Dr Beryl Tan - Surgical and Non-surgical treatment of the Face and Neck
Non-surgical facial injectables are now commonly used for the face. However, there is a limit to what Botox and fillers can do. An ‘over-filled’ face can look stiff, mask-like, unnatural, and heavy.
Surgical procedures aim to treat the lax and ptotic skin by tightening the inner stronger layer of tissue called SMAS (superficial musculoaponeurotic system). This is achieved by rhythidectomy, or facelift procedure. It could be done as a full facelift, or partial, and usually also include neck lift. Adjunctive procedures are commonly performed at the same time, such as deep chemical peel, and lipofilling (fat graft injection) to restore volume (microfat) and improve skin texture (nanofat).
There are other procedures that target a specific area, such as around the eyes or periorbital region.
How is the face assessed?
Dr Tan loves painting portraiture. The assessment is very similar…. proportion, signs of ageing, symmetry/asymmetry, etc. Obviously, assessment for potential surgery is more complicated. The human face is dynamic and mobile. It changes with age (take a look at how the Afghan girl’s face has changed with age and hardship in life!), and sometimes even within a day, depending on how you feel! How does a facial expression change the face? We can tell a happy or sad face apart, but sometimes, we can get it wrong…a person could look tired or grumpy, without actually feeling that way.
The basics….
The face is usually assessed in thirds ( upper, mid, and lower) or as a whole. The regions are divided as follows:
Upper third
- Forehead
- Periorbital – Eyelids
Mid
- Mid cheek (including the cheekbones)
- Nose (classified separately but assessed to check proportions, in relation to the rest of the face)
Lower (usually with neck)
- Lips
- Jowls and chin; jawlines
- Neck – liposuction, neck lift
*Ears are usually assessed separately (ear lobe reduction, otoplasty).
What does facial treatment involve?
A facial treatment can mean many things… but it should include a mix of good skincare with anti-aging ingredients like vitamin A (or its derivative like retinol), antioxidants, and proper sun care.
Non-surgical treatments can include:
- Skin rejuvenation- Intense Pulse light (IPL) therapy, radiofrequency (RF) treatment, laser, chemical peel, nanofat injection, mesotherapy, or the newer treatment as such Profhilo
- Botulinum toxins, e.g. Botox®, Dysport
- Fillers- hyaluronic acid; to replace or add volume
Common Surgical procedures can include:
- Eyelids (upper &/ lower)- blepharoplasty
- Fat graft (own fat) as filler to replace or add volume
- Buccal fat removal (beware of over-resection as ‘sunken, hollow cheeks ages the face)
- Lip surgery- lip lift, fat or dermofat graft to lip, upper lip length reduction
- Facelift- full, midface, lower face and upper neck
*It is important to note that the procedures listed are surgical interventions that address specific physical conditions. These procedures do not stop the natural aging process. Please find more information here.
Why do people seek treatment for their face or neck?
The following can be reasons why people look for face or neck procedures for improvements:
- Non-surgical treatments (e.g. filler and botulinum toxin injection) may not be enough
- Botox® or filler fatigue
- Unhappy with the look of their current aesthetic
- They feel as though fillers make their face look puffy and heavy
- They want to look as young as they feel
What are the signs of facial ageing?
The most common signs of facial ageing are evident when the skin and muscles start to lose tone. The fat may shrink or move to a lower position, causing a different appearance. While a good skincare routine is important, ageing is inevitable and will involve all tissues (fat, muscles, and bone).
Everyone ages differently, and genetics play a big part in how you will be affected. Environmental factors such as smoking, high sun (UV) exposure, lack of good nutrition, lack of sleep, and high stress, can also have a big impact.
The following are the most common signs of ageing:
Forehead
- Transverse creases
- Eyebrows sit lower
- Deep/permanent frown lines
- Hollowing of the temples
Periorbital (around the eye)
- Extra lines/wrinkles at upper and lower eyelids
- Excess skin of the upper eyelid
- Hollowing of eye sockets
- Protrusion/bulging lower eyelid
- Prominent tear trough (shadow/line of the lower eyelid, next to the nose)
Mid-face
- Midface flattening
- Cheek descent
- Prominent nasolabial folds (cheek fat drops lower)
Lower face
- Thinning lips
- Lip lines
- Lengthening of upper lip
- Marionette lines with jowls
Neck
- Transverse neck folds
- Plastysma bands
- Vertical neck plea.
