INTRODUCTION

As people age, the effects of gravity, exposure to the sun and the stresses of daily life begin to take their toll on the face.  Deep creases form between the nose and mouth; the jaw line grows slack and jowly; folds and fat deposits appear around the neck. A Face Lift is a surgical procedure performed to improve the most visible signs of the ageing process, by eliminating excess fat, tightening the muscles beneath the skin of the face and neck (SMAS face lift), and remove any sagging skin.  Many times this procedure is performed in conjunction with Eyelid or even Forehead Surgery.  A well-performed Face Lift should revitalise the face without distorting or changing one’s facial features.  A Face Lift can make you look younger and fresher, and it may enhance your self-confidence in the process.  However it can’t give you a totally different look, or can not restore the health and vitality of your youth.

AM I A SUITABLE CANDIDATE FOR THIS SURGERY?

The best candidate for a Face Lift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity.  There is no need to wait until hanging folds or almost irreversible changes have taken place.  In fact these days, many patients prefer earlier corrections to maintain youthful appearances, and therefore avoid living through a period of looking “old and tired”.

It is important to remember however that surgery cannot erase permanent creases, particularly on the lips, and that it does not stop the ageing process.  A Face Lift just “sets the clock back”; it does not stop it running.  Slight differences in facial symmetry are normal and will be pointed out as many times these are unnoticed by the patient.  It will also be explained that certain areas of the face cannot be helped by surgery, such as the lines around the mouth, frown, and crow feet region.  The newer Skin Resurfacing Lasers best deals with these areas.  If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing.  Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you should avoid these.

ARE THERE DIFFERENT TYPES OF FACE-LIFTS?

Over the years the classical (skin only) operation has undergone a number of modifications to improve the overall results.  These modifications were aimed at lifting not only the skin but also the underlying structures (SMAS), which were equally subjected to the effects of the ageing process.  By addressing these structures, the face could be lifted to enjoy a longer lasting effect.

HOW LONG DOES A FACE-LIFT LAST?

It is impossible to answer this or generalise, as each individual has different skin quality and texture.  However in one sense, ten years later, you will look better than if you never had any surgery. Remember however your face will continue to age with time.

WHAT DOES THE OPERATION INVOLVE?

In broad terms the incision used for both men and women is the same, although there is a slight difference, as result of the hair bearing nature of the male facial skin.  Generally speaking the incision starts high in the temple area (hidden by the hair at this point) then courses down in front of the ear, round the earlobe and up behind the ear before curving gently back into the hairline of the neck.

Using the above incisions the skin is lifted forwards onto the cheeks and down as far as the jawline and into the neck.  The underlying structures are then lifted accordingly so as to ensure a longer lasting effect.  Having repositioned the deep tissues, the loose expanded skin is elevated upwards and any overlapping or excess skin is trimmed.  The wound is then closed.  A bandage dressing is then gently applied around your face.

WHAT TYPE OF ANESTHESIA IS USED AND HOW LONG DOES THE SURGERY TAKE?

A Face Lift can be performed either with local anesthesia or a full general anesthetic.  Surgery for a face lift can take between 2-3 hours, although this takes longer when combined with additional surgery i.e. Eyelid Surgery.

WHAT KIND OF AFTER EFFECTS SHOULD I EXPECT?

Following surgery you will experience swelling which can last up to 2- 3 weeks.  You will also experience a feeling of numbness and tension in the neck and cheek areas.  Sensory nerve fibers in the skin being separated Sensation usually returns to normal but may take sometimes few months.  You may experience a tingling sensation at your face as sensitivity of the area returns.

IS IT PAINFUL?

You will experience a tight feeling around your face following surgery but very minimal pain.  Most patients say they do not need any pain killers during the early postoperative period, the majority of patients experience a surprisingly small amount of discomfort following a face lift.

WHAT COULD GO WRONG?

All surgery carries some uncertainty and risk.  Complications are infrequent and usually minor.  Conditions such as high blood pressure and smoking increase the chances of complications and therefore will be discussed in greater detail at the consultation.  It is mandatory to stop smoking before and after the surgery, until healing is completed, to avoid any trouble with poor wound healing.

HOW LONG BEFORE I CAN GET BACK TO NORMAL?

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery.  However by the third week, you’ll look and feel much better.  Most patients are back at work from about ten days to two weeks after surgery.  If you need it, camouflage makeup can mask most bruising that remains.

