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SURGICAL PROCEDURES

A facelift or rhytidectomy is a surgical procedure that is typically used to give a more youthful appearance to the face. A wide subcutaneous face-lift is usually performed with SMAS Plication (tightening of the superficial muscle system).

The incision starts in the temporal hairline, progresses in a natural crease line in front of the ear, then up behind the ear hugging the earlobe and back into the hairline behind the ear. The incision behind the ear is made high up to prevent the tell-tale signs of a face-lift.

The patient is wrapped up with bandages for forty-eight hours to prevent swelling and bruising.

To achieve the best result, a facelift is often combined with other procedures such as upper and lower eyelid surgery and fat transfers to the face.

According to statistics, facelifts are increasingly popular among both men and women.

Hospital stay – 2 nights
Recovery – 14 days

Exercise – Resumed fully six weeks post-operatively

 

Am I a good candidate for facelift surgery ?

After a one-on-one consultation, Dr. van der Poel will advise you as to whether you are a good candidate for a facelift, or whether an alternate procedure might be preferable. An ideal candidate for surgery would present with:

  • Reasonable skin elasticity
  • Loose skin on the face or neck
  • Realistic expectations
  • Good overall health

What are the benefits of a facelift ?

A Face Lift address concerns associated with ageing such as sagging skin,of the face, neck and jowls, wrinkles, loose facial muscles and loss of definition of facial contours. Patients who are good candidates for facelift surgery can expect a fresher, more youthful and rejuvenated appearance.

long-term follow-up study published in 2014 found that after an average follow-up of 12.6 years, 68.5 percent of face lift patients rated their current degree of improvement as very good or beyond expectations, and an equal number felt that 10 or more years had been added to their youthful appearance. Like all surgery, a Face Lift procedure does carry some risk, so it’s important that you weigh this up against the benefits before making your decision to undergo surgery.

How invasive is the surgery ?

A facelift is a major surgical procedure, which takes approximately two hours. There are many different types of face-lift surgery. These procedures differ in the area of the face being treated.  This would  depend on your individual needs and will be discussed at length with Dr van der Poel during your consultation.

What care is required after the operation?

  • Apply Bactroban or Fucidin ointment around the suture line post operatively, in front and behind the ears. This needs to be done twice a day until all the sutures have been removed.
  • Wash your hair regularly to keep the suture line clean as well as the staples. You can wash with a normal shampoo.  Be careful of a hair dryer as this can burn, especially in front of the ears, as this area is usually numb for the first couple of weeks.
  • It is best to sleep with the head slightly elevated to decrease the swelling. During the day sitting upright is preferable.
  • For ten to fourteen days post-surgery, avoid lowering your head when bending forward, as well as lifting heavy objects, as this can cause a haematoma. .
  • Sutures behind ears and staples are removed at 7 days.

 

BREAST REDUCTION

Breast Reduction is performed under general anaesthetic, after careful pre-operative marking with the patient standing. Generally a supero-medial pedicle is performed – especially in larger breasts. The breasts are taped for six weeks post operatively to reduce tension on the scars and to obtain a narrow scar. The patient is instructed on how to tape the breasts herself for the period. A bra is worn continuously for three weeks, day and night, and then during the day for the next four weeks. All sutures are absorbable.

Hospital stay – 2 nights
Recovery – 10 days


BREAST AUGMENTATION

The procedure is performed under general anaesthetic, after carefully marking pre-operatively to ascertain the exact size, shape and position of the cavity for the implant. The incision is made peri-areolar (i.e. in the lower half of the area around the nipple). This leaves a hairline scar. Generally a pre-pectoral pocket (i.e. in front of the muscle) is created, unless the patient is extremely thin. A pre-pectoral pocket allows for better projection of the breast and prevents the complication of muscle contracture over the implant. Silicone implants are generally used (unless the patient specifies a saline filled implant) as they feel softer and more natural. A small tube drain is left in overnight to prevent blood accumulating in the cavity. Post-operatively the patient massages the breast to keep the cavity as large as possible.

