Face surgery

DEFINITION : The temporal lift improves the stigma of aging in the temple region. The temporal lift can be performed in isolation although, in practice, is often associated with eyelid surgery (blepharoplasty).

AIMS : This procedure will treat the collapse of the lateral eyebrow, smooth out the crow’s feet and tighten the skin of the external eye.

PRINCIPLES :

In this region, the sagging of tissues is mainly of skin.

The temporal lift is performed through a scar:

*Either in the hair (intracapillary scar) but at the cost of a recession in the hairline,

*In flush with the hairline but with the risk of some scar visibility.

The temporal lift can restore a smoother distance between the eyelashes and tail of the eyebrow.

When eyelid surgery is associated, the temporal lift reduces the skin resection and the length of the scar at the upper eyelid.

The procedure, performed as well in women than in men, may be made from 40 years.

BEFORE THE OPERATION :

A preoperative assessment is normally conducted as required.

The anaesthesiologist will be seen in consultation before surgery.

No medication containing aspirin should be taken within 10 days prior to surgery.

TYPE OF ANAESTHESIA AND HOSPITAL STAY

Type of anaesthesia

The temporal lift can be performed under general anaesthesia or under local aesthesia combined with intravenous tranquilizers.

Hospital stay

The procedure can be performed in « ambulatory ».However, in some cases, a short hospital stay may be preferable.

THE PROCEDURE :

We can retain some common basic principles:

In case of intracapillary scar, the incision of approximately 4 to 6 cm is completely hidden in the hair.

In case of precapillary scar, the length of the incision depends on the amount of skin removed.

Then, we proceed to the restoration of tissue tension.

The rise of the tail of the eyebrow and the relocation of the skin are appreciated by taking care to keep his facial expression.

After the operation : post-operative follow-up

During these early days, the patient must not be surprised or worried of:

*a small skin bulge at the upper part of the temporal scar,

*edema (swelling) that may be more pronounced the third day that the first,

*ecchymoses (bruises) in the region,

*a painful sensation of tension in the temples.

THE RESULT :

After two to three months, we can have a good idea of the final result.

DEFINITION : It is the surgical correction of the aging of the neck and the face from the temple region to the jowl region

AIMS : The purpose of the operation is to treat looseness and sagging of the  skin and muscles of the face (temples and eyebrows, cheeks, jowls, oval of the face) and the neck.  The objective of such an operation is not to change the shape and appearance of the face. On the contrary, the simple restoration of the different anatomical structures of the face and neck (skin, muscle, fat) enables the patient operated on to regain his looks as they were several years ago.

PRINCIPLES : The muscles are retightened so as to correct their sagging. Then, the skin is adapted, but not excessively, to the new curves. Thanks to this double action the result appears natural and durable . General the surgical outcomes are simple because the skin is not all that traumatised. Liposuction is able to treat any surplus fat.

On the contrary, if the face is emaciated, this aspect can be corrected in the same time by autologous fat reinjection.

The required incisions are essentially hidden in the hair (at the level of temples and the nape of the neck) and around the ear. The scar is almost completely hidden.

A cervico-facial lift is usually planned at around 40 or 45 years old.

BEFORE THE OPERATION

A preoperative usual check up will be carried out as prescribed.

An anesthesiologist will see you in consultation before the operation.

No aspirin-based medication should be taken during the 10 days preceding the operation.

Giving-up smoking is highly recommended before the operation because it may cause a delay in cicatrisation.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type d’anesthésie : For a cervico-facial lifting, a local anesthesia with sedation given by intravenous drip or a standard general anesthesia can be

planned.

Hospital stay : A 24 – to 48- hour stay in hospital is recommended.

The operation :

The incisions are essentially hidden in the hair and around the ear. From the incisions, a separation is made under the skin.

Then, we proceed to the delivery of tension of the muscular plan.

In the case of localized fat surplus, a liposuction is done (under the neck, the chin, the jowls and the cheeks ).Then, the skin is naturally draped again, the

skin surplus eliminated and the sutures done without tension.

The dressing is done with bandages around the head at the end of the surgery.

After the opreration : THE SURGICAL FOLLOW-UP

Following the first days, the patient should not worry incase of :

• edema (swelling),
• bruising in the neck and chin area,
• a painful sensation of tension, especially behind the ears, and around the neck. These ecchymoses and edema should disappear within 2 weeks.

THE RESULT

It will be appreciated within 2 to 3 months after surgery.

