charles durrant plastic surgery

Cosmetic Surgery - face

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Rhytidectomy (Face Lift)
Blepharoplasty (Eyelid Reduction)
Fat Transfer/Fat Injection/Fat Grafting
Pinnaplasty (Prominent Ear Correction)

Rhytidectomy (Face Lift)

Why undergo a facelift?

As we get older time, gravity and sunshine (among other things) work together to age our faces. The normally youthful fat deposits in the cheeks drop forwards and downwards, causing a sagging jawline and deep folds between the nose and mouth. The skin of the face becomes looser and more wrinkled. The muscles in the neck may become more pronounced, or fatty deposits may appear. A facelift can improve these things.

before facelift

Before

after facelift

After

Who can have a facelift?

While a facelift can be performed on just about anyone, there are certain groups of people who are likely to get better, more predictable results than others. Patients with good underlying bone structure who still have good skin elasticity tend to do well. Smokers tend to run into difficult complications and I would strongly advise against having a facelift procedure if you are still actively smoking or using other nicotine products.

How is it done?

The idea of the facelift is to re-suspend the face back to its more youthful situation. It is important to have realistic expectations from the surgery. A facelift can have dramatic results, taking 10 years or more from your face. However, remember that it is only skin deep and although it may give your confidence a boost, it will not bring back the vitality of your youth.

An incision is made in the natural crease just in front of the ear. It extends upwards just in front of the hairline and backwards behind the ear. In some cases the cut behind the ear needs to be extended along the hairline at the back of the head. The skin of the face and neck is then carefully lifted off the underlying muscles which are tightened up with sutures. This leaves slack in the skin that has been lifted up and, once the skin is draped back down again, the excess is trimmed away and the wound is sutured.

Liposuction to the neck may also be undertaken to improve the contour of the jaw and a separate small incision under the chin may be necessary to correct the front part of the neck.

During our initial consultation, I will evaluate your overall health and examine your facial skeleton and fat distribution. The face is our most individual feature and so each surgical plan is unique. We will come to a decision together based on my examination and the goals you wish to achieve.

facelift example

What are the risks?

When done with due care and attention, facelift surgery is relatively safe. Even in the most experienced of hands, however, complications can occur. There may be a collection of blood under the skin which would generally require a return to the operating theatre to have it washed out. Infection in the face is rare due to the excellent blood supply, but occasionally antibiotics may be needed. The surgery is planned so that the scarring is well hidden from view and is generally extremely difficult to detect. In a few patients, however, the scars may stay raised and pink and this can be difficult to treat. Poor healing of the skin is also a rare complication. Although this is much more common in smokers, it can happen to any patient.

During the procedure, great care is taken to avoid branches of the nerve that moves the muscles of facial expression. Very occasionally, this nerve may become injured, leading to weakness in the muscles on one or both sides of the face. In the vast majority of cases, this rights itself after a few months. However, there have been reports of this weakness becoming permanent.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. Involving your GP is important to control any high blood pressure or blood clotting problems you may have to minimise the risks. It may be a good idea to grow your hair prior to surgery as this is useful to camouflage the early signs of the operation.

The surgery itself is performed under either a local anaesthetic (with you awake) or a general anaesthetic (with you asleep). It takes about 2-4 hours to complete (longer if more procedures are undertaken at the same time). The incisions are closed with fine sutures and covered with antibacterial ointment. You will wear a compression dressing that goes around the face and jaw.

After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you can expect to be able to leave the hospital on the same day. You will need someone to drive you home. You will feel sore, bruised and puffy for a couple of weeks following the surgery, so do not be alarmed when you take the dressing off and see yourself in the mirror. Pain is not normally a prominent feature of facelift surgery but simple painkillers may be required.

Your hair will be washed during the procedure. Thereafter, you can shower as normal from the first week after the operation.

Five to seven days after your surgery you will visit the dressing clinic. Here, the sutures are removed. The face will remain bruised and swollen for 2-3 weeks and the neck may well feel tight for 4 weeks.

