What is an Endoscopic Browlift?

An endoscopic browlift is an operation which lifts the lateral ends of the eyebrows, removing the skin folds and improving the crows feet appearance at the outer corner of the eyes.

This operation used to be done by making a long cut across the top of the head in the hairline. This left a huge scar and gave the operation a bad reputation, despite the good results on the eyes and brows.

Modern surgical methods have enabled these same results to be achieved without this huge scar. Keyhole surgery is now used to lift and anchor the lateral eyebrows. This results in three or four tiny scars (less than 1cm each) which are hidden by the hair.

 What are the limitations of the endoscopic browlift operation?

An endoscopic brow lift is not a good idea for those ladies who have a very high hairline. This is because the hairline is also lifted slightly during this procedure. If a woman has thinning hair then the resultant scars, even though they are small, may be more obvious.

 Are brow-lifts available on the NHS?

Generally speaking, browlifts are not available on the NHS.

 Some pre and postop photos

 How is the operation done?

The operation is done under a general anaesthetic (with you asleep). Three or four 1cm long incisions are made just inside the hairline above the brows. A tiny surgical telescope is inserted through one incision and a special ‘dissector’ is inserted through the other. The forehead skin and muscle are then released from the underlying skull bone, right down to the upper and outer part of the eyelid. The brow is then simply pulled up to tighten the tissue around the eye and the skin is then anchored into this new position. A number of anchoring devices are available, ranging from simple screws and staples, to absorbable synthetic plates – a bit like carpet grippers!

Tissue glue may be sprayed under the skin to allow the skin to stick down, avoiding bleeding, minimising bruising and swelling and avoiding the need for any drains. Metal staples are used to close the tiny skin wounds in the hairline. No dressings are required.

How long is the operation?

An endoscopic browlift usually takes about 1 – 1½ hours.

How many days in hospital?

Most women undergoing an endoscopic browlift may go home from hospital on the same day, but an overnight stay is available if required.

Postoperative period in hospital

You should rest as much as possible for the first 24 hours after surgery. It is wise to sleep with some extra pillows to minimise swelling and avoid frowning (as this pulls the brow down). It is often a good idea to combine a browlift with Botox to temporarily weaken the muscles at the corners of the eyes so that they are not able to exert any downwards pull on the browlift in the early days after surgery.

Depending upon the type of brow fixation, you will be able to wash your hair the day after being discharged, but must ensure you dry it carefully with a hairdryer on a low heat setting (your nerves will have been disturbed and it is easy to burn yourself without being aware of it).

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse six days after your operation. She will check that your wounds are healing satisfactorily. You will return a week later and on this visit, the metal staples in your scalp, and, if screws have been used to fix the brow, these will be removed. This is a painless procedure, so do not get too anxious about it. If the wounds have healed satisfactorily, you will be given an appointment to see me six weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall simply arrange to see you for a final appointment in about six months.

What are the possible risks?

Any surgery has the potential for complications. Although an endoscopic browlift is generally a very safe procedure, it does carry the following risks:

Bleeding: bleeding is uncommon but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. Should a bleed occur under the skin, the face may swell quite dramatically, it can be quite painful and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.

Infection; infection is uncommon and results in swelling, redness and tenderness along the wounds at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics.

Ugly scarring: most wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is very uncommon, but any wound breakdown which occurs in the early postoperative period may result in a slightly stretched, flat scar.

Delayed wound healing; This is not a disaster, but can leave a somewhat wider scar. Delayed wound healing is more common in smokers and you are strongly advised to stop smoking before your operation, and not to start again (if you must!) until the wounds have finally healed.

Alopecia: again this is rare, but if part of the skin which is damaged due to poor blood supply is hair bearing scalp, the hair follicles can die resulting in a bald patch.

Eyebrow weakness: this is the worst complication of a facelift. The facial nerve lies just beneath the SMAS layer, and if it is stretched or cut during the facelift, one or more of the facial muscles may be weakened. This nerve is injured in about 0.5% (one in 200) facelifts. Fortunately, most nerve injuries recover on their own after 2 or 3 months, but weakness can occasionally be permanent.