The patient can appreciate a rejuvenation effect, a natural shape and a relaxed and refreshed aspect. This physical improvement is usually accompanied by

better psychological benefit

DEFINITION, AIMS AND PRINCIPLES

‘Blepharoplasties’ means aesthetic surgical procedures of the eyelids aiming to correct unsightly aspects, whether due to heredity or age. They can be performed on the upper or lower eyelids alone, or all four at the same time.

The goal of a blepharoplasty is to correct signs of aging and remove the tired look due to the heavy eyelids by a more rested, relaxed appearance.

The unsightly aspects most commonly found are the following:

• Drooping heavy upper eyelids, with a more or less marked skin-fold.
• Lower eyelids which have drooped and shrunk, leading to horizontal wrinkles due to distended skin.
• Bulging fat, responsible for ‘bags under the eyes’ at the lower eyelid level, or sagging upper eyelids.

This procedure, for both men and women, is often carried out around the age of forty.

BEFORE THE OPERATION

A specialised ophthalmologic examination will often be prescribed.

A preoperative check up will be carried out as prescribed. An anesthesiologist will see you before the operation.

No aspirin-based medication should be taken during the 10 days preceding the operation.

It is highly recommended to give-up smoking.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type d’anesthésie : Three possibilities exist :

• Local anesthesia alone
• Local anesthesia with sedation given by intravenous drip
• Standard general anesthesia, you sleep throughout the procedure.

Hospital stay : The procedure may be carried out on an out-patient basis, in an ambulatory facility. However, in some cases a short hospital stay can be preferable.

THE PROCEDURE

Incisions :

• Upper eyelids : They are concealed in the fold.
• Lower eyelids : They are 1 to 2mm below the eyelashes, and can go slightly beyond them.

Note : For the lower eyelids, in the case of isolated “bags” (without excess skin to be removed), a blepharoplasty can be carried out by the transconjunctival approach.

Résection :

Once the incision made, unsightly excess fat is removed, as are redundant muscle and sagging skin. At this stage, numerous appropriate adjustments can be made in order to tailor the procedure to the specific needs of the patient.

Sutures :

Stitches are usually made using very fine nonabsorbable thread (they are removed a few days after the procedure).

AFTER THE OPERATION :

The post-surgery

The post-surgery period is mainly marked by an edema (swelling), bruising, and a tearing. However, they are to a variable degree for each individual patient.

The sutures will be removed between the 3rd and 6th day after surgery.

THE RESULT

The final aspect will not be visible before 3 to 6 months.

In general the procedure will have corrected redundant skin folds and removed fatty pads thus rectifying the old, tired look.

DEFINITION, AIMS AND PRINCIPLES

The correction of prominent ears needs a surgical procedure called “otoplasty”, which the goal is to reshape the auricles, we think, are excessively too visible.

The surgery is usually performed on the two auricles but could be done unilaterally.

Surgery aims at , definitively, correcting abnormalities, by reshaping the ear cartilage, in order to obtain well-positionned, symetrical ears also natural in size and aspect.

An otoplasty can be performed in an adult or in an teenager. However, most of the time it is considered in children.

BEFORE THE OPERATION

A meticulous clinical examination of the ears as well as a photographic assessment will be realized by the surgeon himself to determine the needed modifications.

A usual pre-operative evaluation is done, following the prescriptions.An anesthesiologist must be seen in consultation, at least 48 hours before surgery.

No medicine with aspirin in it must be taken for at least 10 days before surgery.

Aucun médicament contenant de l’aspirine ne devra être pris dans les 10 jours précédant l’intervention.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anesthesia : Three possible proceedings:

• local anaesthesia completed by tranquillizing drugs, injected in veins
• classical general anaesthesia, which puts you asleep.

Hospital stay : The surgery can be done in the “day care” department. However, you may sometimes be asked to be kept in hospital for a short stay.

THE PROCEDURE

Skin incisions :

Usually, there are inside the natural retro-auricular fold, that is hidden inside natural folds.

Dissection :

The skin will be then undermine to allow the cartilage to be reached.

Cartilage reshaping:

The principle of this surgery is to create or improve the natural reliefs of the auricles by thinning and/or bending the cartilage framework. Sometimes, cartilage cuting or partial removing is indicated.

Sutures :

Usually, absorbable stiches are used; if not, the stiches must be taken away within 10 days after surgery.

