Mr. David Johnson - Wroughton

Breast augmentation is the term used to describe the surgical technique of enlarging the breast by inserting implants behind the breast. The operation is performed under general anaesthesia and lasts 1½ hours and requires 1 night in hospital. There are a number of different shapes, sizes and types of implant, all of which can give excellent results and which are ultimately chosen on an individual basis. The operation entails making a 5 cm incision on the underside of the breast and making a space for the implant either beneath the breast tissue or beneath the muscle on which the breast lies. The wound is then sutured with dissolving stitches and covered with simple dressings.

A browlift is an operation to try and reverse the effects of ageing on the brow and so rejuvenate the forehead to make it look younger. The operation usually takes between 1-2 hours to perform and is done either as a daycase procedure or else requiring 1 day in hospital. In its simplest form, the direct open browlift involves cutting away an ellipse of skin and muscle just above the eyebrow and stitching the wound closed with dissolving stitches. This can be very effective at elevating the eyebrow, but leaves a visible (albeit short) scar and cannot address the forehead frown lines. An indirect open brow lift involves either a long incision at the junction of hairline with the forehead, or an incision well behind the hairline which passes from the top of one ear across the scalp to the top of the other ear. Through these incisions (cuts), the skin and muscles of the forehead are reflected down and the muscles causing the deep frown lines are reduced. A rim of skin is excised from the edge of the incision so that when the wound is stitched, the eyebrows are elevated. The scalp wounds are then closed with dissolving stitches and the wounds are then covered with a bandage. For smaller elevations of the brow, for example about 5mm, an endoscopic browlift technique can be performed. This involves making 3-4 short vertical incisions (cuts) behind the hairline and passing a telescope connected to a camera through the incisions to show the surgery on a video monitor. Instruments are inserted through the other incisions allowing the muscles which cause the frown lines between the eyebrows to be reduced. The eyebrow is elevated by tightening the deeper layers of the scalp with stitches, but no skin is excised, and so a smaller elevation in the brow is possible with this technique compared with longer scar techniques. The advantages of an endoscopic browlift are that scars are small and can often be well hidden. The bruising and swelling may be reduced.

There are a number of surgical procedures for gynaecomastia. All are performed under general anaesthesia. Depending on the complexity of the procedure required, the operation can take between 1-2 hours and require a 1-2 day hospital stay. In cases where the excess breast tissue is soft and fatty in nature, and particularly when there is not a large amount of excess skin, then liposuction can be very effective. During this procedure, the excess fatty breast tissue is aspirated (sucked) away by a hollow tube placed under the skin through very small access cuts in the skin located at the periphery of the breast tissue. If the amount of excess breast tissue is too firm to be removed by liposuction, then a cut is made around the lower half of the nipple/areolar complex and the excess breast tissue excised, and the wound stitched with dissolving sutures. If, in addition to breast tissue that is too firm for liposuction, there is a lot of excess skin, then a donut shaped area of skin around the nipple is excised to reduced the excess skin as well as excising the excess breast tissue. The wounds are closed with dissolving stitches.

Rhinoplasty (nose job) is an operation to alter the shape and size of the nose and if necessary, to improve the nasal airway to allow more air to pass through the nose. The operation is performed under a general anaesthetic and takes between 1-2 hours to perform and requires 1 day in hospital. There are a number of ways a rhinoplasty can be performed depending on the specific features of the nose to be corrected. Essentially, the operation can either be done with all the incisions (cuts) hidden on the inside of the nose, called a closed rhinoplasty, or else with most of the incisions on the inside of the nose and an additional small incision on the skin of the nose half way down the columella (the thin piece of skin in the midline between the tip of the nose and the upper lip), called an open rhinoplasty. Through these access incisions, the nose is reshaped by a number of techniques, including reducing any hump on the top of the nose, augmenting any flatness of the nose with bone grafts, straightening the nose, narrowing the bridge of the nose by breaking the bones of the nose and resetting them, straightening the septum to improve the air passages, and altering the tip of the nose by either removing and sculpting the existing cartilage, or adding more cartilage to give better support. Of course, not all these techniques are required in every rhinoplasty, and some operations may be very simple, whilst others may be very complex. The wounds are then closed with dissolving stitches and the nose is covered with a plaster support.