Altered sensation; when the forehead skin is lifted the nerves to the skin are often stretched or even cut. The skin of the upper forehead and scalp may be numb after the operation. Initially the patch of numbness may be extensive, but gradually the size of this area of numbness will shrink to recover completely or to just leave a small area of altered sensation in the scalp. It can take up to 2 years for this to recover. During this time, it is possible to injure or burn this skin without realising it. For this reason you should be careful when using hot hairdryers.

Irregularities beneath the skin: high tension stitches are used beneath the skin to hold the face up and sometimes firm areas or lumps can be felt beneath the skin of the cheeks. This can be softened after 6 weeks or so by regular massage, and these areas usually settle completely.

Asymmetry or recurrent slumping of the eyebrows: this is uncommon, but if the anchoring ‘slips’ during the early healing phase, the brow on one side may drop a little.

Postoperative Advice Sheet

What is a facelift?

A facelift is an operation which tightens the skin of the lower half of the face and neck resulting in a more youthful appearing face.

Who will the operation help?

A facelift is very good at reversing the following signs of aging:

•   Sagging cheeks
•  Sagging jowels
•  Sagging neck

 What causes these signs of aging?

The skin and soft tissues of the face are held in place by ligaments (see picture). With age, as a result of:

a) the continual effects of gravity,

b) the reduced amount of fat beneath the skin and

c) the tissues becoming more lax,

the skin of the face starts to sag between the fixed ligaments, resulting in the classic signs of aging (see picture).

Who will the operation NOT help?

A facelift does not rejuvenate the eyes and does not have any significant effect on the skin around the mouth area.

What are the limitations of the facelift operation?

When planning a facelift operation it is important to consider the whole of the face. The aim is to maintain, or achieve, facial harmony. As a facelift only tightens the skin of the lower half of the face, the upper half of the face (the forehead and eyes) may then appear to look “older” in contrast to the rejuvenated lower face. For this reason, people undergoing a facelift often combine this procedure with an endoscopic browlift and eyelid surgery (blepharoplasty).

Sun damage to the skin of the face is one of the main factors which can lead to accelerated aging. A facelift only tightens the skin of the face, it does not reverse the effects of sun exposure. However, it is possible, in many cases, to improve the signs of sundamaged skin by a daily skin care protocol using Retinova.

Are facelifts available on the NHS?

Generally speaking, facelifts are not available on the NHS.

Before and After photos

What types of facelift are available?

There are several types of facelift available, each has distinct advantages and disadvantages and the most appropriate method to achieve your desired outcomes will be discussed with you at consultation.

•  Subcutaneous facelift: this was the earliest type of facelift, in which the skin of the cheeks and neck is undermined and pulled up. Any excess skin is trimmed off and the wounds closed. This is fairly quick and safe, but unfortunately the results are not very long lasting, as the skin and scar stretch after about 1 year.
•  SMAS lift: this is the most popular type of facelift and is described below. It involves the most surgical dissection of tissues and takes the longest to recover from, but offers the best and longest lasting results.
•  Mini-facelift: the facelift operation can be tailored to an individuals requirements and some patients request a mini-facelift, which involves far less surgical dissection, fewer complications and a faster recovery time, the disadvantage is that the “lift” is not as dramatic.
•  MACS lift: is a newer type of facelift which involves less dissection of the cheek skin and then a simple lift of the SMAS layer. Because of the limited dissection it is safer, faster and the recovery period is shorter. It is very effective for the cheek and jowel area, but the main limitation of the MACS lift is that it does nothing to improve the neck area.

How is the operation done?

The operation is done under a general anaesthetic (with you asleep). A 3cm long incision is made just underneath and behind the chin, to keep the scar hidden:

 and through this incision any excess fat under the chin is removed and the muscles beneath the chin are tightened. Then an incision is made in front of and behind the ear and the skin is carefully lifted off the cheeks. A second deeper layer (the SMAS layer) is then raised and it is this layer which is used to lift the face.

