Before & After

This 55 year old man’s primary concerns were the sagging and laxity of his jowls and upper neck that he had come to dislike over many years. However he specifically wanted a result that appeared natural, not “overdone” and appropriate to his years and social groupings. In males the choice of scar location in front of the ear is critical to how the beard grows and must be dealt with in a bespoke way in every case. Use of a composite lateral-only technique avoided a mid-neck scar and resulted in a natural-appearing significant improvement.

This 52 year-old lady consulted me regarding her facial ageing. She had not had any significant facial surgery before and as such I was happy to recommend a deep-plane facelift but without central neck contouring in this case. An associated lateral temporal browlift picked up the slack from what is an effective facelift. She also chose to have a degree of facial fat grafting to restore her facial soft tissue volume which is an important factor in such cases. She did have reasonably significant bruising in her lower eyelid region from a combination of the browlift and the fat grafting but given enough time, this settled progressively to give an overall harmonious facial appearance after surgery.

This 66 year-old lady consulted me specifically with regard to her heavy hooded eyelids an the functional problems she had from this. Given the nature of her hooding, I felt that a simplistic upper blepharoplasty on its own would be inadequate but the patient was not keen on more extensive surgery including a temporal browlift. For that reason a hybrid approach including a brow suspension “brassiere suture” approach was undertaken. The correction of her sagging eyelid skin has resulted in not only aesthetic improvement with an even lid show (where skin immediately above the eyelashes is visible in open gaze) but also functional improvement in terms of her eyelids not feeling so heavy in everyday life.

This 59 year-old lady consulted me with dissatisfaction regarding her eyelid contour and how she felt her sagging upper eyelids and lower eyelid bulges made her look aged and tired. She wished for the least surgery that would be likely to improve these specific issues; as such combined upper blepharoplasty and open transcutaneous lower blepharoplasty was undertaken. In the setting of lower eyelid surgery I often take photographs that are flash-lit and also a separate set that are top-lit only. Top-lit photographs show the contours of the eyelids quite differently to flash-lit photographs. A marked improvement in the lower eye bulging can be seen in the top-lit photographs. My approach to photography underlines an attention to detail that I aim for with all such cases.

This 68 year-old lady was referred to me by a consultant dermatologist colleague who felt that her surface treatments, including laser approaches, would not be adequate to address her concerns about facial wrinkling. Definitive full facelift surgery, including a lateral necklift and a temporal browlift, was recommended. Fat grafting was included to this bespoke surgical plan. This has resulted in a positive refreshing of her facial appearance but one which does not look unnatural. The scarring in front of her ear is neat and fine and in the long term will be difficult to notice unless specifically searched for.

This 62 year-old lady consulted me a regarding the ageing of her eyelids and associated upper facial regions. Interestingly she had some subtle facial asymmetry before surgery and it was important to point this out. Surgery cannot always are correct such asymmetries and choosing an operation based on the ability to modify one side compared to the other is important in cases such as this. A good, but natural-appearing, correction of her eyelid laxity but with preservation of eyelid position and function, has been achieved with the use of upper blepharoplasty, open transcutaneous lower blepharoplasty and a lateral temporal browlift.

This 66 year-old lady consulted me specifically with regard to her heavy hooded eyelids an the functional problems she had from this. She was not keen for more extensive surgery including temporal browlift approaches, but an additional approach to realign the orbital aft volumes was undertaken. The correction of her sagging eyelid skin has resulted in not only aesthetic improvement with an even lid show (where skin immediately above the eyelashes is visible in open gaze) but also functional improvement in terms of her eyelids not feeling so heavy in everyday life.

This 58 year-old healthcare professional, known to me through one of my surgical colleagues, disliked her central neck laxity which she could grasp and wobble around. I explained to her that correction of this in isolation at her age was not advisable and that whilst neck lift surgery can be undertaken to improve neck contour and skin laxity, in her case this should be combined with a facelift. In her case central neck contouring surgery combined with a plane facelift and a form of lateral temporal browlift has smoothed out her facial appearance from bottom to top. This has resulted in a positive change and one that appears natural to onlookers. Unfortunately she suffered some bleeding behind her ear on one side in the hours after surgery; this was due to excessive discomfort from a previous shoulder injury (that had not been disclosed) and these swings in blood pressure resulted in the development of haematoma. Whilst prompt surgical evacuation was carried out on the night of surgery, this has left a small area of delayed healing and scar formation behind that ear that may require subsequent attention with laser enhancement and possibly minor scar revision.