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New Year, New You

Published:
17/01/2017
Author:
Dr John Kippen

The general trend with surgery is to be less invasive. The implication is that there will be a faster recovery with less downtime. This is true to a point but becoming less invasive may reduce the longevity of the results.  

Facelift surgery has completed a full circle. Initially facelift surgery involved excision of skin only. Usually this looked good for a few months but as we all know from pregnancy, skin can easily stretch. Work then moved to progressively deeper levels. The SMAS, superficial muscular aponeurotic system, is a tough fibrous layer in the face which holds the results of lifting for long. This may be accomplished but resecting some of the SMAS or using stitches to plicate the SMAS. Even deeper facelift procedures, close to the bone, gained some popularity. The downside was quite extensive swelling for quite a long time. Then followed a number of minimally invasive procedures with limited dissection and undermining of tissue. These often relied on stitches only to hold the lift. Stitches alone placed in the skin have also been tried. This completes the circle back to skin.

It usually comes down to selecting the correct procedure for the correct person and the balance of outcome to downtime. In general the more invasive procedures require longer recovery but generally the results last longer. Various options, risks, complications, likely outcomes and recovery should be carefully discussed at consultation. 

Changes with eyelid surgery mainly involve the lower eyelids. This is considered a technically more difficult procedure than upper eyelid reduction. Less fat is removed and fat is now re-draped or grafted back to fill the tear trough deformity. This is the groove that develops between the eyelid and the cheek. Lower eyelid surgery that does not require skin excision can be performed from the inside of the eyelid and does not leave an external scar.

Browlifts are a classic procedure where there is quite extensive surgery for millimetres of lift. The classic browlift was an incision across the top of the head to allow access to the forehead and brow. Endoscopic browlifts using special instruments and a camera can be performed through about five smaller incisions. As most of the eyebrow lift is required in the outer or lateral part of the brow, temporal browlifts require only two incisions placed in the temples. The middle part of the brow can then be lifted but removing muscle at the time of eyelid surgery or using muscle relaxing injections. Direct browlift remove skin immediately above the brow or from a forehead crease. This is the least invasive of all the techniques.

Changes to breast augmentation surgery is generally to minimise the risk of capsule contracture. This may be influenced by the choice of implants. Recent changes in techniques attempt to allow ninety per cent of women back to their activities of daily living within twenty four hours. Dual plane techniques attempt to obtain a more natural result by allowing the breast tissue to re-drape over the implant.

Breast reduction surgery is moving towards techniques to minimise the length of the scar. This usually applies to the horizontal component of the scar.

Another trend with surgery is to admit people on the day of surgery and minimise the stay in hospital. More procedures are being performed in the rooms or in a day surgery setting.

All options involving the choice of procedure, the anaesthetic, the likely down time or recovery and the likely outcome should be carefully discussed and individualised to each person and their requirements. Before and after photographs are very useful in this context.

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