This layer is stitched up into its new position and finally the skin is redraped and trimmed as necessary. Tissue glue is sprayed under the skin to allow the skin to stick down, this avoids bleeding and the need for any drains. Metal staples are used to close the skin of the scalp and removable stitches are used to close the facial skin. The wounds are then dressed with a bulky cotton wool and crepe dressing.

How long is the operation?

A SMAS facelift usually takes about 3 – 3½ hours.

How many days in hospital?

Most women undergoing facelift surgery stay in hospital overnight and are discharged home the following day.

Postoperative period in hospital

You should rest as much as possible for the first 24 hours after surgery. It is wise not to talk or laugh in the first few days to allow the cheek skin to stick back down and avoid collections of blood or fluid beneath the skin flaps. The bulky dressing will be removed on the first day after surgery and you will be given a pressure “mask” to wear, which will support the tissues until they have properly bedded down. You should wear this constantly for the first 2 weeks (removing it for one hour a day for hygiene purposes).You will be able to wash your hair before being discharged, but must ensure you dry it carefully with a hairdryer on a low heat setting (your nerves will have been disturbed and it is easy to burn yourself without being aware of it).

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse six days after your operation. She will remove any dressings and inspect your wounds, which may or may not have healed at this time. The removable stitches will be removed and you will be given a further appointment to see the nurse about 5 days later. On this visit, the metal staples in your scalp will be removed. If the wounds have healed you will be given an appointment to see me four weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you in a further month and then arrange a final appointment for about six months.

What are the possible risks?

Any surgery has the potential for complications. Although a facelift is generally a very safe procedure, it does carry the following risks:

Infection; infection is uncommon and results in swelling, redness and tenderness along the wound at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics.

Bleeding: bleeding is uncommon but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. Should a bleed occur under the skin, the face may swell quite dramatically, it can be quite painful and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.

Delayed wound healing; This is not a disaster, but can leave a somewhat wider scar. Delayed wound healing is more common in smokers and you are strongly advised to stop smoking before your operation, and not to start again (if you must!) until the wounds have finally healed.

Ugly scarring: most wounds will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is very uncommon, but any wound breakdown which occurs in the early postoperative period may result in a slightly stretched, flat scar.

Flap necrosis: is fortunately very uncommon, and is usually seen only in smokers. Part of the skin in front of, or behind, the ear dies (usually due to a combination of poor blood supply, infection and haematoma) and a black crust develops. This complication is usually treated conservatively, waiting until the crust comes off spontaneously over the following weeks/months. This may leave an ugly scar, which may be improved by further surgery after a year.

Alopecia: again this is rare, but if part of the skin which is damaged due to poor blood supply is hair bearing scalp, the hair follicles can die resulting in a bald patch.

Altered sensation; when the skin of the cheeks are lifted the nerves to the skin are often stretched or even cut. Almost inevitably, the skin in front of the ears will be numb after the operation. Initially the patch of numbness will be very extensive, extending up to the chin and cheeks and even ears on occasions, but gradually the size of this area of numbness will shrink to leave a small area of altered sensation just in front of the ears. It can take up to 2 years for this to recover. During this time, it is possible to injure or burn this skin without realising it. For this reason you should carefully inspect the skin of this area regularly, and in particular be careful with hot hairdryers and don’t sleep with earrings in.

Facial weakness: this is the worst complication of a facelift. The facial nerve lies just beneath the SMAS layer, and if it is stretched or cut during the facelift, one or more of the facial muscles may be weakened. This nerve is injured in about 0.5% (one in 200) facelifts. Fortunately, most nerve injuries recover on their own after 2 or 3 months, but weakness can occasionally be permanent.

Irregularities beneath the skin: high tension stitches are used beneath the skin to hold the face up and sometimes firm areas or lumps can be felt beneath the skin of the cheeks. This can be softened after 6 weeks or so by regular massage, and these areas usually settle completely.

