I know that most people think that gravity is the cause of sagging facial tissues but I realised that the way we sleep has an enormous impact on how we age. As we sleep on our sides we press the tissues downwards and towards the nose for prolonged periods and that creates the heavy naso-labial lines, drooping jowls and even upper lip lines. I believe that while smoking definitely weakens the collagen lattice-work, the main cause of the lines on the upper (and lower lip is pressure from the sides contorting the upper lip while we sleep. Men have moustaches that thicken the skin and make it relatively more difficult to crease so they are less prone to making these lines.
I also realised that I could protect the suspension sutures in a mid-face lift much better by removing pressure from the cheeks. That’s why I designed the “better pillow” which supports the face on the forehead and below the jaw-line and there is no pressure on the cheek. That way my patients can safely sleep comfortably immediately after their operation without fear of damaging the surgery. The addition of the special facial mask (that I also specifically designed) provides great comfort and support.
This is a procedure that I have pioneered as an alternative to laser resurfacing and it has been featured in the Hot Topics of the Journal of the American Aesthetic Association, a Chapter in an aesthetic surgery textbook (edited by Manders and Peled), a chapter in the Yearbook of Maxillofacial and Oral Surgery devoted to minimally invasive cosmetic surgery (edited by J Niamtu) and has also been featured on TV in the USA.
Special needles are used to finely puncture the skin and induce natural collagen production. This tightens the skin after a few months. The method can also be used to reduce acne scarring, burn scars, wrinkles and creases on the upper lip. In some cases the procedure may be required prior to a face-lift when the patient wants the very bestrejuventation. In all cases it is absolutely essential to be on the highest levels of vitamin A prior to the operation. For acne scars this technique gives the best results without destroying the skin surface. More than one treatment may be required, but the advantage is that the skin gets smoother and smoother with each treatment.
I started doing fat grafting in 1987 and can claim to be one of the pioneers of this type of surgery in South Africa.
We are learning a great deal about fat grafting and we now believe that the fat cells themselves might not really survive but the result comes from the fat stem cells that are more resistant and do survive and then grow to develop more fat cells. These fat stem cells have great potential. They are not the same as foetal stem cells, which can develop into every tissue in the body, but fat stem cells still possess great powers that are being harnessed by modern research. Fat grafting has become one of the best ways to rejuvenate a face and when combined with a face-lift, gives excellent results.
I use fat grafts to
- enhance the cheek bones,
- treat the grooves from the lower eyelid onto the cheek (called the tear-troughs)
- Lip augmentation (and/or needling (see percutaneous CIT) of the skin to reduce lines and give fuller lips. I always use fat and will not do temporary fillers. If you are not certain of the volume that you want, then have a temporary filler injection to help you decide. A second injection of fat is almost always required to get the desired result. I have been doing fat grafts since 1987.
- Full face grafting to fill the “deflated” face that automatically accompanies ageing. This will not only restore volume but also give a more youthful appearance to the overlying skin. The temples and forehead as well as the face benefit from fat grafting.
- chin augmentations
With chin augmentations I never use prosthetic material, but prefer to do either dermo-fat grafts or fat injections.
To correct prominent ears
This operation is virtually always done with local anaesthesia with or without conscious sedation. I shape the ears with permanent sutures and the small scars are in the usual position on the back of the ear.
In some people with lesser changes the lower face and the neck can be corrected without doing a full face-lift. Generally tiny incisions in the temple are used in combination with an incision behind the ears. This is the perfect solution for people who are considered too young for a face lift but want to have a more convincing appearance of youth. Procedures range from the use of simple “Silhouette” sutures to the “Trampoline” type neck lift.
This is an extension of the surgery for the mid-face and is only suitable for people showing less lax skin and early drop of the facial tissues. Generally they will be turned away by most plastic surgeons and told to wait a few more years for a conventional face-lift. This surgery cannot be done in people with lax, photo-damaged skin who need a conventional face-lift.
Suture suspension loops are used to hold the facial tissues in their youthful position. A combination of suture suspension loops as well as threads such as the “Silhouette” threads may be required. In some cases it is only necessary to use four to six “Silhouette” sutures each side.
After the operation you will need to use a special support that I have designed to protect the sutures and improve your comfort. No scars are noticeable and even a hairdresser may never know that the operation has been done.