Hospital stay – 1 night
Recovery – 7 days


BREAST LIFT

This is either performed using a keyhole incision – with the resultant scar around the areola and a very small and insignificant scar in the inframammary fold. A vertical scar joins these 2 scars. All sutures are absorbable and do not need to be removed. Post-operatively the patient has to wear a bra for 4 weeks day and night.

Hospital stay – 2 nights
Recovery – 10 days


GYNAECOMASTIA (Male Breasts)

The procedure is done through a peri-areola incision to remove the breast tissue and usually liposuction is done around the edges to ensure that the whole area is flat. The patient stays in hospital overnight with a bandage around the chest to prevent bruising and swelling, and usually a small drain.

Hospital stay – 1 night
Recovery – 10 days

What care is required after the operation?

BREAST AUGMENTATION (BREAST ENLARGEMENT)

  • The dressings that are applied are steri-strips along the wound, which should be left intact until the sutures are removed.  A larger dressing is placed over this which can be dispensed of after the first couple of days.  This would be changed daily before bathing.  The steri-strips on the wound can be allowed to get wet and then to pat dry with a towel after bathing and a hairdryer can be used to dry the steri-strips.
  • A light bra is usually recommended as this gives a gentle support and is comforting in the first week.  Make sure that this is not a heavy bra, which will keep the breasts in a certain position, as the breasts would then stick down in that position.
  • Initially gentle massage is started and only firmer massage is performed after a week due to the tenderness of the breasts in the first week.  Instruction will be give at the time of suture removal.
  • Sutures are removed after 7 days.

BREAST REDUCTION

  • Micropore is used to tape up the breasts across the lower pole of the breast to support the scars.  This is used to decrease the tension on the scars and minimize the stretching of the scar.  This is usually performed for the first six weeks as the scar takes up to six weeks to be strong enough to withstand stretch.  The tape is usually changed every four days, the first two tapings are done by myself to show you how this is performed.  Occasionally a small serous secretion is noticed under the tape, this is normal.  One can wet this tape during bathing and then after bathing the tape is dried with a towel and a hair dryer can be used to dry the tape.
  • A firm-hold supporting bra must be used continuously for the first two weeks day and night, this can only be removed while bathing.  The next four weeks after this the bra must be used during the day after rising.  With the taping and the bra this would support the scar to prevent stretching of the scar.
  • Arnica can be used and if used a tablet is place under the tongue every two hours to decrease the swelling and the bruising.
  • Absorbable sutures are used and the knots, which are left out through the skin, are clipped off after one week.
  • Massage of the scar is started after the first six weeks and I usually suggest RegimA Scar Repair.  This is massaged and not rubbed to put pressure on the scar to soften and flatten the scar.  The scar usually takes up to one year to mature before it becomes light and less obvious.
  • Heavy weights should not be lifted during the first three to four weeks, as this would put tension on the scar.  One would be allowed to drive after the first five to six days.

Liposuction is a body contouring procedure, not a weight reduction procedure. The procedure is performed under general anaesthetic with a super-wet technique – large volumes of fluid containing adrenaline (epinephrine) and lidocaine are initially infiltrated before the procedure. This is done to cut down on postoperative bruising and to assist in the aspiration to the fat. Pressure garments are used post operatively to compress the area to prevent swelling and bruising and smooth out theaspirated area. Pressure garments are used continuously (day and night) for the first ten days, and up to six weeks afterwards.

Hospital stay – 1 night
Recovery – 10 days

What care is required after the operation?

