(1) DEEP HORIZONTAL LINES ON THE FOREHEAD
A "forehead lift" (also known as a
"brow lift") can be done to pull up and tighten skin in this area to
make the lines less prominent.
The surgical cut is made 1 cm behind the
hairline, running from ear to ear. The skin of the forehead is then lifted
upward and stretched, the excess cut off; the underlying muscles-whose tautness
has caused the wrinkles-are cut to weaken them; and the incised skin edges are
sutured, the scar going into the new hairline.
The overall effects is to lift both, the
forehead as well as the eyebrows.
(2) VERTICAL FROWN LINES
The muscle in the forehead (whose laxity
causes the lines) is cut and tightened. The procedure leaves fine scars in the
area between the eyebrows.
Alternatively, "filler" injections
of collagen or auto (your own) fat can plump out the lines, making them less
(1) EYE BAGS: A result of the aging
process, they are caused by a two-in-one decline: the skin loses its elasticity
and stretches; and globules of fat herniated through the weakened layer of
tissue. This causes the puffiness in the upper and lower lids that we call '
A cosmetic procedure known as blepharoplasty,
in which the surgeon cuts away the excess of loose skin and the protruding fat
then sutures the eyelid, making it taut and smooth again.
The scars get hidden in the natural folds of
In the younger patient who does not have too
much skin laxity, and whose problem is limited to a protrusion of fat, the
surgeon may go through the conjunctiva (membrane) of the eye, pick out the fat
and put in a couple of stitches. This procedure (known as conjunctival
blepharoplasty) can be done only for the lower lids.
This is surgery that calls for finesse and
delicate precision. The lower eyelids are particularly vulnerable to a
heavy-handed approach: removing too much skin can result in a tension in this
area that makes it difficult for the eye to adjust to the upward gaze.
(2) CROWS' FEET
Injections of collagen (a synthetic
version of the protein that gives skin its elasticity) can be used as
"line fillers" which smoothes and even out the area.
Where the lines are several and deep, the
surgeon can cut away a slice of skin and suture the cut margins, which again
has a smoothening effect in the area; the scar is hidden in one of the
creases of skin around each eye.
(3) HOLLOW UNDER THE EYES
A difficult problem to address. Fat has been
tried as a filler, but results are not very effective.
(4) DARK CIRCLES
They cannot be eliminated, but in older skin
that are wrinkled and loose, they can be minimized: The surgeon stretches and
cuts off the excess skin. The skin under the eyes becomes smoother and the dark
area smaller in size.
(5) DROOPING EYEBROWS
There are two possible treatments:
The first is the so-called "eyebrow
lift". The surgeon makes a small incision just above the eyebrow, cuts away
an ellipse of skin and sutures the cut area, pulling the eyebrow higher up. The
scar gets hidden in the eyebrow line.
The second approach is to lift the eyebrows
as part of another procedure, the "forehead lift".
(1) BAT EARS
This is a frequently-seen familial tendency,
characterized by a large, deep conchal bowl that pushes the ear out from the
head at an exaggerated angle.
Surgery which places permanent sutures in the
back of the ear, literally pinning them back to the head.
The scars are generally hidden behind the
The surgery can sometimes result in an
asymmetrical look in the two ears. The distortion may be minimal and evident
only on close inspection; but if it is very obvious, repeat surgery may be
required to correct it.
The final look can also sometimes be
compromised by the collection of blood or fluid between the skin and
cartilage. The possibility can be largely minimized by ensuring that the
post-operative dressings are carefully maintained.
(2) FLOPPY EARS
This is an inherited deformity in which the
hard outer rim of the ear has not properly formed. As a result, the top of the
ear flops down like that of a rabbit-hence the alternative name for this
aberration: "lop-ear deformity".
Surgery involves creating a fold in the
cartilage of the upper ear which will keep it propped up; this is done by
putting in (permanent) stitches in this cartilage and tying them up.
(3) ENLARGED, DROOPING EARLOBES
These are a consequence of the natural aging
The excess can be trimmed, and a stitch or
two can pull back lobes that may have jutted outward.
