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Decision making in facial rejuvenation

By Simon Eccles
Posted: 18th May 2016 08:48
The last 10 years has seen a huge increase in patients requesting facial rejuvenation. There are over 48,000 surgical procedures carried out annually in the UK, and this includes facelifts, eyelid surgery, and rhinoplasty (nose modifying) surgery. The range of treatments available to patients is bewildering, and the largest area of growth has been in the non-surgical aesthetic market. Complex facial surgical procedures still rate in the top 5 surgeries listed for men and women in the UK, but the non-surgical market has increased so that now it generates £3.6 billion a year.
Patients are subject to constant battering from the press, TV and celebrities, and the offer of ‘quick fix’ surgery and treatments. These offers seem appealing and low risk, but often this is not the case. Patients are left dissatisfied and unhappy, and do not achieve the results they seek. The department of Health has commissioned several reports to attempt to regulate non-surgical treatments, and ensure that those who are offering these treatments are adequately trained. This has not really had the effect that one might hope for, and the unwary patient may still not achieve the results that they desire despite spending a considerable amount of money. Likewise, the Royal College of Surgeons of England, supported again by the department of Health is going to introduce surgical standards for aesthetic surgery and this will provide a means of ensuring that your chosen surgeon is properly trained and has sufficient experience.
When choosing a surgeon, you should ensure that they are a member of a professional organisation such as BAAPS (British Association of Aesthetic Plastic Surgeons) or BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons). Both of these organisations seek to ensure that their members are well trained and operate to the highest clinical standard.
I always see my facial aesthetic patients at least twice. The first consultation is a ‘getting to know you’ experience for us both, and the goal of this should be an understanding of what the patient wants to achieve. It also allows me to as the surgeon to examine them fully, and discuss how we may address their concerns. I encourage patients to bring photographs with them, and this can provide vital information and be very helpful in planning treatment, surgical and non-surgical. There is usually a ‘cooling off’ period between the appointments, and time for reflection by the patient and the ability to consider the surgery I have discussed.
It is not possible to design a universal facial rejuvenation process, but this needs to be highly individualised. It is important never to ‘sell’ an operation to a patient, and I think patients should be wary of this. My patients usually tell me that they want to look younger and not different, and for me this means facial rejuvenation. Patients are often surprised that I use surgical and non-surgical treatments, and I think now that many of my colleagues would advocate this. Nonsurgical treatments that I routinely carry out include use of Botox and fillers.
The only synthetic fillers I use are based on hyaluronic acid, and are semi permanent. By this I mean that they will if used correctly produce subtle changes in the shape of lips, nasolabial groves and cheeks, but their effects last for 6 months of so, and after this time will need to be repeated. Likewise Botulinum toxin, which has been used routinely in facial aesthetic treatments for 15 years only has a temporary effect, and may last for between 4 to 6 months.
These products offer very different things. Botox is used to soften creases or wrinkles in the skin, and is very effective around the eyes and forehead. It will, if used correctly still allow for movement of the eyebrows and forehead, but will give a softer appearance. Hyaluronic acid based fillers can treat deeper lines, particularly around the mouth, can fill out deflated lips, and fill out the cheeks. Again I always feel it is best to start subtly, and then add more if necessary. This may mean several visits, but I find my patients are happier, and I can achieve the results that they are seeking.
Most of the patients I see in my practice, however are seeking a more permanent solution to address their concerns, and come requesting facelift surgery. There has been a huge evolution in face-lifting techniques in the last 30 years, as we now understand the anatomy of the face in more detail, and understand what we need to do in order to reverse or halt the signs of ageing. The ageing face tends to deflate, giving a hollow and empty appearance to the midface, and a squaring off of the jawline, with the appearance of jowls. By tightening the deeper tissues of the face underneath the skin the SMAS (superficial musculoaponeurotic system), this can reposition the soft tissues and fat pads and will create a natural and more youthful look. It also addresses the looseness and sagginess of the neck that occurs with ageing. These procedures are often combined with eyelid surgery (blepharoplasty) and brow surgery, and it is important to harmonise the face.
I like to take photographs and use these to show my patients where the incisions will be placed, which areas I am going to address and demonstrate the improvements that can be made. I also make my patients aware of the healing time and risks associated with surgery. In planning surgery I like to emphasise that the healing time is just as important as the surgery, and to get a good result you must allow yourself a few weeks to recover from the surgery. I see all my patients until they are fully healed, and my nursing team will help them through the postoperative period.
Facial aesthetic surgery is a very rewarding process for the patient and the surgeon; I cannot stress enough how important it is to have a good working relationship with your patient. This will then lead to a successful outcome.
Simon Eccles
Consultant Plastic Surgeon
Simon Eccles qualified as a dental surgeon before undertaking his medical degree. He trained to be a plastic surgeon on London, undertaking fellowships in microsurgery, craniofacial and aesthetic plastic surgery. He has been a consultant craniofacial plastic surgeon at the Chelsea and Westminster Hospital for the last 10 years. He is a past President of the Royal Society of Medicine, and a surgeon working with the charity ’Facing the World’. His surgical interests are in paediatric and adult craniofacial surgery and in facial aesthetic surgery. He regularly teaches in aesthetic and craniofacial surgery, and recently organised the BAPRAS advanced course in Aesthetic plastic surgery in Manchester.
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