  • The pressure garments should be used continuously day and night for the first two weeks and should only be removed for bathing.  Pressure garments are worn during the day for a further four weeks.
  • When bathing do not make the water too warm as this would increase the amount of swelling.
  • Gently massage the area which has been aspirated upwards to improve the drainage especially when bathing.  I usually suggest aqueous cream to massage the legs during bathing.
  • The sutures can be wet while bathing.
  • Arnica can be used and if used one tablet is placed under the tongue every two hours to decrease the swelling and bruising.
  • Sutures are removed after seven days.
  • Bruising takes 2 to 3 weeks to subside.
  • Swelling – 85% of swelling has subsided after first 6 weeks.
  • Final result visible after 3 months.

Blepharoplasty Eyelid Surgery may involve the upper or lower eyelids, or both. The procedure in performed under deep sedation by an anaesthesiologist and local anaesthetic. Upper eyelid excess skin and fat is removed, as well as muscle strip if necessary. The resultant scar is a fine line, which falls into the natural crease. Lower eyelid surgery can be performed as a direct surgical approach, with an incision just below the lower eyelashes (in the natural crease) to excise excess bags of fat and excess skin. Transconjunctival removal of fat bags and laser resurfacing (to tighten skin and remove fine wrinkles) is also performed.

Hospital stay – 1 night
Recovery – 5 days

What care is required after the operation?

  • Use the tear gel in the eyes, especially at night to prevent the eyes from drying out.  This can also be used during the day if the eyes feel dry.  The tear gel can also be used along the suture line to keep this moist and more comfortable.
  • Clean gently with a saline solution to prevent and clots along the suture line or around the sutures.
  • Ice packs – Ice with water or saline placed over the ice is used to dip a gauze swab in and this is placed over the eye to act as a cold compress.  This alleviates the swelling and bruising and is also comforting.
  • Sit up rather than lie flat, as gravity will help to decrease the swelling.
  • Massage and squeeze the eyes, the massage is done on the lower lid pushing the eyelid against the eyeball in the outer corner.  This decreases the swelling and also allows the eyelid to touch the eyeball as this tends to drag away due to the swelling, also squeeze the eyes at the same time.  This is the rule of tens, ten second ten times a day for ten days.
  • Do not lean over forwards, as this will increase the swelling around the eyes.
  • Arnica can be used and if used a tablet is placed under the tongue every two hours to decrease the swelling.
  • Sutures are usually removed after 4 – 5 days.
  • Contact lenses should only be worn after sutures have been removed.

Nose surgery (Rhinoplasty)

Correction of nasal tip, dorsal lump and broadness of nose is performed under general anaesthetic. Working through the nostril, the closed technique is usually performed. The open technique is reserved for a very difficult nasal tip correction. A splint is applied (which remains for seven days) and plugs are inserted overnight. As an in-fracture is performed bruising around the eyes is experienced in varying degrees.

Hospital stay – 1 night
Recovery – 7 days

What care is required after the operation?

  • After the procedure nasal plugs are inserted to prevent swelling and bleeding within the nose.  These are usually removed the morning after the procedure.
  • A Splint is placed across the nose to prevent swelling and hold the bones in position.  The splint remains on for one week post-operatively.  This should be kept as dry as possible to prevent the splint from coming off.
  • Ice packs – ice packs can be used over the eyes as some swelling and bruising does occur if an in fracture is performed.  Normally if one places an iced water solution in a basin and dips a gauze swab into the iced water solution and places over the eyes, this cuts back on the swelling and bruising.
  • Arnica – this can be used from the day after the procedure to cut back on the bruising and swelling.  Normally place one tablet under the tongue every two hours for the first five days.
  • Levage – a saline solution can be sniffed up into the nose and allowed to drain out to clean inside the nose if required.  Normally a saline solution is placed in the cup of your hand and then this is sniffed up into the nose to fill the nose and then allowed to run out.  Not everybody likes this and it is not absolutely essential.