Dressing :

It is done with elastic bandages around the head to keep the ears in a good position.

AFTER THE OPRERATION : THE SURGICAL FOLLOW-UP

Pains are usually moderate .

The first big dressing is taking away the day following the surgery. It will be replaced by a lighter one for another few days.

The ears may then appear swollen with edema (swelling). There may be some more or less important bruises.

A maintaining and protecting head-band (like a tennis head-band) wil be used day and nights for 15 days and then for another few weeks, during night, only.

Sport and exercise should be avoided for 1 month.

THE RESULT

It will be appreciated within 1 to 2 months after surgery.

This surgical procedure will be most of the time efficient to correct auricles abnormalities and to give back natural well positionned, well oriented and well

folded ears, also normal in size, symetry and in general aspect.

L’intervention aura le plus souvent permis de corriger eficacement les anomalies présentes et d’obtenir des oreilles normalement positionnées et orientées, bien plicaturées, symétriques, de taille et d’aspect naturels.

DEFINITION, AIMS AND PRINCIPLES

This procedure aims to modify the shape of the nasal pyramid and can also if necessary correct nasal breathing problems.

The aim is to have a nose that looks natural, in harmony with the facial features, and which corresponds to the personality and expectations of the patient.

This procedure carried out both for men and women, can be done from the age of 16, when growth is complete.

BEFORE THE OPERATION :

The motivation and expectations of the patient will have been analysed.

Prior to the operation a thorough examination of the nasal pyramid and its harmony with the other features of the face will have been carried.

A preoperative usual check up will be carried out as prescribed.

An anesthesiologist will see you in consultation before the operation.

No aspirin-based medication should be taken during the 10 days preceding the operation.

Giving-up smoking is highly recommended before the operation.

HOSPITAL STAY AND TYPE OF ANESTHESIA

This operation is usually performed under general anesthesia.

Hospital stay: Rhinoplasty can be carried out in an ambulatory facility.

THE PROCEDURE

They are usually invisible, very often hidden inside the nostrils. However, an external incision may sometimes be required : an ‘open’ rhinoplasty (giving access to the internal structure of the nose) is required when
Deformations are serious or for touch-up surgery.

Dissection : These incisions permit separation of the bone structure and cartilage from the skin which covers it from outside and mucosa hich is lining inside.

Reshaping : The osteocartilaginous structure will then be reshaped as planned.

The nose may be made smaller or straightened, a bump removed, the tip may be redefined, the septum may be straightened or the nasal concha reduced in size.

Sutures: The incisions are closed with fine sutures, usually dissolving ones.

Dressings and splints : The nostrils are packed with wadding. A protective splint is molded and fixed to the nose.

AFTER THE OPERATION

There is rarely actual pain, it is rather the difficulty to breathe (because of the wadding) through the nose which is a problem for the first few days.

Sometimes, a swelling can be observed around the eyelids accompanied sometimes with bruising. The wadding is removed 2 to 5 days after the procedure.

The splint is removed 5 to 8 days after surgery.

A return to normal social and professional life is possible after 10 to 20 days. Sport and strenuous exercise should be avoided for 3 months.

THE RESULT

Two to three months are necessary before the final result becomes appreciable, and it will only be after 6 months to one year that the final aspect will become apparent after a slow and subtle healing process.

This result usually corresponds to the expectations of the patient and is fairly close to the initial project drawn up before surgery.

This procedure brings about not only an improvement in appearance which is usually considerable, but also an undeniable psychological benefit.

Concerning surgery : by choosing a competent, qualified Plastic Surgeon, used to performing this procedure, you limit the risks, without however eliminating them completely .

Fortunately, real complications are rare following a
rhinoplasty which has been carried out correctly. In fact practically all the operations go well and patients are completely satisfied with the result.

In spite of the fact that complications are so rare you must be aware of the following possible problems :

• Bleeding : this can occur in the first few hours after
surgery but is usually moderate. If bleeding persists
more wadding should be added, or a return to the
operating room may be necessary.

• Hematoma : these must be drained if too painful or too large.

• Infection : in spite of the natural presence of germs in the nostrils this is very rare. If it occurs, it requires a uick and appropriate treatment.

• Abnormal scarring : this can only concern external scars (if any) and is rarely a problem to the point of requiring a second procedure.

• Sores : these are rare but can be caused by the splint. Small sores or wounds heal spontaneously leaving no mark, but skin necrosis, which is very rare, will leave a small scar.

All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.