Mr. David Johnson - Oxford

During the procedure the excess skin and fat are excised leaving a short horizontal scar in the armpit connected to a long scar on the inside part of the arm extending from the armpit to the inside of the elbow region. The wounds are stitched with dissolving sutures leaving the resulting scars as hidden from view as possible. This cosmetic procedure has high patient satisfaction and low complication rate. It can be performed in conjunction with liposuction if additional excess fat needs removing.

A mastopexy (breast uplift procedure) is an operation performed to tighten the skin of the breasts, make the breasts look and feel firmer and place the nipples in a higher, more youthful position.  It is performed under a general anaesthetic and the operation takes 2 hours and requires a hospital stay of 2 days. There are different technical ways the operation can be carried out depending on a number of individual factors including the starting shape of the breast and this determines the extent and location of the incisions and resultant scars on the breast. The excess skin is excised and the breast tissue tightened with stitches. In addition, a reduction in the diameter of the areola (the pink/brown part of the nipple complex) is usually required. The nipple is moved to a higher, more youthful position and the wounds are stitched with dissolving sutures, and covered with light dressings. The resultant scars depend on the exact techniques employed and vary from only a circular scar around the new nipple/areoalar complex, to additional scars such as a vertical scar passing from the nipple to underneath the breast. In some individuals, it is necessary to have an additional long curved scar passing in the breast fold. It is important to realise that a mastopexy procedure does not alter the size/volume of the breast. but rather its shape. The procedure can be combined with breast augmentation using an implant if an increase in breast size is also desired.

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.

During a standard facelift, an incision (cut) is made on each side in the hairline above the ear extending just in front of the ear and then passing behind the ear back into the hairline. The skin is lifted off the face and the neck, and the underlying platysma muscle together with its fibrous attachment is pulled and tightened with stitches. The excess skin is pulled and excised and the wounds are closed with a combination of dissolving stitches and stitches that need to be removed after 7 days. In the composite/deep plane type of facelift, the incisions are the same but the skin and underlying layer are lifted together rather than separately. In the subperiosteal facelift, there are incisions in the hairline above each ear, as well as a small incision on the inside of the mouth in the upper gum line, and an additional cut just underneath the eyelashes of the lower eyelid. Using these incisions, the full thickness of the facial structures are elevated off the facial bones and lifted to a more youthful position, and held in place with deep stitches that dissolve. The wounds are then closed with a combination of stitches that dissolve and those that need to be removed after 7 days. The wounds are then covered with a bandage.

During the procedure, the donor area for harvesting fat is prepared in a similar fashion to performing liposuction. The fat is harvested using a special suction cannula so it is not damaged. it is then centrifuged to allow separation of the intact healthy fat cells from those that have damaged. The live fat cells are then injected in the treatment areas using a very fine cannula to place tiny amounts of fat in tunnels which are carefully built up to form layers which restore volume and shape. Between 50% and 60% of the transferred fat survves. This means a certain amount of overcorrection is required which also contributes to some of the swelling following surgery. Fat transfer is often performed in conjunction with other surgical procedures such as a facelift.

Liposuction is mostly performed under general anaesthetic (though very small areas can be performed under local anaesthetic) and the length of the operation is determined by the extent of the liposuction required. Usually 1-2 days in hospital is required. First, an injection of saline, adrenaline and local anaesthetic is given in the area to be treated. The fat to be removed is accessed through tiny incisions (cuts) positioned near the area to be treated. A hollow tube is placed through these cuts into the fat underneath the skin. The tube is then connected to a special suction pump which removes the fat. The small incisions are either sutured or simply covered with steristrip tapes.

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.

During the procedure a long curved cut is made in the skin across the lower abdomen at the level of the top of the pubic hair, and a separate small cut is made around the umbilicus ("tummy button"). Beneath the skin and fat the abdominal wall muscles are tightened with stitches and the excess skin and fat are then excised.  The lower wound is stitched with dissolving sutures leaving the resulting scar concealed by bikini style underwear. The umbilicus ("tummy button") is stitched with a combination of dissolving sutures and some that will need to be removed 7-10 days after the operation.