Reconstructive Surgery

• Cleft Lip and Palate Repair
• Reconstructive soft tissue surgery for Children
• Congenital Hand Surgery
• Prominent ear correction
• Ear Reconstruction
• Adult Surgery for Cleft Lip and Palate related conditions
• Further surgery for cleft palate speech related problems
• Scar revision

Aesthetic Surgery

• Breast reduction
• Breast augmentation
• Breast lift (mastopexy)
• Male Breast reduction surgery
• Abdominoplasty (tummy tuck)
• Liposuction
• Nose reshaping (rhinoplasty)
• Eyelid surgery (blepharoplasty)
• Brow Lift
• Face Lift
• Permalip
• Scar revision

Non Surgical Procedures

• Fillers
• Botox

Reconstructive Surgery

Surgery for children with cleft lip and palate is performed in conjunction with the team of experts form the South Thames Cleft Service based at Guy’s and St Thomas' Hospital.

A general anaesthetic is needed.

Children usually stay one to two nights in Hospital and may be uncomfortable for the first couple of weeks after surgery. One parent is always able to stay overnight with their child.

Surgery to the soft tissues may involve the removal of moles, or scar revision folllowing injury. Depending on age these procedures may be performed either with local or general anaesthetic and usually on a daycase basis.

Soft tissue surgery for the limbs such as the treatment of trigger finger, division of syndactyly (webbing) and the removal of skin lesions can usually be performed as a day case but are likely to need a general anaesthetic in most cases.

A splint or plaster may be placed at the end of the surgery both for comfort and to allow healing to take place.

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Prominent Ear Correction

Ear correction surgery helps children or adults who consider their ears to be too prominent The most prominent ears often lack a normal fold, and sometimes one ear is more prominent than the other. People with prominent ears can be teased, particularly during their school years, and this can lead to a loss of self confidence. Ear correction surgery can resolve this very quickly.

An incision is made behind the ear leaving a scar. The cartilage is then reshaped, and then the ear is anchored with stitches into a more normal position. Ear correction surgery takes about 40 minutes for each side.

A head bandage is placed after surgery and is to be worn for 7 to 10 days and a sports type head band needs to be worn at night following that for 6 to 8 weeks.

Ear correction surgery helps people who consider their ears to be too prominent.

The most prominent ears often lack a normal fold, and sometimes one ear is more prominent than the other. People with prominent ears can be teased, particularly during their school years, and this can lead to a loss of self confidence. Ear correction surgery can resolve this very quickly.

An incision is made behind the ear leaving a scar. The cartilage is then reshaped, and then the ear is anchored with stitches into a more normal position. Ear correction surgery takes about 40 minutes for each side.

Recovery:

A head bandage is placed after surgery and is to be worn for 7 to 10 days and a sports type head band needs to be worn at night following that for 6 to 8 weeks.

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Ear Reconstruction

Either for congenital reasons or following injury it may be necessary to rebuild part or almost all of the external ear. Ears are reconstructed for aesthetic reasons rather than to improve hearing in any way. Children need to be of adequate size and stature to have this carried out and are usually aged eight or more.

Cartilage can be taken from the rib area to rebuild what is missing and is then covered with soft tissue from the scalp. Two stages of surgery may be needed spaced about six months apart. The procedure may take several hours to do.

Other types of reconstruction are possible also.

A one to two night stay in hospital is necessary following the procedure and more discomfort is noted in the rib than in the ear area. The head is bandaged to protect the ear for about two weeks.

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Adult Cleft Lip and Palate Conditions

Though most primary surgery for cleft related problems is performed during childhood, there are often areas that would benefit from further adjustment. Scar revision on the lip area, adjustment of the tip of the nose and further palate surgery for speech problems are some of these.

An individual consultation is needed to determine what might be of benefit in each case.

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Breast Reduction

Large breasts may cause back and neck pain, bra strap indentation and skin irritation. It may also be socially debilitating. The goal of breast reduction is to give a woman smaller, more shapely breasts in proportion to the rest of her body.

The procedure:

Breast reduction involves reducing the amount of breast tissue whilst uplifting the breast at the same time. In order to achieve the desired outcome the Surgeon may need to reposition the nipple and areola to give the breasts a natural appearance. This surgery usually takes about three hours to complete, depending on the amount of tissue to be removed. The operation is carried out with general anaesthesia, and requires a 1 to 2-night stay in hospital.

Recovery:

Following breast reduction surgery, it may be necessary to take one or two weeks off work, and avoid heavy lifting or pushing during that time. A sports type supportive bra should be worn afterwards for up to 6 weeks, day and night whilst healing takes place.

Breast Augmentation

Breast augmentation is performed for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breasts are too small.
• To restore loss of breast volume after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following surgery to remove tissue.