What is a forehead or eyebrow lift?
A forehead or brow lift is a non-surgical procedure that will relax the transverse crease to mask permanent deep or fine lines.
The surgical option is known as a “browlift”. This particular surgery is patient-specific and the technique can vary based on your need.
What is eyelid surgery?
Blepharoplasty: This procedure involves the removal of excess skin and muscle from the upper and lower eyelids. It is designed to address issues where the skin may obstruct vision. Blepharoplasty can also include the creation of an upper eyelid fold that is considerate of the individual’s racial or ethnic background.
For conditions such as rhytids (wrinkles), dark circles under the eyes, or ptotic eyebrows, alternative procedures may be considered.
Eyelid surgery can be performed on either the upper or lower eyelids and may be combined with other facial procedures for comprehensive results. In cases where there is significant looseness between the lower eyelid and the eyeball, a tightening procedure such as canthoplasty or canthopexy might be recommended.
*As with any surgical procedure, Blepharoplasty carries potential risks, which may include but are not limited to infection, dry eyes, difficulty closing eyes, and other complications. It is important for patients to discuss these potential risks with their healthcare provider to make informed decisions based on a full understanding of the possible outcomes and recovery process.
What is a neck lift?
This procedure offers a range of possible solutions from the removal of jowls caused by fat and ptotic skin due to extra fat under the chin, loose neck skin, or muscle banding.
Before and After photographs showcased involve actual patients who underwent surgical procedures performed by Dr. Beryl Tan, all of whom provided consent for photo sharing. Dr. Beryl Tan(FRACS; MED0001806513) is a certified medical professional specialising in plastic surgery. It’s critical to understand that surgical outcomes are unique to each individual, influenced by genetic and lifestyle factors; therefore, your results may not mirror those depicted. Surgical procedures carry inherent risks and necessitate recovery periods. The information provided is general and should not replace specific medical advice.
Prior to committing to surgery, consider obtaining a second opinion from a suitably qualified medical professional such as a plastic surgeon. The term ‘plastic surgeon’ is regulated and exclusively used by surgeons who have undergone specialised training in plastic surgery and are fellows of the Royal Australasian College of Surgeons (FRACS).
What is a facelift?
A facelift involves tightening of the superficial musculoaponeurotic system (SMAS) layer, a fibrofatty tissue layer under the skin, re-draping the skin, and removing fat as needed. Fat graft injection is sometimes needed to replace volume loss in some areas of the face. The facelift can also be combined with a brow lift, eyelid surgery, nasal surgery, and other procedures
What is fat graft injection?
If you have lost significant volume around the temples, cheek and lips, fat graft injection (lipofilling) can be performed to create a fuller look. Performed in place of traditional fillers, the use of the patient’s own living fat offers a longer-lasting solution. However, the volume can change depending on your weight change.
The process involves fat being removed from an area where it is less needed to increase volume is another area that has lost volume due to ageing, trauma, or other causes.
Book a consultation for a face and neck review with Dr Tan today
Understand which facial or neck procedure may be best for you by booking a consultation with Dr Tan today. With over fifteen years of experience, Dr Tan will assess your needs and apply her in-depth skills and knowledge to find the best solution for you today. Find Dr Beryl Tan at Brighton, Cabrini or PRSM in Donvale..
What are the risks of surgery?
ALL Surgery is associated with some risk. There are general and specific risks related to the operation.
Understanding the Risks of Surgical Procedures: Every surgical procedure involves inherent risks, and it’s crucial for patients to be well-informed about these before deciding to proceed. Here, we outline not only the general risks associated with surgeries but also emphasize that specific procedures have their own unique risks.
