A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. Brow lifts are an important part of eyelid and upper face rejuvenation. A browlift effectively repositions the eyebrows and smoothes the forehead to address one of the very first signs of aging, the lengthening of the forehead and drooping of the eyebrows. Sun, wind, excessive squinting and the pull of gravity all affect the face resulting in frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows. Even people in their thirties may sometimes have faces that look older than their years. Some times people inherit low set heavy brows which can at times make them look angry, sad or tired. This tired, angry, or sad expression may not reflect how you actually feel however. As a result, many people opt for this procedure in order to give them a more youthful, awake and alert appearance.

Moreover many people are not aware of the impact that descent of the brow has knock on effect on the appearance of our upper eyelid skin. As the brow drops, the skin in the area of the upper eyelid region becomes fuller and can cause significant skin overhang in the upper eyelids. In fact upper eyelid fullness can sometimes mistakenly be treated by removing upper eyelid skin alone (upper blepharoplasty), when the real problem is actually caused by low eyebrows. In reality however the problem is more complex and is usually caused by a combination of drooping brow and excess skin of the upper eyelids. This is why many times upper eyelid surgery is performed at the same time as a brow lift. Moreover, a brow lift is quite often performed in conjunction with a facelift to provide a more harmonious and balanced overall look to the face.

Frequently however it only becomes apparent that the ears are prominent or stick out when the child is older. At the age of four to five years the ears have just about completed all their growth while the rest of the face hasn't, they therefore appear proportionately larger. If a surgical operation is to be undertaken to correct the ears, then the cartilage needs to be relatively stiff and this does not happen until about five years of age.

The rim of the normal ear should lie within 2cm from the side of the head. If the ear is over corrected and lies too close to the head it frequently looks as abnormal as appearing too prominent. Modern operations try to avoid dividing the cartilage on the ear, as frequently this split will show through and in general large ears cannot be made smaller.

The operation of bat ear correction depends upon:

a) creating a fold in the cartilage of the ear (antihelical fold)

b) drawing the ear closer to the side of the head

This operation can frequently be done under local anaesthetic, but in younger or more nervous patients as a day case general anaesthetic. A head bandage is to be kept post-operatively for a week, continuing with just the head band at night for a further month.

Private health insurance schemes will sometimes cover this operation.

Our surgeons and staff are well trained in the practice of this operation and we would be delighted to discuss with you the pros and cons of such surgery in your particular case

Pre operative care

Pre operatively, no aspirin or medicine containing aspirin should be taken for two weeks before surgery. For children, this operation is done under a general anaesthetic as a day case procedure. The patient should have nothing to eat or drink from midnight the night before and you will be advised what time to arrive at hospital. Older patients having the operation under local anaesthetic do not need to starve before surgery and can go home immediately after surgery. It is better if you arrange for someone to drive you home as you will not be able to hear very well with the dressing on.

The operation is done through an incision on the back of the ear so that no scar is apparent from the front and it is designed to produce an entirely normal looking ear. You should bring an elasticated sweatband to hospital with you.

Post-Operative Care

There may be some soreness and tenderness and minor pain associated with bat ear correction. Usually by sleeping with the head and shoulders well propped up, this can improve the pain and if painkillers are required, usually Paracetamol is adequate. Please be very careful not to take aspirin or any other painkillers which contain aspirin as this will cause bleeding.

After one week you will be asked to return and the foam dressings will be removed. We use dissolving stitches. It is a good idea to continue using the sweatband at night in bed for a further month.

Long term results

The ears will feel sensitive for approximately six weeks after surgery and contact sports such as rugby should be avoided. During the first six months the ears may feel unusually sensitive to the cold, this will subside with time.

Fortunately complications are rare. 2% of patients can get excessive bruising in the skin, a further 2% of patients may get a minor problem of healing of the skin on the front of the ear and a further 2% of patients may have long-term healing problems with the scar behind the ear where the scar becomes raised and itchy (hypertrophic/keloid scar). This complication is more common in younger, darker skinned people. Fortunately this can usually be corrected.

Overall about one in twenty patients get a minor recurrence in the protrusion of their ears and require a small secondary adjustment, usually under local anaesthetic.

