• Arm reduction
• Breast Enhancement (Augmentation)
• Breast lifting (Mastopexy)
• Breast Reduction MAMMAPLASTY
• Breast Reconstruction
• Cheek Augmentation
• Chin Augmentation/Reduction
• Ear Correction (Pinnaplasty)
• Endoscopic Brow Lift
• Eye Lid Surgery (Blepharoplasty)
• Face-lift
• Liposuction and Liposculpturing
• Male Breast reduction surgery (Gynaecomastia)
• Nose Reshaping (Rhinoplasty)
• PermaLip
• Thigh lift
• Total Body Lift
• Tummy Tuck (Abdominoplasty)
• Weight loss body contouring (Surgery after weight loss)

Out Patient Procedures

• Moles and skin lesions
• Scar revision
• Split ear lobe

Non Surgical Procedures

• Botox injections
• Facial Rejuvenation
• Permanent and non-permanent fillers
• Sculptra
• Asian Aesthetics

Breast Reduction MAMMAPLASTY

Large breasts may cause a variety of medical problems - back and neck pain, bra strap indentation and skin irritation. It may also be socially debilitating due the self-consciousness. The goal of breast reduction is to give women smaller, more shapely breasts in proportion to the rest of her body.

The procedure for breast reduction surgery

Breast reduction procedure involves reducing the amount of breast tissue whilst uplifting the breast tissue at the same time. In order to achieve the desired outcome the Cosmetic Surgeon will reposition the nipple and areola to give the breasts a natural appearance. Breast reduction surgery takes up to three hours to complete, depending on the size of your breasts. The operation is carried out under general anaesthetic, and you will need to stay in hospital for 1 or 2 nights.

Recovery from breast reduction Surgery

Following breast reduction surgery, you should be up and about in a day or two but your breasts may still ache occasionally for a couple of weeks. You will need to take one or two weeks off work, avoid lifting, pushing anything heavy for a couple of weeks. You will be required to wear a supportive bra (eg a sports bra) for up to 6 weeks, day and night to keep the breasts well supported whilst healing takes place.

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Breast Enhancement (Augmentation)

Breast augmentation is performed for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breasts are too small
• To restore loss of breast volume after pregnancy
• To balance a difference in breast size
• As a reconstructive technique following surgery to remove tissue

By inserting implants surgeons are able to increase breast volume and cup size. The implant is usually inserted through an incision made in the natural crease beneath the breast. It is also possible to make the incision in the armpit or around the edge of the areola (the dark skin surrounding the nipple).

A pocket for the implant is made either beneath the muscle or breast tissue. Your current breast size and shape along with the size of implant will determine the final result. A through consultation is mandatory. The surgery is usually around and hour and patient can either go home the same day or have a one night stay in hospital.

Recovery from breast augmentation

It is advisable to wear a sports bra which you should wear constantly except taking it off briefly to shower. Re-bleeding in the implant pocket causing a collection of blood or haematoma may occur in the first 24 hours. Therefore limitation of arm movements is advised You may experience a burning sensation in your nipples for about two weeks but this will subside as the bruising goes away. The swelling in your breasts may take a couple of months to go completely. You should be able to return to work after two weeks but avoid exertive upper body exercise for six weeks.

Breast Implants

A breast implant is a silicone rubber shell filled with either medical grade silicone gel or a salt-water solution known as saline. Medical grade silicone shows that it is the least reactive substance in the human body of any man-made substance that we know. Saline is a natural body fluid, accounting for 80% of a woman's body weight. Many people do feel that silicone-filled implants give a slightly more natural look and feel to the breast. The differences between the two implants can be subtle and you should discuss the best option for you with your surgeon. Different implants have different advantages and disadvantages. You will be guided by Mr. Ho-Asjoe as to which is the most appropriate for you. There should not be any concern regarding silicone implants which was reviewed by an Independent Review Group (IRG) set up by the Chief Medical Officer in 1997. A complete report can be obtained on the web site https://www.silicone-review.org.uk.

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Breast lifting (Mastopexy)

A number of factors can cause women’s breasts to lose their shape and firmness, such as pregnancy, age, and gravity. Over the passage of time, the skin loses its elasticity and the breasts often begin to sag. If you would like to increase the size of your breasts, augmentation can be carried out in conjunction with mastopexy. Breast uplift surgery can raise and reshape such breasts for a time - though surgery cannot permanently delay natural changes. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple.

The Procedure for breast uplift surgery

To achieve the ‘lift' that is required from a breast mastopexy operation, the loose skin is removed whilst at the same time, the nipple is repositioned centrally on the new, now firmer breast. If there is only a small amount of breast tissue present, implants can be inserted during the surgery to improve size at the same time. The breast uplift procedure takes from one and a half to three hours for both breasts and usually involves an overnight stay in hospital.

