stretching of the skin. They are usually most apparent on the lower part of
the abdominal wall. There is no specific treatment for these stretch marks, but many of them are excised in an
abdominal reduction and those that are left are tightened making them look less obvious.
Patients that are unable to tighten the abdominal wall skin with exercise or wish to achieve a smoother flatter abdomen
will also benefit.
WHAT ARE THE CONSEQUENCES?
The patient is left with noticeable scars. The main scar runs transversely across the lower part of the abdomen (see
illustrations) and in a standard abdominal reduction there will be a scar around the umbilicus. Other or different scars
may be left where the patient has particular individual problems. Some patients make better scars than others and in
any case all scars are red initially. It is essential that the patient understands where these scars will be and should discuss
them with the surgeon. Although we try and hide them beneath underwear and swim wear fashions can change making
previously covered scars visible.
There is numbness in the lower part of the abdominal wall after surgery this is usually temporary but could be
permanent. Swelling above the scar is usually present due to a collection of tissue fluid which normally drains to the
groin. This swelling or oedema settles within a few months.
WHAT ARE THE LIMITATIONS?
The skin is usually tightened downwards and this does not tighten the waist. If this is desired then one can consider
removing skin vertically, but one should bear in mind that vertical scars of the abdomen are less good. The tissue of the
abdominal wall is generally fatter than the groin and if liposuction is not carried out a fatty bulge may remain above the
scar.
The beneficial effects of the operation will last well, however, the effects will be maintained better if the patient keeps
exercising the muscles and the weight steady. A further pregnancy will of course stretch the skin again, although
probably not to the same degree.
WHAT ARE THE RISKS ?
The standard abdominoplasty is a large procedure requiring two to four days hospitalisation. Drains are removed when
they stop draining blood and serum a few days after the procedure. This fluid can reaccumulate after the drains are
removed requiring drainage or aspiration.
Healing can be slow particularly in the tighter central part of the wound and sometimes dressings are needed for a few
weeks. This is more common in patients who are overweight and who smoke. This tends to leave more obvious scars
which are tethered – these can be revised.


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Secondary procedures are sometimes carried out to tidy up the results and will involve scar revision and limited
liposuction. Displacement of the umbilicus to one side has been over publicised and is rare. Deep vein thrombosis and
pulmonary embolus are rare complications of any operation including this one.
WHAT WOULD YOU NEED TO DO BEFORE THE OPERATION?
If you are overweight you would be well advised to diet as best results are obtained in people who are the correct
weight for their height. If you are taking the contraceptive pill you should stop doing so for six weeks before surgery and
use an alternative method in order to reduce the risk of thrombosis. If you smoke there is a greater risk of chest
infection and in particular healing of the abdominal wound is less good.
WHAT YOU SHOULD EXPECT AT THE TIME OF THE OPERATION?
You will need to be in hospital for one to three days. When you wake up for your operation it is likely that you will be
having a transfusion of salt solution. This is quite normal and is to provide you with fluid you need whilst you are not
drinking. You are likely to have drainage tubes coming out of each side of the lower abdomen which are there to drain
any collection of blood or serum. You can expect some moderately severe pain for which you will be given pain killing
tablets or injections. You will be asked to keep your knees and hips bent to take the strain off your stitches.
RECUPERATION
Over activity in the early days reduces healing and increases fluid accumulation. Light activities are comfortable in 10 to
20 days. Sports will not be possible for about 6 weeks particularly when the muscles have been strengthened with
sutures. A corset is usually helpful to reduce the swelling and improve comfort in the first month.


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Botulinum toxin injections
(Botulinum toxin is commercially available as Botox® or Dysport®. However, these injections arecommonly referred to as
‘Botox injections’ whichever product is actually used. This leaflet will therefore refer only to ‘Botox injections’).
INTRODUCTION
Wrinkles are part of the ageing process. They can be attributed to
sun damage, effects of gravity and muscle contraction resulting
from facial expressions such as frowning and laughing. Wrinkles
due to the effects of gravity represent natural sagging of tissue
with age and are generally only improved by surgical tightening
procedures. Wrinkles caused by muscle contraction such as frown
lines, forehead lines and crows’ feet, can be improved by Botox
treatment. The various wrinkles caused by facial muscle
contraction are illustrated on diagram 1. Botox can also be used to
treat excessive sweating of the armpits and palms of the hands.
WHAT IS BOTOX?
Botox® and Dysport® are the trade names for Botulinum toxin, produced by bacteria called Clostridium botulinum.
Several types of toxins have been identified, but type A, which is used commercially, is the most potent. Botox acts by
blocking acetylcholine, a chemical that is responsible for transmitting electrical impulses that cause muscle contraction.
This results in muscle paralysis. The resultant paralysis, however, is temporary, as the new growth of nerves will reinnervate the muscles. Botox was first used in 1978 to weaken over active muscles in the eye, followed by other
neurological conditions such as dystonia and hemifacial spasm with good effects and little side effects. Botox was first
used cosmetically in 1990, to reduce facial wrinkles arising from muscle contraction.
WHAT CAN YOU EXPECT AT THE TIME OF YOUR PROCEDURE ?
Botox is injected directly into the muscles that cause the wrinkles, using a very small needle. Several injections are
usually needed at specific sites, depending on the area treated (see diagram 1). When used to treat excessive sweating
in the armpits, Botox is injected directed into the axillary skin. Localised discomfort and bruises can occur, but no
sedation or local anaethesia is generally required. Normal activities can be resumed immediately.
WHAT ARE THE RESULTS ?
Botox usually takes effect 24-72 hours after injection, with maximum effect at about 1 to 2 weeks. Its effects generally
last for approximately 3-4 months. When injected into the muscles that are responsible for expression wrinkles, it gives
the face a more relaxed and smoother appearance. Sometimes longer lasting effects (9-12 months) are seen after
treatment of excessive sweating. When a gradual fading of treatment effect is noticed you may return to have another
treatment.


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Whilst Botox can be very effective in reducing wrinkles due to muscle contractions, it has no effect in reducing the fine
lines on the face caused by sun damage, and lines due to sagging of facial skin. In those patients with very heavy lines,
repeated treatments may be needed for maximum effect. Too frequent or excessive dosing of Botox may lead to
patient’s resistance to treatment due to antibody formation and Botox treatment may exaggerate any facial asymmetry.
WHAT ARE THE CONTRAINDICATIONS FOR TREATMENT?
The use of Botox is contraindicated in people with neuromuscular disorders such as myasthenia gravis, those who are
taking certain muscle relaxants and antibodies such as aminoglycosides, pregnant or breast feeding women, those with
infection or inflammation at the proposed site of injections and bleeding disorders.
No severe complications after cosmetic use of Botox have been reported in the literature. Very rarely excessive
weakening of the target muscles and paresis of adjacent muscles can occur, resulting in facial weakness. This is selflimiting. When injecting above the eyebrows, upper eyelid ptosis or slight drooping may occur but only 1:100. This can
be corrected with eyedrops but will also improve as the effects of the Botox wears off.