It is important to wear a compression garment for as much as possible during the first 4 weeks after the surgery.

Returning to work and play

Most people can return to work after 1-2 weeks, although some make-up may be needed to camouflage the last of the bruising. More active occupations may require longer, but this will be discussed fully with you. It is important not to cough, strain, or place your head below your heart (for example, bending down to pick something up) for the first couple of weeks to avoid bleeding.

Strenuous exercise and drinking more than a minimal amount of alcohol should be avoided for 6 weeks.

After a final review with your surgeon at 2 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

The benefits of a facelift stay with you as you age. However, it will not stop the hands of time and you may find that you want a further facelift in the future. However, the benefits are generally long-lasting and you can enjoy them for several years.

Blepharoplasty (Eyelid Reduction)

Why undergo Eyelid Reduction?

Time, gravity, sunlight and the stresses of day-to-day living can lead to the skin of your eyelids becoming looser. The fatty pockets under the skin can push forwards, making you look tired and older than you feel. In extreme cases, it may even interfere with vision.

Eyelid surgery can give the eyes a more alert and youthful appearance that is generally long-lasting.

before blepharoplasty (eyelid reduction)

Before

after blepharoplasty (eyelid reduction)

After

How is it done?

Blepharoplasty surgery may be performed on the upper eyelids, the lower eyelids, or both together.

The surgery itself consists of removing the excess skin, muscle and fat from the eyelid that is causing the eyelid to droop or to look baggy. In the upper eyelid, the incision is made in the natural creases of the eyelid in order to keep any scars as inconspicuous as possible.

In the lower eyelid, the incision is made just under the eyelashes. In both cases, the incisions extend to the outer corner of the eye where they become hidden in one of the laughter lines.

The decision as to which incision to use and which eyelids are causing concern is made during the first consultation. I will evaluate your overall health and make a surgical plan based on the shape and quality of the eyelid skin and, importantly, the position of the eyebrows. Eyebrow position is important because dropping eyebrows may give the impression that the upper eyelids are too loose and an upper blepharoplasty alone may not solve the problem.

At the initial consultation I will also need to test your eyesight and take a full history from you concerning any eye problems you may have had in the past.

eyelid reduction example eyelid reduction example

What are the risks?

When performed by an appropriately qualified plastic surgeon, eyelid surgery is a safe and effective procedure. However, as with all surgery, there is a degree of uncertainty and risk. Meticulous steps are taken during the surgery to minimise and control bleeding. In a very few cases, this can lead to more bruising than expected which can take a longer time to settle down. An extremely rare complication associated with bleeding after surgery is blindness (about 1 in 40,000 risk).

Great care is taken to ensure that the correct amount of tissue is removed. However, if too little is taken, the surgery may have to be repeated. If too much is taken, it can lead to difficulty closing the eye, or an ectropion (pulling downwards of the lower eyelid away from the eye). These problems are usually temporary due to swelling, but in rare cases will need correction.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under either a local anaesthetic (with you awake) for the upper eyelids only, or a general anaesthetic (with you asleep) for the upper or lower eyelids . It takes about 1 to 3 hours depending on the extent of the surgery. The incisions are closed with fine sutures and covered with an antibiotic dressing.

After The Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you will be up and ready to leave the hospital on the day of your surgery. You will need someone to drive you home. You will need to wear a cold compress over your eyes several times a day for the first few days to reduce swelling. You will feel a little sore for a few days following the surgery, but this is usually well controlled with normal painkillers. You may notice some blurring or double vision, but this usually settles with a couple of days.

You will be able to shower normally from the second day after the operation.

Five to seven days after your surgery you will visit the dressing clinic. Here, the tape and sutures are removed. Take care not to bend down or strain during the first 2 weeks as this can cause the bruising and swelling to worsen.

The eyelids will remain bruised and swollen for up to 3 weeks and you may even notice that they settle down at different rates. You will be given advice as to how to help the swelling reduce and after a couple of weeks the swelling should have resolved enough that you will be able to go out with a small amount of make-up to camouflage any remaining areas of bruising.