SUMMARY

The chances are excellent that you’ll be happy with your face-lift, especially if you realize that the results may not be immediately apparent.  In the properly selected individual it is likely to boost ones self-confidence and self-image.

The MACS lift (minimal access cranial suspension lift) was described as a modification of the S-lift.

ESSENTIALLY, IT DIFFERS FROM A REGULAR FACELIFT IN THE FOLLOWING WAYS:

• The incision is limited to the skin hairline junction above the ear and anterior to the ear.  There is no extension behind the ear.
• The area of undermining, unlike a conventional facelift, is much smaller and essentially involves a portion of the cheek.  Because there is less undermining, the blood supply to the skin is much more robust and the technique is, therefore, safer in smokers.
• Permanent suspension sutures are used to elevate the underlying tissue.  These pass down to the neck, jowls and malar fat pad.  Unlike many other facelifts which do not include significant mid face elevation the MACS lift elevates the malar fat pad reducing the naso labial folds.
• Because the undermining and dissection are much more limited the post-operative swelling  is much less than in normal facelifts and recovery is, therefore, quicker.
• Because the malar fat pad is elevated it combines very well with lower lid blepharoplasty.  It essentially reduces the height of the lower eyelid giving a more youthful, smooth appearance.
• In nearly all cases liposuction is performed to the neck area below the angle of the mandible, both to remove excess fat there and also to free up the skin to allow it to be re-draped by the suspension sutures.
• MACS lift produces results at least equivalent, or in most cases, better than a conventional face-lift.  It is ideally suited to the younger patient with a sagging mid face.

DETAILS OF PROCEDURE

The operation usually is performed under local anaesthesia.  The operation generally takes about two hours and in nearly all cases should be combined with lower lid blepharoplasty, as lifting up the malar fat pad also lifts up the lower eyelids and it is relatively simple to remove the excess skin.

Stitches in the lower blepharoplasty incision are removed at three days, and those in front of the ears are removed at five days.  MACS lift is a significant advancement in facial rejuvenation surgery as it involves relatively little undermining and consequently, the recovery is quicker.  It also has the significant advantage of improving the mid face and malar area which other facelift techniques do not tend to help.  This lift is ideally suited to the younger patient with mid face ageing changes and moderate changes in the neck.

For many people, the neck is the first area to show age.  For people who have lost weight, an unfortunate side effect may be leftover, loose-hanging skin that has lost its elasticity.  Whether it is band lines, excess skin, or fat, a neck lift can bring your neck back into shape.

WHAT IS A NECK LIFT?

Neck Lift can be performed in a variety of ways, depending on the needs of the individual.  Three possible neck-lift procedures include:

• Liposuction
• Cervicoplasty
• Platysmaplasty

Typically, a Neck Lift will include liposuction to remove fat.  Cervicoplasty may be included to remove excess skin, and platysmaplasty to tighten neck muscles (platysma): a process that gets rid of unwanted band lines.  A neck-lift may also be part of a Face Lift or performed as an individual procedure.

THE NECK-LIFT PROCEDURE:

The procedure may be performed under local anesthesia or general anesthesia, but usually does not involve an overnight stay.  If liposuction is needed is performed first.

The platysmaplasty procedure is performed to reduce the banded appearance of the neck.  During the procedure, incisions will be made under the chin or behind the ears, or both.  Dr. Skarparis will then insert a tiny instrument to either remove a portion of specific neck muscles or realign them, which will tighten the middle area of the neck.  An elastic bandage will be wrapped around the neck and head.

COMPLICATIONS AND RISKS OF NECK LIFT:

Numbness of the skin occurs often for a few weeks after neck-lift surgery.  Infections rarely occur.

A Forehead Lift or “Brow Lift” is a procedure that restores a more youthful, refreshed look to the forehead.  The procedure corrects drooping brows and improves the horizontal wrinkles and frown lines that can make a person appear angry, sad or tired.  In a Forehead Lift, the muscles that cause the frowning or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines.  Dr. Skarparis may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions.  Both techniques yield similar results — smoother forehead skin and a more animated appearance.

THE BEST CANDIDATES FOR A BROW LIFT

 A Forehead Lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.  Forehead Lift is often performed in conjunction with a Facelift to provide a smoother overall look to the face.  Eyelid Surgery (Blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Complications are rare and usually minor. Yet, the possibility of complications must be considered.  In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead.  Additional surgery may be required to correct the problem.  Formation of a broad scar is also a rare complication.  This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result.  Also, in some patients, hair loss may occur along the scar edges.  Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients.