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Breast Augmentation
CAUSES OF SMALL BREASTS
The size of breasts is genetically determined. Once developed, the breasts may fluctuate in size in response to changes
in weight, pregnancy and breast feeding.
The aging process causes the shape of the breast to change so that they gradually droop (called ptosis). This effect is
greater following pregnancy, breast feeding and in particular after a large weight loss. Most women have breasts of
slightly different sizes, but occasionally a very marked difference may develop.
THE OPERATION
Breasts can be made larger by placing an implant either under the breast tissue or
behind the muscle on which the breast lies. Implants are usually inserted through
incisions in the fold under the breast (i.e. inframammary fold). Alternatively, the
incisions may be made around the areola or in the armpit.
BREAST IMPLANTS
A breast implant consist of an outer shell and a filling material which is most often
silicone gel or sometimes salt water (referred to as saline). Some implants are round
and others are shaped more like a natural breast referred to as tear drop or
anatomical implants. Either can give excellent results. The manufacturers life
expectancy of breast implants is 10 or more years, although implants can stay in
without problems for a much longer time.
EXPECTATIONS AND COMPLICATIONS
Breast augmentation has for many years been the most common cosmetic
procedure in the UK which is testimony to its safety and ability to achieve a
satisfying outcome in most patients. However no surgical procedure is without risk
and understanding these risks as well as having a realistic expectation is essential.
When any foreign material is inserted in the body it makes a protective coating
around it which in most women forms a thin membrane that remains undetectable
externally. In a few women however the reaction to the implant is greater and this is referred to as a capsule as the
membrane becomes much thicker. The capsule around the implant can become thickened and contracted. The newer
designs of implants have features to reduce the likelihood of this happening. This problem occurs to some extent in
around 5 or 6% of patients and usually starts at about a year after surgery although it may take many years to become
noticeable when looking at the chest. This can lead to pain, and/or an abnormally hard feel of the implant in the breast.
Treatment may be needed and occasionally removal of the implant. Breast augmentation does not usually interfere in
breast feeding, and there is no evidence that any silicone is found in breast milk. The presence of breast implants may
interfere in mammography, which is an X-ray screening method for breast cancer. Special X-ray views can be taken to
minimize this interference and studies have shown that the sensitivity of detecting a breast cancer in patients who have
had implants is not reduced compared to normal women who do not have implants.


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Most women have some degree of asymmetry between breasts and breast augmentation may occasionally exaggerate
this difference. A breast that has an underlying implant will not necessarily feel like a normal breast, and some women
may be acutely aware of the implant as a foreign body within the breast. The size and shape of the breast following
breast augmentation surgery will adjust with time and can be unpredictable. It is also not always possible to create a
cleavage with breast augmentation. Please remember that the weight of the implant may influence the age-related
changes that normally take place in breasts. Movement of the fluid which fills the implant may occasionally be seen
through the skin, this being more likely in the saline (salt water) filled implants, and less likely in the more viscous
silicone implants, which also have a more natural feel. Breast augmentation will always leave scars on the breast or in
the armpit, and although the scars will settle over 12 or more months, the appearance of the scars does vary between
different individuals. This scarring is placed in such a position as to minimize visibility even when wearing a swimming
costume. Complications that occur with breast augmentation include those associated with all forms of surgery, as well
as the specific problems of bleeding and infection. Any infection that may occur in the tissue around the implant can
usually be treated with antibiotics, but may require surgical removal of the implant.
SAFETY OF SILICONE
Whatever the filling of the implant, the outer layer is made of silicone which is a firm type of material referred to as
silicone elastomer. Silicon is a naturally occurring element which becomes silicone when it is combined with carbon
hydrogen and oxygen. Silicone is manufactured into many items including cosmetics, foods and medical implants. Many
studies have been conducted to establish whether silicone breast implants cause certain diseases. As a result of these
studies we can say that at present there is no evidence to suggest that silicone breast implants are associated with an
increased incidence of breast cancer. There is also no evidence to suggest that these implants cause autoimmune
diseases such as rheumatoid arthritis.


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Breast Reduction
REDUCTION MAMMOPLASTY (BREAST REDUCTION )
The size of women’s breasts may be determined by several factors, such as
inherited genes, body weight and hormonal influences. They can, therefore,
be a problem to some women early in adolescence or may not become
uncomfortable until middle age following the menopause or the use of
HRT. The problem of large breasts, however, may cause similar problems at
all ages and these are chiefly backache, neck pain, grooves in the shoulders
from bra straps, rashes under the breasts and the feeling of self
consciousness. Because of the sexual nature of breasts the undue
prominence may attract unwanted attention from the opposite sex,
comments and sexual innuendoes. These can cause psychological distress
to many women. One of the commonest complaints of women with large
breasts is that it is very difficult to wear fashionable clothes and indulge in
active sports, particularly in the summer months.Before the operation
After the operation, showing the scar lines around areola of the breasts in a ‘T’ shape
WHAT CAN BE DONE ?
Reduction mammaplasty is an operation which removes the excess fat and skin from the breasts, which are reshaped
and the nipples repositioned to form newer smaller breasts. This should result in more attractive breasts and reduce
many of the problems outlined above. There are several different surgical designs to reshape the breasts and are
illustrated opposite. All of them will involve a scar around the areola of the breast. Each method will use different scars
and will have advantages and disadvantages and your surgeon may select with your approval the best technique in your
particular case. Reduction mammaplasty may be used to correct asymmetry of the breast, where one breast is very
much larger than the other and where it is considered to be the least normal of the two.
Apart from the change of shape and reduction in size the most obvious consequences are the scars. These are designed
to be invisible whilst wearing normal clothing and as far as possible are designed to lie under the average bra or bikini
top. Over the months following surgery the scars will fade from being red, possibly thick and uncomfortable, to
becoming much more pale and less obvious. However, they will always be present and visible when clothing is not worn
and the scars will vary from one woman to another. In some they may be very thin, in others they may stretch and
become quite red and possibly ugly. In the vast majority of women, however, the scars are acceptable and a small trade
off for the benefit of dealing with the problems of large breasts. Very few women are able to breast feed following
breast reduction surgery as the nipples are separated from the underlying milk ducts and at the time of pregnancy the
milk supply will gradually dry up, sometimes with the assistance of hormone treatment. Breast reduction is no contra
indication to pregnancy but young women may well wish to take the fact that they are unable to breast feed into
account before embarking on this procedure.