Following surgery, to keep the breasts supported, you will need to wear a supportive bra (e.g. sports bra) day and night for 6 weeks. Your breasts will be bruised, swollen, and uncomfortable for a day or two but the pain should not be severe and can be relieved by prescription medications. For protection you wear an elastic bandage or a surgical bra over gauze dressings.

After a few days you will be able to switch to a soft support bra. You can expect some loss of sensations around your nipples but should improve after about six weeks. In some patients, however, the numbness may last a year or more, and rarely it may be permanent.

Similar to other breast surgery, rest is recommended and no upper body exercise for 6 weeks. You may return to work after 1 to 2 weeks providing the job does not involve excessive lifting.

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Breast Reconstruction

Breast reconstruction is a surgical procedure restoring the size and shape of breasts after mastectomy or wide local excision.

Women who have been stricken with breast cancer turn to reconstructive surgery to restore their body image which can be accomplished in several ways.

'FLAP' RECONSTRUCTION

Flap surgery is far more complex than other methods of breast reconstruction. During the procedure, Mr Ho-Asjoe partially detaches a flap of skin, muscle, and fat from the patient's abdomen or back, and then rotates it, tunneling it underneath the skin to the mastectomy site - making sure that enough of the arteries and veins that channel blood through the flap continue to do so. The surgeon then forms the flap into a mound that matches the healthy breast as closely as possible and sutures it into position. If both breasts have been removed, a bilateral procedure using two flaps can be carried out.

Latissimus Dorsi is the largest muscle on the back and can be used for breast reconstruction. It can be lifted from the back with a skin paddle via a transverse scar (bra strap scar) or an oblique scar. It can then be tunneled to the front to replace the skin loss from the breast and part of the volume lost. In general, an implant is required for the volume replacement and the muscle is mainly used for padding and skin replacement. There are pros and cons when comparing the Latissimus Dorsi flap with implant reconstruction verses purely autologus tissue (own tissue with no implant). Mr. Ho-Asjoe will explain the options available depending on your suitability.

In the most common type of autologus flap reconstruction, the TRAM (Transverse Rectus Abdominus Myocutaneous) flap procedure, a piece of skin, fat and/or muscle is moved from the abdomen and used to rebuild a breast. On most occasions, the abdominal muscle can be spared leaving the abdominal wall structure intact. In order to achieve this, single blood vessel is dissected out carefully from the muscle and this is known as Deep Inferior Epigastric Perforator flap (DIEP flap). Both TRAM and DIEP eliminate the need for an artificial implant and, since the 'donor' tissue comes from the abdomen, women undergoing a TRAM/DIEP flap procedure effectively have their waistlines reduced at the same time.

If the abdomen is not suitable due to scarring, lack of tissue or for other reasons, autologus tissue can be used from the buttock (S-GAP) or possible the inner thigh (TMG flap). They are alternative but patient may not be suitable for the above. Consultation with Mr Ho-Asjoe will clarify the suitability and the pros and cons associate with the different options. Subsequent to the initial reconstruction, the scars surrounding the reconstructed breast heal in about two months. At this point the surgeon may go on to create a nipple and an areola using the flap skin, and later he may tattoo the areola to give an even more natural appearance.

IMPLANTS AND 'TISSUE EXPANSION'

A simpler and more common way to reconstruct breasts following mastectomy involves the insertion of breast implants filled with saline or silicone gel, often in conjunction with a procedure called tissue expansion. Tissue expansion produces improved results for many women, particularly those who, after mastectomy, are left with chest skin that is too tight and taut to accommodate an implant of sufficient size to restore body symmetry. This procedure is now being used more widely since general surgeons are performing less radical mastectomies these days and are also recommending less radiation treatment.

What happens?

Women who have tissue expansion as part of breast reconstruction undergo several procedures. First, a tissue expander is placed beneath the skin, usually at the time of mastectomy. This has three parts: a saline bag, a self-sealing valve, and a tube that connects the two parts. For a period of weeks or months your surgeon will use the self-sealing valve to fill the tissue expander gradually with saline solution until a sufficient amount of extra tissue has been created. The expander is then normally removed and a permanent saline or silicone gel implant is inserted, although in some cases the expander can be left in place as the permanent implant. At the same time of the exchange, some patient may benefit from an uplift, reduction or enlargement of the opposite breast to achieve symmetry. This would have been discussed before in the initial consultation as the new breast from reconstruction is determined by the shape of the implant.

After Surgery

The initial surgery to implant the expander causes most people only temporary discomfort, which can be controlled with medication. When tissue is expanded gradually, there may be slight discomfort each time the saline solution is injected.