By inserting implants surgeons are able to increase the breasts by one or more bra cup sizes. The procedure generally requires an overnight stay in hospital but can be performed as a day case. The implant is usually inserted through an incision made in the natural crease beneath the breast. It is also possible to make the incision in the armpit or around the edge of the areola (the dark skin surrounding the nipple).

Recovery:

Constant bra support is necessary for a minimum of 4 weeks. Discomfort around the nipples is common in the first two weeks but this will subside as the bruising goes away. Swelling of the breasts may take a couple of months to settle completely and upper body exertion should be avoided during this time. About two weeks off work is recommended.

The Implants

A booklet entitled "Breast Implants", produced by the Department of Health, is available from the clinic, and provides a full understanding of breast implants clinical safety studies and advice on breast-feeding.

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Breast lift (Mastopexy)

A number of factors can cause women's breasts to lose their shape and firmness, such as pregnancy, age, and gravity. Breast uplift surgery can raise and reshape such breasts for a time - though surgery cannot permanently delay natural changes. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. It is also possible to have a breast augmentation in conjunction with a lift procedure in suitable cases.

The procedure:

To achieve the 'lift' that is required from a breast mastopexy operation, the loose skin is removed whilst at the same time, the nipple is repositioned centrally on the new, now firmer breast. The procedure takes from one and a half to three hours for both breasts and usually involves an overnight stay in hospital. Following surgery, it is necessary to wear a supportive sports type bra for 6 weeks. You can expect some loss of sensations around your nipples but should improve after about six weeks. In some patients, however, the numbness may last a year or more, and rarely it may be permanent.

Recovery:

Similar to other breast surgery, rest is recommended and no upper body exercise for 6 weeks. One to two weeks off work is recommended providing the job does not involve excessive lifting.

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Male Breast reduction surgery (treatment of Gynaecomastia)

Enlargement of the male breast, also known as gynaecomastia, is a problem that affects over 40% of the male population. It is usually treated with liposuction and glandular excision. In some cases, skin reduction may be necessary.

Male breast reduction surgery typically takes between 1 / 2 hours to complete, but is very dependent upon the amount of fat and tissue to be removed. Patients will need to be under a local or general anaesthetic.

Recovery:

Male breast reduction surgery takes about 2 weeks recover time. During this time soreness of the chest will subside. Strenuous activity should be avoided for up to a month after the procedure. Wearing a compressive garment for 4 weeks is highly recommended to reduce swelling.

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Abdominoplasty / tummy tuck

Abdominoplasty, is a surgical procedure to remove excess fat and skin from the middle & lower abdomen and from the waist. Patients are rewarded with a toned and more youthful looking abdominal area. Midline protrusion due to split muscle or hernia can be repaired at the same time.

A long incision is made across the lower abdomen just above the pubic area. The skin is then lifted and separated from the underlying tissue and muscle of the abdominal wall. It is then pulled down tight over the abdomen, the navel re-positioned, excess skin trimmed and the incision sewn.

Abdominoplasty takes between 2 - 3 hours to complete. The procedure is done under a general anaesthetic and an overnight stay in hospital is required.

Recovery:

A full recovery takes 2 / 4 weeks, although normal activity can be resumed within 7 / 10 days. Strenuous activity should be avoided for about a month after surgery. Abdominal support is advisable for 1 month.

The result of abdominoplasty is generally long lasting, but is very dependent upon the lifestyle, diet and exercise regimes of the patient

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Liposuction and Lipo-sculpture

If you have ever despaired about those areas of fat that never seem to respond to dieting or exercise, then liposuction surgery may be the solution.

Women tend to accumulate fat around the buttocks, hips, thighs, knees, ankles and lower abdomen. Men tend to store excess fat around the flanks, abdomen and the breasts. Liposuction can be used to target these difficult areas.

Liposuction surgery is currently the only medically approved procedure that allows the selective removal of localised fat cells.

Liposuction is usually carried out under general anaesthetic and 1 night in hospital is needed afterwards.

Smaller areas can be treated with liposuction using a local anaesthetic, on a day care basis. Individuals who are grossly overweight are poor candidates for liposuction, since it is not a treatment for obesity. It is recommended for those patients who wish to improve their body contour, by the removal of unsightly fat pads.

Recovery:

A pressure garment is worn around the treated area following the liposuction for about 21 days. Recovery time is approximately 2 weeks.

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Rhinoplasty / nose reshaping

Nose surgery or Rhinoplasty is performed to improve the appearance of the nose and achieve better facial harmony.

It is important to discuss one’s expectation of the outcome with the surgeon who will then evaluate the structure of the nose and associated facial proportions. Then it is possible to discuss what can be achieved and what is most suitable in terms of facial appearance. It is important to have a realistic expectation Nose surgery is performed either via incisions made inside the nose, so that no scars are visible afterwards, or in some cases, better result can be achieved with a small scar on the columella (the area between the nostrils).