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The nipples are likely to be very much less sensitive following surgery due to the nature of the cuts and the nerve supply
and it is quite possible that numbness will extend over part of the breast as well.
WILL THE IMPROVEMENT LAST?
Unless your operation is done at an age when your breasts are still growing, they should not regrow afterwards. They
will, however, increase in size if you either put on weight or become pregnant and decrease in size if you lose weight.
Even normal breasts have a tendency to droop with time and you can expect some change in shape to occur after a
reduction mammaplasty. You can delay this tendency by supporting your breasts in well-fitting bras.
It is very important that you discuss thoroughly with your surgeon beforehand the size of breasts you wish to achieve.
Many women wish for a very radical reduction but in order to achieve this the shape and aesthetic quality of the breasts
may be compromised. It is also possible that there may be a degree of asymmetry. This is often less than existed before
the surgery. In women with very large breasts the benefits of a significant reduction may outweigh the potential
imperfections of poor shape and loss of nipple function and sensitivity. However, in women with breasts which are only
slightly larger than normal very careful thought must be given to the scarring and the potential shape and size as the
outcome of the surgery may not be as aesthetically pleasing as a normal breast appearance.
Any major operation with a general anaesthetic carries a small risk of chest infection particularly among people who
smoke and there is also a small risk of thrombosis in the veins of the leg, particularly for patients who are taking the
contraceptive pill.
Occasionally, heavy bleeding can occur after the operation is finished which may need a further operation and a blood
transfusion.
Occasionally, infection from germs harbouring in the ducts of the breast can be troublesome. Infection can be treated
with antibiotics but it will delay the healing process, scars are likely to be worse to start with and there may be a need to
restitch them at a later date. If you have a discharge from your nipple, it is most important to tell your surgeon about it
before your operation.
Occasionally, skin can become sloughy and form a scab which gradually separates to leave a broad scar. The nipple disc
and the skin where the scar meets underneath the breast are parts most likely to be affected. People who smoke are at
greater risk of this happening. Usually the scars settle well to end up as white lines but they will always be noticeable.
However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable
for a long time.
When reducing large breasts it may occasionally be necessary to adjust the folds of skin at the end of the scar, both
between the breasts and at the sides. This can simply be carried out under local anaesthetic several months later.
There is no evidence that reduction mammaplasty causes breast cancer. Nor does it prevent your breast from being
examined for cancer in the usual way.


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WHAT YOU SHOULD DO BEFORE YOUR OPERATION ?
Your surgeon is likely to recommend that you reduce weight if you are overweight and to make alternative
arrangements if you are on the contraceptive pill. Smoking does seriously effect the healing of the breast wounds and
should be discouraged and attempts to give it up made.
WHAT CAN YOU EXPECT AT THE TIME OF THE OPERATION?
This procedure is carried out under a general anaesthetic and when you wake at the end of the operation there will be
some discomfort which will last for two or three days. You will be given suitable pain killing injections or tablets.
Drainage tubes are frequently used and will be removed within a short period of time. You may need to remain in
hospital for three to four days. The stitches will normally be removed between ten to fourteen days and you will be tired
and require help at home for a period of time, from two to six weeks depending on your age and general fitness. A wellfitting bra will need to be worn following surgery but because of the post-operative swelling the final size of your breasts
may not be obvious for several weeks. There is likely to be some tenderness and lumpiness of the breasts for several
weeks or even months following surgery but there is no reason why you cannot sunbathe and go swimming once the
scars have fully healed.
Cosmetic Surgery is carried out by members of several different organisations and, therefore, your general practitioner
is the best person to advise you on whom you should see.


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Breast Uplift
MASTOPEXY (UP-LIFTING OF DROOPY BREASTS)
Droopiness of the breast is a common legacy of motherhood, nursing and the force of gravity taking their toll, and the
effect of pregnancy and a distension of the breasts with milk causes the fibrous bands which support the breasts in their
youthful shape to break down and the skin to stretch. With the subsequent shrinking the unsupported breasts settle into
the stretched skin and gravity pulls them down. Putting on weight and then losing it can have the same effect. So too
does the ageing process, which is why women dislike the appearance of their droopy breasts.
WHAT CAN BE DONE ?
Whilst it is not possible to recreate
surgically the natural supporting structure
of the breast, it is possible to reshape the
breast into one which looks more youthful
and feels more firm. The operation is
called a Mastopexy. Pleats of surplus skin
are removed from underneath the breast,
the breast itself is remodelled into a
tighter cone and the nipples are
repositioned at a higher level so that they
lie at the points of the tightened breasts.
Mastopexy can also reduce the size of the
areola ( the darker skin surrounding the
nipple). If the breasts are too small as well
as droopy, their size can be increased
during the operation by placing silicone
breast implants underneath the tightened
breasts. The best results are achieved in
women with small sagging breast although
breasts of any size can be lifted. The
results may not last as long with heavy
breasts. Many women seek mastopexy
when their families are complete so if you
are planning to have further children it
may be a good idea to postpone the
operation for though there is no risks for
future pregnancy and mastopexy does not
usually interfere with breast feeding,
pregnancy is likely to stretch the breast
again and reduce the effectiveness of the
procedure.


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This is a good operation to improve the appearance of droopy breasts but you would be left with scars, possibly some
numbness of your nipples and you may not be able to breast feed again. Mastopexy can be carried out by a number of
different techniques and the scars will differ accordingly. The most common technique involving scars are illustrated
below. It may be possible for the operation to be performed with less scars and your surgeon will discuss the possibility
of this with you. Usually these scars are fine but they are not invisible and could be noticed by others for example, if you
were topless on the beach.
Different types of scarlines after a Mastopexy
Because it is not possible to recreate the natural attachment of the breast to the tissues underneath, a mastopexy alone
will not greatly increase the fullness of the breasts above the nipples. Fullness above the nipples can be achieved,
however, by increasing the size of the breasts with silicone implants. The extra weight of the silicone implants may
accelerate the return of the droopiness of the breasts and in any event there is a tendency for the breast to sink
downwards as time goes by. You can lessen the rate at which this happens by supporting your breasts in a bra as much
as possible.
As with any major operation under general anaesthetic, there is a small risk of chest problems particularly if you are a
smoker and a small risk of thrombosis of veins in your legs, particularly if you are taking a contraceptive pill. In addition
there is a small risk of one or more of the following complications.
Rarely heavy bleeding from the broken blood vessels can occur after the operation, which requires treatment in theatre
under another anaesthetic. Occasionally, infection (usually from germs that are lying dormant in the ducts of the breast)
can cause part of the wounds to break down which prolongs the healing period and worsens the quality of the final
scars.
Some people have an inborn tendency for scars to stretch and some people produce scars which remain thick, red and
irritable for a long time.
If silicone implants are used you will need to refer to the leaflet on breast augmentation which will discuss the issue of
breast implants and the potential complications in much more detail.
WHAT YOU SHOULD DO BEFORE THE OPERATION ?
If you smoke, you should stop now. If you are taking the contraceptive pill, change to an alternative method at least six
weeks beforehand. If you are overweight, reduce it beforehand.
WHAT YOU CAN EXPECT AT THE TIME OF THE OPERATION?
This surgery is normally carried out under a general anaesthetic and will often involve an overnight stay in hospital
depending on the extent and size of the procedure. Your surgeon will need to mark the size and shape of the breast
while you are standing and following the operation you may find that you have two small tubes emerging from each of
your breast so that any collection of blood can drain. These will remain in place for a short period of time. You will be
given painkillers for the discomfort you experience in the first few days. Your surgeon may encourage you to wear a firm


