A facelift is a highly effective method to rejuvenate the face. It involves assessment
in clinic, usually over two to three appointments, where we'll establish the aims of the patient
and also examine them in detail. From there, we'll select a range of procedures to treat
the patients from a number of options. For example, a mini versus a full-face neck lift,
together with any eyelid procedures such as eyelid surgery, brow lift or fat grafting
to the face. Younger patients with better necks, they may often be suitable for a mini
facelift alone. More older patients, particularly where their neck slacks, are probably best
suited to a full-face neck lift and we'll also discuss with the patient any additional
procedures that may be of a benefit to them. Surgery for the actual facelift incisions
are made on the front of the ear alone if it's a mini facelift, if it's a full-face
neck lift, the incision will extend around the back of the ear and into the hairline
adjacent. Skin envelope is then raised and the deeper tissues which are called the SMAS
tissues in the face are re-suspended and re-contoured to produce the new rejuvenated shape. This
usually results in the fuller cheek, slimmer lower face, sharper neckline and sharper jawline.
A surgery takes place over a number of hours. Normally requires a night in hospital. Drains
are placed together with head bandage which we remove the following day before the patient
goes home and then return for stitches at about a week post-op. They'll normally need
about two to three weeks downtime to recover from the procedure.
Rhinoplasty is a procedure to produce a more idealised version of a patient's nose and
fit optimally with the rest of their face. Usually, we'll see the patient for assessments
at least a couple of times in clinic to establish their aims and to take a number of detailed
measurements. From there, we'll recommend treatment plan for the patient. For surgery,
there's a number of different options usually between an open and a closed rhinoplasty.
Closed rhinoplasty involves incisions just on the inside of the nostrils. An open one
involves a small incision between the nostrils also. From there, we will normally elevate
the skin envelope or find the tip and then address the bridge. This after may involve
removing a hump or straightening the dorsal profile. We also often narrow the bridge and
commonly reduce the whole size of the nose and perhaps shorten it. This may also involve
adding some cartilage grafts to produce support or adjust the shape in certain areas. Other
patients who have the nose that's deviated, we may need to straighten the nose or they
have an ethnic nose, we may need to augment the dorsum to increase the profile. After
surgery, the patient normally has a pack overnight, they normally have a plaster on for about
ten days, they'll come back to clinic for the plaster to be removed and then we'll tape
the nose usually for another three or four days afterwards. So, the patient now needs
about two weeks downtime from their work and social activities and normally have a pretty
good view of the new shape of the nose by two to four weeks, but the final results can
take longer, certainly up to about nine months to see the final shape particularly around
the tip as a swelling settles.
Regarding face lifts and rhinoplasty surgery, there's not necessarily a strict order into
which one should be done first. It really depends on the patient's priorities. If a
patient's got a very strong nose that's causing them a lot of distress as opposed to facial
laxity, then they'll tend to prioritise the nose first. If ageing is much more significantly
a problem rather than nose shape, then they'll usually look to address that at the first
stage. There may be some discussion among surgeons to whether the order effects the
we draping the skin around the face and nose, but I don't feel this is a significant issue.
It's possible to have a facelift and a rhinoplasty together, but it depends on the length and
complexity of each procedure. For example, in a relatively younger patient with a more
straightforward rhinoplasty, who is perhaps having a mini facelift, it may well be possible
to combine the procedures as the length of procedure is not likely to be too long. However,
in an older patient who may be well be getting a more extensive facelift surgery such as
a full-face neck lift perhaps together with further neck surgery, brow lifting, eyelid
surgery or fat grafting, this procedure can be quite a lot longer. Combining it with a
rhinoplasty in addition, it is likely to lead a very long anaesthetic times. It's probably
not best combined in this manner. So yeah, I think for the older patient it's probably
better to separate the procedures.
Patients looking to undergo cosmetic surgery should have a clear view of the aims and results
they'd like to achieve from the treatments. They perhaps have researched it online or
from other sources and optimally they would take an opinion from more than one surgeon
to get a range of views. Best to see a surgeon who's specialised in cosmetic surgery and
is on the GMC specialist register for plastic surgery. It's also worth checking if they're
a member of a professional body around cosmetic surgery such as BAAPS or BAPRAS. When they
go to their consultation, they should make sure they're seeing the surgeon who's actually
going to do the procedure rather than a salesperson or nurse or another person. They should allow
plenty of time to discuss the procedure with the patient and to examine them in detail.
Patient should also look to see examples photos of their work and perhaps speak to one of
their previous patients.