Facial Aesthetic Surgery
Our philosophy is based on the concept of "Beauty is more than skin deep". Aesthetics is a balanced product of healthy living and structured treatment bringing out the natural proportions.
The clinic provides counselling and support from diet, skin care solutions, oral health, cosmetic dentistry, non surgical and cosmetic facelift procedures. The non surgical skills are to replenish lost volumes, remove dead cells and aid augmentation with chemically de-innervating over active muscles. There are surgical procedures where bone, muscles, fat and skin are repositioned to a desirable position. Leonardo Da Vinci viewed the human body as an art form and he studied and recognised a consolation of facial characteristics and proportions that seemed to give the face an ideal harmony. These ideal facial proportions have shaped current conceptions of facial beauty. Analysing facial aesthetics is simplified when the length of the face is divided into three equal thirds. The upper third of the face includes the forehead and brows, to some degree the eyelids. The middle third includes the mid face, lower eyelids, nose and cheeks. The lower third includes the lower cheeks, jaw line, neck and chin. The lower third may even be broken down further into an upper third consisting of the vertical height of the upper lip and the lower two thirds consisting of the lower lip and chin.
Although somewhat controversial, it has been suggested that facial symmetry contributes to facial beauty and harmony. Facial symmetry may be measured by dividing the face in the mid sagittal plane and then comparing the left and right side. Rarely however, if ever, the two sides are perfectly symmetrical. This is why equating symmetry with beauty seems artificial and inaccurate. The degree of asymmetry between the two sides of the face depends primarily on the degree of bony development, fat deposition and muscle activity on either side. Expressive measures of facial symmetry may be obtained by dividing the width of the face into equal fifths.
It is important to understand why wrinkles form and why they are of different depths. Why thread veins and broken veins appear, how they can be improved? Why skin blemishes appear and do we have solutions to improve them? Why some areas present with more fat than other areas where this is fat loss? These are simple common questions asked by patients and are raised in the media.
Non surgical treatments are at present mostly uncontrolled. If the diagnosis is not made accurately, then the treatment offered will not be correct. A clinician who understands the facial anatomy of how the tissues behave in different situations should make the diagnosis and further treatment plan.
Forehead and eyebrow are depressed by six muscles and elevated by two. Botulinum toxin (Botox) can de-innervate any muscles for a period of 4 to 6 months. Frown lines and crows feet are caused by muscle contraction and subsequent skin depression. Botulinum toxin and surgical brow procedures will act on muscle action. However, laser resurfacing or chemical and jet peel will act on the skin crevices. A combination of both to various degrees will provide a pleasing appearance.
Therefore it is important to identify where the over activity is in response to the wrinkles and offer a correct treatment or combination of treatments. It is important not to produce an inanimate face. Over active muscle action is another causative factor for persistent frontal headaches and some migraine attacks. Botulinum toxin is effective as a remedy for such medical problems. Therefore, it is of paramount importance that the clinician who performs such injections understands the management of facial pain and migraine attacks.
Skin health restoration is as important an element of medical aesthetics as dental hygiene to dentistry.
Hormonal imbalance, age changes, exposure to extreme environments and sun exposure with reflections can cause damage to skin resulting in keratosis, lentigines, melasma and other irregularities. In addition to chemical and jet peel which can remove the dead epidermal cells and promote cell regeneration from the deeper layers, interventional treatment with lasers of CO2, erbium, ruby Q switched are effective remedies. Thread veins can be treated with KTP lasers. After 3 years of research, we have also formulated a skin lightening moisturiser using only natural products from Asia which proved to be a successful adjunct to surgical and non surgical skincare solutions.
Aging results in loss of fat volume and augmentation of facial folds. Semi permanent, permanent or temporary fillers are on the market to mask these problems. Patients own fat is a very useful tool as a natural treatment for lost volume. The down side of fat injection is the prolonged recovery time and over correction may be needed. However, it is the safest product available.
The fillers based on Hyaluronic Acid (for example Restylane, Perlane and Teosyl) provides a user friendly semi permanent alternative. It is however, important to make a correct diagnosis, identify patient requirements and recommend a suitable therapy once the +/- have been discussed. Correct local anaesthetic nerve blocks make these procedures reasonably pleasant as opposed to treating a non anaesthetised patient.
Facial anatomy is composed of three general elements of skin, soft tissue and the underlying bone support which provides the basic shape of the face. Age is the most significant factor determining the structure of the face where as gender and ethinicity have minor roles.
Aging is associated with elongation of the upper third of the face, as the hair line moves upward and the brow droops downwards. Brow ptosis, lateral brow hooding, frown and crows feet lines are characteristic aging features of the upper face. Excess upper eyelid skin, pseudo herniation of the orbital fat and muscle hypertrophy need directed surgical correction once the accurate diagnosis is made. Hence it is essential that examination should be carried out by an experienced Clinician who deals with the face day in day out. Upper eyelid surgery may be combined with lateral brow correction. Sometimes, the only correction required is brow elevation. Lower eyelid problems are caused by weakness of the septum which is in fact a curtain for the lower eyelid contents and when weakened, results in eye bag formation. Weakness of the tendon results in loss of sharp definition on either side of the eyelid. Instead of fat excision, strengthening the curtain should be the objective in corrective surgery. Hollow eyelids do not give a natural appearance. A millimetre makes a lot of difference, particularly in eyelid and nasal surgery. Therefore the philosophy should be towards an under correction rather than excessive surgery.