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bra or dressing following surgery which will continue until the stitches are removed some 10 days to 2 weeks later. You
should refrain from strenuous physical exercise including swimming, for a month and you will probably require at least
two weeks off work. Over the next 6 to 12 months the scars will gradually fade from red to pale. Your surgeon will make
every effort to make your scars as inconspicuous as possible but it is important to remember that the scars are extensive
and permanent. It is not possible to reshape droopy breasts without significant scars for although the use of breast
implants alone will improve the fullness they will not deal with any significant drooping. Breast lift will not last forever
and the effects of gravity, pregnancy and weight gain will take their toll, as will time.
Cosmetic Surgery is carried out by members of several different organisations and therefore your general practitioner is
the best person to advise you on whom you should see.


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Cosmetic facial injections
DERMAL FILLERS
Many methods and substances have been used to treat facial
wrinkles and to conceal the effects of aging on the face. In
addition to formal surgical procedures, laser treatment and
botulinum toxin there are a large number of fillers available
which can be injected as an outpatient. These are the subject of
this information sheet.
Types: Dermal fillers may be biocompatible or synthetic and are
marketed alone or in combination.
Biocompatible fillers have a perceived safety record and are
resorbable. However the period of benefit is of limited duration
normally lasting about 6 months. Synthetic fillers are permanent
but are associated with rejection, migration and granuloma
formation and are unable to change with the ageing face. In the
case of an adverse reaction removal is almost impossible to achieve. There are few indications in current practice for the
injection of synthetic fillers to the correct lines and effects of ageing. They are included for reference rather than
recommendation.
BIOCOMPATIBLE FILLERS
Ideally the effects of a filler should last about 12 months. This allows reasonable respite from the injections and also
enables accommodation of changes in the face which may occur with continued ageing.
COLLAGEN
Collagen implants are prepared from three sources: bovine, human or autologous. Collagen synthesis may also be
increased by fibroblast stimulation or injection of cultured cells.
Bovine Preparations – This comes in a highly purified or monomolecular form in different concentrations and mixed with
local anaesthetic. A test dose is required as approximately 3% of patients demonstrate sensitivity and another 1% will
develop sensitivity with treatment. In most patients it will be completely resorbed within 3 to 6 months.
Human Preparations - These are a preparation of human collagen, elastic fibres and other dermal components from
screened donors. No pre-treatment skin testing is necessary and the effects last from 3 to 12 months.
Autologous Preparations – These require skin harvest, which is processed into a collagen suspension for injection and
requires 2-3 treatments over a 3 month period. This is reported to provide greater than 75% correction for more than a
year.
Injectable Fibroblasts can be cultured from a small skin biopsy and following a test dose at one month a series of 3
injections is given at 2 week intervals. Gradual improvement occurs over 6 months and repeat injections can be
prepared as required from the original biopsy.


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Polylatic acid stimulates fibroblast production. The effect takes 4 to 6 weeks to achieve but can last for years. This should
not be injected superficially as obvious fibrous nodules can result which may be difficult to treat.
HYALURONIC ACID
Hyaluronic acid preparations (hyaluronan) are obtained by bacterial synthesis or from an avian source and are cross
linked to varying degrees to maximise viscoelasticity and persistence. They last between 6 and 9 months and although
well tolerated there is a 1% incidence of adverse reactions including granulomatous inflammation and sterile abscesses.
Synthetic Permanent Dermal Fillers
TYPES AVAILABLE
Methylmethacrylate has been used for many years as bone cement for joint replacement surgery. However in the skin
redness, inflammation and infection may occur. One preparation utilises Methylmethacrylate microspheres suspended
in bovine collagen whilst an alternative suspends them in Hyaluronic acid. These are intended to permit even
distribution of the microspheres prior to absorption of the collagen or Hyaluronic acid. A series of injections are required
to achieve the final result and allergic reactions to collagen may occur.
Polyacrylamide Gel is used alone or in combination with polyvinyl microspheres. The injected volume is reported to
diminish by one third post injection and then build up again over the next 2 months. The augmentation is supposed to
be permanent but additional injections may be required. This augmentation tends to stay soft but Polyacrylamide gel
can act as a reservoir for bacteria and has been associated with a significant delayed infection rate.
Silicone Injections are banned in most countries but are still used in France and Italy. Although giving apparently
excellent initial results, migration and inflammation are almost inevitable and the surgery then required is likely to result
in much greater aesthetic deformity than that leading to the initial treatment.


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Eyelid Surgery
The skin loses its elasticity and our muscles
slacken with age. For the eyelids this results in
an accumulation of loose skin which collects as
folds in the upper lids and forms deepening
creases in the lower lids. At the same time
there is slackening of the muscle beneath the
skin allowing the fat, which cushions the eyes
in their sockets, to protrude forward to give the
appearance of bagginess. In some families
there is an inherited tendency for bags to
develop during early adulthood before any skin
changes.
The problem often seems worse in the morning particularly with prolonged stress and lack of sleep. Fluid that is
normally distributed throughout the upright body during the day, tends at night to settle in areas where the skin is
loose, such as the eyelids. Drooping of the eyelids is also an effect of the ageing process and aggravates the
accumulation of the skin in the upper eyelids. Sometimes so much skin accumulates in the upper lids that it hangs over
the eyelashes to obstruct vision.
Bags are caused by an accumulation of fat and with age the skin stretches and the muscles around the eye weaken.
WHAT CAN BE DONE ?
An eyelid reduction (blepharoplasty) removes the surplus skin and protruding fat to produce a more alert appearance
and reduces the morning swelling. Sometimes it is only necessary to reduce the skin, sometimes the skin and the fat and
sometimes just the fat. If only the fat is being removed from the lower eyelids, then this can be removed from the inside
of the lower eyelid avoiding an external excision (transconjunctival blepharoplasty)
People who have the familial problem of bags beneath the eyes may well undergo surgery in their 20?s. Ageing effects
of the skin are apparent earlier in the eyelids than elsewhere. A reduction of the skin can be carried out from the age of
35. Patients with thyroid disease often develop eye signs which can be helped by surgery. Where there is reduced
secretion of thyroxin (hypo-thyroidism) there is an increase in fat and where there is an increase in thyroxine (hyperthyroidism) there is often so much increase in fat that the eyes protrude. An extended eyelid reduction (Olivari?s
procedure) can treat this satisfactorily.
It is important for you to understand that only the wrinkles which are in the skin which is cut away will be removed. We
are only treating the eyelids within the bony margin of the orbit (eye sockets). Folds of skin extending on to the cheek
(festoons) will not normally be improved. Wrinkles in the area of the crow?s feet will remain and although the skin is
much tighter it is still necessary to be able to open and close the eyes freely. The skin has less elasticity with age and for
proper closure of the eye the upper eyelid will need to have surplus skin when it is open. Descent of the eyebrow can be


