Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Frequently Asked Questions

Cosmetic Face Procedures FAQs

Ear Surgery (Otoplasty)

Do I need to wear a bandage after my ear surgery?

Head bandages are usually worn for 7-10 days.

I am 24 years old now. My right ear sticks out and I always have disliked it. Can you make this better?

Prominent ears can be corrected at any age although it is easier in childhood. Once an adult the cartilage in the ear becomes stiffer and can be more difficult to shape. However, it is still very feasible to get some good improvements to the prominence of the ear. This can be done on one side or both. There is a risk of some of the prominence returning within the first few months but otherwise it will be a permanent change.

Eyelid Surgery

I have fluid swelling on my lower eyelids that really bothers me. Can you remove this?

It depends if this is really on the eyelid or the eyelid/cheek junction. Swelling on the border between the cheek and the eyelid is called a festoon and can be difficult to fully correct. It is a mixture of excess skin, muscle and some long-standing swelling. Sometimes an extended lower blepharoplasty with tightening of the skin and muscle layer can help. If really obvious a direct excision is sometimes performed but this does leave a scar in this area.

How long before I look OK after eyelid surgery?

This will be about 10-14 days. The bruising looks very noticeable at 5 days but then improves dramatically.

Do I need to go to sleep for eyelid surgery?

Eyelid surgery can often be performed under local anaesthetic, especially for the upper eyelids.

I have very droopy upper eyelids that affect my vision. Can you help?

This can be markedly improved with an upper blepharoplasty (eyelid modification). The excess skin is removed leaving a scar in the newly formed upper eyelid crease. This operation is sometimes combined with a brow lift to raise the eyebrow itself.

What can you do about my lower eyelid bags? They make me look tired.

This is a common request and can be improved with a lower blepharoplasty (eyelid modification). The eyelid bags are actually caused by bulging fat around the eye itself. Usually this will be held back by membrane but this weakens as we age, allowing the fat to bulge. The excess fat can either be removed or re-positioned. Any excess skin is also removed leaving the lower eyelid bags much less obvious.

Facelift

My cheeks look very sunken and hanging, can you improve this?

As we get older we actually loose fat in our face and this contributes to the face hanging and sometimes looking a little sunken. Facelift can lift and thicken the cheeks to a degree. However, the addition of fat injection techniques can greatly help here. This is when your own fat is harvested and injected in multiple small injections to replace some of the lost fat to leave a fuller more youthful looking cheek.

What can you do to my jowls and lines at the corner of my mouth?

Both short scar and full facelifts are good at treating the jowl area and stop the jawline from looking square. The lines from the corner of the mouth may be softened but certainly not eradicated by a facelift. You may need some fillers or fat injection to help this.

How long will the effects of my facelift last?

As you will continue to age after a facelift the process is constantly changing and progressing. In reality the benefits of a facelift will probably last 10-20 years. However, because of continued ageing some patients look to repeat the surgery after 6-10 years.

How much younger will I look after a facelift?

A difficult question to answer!! However, we usually prefer to say that you will look very good or fresher for your ageā€¦..saying that you can often, if not usually, look about 10 years younger.

How obvious are the scars in a face-lift?

The scars tend to settle extremely well and become difficult to see within a few months in front of the ear. Behind the ear the scars can take 6-12 months to fully settle but do tend to stretch slightly in comparison. Being behind the ear and often covered by hair the scars are not easily seen.

What are the chances of something going wrong?

Major problems like nerve injury or loss of some of the skin are very uncommon. Done carefully a facelift is a safe operation. However, a facelift can have some problems and altered sensation, some small temporary lumpiness or slight healing problems around the ear are not uncommon but settle over time.

I really hate my neck. Do I need a neck or face-lift and can I have a mini-facelift?

A full facelift essentially lifts the jowls and neck so does not change the whole face as the name suggests. In reality it is a ‘neck and lower face lift’ operation! The scars are in front of the ear and then up behind the ear and hairline. Although there are operations that try to keep the scars just behind the ears these are not, in my opinion, as good at tightening the neck as a full facelift would be. In reality when the neck is the major problem most of the attention will go to this area to maximize the results. A mini facelift can also tighten the neck area but not quite as well as a full facelift. Therefore, for lots of neck laxity I usually recommend a full facelift.

Nose Re-shaping (Rhinoplasty)

How long before the bruising disappears after my rhinoplasty?

The main bruising is around the eyes and can last 2-3 weeks, although is usually less than this.

The tip of my nose is really big. I want a smaller more feminine nose. Is this possible?

Changing the tip of the nose is possible but it is one of the more difficult areas to guarantee changes. This is because the skin of the nasal tip can be quite thick and does not always shrink to the shape we want it to. The tip cartilages are fine structures and if we cut and change them too much it can lead to deformity or other problems. So, yes we can make your nasal tip smaller, more feminine but there are limitations! This would be done through an open rhinoplasty.

My nose is bent and I want it straightened. Can this be done?

Straightening a bent nose often involves a mixture of straightening both the bones and cartilage in the nose. The central strut to the nose is called the septum. If this is bent it often curves into one side making it difficult to breath. All of this can be improved but not always fully corrected. Sometimes it can all be done through the nostrils and sometimes the nose skin is lifted in an open rhinoplasty.

I dislike the hump on my nose. Can this be safely removed?

This is probably the most common request with a rhinoplasty. Fortunately, done carefully, this is a very successful operation. The cartilage and bony ‘hump’ are removed through the nostrils (closed rhinoplasty). The side bones of the nose are then broken to allow the nose to be reshaped and narrowed slightly.