ANESTHESIA

Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy.

THE SURGERY

Endoscopic Brow Lift: Four or five short scalp incisions, each less than an inch in length, are made.  An endoscope which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin.  Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance.  The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin’s surface or by temporary fixation screws placed behind the hairline.

AFTER THE SURGERY

In Endoscopic Brow Lift patients may experience some numbness, incision discomfort and mild swelling.  Incision site pain is usually minimal. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.  The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation screws within two weeks.

GETTING BACK TO NORMAL

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery.  Most patients are back to work after a week up to 10 days.  Endoscopic patients may feel ready to return even sooner.  Vigorous physical activity should limited for few weeks.  Prolonged exposure to heat or sun should be limited for several months.  Most of the visible signs of surgery should fade completely within about three weeks.  Minor swelling and bruising can be concealed with special camouflage makeup

YOUR NEW LOOK

Most patients are pleased with the results of brow lift.  Often, patients don’t realize how much their sagging forehead contributed to the signs of ageing until they see how much younger and more rested they appear after the lift.

Eyelid Surgery (Blepharoplasty) is a procedure to remove fat-usually along with excess skin and muscle from the upper and lower eyelids.  Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a Facelift.  The normal ageing process involves the stretching of the eyelid skin resulting in excess folds and wrinkles, and sagging of the fat around the eye itself, and appears as bulges in the upper and lower lids.  Heredity is often an important factor when young or middle-aged patients exhibit changes that are usually associated with older age.  These patients are fed up of comments from their friends that they constantly look tired, despite having had a good night’s rest.

Although Eyelid Surgery can correct drooping upper eyelids and puffy bags below your eyes, it cannot remove crow’s feet lines, or eradicate all eyelid creases.  Any attempt to do so would invariably require excessive tensioning of the skin, which would result in a downward pulled or staring appearance of the eyelid. Nor does it improve or lift sagging eyebrows.  Procedures such as Laser Skin Resurfacing (for lines and wrinkles) and the Brow Lift (for sagging eyebrows) are designed for these purposes.  Dark circles under the eyes may improve a bit following blepharoplasty, if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.  A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance.  In some patients the procedure might improve vision by removing the excessive skin of the upper eyelids, which can hang down and interfere with peripheral vision.

WHAT DOES THE OPERATION INVOLVE?

On the upper eyelids the incision is carried out in the natural crease line that occurs approximately 1 cm above the eyelashes.  Surgery here is designed to correct both the excess skin and the excess fat.  After making the incisions, the excess skin and muscle is trimmed from the upper eyelids together with any fat, which is usually present on the area adjacent to the sides of the nose. On the lower eyelids, the technique very much depends on the patient’s individual circumstance and requirements.  Therefore if the problem is mainly prominent lower bags without excessively loose skin, you may have what is termed as a transconjunctival blepharoplasty.  In this procedure the incision is made inside your lower eyelid, leaving no visible scar.  Alternatively, when loose skin needs to be trimmed, the incision starts underneath the eyelashes and extends 1 cm or so outwards into the crow’s feet area. The skin is then lifted upwards and outwards, gently tensioning the area and overlapping skin removed.

WHAT TYPE OF ANESTHETIC IS USED?

Eyelid surgery is usually performed using local anesthesia.  This is usually accompanied by some intravenous sedation to make you feel relaxed and insensitive to pain.  It is most commonly performed as a day case procedure.

HOW LONG DOES IT TAKE?

Blepharoplasty usually takes between 45 and 90 minutes, depending on the extent of surgery.

WHAT HAPPENS AFTER THE SURGERY?

Following surgery you will have cool compresses applied to the eye region.  Sutures are usually removed in around 4 days.  In the transconjunctival technique mentioned above, there are no sutures in place.

WHAT KIND OF AFTER EFFECTS SHOULD I EXPECT?

Following surgery you will experience swelling around the eyes to varying degrees.  The majority of the swelling usually subsides after the first 10 days postoperatively.

WHAT ARE THE SCARS LIKE?

Overall, blepharoplasty scars heal relatively well.  The scars along side the eyelashes almost always heal with a near invisible line after several months have passed.

IS IT PAINFUL?

There is no pain while or after this surgery.