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helped by endoscopic brow lift and an extension of this, the deep facelift, can be used to not only lift the eyebrow and
the upper eyelid, but also lift and open the outer angle of the eye.
Sometimes residual or recurrent wrinkles are suitable for treatment by chemical peeling or laser resurfacing. The
operation has no effect at all on the dark colour of the lower eyelid.
THE OPERATION
Both upper and lower eyelid surgery can be carried out under local anaesthesia or under general anaesthesia in a
hospital.
In a typical procedure the surgeon makes incisions following the natural lines of your eyelids; in the creases of upper lids
and just below the lashes in the lower lids (see illustration). These incisions are extended a little way into the crow?s feet
or laughter lines at the corner of the eyes. Through this incision surplus fat is removed and excess skin and sagging
muscle removed.
If you have a pocket of fat beneath your lower eyelids without surplus skin then the fat may be removed through the
inside of the lower eyelid.
The resurfacing laser can be used at the same time as a transconjunctival blepharoplasty to tighten the external skin and
reduce wrinkles, although there is no external scar there is residual redness in the skin which will last a few months.
Following surgery it would be best to keep your head elevated for a few days to reduce swelling. Cold compresses can
also help. The surgeon will normally apply some suture strips or steri-strips as support to the eyelids after surgery and if
these become crusted they can be replaced. Cleaning the eyes with water is useful and the surgeon may advise the use
of eye drops or ointment.
The sutures are usually removed after 3 to 5 days and soon after you will be able to use make-up. Sometimes you will be
advised to use the suture strips or steri-strips as support to the lower eyelids for a week or so.
The closure of the eyes appears tight after surgery because of the swelling and because skin has been removed. If
closure is not complete at night the patient should apply some eye ointment before going to sleep. This sensation will
settle as the swelling goes down.
The eyes appear watery after surgery, partly because of swelling under the conjunctiva (chemosis) and partly because
the tear ducts are swollen and do not drain as readily. This will last a few weeks. Although there is bruising it can quite
readily be disguised with make-up and dark glasses. The scars will be pink for a few months, but eventually they become
almost invisible.
All surgery carries some uncertainty and risk. When eyelid surgery is performed by a qualified Plastic Surgeon
complications are infrequent and usually minor. You can check that your surgeon is on the Specialist Register kept by the
General Medical Council (telephone 0171 915 3638). All members of the British Association of Aesthetic Plastic Surgeons
(BAAPS) are on the Register.
You can reduce the risks by closely following your surgeon?s instructions both before and after surgery. You should tell
him of any thyroid disease, high blood pressure, diabetes or eye disorder such as detached retina or glaucoma. It may be
that he/she will wish you to be checked by an Ophthalmologist.


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Occasionally a pool of blood can collect under the skin after the operation has finished (haematoma) this usually
disperses spontaneously over 2 or 3 weeks but it may need to be drained if it is large. Quite commonly the margin of the
lower lid is slightly pulled away from the eye during the first day or two after surgery due to swelling. This will settle on
its own or with the help of suture strips or steri-strips. Very occasionally another operation is necessary.
Sometimes tiny white cysts can appear along the stitch line. They are nothing to be concerned about but can be pricked
out with a needle. Blindness is an exceptionally rare complication.


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Facelift
As part of the aging process which happens to all of us sooner or
late, our skin progressively loses its elasticity and our muscles
tend to slacken. The stresses of daily life, effects of gravity and
exposure to sun can be seen on our faces. The folds and smile
lines deepen, the corners of the mouth droop, the jaw line sags
and the skin of the neck becomes slack. Around the eyes, the
eyebrows droop and the skin of the eyelids gathers in loose folds.
In the skin the first sign is fine wrinkles developing around the
lips, at the outer corners of the eye and lines of expression. The
rate at which this happens varies from one person to another and
is probably determined by our genes. Aging of the skin of the face
does not necessarily reflect the rate that the rest of our body and
mind is ageing and many people feel frustrated that the face they
see in the mirror is not the one they feel should be there.
Substantial weight loss can produce similar changes in facial
appearance to those of the aging process.
WHO WILL BENEFIT FROM A FACELIFT ?
The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose
bone structure is strong and well defined. Most patients are in their 40′s to 60′s, but facelifts can be done successfully on
people in their 70′s or 80′s.
It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a
procedure that technically works well but also increases morale and is well appreciated by the patient.
WHAT A FACELIFT DOES NOT DO?
A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows
and wrinkles of the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles,
freckles and rough areas will benefit more by chemical peel or laser resurfacing.
WHAT SHOULD YOU DO BEFORE THE OPERATION ?
If you are overweight and intend to lose it you should do so before the operation. This allows the surgeon to remove
more skin and therefore achieve a more pleasing result. You should avoid taking tablets containing aspirin and non
steroidal anti-inflammatory drugs such as Voltarol and Indocid for at least two weeks before surgery as they increase the
risk of bleeding.
You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases
circulation of the skinflaps, particularly behind the ears.
Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a
few weeks.


