Facial Surgery

The range and sophistication of procedures to restore a youthful appearance to the ageing face has advanced considerably in the last few years. The traditional ’face lift’ that tightened and re-draped the skin is now only rarely indicated.

Better understanding of the changes in soft tissues and muscles of the face has stimulated the development of a range of procedures that are tailored to the needs of each individual.


The aim of a selected procedure is to produce a brighter, fresher more youthful appearance without a ’tight’ or ’operated’ look. Equally, it is important that bruising and swelling in the postoperative period are minimal and the recovery period is short. Most patients can return to social and professional activities after two weeks.


All procedures result in scars discreetly placed in the hairline and skin creases. Generally, these fade quickly and are not noticeable. Some techniques do not require a scar behind the ear and endoscopic surgery (keyhole) can avoid any facial scars. Some numbness in front of the ears is usual but normally disappears after a few months.


Major complications after facelifts are rare. The commonest problem is bleeding in the first few hours after surgery, which requires prompt treatment. This occurs in about 3% of all patients and is more likely for smokers, males, people with high blood pressure and those taking regular Aspirin. (Source: The Prevention of Haematoma following Rhytidectomy: a Review of 1078 Consecutive Facelifts, British Journal of Plastic Surgery (2001) 54, pp 481-486). Norman Waterhouse co-authored this research.


Thorough preparation for surgery includes a review of general health, allergies, medication and anaesthetic history. The choice of surgical procedure is determined by assessment of individual facial changes and patient’s desires and expectations. Frequently, facelifts are combined with other procedures including browlift, lip enhancement and eyelid surgery.

The ‘Waterhouse Lift’

Mr Waterhouse has developed a variant of the SMAS procedure and has used it very successfully for several years. The philosophy is to reposition facial soft tissue rather than remove it. This recreates the form of the face in youth and avoids an ‘operated’ look.


He often combines this with a lateral endoscopic brow lift. This procedure recreates a feminine shape to the brow without producing an unnatural ‘surprised’ look. He does not remove the central frown muscles from the brow as some movement here is essential for a natural appearance.


The Mask Lift or Subperiosteal Facelift

Advances in surgical techniques have produced a wide range of different procedures to reverse facial ageing. All these operations are termed ‘facelifts’ which is confusing for the public and potential patients. Despite the variations, almost all procedures involve incisions around the ear and lift the soft tissues (muscle / fat / skin) of the neck and face. The mask lift is fundamentally different from other techniques in its approach and philosophy. It is not appropriate for most patients with typical features of ageing such as jowls and a loose neck. However, for a number of specific problems, it is a highly effective procedure.


The mask lift evolved from advances in facial reconstructive surgery where the soft tissues were lifted from the underlying facial bones to allow correction of severe disfigurements of facial bone growth. Surgeons carrying out these procedures realised that the entire facial ‘mask’ could be repositioned and lifted to produce a more youthful appearance.


In general, the mask lift is suitable for younger people with heavy brows, ‘tired eyes’ and sagging of the cheeks. There are specific problems for which the mask lift is particularly useful.

Post Blepharoplasty Syndrome

Lower eyelid blepharoplasty is a popular procedure for restoring a more youthful appearance to the eyes. However, even when properly carried out, it can produce some problems which are difficult to correct with traditional techniques. These problems include ‘rounding’ or shortening of the eye, descent of the lid, asymmetry of the lids, exposure of too much of the ‘white’ of the eye and a ‘stary’ look. In severe cases, these problems may result in irritability and soreness of the eye. This is often noticed in windy, dusty or air conditioned environments. The mask lift is a highly effective procedure in restoring a more natural look to the eyes and reducing soreness and irritability. In our practice, the correction of problems from previous eyelid surgery is the commonest indication for a mask lift.


Facial Feminisation

The female face differs from a male face in several specific areas. The female forehead is smoother and less prominent, the eyebrow has an upward slope, the cheekbones are more prominent and the overall shape is oval. The mask lift can be used to enhance the femininity and attractiveness of the face by modifying the tissues and the underlying facial bones. For this reason, the mask lift is of singular benefit in transsexual surgery to radically soften and feminize the face.


The mask lift has many other applications in facial enhancement where traditional methods are of limited value. Equally, it is not suitable for everyone and, like all operations, has its limitations and drawbacks. A mask lift should only be performed for an appropriate problem and after thorough discussion and explanation of the procedure.