Asymmetry: The two sides of a persons face are almost never the same, and some degree of facial asymmetry is common both before and after this procedure. This is part of what makes our own face unique. Great care is taken to ensure that the two sides are as symmetrical as possible by the end of the procedure, but occasionally different degrees of scarring will occur after the operation and result in facial asymmetry. You may be acutely aware of this immediately after the operation, but given time for the scarring and swelling to settle it usually settles to an acceptable result.

Postoperative Advice Sheet

What is Blepharoplasty?

Blepharoplasty is an operation whereby the appearance of the eye is rejuvenated by removing excess skin or fat to remove bags. It can be an excellent operation because it ‘refreshes’ the eye area and the scars usually heal really well and are almost invisible after 3 months.

Who will Blepharoplasty help?

Upper lid blepharoplasty aims to correct the excess skin which falls forward onto the eyelashes. This excess skin produces a vary aged appearance. Women often complain that this excess skin interferes with applying makeup so that it ‘cakes up’ underneath this fold, or cannot be seen. Sometimes the skin excess can be so great that the skin falls forward onto the eyelashes pushing them downwards and interferes with peripheral vision, which may affect driving or reading. A further group of patients who request upper blepharoplasties are Asian patients. About half of all Asians lack a fold in their upper eyelids. This is quite normal but some prefer to have a ‘double eyelid’ rather than a ‘single’ eyelid. This can be created quite simply and is the most popular cosmetic procedure amongst Eastern and South Eastern Asians.

Lower lid blepharoplasty is usually done to improve the ‘puffy’ lower eyelids or ‘eyebags’ and also to reduce the wrinkling of the lower lids.

What is the best age for blepharoplasty?

There is no ideal age to undergo this surgery. It should be considered when you do not like the appearance of the eyelids, or feel that they are starting to make you look old.

A lot of patients worry that if they have a blepharoplasty done too soon they will need it doing again at some point. However, in my experience, the eyelid operation is usually only undertaken once, it is uncommon to require a second procedure.

What are the limitations of this procedure?

There is a limit to how much skin can be removed from the eyelids. If too much is removed from the upper eyelid, the eyelid may not close fully when asleep and this could lead to a dry, sensitive eye. The idea is to remove just enough skin to allow the eyelid to fully close.

Lower lid surgery aims to reduce the bulging fat pads and tighten the skin. However if too much skin is taken, the lower eyelid can be pulled downwards, which exposes the eyeball making it very sensitive. For this reason, a blepharoplasty will never remove all of the wrinkles from the lower eyelid.

Some pre and postop photos

Is Blepharoplasty available on the NHS?

Generally speaking blepharoplasties are considered cosmetic and as such are not usually available on the NHS.

How is the operation done?

An upper blepharoplasty is a relatively simple, safe straightforward procedure and can usually be done awake under local anaesthetic. However, it can be done asleep too and some nervous patients will prefer this. Blepharoplasties are usually peformed through small incisions placed along natural lines on the eyelids. On the upper lid we use the small crease found about 8-10mm above the eyelash margin. The excess skin is removed and any bulging fat pads (usually found close to the side of the nose) can be reduced. The wound is usually closed with buried dissolvable stitches, although one or two removable stitches may be placed at the outer corner of each eye – to ensure a neater scar.

A lower blepharoplasty is a little more involved and generally it is better to be asleep for this procedure, although it can be done awake under local anaesthetic if you would prefer. The incision is usually placed on the lower lid in the small crease immediately below the eyelashes. The skin and muscle layers are undermined to reveal the bulging fat pads. I do not usually remove any fat, as the fat serves a purpose in the orbit and removal of this fat can lead to an unpleasant hollowing of the upper orbit in later years. The membrane which bulges forward is tightened to prevent the fat from bulging and the excess skin and muscle is carefully trimmed. The wound is closed with buried dissolvable stitches, although again, one or two removable stitches may be placed at the outer corner of each eye – to ensure a neater scar.

How long does the operation take?

Blepharoplasty usually takes about 60-90 minutes

How many days in hospital?