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THE SURGERY
A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. It is possible to carry
out the procedure under local anaesthetic and intravenous sedation but the patient would still be advised to spend the
night in hospital. The procedure, although long, can be combined with other operations of all sorts. The most common
however would be an endoscopic brow lift and an eyelid reduction. Other extra procedures which can be used to
enhance the face at the same time are malar (cheek bone) and chin augmentation and lip enhancement.
This is an extension of the forehead lift which is designed to tighten the skin of the upper half of the face, as opposed to
the standard facelift which helps the lower half of the face. The Deep Facelift carried out endoscopically avoids the same
ear to ear incision. It is usually carried out at a younger age than the standard facelift. It tightens the skin of the mid-face
and freshens the eyes, opening and lifting the outer angle and reducing the wrinkles of the crows feet. There will be
swelling around and below the eyes which gradually resolves in about a month. There will also be scars beneath the
eyelashes of the lower eyelid and sometimes in the upper gum line. There is a slight risk of damage to the nerve which
supplies the muscles of the forehead. This weakness is usually partial and temporary, on rare occasions it may be
permanent.
Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, or just
inside the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear
and off into the lower scalp. Occasionally it may be necessary to make a small incision under the chin. Sometimes only
the skin is lifted following separation from the underlying platysma muscle.
More usually however the platysma muscleand its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to
the solid structures in front and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a
single layer, but will still be sutured separately. Fat along the jaw line and under the chin may be removed by liposuction
or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards, just as
when one lifts the skin when looking in the mirror. Sometimes drains are inserted. Most surgeons will bandage the face
to minimise bruising and swelling. These bandages will stay for one or two days and the sutures are removed in 7 to 8
days.
After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck.
Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the
skin of the cheeks and ears. This will usually disappear in a few weeks or months. It is better to keep the head elevated
for a couple of days to reduce swelling. Drainage tubes will be removed a day or two after surgery. Avoid strenuous
activity, saunas and massage for at least two weeks.
At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can be very well hidden
by women with their hair and disc shaped earrings so that they should be able to resume work and social activities
within a couple of weeks. Camouflage make-up can be helpful in masking bruising.
Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also
behind the ear where the skin has been lifted.
The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may
be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and
repeated facelifts are being carried out.


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HOW LONG DOES A FACELIFT LAST?
A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in
that you will not look as old as you would have done if it had not been carried out.
CHOOSING YOUR SURGEON
A facelift is a skilled procedure and we would recommend that you choose a surgeon who has undergone a full training
programme for cosmetic surgery. These surgeons will be on the Specialist Register in Plastic Surgery at the General
Medical Council. All members of the British Association of Aesthetic Plastic Surgeons (BAAPS) are on the Specialist
Register.


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Lip Enhancement
This is suitable for anyone who would like larger or fuller lips. In addition there are people who were born with
abnormalities of the lips or who’s lips have become deformed for one reason or another in later life.
PROCEDURES AVAILABLE
There are a large number of different procedures to choose from but they can be grouped together.
Temporary enhancement Many substances have been used to temporarily enlarge the lips. These substances are
primarily injected under the white line. That is the white hair free line which outlines the vermilion (red mucosa) of the
lip and is distinct from normal lip skin. This gives a pouting (Paris) lip. (see illustration). The bulk of the lip can be
increased by injections into the muscle but these tend to dissolve at a faster rate. The commonest material used is
collagen for which an allergy test is required. Recently hyaluronic acid gel (Hylaform,Restylane) has been used. All these
dissolving substances need to be topped up every 3 to 6 months.
FAT INJECTION
This is usually considered to be
temporary. It has the advantage that
one is using the patient’s own tissue
and therefore there will be no allergic
reaction. The fat is collected either as
part of some other liposuction
procedure or harvested specifically for
the purpose of augmentation of the
lips. Usually it is taken from the
abdomen or buttocks. It can be stored
in the fridge for later use for many
months. Injection of fat does cause
more temporary swelling (bee sting
lips) than the injection of other
substances.
Permanent lip enlargement using the
patient’s own tissue
Dermis, or the deeper layers of the skin, has been used as a graft for many years, but recently has become popular for
lip enhancement. The tissue is harvested as a by product of some other operation where it would otherwise be
discarded – e.g., abdominal reduction, breast reduction, facelift, etc. The epidermis or outer skin is removed and the
shaped dermis threaded through from one side of lip to the other. The advantage is that this tissue takes well as a graft
because it is the patient’s own tissue therefore there will be no problems of allergy. The graft may not take fully and
there will be some thinning of the dermis with age. However, good results can be achieved. It is a bigger procedure,
producing more swelling for longer (one to three weeks) and can also create complications of infection and bleeding, as
in any operation. An alternative graft to dermis is fascia (the covering of muscle). This can be the temporalis fascia from


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the covering of the temporalis muscle under the scalp at the temple, or from elsewhere. Lip enhancement by injection
or graft is limited by the amount of vermilion or mucosa of the lip that is available. Some older people have very limited
amounts of vermilion.
SURGICAL ADVANCEMENT OF THE VERMILION
The mucosa of the inner side of the lip can be advanced downwards to make a fuller lip or even advanced downwards
and round to replace normal skin. This last operation will however destroy the normal white line. These reconstructive
procedures tend to be used to treat congenital deformities and those acquired through injury or disease.
WHICH PROCEDURE IS THE BEST?
There are many procedures that can be used to enhance the lips. Some patients prefer temporary ones as they can
change their minds. They may also wish just to try the appearance of larger lips as a preliminary to something more
permanent. Many patients and surgeons will prefer to use the patient’s own tissue, although the injections are simpler.
The choice will depend very much on the patient’s wishes and the surgeon’s experience.


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Liposuction
Liposuction, also known as liposculpture or suction assisted lipectomy, is a technique to remove unwanted fat deposits.
The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the
body, most commonly the hips. Other areas include; the neck, arms, tummy, loins, thighs, inner side of the knees and
the ankles. The growth of a benign fat tumour (lipoma) can also be a disfigurement, and in men fatty swellings can
develop under the nipples to look like breasts (gynaecomastia).
WHAT CAN BE DONE ?
If you have a
localised area of fat
it is possible to
reduce its bulk by an
operation
called
Liposuction.
A
narrow metal tube is
inserted through a
small incision in the
nearby skin. It is
attached to a strong
vacuum pump which
is drawn back and
forth within the area
of excess fat. The
process
removes
tunnels of fat leaving
the small blood
vessels and nerves intact. The skin will then retract.
There are some minor variants in the techniques. Some surgeons inject the area to be treated with solutions (wet or
tumescent technique) others do not. Suction is usually applied with a powerful vacuum machine, but it is some-times
perfectly adequate to use a simple syringe for small areas. Ultrasound assisted lipectomy is another variant.
You can expect considerable bruising which will be uncomfortable and at times painful. The larger the area treated the
greater it will be. Some people bruise more easily than others. The discoloration of this bruising will usually last for
about a month, but the lumpiness and swelling of deep bruising can take up to six months to disappear, particularly
when the abdomen or ankles have been treated.
As swelling can take a long time to settle you may not see the full benefit of the operation for up to six months. Rarely, a
greyish stripe can discolour the skin for several months and is more commonly seen when the ankles have been treated.
If you have a tendency to be anaemic, or if you were to have a large area treated, you may need to take iron tablets for a
month. You can expect some numbness in the treated skin which lasts for several months.