The Operation

Mask lifts are performed under general anaesthetic as an inpatient procedure requiring an overnight stay in hospital. There are no incisions on the face or around the ears. The incision is placed in the scalp within the hairline, and no hair is shaved. This approach allows the underlying bones to be shaped and changed. The facial tissues can then be re-draped incorporating changes to eye shape, cheekbone prominence, eyebrow position and forehead contour. The incision is closed with clips which are removed at ten days.


Active measures are taken to reduce swelling and bruising post-operatively. However, some swelling around the eyelids does occur and may take four to six weeks to completely settle. Some numbness of the scalp is experienced and may take up to six months to disappear.



The mask lift is a very different procedure from most traditional facelifts. It is of most value in enhancing the forehead, eyes and cheek area rather than the effects of ageing in the neck. The techniques used in this operation are learned from the discipline of Craniofacial Surgery. This is centred on reconstructive facial surgery and requires specific training and experience. The commonest reason for choosing a mask lift is to correct problems associated with previous eyelid surgery.


Common Types Of Facelift


The ’Smasectomy’ Facelift

This operation was developed by Dr Baker in the US several years ago. It is applicable for most patients and has the advantages of combining an excellent and natural result with a short recovery time.


The ‘Extended Smas’ Facelift

This procedure is useful when there is a need to restore fullness to the cheekbone area as well as the neck and jowls. Swelling after surgery can last for longer than with the ’Smasectomy’.


The Macs Lift

Suitable for patients with mild to moderate jowls, this macs lift operation has the advantage of no scars behind the ears and a very fast recovery.


The ’Masklift’

Although less frequently used, this technique is very effective for patients with ageing in the areas around the eyes and cheeks. It is also useful in correcting ’sad’ looking eyes that may occur after eyelid surgery. There are no scars on the face as the incision is within the hair.


The Volumetric Facelift

Facial ageing often results in loss of fat in the face and a gaunt or hollow appearance. The solution to this is fat transfer. Particularly useful for thin faces, fat transfer procedure uses a different approach to restoring a youthful appearance by injecting the patients’ own fat into the face. Advances in the knowledge of fat biology has made this a predictable and reliable option in combination with modified facelift procedures. Norman Waterhouse is one of the most renowned surgeons in the field of fat transfer in the UK.


If you want more information on fat transfer, endoscopic browlift, facelift, necklift, midface lift, masklift and macs lift, please call us in London on 020 7636 4073.




Endoscopic Browlift Surgery to reverse the features of the ageing face must include the upper part of the face as well as the neck and jowls to ensure a harmonious and balanced outcome. Until relatively recently, traditional eyelid surgery (blepharoplasty) was routinely used for this purpose. However, it is increasingly realised that blepharoplasty has a limited effect and can result in unwanted complications and an ’operated’ look.


Endoscopic browlift is often a more logical and effective way of reducing forehead lines and wrinkles, and elevating the eyebrows to correct hooding of the eyelids. Using ’keyhole’ techniques, large scars in the scalp can be avoided. The endoscopic browlift procedure is quick and recovery is rapid although some temporary numbness and itching is normal.


The results of endoscopic browlift are natural and long lasting. A patient evaluation study (published in the British Journal of Plastic Surgery, ‘One hundred cases of endoscopic browlift’, British Journal of Plastic Surgery, Vol 55 No 1, 2002 pp20-25) has shown a high level of satisfaction with the results.


The endoscopic browlift procedure is less suitable for men with male pattern hair loss and women with a high forehead.


Endoscopic Browlift


Eyelid cosmetic surgery to improve ’eyebags’ can be very successful in restoring a more ’open’ and youthful appearance around the eyes. However, the perception that it is a simple, quick and straightforward procedure for bilateral blepharoplasty lid lift and tuck should be qualified.


The operation of lower and upper lid blepharoplasty generally involves removing excess skin, muscle and fat from the eyelid. Scars are placed in natural creases and easily concealed.


Upper and lower eyelid surgery can be carried out under local or general anaesthesia as a day procedure.


Although bilateral blepharoplasty lid lift and tuck is a popular procedure, there are limitations as to what can be achieved. Fine wrinkles in the lower eyelid are not removed and removal of too much fat can produce a hollowing effect after a few years.