Tummy tuck (Abdominoplasty)

Different techniques are used, depending on the problem. If a small area of excess fat is found in the anterior abdominal wall, with no loose skin, liposuction is performed (see liposuction). If a small excess of skin is the problem a mini tummy tuck is performed, with or without liposuction. Lastly, a full tummy tuck involves a larger scar – which is made as a high-cut (in a natural line inside the pelvic bones). The umbilicus is repositioned after the excess skin has been removed.

Hospital stay – 2 nights
Recovery – 12 days

What care is required after the operation?

  • Dressings – initially for the first 48 hours elastoplast is placed across the wound to put pressure on the wound.  Small drains are left through the wound along the suture line.  These are removed after the first 24 hours.  After 48 hours the elastoplast is removed and the wound is taped to prevent the scar from stretching.  This tape is changed every four days and can be wet during bathing.  After bathing pat the tape dry and a hairdryer can be used to dry the tape.  The first two dressings are done by myself and instruction is given as to how to tape the wound after that.
  • Pressure garment – a pressure garment would be applied over the tape to compress the area to prevent swelling and bruising.  This must be worn continuously for the first two weeks day and night, and may only be removed while bathing.  The pressure garment is then worn for the next four weeks after that during the day only.
  • Lifting and driving – lifting heavy weights should be avoided at all costs as this would put tension on the scar and cause stretching of the scar or even opening of the wound.  I usually permit driving after the first ten days provided all is going well.
  • Sutures – the wound is sutured with absorbable sutures and the knots are clipped off one week after the procedure.
  • Arnica – arnica can be used if required and I normally suggest that one tablet is placed under the tongue every two hours to prevent swelling and bruising.
  • Fluid under the flap – occasionally some fluid develops under the skin flap and if this occurs this is aspirated in my rooms.  In the lower portion of the abdomen where there is no feeling for the first couple of weeks.  This normally occurs if a liposuction and a mini-tuck is performed.
  • Analgesics – Painkillers are supplied and should be used if needed.

NON-SURGICAL PROCEDURES

The results after a Restylane Vital treatment are long lasting and very natural. Your face will not look like you had any “work done”.
The great thing about Restylane Vital is that it gradually releases its benefits over several months which means that it keeps your skin hydrated, plump and fresh for the duration of the treatment. The when you need a top up treatment, you will likely only need a fraction of the initial treatment amount, saving you time and money.
The Restylane Vital treatment produces a long-lasting, natural and safe improvement to your skin by gradually releasing its benefits over several months.
The treatment is not at all like traditional dermal fillers but instead offer skin hydration.
If you want to reduce facial wrinkles and lines without having to go through surgery, Restylane Vital is a wonderful option as this dermal filler uses micro droplets of hyaluronic acid to add moisture to the skin, and therefore thicken the skin reducing wrinkles and dryness.

What happens during a Restylane Vital treatment?

The initial Restylane Vital treatment series comprises of 3 treatment sessions spaced 3-4 weeks apart. Treatment benefits generally last between 7 and 9 months and can be maintained by repeat treatments once or twice a year. Each session will last approximately 45 minutes. Immediately after treatment with Restylane Vital you may look a little red. Sometimes patients can see small raised nodules at the treatment site; this is a normal reaction and will subside within a day or so. If you are using the micro-cannula the chance of excessive redness is greatly reduced. Patients should not touch the treated area for 6 hours following any dermal filler treatment. It’s also important to stay away from the sun until any side effects have subsided. Remember the sun dehydrates the skin whereas the dermal fillers are trying to do the opposite.

What areas does it work best on?

In my practice I use Restylane Vital to improve the general quality of the skin It is especially useful in the area around the mouth with a great improvement in those fine “smokers lines” around the mouth. I can also use it to fill in pockmarks, acne scars, and irregularities in the skin. Restylane Vital is effective in reversing the damage caused by photo-aging particularly in those difficult to treat areas that ‘give away’ your age, such as:

 

  • Skin elasticity
  • Around the mouth
  • Sun damaged décolletage
  • Backs of your hands
  • All areas of the face to improve skin tone and firmness.