WHAT COULD GO WRONG?

Complications are rare in a well designed and performed blepharoplasty.

SUMMARY

Blepharoplasty is one of the most popular aesthetic surgery procedures.  The chances are excellent that you’ll be happy with your surgery, especially if you realize that the results may not be immediately apparent.  The positive results of freshening your eyes and reducing a tired appearance will benefit your self-esteem, confidence and should last for years.

Full cheeks and prominent cheekbones allow you to look younger and more appealing.  When your cheeks are hollow, your face may look older than it is, especially around the under-eye area. Whether you have never really had full cheeks, or you’ve simply lost fullness with age, cheek implants can help give you the look you want.  Cheek implantation — also known as malar augmentation – can provide your face with contour, essentially changing it’s proportions to look more pleasing.

ARE YOU A CANDIDATE FOR CHEEK IMPLANTS?

With age, you may lose fullness in your face, especially in the cheek area.  If this has happened to you, you may be an ideal candidate for cheek augmentation.  However, cheek implant candidacy is not reserved for those who have lost this fullness.  Perhaps you have always had “weak” cheeks, with little fullness (hypoplasia of the malar bones).  You too may be an ideal candidate for augmentation.

CHEEK IMPLANT PROCEDURE

Cheek implant surgery can be performed as a single treatment, or in combination with other surgical procedures such as a Facelift, Eyelid Surgery or Rhinoplasty.  Sometimes individuals seek out Cheek Augmentation in conjunction with a Chin Implant to fill out their facial profile.  Dr. Skarparis will choose the right shape and size to best fit your anatomy and help you achieve your aesthetic goals. The implants may be composed of solid silicone or other biocompatible materials.  The surgery itself can be performed through a small incision inside the mouth.  A pocket is made for the implant, over the cheekbone, and the implant will be secured within the pocket.  In all, the surgery requires 30 to 45 minutes and is performed usually under local anesthesia with sedation.

CHEEK IMPLANT SURGERY RISKS

As with any surgery, potential risks accompany the Cheek Implant procedure.  Among them: Implants could shift.  To help minimize this possibility, Dr. Skarparis will advise you to avoid contact sports for a period of time, until healing is complete.  Infection may occur even is rare.

RECOVERING FROM CHEEK IMPLANT SURGERY

Recovering from Cheek Implant Surgery alone shouldn’t take too long at all. In fact, you should feel fine the day of the surgery.  You may have mild soreness in the cheek area and some swelling. The cheek area may feel tight due to the increased volume from the implant.  If the incision for your surgery was made in the mouth, your upper lip may feel a bit numb, as it does after having anesthetic at the dentist’s office.  Usually there is no pain or the pain is mild.  When is needed, pain medications typically are only required for a few days.  Also antibiotics are prescribed to prevent infection.  In general, returning to work and other normal activity can commence within a week.

A balanced facial appearance depends partly on the shape and size of your chin in relationship to your nose.  Chin Surgery can reduce (mentoplasty) or augment (genioplasty) the chin to give your face a more balanced appearance.  A recent study of facial bones demonstrated that individual facial bones shift, reduce, or enlarge with age.  Because of the age-related nature of the changes, most chin surgery patients are adults.

OPTIONS AND COMBINATIONS

Other procedures may be performed with chin surgery.  For example, Liposuction may be used to treat a double chin or to remove excessive fat in the chin area and neckline.  Dr. Skarparis may suggest Chin Surgery as a supplement to nose reshaping because a small chin can make the nose appear larger.  Chin Surgery may be recommended as part of a combination treatment plan for a face-lift patient as well.

*For a Droopy Chin (sometimes call “Witch’s Chin”), Dr. Skarparis may recommend corrective elevation.

GETTING STARTED WITH CHIN SURGERY

Chin Surgery is usually performed under local anaesthesia (sedated, numbed, and awake).  For more complicated cases, general anaesthesia may be used.  Patients usually return home within hours of the procedure.  Depending upon the extent of the case, time in surgery may be one hour or less.

MENTOPLASTY: CHIN REDUCTION

During mentoplasty surgery, Dr. Skarparis makes an incision in one of two possible locations:

• Under the lower lip inside the mouth
• Under the chin in an inconspicuous location

Then Dr. Skarparis will use an electrical instrument (a bone burr or a drill) to reduce and reshape the bone to create a more natural appearance.