General Surgical Risks: All surgical procedures can potentially lead to complications such as:
- Bleeding or hematoma formation
- Infection
- Healing issues, including slow/delayed healing or separation of the incision (wound dehiscence)
- Excessive or abnormal scarring, such as keloid formation
- Seroma (accumulation of tissue fluid)
- Deep suture extrusion that could lead to infection
- Fat necrosis (death of fat tissue)
- Pain- acute post-surgical pain; sometimes chronic pain
- Change in sensation (usually temporary but may be permanent)
- Allergic reactions to drugs or local anesthesia
- Deep vein thrombosis (blood clots in deep veins) that could lead to pulmonary embolism (clots travelling to the lungs)
- Pressure effect- excessive, unrelieved, or prolonged pressure on tissues can cause temporary or permanent damage. The risk of these complications is increased in lengthy operations and in the obese (BMI 30 or more), smokers, diabetics, and medically compromised patients. Great care is taken to minimize these risks during operations.
- Unsatisfactory result and need for revisional surgery
Informed Consent: Before any surgical operation, it is mandatory for all patients to read and sign informed consent forms. These documents are essential as they ensure that you have been provided with comprehensive information about the risks associated with your procedure. Dr. Tan and her team are committed to ensuring that you feel informed and confident in your healthcare decisions.
Procedure-Specific Risks: Each type of surgery carries additional risks that are specific to the procedure itself. During your consultation, Dr. Tan will provide a detailed explanation of these risks tailored to the specific surgery being considered. This information will also be included in the informed consent forms, which are discussed and thoroughly reviewed during your consultation. You are encouraged to ask any questions you may have during this time to ensure you fully understand all aspects of the procedure and its risks.
Asymmetry:
Most people have differences between the right and left side of their faces before any surgery is performed. Symmetrical facial features may not result after surgery, as this is influenced by factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone. Additional surgery may be necessary to attempt to diminish asymmetry.
Hair loss:
Hair loss may occur in areas of the face where the skin was elevated during surgery. Though an unusual occurrence, the most common locations are the temple area and behind your ear. The occurrence of hair loss is not predictable.
Nerve Injury:
Motor and sensory nerves may be injured during a facelift operation. Weakness or loss of facial movements may occur after surgery. Nerve injuries may cause temporary or permanent loss of facial movement and feeling. Such injuries may improve over time. Injury to the sensory nerves of the face, neck, and ear regions may cause temporary or (more rarely) permanent numbness. Painful nerve scarring is very rare.
Parotid Fistula:
The parotid gland rests at the angle of your jaw and produces saliva. In deeper facelifts, the gland can be opened, resulting in persistent leakage of this saliva into the facelift surgery site. This is referred to as a salivary or parotid fistula. A simple test of the fluid, using an amylase assay, will determine if a salivary or parotid fistula is present. Additional non-surgical treatment such as a muscle-relaxant injection or surgical treatment may be required to close a salivary or parotid fistula.
Seroma:
Infrequently, fluid may accumulate between the skin and the underlying tissues following surgery, trauma, or vigorous exercise. Should this problem occur, additional procedures for drainage of the fluid may be required. A seroma following a facelift usually resolves with repeated aspiration.
Recurrence of Signs of Aging/Redo-Facelift:
A facelift is a temporary measure to improve the visible signs of aging. The exact duration or longevity of your facelift can be dependent upon many factors including your bone structure and weight gain/loss, as well as the technique utilized to perform your facelift. It can reduce the most visible signs of aging by tightening deeper structures, re-draping the skin of the face and neck, and removing selected areas of fat if necessary.
Distortion of Anatomic Landmarks:
There is the inherent risk of distortion of the hairline, side burns, and earlobes along with the shape of the face, eyes, and neck during a face/neck lift procedure. These may be permanent, and may require further surgeries for improvement.
Previous Surgical Scars:
The presence of surgical scars from previous facial surgery may limit the amount of skin tightening that can be achieved.
Book a consultation for a Face and Neck Assessment review with Dr Tan today
Dr Tan is passionate about the face and neck. She applies over fifteen years of experience, in-depth skills and knowledge to each case to achieve this. Book an appointment with Dr Beryl Tan today at Brighton, Cabrini or PRSM in Donvale, and find out if she can help you.