Category: Blog

As we get old, it’s not just our skin that sags, facial bones shift and droop with time, too. 

Now scientists from the Rutgers New Jersey Medical School, USA, have, for the first time, mapped these bony ageing changes in detail. 

And they conclude that both medicines and ‘mechanical devices’ could allow surgeons not just to treat the symptoms, but to prevent these ‘facial skeleton changes’ from occurring in the first place. 

Lead researcher Boris Paskhover, of the Department of Otolaryngology–Head and Neck Surgery, says the venture could open a ‘whole new paradigm in facial ageing prevention.’

He studied a group of fourteen patients, aged between 40 and 55. 

Over the course of eight years the patients underwent repeated facial imaging that included the entire mid-face and cranium.

He says skeletal changes were found to occur in the exact regions where cosmetic surgery is popular – around the cheeks, eyebrows, eye socket and forehead. 

Dr Paskhover also noted decreases in three important angles used to measure facial geometry, as the facial bones appears to shift and tilt forwards, creating a more aged look. 

He adds: “These bony changes likely contribute to the appearance of many common mid-face ageing changes, such as prominent nasolabial folds, facial hollowing, loss of dentition, and the senile nose.

“Ultimately, defining a methodology to longitudinally document the 3-D patterns and timing of facial skeletal ageing changes will allow us to objectively test specific treatments aimed at slowing or reversing these bony ageing changes. 

“The timing of when intervention can be helpful can also be defined. 

“Treatments already in use for osteoporosis such as hormone modulators, bisphosphonates, or calcitonin may be effective for ageing. 

“Mechanical devices used in orthopedics and orthodontics, as well as novel pharmaceutical approaches, may allow us not only to treat but also to prevent these facial skeletal changes from occurring, opening up a whole new paradigm in facial ageing prevention.”

Leading UK cosmetic surgeon Gary Ross, based in Manchester, welcomed the new research, saying it promised to open-up new avenues of possibility when it comes to facial rejuvenation surgery. 

Mr Ross, who recently became the first plastic surgeon to be officially certified by the Royal College of Surgeons professional standards system, said: “Certainly, we are aware of the ageing of the facial skeleton, the apparent growth of cartilage and the descent and reduction in volume of the soft tissues.

“Although implants and enhancement of the areas overlying the bony skeleton have been the mainstay of facial ageing there may be newer innovative mechanical devices and pharmacological treatments targeted at bony rejuvenation therapies that are worth exploring further. 

“Cosmetic orthodontics and manipulation of the bony skeleton is a rapidly expanding field in facial rejuvenation surgery.

“Having read this new paper. I would be particularly interested to look at facial ageing in patients already undergoing treatments for osteoporosis, such as hormone modulators, bisphosphonates, or calcitonin and compare facial ageing against those not undergoing treatments. 

“This may give us some insight into whether these pharmacological treatments may open a new paradigm in facial ageing prevention.”

Reference

Patterns of Change in Facial Skeletal Aging.

Paskhover B, Durand D, Kamen E, Gordon NA.

JAMA Facial Plast Surg. 2017 Aug 10.

The full article was published in the Daily Mail http://www.dailymail.co.uk/health/article-4792038/Bone-lifts-future-cosmetic-treatments.html

Many of us have a different, and often more critical view of ourselves than how others perceive us. This is also very true of how we feel about the way we look, but there is a devastating condition which affects a small percentage of people called Body Dysmorphia.

What is Body Dysmorphia?

It is always shocking to see the extreme measures some individuals go to when it comes to changing their body shape or appearance through cosmetic surgery. Quite often these individuals have a psychological disorder called body dysmorphia. Body dysmorphic disorder, or BDD as it can also be referred to, is an anxiety disorder that will cause a person to have a distorted view of themselves and how they look. They may spend excessive amounts of time worrying about their appearance, which often affect every aspect of their everyday life. 

What may appear to be a completely normal looking feature to everyone else, to those that suffer with BDD they will often obsess over it daily and try to change their appearance in any way they can. 

Is it responsible for a cosmetic surgeon to perform surgery on a person with body dysmorphia?

Mr Ross will recognise patients with this condition through conducting a thorough consultation. When this condition is identified Mr Ross will then refer these patients on to specialist councillors to ensure that these patients are treated appropriately by psychologists for this condition.

Surgeons have a moral obligation to the patient to ensure their safety. This includes not performing surgery on a patient with any psychological illness without a specialist psychiatric evaluation to guide their assessment. Mr Ross will always be truthful with his patients, and if he feels you are not a good candidate for surgery, he will refer you elsewhere to the right individuals and give you advice on how best to proceed.

Media culture and its influence with unrealistic expectations

We can often be quick to blame the media and its constant push for perfection. Most images commonly featured in the media of celebrities and size zero models will undoubtedly have been airbrushed. While many of us are quick to identify this, it frequently causes us to compare ourselves with these altered images, resulting in a negative view of how we see ourselves.

