Other Surgery

Non-Surgical Enhancements

 

Botox Correction of Wrinkles

Wrinkles are the direct result of the skin losing elasticity with age and the long term effects of muscle contractions from smiling, frowning and laughing. They are also worsened by sunlight damage and smoking. Wrinkles can be reduced to give a smoother more youthful complexion by muscle relaxing injections (Botox), the use of dermal fillers (Restylane), skin resurfacing (laser or chemical peel) or facelifting). Mr Malata will discuss the advantages and disadvantages of the different treatment options to help you decide which is best for you.

Botox is an attenuated form of the Botulinum toxin, which has been rendered harmless by “chemical” treatment. When injected in minute amounts it blocks the nerve impulses that cause muscle contraction thus causing a reversible localised weakening (paralysis) of the muscles of facial expression. In this manner it improves the dynamic wrinkles and furrows caused by repetitive and excessive contraction (pull) of facial muscles thus smoothing the nearby skin. Botox is usually given into the forehead, glabellar (between the eyebrows), and crow’s feet areas. It thus prevents frowning and cosmetically improves the expression lines of the forehead and those around the eyes making your (upper) face look younger, smoother and imparting a more serene (rested) and less angry appearance to it.

Botox starts to take effect in 2 – 3 days following injection, gradually increasing over the next few days and is well established by the end of 1 week. The effect lasts about 6 – 9 months, and the action of your muscles recover completely. The improvement in the wrinkles wears off gradually and so you will need repeat injections / treatment to maintain the results.

Botox has been used for more than 20 years in children and adults to improve the problems of facial muscle spasms, double vision caused by muscle imbalance, spasmodic disorders of the head and neck, etc.

 

Advantages of Botox injection

  • Avoids a general anaesthetic / surgical operation

  • Totally reversible

  • Alternative to surgery – attractive for younger patients or anyone wishing to avoid surgery.

 

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

 

Some risks of Botox injection

  • Minor swelling and bruising: usually settles within a few days

  • Infection: extremely rare (almost unheard of)

  • Allergic reactions: burning sensation, redness, swelling

  • Eyelid ptosis: rarely a droopy upper eyelid may occur: lasting several weeks: 1: 1, 000 risk

  • Eyebrow ptosis: rarely a droopy eyebrow leading to an asymmetrical upper face. Lasts several weeks

  • Partial effect or inadequate response: may require later touch –up.

  • Reversible (not permanent) ~ 6 months or so: requires further treatment.to maintain results

 

Eyelid Ptosis: Very rarely if the botox reaches the upper eyelid muscle there may be transient drooping. This is the most significant risk and occurs in about 1 in 1000 injections. It occurs from local spread of the botox from the injection site and can be minimised by accurate dosage, proper placement, as well as keeping in an upright position for three to four hours after the injection. If drooping eyelids occur, it usually resolves over a few weeks. Special eye drops may temporarily reduce eyelid droop if it occurs.

 

Alternatives to Botox injections

  • No treatment

  • Forehead/ Brow lift: for horizontal forehead & frontal nasal lines and vertical glabellar lines

  • Face lift surgery: temporal facelift & lateral extension of eyelid tuck incision for lateral canthal lines

  • Eyelid tuck (blepharoplasty)

  • Chemical peel of the face

  • Laser resurfacing of the face: CO2 or Erbium

  • Collagen or fat injections

  • Combination with collagen injections:

    • for already formed (fine) intradermal lines

    • also prolongs the duration of the collagen injections

 

Indications or areas treated by Botox:Botox is most commonly used in the upper face. As a quick and effective treatment, with excellent results and virtually no downtime, it is perfect for those patients who have minimal signs of facial aging such as forehead furrows and crow's feet. The most common areas requested are the horizontal forehead lines, vertical frown lines between the eyebrows, and crow's feet (or laughter lines) radiating away from the eyes. While it would probably work around the mouth and chin, it would almost undoubtedly weaken the smile and Mr Malata does not recommend its use around the mouth. Creases around the mouth can, however, be improved by filling them out with a dermal filler such as Restylane.

Safety: As for any cosmetic procedure, there are benefits, risks & the final results are not guaranteed. Botox injection is currently the most popular cosmetic procedure in the World. It has several years of a well established safety record and is indeed licensed by the American Food and Drug Administration (FDA) for cosmetic use.