Ear Lobule is a very important aesthetic component for feminine facial beauty. Ear lobule can be of different types, shapes and at a different level. Many times there might be asymmetry of ear lobules. The ear lobules are pierced with a view to use earrings. Split ear lobules is the commonest acquired condition mainly because of use/over use of heavy earrings in conjunction with maturity of age and loss of soft tissue elasticity. Sometimes ear lobules could be very big in size or stretched, widened and elongated. Ear lobules can be reduced in size under local anaesthetics as an office procedure.

Many times ear lobule is not completely split but there is significant widening of the hole in the ear lobule, this may compromise and or unable a woman to use earrings. Repair of split ear lobule can be performed under local anaesthetic as an office procedure.

Mr Vadodaria uses dissolving stitches. The post-operative care involves topical application of anti-biotic ointment following daily shower and use of pain killers as and when required.

Mr Vadodaria advises to wait for three months for maturation of scar following the split ear lobule repair before embarking upon re-piercing.

We would advise you to send us some good quality photographs for Mr Vadodaria’s initial comments. Like every surgical procedure, split ear lobule repair also involves a list of complications like scarring, bleeding, infection, under correction, over correction, asymmetry, recurrence and a possibility of revisional surgery. However, incidents of these complications are very low.

Please contact Mr Vadodaria’s office on 0208 997 3976 for booking a consultation or if you need any further assistance.

Rhinoplasty is the operation to reduce or refine the nose, and it is one of the most frequent facial surgery requests. The reason may be simply that the person is self conscious of a large hump or a prominent tip or it may just be that this is the subject of irritating jokes. Some individuals may have sustained injuries to their nose, which have given rise to unsightly deformities. In either event, prominent nasal humps and tips are frequently associated with more masculine features and therefore if these are present on the nose of the female, may give rise to an overall harsher feminine facial appearance. For men, it can mean that the nose disturbingly dominates the face. In the vast majority of cases, men and women alike wish to have a normal, average nose that will blend into their face rather than dominate their features.

Any plastic surgery operation is a very personal choice and understandably there are a number of questions that naturally arise. This brochure has been produced by us as a helpful introduction if you are considering surgery. Changing the shape or reducing the size of the nose (rhinoplasty) is a common operation and was one of the first cosmetic procedures performed in the early 1900's.The aim of a good rhinoplasty is to provide a harmoniously shaped nose with regards to the other features of the face, with an un-operated look which does not draw attention to itself.

At the first consultation you will be asked what exactly you feel is wrong. Your face will be evaluated to see if it is symmetrical, to determine whether you have a blocked nose or if there is a problem with the airway. The inside of the nose will be examined to look at the septum which is often bent and then we look at the bone and cartilage which form the external shape. Sometimes the chin is too long or too small compared with the nose and you may be advised how it could be altered. Sometimes the nose is much damaged and building blocks of cartilage or bone may be required from other parts of the body. Finally by using computer imaging it will be possible to discuss with you the practicalities of what can, and cannot, be sensibly achieved. Remember the computer image is not, and can never be, an exact picture of how your nose will be, as unfortunately scarring and the thickness of the skin of the nose will ultimately decide how things turn out. However, the computer imaging will allow a discussion with you on what you mean by the top or the side of the nose and give us both an idea of how we should try and change things.

Many plastic surgeons only perform surgery on the nose by making their incisions inside the nostrils (endonasal). In straightforward operations it is usual to perform the operation endonasally. However, an open procedure will be undertaken in more complicated cases and a small incision will be made across the base of the nose on the columella, which is the vertical strip of tissue separating the nostrils (external). This scar is rarely visible.

The operation of rhinoplasty usually takes between one and two hours depending on whether any added procedures are being performed such as an operation to improve the breathing or if at consultation it has been decided that further procedures on your face such as to the chin are required.

Surgery can be undertaken in many cases under a daycase general anaesthetic or with a one night stay in hospital. Any external stitches are removed at four days and frequently the plaster is removed at about 11 days after surgery (sometimes less).

Usually about one and a half weeks is required before you return to work, at which time there should be little to give away that you have had an operation. Any bruising at this time can be disguised by cosmetic camouflage.

Pre-operative Preparation

Before your operation you should note that smoking undoubtedly leads to more swelling around the eyes and to more problems with the anaesthetic. Please let us know about any medication you take, no matter how infrequently. Aspirin, which is contained in many medicines e.g. Alka-Seltzer and Nurofen, should not be taken for two weeks pre-operatively. I recommend that patients take Arnica for 7 days pre-operatively and 7 days post-operatively as this will help with your post-operative bruising.