Returning to work and play

Most people can return to work after 1-2 weeks. After 2 weeks, you can start wearing contact lenses again. Avoid strenuous exercise, or other activities that raise the blood pressure for 6 weeks. It may also be advisable to avoid alcohol as this can lead to fluid retention and increased swelling.

After a final review with your surgeon at 2 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

Fat Transfer/Fat Injection/Fat Grafting

What is Fat Transfer?

Fat transfer is, literally, the transfer of fat from one part of the body to another. It can be used to fill hollows in most parts of the body, as well as to augment existing areas such as cheek bones and lips. It can even be used to increase breast size (although this requires multiple procedures). Its commonest use is in facial rejuvenation, where it can be used to replace areas of volume loss that contribute to the aging process, without needing to remove and stretch skin.

Who can have Fat Transfer?

Since the volumes of fat being transferred are usually very small, pretty much everyone will have enough spare fat to have it done. Compared to other methods, fat transfer is still in its infancy and we are still developing its use, but it is rapidly replacing much of the work that used to be taken up by synthetic 'fillers'. It can be used as a stand-alone procedure, or as an adjunct to other procedures, such as facelift, to improve the results.

How is it done?

Fat is 'harvested' from any parts of your body that can spare it, much like liposuction. However, unlike liposuction which uses a suction machine, the fat is removed using a hand-held syringe which is far more gentle on the fat cells that are eventually going to be replaced into your body. The fat is harvested using small tubes (cannulae) that are inserted through tiny incisions hidden in your body's natural creases. Once enough fat has been obtained, the fat is washed to separate the healthy fat cells from the other oily debris. The healthy remaining fat cells are then injected into the area that needs more volume until the required result is achieved.

During our initial consultation, I will evaluate your overall health and together we can discuss the areas of concern and the goals you wish to achieve with your fat transfer.

fat injection syringes

Fat injection syringes after fat harvest

areas suitable for fat injection

Areas suitable for Fat Injection

What are the risks?

Fat grafting is generally a safe procedure. The greatest limitation is the unpredicatability as to the amount of grafted fat that will survive. It is variable from patient to patient, but a good guide is that we can expect at least 60% of the injected fat to survive. The remaining fat is absorbed by the body. This means that the procedure sometimes needs to be repeated to achieve the best results.

Fat transfer has much the same risk profile as liposuction so, although exceedingly rare, it can be associated with some serious complications such as fat clots and blood clots that may become lodged in the lungs. However, more common complications include irregularities of the skin contour, lumps under the skin, loose skin, bruising, numbness, some pigment changes and the need to repeat the procedure. Most of the time these minor issues settle with time, but occasionally they will need correction.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed under a general anaesthetic (with you asleep). It takes about 1 to 2 hours to complete (depending on extent of the fat grafting). The incisions are closed with fine sutures and covered with tape.

After The Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary. Fat transfer is generally a day case procedure, so remember to bring someone with you who can drive you home. You will need to wear a support garment such as Spanks for the first 6 weeks after the surgery over the area from which the fat was taken. You will feel a little sore for a few days following the surgery, and may find a good deal of bruising in the involved area. However, this is usually well controlled with normal painkillers.

You will be able to shower normally from the second day after the operation.

Five to seven days after your surgery you will visit the dressing clinic. Here, the tape and any sutures are removed.

It takes quite a long time for the swelling to settle and for the grafted fat to declare its final shape so, although you will see an immediate difference, do not expect to see the final benefit of the procedure for up to 2 months afterwards. At this stage, a review will be necessary to decide if further fat transfer is necessary.

Returning to work and play

Most people can return to work after 1-2 weeks, although some make-up may be needed to camouflage the last of the bruising if the face was involved.

After a final review with your surgeon at 2 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

Fat transfer has revolutionised the way we perform many procedures and, even if the procedure needs to be repeated, the benefits it confers make it a valuable and cost-effective technique.

Pinnaplasty (Prominent Ear Correction)

Why undergo a pinnaplasty?

