Aesthetic Surgery
Aesthetic surgery also called “cosmetic surgery” is a natural extension of the general practice of plastic surgery. The term plastic surgery originates from the French term “plastique” or to mould shape or form rather than anything to do with the material! To correctly perform these procedures a thorough knowledge of anatomy is required as well as an understanding of both the normal processes of skin and tissue ageing as well as the correct means to address these and other causes of anomalies such as injury or previous surgery. Plastic surgeons are unique in that we perform operations from the scalp to the toes and everywhere in between. We fully understand the techniques that work in one area and nor another and are fully versed in the various options and not limited to one site or technique.
In general aesthetic surgery is broken down by the different sites around the body but sometimes more than one will be addressed. Most of these procedures are performed under general anaesthetic but some smaller interventions use local anaesthesia if appropriate. Depending on the procedure patients may need to stay one- or two-nights following surgery whilst for some they may go home the same day. This will depend on the extent of the surgery and the patient’s health and specific requirements.
The Face
Around the face the commonest cause is age-related laxity of the skin and volume loss of both fat and muscles. Anatomy is as always the key and the limits of the surgery must be understood and respected
Eyelids: The surgical correction of both upper and lower eyelids is termed “blepharoplasty”. Surgical scars are hidden in the natural creases around the eyes and usually settle well in most patients
Cheeks and neck: a ”face-lift” or “neck-lift” or combined surgery attempts to both tighten and lift the skin that is draped across the muscle and bones of the face by first partially releasing it and then removing the excess whilst minimising the scars with placement in lines where they will be least noticeable
The forehead: a brow-lift is performed through either small or mostly well-hidden incisions that allow safe access to the tissues that require tightening. Similar to a face-lift type procedure, the skin is partially released and brought upwards toward to scalp, re-anchored there. A brow-lift can have a dramatic effect on not just the forehead and eyebrows but also on the upper eyelids. For many patients considering upper eyelid surgery a brow lift may be more appropriate after careful assessment.
Injectables
Broadly speaking two forms of injectables are used either Botox (botulinum toxin) which is used to selectively weaken the action of certain muscles around the face which calls rhytids (wrinkles). Poorly performed Botox can result in excessive weakness of these muscles resulting in a “frozen face” or drooping of the eyelids which can be glaringly apparent to even the casual observer. The second common injectable group are “fillers”. These are used to correct defects in the skin superficially or in the other soft tissues when used more deeply or in a combined fashion. These can introduce volume to an area which due to ageing or other conditions has become flattened or hollowed out. All modern licensed fillers are temporary and can last a variable amount of time depending on the product used and the location. The excessive use of fillers as many people will be aware of can result in a quite grotesque appearance which is not cosmetically desirable and may in fact damage the tissues. Some pain and bruising are to be expected with this surgery and exercise or strenuous activity should be avoided for 48hrs. Patients on anti-coagulants/blood thinners are especially vulnerable.
Breast
Three common conditions are seen in breast aesthetic practice these include:
Excessively large breasts: surgical correction is a must play a role breast reductionwhich functionally cause pain around the neck and shoulders, poor posture (and lower back pain), difficulty with obtaining correctly supportive bras and restrictions on the type of clothing that can be worn without being excessively self-conscious. All these can lead to both physical and psychological symptoms for women in all age groups. Breast reduction surgery has evolved significantly over many years and a number of different techniques are now used again depending on the individual patient’s anatomy and ultimately their aims for the surgery.
Excess breast laxity: the term used for this surgery is mastopexy or a “breast-lift”. This form of drooping occurs both as part of the ageing process and in conjunction with normal life events such as pregnancy and breastfeeding. For many women this results in loss of the volume of the breast combined with excess laxity of the skin causing the breast to droop when not supported. The aim of surgery in this condition is to preserve the remaining breast tissue while tightening the skin and will usually require correction of the position of the nipple accordingly. Occasionally, the volume loss of breast tissue is so excessive that it may be combined with breast augmentation called a “mastopexy-augmentation” to correct the two problems of drooping and losts volume snd shape of the breasts.