If you have any doubts or queries then please arrange a second consultation. We do not charge extra for this and it allows us to again go over your pre-operative photographs and to answer any of your questions.

If your operation is in the morning you will be asked to have nothing to eat or drink from midnight the night before and if it is in the afternoon you should just have a light breakfast and nothing to eat or drink after 7.00am. Arrange for someone to drive you to hospital.

Post Operative Care

When the surgery is completed a splint is applied to your nose which will maintain its new shape. I use nasal packs particularly when I have undertaken septal surgery. You will be left with a little bib across your nose which can be removed the following day. You should insert nothing, especially Q tips, up your nose for at least three weeks. Please leave the surgery to me!

Once you are around from the anaesthetic we will sit you up with your shoulders being supported on three to four pillows as this helps to reduce the swelling around the eyes. At the same time you will be given ice packs to apply to the eyes. As and when you go home you should try and sleep upright for at least a week.

Operations on the nose are not painful which surprises most people. You will have discomfort if packs are placed in the nose. This is the same discomfort you get from a blocked nose with a cold. On discharge form hospital get someone to take you home and stay with you for at least a further two nights. An appointment will be given for you to reattend four or five days after surgery if you are to have stitches removed and ten days after surgery for removal of the plaster.

For the first few days after surgery try and avoid sneezing vigorously, very hot baths, hot food, drink and exercise. You will have bruising around the eyes which is more marked if you are a heavy smoker and sometimes swelling in the upper lip. Usually the swelling reaches its peak two days after surgery and then subsides. When the plaster is removed at ten days all visible swelling will usually have disappeared, but there will be a feeling of numbness and stiffness in the tip of the nose which means that some swelling persists. It will take the swelling several months to subside completely but it will not be visible to anyone else but you. In patients with thick, oily skins the swelling is slower to resolve. While many patients want to see the final result immediately upon removal of the plaster, the presence of early swelling can be misleading and a premature judgement should not be made. At this stage your hair can now be washed and it is now safe to blow your nose and clean its lining gently with cotton and salt water.

The nose will be delicate for some weeks and potential harmful activity such as contact sport should be avoided for this period as well. Glasses can be worn while the cast is on and after it is removed they can still be worn but they should not rest on the nose. Contact lenses can be worn as soon as the swelling goes down from around the eyes.

It is common for relatives and friends not to comment on any difference after a nasal operation. Do not consider such a reaction as an indication of failure, on the contrary if it looks better and natural it will go unnoticed. The intention is after all to create a new nose that draws little attention to itself and that blends into the overall features of your face in proper proportions.

Long Term Results

Complications are fortunately rare. If you follow the advice given, the most common is swelling around the nose which settles on its own and we will show you some massage exercises. Occasionally the dark colour of bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. Should a nosebleed occur, then the first aid treatment is to sit with the head held up and backwards and plug the nostrils with some lint. If there are any problems please get in touch with a member of my team.

Very occasionally, in about one in fifteen cases, a small secondary adjustment will be required. It is difficult for the patient to understand that all the scarring on the nose must be allowed to mature and soften before this can be safely undertaken. This means at least one year.

Hopefully this information will give you a better understanding about nasal surgery. I am sure it will not answer all your questions, but it will help us during our further discussons.

Our eyes are the most important features on our face and their beauty can be greatly reduced by excess skin creases and eyebags. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat-usually along with excess skin and muscle from the upper and lower eyelids. Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift or a browlift.

The normal ageing process involves the stretching of the eyelid skin resulting in excess folds and wrinkles, and sagging of the fat around the eye itself, and appears as bulges in the upper and lower lids. Heredity is often an important factor when young or middle-aged patients exhibit changes that are usually associated with older age. These patients are fed up of comments from their friends that they constantly look tired, despite having had a good night's rest!

eyelid surgery can correct drooping upper lids and puffy begs from lower eyelids. A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. And while it is true that it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Additionally in some patients the procedure might improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision.

The skin loses its elasticity and our muscles slacken with age. For the eyelids this results in an accumulation of loose skin which collects as folds in the upper lids and forms deepening creases in the lower lids. At the same time there is slackening of the muscle beneath the skin allowing the fat, which cushions the eyes in their sockets, to protrude forward to give the appearance of bagginess. In some families there is an inherited tendency for bags to develop during early adulthood before any skin changes.

