Other Surgery

Facial Contouring

 

Lip Augmentation or Lip Enhancement(linked to facial cosmetic surgery - others - lip augmentation)

Lip augmentation is indicated to make thin upper and lower lips fuller, more rounded and youthful looking by using your own tissues, treated donor materials or synthetic substitutes. Augmentation also effectively improves the vertical wrinkles of the lips brought about by ageing or smoking. It also reverses the tendency of very little red lip being visible brought about by the ageing process. Professor Malata would decide in full consultation with you the most appropriate way to augment your lips since a variety of techniques are now available for lip enhancement. The options include:

Your own tissues: fat injections, grafts (dermis, dermal-fat, fascia).

Treated donor substances: bovine collagen injections, allogeneic dermis (Alloderm)

Synthetic materials:

  • Injectable: Restylane, Juviderm, etc.

  • Implantable: PTFE (Goretex), etc.

 

Enhancement with Fillers:

Restylane (hyaluronic acid) therapy offers excellent immediate results. Injections are performed in the outpatient clinic/ office and can be done during your lunch hour. However, ongoing treatment is necessary to maintain results. These generally last 6 - 9 months, although each individual breaks down the restylane at varying rates. For further details on restylane please see the section on Fillers (link to Fillers).

 

Permanent Enhancement:

Permanent Enhancement is achieved by either using a dermo-fat (skin and fat) graft from a non-hair bearing part of the groin or fat transfer from the hips or abdomen, or “AlloDerm” grafting.

  1. Lip augmentation is generally undertaken under local anaesthetic unless the patient prefers otherwise, or is undergoing other surgery at the same time such as a face lift, a "nose job", chin or cheek implants, liposuction, etc.,

  2. It is done as a day case but an adult must take you home on discharge from hospital.

  3. The two or three small incisions on the lips are sutured with dissolving stitches.

  4. At the end of the surgery your lips will look bruised and swollen, and feel numb and excessively large because of the effect of the local anaesthetic.

 As in any cosmetic surgery, there are benefits, risks and the final results are not guaranteed.

 

Risks of Lip Augmentation with implants

  • Bruising and swelling: common

  • Numbness and stiffness: common but temporary

  • Infection: rare

  • Cold sores: activated by the trauma of surgery

  • Bleeding (haematoma) - rare

  • Exposure of material +/- extrusion

  • Delayed wound healing/ fistula formation

  • Asymmetry/ implant malposition or migration / distortion of lip

  • Resorption of fat, dermis, collagen: unpredictable

  • Incomplete improvement

  • Induration (firmness or hardening of the lip)

  • Irregularities

  • Donor site problems

  • Deformity of lip due to buckling of implant

  • Possible revisional surgery +/- removal of implant

 

Alternatives to Lip Augmentation with implants

  • No surgery

  • Lipstick

  • Tattooing

  • Camouflage cosmetics

  • Fillers i.e., Temporary augmentations

 

 

Chin Augmentation and Chin Implants

Chin augmentation is important because the chin is an important facial feature which creates a defined but balanced profile. There are two main reasons for augmenting the chin; the first is to rejuvenate a sagging chin and the second is to improve or correct a receding chin, which will enhance the profile of the face. In addition to giving you a stronger jaw line, a chin implant can improve the balance and proportion of your face by creating a better balance between the chin and nose in profile. It is not suitable for severe degrees of chin recession which are best dealt with by sliding forward the jaw bone.

The specific indications for chin implants include

  1. strengthen the “weak” chin by increasing the forward projection of the receded chin in profile.

  2. Enlarge or widen the narrow pointed chin.

  3. Rejuvenate a sagging chin

  4. It is sometimes recommended to patients requesting reduction of their apparently large or long nose (rhinoplasty) when on assessment the primary problem is found to be a retruded or recessive chin rather than a large nose.

  5. It may also be indicated in patients requesting neck lift surgery when the profile of the neck can be dramatically improved by chin augmentation.