Relative underdevelopment of breast tissue is also a common problem and is usually addressed after puberty has failed to give an adequate feminine shape for the patient. For some women, small breasts are absolutely perfect whilst for others it can affect their self-confidence, self esteem and their ability to wear certain clothes. Breast augmentation surgery, as with all procedures, is a tailored process and needs to reflect not just the patient’s requirements but also their natural breast tissues and the experienced advice of their surgeon. Absolutely vital parameters include the patient’s general body shape as well as reasonable expectations to provide a natural look and avoid an artificial appearance. The placement of implants in the correct position and with an appropriate size is critical for a good result and is agreed well in advance of surgery. The majority of patients have very realistic aims this will typically mean a change in cup size from an A to a C and will not result in anything unnatural.
Breast surgery will usually require a period wearing a surgical support bra followed by an addition period wearing a tight sports bra for a number of weeks after surgery. Unlimited post operative care with your personal consultant is part of the package and unlike traveling abroad for your surgery you have the peace of mind of having a fully trained, specialty registered plastic surgeon looking after you.
Abdomen
Surgery on the abdominal wall below the chest is usually directed at tightening excessively lax skin and the underlying muscles of the abdominal wall. A combination of ageing, pregnancies, weight loss and possibly surgery may have resulted in a flap of skin hanging down over the groin at worst but for others it may just be more diffuse loose skin and wrinkling. Some patients will have noted a weakness in the centre of the abdominal wall where a “sixpack” should be on a bodybuilder but instead there is a gap called a rectus diversification which can give the appearance of a pot belly despite the patient not being overweight!
The key to successful abdominoplasty is not just the surgical technique and recovery but also to correctly select the patients for whom this surgery will deliver great results. With Paul, you will not be given “quick fixes” but honest advice about whether you are actually suitable for a particular procedure and not just taking advantage of unrealistic expectations. Following massive weight loss techniques may need to be adjusted to account for excess skin at the sides of the abdomen and not just in-front. The surgery works optimally when the tissue to be removed is mainly skin without excessive amounts of fat. Most patients will usually present in good health without excessive weight but with folds of skin that are completely resistant to their best efforts with diet and exercise. A number of week is needed for an adequate recovery from this type of surgery and is dependent on work and home requirements which should be discussed. Excessive tightening increases the risks of wound healing issues and other complications. For some patients, prolonged periods of excess weight will have resulted in significant medical issues which may need to be addressed and accounted for both before and after surgery.
Legs and Arms
The correction of excess skin folds in the arms is termed “brachioplasty” and in the thighs a “thigh-lift”. For most patients it is occurred due to significant weight loss when fat has been lost and the skin has been excessively stretched but does not return to its original shape leaving bowls that are unsightly, difficult to hide and interfere significantly with the type of clothing that patient can wear. Following enormous efforts to lose weight and improvements in general health this surgery can be useful in completing the patient’s transformation and improving their psychological well-being.
Liposculpture
My liposuction is not a cure for excess weight but is more selective in targeting areas where despite a normal or near normal weight persistent areas of fatty tissue remain despite all efforts by the patient to correct it with diet and exercise. It aims to remove volumes of fat while maintaining the overlying skin which can hopefully tighten as the healing process progresses. Bruising and the need to wear compression garments for a number of weeks post-operatively are features of this surgery.
In General
All these interventions have certain pros and cons and are very much individualised to the patient and not any strict pro forma and will be discussed in detail at the time of consultation. Initial consultations are detailed and the patient will then be asked to think over what was discussed and return a few weeks later for a further consultation at which time any additional questions can be answered and a decision made on whether to proceed or not. The first consultation is just that: an opportunity to discuss the patients concern and for the surgeon to give an opinion on how best to address this. There is absolutely no obligation to go ahead by either party with any intervention unless the patient and surgeon are 100% happy to do so after the second consultation. Adequate time is essential for the patient to consider all the factors involved such as the recovery period, home and work commitments, the expected side-effects as well as the risks and complications that are associated with these procedures.
It may not be possible to meet a patients expectations even if the surgery has gone according to plan and this is usually best addressed beforehand rather than afterwards; reasonable patient expectations will usually be met but cannot be guaranteed and sometimes results are not ‘perfect’ despite the very best efforts.