Harley Plastic Surgery

You may have decided to change the size of your breast implants or to have them removed altogether.  Alternatively the shape or texture of one or both breasts may have changed with time.  This is typically due to a membrane which forms around the breast implant, tightening and thickening with time - it is known as a ‘capsule’.  As the capsule tightens it causes the shape of the breast to become more rounded; wrinkles can sometimes be seen or felt and sometimes there is pain also.  Capsule tightening and the shape change which results occurs in approximately 1-2% of implants per year.  Change in body and breast shape following pregnancy or weight loss may also have contributed to this.

What does the operation involve?

Usually, your previous breast implant scar is reopened and sometimes it may be made a little longer.  The ‘capsule’ is removed in part or as a whole (‘capsulectomy’) or it may be left behind but loosened with some internal incisions (‘capsulotomy).  The old implant is also removed and typically this is exchanged for a new implant of the same or of a different size.  The old implant can be returned if it is in good condition.  Some women choose not to have the breast implant replaced at all. 

A small plastic tube (‘drain’) is positioned in the breast cavity and it is connected externally to a vacuum bottle.  The drain is left in position for approximately 48 hours and then removed.

  Ordinarily you will go home with the tube in place and return to the hospital to have it removed on the second or thrid day after operation.  Sometimes the operation will be combined with an uplift of the breasts (‘mastopexy’) especially if a smaller implant is chosen.  Mastopexy usually involves an incision around the nipple and may also require a vertical incision from the nipple to the fold and a longer incision in the fold.  This adds some further complexity and time to the operation.

Introduction

Upper eyelids

When an extra fold of skin develops on the upper eyelids the eyes look ‘hooded’ and may have a tired, sad or ageing appearance.  This tends to happen with the passage of time but it can also be significant in younger adults.  Sometimes there is so much extra skin that it rests on the eyelashes and it can obscure peripheral vision.  

Lower eyelids

Extra skin also develops on the lower eyelid.  In addition, there is a small pad of fat which sits under the eyeball and this may spread forwards.  Wrinkles and bags are present in the lower eyelid as a result of these changes.  This makes eyes look puffy and tired.  Again, this is age related but it may be seen in younger adults.  

What is blepharoplasty?

This is a plastic surgical procedure which refreshes the eyes.  Blepharoplasty treats hooding and heaviness of the upper eyelids and removes bags and wrinkles in the lower eyelid.   As a result the eyelids look younger, less tired and puffy.  You may also feel more comfortable and improve peripheral vision by having excess eyelid folds removed. 

How would I be helped by liposuction?

If you would like to change the profile of your body and this has not been achievable with diet and exercise then liposuction may be helpful for you.  ‘Love handles’ above the hips, ‘saddle bags’ overlying the hips, inner thighs, inner knees, back rolls, neck, tummy and ‘man-boobs’ may all be reshaped with liposuction.  Although it is not essential to be at ‘ideal body weight’,

liposuction is not intended as an alternative to being a healthy weight so it not appropriate for patients who are significantly overweight and looking to lose weight through surgery.

Liposuction relies on your own skin being elastic enough to shrink once fat has been removed.  This effect is impossible to predict accurately.  If your skin elasticity is reduced, liposuction will result in wrinkles, folds or uneven skin - typically the skin loses its elasticity increasing age, sun exposure, cigarette use and stretch (pregnancy / weight-gain).

Liposuction does

not

treat cellulite; in fact, liposuction can leave the skin with a slightly uneven appearance similar to cellulite.

In summary, liposuction will definitely reduce overall bulk and change the outline contour but there are often imperfections in the flatness of the bare skin afterwards.

What is pinnaplasty?

The medical term for the external ear is the ‘pinna’.  A pinna-plasty alters the shape of the external ear.  In almost all cases this involves altering prominent ear so that it sits closer to the side of the head.  People talk about ‘pinning’ ears…..no pins are involved!  The shape and position of the ear is corrected by scoring the cartilage in the ear and / or holding it in a new position with stitches.  A headband is worn full time for a week to protect the corrected ears.

Why do ears stick out?

This is simply a variation between humans.  The cartilage of the pinna is a complex of folds and recesses which forms during the first few months of foetal development.  In most cases the prominent ear will have quite a deep bowl ‘concha’ immediately next to the ear hole.   Additionally, the principal fold in the mid and upper section of the pinna has a very open angle or it is deficient altogether.  Prominent ears can be a source of ridicule and self-consciousness and for this reason patients frequently ask for the ears to be corrected.

What is Rhinoplasty?

Rhinoplasty is also known as a ‘nose-job’.  It is an operation which changes the shape of the nose to give a more aesthetically balanced appearance or perhaps to correct an established deformity.  There are a combination of changes which can be made to improve the appearance of the nose which include reshaping the bridge of the nose (usually reducing a hump), refining the tip of the nose, improving the projection of the tip, shortening the nose or narrowing wide nostrils.  The aim is to shape the nose so that it is more in keeping with the desired appearance of the patient and also in balance with the proportions of the face.

What does the surgery involve?

Rhinoplasty is typically carried out under general anaesthetic and you can go home on the day of surgery.  Sometimes a single night in hospital is advised.  The shape of the nose is determined by a framework of cartilages and bones.  Small cuts are made inside the nostrils to access the framework and reshape it.  Occasionally it is also necessary to have a small scar at the base of the nostrils or across the central strut (‘columella’) of the nose or tiny access incisions on the side of the nose.  The operation takes about 90 minutes. At the end of the operation a small splint and some tapes will be positioned and packs are inserted into the nostrils.  This is done to support the new shape of the nose while it sets.  Some cases are more complex and may require internal access to the central strut deep inside the nose ‘septum’ which is necessary to correct shape, airflow or to obtain cartilage grafts to assist with shaping the nose.  This is known as septo-rhinoplasty.

Tummy tuck aims to restore a more youthful, toned tummy which has been affected by ageing, pregnancy and weight gain that all take their toll on your shape, especially around the waist and hips. Skin laxity and extra fat contribute to the heavy abdomen and hips making it difficult to wear the clothes you want and sometimes contributing to lower back pain or poor posture.

What is a Tummy Tuck?

Tummy tuck is a plastic surgical procedure which removes excess fat and loose skin around the lower abdomen between the navel (belly button) and the pants line.  Skin from the upper abdomen is stretched downwards to replace the removed skin and the navel is stitched into position.  This greatly improves the abdominal contour.

What is a Mini Tummy Tuck?

A few patients have a very small skin roll which is confined to the lowest section of the abdominal wall.  In these cases is is possible to simply remove the small roll of skin without the need to reposition the navel.  This is a less extensive procedure, taking approximately half the time of a full abdominoplasty.  It leaves scar in the pants line, as does the abdominoplasty but no surgical scar is present around the navel.  It may be possible to do this as an awake ‘local anaesthetic’ operation although general anaesthetic remains preferable.  Other aspects of the surgery are similar to a full abdominoplasty - see below.

Does the surgery require a general anaesthetic or hospitalisation?

Tummy tuck surgery is done under general anaesthetic, as a day case or a one-night-stay procedure.

How long is the procedure?

Tummy tuck normally takes approximately 3 hours to complete depending on the complexity of the surgery.