The media can make you feel inadequate, for example after a celebrity has a baby they’re incredibly quick to spring back to their pre-baby bodies and this puts an enormous amount of pressure on women to lose weight straight after birth.

What is often misunderstood is that behind the celebrity is a team of nutritionists, personal trainers, nannies and sometimes surgical or non-surgical procedures as well to help them look fabulous a few weeks after giving birth. Such transformations are not healthy expectations to put on yourself or achievable for the average woman. Although most people understand this and have a realistic view of what they are seeing in the media, such images to those suffering with body dysmorphia can have a devastating effect on those individuals.

Mr Ross is trained and well-practiced in recognising body dysmorphia as a condition and will encourage any individual to seek the appropriate treatment. Mr Ross’s professional and ethical standards ensure that he does not operate on individuals who may be vulnerable without a thorough and detailed evaluation of their medical and psychiatric history.

The eyes are one of our most striking facial features but as we age, our skin slowly loses its elasticity causing the tissue of the brow, lower and upper eyelids to sag. This can cause both functional and aesthetic concerns. 

In the upper lids excess skin can interfere with sight, impairs vision and an upper lid blepharoplasty may offer a functional improvement. Removal of excess skin and fat can reduce the heaviness, create a more aesthetic lid crease and also provide an aesthetic improvement. Upper blepharoplasty is a common procedure where the skin of the upper eye is removed, placing the scar in a natural crease line. It is one of the commonest aesthetic procedures and results in minimal downtime with minimal risks and complications. It is often performed under local anesthetic. Sometimes small amounts of fat need to removed and occasionally fat needs to be added in the form of autologous fat transfer. It can also be performed alongside a brow lift, lower lid blepharoplasty and face-lifting surgery.

In the lower lids the fat that sits next to the lining of the eyeball often moves forward as the muscle and the septum, a thin membrane that separates the fat and the muscle, weaken with age. This septum is fixed to the bone of the orbital rim and as the upper facial structures drop the orbital rim can become more visible and often leads to a groove that is often referred to as the tear trough. Lower lid surgery can be performed through an incision inside the eye or through an incision on the skin. Sometimes small amounts of fat need to removed and occasionally fat needs to be added in the form of autologous fat transfer. More commonly the fat that was moved forward can be repositioned to disguise the groove or tear trough.

For patients in whom the midface has dropped and there is excess skin around the lower lids a lower lid blepharoplasty through a skin incision can be combined with a mid face lift. The mid-facelift in combination with lower lid blepharoplasty can tighten the sagging lower eyelid and the mid-face through a lower blepharoplasty incision with a net effect that the existing tissues are simply repositioned into a higher position. This can be performed with a facelift and in Mr. Ross’s practice is performed under general anesthetic.

It is important for all patient undergoing blepharoplasty procedures that you are a suitable candidate and it is important to consult with an experienced clinician regarding your aims and expectations. It is important to discuss any previous eye, eyelid / facial surgery or non-surgical treatments, any eye problems, past medical and surgical history, allergies, medications and whether you smoke. 

There are risks and complications and although these are rare if they happen to you they can be devastating. Take your time to do your research and do not rush into surgery. Mr. Ross only operates on around 30-40% of patients he consults with and will be able to give an honest opinion regarding the pros and cons of eyelid rejuvenation surgery.

Who Is It Suitable For?

Those with excessive skin and/or noticeable fat deposits. Excessive skin can even interfere with vision and removing the excess skin and removing/repositioning the fat can improve the appearance.

Who Is It Not Suitable For?

Those with unrealistic expectations and those with a significant medical history. It is important to declare any history of thyroid disease, glaucoma or previous eye surgery.

How Much Does A Blepharoplasty Cost?

This depends on what is required. After a consultation if you are suitable for eyelid rejuvenation surgery you will be given a quote for surgery that will include the surgeons, hospitals and anaesthetic fee.

What To Expect During Your Consultation?

The success of the consultation depends on your openness and honesty in relation to what troubles you and your expectations of surgery. You will be asked questions about your health, desires and lifestyle. Different operations can be tailored to your needs and the potential outcomes and the risks and complications will be discussed with you. The operation often involves the removal skin and removal / reduction or repositioning of fat. The operation can be combined with other operations such as a mid-face-lift or a brow lift.

Preparing For Blepharoplasty Surgery

Blepharoplasty procedures may be performed under either general or local anaesthetic. Your health is of prime importance and any cosmetic surgery should be postponed if you are unwell for any reason. It is important that if anything changes with your health that you make contact with us. You should ideally stop smoking 6 weeks prior to surgery and stop taking aspirin, anti-inflammatory drugs and herbal supplements before surgery. You may need preoperative tests prior to surgery, which we will arrange if required. You will generally experience bruising, swelling and discomfort following the surgery and should aim to be off work for at least 1 week depending on the type of work you do.