(1) PROBLEM OF EXCESS IN THE NASAL REGION,
A hump, caused by an excess of bone
A bulbous nose, caused by and excess of
Flaring nostrils, caused by very thin
Rounded nostrils (rather than the ideal:
pear-shaped nostrils), caused by an excess of cartilage in the lower,
Nasal surgery (known as rhinoplasty) can trim
the excess and then mould the nose into its final shape.
It can take from 1 to 2 hours and is done
under local anesthesia combined with sedation, or under general anesthesia in
the case of a highly-strung patient.
The surgery is carried out within the nasal
cavity and/or the mouth so that scars are not visible.
It is inadvisable to have nasal surgery
done (unless the deformity is life-threatening or psychologically
traumatizing) until the age of 16 or 17. This is when the nose has grown
into its final shape. Carrying out surgery before this age may make it
necessary to re-operate later because the shape of the nose will have
altered again in the intervening years.
Infrequent complications (of all nasal
----Haemorrhage, which is easily treatable
----Infection, which is rare, occurring only if operating conditions are less
than optimal or if the surgeon has not carefully "cleaned up"
the area before surgery.
----Poor healing, which generally cannot be predicted in advance. Dark skins are
however more prone to scarring; and those with circulatory problems are likely
to suffer from temporary or lasting discoloration.
(2) PROBLEM OF DEFICIENCY IN THE NASAL
A bridge that's too short
A nose tip that's too blunt
A short bridge calls for the addition of
something that's solid and possesses strength-either bone from a hip or rib or
a hard silastic implant.
If the tip (which is composed of cartilage)
is small, you need to add something pliable or cartilaginous. This can be either
the curved cartilage of the ear or a soft silastic implant.
It is difficult to predict how much of
grafted bone will survive the process. Once surgically detached from its
original place, it is no longer connected to the circulation: in its new
position, it has to develop its own blood supply to survive. Sometimes 90%
of the bone may survive, sometimes only 10%: the amount is unpredictable.
So, a surgeon may have added 4 mm of thickness of bone to a nose, but six
months down the line only 3 mm. may be still in, or perhaps only 1 mm.
Correcting this may mean a second round of surgery, using either bone from
the opposite hip or from another rib.
Silastic implants do not get absorbed,
but they can get dislocated in case of an injury such as a knock or a blow
to the area. Also, you may not like the presence of a foreign body under
If the cartilage is taken from the ear,
the organ looks deformed; this is particularly visible in the case of men
who wear their hair short.
(3) ELONGATED/DROOPY NOSE ARISING FROM
LAXITY OF THE SKIN AS A RESULT OF AGING.
A surgical incision is made at the root of
the nose (i.e. the place where it joins the forehead), and about 3 mm of skin is
excised. Then the remaining skin is lifted upward and sewn into place (a
"nose life" as it were). The scar is hidden by glasses which you need
after 45 anyway.
(1) HOLLOW CHEEKS
Injections of auto-fat, taken other areas of
your body ---- preferably an area like the abdomen which has thick, globuly fat
---- can fill out hollow cheeks.
(2) OVER-CLUBBY CHEEKS
Minor liposuction can result in a slimmer,
more accentuated look. Liposuction involves the use of suction to "suck
out" far from different areas of the body with the help of a canula, a
miniaturized one in the case of the face.
The surgeon has to be very precise and
careful in suctioning out fat from the face where the layer lies more thinly
than in, say the buttocks or the thighs. Over-correction (vacuuming out too much
fat) can leave difficult-to-treat grooves.
(3) FLAT CHEEKBONES
Inserting a "malar" (cheekbone)
implant, made of silicone and custom-shaped to suit the contours of your face,
can provide greater definition to cheekbones. Most commonly, it is inserted through the
The risks of cheekbone augmentation with
an implant include:
Infection (rare since antibiotics are
administered these days as a matter of routine). But if it does occur, the
implant will extrude, in which case it can be replaced at a later date.