The problem often seems worse in the morning particularly with prolonged stress and lack of sleep. Fluid that is normally distributed throughout the upright body during the day, tends at night to settle in areas where the skin is loose, such as the eyelids. Drooping of the eyelids is also an effect of the ageing process and aggravates the accumulation of the skin in the upper eyelids. Sometimes so much skin accumulates in the upper lids that it hangs over the eyelashes to obstruct vision.

Bags are caused by an accumulation of fat and with age the skin stretches and the muscles around the eye weaken.

What can be done?

An eyelid reduction (blepharoplasty) removes the surplus skin and protruding fat to produce a more alert appearance and reduces the morning swelling. Sometimes it is only necessary to reduce the skin, sometimes the skin and the fat and sometimes just the fat. If only the fat is being removed from the lower eyelids, then this can be removed from the inside of the lower eyelid avoiding an external excision (transconjunctival blepharoplasty)

What are the consequences?

People who have the familial problem of bags beneath the eyes may well undergo surgery in their 20?s. Ageing effects of the skin are apparent earlier in the eyelids than elsewhere. A reduction of the skin can be carried out from the age of 35. Patients with thyroid disease often develop eye signs which can be helped by surgery. Where there is reduced secretion of thyroxin (hypo-thyroidism) there is an increase in fat and where there is an increase in thyroxin (hyper-thyroidism) there is often so much increase in fat that the eyes protrude. An extended eyelid reduction (Olivari’s procedure) can treat this satisfactorily.

Transconjunctival blepharoplasty - incision made inside.

In a typical eyelid reduction operation incisions lines follow the natural lines of the eyelids.

What are the limitations?

It is important for you to understand that only the wrinkles which are in the skin which is cut away will be removed. We are only treating the eyelids within the bony margin of the orbit (eye sockets). Folds of skin extending on to the cheek (festoons) will not normally be improved. Wrinkles in the area of the crow’s feet will remain and although the skin is much tighter it is still necessary to be able to open and close the eyes freely. The skin has less elasticity with age and for proper closure of the eye the upper eyelid will need to have surplus skin when it is open. Descent of the eyebrow can be helped by endoscopic brow lift and an extension of this, the deep facelift, can be used to not only lift the eyebrow and the upper eyelid, but also lift and open the outer angle of the eye.

Sometimes residual or recurrent wrinkles are suitable for treatment by chemical peeling or laser resurfacing. The operation has no effect at all on the dark colour of the lower eyelid.

The Operation

Both upper and lower eyelid surgery can be carried out under local anaesthesia or under general anaesthesia in a hospital.

In a typical procedure the surgeon makes incisions following the natural lines of your eyelids; in the creases of upper lids and just below the lashes in the lower lids (see illustration). These incisions are extended a little way into the crow’s feet or laughter lines at the corner of the eyes. Through this incision surplus fat is removed and excess skin and sagging muscle removed.

If you have a pocket of fat beneath your lower eyelids without surplus skin then the fat may be removed through the inside of the lower eyelid.

The resurfacing laser can be used at the same time as a transconjunctival blepharoplasty to tighten the external skin and reduce wrinkles, although there is no external scar there is residual redness in the skin which will last a few months.

Following surgery it would be best to keep your head elevated for a few days to reduce swelling. Cold compresses can also help. The surgeon will normally apply some suture strips or steri-strips as support to the eyelids after surgery and if these become crusted they can be replaced. Cleaning the eyes with water is useful and the surgeon may advise the use of eye drops or ointment.

The sutures are usually removed after 3 to 5 days and soon after you will be able to use make-up. Sometimes you will be advised to use the suture strips or steri-strips as support to the lower eyelids for a week or so.

The closure of the eyes appears tight after surgery because of the swelling and because skin has been removed. If closure is not complete at night the patient should apply some eye ointment before going to sleep. This sensation will settle as the swelling goes down.

The eyes appear watery after surgery, partly because of swelling under the conjunctiva (chemosis) and partly because the tear ducts are swollen and do not drain as readily. This will last a few weeks. Although there is bruising it can quite readily be disguised with make-up and dark glasses. The scars will be pink for a few months, but eventually they become almost invisible.

What are the risks?

All surgery carries some uncertainty and risk. When eyelid surgery is performed by a qualified Plastic Surgeon complications are infrequent and usually minor. You can check that your surgeon is on the Specialist Register kept by the General Medical Council (telephone 0171 915 3638).

You can reduce the risks by closely following your surgeon’s instructions both before and after surgery. You should tell him of any thyroid disease, high blood pressure, diabetes or eye disorder such as detached retina or glaucoma. It may be that he/she will wish you to be checked by an Ophthalmologist.