What should be expected after Botox therapy? Botox is a remarkably safe treatment for wrinkles with little down time associated with the treatment. Occasionally slight bruising may occur where Botox is injected and a mild headache may follow. Bruising may be greater in patients who are taking aspirin or any blood thinning medicines. These products should be avoided if possible prior to the injection. Muscle weakness is first noted at between the 3rd and 10th day after injection; it is not immediate.

How long does Botox last? Successful therapy is signalled by muscle weakness that begins 3 – 5 days after injection with the main effect visible at about 7 days. The effect after the initial injection lasts between 3 and 5 months for most patients.

How often is Botox needed? Repeat treatment is suggested every 4-5 months to keep the muscles sufficiently frozen to allow the furrows to smooth out. In practice this means coming three times in the first year. After using botox for one year the intervals between injections may be a little longer so that you need it only twice a year.

Alternatives to Botox: Filling agents including Restylane and Hyaluronic acid may help to eliminate the finer expression lines. Whilst Botox can often delay the need for more extensive surgery, it is important to stress that it does not achieve the same results as surgical procedures. Depending on the severity of the skin changes it may be more appropriate to recommend lifting operations of the forehead, temporal region or face which would also have the longest lasting effect.

Unexpected benefits of Botox: Tension headaches and migraine for some patients have disappeared. These occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded.

How painful are the injections?The smallest needles are used and the medicine itself does not tend to sting as much as injections of local anaesthetic. Most patients feel it as painful as having their eyebrows plucked. It is advised not to use aspirin as this can increase the risk of bruising.

 

Contraindications to Botox: The following groups of people should not receive Botox injections:

  • Pregnant women; although there have been no reports of adverse effects on the fetus Mr. Malata will not treat pregnant patients with Botox.

  • Breastfeeding; similarly, there is no evidence that Botox is expressed in breast milk but it is best avoided if breastfeeding.

  • Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.

  • Patients taking the following medicines should not receive Botox: aminoglycoside antibiotics, penicillamine, and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia, Verelan).

  • Known allergy to human albumin (egg white) or Botox; currently there are no documented cases of allergy to Botox.

 

What to do after Botox injections:

    • Do not massage the area of the injection.

    • Do not lie down for a nap - keep upright for about 3-4 hours.

    • Using the muscle intentionally makes it contract and may help to localise the botox to the selected muscle.

    • Do not take any aspirin for two or three days either side of the injections as this may help to reduce the chance of bruising.

    • Do not to perform any vigorous exercise for 24 - 48 hours after the treatment.

 

Injectable Fillers / Facial Injectable Fillers

Introduction

Dermal Fillers – These are injections given into the skin of Hyaluronic Acid (e.g. Juvaderm, Juvaderm Ultra, Restylane, Hydrafill) or collagen (e.g. Evolence) to plump up wrinkles and folds in the skin

Facial rejuvenation using injectable fillers involves injecting a substance into and beneath the skin to correct lines, folds and wrinkles in order to provide volume where the concentration of the body’s own hyaluronic acid has decreasec.; a wrinkle or deep fold such as the nose to mouth lines. When injected beneath the skin, these fillers plump up creased wrinkles and folds of the face. They can also add fullness to the ageing lips and cheeks which have lost volume and hence prominence. This restoration of fullness minimizes the effects of ageing and it restores youth and beauty.

Injectable fillers may be used alone or in combination with other procedures such as Botox or surgery. Fillers are usually not sufficient for severe lines and wrinkles on the face, such as deeper folds and creases in the face and brow which may be more effectively treated using surgery. Mr Malata will give you an honest opinion as to what the best way of treating you will be.

Restylane can also be used to create fuller and more youthful lips by accentuating pouting and fullness. It may be injected along the lip margins to enhance contour and prevent lip stick “bleed”.

A popular method to reduce wrinkles uses injectable fillers to smooth and plump out wrinkles, crows feet, laughter lines, some types of sunken scars, cheeks and lips. The filler is injected using a fine needle, until your facial lines and wrinkles are filled out. Different substances are used as fillers.

Hyaluronic acid is the most commonly used dermal filler. It is used under the common brand names Restylane, Hydrafill and Juvaderm. Mr Malata performs hyaluronic acid (Restylane) treatments at his clinics in Cambridge and Peterborough.

