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Complimentary Procedures

Facial aging is a complex process and the best results are achieved by a combination of adjunctive procedures. These include forehead and brow lift procedures, blepharoplasty, perioral rejuvenation, Lip lift, Buccal Fat removal and fat grafting.

How a Brow lift Works

As we age, the brow and forehead descend. A Browlift is often an effective way of elevating the eyebrows to correct hooding of the eyelids and reducing forehead lines and wrinkles. 

Types of Complimentary Brow Lifts

Gliding Brow lift

Using external quilting techniques, large scars in the scalp can be avoided. The so called Gliding Brow lift procedure is quick and recovery is rapid although some temporary numbness and itching is normal.

Temporal Brow lift

Also known as a lateral brow lift, the temporal brow lift does not lift the central brow. Instead, only the outer 1/3 of the brow is lifted through a small incision hidden within the hairline.

Endoscopic Brow lift

The endoscopic brow lift, on the other hand, uses small incisions hidden within the hairline. The results of endoscopic browlift are natural and long lasting. A patient evaluation study (published in the British Journal of Plastic Surgery, ‘One hundred cases of endoscopic browlift’, British Journal of Plastic Surgery, Vol 55 No 1, 2002 pp20-25) has shown a high level of satisfaction with the results.

The endoscopic browlift procedure is less suitable for men with male pattern hair loss and women with a high forehead.
Gliding Brow Lift

Blepharoplasty

Eyelid cosmetic surgery to improve ’eyebags’ can be very successful in restoring a more ’open’ and youthful appearance around the eyes. However, the perception that it is a simple, quick and straightforward procedure for bilateral blepharoplasty lid lift and tuck should be qualified.

The operation of lower and upper lid blepharoplasty generally involves removing excess skin, muscle and fat from the eyelid. Scars are placed in natural creases and easily concealed.

Upper and lower eyelid surgery can be carried out under local or general anaesthesia as a day procedure.

There are now several alternatives and refinements to the traditional procedure of lower and upper lid blepharoplasty. Removal or transposition of fat alone can be performed through an incision on the inside of the eyelid without any scar on the skin. For some patients, the fat can be reshaped rather than removed. Laser can be used to improve the wrinkling of the skin although this can result in a permanent lightening of the skin colour.

Lower Lid Surgery (Canthopexy)

The lower lid can be tightened or elevated as a part of the procedure. This is known as a ‘Canthopexy’.

Excess skin folds in the upper lid can commonly occur when the eyebrows become lower and heavier. In these circumstances, a more natural and long lasting improvement can be achieved by elevating the brow. This is known as a browlift (See above).
Careful assessment preoperatively is essential to avoid complications. A history of dry eyes or eye allergies may predispose to problems postoperatively. 

Complications after Upper and Lower Eyelid Cosmetic Surgery (Blepharoplasty)

Cosmetic upper and lower eyelid surgery can result in a variety of complications. Most of these are minor and temporary.

Excessive removal of skin and/or fat can result in a variety of unwanted effects. These include, ’rounding’ of the eye, asymmetry of the lids, a ’hollowing’ in the lower lid and a lowering of the position of the lower lid. The result of these problems is to produce an ’operated’ look. This is known as post blepharoplasty syndrome. Correction of post blepharoplasty syndrome is difficult and may involve secondary procedures including canthopexy or even ’Mask’ lifts (See Facelift).

Some patients request upper and lower eyelid surgery as a result of specific problems. Thyroid disease can cause bulging of the eyes and retraction of the eyelids. The management of thyroid eye disease is complex and may require surgery to the bones of the orbit as well as the soft tissues.

Sometimes, drooping of the upper eyelid (ptosis) may be caused by a problem with a specific muscle. This condition must be recognised preoperatively as it will not be improved by blepharoplasty.

Lip lift 

A lip lift is a surgical procedure that shortens the distance between the upper lip and the nose, creating a more youthful and balanced appearance. The incision is concealed in the natural crease of the nose, and the scars from the incision may take up to a year to fully heal and fade. Improved facial harmony and increased lip volume are long lasting effects, thus reducing the need for no surgical lip injections with filler.

Buccal Fat Removal

Buccal fat surgery trims and repositions fat in hopes of creating a more pleasing facial contour. Buccal fat surgery is a minimally invasive but effective procedure with invisible incision placed inside the mouth.

Chin Surgery

A retrusive chin may have a negative effect on facial balance. If the chin is very small it may be due to an underdevelopment of the whole lower jaw. For most people, however, a relatively simple procedure can be carried out to increase the chin projection and improve facial appearance. 

Chin implants are the simplest option, but they can result in problems including infection and rejection. Alternatively, an advancement of the chin using the patient’s own bone can be carried out. This is a relatively simple procedure although can produce some temporary numbness of the lower lip.
A relatively new option for mild cases is to strengthen the chin prominence with the use of fat injections into the soft tissues of the chin area. The reliability of chin augmentation surgery has improved enormously in the last few years.

Each person has to be assessed to determine the best procedure of chin augmentation surgery for their individual needs.

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