Occasionally a pool of blood can collect under the skin after the operation has finished (haematoma) this usually disperses spontaneously over 2 or 3 weeks but it may need to be drained if it is large. Blindness is an exceptionally rare complication.

Quite commonly the margin of the lower lid is slightly pulled away from the eye during the first day or two after surgery due to swelling. This will settle on its own or with the help of suture strips or steri-strips. Very occasionally another operation is necessary.

Sometimes tiny white cysts can appear along the stitch line. They are nothing to be concerned about but can be pricked out with a needle.

As people age, the effects of gravity, exposure to the sun and the stresses of daily life begin to take their toll on the face. Deep creases form between the nose and mouth; the jaw line grows slack and jowly; folds, loose skin and fat deposits appear around the neck.

A face-lift is a surgical procedure performed to improve the most visible signs of the ageing process, by eliminating excess fat, tightening the muscles beneath the skin of the face and neck, and remove any sagging skin. Many times this procedure is performed in conjunction with eyelid, forehead or other surgery. A well-performed face lift should revitalise the face without distorting or changing ones facial features. A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. However it can't, and shouldn’t, give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them at your consultation.

As part of the aging process which happens to all of us sooner or late, our skin progressively loses its elasticity and our muscles tend to slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile lines deepen, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression. The rate at which this happens varies from one person to another and is probably determined by our genes. Aging of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is ageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weight loss can produce similar changes in facial appearance to those of the aging process.

Who will benefit from a facelift?

The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40's to 60's, but facelifts can be done successfully on people in their 70's or 80's.

It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure that technically works well but also increases morale and is well appreciated by the patient.

Incision lines follow the natural crease, or tagus, in front of the ear and extend into the hairline above and behind the ear

Platysma muscle and its fibrous attachment (SMAS) are sutured tightly in front and behind the ear as an extra sling under the chin

What a facelift does not do?

A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical peel or laser resurfacing.

What should you do before the operation?

If you are overweight and intend to lose it you should do so before the operation. This allows the surgeon to remove more skin and therefore achieve a more pleasing result. You should avoid taking tablets containing aspirin and non steroidal anti-inflammatory drugs such as Voltarol and Indocid for at least two weeks before surgery as they increase the risk of bleeding.

You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases circulation of the skinflaps, particularly behind the ears.

Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a few weeks.

The surgery

A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. It is possible to carry out the procedure under local anaesthetic and intravenous sedation but the patient would still be advised to spend the night in hospital. The procedure, although long, can be combined with other operations of all sorts. The most common however would be an endoscopic brow lift and an eyelid reduction. Other extra procedures which can be used to enhance the face at the same time are malar (cheek bone) and chin augmentation and lip enhancement.

This is an extension of the forehead lift which is designed to tighten the skin of the upper half of the face, as opposed to the standard facelift which helps the lower half of the face. The Deep Facelift carried out endoscopically avoids the same ear to ear incision. It is usually carried out at a younger age than the standard facelift. It tightens the skin of the mid-face and freshens the eyes, opening and lifting the outer angle and reducing the wrinkles of the crows feet. There will be swelling around and below the eyes which gradually resolves in about a month. There will also be scars beneath the eyelashes of the lower eyelid and sometimes in the upper gum line. There is a slight risk of damage to the nerve which supplies the muscles of the forehead. This weakness is usually partial and temporary, on rare occasions it may be permanent.

Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, or just inside the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off into the lower scalp. Occasionally it may be necessary to make a small incision under the chin. Sometimes only the skin is lifted following separation from the underlying platysma muscle.

More usually however the platysma muscleand its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to the solid structures in front and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a single layer, but will still be sutured separately. Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in the mirror. Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling. These bandages will stay for one or two days and the sutures are removed in 7 to 8 days.

After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months. It is better to keep the head elevated for a couple of days to reduce swelling. Drainage tubes will be removed a day or two after surgery. Avoid strenuous activity, saunas and massage for at least two weeks.

At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising.

Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also behind the ear where the skin has been lifted.

The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out.

How long does a facelift last?

A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in that you will not look as old as you would have done if it had not been carried out.