GENIOPLASTY: CHIN AUGMENTATION

Chin Augmentation can be performed by the use of a chin implant to augment a receding chin, or by the surgical advancement of the bone itself.  Dr. Skarparis will decide whether to use a Silastic Chin Implant or to advance your own bone, depending on the degree of projection that is needed for correction.  If you choose a Chin Implant, the incision is under the lower lip inside the mouth. The implant is placed in an appropriately sized pocket.  Sizers are used to achieve the best appearance; then the actual implant is carefully placed and the incisions are closed.  If you choose to advance bone in the chin, Dr. Skarparis makes an incision under the lower lip inside the mouth and separates the edge of the chin bone.  The plastic surgeon moves the separated chin-bone tip forward and positions it with wires or special bone plates and screws.  Finally, the surgeon stitches the incision closed and applies tape to the chin area.

AFTER CHIN SURGERY

You may also experience significant swelling in the treated area, which will subside over the course of several weeks.  Follow doctor’s postoperative instruction list to help reduce the risk of complications.  There may be some pain, which can be managed with oral medications.  Normal activities can be resumed typically within seven days.

COMPLICATIONS AND RISKS OF CHIN SURGERY

Complications in the mentoplasty or genioplasty procedures do not occur often.  Although rare, some patients may develop an infection in the chin or lip area, usually treated with antibiotics.  Over time, portions of the bone may erode; however, this does not typically cause any medical concerns, discomfort, or changes in the appearance of the chin.

In the genioplasty procedure, wires or plates are removed if they cause discomfort.  Patients may experience the lack of sensitivity in the chin or lip area; however, the numbness is usually temporary. It is important to note that complications are infrequent.

Chin surgery can restore the balance between the facial features and gives very rewarding results.

Nose reshaping is the operation to reduce or refine the nose, and it is the most frequent facial surgery request.  The reason may be simply that the person is self conscious of a large hump or a prominent tip.  Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities.  In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance.  In the vast majority of cases, men and women alike wish to have a normal nose that will blend into their face rather than dominate their features.

AM I SUITABLE FOR THIS SURGERY?

Only a consultation can establish this.  If you require corrective surgery to the nose as a result of a previous rhinoplasty it is important to wait usually at least 1 year before any further surgery is attempted.
Enquiries will also be made as to your breathing patterns and whether you suffer with any nasal obstruction.  Many times this can also be addressed at the same time as a nose reshaping. The most common request is to reduce the size and alter the shape of a large nose.  Dr. Skarparis will try always to give a nose that is attractive and proportional in size and shape to the rest of your face.

WHAT DOES THE OPERATION INVOLVE?

The operation is usually performed through incisions inside the nostrils.  Occasionally there are external scars, particularly when reducing nostril size (alar base reduction) or if complicated tip work is required.  In complex tip surgery, you may require an external incision carefully placed in the columella (the lower middle segment of skin situated between your nostrils) but you will be informed appropriately.

Any bump on the bridge is removed with a delicate chisel to give a new profile.  The nasal bones, depending on the circumstances, are then usually broken and reset in a careful way to allow them to meet in the mid-line and narrow the bridge line.  If any breathing difficulties exist, then the septum (structure separating the two nasal compartments) is altered accordingly.

Finally the tip of the nose, comprising of cartilage beneath the skin, is adjusted in size and shape to refine the nose so that it matches the new profile.

WHAT TYPE OF ANESTHETIC IS USED?

Nose reshaping is usually performed using a general anesthetic, and frequently requires an overnight stay in hospital.  Occasionally a local anesthetic can be used.  In the latter instance then this can be performed as a day case.

HOW LONG DOES IT TAKE?

A rhinoplasty takes approximately 1 hour to perform.

WHAT HAPPENS AFTER THE SURGERY?

The bridge of the nose is usually protected after the operation by a plaster cast, which is worn usually for about 7 days.  During this time you should avoid blowing your nose and any vigorous activity for next three weeks.

WHAT KIND OF AFTER EFFECTS SHOULD I EXPECT?

As the nasal bones are usually broken and reset, you should expect to have “black eyes” and some swelling of the face.  This usually settles by 2 weeks although as soon as the plaster cast is removed you may, in fact, apply light make up to mask this.

It is very important to realize that even once the plaster cast is removed from the bridge of the nose there will almost certainly be a significant degree of swelling still present. Therefore the shape of the nose at this stage is not the final one.  This obvious swelling will rapidly decrease in the ensuing 3-4 weeks.  However, it is important to remember that even after this time, the shape of the nose is still not the final one.  The process make take up to one year.