Chin augmentation or chin implant surgery is undertaken alone or frequently in combination with other facial procedures such as a rhinoplasty, a lower face-lift, liposuction of the neck or neck lift. These facial procedures are designed to accentuate the lower face and neck lines and complement the chin implant.

Professor Malata prefers to use silicone rubber implants (rather than porous polyethylene = medpor) placed subperiosteally, because they are smooth and flexible. The implants can be of various lengths and thicknesses so as to be tailored to the individual patient’s contour or appearance. The chin implant is placed either through the mouth (transoral/ intraoral route i.e., via an incision between your lower lip and gum) or through an incision under the chin (submental) in a natural crease.


As in any cosmetic surgery, there are benefits, risks and the final results are not guaranteed.

 

Risks of chin augmentation with implants

  • Swelling & bruising of lower face, chin and neck - very common: but resolved by 10-14 days

  • Numbness – very common but usually temporary. Rarely permanent numbness

  • Sensory nerve injury: mental nerve trauma – common but transient for 6 weeks usually.

  • Bleeding and hematoma: rare

  • Infection: < 5% but disastrous (entrance of bacteria into wound): explant + washout.

  • Wound dehiscence: uncommon.

  • Facial nerve injury - marginal mandibular nerve damage: corner of the mouth.

  • “Rejection” of the implant/ extrusion of the implant

  • Malposition of the implant: more common with the intraoral approach. Rotation or mobility

  • Chin ptosis (droopy chin) results from damage to mentalis muscle or removal of the implant

  • Poor aesthetic results due to:

  1. Overcorrection: results in overprojecting masculine look.

  2. Under-correction

  1. Asymmetries

  • Unsightly scarring for external approach.

  • Capsular contracture around the implant

 

Alternatives to Chin Augmentation with implants

  • No surgery

  • Fat Injections

  • Sliding Genioplasty (breaking & sliding of the mandibular bone)

 

 

Cheek Augmentation

The cheeks are an important facial feature which create a youthful and balanced profile. There are a number of reasons for augmenting the cheeks; to rejuvenate the mid-face and improve or correct a flat facial profile caused by congenital deficiency, age related bone resorption or facial trauma. Cheek implants can provide balance and highlights to a less defined face or further enhance an already existent cheek structure. A weak cheek structure can make the face appear jaw heavy or give a gaunt appearance. A full, high cheek is considered more youthful.

Cheek augmentation surgery is performed either using injections of your own fat (autologous fat transfer) or by inserting soft silicone implants, or restylane sub-Q injections. The cheek implants can be inserted through the mouth or through a lower blepharoplasty incision.

As in any surgeryAs in any cosmetic surgery, there are benefits, risks and the final results are not guaranteed.

 

Risks of cheek augmentation with implants

  • Swelling and bruising: very common

  • Numbness – very common but usually temporary. Rarely permanent numbness

  • Bleeding and hematoma: rare

  • Infection: rare but disastrous as explant + washout mandatory.

  • Wound dehiscence: uncommon.

  • Facial nerve injury:

  • “Rejection” of the implant/ Extrusion of the implant

  • Malposition of the implant: due to rotation or mobility

  • Poor aesthetic results:

  • Asymmetries

  • Overcorrection:.

  • Under-correction

  • Capsular contracture around the implant

 

Alternatives to Cheek Augmentation with implants

  • Fat Injections

  • Midface Lift

  • No surgery

 


Cheek Enhancement with Restylane Sub-Q

Cheek enhancement may be desirable either to improve the definition over the cheek bones or to lift the mid-face as part of facial rejuvenation. Restylane SubQ is an alternative to permanent cheek implants which is used because implants can sometimes become infected or move, creating asymmetry in the face. Although fat can injected into the face to add volume with excellent results, Restylane SubQ is the only method available to achieve a similar result without the need for surgery.