Upper lid blepharoplasty is usually done on a day case basis, though occasionally patients having a general anaesthetic in the afternoon may stay in hospital overnight and go home on the day after surgery. Combined lower and upper lid blepharoplasties are often done on an overnight basis to ensure the eyelids are not too swollen before discharge.

Postoperative period in hospital

When you wake up you may have gauze pads and icepacks on your eyes, so be prepared not to be able to see anything when you first wake up. I will have injected long acting local anaesthetic around your eyes so you will not feel any pain or discomfort for 6 hours. It is very unusual for patients having a blepharoplasty to report any significant pain, but you will be given regular painkillers to ensure you remain comfortable.. You should sleep with some extra pillows to minimise postoperative swelling for the first week. You may use ice packs on your eyes intermittently for the first 48 hours to limit swelling.

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove any stitches and inspect your eyes. There will be bruising and swelling, so do not expect to see perfect eyelids at this stage! She will give you advice on wound care at this stage. You will probably experience bruising and swelling, and a feeling of ‘tightness’ for 10-14 days after surgery. You should avoid wearing contact lenses until your eyelids have fully settled down.

You will be given an appointment to see me six weeks after your operation. At this appointment I will be checking on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.

What are the possible risks?

All surgery carries the potential for complications. Blepharoplasty is generally a safe procedure but occasionally, specific complications that may occur with an blepharoplasty are:

Ugly scarring: although most scars settle very nicely to leave a pale flat line which is well hidden in pre-existing skin creases, occasionally scars may become red, raised, wide, itchy or ugly (called hypertrophic or keloid scarring). This happens in about 2% of people and is mostly seen in younger, darker skinned individuals.

Infection; fortunately infection is rare, but can cause swelling, redness and tenderness up to 3 weeks after surgery. This usually responds well to a course of antibiotics.

Bleeding: bleeding is fairly rare (2%) but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid anything which could raise the blood pressure in your head, for example bending over, lifting anything heavy or strenuous exercise.

Skin numbness: the skin over the eyelids can be numb after surgery. This usually improves with time, but can occasionally be permanent. As the nerves begin to regain function you may notice occasional sharp shooting pains which could be described as being like a small electric shock. This is a good sign indicating nerve recovery and can continue for up to 18 months after surgery.

Eye sensitivity; the eye can become quite sensitive for several months after surgery with feelings of dry grittiness or excessive watering.

Lid retraction: swelling in the lower eyelid tissues, and subsequent contraction of underlying scar tissue can pull the lower eyelid downwards. This is uncommon but does occasionally happen. The solution is usually to massage the lower eyelid outwards and upwards to reduce the swelling and encourage softening of the scar tissue whilst pushing the eyelid upwards into its normal position. Occasionally the eyelid may need to be taped up to support it until the swelling subsides. Reoperation is rarely necessary.

What else should I know?

Postoperative Advice Sheet

What is Rhinoplasty?

Rhinoplasty is an operation whereby the shape of the nose is changed by modifying the underlying bone and/or cartilage (gristle) of the nose.

Who will the operation help?

There are many features of a nose which can be changed, including:

• Removing a bony “hump” from the top of the nose
• Narrowing the nose
• Shortening the nose
• Lengthening the nose
• Making the tip less bulbous
• Lifting a drooping tip
• Lowering an upturned nose
• Straightening a twisted or bent nose
• Making the nostrils smaller

In addition to altering the external appearance of the nose, the cartilage inside the nose can be straightened to improve the nasal airways. This procedure is called a septorhinoplasty.

What are the limitations of rhinoplasty?

It is important that any patient contemplating a rhinoplasty understands that there are limitations to how effective this operation can be, and that patients have realistic expectations before proceeding with surgery.

Because we are all individuals, every nose is slightly different. Differences in skin thickness, skin tension, relative stiffness of cartilage, underlying scar tissue from previous injury to the nose etc mean that every nose will respond in its own unique way to surgery. As a consequence of this there are limitations to what can be achieved with a rhinoplasty, and no surgeon can guarantee the outcome of surgery. The surgical aims will be discussed at the consultation and at operation those aims will be achieved as closely as possible within the limitations of that individual patient’s tissue characteristics.