There are now several alternatives and refinements to the traditional procedure of lower and upper lid blepharoplasty. Removal of fat alone can be performed through an incision on the inside of the eyelid without any scar on the skin. For some patients, the fat can be reshaped rather than removed. Laser can be used to improve the wrinkling of the skin although this can result in a permanent lightening of the skin colour.


Lower Lid Surgery (Canthopexy)


The lower lid can be tightened or elevated as a part of the procedure. This is known as a ‘Canthopexy’.


Excess skin folds in the upper lid can commonly occur when the eyebrows become lower and heavier. In these circumstances, a more natural and long lasting improvement can be achieved by elevating the brow. This is known as a browlift (See Facelift).


Careful assessment preoperatively is essential to avoid complications. A history of dry eyes or eye allergies may predispose to problems postoperatively. Occasionally, an assessment by an eye doctor or ophthalmologist is advisable before proceeding with surgery.


Complications after Upper and Lower Eyelid Cosmetic Surgery (Blepharoplasty)


Cosmetic upper and lower eyelid surgery can result in a variety of complications. Most of these are minor and temporary.


Excessive removal of skin and/or fat can result in a variety of unwanted effects. These include, ’rounding’ of the eye, asymmetry of the lids, a ’hollowing’ in the lower lid and a lowering of the position of the lower lid. The result of these problems is to produce an ’operated’ look. This is known as post blepharoplasty syndrome. Correction of post blepharoplasty syndrome is difficult and may involve secondary procedures including canthopexy or even ’Mask’ lifts (See Facelift).


Some patients request upper and lower eyelid surgery as a result of specific problems. Thyroid disease can cause bulging of the eyes and retraction of the eyelids. The management of thyroid eye disease is complex and may require surgery to the bones of the orbit as well as the soft tissues.


Sometimes, drooping of the upper eyelid (ptosis) may be caused by a problem with a specific muscle. This condition must be recognised preoperatively as it will not be improved by blepharoplasty.


If you want more information on Bilateral Blepharoplasty lid lift and tuck of lower and upper eyelid, please call us in London on 020 7636 4073.








This frequently requested procedure can be very successful in improving, refining or reducing the nose. As with most modern aesthetic surgery, rhinoplasty has evolved into a range of sophisticated and demanding techniques. Choosing the best rhinoplasty procedure for each individual is essential and takes account of patient’s desires and expectations. The aim of the rhinoplasty procedure is to produce a natural, aesthetically pleasing nose in proportion with the face. It is rarely possible or appropriate to produce a replica of an idealised ’celebrity’ nose. Realistically, surgery is tailored to achieve the best shape and size of nose for each individual.


Rhinoplasty is carried out under general anaesthetic and usually involves an overnight hospital stay. Large plaster splints have been replaced by smaller mouldable splints, which remain in place for several days. Placing packs in the nose is rarely necessary and bruising around the eyes is normally minimal.


Swelling of the nose is to be expected and may last for some months before completely resolving.


Complications from the rhinoplasty operation are rare. However, minor irregularities and asymmetries can sometimes occur when all the swelling has resolved. This may require a small secondary adjustment in about 5% of patients.


Rhinoplasty or Septorhinoplasty is also carried out for breathing problems when the internal cartilage of the nose is deviated or damaged. This can occur after nasal injuries but can be present from birth. Straightening the septum or improving nasal breathing requires a range of specific techniques. Although improvement is almost always possible, complete straightening of a severely deviated septum or nose cannot always be guaranteed.






Nasal Surgery



A retrusive small chin may have a negative effect on facial balance. If the chin is very small it may be due to an underdevelopment of the whole lower jaw. For most people, however, a relatively simple procedure can be carried out to increase the chin projection and improve facial appearance. Although chin implants are the simplest option, they can result in problems including infection and rejection. For this reason, I prefer to carry out an advancement of the chin using the patient’s own bone. This is a relatively simple procedure although can produce some temporary numbness of the lower lip.


A relatively new option for mild cases is to strengthen the chin prominence with the use of fat injections into the soft tissues of the chin area. The reliability of chin augmentation surgery has improved enormously in the last few years.


Each person has to be assessed to determine the best procedure of chin augmentation surgery for their individual needs.


If you want more information on Genioplasty (Chin Augmentation Surgery), please call us in London on 020 7636 4073.



Chin Surgery



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