NASO-LABIAL LINES (Laugh Lines)
These are lines that set in with age, running
from each side of the nose down to the angle of the mouth.
Filler injections of auto-fat or collagen.
If a face-lift is going to be done anyway,
such injections may not be required in addition; this is because the pulling-up
and tightening of the skin that takes place in a face-lift will itself smooth
out laugh lines (though it cannot obliterate them).
A test for a possible reaction to synthetic
collagen must be carried out four weeks before it is injected.
(1) THIN LIPS
Collagen is generally used to plump up the
outline of lips, redefine this area (which lies at the junction of the skin and
the mucous membrane of the lips). It can also create a Cupid`s bow. But collagen is not generally used for the
meat of the lips: fat is preferred for this area.
(2) THICK LIPS
A cut is made on the inside (the mucus
membrane area) of the lips, and a sliver of this membrane is cut off. The cut
edges are sutured, taking the visible part of the lower lip up and in, thus
reducing its thickness.
Over-correction can skew the final look.
(3) UPPER-LIP DROOP AT THE CORNERS
Collagen injections can firm up this area and
provide lift, which obliterates the sag.
Cautions/Risks and Comments
(4) VERTICAL LINES ABOVE THE LIPS
Collagen injections, or
Light dermabrasion (sand-papering of the
superficial layers of the skin, using a diamond-coated cutter or, sometimes
today, a laser beam)
Risks of dermabrasion include:
Serious scarring if the deeper structures
of the dermis (the skin`s lower layer) have been damaged.
(1) EARLY JOWLS
Very early sags that make it seem as if your
jawline is disappearing are caused by gravity taking its toll on the flesh as a
result of the weakening of the platysma muscle (which extends from the jaw to
the neck), combined with the download shift of fat (which lies just below the
The excess of fat can be trimmed with
liposuction, re-defining the jaw line. The entry point for the canula is behind
the ears, where the scars of surgery then lie hidden.
(2) DOUBLE CHIN
Liposuction, going in again from behind the
(3) RECEDING CHIN
A silastic chin implant can restore
balance to the facial profile as well as impart a more youthful look.
Some surgeons do a procedure in which
they split the mandible (the lower jaw) and slide one portion forward to
create a more prominent chin. New bone grows in the gap resulting from the
EXTENSIVE SAGGING, DROOPS AND CREASES ON
THE FACE AND NECK
When the face begins to "fall
down", it`s time for a face lift. In this classical procedure, the surgeon
makes a cut starting from the hair-bearing area above the ear, continues
downward (in front of the ear), turning round to go under the earlobe, and up
again behind the ear to end in the delicate, hair-bearing area behind the ear.
He then undermines the skin of the face and
neck, lifts it from the under-surface, pulls and stretches it upward and back,
and cuts away the excess.
Liposuction may be done to remove any excess
of underlying fat; and a couple of stitches are put into the deeper structures
to tighten them.
The platysma muscle in the neck is trimmed
and tightened to provide firmer support for the surface skin.
The trimmed skin is finally sutured in place.
The scars are largely hidden in hair-bearing
skin or behind the ear. The scar in front of the ear is successfully hidden by a
suitable hairstyle in women: it is not so easily dealt with in men, though
growing sideburns may help.
A face-lift is major surgery---- around 3
hours or more ----- and you need to be in good health overall health.
Since the face is a highly vascular area,
bleeding is a possible complication. Blood clots may form under the skin,
and may range from minor to major. The latter causes painful swelling of the
face, and very occasionally the sutures may need to be opened up to treat
the bleeding points.
The procedure can also cause injury to
branches of the facial nerves. If a motor nerve has been cut, it can result
in permanent asymmetrical movement of the mouth or forehead. However, if it
has been only bruised or stretched, the asymmetry may be temporary; recovery
may take from 3 months to a year.
Rather less seriously, damage to a large
sensory nerve running up the side of the neck can result in temporary or
permanent sensory loss in the lower half of the ear.
The risk of complications is slightly
higher in men. Scars are also less easy to disguise, especially in those men
with thinning or balding scalps.