As people age, the effects of gravity, exposure to the sun and the stresses of daily life begin to take their toll on the neck. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds, loose skin and fat deposits appear around the neck. The neck can begin to show age faster than whole face and many times patients only need a neck lift, rather than a full face lift. Aging does not always determine the need for a neck lift, but rather having lost considerable weight or it may even be hereditary. Many patients choose to have a neck lift with their face lift procedure.

Neck Lift is a surgery designed to reduce the loose look of sagging skin in the neck area and under the jaw. Neck Lift is an operation that usually takes 2 hours to complete using a general anaesthetic and normally includes an overnight stay at the hospital.

Your expectations need to be realistic. Most patients are pleased with the outcome and find they gain a feeling of increased self-confidence. The overall achievement will be having a completely natural look that gives the impressions that you have lost weight and/or look younger.

Full red lips are one of the hallmarks of youth and beauty in woman. Conversely narrowing and thinning of the lips is a feature of the ageing face. The perceived sensuality associated with fuller lips has no doubt been propagated by the appearance of popular sex symbols such as Marilyn Monroe and Brigitte Bardot (Paris lip) and more recently Angelina Jolie. Initially the procedures for lip enhancement consisted of lip tattooing for permanent colour. Now simply improving the colour of the lips and giving the impression of fullness is no longer satisfactory. More commonly, many now desire a more enhanced and physically fuller look to their lips.

Lip enhancement is done by either synthetic material like NASHA product or by using your own fat from your tummy or buttocks. There is also an option of permanent lip enhancement using synthetic implant. We will discuss these options and their feasibility at the time of your ‘consultation.

Buccal fat pad debulking:

Introduction
A face with some fullness looks healthy and youthful. Excessive fullness, however, disrupts the harmony of the features and produces a "chipmunk cheek" effect that makes many people self-conscious.
Buccal fat reduction addresses this problem by removing excess fat from the cheeks to produce a more delicate, chiseled appearance.
Points to ponder on whilst considering this operation
Although effective, this procedure should not be undertaken without some considerations for the future. Most people's faces begin to thin as they reach mid-thirties, so the fullness that may concern somebody in their young age, may disappear on its own. If you choose to have buccal fat reduction performed before this natural slimming of the face occurs naturally, you may find your face becoming too thin as you begin to age. It is best to take a careful look at your genetics and also factor your ethnic origin. Asians and Far-eastern population tends to have round face with significant buccal fat deposition. Did your parents have overly plump faces when they were young? Did this plumpness persist once they reached their 30s and 40s? If so, you may have inherited their more rounded facial appearance. If not, having buccal fat reduction surgery while you are still young may leave you looking gaunt as you get older. This can be corrected but would require additional surgery.
Preconsultation
Mr. Vadodaria does a detailed consultation which includes history, intraoral examination, assessment of the harmony of your face, taking photos and making a plan of action and detailed explanation of the procedure if you are a suitable candidate. His staff member will supply you with an informative fact sheet regarding the procedure.
Surgery
A solution of Lidocaine, epinephrine and saline is used to numb the area and limit bleeding. He uses a small (2-4 cm long) incision between your cheek and gums near your second molar from the back. He then presses on the outside of your cheek to make the buccal fat protrude through the incision so he teases it out a little at a time with surgical tweezers. Once an adequate amount has been removed he will close the incision, most often with dissolvable sutures. You will be given intravenous antibiotic during the operation and advised to continue with oral antibiotic for a period of 5 days. You will be advised to use antiseptic gargles for a period of one week following the operation before and after taking food or drink.
After your surgery you will need to sleep with two pillows under your head, to keep your head elevated for at least two weeks and take it easy for at least three.
What to expect whilst recovering from the operation

• You will have some discomfort, but this should be controlled by pain medication that will be prescribed for you. Should you experience excessive pain, redness or any other symptoms that seem abnormal you should contact Mr. Vadodaria’s team immediately. These symptoms could be signs of infection.
• Bruising and swelling are normal after surgery and will subside in a matter of days or weeks. In most instances however, bruising and swelling is very limited from the beginning.
• Because of the incision inside your mouth you may have to eat a restricted diet for a while. Mr. Vadodaria will tell you what foods you should avoid. You will also be instructed to rinse your mouth several times a day with an antibacterial mouthwash.
• As your sutures are dissolvable, it will not be necessary to have them removed. Please resist the temptation to chew on the stitches you feel inside your cheek.
• At your first follow-up meeting, usually a week after surgery, Mr. Vadodaria will assess the healing of the wounds inside your mouth. Even though you should be feeling better by this time it is important to continue to take it easy, not bend over and not lift heavy objects. Contact sports should be avoided for at least six to eight weeks.
• Your swelling will continue to subside for several weeks and as it does, your new, more defined facial structure will be revealed.
• During this time you may notice a change in your smile or odd sensations like tingling, pulling, burning, hollowness, cold or sudden sharp pain. These feelings, which are related to the healing of the nerve branches in the area of the operation, usually subside within the first few weeks.