The age related changes in the middle third of the face are primarily reflected by changes to the nose and cheeks. In general, nasal skin, bone, muscle and cartilage become thin and weak. The support structures that once maintained aesthetic and function of the nose may become inadequate. The nasal tip grooves and the tip becomes boxy. Rhinoplasty is a challenged procedure when performed on a patient of any age. Those changes associated with aging, introduce new variables to the procedure which make it even more complex surgery.
The importance of youthful attribute of the human face is a soft tissue distribution and the fullness it creates in the upper mid face in relation to the lower mid face. In youth, the eye muscles maintain a sling around the bony orbital ring. With the loss of muscle tone, malar (cheek) soft tissue descends. This results in lower eyelid fat bulge, hollowness between the eyelids and cheek and deepening of the nasolabial fold. A cherubic youthful face will become flatter or even concave. Fat repositioning, ligament tightening and bony augmentation with implants are procedures that need to be carried out for rejuvenation of the mid face. The aim is again, producing a natural appearance for the age and gender of the patient rather than producing an ideal structure that does not blend with the rest of the body.
Nasal deformity, ear malformation, familial fat herniation and jaw disproportion are problems seen in younger patients. Again the philosophy of correction here is different to that of the aging population.
Where teeth are lost, the bone supporting the dentition will gradually resorp like a slow melting ice cream from a cone. Over closure of the jaw results in chin ptosis. Jowls, loss of jaw line, deposition of neck fat and neck muscle separation are all characteristics of lower facial problems of aging.
Correction of bony and dental height is of paramount importance in lower facial aesthetics. If a denture is placed, the height needs to be adjusted periodically to maintain the vertical dimension and eventually the patient finds it difficult to keep it inside the mouth due to the sheer weight of the denture. This then brings in "denture adhesives" which may cause mucosal inflammation and persistent development of oral thrush. Bulky dentures are not conducive functional gadgets. Dental implants have transformed this problem. Once implants are placed, the bone resorption is halted, vertical height is restored and a beautiful smile is reproduced. A balanced smile is critical to a youthful appearance.
"Smile and the whole world smiles with you". As the saying goes a beautiful smile lightens the hearts around you and gives you an extra dose of self confidence at the same time. It maybe hard to smile even if you want to when your teeth are uneven, chipped or discoloured. If this is a problem, porcelain veneers could be the answer. Lumineers by cerinet is a porcelain veneer which can be made as thin as a contact lens and is placed over the existing tooth requiring limited tooth preparation which many patients are not keen about. Another area for which to provide a beautiful smile is laser assisted bleaching. Bleaching of teeth is to some degree uncontrolled. Recent publications deal with the uncontrolled bleaching by non professionally trained personnel causing major complications to patients, an important warning sign. Although bleaching provides an excellent beautiful smile, it is of paramount importance that the health of the gum tissue and prevention of any other damage to the rest of the oral mucosa be taken into consideration in any such treatments. The laser assisted bleaching we carry out is safe and produces a well controlled outcome.
Chin ptosis results in "witch skin" appearance. Various techniques are available to correct this deformity. This varies from chin implants to bony surgery with simultaneous adjunct treatment of neck liposuction and muscle plication. These procedures can also be carried out as part of a standard face lift procedure. Ear lobe elongation is a tell tale sign of aging. Adjustment of the length can again be part of a facelift procedure.
Peri-oral aesthetics of young and old should be correctly diagnosed and a definitive treatment. Asymmetry or lack of philtral ridge vermillion border prominence requires a different treatment as opposed to thinning of soft tissue, droopiness of the corner of the mouth and volume loss which is seen in older patients. A clinic should be able to provide the whole area of treatment so that a balanced outcome can result.
Facial aesthetic surgery is a balance between art and science. This has been in existence for centuries. The aim and expectations are changing throughout the periods. Self image and being confident are necessary requirements of a patient or persons well being. These patients are no longer hiding these treatments and the procedures have become part of the necessary requirements. However, surgery on the fact cannot go unnoticed. Therefore it is essential that the correct diagnosis is made and ideal treatment for each particular patient identified and executed, tell tale signs of surgery should not be evident.
The face is a complex structure and a facial surgeon with thorough knowledge and expertise of all facial and oral structures would be well suited to provide such a service.
Medical tourism is becoming very fashionable, particularly for financial reasons. A word of caution however is that one should not put finance before one's safety. It is of paramount importance that the correct clinic or hospital is identified and the background of the surgeon's experience is know prior to any medical or surgical intervention. Any procedures may post operative problems or corrections. Access to your surgeon's clinic should be made available easily. Pre operative counselling and support is essential.
If may prove difficult to fulfil this criteria with overseas trips for treatment.