Mr Malata prefers to use temporary fillers because in his opinion permanent fillers are difficult if not impossible to remove and they can leave the face looking inharmonious in the future - lips of a 30 year-old will not be appropriate at 60. A more natural alternative is fat transfer for deeper folds and wrinkles, but this may require a general anaesthetic.

Worldwide there are many different types of dermal fillers on the market but only a few of them have demonstrated predictable long term results with minimal swelling and reliable safety. Mr Malata restricts his practice to Restylane/ Juvederm/ Hydrafill as they have consistently demonstrated predictability and safety.

 

Restylane

Restylane is the brand name for an injectable form of hyaluronic acid specially formulated for facial contouring. Hyaluronic acid is an abundant natural substance that provides support and volume to the tissues. It is a 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 been used in over 3 million treatments. It has a proven safety record. The result from the treatments is immediate and will last about 6 – 9 months.

Indications:

    • Accentuated nasolabial fold or melolabial fold (face to lip transition).

    • Junction between lower lid and cheek (nasojugal fold or “tear-trough).

    • Progression of the jowl to the chin (marionette lectu

    • Thin  wrinkled lips

    • Cheek which lost their prominence.

 

Mechanism:

Restylane is formulated as a crystal clear gel and uses a dual mechanism to correct wrinkles and folds. Upon being injected beneath the skin Restylane gel integrates into dermal tissue then attracts and binds to water molecules to help maintain volume. Restylane is gradually degraded by the body's own mechanism and disappears without any residue. Results can be seen immediately following treatment. Restylane and juverderm are injected into the skin in tiny amounts producing a natural volume “foundation” that lifts and smoothes the skin contour.

Restylane Perlane, like Restylane, is a dermal filler and is a long-lasting gel that will lift and add volume helping to resculpt deep folds.

After a thorough discussion of your desires with Dr. Malata, a treatment plan with Restylane or Juvederm will be developed specifically to achieve your goals.

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

 

Risks of Restylane Injections

  • Injection is painful

  • Bruising and swelling for 2 – 3 days

  • Allergic reaction: rare and minimal: 1 in 2,000 patients: treated with anti-inflammatory.

  • Local redness and swelling (can be reduced by cover make up).

  • Infection: very rare

  • Poor aesthetic results:

  • Overcorrection:

  • Under-correction

  • Asymmetries

 

Alternatives to Restylane

  • No surgery : make up

  • Temporary collagen injections.

  • Fat Injections

 

Chemical Peels:Skin Resurfacing using chemical peels - rephrase

 

Introduction: Chemical peeling is the process of peeling the skin using a chemical. The chemical peel removes the outer layers of the skin, removes sun and liver spots and rough scaly patches, reduces freckles and irregular pigmentation and thus revealing the underlying layer, which is newer and smoother in texture. The depth of a peel can be superficial, medium or deep. Mr. Malata only peforms the “medium depth” peel with trichloroacetic acid (TCA).

Indications: Patients who would benefit from a TCA chemical peel treatment are those individuals with fine surface wrinkles, pigment discoloration (blemishes and blotches), age (liver) spots, superficial acne scarring and dark circles under the eyes.

Procedure: Before the chemical peel is applied, the skin of the face is thoroughly cleaned with an agent to remove excess oils. The eyes and hair are protected from contact with the acid. The peel is applied by Mr. Malata in the treatment room. TCA peels will cause a slight burning sensation that will last about two to ten minutes. In most cases, an anesthetic is not required because the chemical itself acts as an anesthetic; however, a relaxing sedative may be used. When the desired depth has been achieved, Mr. Malata will neutralize the peel by applying ice cold saline. Once all areas have been neutralized, your skin will return to its normal color in 15 to 45 minutes. Your face is then covered with an oil-based ointment, antibiotic (or steroid) ointment such as polyfax to keep your skin moist and promote healing.

Advantages of a TCA peel: Tricholoracetic (TCA) peel’s degree and depth of penetration within the skin can be controlled accurately according to specific requirements. TCA chemical peels provide an intermediate level of improvement at an intermediate cost and recovery period. They are ideal for individuals who want more than a superficial peel, but cannot afford the expense or recovery time of a deeper treatment. Unlike deep peels, medium peels may be performed safely on people with olive and light brown skin. However, people with dark brown skin are at a higher risk of discoloration.