The Surgery

Blepharoplasty usually takes between 1 and 2 hours. For upper blepharoplasty an incision is made in the crease of the upper lid. For lower blepharoplasty an incision may be made on the skin below your lashes or within the eye. Skin is usually removed as required and the fat deposits may be reduced, removed or repositioned. The skin is sutured and some steristrips are often applied.

After Surgery

You will usually return to the ward within an hour following surgery. You will be able to drink and eat and mobilize. You will feel swollen and have bruising and discomfort that may require analgesia. You may be able to go home on the same day and should keep the wounds dry for the next week. You should keep your head upright and avoid hot baths. You will be given an ice pack to place over your eyes and you should keep this in place for the first 24-48 hours. You should arrange for someone to pick you up following surgery and have some support at home when you are discharged. You may experience either dry or watery eye and occasionally you will feel a sensation of grittiness for a few days/weeks afterwards. You should avoid wearing contact lenses for 2 weeks although for lower lid blepharoplasty this should be extended to 4 weeks. You will be reviewed in clinic and the eyes checked after a week and any stitches removed. The final results of blepharoplasty can take a few months to become apparent. The scars can be red initially but usually fade over time and usually fade to become a white line.

If you are interested in undergoing eye surgery, be sure to book in for a consultation to speak with Mr Ross about your available options and the best course of action.

Breast hypertrophy is a condition in which there is an increase in the size of the breasts out of proportion with the rest of the female body.  

Women with increased breast size experience symptoms such as neck / back / shoulder pain, headache, intertrigo in the inframammary fold, difficulty exercising and performing daily activities alongside, low self-esteem and body dissatisfaction. 

A breast reduction or reduction mammoplasty can provide women symptomatic relief while also improving quality of life. 

Recently a study from Brazil has looked at how breast reductive surgery can have a positive impact on productivity and health in the workplace.

The authors used a similar technique to Mr Ross utilizing a superior / superomedial pedicle with inverted T scar without the need for drains. Mr Ross believes that this technique allows a better long term result by maximizing the tissue higher up the chest wall while preserving as much tissue in the upper pole of the breast as possible. This method can produce an aesthetic result while removing sufficient volume to give a functional improvement.

The authors evaluated 60 patients with breast reduction resection weights median, 617.5 g and mean, 465g which is similar to Mr Ross’s practice. They subsequently showed that breast reduction surgery led to a decrease in working hours lost, impairment at work, overall productivity loss and also in daily activity impairment outside of work. 

The authors concluded that reduction mammaplasty improved the work capacity and productivity of women with breast hypertrophy. Thus, its implementation, in addition to providing physical and psychological benefits for women can result in direct quality of life gains for patients and indirect economic gains for the production sector. 

Reference

Cabral IV, Garcia ED, Sobrinho RN, Pinto NL, Juliano Y, Veiga-Filho J, Ferreira LM, Veiga DF. Increased Capacity for Work and Productivity After Breast Reduction. Aesthet Surg J. 2017 Jan;37(1):57-62.

Arnica montana, is a European flowering plant in the sunflower family which is noted for its large yellow flower head. The main constituents of are essential oils, fatty acids, thymol, pseudoguaianolide sesquiterpene lactones and flavanone glycosides.

Arnica montana has a history of medicinal use dating back to the 1500s and patients have been using Arnica to help reduce post-surgical swelling and bruising. It is postulated that Arnica’s actions may be due to two chemicals called helenalin and dihyrdohelenalin.

In plastic surgery where bruising and swelling can be more apparent the widespread use of arnica has often been recommended even though the evidence has been somewhat contradictory.  

A recent randomized, placebo-controlled trial study from Holland has evaluated arnica and its effect on patients undergoing blepharoplasty surgery. The authors evaluated patients who had undergone bilateral upper blepharoplasty patients into two study arms: One received arnica ointment 10% and the other a placebo ointment. The periorbital area of the treated side received either arnica or placebo ointment, whereas the opposite periorbital area received no ointment and served as an internal control. The overall periorbital appearance was assessed by a medical and nonmedical panel using light photography at 3 days, 7 days and 6 weeks. Swelling, pain, ecchymosis (bruising), erythema and patient satisfaction with recovery/outcome were also assessed.

The study found no significant differences between arnica and placebo justifying the conclusion:-

“Our study demonstrates that the use of topical arnica after upper blepharoplasty does not reduce postoperative ecchymosis, erythema, swelling, or pain of the eyelids, nor does it increase patient satisfaction with postoperative recovery or outcome.”

As the authors suggest this study should provide guidance to patients and clinicians about the role of arnica in postoperative recovery.

Mr Ross believes that patients should be empowered to make their own decisions regarding the use of Arnica Montana and does not routinely recommend its use within his plastic surgery practice.

Reference:

Van exsel DC, Pool SM, Van uchelen JH, Edens MA, Van der lei B, Melenhorst WB. Arnica Ointment 10% Does Not Improve Upper Blepharoplasty Outcome: A Randomized, Placebo-Controlled Trial. Plast Reconstr Surg. 2016;138(1):66-73.