Rhinoplasty usually takes an hour or two but complicated procedures may take longer.

Recovery:

In the first two weeks after nose surgery, there may be nasal stuffiness. Also, the sense of smell may be diminished for a few days. There may be bruising around the eyes but this will usually settle within two weeks. A splint is worn over the nose and is removed at 7 days. The swelling of the nasal tissue can take up to six months to settle fully.

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Blepharoplasty

Blepharoplasty is a surgical procedure to rejuvenate the eye area by removing excess skin with or without fatty tissue from either upper or lower eyelids. Patients usually complain of looking tired. Blepharoplasty can improve the appearance. In some cases, a better result can be obtained in conjunction with other procedures such as brow lift or Botulinum toxin injections (Botox). Blepharoplasty of the lower lid will eliminate baggy folds of skin below the eyes.

Blepharoplasty surgery typically takes between 1-2 hours to complete and may be performed either under local or general anaesthetic. If the operation is performed on just the upper or lower lids, less time is needed. An overnight stay is often required to minimize post-operative swelling and bruising.

Recovery:

Typically, it takes approximately 7-10 days to fully recovery from Blepharoplasty surgery, however some patients may return to work within 4-5 days.

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Brow-lift surgery

This procedure targets loose skin and wrinkles on the forehead. An incision is made slightly behind the natural hairline and running from ear to ear across the head. The eyebrows are raised which will give a more open appearance to the eye area. The forehead skin is lifted and the incisions are closed with stitches.

This particular procedure is not suitable for someone with a receding hairline. Surgery takes one to two hours and an overnight stay in hospital is usually necessary.

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Endoscopic Brow-lift

In this type of procedure scars can be minimized. The brow can be re-suspended with devices inserted through scalp incisions where the scars are hidden behind the hairline.

The position of the eyebrow descends with age and can produce an appearance of tiredness or sadness. Re-positioning of the brow at a slightly higher position can produce a younger and fresher look.

Minor correction can be done in combination with upper eyelid surgery where a dissolvable device is placed behind the brow through an upper eyelid incision. The scar is hidden in the eyelid crease and the brow is re-positioned.

Patients will experience bruising and swelling and sometimes headaches for a few days.

The surgery may be carried out in combination with other facial procedures, such as blepharoplasty.

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Face-lift

Face lift surgery can delay the effects of ageing by smoothing out lines and wrinkles and tightening up loose skin on the face and neck. Face lift surgery when performed properly by an experienced surgeon, leaves the patient looking more youthful and relaxed.

During a facelift, an incision is made from the temple to the ear on both sides. The incision from a face lift is hidden in the hairline and behind the ears so that visible scarring is minimized.

It takes several hours depending on how much work a particular face lift involves. Many people combine face lift surgery with eye bag removal which takes longer. Face-lift surgery is performed under general anaesthetic with an overnight hospital stay.

Recovery:

Recovery time following face lift surgery varies. Many patients return to work after 3 weeks. Most women can disguise the effects of face-lift surgery with make up after 10-14 days.

Side effects from facelift surgery are temporary. Bruising and swelling of the face is to be expected initially.

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Out Patient Procedures:

Smaller procedures such as, removal of moles, small skin lesions, skin tags, repair of split earlobes and scar revision may be performed with local anaesthetic in an outpatient setting.

Healing may vary between individuals with a greater risk of keloid scarring in those with African or Caribbean heritage and an increased risk of hypertrophic or thicker scarring in those with very fair skin.

Post operative pain is usually minimal. Sutures are usually removed in 4 to 6 days from the face and 7 to 10 days from other parts of the body. Scars may be red and lumpy initially, but eventually soften and fade with time.

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Non Surgical Procedures

Facial Rejuvenation

If any of the following procedures are required then a referral to our practice aesthetician who is expert in these procedures will usually be made.

Injectable Fillers

As we age the underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can. The most important fact to remember about injectable fillers is that the results are not permanent.

Soft-tissue fillers, such as Scultpra, Restylane and Radiesse, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks.

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Botulinum Toxin Injection

Botox has been proven to smooth and even eliminate forehead lines, frown lines, crows feet and neck bands and is also used in conjunction with forehead lifts, facelifts, and eyelid surgery.

Botox is injected directly into the muscle with a tiny needle and works by relaxing targeted muscles.

Patients may experience a slight discomfort when the needle is inserted and the Botox® is injected. The entire treatment is performed in 10 to 15 minutes with no recovery time. Patients can immediately resume normal activities, although, it takes a few days to see the results of the Botox injections. Typically the effects of Botox last three to six months and must be repeated to maintain results.

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