Can rhinoplasty improve my breathing through my nose?

Rhinoplasty will help the functionality of the nose by creating a less obstructed nasal package with clearer channels to breathe through. Sometimes, however, breathing can be affected by sinus problems, so it is worth highlighting the source of the problem before electing to have rhinoplasty for this purpose alone.

How soon after breaking my nose can I have a rhinoplasty?

As with all post-accident reconstructive surgery, different injuries will require different approaches. With this in mind, it is advisable to speak to your surgeon shortly after the accident to give them chance to decide whether urgent action needs to be taken or not.

In most cases, a broken nose will come hand in hand with a considerable amount of swelling, and is therefore advisable to let the injury settle down before scheduling rhinoplasty surgery. Most surgeons will suggest waiting between 4-6 weeks, for the swelling to subside. However, in some cases, when the bones in the nose are badly broken and displaced, your surgeon may prefer to operate immediately.

I have large nostrils but I’m happy with the rest of my nose – can you do anything to minimise the size of my nostrils?

It is possible to have nostril reduction surgery (alarplasty) without having to undergo a complete rhinoplasty. The surgery is likely to involve narrowing the nostril by removing a crescent shaped piece of tissue from the area where the nostril wall meets the cheek. As the incision is made at the base of the nose, scarring is likely to be relatively inconspicuous.

How old do I have to be to have a nose job?

Unless there is a significant health issue which would require urgent attention, it is advisable to wait until a young person has finished growing as features can change. This is roughly around 17-18 years old for boys and 16 years old for girls.

Each individual is different however, and emotional maturity is also likely to be taken into account. Although rhinoplasty can have huge confidence enhancing benefits for young people, undergoing cosmetic surgery is still a serious decision that shouldn’t be taken lightly.

Facial Makeover Surgery

What is Facial Makeover Surgery?

Facial Makeover Surgery is when two or more surgical procedures are made during one operation. This means that the patient is under anaesthetic just the one time, for a longer period of time.

Why would I choose to have Facial Makeover surgery?

If patients want to have cosmetic surgery in more than one area on the face (or on the face and another part of the body), it can be beneficial to have all of the procedures done in one operation. This not only cuts down the amounts of time that the patient needs to go under anaesthetic, it is also cost effective.

What Procedures can be performed in Facial Makeover Surgery?

It is common for eyelid surgery to be performed along with face & neck lifts. This combination allows all of the swelling and settling to happen in one occasion, as facelift and eye surgery usually take around the same time to heal.

A brow lift can also be added to the surgery, but patients should be aware that this will add some further swelling and therefore recovery time will take slightly longer.

Nose re-shaping (Rhinoplasty) can be done in addition to many procedures. It is possible to combine it with upper eyelid surgery but it is worth noting that this will incur additional swelling and therefore increase recovery time. Stephen McCulley prefers not to perform Rhinoplasty with lower eyelid surgery or a facelift as the swelling post-operation could become problematic.

It is also possible to have a face-lift alongside other surgery around the body, the details of this can be discussed during the consultation.

Is Multiple Facial Surgery advisable for all patients?

Stephen McCulley will assess if multiple procedure facial surgery is right for each individual patient during a thorough consultation. He will advise on whether procedures are likely to have a negative impact on each other and on how the recovery time will be affected.

Some patients will naturally pose a higher risk than others and therefore might not suit a longer operation, these include patients who smoke, are overweight and those with a history of blood clots. In this scenario it may be advisable to split the surgery to separate occasions.

Can I take other medication at the time of surgery?

During the consultation, patients will need to give a full medical history, including any medication that they may be taking. It is also important that any over the counter or herbal medicines are avoided prior to surgery and for three days following the operation. This also applies to medicines that contain Aspirin, Ibroprufen and Voltarol.

I am a smoker, will this cause complications with the surgery?

Smoking always poses a risk to anyone undergoing surgery, no matter what the surgery is for. It is essential that you try to stop or radically cut down prior to your operation to prevent the risk of complications.

How long is the recovery time after Multiple Facial Surgery?

Recovery time will depend on the individual patient, and also on the type of surgery that they have undergone. In your consultation Stephen McCulley will advise you on what to expect during your recovery.

Are there any complications associated with Facial Makeover Surgery?

As with all surgery, there is always a slight risk of patients developing blood clots in the leg or lung whilst under anaesthetic. In most cases, these risks are uncommon, however, the increased time length required for multiple facial surgery naturally poses an additional risk of a patient experiencing complications.

Whilst uncommon, when these complications occur they can be serious. Therefore, it is important to consider the risks when electing to undergo multiple procedure surgery.

Multiple procedures also involve an increased number of scars. This means that a patient may also be at a higher risk of infection or bleeding.

How much should I expect to pay for Facial Makeover Surgery?

During your consultation with Stephen McCulley prices for the specific combination of surgery that you require will be discussed. It is certainly cost-effective to combine the operations, in general a second procedure will cost 65% of the normal price, and a third operation will be 50% of the normal price.

These savings include one hospital stay and a reduced overall time in the operating theatre. As with any procedure with Stephen McCulley, any follow-up care and nursing that relates to your surgery will be included in the price.

Answers provided by Mr Stephen McCulley and his expert team. You can see further helpful information in our Resource Centre or in our Ask Our Specialist Nurse section.

Stephen McCulley offers a wide range of Face Procedures including face & neck lifts, blepharoplasty, brow lifts, rhinoplasty and more.

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