Restylane SubQ is the trade name for an injectable form of hyaluronic acid specially formulated for facial contouring. Hyaluronic Acid is a natural sugar that is found in the connective tissue of the skin and, along with collagen, forms the building blocks of healthy tissues. Restylane is the most popular facial filler in the world today and has a proven safety record. The result from restylane treatment is immediate and will last about 9 to 12 months.

Professor Malata does not use permanent fillers for the face as the body's response to them can sometimes be unpredictable and removing them can be difficult if not impossible. The soft tissue fillers that have demonstrated consistent safety for the last 20 years are the non-permanent fillers such as Restylane.

The Procedure

Before treatment, your cheeks will be marked in the standing position to get a good idea where is the best place for enhancement. The area is then treated with a local anaesthetic injection to make the actual treatment comfortable. Restylane SubQ is finally injected into the cheek area to sculpt your midface for rejuvenation or enhancement.

The anaesthetic wears off about 6 hours later and you are advised to take some pain killers at about that time to prevent any discomfort.

 

As for any cosmetic procedure, there are benefits, risks & the final results are not guaranteed.

Risks of Cheek enhancement with Restylane Sub-Q

  • Bruising and swelling for 2 – 3 days
  • Allergic reaction: rare & minimal: 1 in 2,000 patients: treated with anti-inflammatories such as brufen.
  • Movement of the product from the desired position by

a) sleeping on that side

b) touching the site

c) massaging the cheek.

  • Infection: very rare
  • Poor aesthetic results:

a) Overcorrection:

b) Under-correction

c) Asymmetries

Alternatives to cheek augmentation with Restylane sub-Q

  • Fat Injections 
  • No surgery
  • Cheek Augmentation with implants            

WHAT YOU NEED TO KNOW
(Lip Enhancement with Implants)

LENGTH OF SURGERY

1 hour

ANAESTHESIA

Local or General anaesthetic or Local with sedation

NO. OF NIGHTS IN HOSPITAL

Day case (or rarely overnight stay)

RECOVERY

5 days until socialising with close friends and family

1 week until return to work & normal social engagements

2 – 3 weeks until bruising and swelling disappeared

3 – 5 days until driving

4 weeks until return to gym and other strenuous activities

12 weeks until final result

DURATION OF RESULTS

Permanent

WHAT YOU NEED TO KNOW
(Chin Augmentation with Implants)

LENGTH OF SURGERY

1 - 1.5 hours

ANAESTHESIA

General anaesthetic

NO. OF NIGHTS IN HOSPITAL

Day case

RECOVERY

5 – 10 days until socialising with close friends and family

10 – 14 days bandaging / taping the chin to reduce swelling

2 – 4 weeks until bruising and swelling disappeared

2 weeks: driving, return to work & normal social engagements

4 – 6 weeks until return to gym and other strenuous activities

12 weeks until final result – scars continue to improve for 1 year

DURATION OF RESULTS

Permanent

WHAT YOU NEED TO KNOW
(Cheek Implants)

LENGTH OF SURGERY

1 - 1.5 hours

ANAESTHESIA

General anaesthetic

NO. OF NIGHTS IN HOSPITAL

Day case

RECOVERY

5 – 10 days until socialising with close friends and family

2 – 4 weeks until bruising and swelling disappeared

2 weeks until return to work & normal social engagements

2 weeks until driving

6 weeks until return to gym and other strenuous activities

12 weeks until final result – scars continue to improve for 1 year

DURATION OF RESULTS

Permanent

WHAT YOU NEED TO KNOW
(Cheek Augmentation with Restylane Sub-Q)

LENGTH OF SURGERY

15 - 30 minutes

ANAESTHESIA

Local

NO. OF NIGHTS IN HOSPITAL

Day case

RECOVERY

3 – 4 days until bruising and swelling disappeared

36 – 48 hours until return to work & normal social engagements

DURATION OF RESULTS

Permanent

To find out more or make an appointment please contact Mr. Malata's Secretary on 01223 573 715 or glenys.secretary@ntlworld.com