What else should I consider?

Facial harmony is important, and ideally the size of the nose should be in proportion with the rest of the face. Occasionally patients come along requesting a rhinoplasty because their nose looks too big. On examination, their nose is the correct size but their chin is too small. A small chin can make the nose look too big. In this case a chin implant can correct the small chin and restore facial harmony without needing a rhinoplasty.

Before and After photos

Is rhinoplasty available on the NHS?

In general, rhinoplasty is a cosmetic operation and as such is not available on the NHS. However, an NHS rhinoplasty is available for significant deformity after injury and congenital abnormally shaped noses. If patients are experiencing significant difficulty breathing through their nose, a septorhinoplasty may be considered.

Which approach is best?

Closed rhinoplasty: Rhinoplasty can be done with small incisions hidden up each nostril. The advantage of this is that there are no visible scars afterwards. The disadvantage is that there is far less control over the final shape of the tip of the nose.

Open rhinoplasty: Alternatively, rhinoplasty can be done with an additional scar across the bridge of skin between the nostrils (see picture). This allows accurate modification of the nasal tip. The final scar usually settles beautifully (see picture).

For these reasons if any tip work is required, an open rhinoplasty is my preferred approach.

How is the operation done?

Each rhinoplasty operation is tailored to the individual patient to achieve their aims. The operation is done under general anaesthetic (with you asleep). Instruments are passed up into the nose through the incision in each nostril. The bony hump is removed with a fine chisel or rasp , and the cartilage hump is removed with a scalpel or scissors:

This leaves the top edge of the nose too flat and too wide, so the bony sides of the nose are then gently fractured and moved inwards:

The cartilage of the tip of the nose is then reshaped by trimming and stitching it:

Finally the incisions are closed with dissolvable stitches inside the nostrils and removable stitches outside. A plastic splint is placed on the nose to hold the bones in place for one week, and each nostril is gently packed.

How long does the operation take?

Rhinoplasty usually takes about 60-90 minutes

How many days in hospital?

Rhinoplasty patients usually stay in hospital overnight and go home on the day after surgery.

Postoperative period in hospital

When you wake up you will have a splint on your nose and packs up each nostril. You will only be able to breathe through your mouth, and as you will also have had a tube in your throat during the anaesthetic, you are likely to have a sore throat for a couple of days afterwards. You will receive regular painkillers which should keep you comfortable. Black eyes are common and you can limit eyelid swelling by sleeping propped up with extra pillows.

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your dressings and inspect your nose. There will be bruising and swelling, so do not expect to see a perfect nose at this stage! She will remove any stitches and will give you advice on wound care, bathing and exercise.

You will be given an appointment to see me six weeks after your operation. At this appointment I will be checking on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.

What are the possible risks?

All surgery carries the potential for complications. The specific complications that may occur with breast augmentation are:

• Infection; fortunately infection is rare, but can cause swelling, redness and tenderness up to 3 weeks after surgery. This usually responds well to a course of antibiotics but very infrequently the infection can spread inside the nose. If any cartilage grafts have been used to build up part of the nose, infection can dissolve these grafts.
• Bleeding: bleeding can occur at any time over the first ten days after surgery, and therefore it is wise to avoid anything which could raise the blood pressure in your head, for example bending over, lifting anything heavy or strenuous exercise. Minor nosebleeds are fairly common in the first few months after surgery.
• Ugly scarring: although most scars settle very nicely to leave a pale flat line, occasionally scars may become red, raised, wide, itchy or ugly. This is very uncommon in rhinoplasty, and is determined more by a person’s body tissue than by the surgery itself.
• Skin numbness: the skin of the top of the nose and especially over the nasal tip can be numb after a rhinoplasty. This usually improves with time, but can occasionally be permanent. As the nerves begin to regain function you may notice occasional sharp shooting pains which could be described as being like a small electric shock. This is a good sign indicating nerve recovery and can continue for up to 18 months after surgery.
• Asymmetry: despite leaving the nasal structures symmetrical at the end of surgery, the natural scarring processes that will follow surgery may act asymmetrically on the nasal framework and result in a degree of asymmetry. This is more likely to occur if the postoperative recovery period is complicated by an infection or bleeding.
• Bony irregularities: great care is taken to cut the nasal bones in exactly the right place, but occasionally (with weak or previously injured bones) the bone may fracture in the wrong place or irregularly and give rise to bony irregularities. Thick skin may disguise this well, but in thin skinned individuals these bony irregularities may even be visible. If this is the case the bony spicules can be rasped smooth under local anaesthetic.
• Rhinitis: rhinitis is an inflammation of the inner lining of the nose. This can make the nose run, itch, swell, and sneeze and give you a “bunged up” feeling for several months after surgery. It usually settles on its own, but may require steroid nasal sprays.
• Watery eyes: the tear ducts which drain tears from the corner of your eyes empty into your nose. Any swelling near the tear ducts may block these ducts. As a result of this tears may spill over the lower eyelids until the swelling has fully resolved.
• Airway problems: removing bony humps and narrowing noses often narrows the airway and it is not uncommon for their to be some noticeable reduction in the nasal airway after rhinoplasty. This often improves with time, as it can take up to a year for the swelling to fully settle.
• Altered sense of smell/taste: as a result of localised swelling in the lining of the nose the nose may be much less sensitive to smells, and as a result there can be a loss of taste for many months after surgery.
• Pigmentation; the skin of the nose may become slightly darker for up to a year or so after a rhinoplasty. To avoid or minimise this you should avoid sunbathing or sun exposure in the early months after surgery.

Postoperative Advice Sheet

What is Otoplasty?

Otoplasty is an operation whereby the shape or position of the ear is changed.

Who will the operation help?

The commonest reason for undergoing an otoplasty is to correct prominent, sticky-out ears. During childhood teasing is the main reason for wanting an otoplasty. Many adults request prominent ear correction, with reasons including; “always wanted it done but was told as a child to wait until I was older”; or “I have always worn my hair long to cover my ears but now I want a change of hairstyle”; or “I simply want to look better on my wedding photographs”.

What is the best age for Otoplasty?

Prominent ears may be evident at birth. During the first few months of life the ear cartilage (gristle) is still under the influence of maternal hormones and is very soft and pliable. It is possible at this stage to make a tiny splint to reshape and hold the ear so that when the cartilage stiffens the ear shape is normal, thus avoiding any operation.

The ear then undergoes a period of growth and it is unwise to operate during this time as this may impair the growth potential and lead to small, misshapen ears in adulthood.

Three conditions arise by the age of six, which make this a good time to have prominent ears corrected. By six years of age children start to become aware of each other’s “differences” and teasing may become an issue; the ears are sufficiently large and stiff to enable predictable results from surgery; and the child is sufficiently mature to comply with postoperative instructions.

From the age of six onwards into adult life, prominent ears can be safely and predictably set back into a normal shape and position.

What are the limitations of this procedure?

Most patients requesting prominent ear correction have been self-conscious of their ears for many years and ask for them to be pinned back as far as possible against the side of their head. This is a big mistake as overcorrected ears can look as abnormal as prominent ears. The aim should be to set the ears back so that the rim lies about 1.5 – 2cm from the side of the head.

Another limitation of this procedure is that large ears cannot be made smaller.

Before and After photos

Is Otoplasty available on the NHS?

Otoplasty is generally available on the NHS for children under the age of 16. For adults, an NHS otoplasty may be available for significant ear deformity or ear asymmetry. However, prominent ear correction in adults is deemed to be cosmetic surgery and is not available on the NHS.

How is the operation done?

Otoplasty is frequently done under local anaesthetic (with you awake), but younger or more nervous patients prefer a general anaesthetic (asleep). A 3cm incision is made behind each ear and the ear cartilage is carved to reshape it. Finally dissolvable stitches are used to close the wound and a large padded bandage is applied to support the ears in their new position.