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You will have small scars 1.0 to 2.0 centimetres long at the sight of insertion of the suction cannulae. There is a small risk
in some people that these scars may stay red for a while but they are usually sighted in less obvious areas.
If you are having treatment to your legs you may find that your ankles are swollen for a few weeks and if your ankles
themselves have been treated, they may stay swollen for a few months.
WILL IT LAST ?
Fat cells are thought not to be regenerated in adult life. Therefore their removal by liposuction will give a permanent
change in contour and be independent of any changes in your body weight.
A snug pressure garment is worn after surgery around the lower part of the body to help reduce swelling.
It is important for you to understand that liposuction is not a treatment for obesity. The amount of fat that can be
removed from a localised area is limited by what is safe (maximum of 3 litres) and a natural limitation when no further
fat can be removed. Therefore it may not be possible to slim down an area as much as you might like. Further
treatments may be carried out in the same area after six months. In certain situations the skin is inelastic and loose.
Liposuction in these areas will then tend to leave the skin more loose and it may be recommended that a skin excision
be carried out to correct this, either at the same time as the liposuction, or as a second procedure. This is most likely in
the abdomen, after pregnancy or weight loss, the buttocks or the neck. Dimples and wrinkles of the skin, sometimes
called cellulite will not be improved by liposuction.
WHAT SHOULD YOU EXPECT AT THE TIME OF YOUR OPERATION?
The procedure is normally carried out under general anaesthesia as a day case. You may wish to stay the night if you
have had many areas treated. An epidural is an alternative for the lower part of the body, but a local anaesthetic alone is
only suitable for small areas as it is uncomfortable to administer and does not work particularly well.
You are likely to need simple pain killers for a day or so after the operation and you will probably be asked to return a
week after surgery to have sutures removed. A snug pressure garment or corset is usually advised around the lower part
of the body. This is used to reduce bruising but can be taken off to wash, quickly dried and put back on. You can take this
opportunity to bathe yourself. The corset is usually worn for two to three weeks.
You will only need to take a few days off work if a small area is treated, but larger areas may necessitate 7 to 10 days off
work. You may be somewhat anaemic and need to take iron. You are welcome to sunbathe but remember that
discoloration of bruising will last about a month and you will not achieve your best appearance for three to six months.
The large majority of patients who have this operation done by an experienced surgeon run into no problems at all. You
should, however, take into account the following: Any major operation which is done under general anaesthetic carries
with it a small risk of infection and thrombosis of the veins. Heavy bruising can happen particularly in patients who have
a tendency to bleed or have been taking aspirin or anti-inflammatory drugs. Serious infection is very rare, but there is
sometimes inflammation in the areas that have been treated with perhaps some oozing from the incisions. It normally
settles with a course of antibiotics. Thrombophlebitis (which is an inflammation of the veins and not the same as
thrombosis) can occur around the inside of the knee and inner part of upper thigh when these areas have been treated.


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It gradually settles over a period of weeks. The surface contour over the treated areas can sometimes be irregular
particularly if a lot of fat has been removed but if the technique is properly carried out these irregularities are minor.
Occasionally the skin appears to be tethered to the deep tissues, this is part of the bruising and will settle in time. Risks
will be reduced by choosing a surgeon who is an accredited plastic surgeon trained in Liposuction. Members of BAAPS
are all on the General Medical Councils Specialist Register in Plastic Surgery.
WHAT SHOULD YOU DO BEFORE THE OPERATION ?
You should avoid aspirin and anti-inflammatory drugs for 2 weeks before the operation. You should take iron if you are
anaemic. Occasionally your surgeon will advise you to stop taking the contraceptive pill if the liposuction is going to be
extensive, perhaps involving skin excision.


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Rhinoplasty
Reduction Rhinoplasty “nose job” to reduce the size of the nose
Surgery to reshape the nose is a very common plastic surgery procedure
and it can both increase or decrease the size of nose. The shape of the
tip, the bridge and also the nostrils can be changed as can the angle
between the nose and the upper lip. Sometimes breathing difficulties
can be corrected at the same time.
The nose is the central feature of the face, many people are selfconscious of shape which they may regard as too big, too small or have
some other feature which they dislike. The characteristics of the nose
are inherited from parents and develop during adolescent years. It
continues until the age of 16, when the nose stops growing. It is,
therefore, unwise to operate before this age.
WHAT CAN BE DONE ?
An operation called Reduction Rhinoplasty reduces the size of the framework of the nose over which the skin is draped.
The skin itself is not touched. The frame of the nose which is made up of bone in its upper half and gristle (cartilage) in
its lower half is approached from underneath the skin through cuts which are made inside the nostrils. Think of the
frame of the nose as being like the roof of a house. In order to straighten the nose and bring its bridge closer to the face,
its “ridge” is cut away. Then, to restore a new ”ridge” or bridge-line, the two sides of the nose are bought together by
cutting the bones of the nose where they join onto the cheek bones. The elasticity of the overlying skin allows it to
shrink down on the smaller frame.
This operation effectively narrows the width of the nose. If doing so makes the nostrils seem too wide, it may be
necessary to narrow them as well by cutting out a small piece of skin in the floor of the nostril which would leave a fine
scar on each side. It is also possible to shorten the nose and to slim down a bulky tip by reducing the amount of cartilage
which shapes the end of the the nose. If you have some difficulty breathing through your nose, it may be possible to
improve this at the same time by adjusting the lie of the plate of the bone which separates one half of your nose from
the other. This is referred to as a Septoplasty. Sometimes the size of the nose as a feature of the face is influenced by
the proportions of the other features, such as the chin and the cheek bones, and to ”normalise” the appearance of the
face it may be advisable to alter these features as well, either at the same time as the rhinoplasty, or during a separate
operation.
There is always some bruising and swelling, particularly around the eyes, which can take up to three weeks to
completely disappear and you would need to wear a firm splint over your nose during part of this time. By the end of
three weeks, swelling will have settled sufficiently for you to look normal to others and as if you had not had recent
surgery. Indeed, it is likely that you will be surprised by the absence of other people’s reactions to the fact that you have
a new nose. They, of course, have not been self-conscious of your nose as you have been. If you have any anxieties