Complications

• Numbness is also possible and, while it usually settles within the first few weeks, it may occasionally become a permanent issue.
• Asymmetry
• Under/over correction
• Hematoma
• Seroma
• Damage to nerves- e.g. Infraorbital nerve and facial nerve buccal branch
• Parotid duct dysfunction.

There are many variables that affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and colour of your skin, and the direction of the scar. No scar can be removed completely; however Mr.Vadodaria can often improve the appearance of a scar by making it less obvious through injections, IPL Photorejuvenation or through surgical procedures known as scar revisions. the principle of scar revision surgery is to make it less noticeable either by reducing the thickness or by realigning in such a way that it merges with natural crease of the surrounding skin.

Introduction

Is there anybody in the world who does not like dimpled cheeks? It is a lovely sight when somebody smiles and a cute dimple is formed. Dimples are considered by the majority as a very attractive facial feature. In traditional Asian folklore, the presence of a dimple suggests good fortune and fertility, while in the West it is more simply viewed as cute and unique.

Natural dimples usually occur on both sides of the face, and are generally present only when the face is animated, often to an unnaturally exaggerated degree. A natural dimple is usually formed when there is a small defect in the cheek musculature (most often the buccinator muscle). The skin overlying this small defect is stuck down to the underlying connective tissue when the muscle contracts with smiling; it splits apart and allows the overlying skin to indent.

It is possible to create a dimple by a minor plastic surgical procedure under local anaesthetic as an office procedure as a day case. As such, there is a huge demand now for surgically created dimples both from women and men. The results of this cosmetic procedure are usually permanent. The location and size of the dimple is a personal choice, which will be further evaluated with Mr. Vadodaria in your consultation.

Technique

Dimple creation surgery is, in itself, a fairly simple one and is commonly done under local anesthesia on an outpatient basis. You will be awake and comfortable during the entire dimple surgery process. Special arrangements can be made if you would rather be asleep for the dimple creation surgery. The dimple surgery takes about 20 minutes to perform and you can go home right away after the procedure. Usually normal activities can be resumed straight after the procedure.

A punch biopsy instrument is placed against the buccal mucosa (inner cheek) and circular motions are made to cut through the mucosa, submucosal fat, and cheek muscle. A circular core composed of these tissues is removed, leaving the skin intact, which will create a shallow cylindrical-shaped defect under the skin.

This 'defect' then is closed by placing an absorbable suture through the inner skin of cheek (muscle) on one side of the defect, then through the dermis layer of the skin and finally through the inner skin of cheek (muscle) on the other side of the defect. A surgical knot is tied, which in turn will result in dimpling of the skin even without smiling.

The skin will, however, flatten out in a week or two. The internal scarring which takes place will connect the muscle to the skin, creating a dimple when one smiles.

The surgery can be performed on any kind of cheek, be it chubby or not. It would be easier if the cheeks are not too chubby. If someone wants dimples that are very prominent, a bigger punch biopsy will be used to be able to remove a bigger core of soft tissue.

Recovery and Post operative care

There is usually minimal swelling following the procedure, and the after care is just as simple and uncomplicated as the procedure. The after care usually involves regular mouth rinsing with antiseptic solution and a course of antibiotics.

You can go back to work the next day, but avoid strenuous activities like contact sports and exercise that can injure your face. The healing period is between 7 to 10 days. After a few weeks, you will notice that the operated area is already taking shape; the dimples or the cleft chin is becoming more apparent while you smile (during active animation of facial muscles) and feels natural like you are born with it. Final results can be seen after a month.

Risks and complications

As in any operation, there are risks involved in the form of infection, bleeding, scarring, under/over correction, revisional surgery and weakness of the involved muscles although extremely rare. There are minimal complications with dimple formation aside from a little bit of swelling and bruising. You should be able to resume your normal activities the following day.

Summary

Dimple creation surgery is a relatively easy way to form a dimple either in the cheeks or chin, under short local anaesthetic as a day case, for those people who have always wanted one.