IS IT PAINFUL?

Remarkably enough, pain after this operation is not usually a problem and is easily relieved by an injection in the first few hours and a mild analgesic such as paracetamol as necessary afterwards.

WHAT ARE THE SCARS LIKE?

In most instances, all the incisions for a rhinoplasty, are placed within the nostrils and therefore cannot be seen.

WHAT COULD GO WRONG?

All surgery carries some uncertainty and risk.  When nose reshaping is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor.

Irregularities of skin, bone or cartilage may occasionally appear following surgery.  These may show up on the surface as slight depressions, dips of bumps.  Although through conservative measures and time, most of these situations improve, additional surgery may be required for correction.

It is also quite possible that surgery on a badly deviated or bent nose may not result in a perfectly straight, well-aligned nose.  Many reasons may be responsible for this but it is conceivable, in particularly difficult situations, that two or more procedures may be required to remedy these noses.  You will be advised at the consultation what the likelihood of this occurrence will be with you.

HOW LONG BEFORE I’M BACK TO NORMAL?

Once any plaster cast is removed, you will gradually start to resume your daily activities.  This will largely depend on the amount of bruising and swelling you will experience.  Most bruising has dissipated by about 2 weeks, although there may be some slight residual bruising present. This can usually be masked quite easily with makeup.  Most people are back to work by about 10 days.  Although slight swelling may still be present at this time, it is not usually noticeable to the majority of people.  By 3-4 weeks most people are back to their normal routine and are enjoying their new nose.

SUMMARY

By changing the most prominent feature on their face into a more desirable shape, many patients gain a feeling of increased self-confidence, improvement in body image, and general well being.

Ear Surgery, or Otoplasty, is usually done to set prominent ears (ears that appear to stick out ) back closer to the head or to reduce the size of large ears.  For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear Surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.

Complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.

Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.

PLANNING FOR SURGERY

Most surgeons recommend that parents stay alert to their child’s feelings about protruding ears; don’t insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.

In the initial meeting, Dr. Skarparis will evaluate your child’s condition or yours if you are considering surgery for yourself, and recommend the most effective technique.  Ear surgery is usually performed as an outpatient procedure under local anesthesia with sedation.  If your child is young, Dr. Skarparis may recommend general anesthesia.

THE SURGERY

Ear Surgery usually takes about one-two hours. The technique will depend on the problem. With one of the more common techniques, Dr. Skarparis makes a small incision in the back of the ear to expose the ear cartilage. He will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, Dr. Skarparis will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete. In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time.

GETTING BACK TO NORMAL

Adults and children are usually up and around within a few hours of surgery.

The patient’s head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing.  The ears may throb or ache a little for a few days, but this can be relieved by medication.

Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow your surgeon’s directions for wearing this dressing, especially at night. Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work 2-3 days after surgery.

OTHER EAR PROBLEMS

Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: “lop ear,” when the tip seems to fold down and forward. Surgery can also improve large or stretched earlobes. Dr. Skarparis can even build new ears for those who were born without them or who lost them through injury.

MORE NATURAL-LOOKING EARS

Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is improvement, not always perfection. If you’ve discussed the procedure and your expectations with the plastic surgeon before the operation, chances are, you’ll be very pleased with the result.

Fat loss from the face is part of the ageing process. As the face ages (especially thin faces) loses it’s contour and volume and gets a skeletonized look.  The transferred fat to the face is used to restore the lost volume of the face and bring back your youthful beauty, vitality and attractiveness lost with the process of ageing.  Autologous fat grafting, also called Lipo-Injection or Fat Injection, involves extracting fat cells from one part of the body and relocating it to another area.

Typically, fat is removed through Liposuction, often from the abdomen, buttocks or thighs, and then processed and injected into the area being treated.  Fat grafting is most often used to fill in “sunken” cheeks or laugh lines, correct skin depressions or indentations, minimize forehead wrinkles, and augment the lips.  Since the transplanted fat comes from the patient’s own body, fat grafting does not carry a risk of allergic reaction or rejection.  Other advantages include a short recovery time, long-lasting results, and effectiveness on any skin type.  Many times fat transfer is used in combination with the Face Lift procedure to enhance the volume of the face and obtain better results from the procedure.