Cosmetic Surgery
There are many elements to cosmetic surgery, and very many different treatment options. It is most important is to have a clear idea of what you would like to achieve and to find someone who can discuss the options with you.
As we age our skin loses its elasticity, stretches and is pulled downward by gravity. Our range of facial expressions then repeatedly creases our skin to give us the classic deepening wrinkles of an older face. Many of these lines are welcome as they give “character” to our faces. Many, however, are less welcome, especially if they make us look older than we feel, or crease the brow to suggest that we are concerned when we feel carefree.
The Essentials
The absolute essentials of face care should be started young. Never smoke, minimise sun damage by wearing sunglasses, suncream and a hat. Moisturise regularly, drink lots of water and sleep well. Easy to write, not so easy to do.
Once the skin has developed age related changes the treatment options are now well understood.
Botox
When a deep line is generated by the skin being repeatedly creased by an underlying facial muscle, temporarily paralysing the muscle with Botox causes the musle to relax and the overlying skin to smooth out. This technique is most effective for frown lines. Botox is the most popular cosmetic treatment in both the UK and the USA. It is simple, effective, and if you don’t like the effect it wears off over 4 months.
Fillers
Deeper expression lines, folds and furrows can be lifted by “filling” the tissue deep to the crease. These plumping agents are injected deep to the crease. The filling agents wear off slowly over months, and can be repeated.
Smoothers
Fine lines can be smoothed with a chemical peel using trichloroacetic acid, or with CO2 laser resurfacing. The treated areas can be quite reddened while healing, which usually takes from days to weeks depending on the intensity of treatment.
Surgery
Ultimately if the skin has stretched too much, or the deeper tissues have been pulled too far downward by gravity, then a surgical aproach is required. An eyelid lift (Blepharoplasty) is the most popular facial surgery in both the UK and USA. The upper lids and lower lids can be lifted and tightened with the scars hidden in the upper eyelid crease or the subciliary line.
A facelift is more dramatic and not particlularly well named, as it is more of a jowl and neck lift than face lift. There are now many techniques described to try to lift the midface, but this area remains the most difficult, and the interface with the lower eyelid is key.
What can go wrong with surgery?
1. Infection of the wound. This is minimised with sterile technique and by using antibiotic ointment to the stitches and antibiotic tablets. Wound infection can be minor but can lead to a worse scar.
2. Large bruise or haematoma. This is minimised by taking it easy for 2 weeks after surgery, stopping aspirin and other anticoagulants if safe so to do, and regular use of ice packs. A haematoma may mean you have to go back into theatre to have the blood clot evacuated and then be resutured with the risk of a worse scar.
3. Visible scar. The cuts to the skin should fade to a thin white line. Not every scar heals equally well. A thickened or reddened scar can be improved with silicone scar remodelling gel, but the treatment needs to be continues for months to have a good result.
4. Theoretical risk to vision. Any eyelid surgery carries the risk that an undiagnosed infection or bleed could damage the optic nerve. This is so rare that in comparison a normal car journey is a much greater risk to your vision.