Risks/ Side effects: A crust or scab may form on the treated area and there may be significant swelling. The swelling will subside within the first week. After about 10 days, the new skin should be apparent and healing should have progressed enough to allow a return to normal activities. Your flushed appearance will fade slowly over several weeks.

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

 

Risks of Chemical Peel

  • Crusting and scab formation

  • Significant swelling

  • “Down time”: normal activities in 10 days.

  • Flushed appearance fades slowly over several weeks.

  • Discolouration or depigmentation (especially in the neck)

  • Infection: very rare

  • Poor aesthetic results:

  • Scarring: if infected or too deep

  • Under-correction

  • Asymmetries

 

Alternatives to Restylane

  • No surgery : make up

  • Temporary collagen injections.

  • Fat Injections

 

Duration: Medium chemical peels such as the TCA peel will last six months to two years. The use of skin care products regularly after your peel will maximize the duration of improvement. Most women who choose medium chemical peels as the mainstay of their facial rejuvenation have a repeat peel every six to twelve months.



Summary of Chemical Peel

Procedure time

1 – 1½ hours

Anaesthetic

Local or sometimes General (based on choice & size)

Hospital stay

0 (rarely overnight if other surgery done)

Time off work

12-14 days

Sensitivity period

2 - 4 weeks

Return to Exercise

2 – 3 weeks

Back to normality / sports

2 - 3 weeks

 

 

Laser Skin Resurfacing with a CO2 & Erbium

Introduction: As we age, the colour and texture of our skin ages with us. Pigmented spots can develop on the face and hands and chest, red vascular marks and spots can be found on the nose, cheeks, and elsewhere, and the skin loses its lustre. Fine lines and wrinkles begin around the eyes and mouth, and slowly progress to the rest of the face. There are a number of solutions for the colour and textural changes of our skin, and laser and intense pulsed light treatments can be extremely effective.

The two forms of laser and light treatments are those with little or no down-time [non-ablative laser (1064nm Nd:YAG) and intense pulsed light or IPL], and those with a recovery period (laser resurfacing treatment such as CO2, Erbium, or fractional laser therapy such as Active FX). The no-down-time and rapid recovery laser and intense pulsed light treatments select a specific color within the skin and deliver light energy to treat it; red spots, sun spots, brown or dark pigmentations, spider veins, and hair follicles can be targeted and treated. Resurfacing laser treatments produce a reorganization of the collagen layers of your own skin and result in a tightened and rejuvenated appearance.

Laser resurfacing procedures are used to treat more substantial textural changes of the skin including wrinkles and diffuse pigment changes. Laser resurfacing will most often require anesthesia (most often local anesthesia or local anesthesia with sedation), and can be used to treat specific areas of the face such as the eyelids, the upper lip, or the entire face. Laser resurfacing can also be used to treat pigment changes and fine wrinkles of the neck and decolletage area of the chest. Mr. Malata only has access to an Erbium laser or CO2 laser. He currently does not use "fractional photothermolysis" laser treatment (such as Active FX, Deep FX, and Total FX) in which only a portion of the surface of the skin is treated with laser energy, leaving "bridges" of untouched skin to aid in the regeneration process. With fractional laser resurfacing, recovery is more rapid. Laser resurfacing may be performed alone, or in combination with other surgical procedures such as facelift and blepharoplasty.

The ideal candidates for laser resurfacing are those with

  • Minimal, mild or moderately pigmented skin types

  • Areas of discolorations or texture changes

  • Fine lines or wrinkles

Advantages of laser resurfacing:

• Improves and balances colour of skin
• Removes dyschromias (pigmentations) and spots
• Evens skin texture
• Smoothens skin and reduces wrinkles

Recovery from Laser Resurfacing

Following intense pulsed light (IPL) and non-ablative laser treatments, you can often go back to work immediately after the laser / light energy procedure. After laser or IPL treatment of pigmented areas, the sites may darken or crust before they lighten or disappear. After laser resurfacing treatments, you will go home on the same day with a friend or family member. Care of the laser-treated areas will vary depending upon the location, type, and depth of treatment. Most often, recovery is six or seven days following a fractional laser treatment, and between 10 and 14 days following a full CO2 laser resurfacing. The redness after laser resurfacing often begins to resolve after two weeks, however it may take up to 12 weeks for the final results of the laser resurfacing procedure to be evident. After non-ablative laser and light treatments, you can return to unrestricted exercise in about two hours. After laser resurfacing procedures, light aerobic activity (elliptical, walking, bicycle) may be resumed as early as four to five days following, and more strenuous activity is begun at two to three weeks. Mr. Malata will review you frequently after your treatment..