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about family and friends noticing a change in your appearance, change your hairstyle at the same time and they will
think it is that which accounts for your new looks.
It is worth anticipating your own reaction to the first sight of yourself and your new nose. To start with, you will look
rather strange in the mirror and not quite ‘you’ because of your different nose. Remember that it takes a few days for
your mind’s eye to adjust itself to your new appearance and to recognise it as ‘you’. You should also bear in mind that it
takes a good three months or more for all the swelling to settle out of the nose so, if there are any minor problems of
shape soon after the operation, do not worry, they will almost certainly improve with time. Your nose will also feel
rather numb and stiff for several months, particularly around the tip.
The object of the operation is to make your nose look right for your eyes so that you lose your self-consciousness of it. It
is, therefore, most important that you are clear in your mind what it is that you dislike about the appearance of your
nose and that you are able to explain this to your surgeon. He or she will then be able to tell you what is surgically
possible and what is not. For instance, if the skin on the tip of your nose is thick and oily, it may not be possible to
reduce its bulky appearance as much as you might like because, generally speaking, it is not possible to thin the skin
without leaving scars.
If you are in middle age or if you have a very large nose, there may be a limit to the amount of reduction that can be
achieved to the size of your nose within the limitations of the elasticity of your skin to shrink down on the smaller frame.
If your nose is bent from previous injury, it may not be possible you make it perfectly straight. Large nostrils can be
difficult to reduce without cutting the skin and leaving noticeable scars.
Like any operation that is carried out under general anaesthetic, there is a small risk of chest infection, particularly
among people who smoke. There is a small risk that infection could complicate the operation. You can minimise this risk
by ensuring that you are free from cough, cold or sore throat at the time of your operation and, if you have any doubts,
you should contact your surgeon.
Occasionally, the operation is complicated by heavy nose bleeding either shortly afterwards or after a week to 10 days
which may require treatment in hospital.
It is quite common for there to be some difficulty with breathing through the nose during the first week after the
operation which disappears as the swelling settles. occasionally, though, the difficulty persists and can be permanent.
Sometimes (in about 10% of patients) the nose does not look right for the patient after all the swelling has settled. In
these cases, it is usually possible for the surgeon to carry out a second operation to the residual problem of appearance
but, not until all swelling has settled from the first operation. Most surgeons wait for a year for this to happen.
Secondary surgery like this may involve additional expense.
WHAT CAN YOU EXPECT AT THE TIME OF YOUR OPERATION?
Most British surgeons prefer to do this operation under general anaesthetic and you will need to be in hospital at least
overnight. The operation is remarkably painless and it is unlikely that you will need anything other than mild painkillers
afterwards. It is, however, uncomfortable because you will probably have dressings in each nostril for a day or two


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which prevent you from breathing through your nose. You will also have a firm splint over your nose to hold the bones
in their correct position.
WHAT YOU SHOULD DO WHEN YOU GO HOME ?
You can expect to have some minor bleeding from your nose for the first day or two after your operation and you should
dab this away gently with gauze squares or a clean handkerchief. Keep your head up as much as possible and avoid
having hot baths. Do not blow your nose and try your best not to sneeze through your nose. If you are going to sneeze,
cough it out. Once the dressings have been removed from the nostrils, you can clear your nose by sniffing into the back
of your throat if you wish. Unless you are advised otherwise, it is better to leave any crusts in your nostrils until you see
your surgeon for removal of the splint 1-2 weeks after the operation.
Although there is no medical reason for you to stay away from work for more than a few days, you will probably feel
more comfortable if you take two weeks off and go back when the bruising has gone. Cosmetic Surgery is carried out by
members of several different organisations and therefore your general practitioner is the best person to advise you on
whom you should see.


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Setting Back Prominent Ears
Approximately 1 to 2% of the population in the United Kingdom consider their ears to be too prominent. In many cases
the shape and lie of the ears is inherited, and a family trend can be seen. The most prominent ears often lack a normal
fold, and sometimes one ear is more prominent than the other. People with prominent ears are sometimes teased,
particularly during their school years, and this can lead to a loss of self confidence.
WHAT CAN BE DONE ?
When an ear is noted to be prominent within the first few
weeks of life, it is possible to reshape it by applying a small
splint to the rim. The cartilage or gristle of a new-born?s ear is
very floppy and easily remoulded and after several weeks of
splintage a permanent correction can be achieved. The older
the child, the more stiff is the cartilage and the longer the
period of splintage must be. By the age of six months the
cartilage is too hard to be remoulded and a surgical solution is
required.
Pinnaplasty or Otoplasty is an operation which adjusts the shape of the cartilage within the ear to create the missing
folds and to allow the ear to lie closer to the side of the head. Because the operation is carried out from behind the ears,
a small scar is left close to the groove between the ear and the side of the head. The procedure can be carried out under
local anaesthetic, but in young children a general anaesthetic is usually required. Where the lobe of the ear is especially
large, a small procedure to reduce its size may also be required.
A small protective dressing is usually worn after the surgery until the stitches are removed at between 5-10 days after
surgery. Once the dressing has been discarded, it is wise to wear a protective head-band or bandage when sleeping to
avoid the ears being bent forward against the pillow. The ears are often sore and tender for several weeks and
painkilling medication such as Paracetamol or Codeine may be required. Other drugs such as Aspirin or Nurofen can
occasionally cause unwanted bleeding following the surgery and should be avoided. The scar behind the ear usually
settles well, but on rare occasions it can become red and lumpy. A small number of patients, particularly those who are
very sensitive about the precise shape of their ears, may require a minor adjustment procedure. The vast majority of
patients, however, are well pleased by the result, and the procedure has a high satisfaction rate.
WHAT YOU SHOULD DO AFTER THE OPERATION ?
The hair can be washed after the dressing and the stitches have been removed. It is important to keep the grooves
behind the ears clean.
The operation is most often done during childhood, but it is best to operate when the patient is 5 years old or more, as
until then the cartilage is very floppy and does not hold the stitches well. It is recommended that although parents may
feel that their child?s ears should be corrected to avoid teasing and stigmatisation it is best to wait until the child


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recognises the problem and wants the ears corrected. Children are generally more co-operative and happy with the
outcome when they fully understand why the surgery is taking place. Pinnaplasty is also performed during the teenage
years and in adult life, when either a local or general anaesthetic can be used.
In children the operation is carried out under general anaesthetic, and this carries with it a very small risk. In a small
number of patients (approximately 3%) the scars can become thick and red, and may require further treatment.
Infection is not common, but should this occur it would require treatment with antibiotics and regular dressing changes.
Sometimes the dressing can chafe the ears to produce a break in the skin which can take a long time to heal. There is a
small risk that the repair may not hold properly, and further adjustment surgery is occasionally required. The ears are
often a little numb after the procedure, and this usually takes several weeks to settle.
Cosmetic surgery is carried out by members of several different organisations and therefore your general practitioner is
the best person to advise you on whom you should see.


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Getwell Soundarya Cosmetic surgery

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Getwell Soundarya Cosmetic surgery