An arm lift is a surgical technique to remove excess skin and fat from the upper inner arms in order to improve the contour.

The shape of the ear is as unique to each individual as their fingerprints. Normally, the ears are relatively flat against the side of the head and are inconspicuous. During development of the ear, certain structures may be over or under formed leading to the ear protruding forwards and making them more obvious. Sometimes the appearance of protruding ears can become an object of ridicule that can damage self-confidence.

before prominent ear correction

Before

after prominent ear correction

After

Who can have a pinnaplasty?

Although a pinnaplasty can technically be performed at any age, it is important to remember that meaningful teasing does not really occur until the age of 6 or so. When a child reaches this age, they can usually decided for themselves if they want their ears corrected. If a parent wishes their child to have the surgery, but the child is not concerned about their ears, I would strongly recommend that you do not proceed.

Of course, some children with prominent ears continue to have prominent ears into adulthood and may decide to correct them later in life. Ear correction in an adult achieves the same excellent results as in children.

ear diagram

How is it done?

A small ellipse of skin is removed from the back of the ear. Through this, the cartilage of the ear is accessed. It is this cartilage that gives the ear its unique shape. If the problem involves an underdeveloped anti-helix (see diagram above), the cartilage of the anti-helix is moulded into the correct shape and held with sutures. If the concha is also prominent, then further sutures hold the concha more firmly against the side of the head. In older children and adults, the cartilage can be a little hard. In these cases, it may be necessary to remove a piece of cartilage from the concha to allow it to bend inwards.

During our initial consultation, I will evaluate your overall health and examine your ears. We will come to a decision together based on my examination and the goals you wish to achieve.

At this stage a photograph is taken which forms part of your medical record. It will not be used for publication or teaching purposes without your express written consent .

What are the risks?

Pinnaplasty is a safe and reliable procedure. However, even in experienced hands, complications can occur.

Although bleeding is meticulously controlled throughout the procedure, it is possible to get a collection of blood under the skin which would require an urgent return to the operating theatre to have it washed out. Infection is rare due to the excellent blood supply, but occasionally antibiotics may be needed.

The surgery is planned so that the scarring is well hidden from view and is generally extremely difficult to detect. In a few patients, however, the scars may stay raised and pink, particularly in black and Asian ethnic groups and in natural redheads.

The repair is only as strong as the sutures used. If there is even minor trauma to the ears before your natural healing has occurred, then the sutures can fail and one or both ears may return to their original position.

The Surgery

Prior to the surgery, you will be given all the information you need in terms of how best to prepare for the operation. The surgery itself is performed either under a general anaesthetic (with you asleep) or a local anaesthetic (with you awake). The choice depends on your age, preference and the complexity of the operation. It takes about 1 to 2 hours to complete (depending on the nature of the problem). The incisions are closed with dissolvable sutures and the ears are dressed with a headband, whcih you should bring with you for the surgery.

After the Surgery

After a general anaesthetic it is normal to feel tired and out of sorts, but this is temporary and you can expect to go home on the day of your surgery, so remember to bring someone with you who can drive you back home afterwards. Due to the strange anatomy of the nerves in the ear area, it is not uncommon to feel nauseated after the surgery but, again, this is temporary. You will feel a little sore and bruised for a week or so following the surgery.

One week after your surgery you will visit the dressing clinic to have the wounds inspected. The ears will remain bruised and tender for a further week or so.

Returning to work and play

Most people can return to work or school after a week or so. It is important to take great care of your ears for the first few weeks as this is the time when the ears can return to their original position if knocked or pulled.

After a final review with your surgeon at 2 months, it is not usually necessary to be seen again. However, regular appointments with your surgeon are recommended so that if any complications do occur, they can be picked up and addressed early.

Bear in mind that achieving perfect symmetry is impossible. In fact, ears are never completely symmetrical to start with. Fortunately, it is very unusual to see two ears together at the same time, so minor asymmetry is not noticed and both children and adults are usually thrilled with the results.

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