To lighten the creases from the nose and soften the “tear-trough” from the medial eye to the cheek. Click to see more detailed notes
The lower eyelid is virtually always treated together with the mid-face This is another operation that I have pioneered. I realised that the conventional lower eyelid operation which I used to do, did not correct the drop of cheek tissues that are responsible for revealing the fat in the lower eyelid. In fact that fat has merely been exposed, even if there has been some herniation of fat through the membrane defining the lower eyelid.
I lift the fat of the cheek which has generally accentuated the naso-labial crease and restore it to the position it occupied when the patient was about 25yrs old. I believe that the mid-facelift is the real lower eyelid lift (lower blepharoplasty).
Permanent suture loops are used to ensure a long-lasting result. If there is any excess skin on the lower eyelid then it is removed without disturbing the anatomy of the lower eyelid muscle. The scars are on the inside of the lower eyelid and in the hairline of the temple. If skin has been removed from the lower eyelid then there will be a barely perceptible scar in the crow’s feet and immediately below the eyelashes. The result of this operation is rejuvenation of the face between the eyes and mouth with correction of the bags of the lower eyelids and also some softening of the jowl creases without visible scars. I often support the skin with added “Silhouette” sutures.
The scarless mid-facelift can be “serviced” at a later date to restore the original younger appearance through a relatively small procedure.
With excision of excess skin in front of the ear.
This is the traditional face-lift but I always preserve the side-burn and make the incisions in the most concealed position going behind the tragus of the ear. There is minimal scarring behind the ear. I have always done lifting of the deeper tissues of the face and the skin is never tightened more than natural tension. This allows patients to appear naturally rejuvenated without the telltale signs of a face-lift.
I have an important philosophy that differs from the conventional. I believe that face-lifts can and should be “serviced” just as a car needs a service periodically in order to keep it in the best condition. The result of a face-lift can be maintained by use of the suture suspension loop technique (see below) or special threads such as Silhouette Sutures which are attached onto a small “anchor”. When necessary the anchor can be repositioned to restore the best tension of the facial tissues.
Deep permanent suspension sutures help to give a longer-lasting result. After the operation you will need to use a special support that I have designed to protect the sutures and improve your comfort. If necessary, additional sutures may be added at a later date to restore the face-lift. Please note that the fee for a face-lift does not include lifting of the brows or correction of the upper eyelids.
People often ask how long a face-lift will last and the usual reply is about six to ten years. If you analyse this response then what they really mean is that by six to ten years you will have slowly developed lax and droopy skin to such an extent that if you are inclined to, then that is the time for the next face-lift. I believe that we should intervene earlier by “servicing” the facelift by re-tightening the suture loops and threads.
THE BROW LIFT for lifting brows that are too low.
This is a long-lasting procedure that I have refined over the past 20 years.The brows are lifted by nylon-type threads implanted through minute incisions using a needle. The threads are durable and will ensure a lasting result. The hairline is not pulled backwards and hair growth is not affected. The scars are within the hairline and are each about 3-4mm long.
The knots are not palpable.
Initially the eyebrows may appear to be excessively lifted upwards, but as the swelling abates, the brows assume a normal position well related to the bony margin of the eye-socket. This system also often helps me to design the brow according to a desired shape. I ask patients to inform me of their preference.
Forehead operations can be painful for the first 24 hours but I have a simple trick that reduces the pain significantly.
If the eyebrow needs to be adjusted at a later date this can easily be done by adding one of two extra sutures. After 6-8 months one forgets that the sutures exist.
Another version of these sutures allows me to tighten the lateral sides of the eyebrow and temple skin to reduce crow’s feet without lifting the brow.
To correct the upper eyelids
This is the well-known operation to remove excess skin on the upper eyelid once the brows are in their correct position. In some people the excess skin is removed by lifting the brows (so only a brow-lift is required) whereas in others the brows are in their correct position and there may be excess skin and herniation of the fat that has to be corrected. The scar lies in the eyelid crease.
Please note that if one has excess skin on the upper eyelid and the brows are too low, then I will correct the brows first and then do an upper blepharoplasty as a separate procedure after at least 6 months. This allows me to give a more precise and better result.
I rarely excise skin from the lower eyelids because I believe the mid-facelift is the real lower eyelid corrective procedure