How long does the operation take?

Otoplasty usually takes about 60-90 minutes

How many days in hospital?

Otoplasty is usually done on a day case basis, though occasionally patients having a general anaesthetic in the afternoon may stay in hospital overnight and go home on the day after surgery.

Postoperative period in hospital

When you wake up you will have a crash-helmet sized head bandage on. I will have injected long acting local anaesthetic around your ears so you will not feel any pain or discomfort for 6 hours, and after this you will be given regular painkillers to keep you comfortable. You should avoid lying on your side or having any pressure over your ears for the first week.

Postoperative Follow Up

After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your large head bandage and inspect your ears. There will be bruising and swelling, so do not expect to see perfect ears at this stage! She will give you advice on wound care, bathing and exercise and advise you to wear an elasticated headband at night for a further month.

You will be given an appointment to see me six weeks after your operation. At this appointment I will be checking on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.

What are the possible risks?

All surgery carries the potential for complications. The specific complications that may occur with an otoplasty are:

Infection; fortunately infection is rare, but can cause swelling, redness and tenderness up to 3 weeks after surgery. This usually responds well to a course of antibiotics.

Bleeding: bleeding is fairly rare (2%) but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid anything which could raise the blood pressure in your head, for example bending over, lifting anything heavy or strenuous exercise.

Ugly scarring: although most scars settle very nicely to leave a pale flat line which is well hidden behind the ear, occasionally scars may become red, raised, wide, itchy or ugly (called hypertrophic or keloid scarring). This happens in about 2% of people and is mostly seen in younger, darker skinned individuals.

Wound breakdown: as the skin of the front of the ear is numb, it is important not to lie on the ears as this can cause small sores or ulcers which heal on their own, but are seen in about 2% of patients undergoing otoplasty.

Skin numbness: the skin over the front of the ear and can be numb after an otoplasty. This usually improves with time, but can occasionally be permanent. As the nerves begin to regain function you may notice occasional sharp shooting pains which could be described as being like a small electric shock. This is a good sign indicating nerve recovery and can continue for up to 18 months after surgery.

Pigmentation; the skin of the ear may become slightly darker for up to a year or so after a rhinoplasty. To avoid or minimise this you should avoid sunbathing or sun exposure in the early months after surgery.

Asymmetry: despite leaving the ears as symmetrical as possible at the end of surgery, the natural scarring processes that will follow surgery may act asymmetrically on the cartlage framework of each ear and result in a degree of asymmetry. This is more likely to occur if the postoperative recovery period is complicated by an infection or bleeding. Minor degrees of asymmetry are usually acceptable, but more marked asymmetry, or even recurrence of the prominent ear, occasionally requires surgical correction once the scarring process has fully settled (about 1 year later).

Postoperative Advice Sheet

Chin implants are used to ‘strengthen’ the chin and bring balance to the face. The operation is done under a general anaesthetic (with you asleep) and a silicone chin implant is inserted through a small incision either inside the mouth or underneath the chin. The operation is relatively simple and safe, but there will be some bruising and swelling which can take up to 4 weeks to settle. This procedure is usually done as a day case – meaning you can go home on the day of surgery.

The main risks involved are movement or displacement of the implant, which may require further surgery to correct, or rarely, the implant may get infected and need to be removed.

Some patients prefer to avoid an implant, in which case the chin can be ‘strengthened’ by fat transfer to the chin. This is becoming a very popular technique LINK TO FAT GRAFTING.

Mole and skin lesion removal is one of the commoner procedures no longer available on the NHS (unless there is any suspicion that the lesion may be a cancer). The cost of having a mole removed privately is surprisingly affordable.

Small spots, moles and skin lesions are a common nuisance which can be unsightly and are easily treated. Small lesions can be removed under local anaesthetic (numbed, while you are awake) on an outpatient basis (you turn up, have the mole removed in the clinic setting and go home within an hour) and the wound usually heals to leave a small, neat scar.

If you would like to have a mole removed, or discuss mole removal, please contact us at the above number and we shall arrange this for you.