 

Summary of CO2 or Laser Resurfacing of the Face

Procedure time

1 – 1½ hours

Anaesthetic

Local or sometimes General (based on choice & size)

Hospital stay

0 (rarely overnight if other surgery done)

Time off work

12-14 days

Sensitivity period

2 - 4 weeks

Return to Exercise

2 – 3 weeks

Back to normality / sports

2 - 3 weeks

 

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

 

 

Fat transfer surgery or Fat Grafting

Introduction: Fat transfer surgery involves taking fat from one area of the body and transferring it to another to restore shape and definition. This technique is widely used in aesthetic and reconstructive surgery, but most commonly in restoring facial volume which has diminished in the natural ageing process. Small amounts of fatty tissue harvested from the abdomen, buttocks or the thighs using a technique similar to liposuction. The fat is purified and then injected using a fine cannula in a controlled fashion to the areas to be treated. Mr. Malata used the Coleman fat transfer technique.

Fat grafts are often performed in conjunction with other procedures, such as liposuction, facelift, blepharoplasty (eyelid lift), and other facial and body plastic surgery procedures

The indications in the face or the ideal fat transfer candidate:
Wrinkles, folds, or areas of volume loss of the face or elsewhere on the body

  • Nasolabial folds,

  • Glabellar lines, fat grafts to lips, fat grafts to eyelids

  • Tear troughs or nasojugal folds

  • Cheeks

  • Other sites: Breasts, Hands, Buttocks

 

Fat Transfer Advantages
• Restores volume with your own natural filler
• Fat takes as a graft
• Long lasting

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

 

Some risks of fat transfer

  • bruising, swelling  numbness (temporary)

  • bleeding (haematoma): rare  incomplete improvement

  • infection: rare  mild residual asymmetry

  • delayed healing  need for revisional surgery

  • facial nerve injury  fat embolisation into vessels

  • unsightly scarring – infrequent  mild residual asymmetry

  • scar hypertrophy or keloid formation

 

Summary

Procedure time

1 – 1½ hours

Anaesthetic

General (or local based on choice & size)

Hospital stay

0 (rarely overnight)

Time off work

1 - 2 weeks

Sensitivity period

2 - 4 weeks

Back to work

2 weeks

Back to exercise

2 – 3 weeks

Back to normality / sports

4 - 6 weeks

 

WHAT YOU NEED TO KNOW
(Restylane Injections)

LENGTH OF PROCEDURE

15 - 45 minutes

ANAESTHESIA

Local anaesthetic or topical anaesthetic cream

NO. OF NIGHTS IN HOSPITAL

0

RECOVERY

Return to work: same day or preferably next day (36 – 48 hours)

3 – 4 days until bruising and swelling disappeared

24 hours until return to gym and other strenuous activities

Immediate result

DURATION OF RESULTS

6 – 12 months or sometimes longer

WHAT YOU NEED TO KNOW
(Chemical Peel)

LENGTH OF PROCEDURE

1 - 1.5 hours

ANAESTHESIA

Local or sometimes General (based on choice & size)

NO. OF NIGHTS IN HOSPITAL

0

RECOVERY

12 - 14 days until return to work & normal social engagements

2 - 4 weeks until sensitivity subsides

2 – 3 weeks until return to gym and other strenuous activities

DURATION OF RESULTS

6 Months - 2 years

WHAT YOU NEED TO KNOW
(CO2 or Laser Resurfacing of the Face)

LENGTH OF PROCEDURE

1 - 1.5 hours

ANAESTHESIA

Local or sometimes General (based on choice & size)

NO. OF NIGHTS IN HOSPITAL

0

RECOVERY

12 - 14 days until return to work & normal social engagements

2 - 4 weeks until sensitivity subsides

2 – 3 weeks until return to gym and other strenuous activities

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