Is It Right For You?

Your age, the amount and thickness of your chest skin, and any tissue changes resulting from radiation therapy will all affect your surgeon's view. He will also discuss with you the possible risks involved in using tissue expansion and inserting breast implants. For example, in rare cases, the device used to expand tissue may rupture and leak. Remember, however, that the saline solution with which the expander is filled can be readily absorbed into your system and the expander can also be replaced easily if necessary. The permanent implants may also leak and rupture, although this has not been found to cause problems. In addition, the natural scar tissue that the body forms around the implant may harden and contract (capsular contracture) which can make the reconstructed breast feel hard. In most cases, however, such problems can be corrected with relative ease.

Finally, your expectations will be a factor in post-mastectomy reconstruction of any kind. While these operations can improve your appearance and renew your self-confidence, they will not result in perfection. Talk openly with Mr Ho-Asjoe about how you expect to look and feel after surgery to be sure your expectations and what the surgery can accomplish are one and the same.

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Male Breast reduction surgery (Gynaecomastia)

Enlarged male breasts, also known as gynaecomastia is usually treated with liposuction and glandular excision. In some cases, skin reduction may be necessary. In general, a small stab incision is made on the chest wall for liposuction and a small incision beneath the areola margin for removal of the glandular tissue.

Male breast reduction surgery typically takes between 1 - 2 hours to complete, but is very dependent upon the amount of fat and tissue to be removed. Patients will need to be under a local or general anaesthetic.

Recovery from male breast reduction surgery takes about 2 weeks. During this time soreness of the chest will subside. Strenuous activity should be avoided for up to a month after the procedure. Compressive garment for 4 weeks is highly recommended for reducing swelling and bleeding.

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FACIAL AESTHETIC SURGERY

Face-lift Surgery

Facial aging include the loss of midface volume, jowling, development of nasal labial fold, wrinkling, laxity in the neck region and loose skin. Patient with the above appearance who would like to have improvement to the facial appearance would benefit from face and neck lift surgery, be it full face lift or short scar face lift (MACS). Face lift surgery can minimise the effects of ageing by smoothing out lines and wrinkles and tightening up loose skin on the face and neck.

Face lift surgery when performed properly by an experienced surgeon, leaves the patient looking more youthful and relaxed.

During a facelift, an incision is made from the temple to the ear on both sides. Excess fat is removed and the facial muscles tightened. To complete the face lift the skin is pulled up across the face, trimmed and sewn. The incision from a face lift is hidden in the hairline and behind the ears so there is no visible scarring.

It takes between 2-3 hours depending on how much work your particular face lift involves. Many people combine face lift surgery with eye bag removal which takes longer than just a face lift. Face lift surgery is performed under general anaesthetic with an overnight hospital stay. Recovery time following face lift surgery varies. Many patients return to work after 3 weeks after their face lift. Most women can disguise the effects of face lift surgery with make up after 10-14 days.

Side effects from facelift surgery are temporary. Bruising and swelling of the face is to be expected in the days after your face lift. Following a face lift, your face will feel tight and sore for several days, but the discomfort is adequately dealt with by prescription painkillers.

Endoscopic brow lift.

The position of the eyebrow descends with age and can produce an appearance of tiredness or sadness. Re-positioning of the brow at a slightly higher position can produce a younger and fresher look. Before you proceed, you should always compare your brow position currently with old photographs.

The procedure involves small 1cm stab incisions behind the hairline and elevation of the forehead skin from the underlying facial bone. The skin is the resuspended with sutures in the scalp. In some cases where only minor adjustment is required, a dissolvable device can be placed behind the brow through an upper eyelid incision (Transbleph Endotine), usually in combination with upper blepharoplasty. The scar is hidden in the eyelid crease and the brow is re-positioned. In very rare occasions, a full browlift with a scar transversing from ear to ear is still the preferred choice. Mr. Ho-Asjoe will assess your suitability and guide you accordingly.

Patients will experience bruising and swelling for a few days. Some will experience headache which can usually be relieved with analgesia.

The surgery is usually carried out in combination with other facial procedures such as blepharoplasty, face lift.

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Blepharoplasty

Blepharoplasty is a surgical procedure to rejuvenate the eye area by removing excess skin with or without fatty tissue from either upper or lower eyelids. Patients usually complain of looking tired, heaviness and upper lid blepharoplasty can improve the appearance. In some cases, a better result can be obtained in conjunction with other procedures such as brow lift, Botox and fillers. Blepharoplasty of the lower lid will eliminate baggy folds of skin below the eyes.

Mr ho-Asjoe will make an incision along the natural lines and folds of the skin around your eyes while under local or general anaesthetic. The incision is done with precision to ensure minimal scarring. Excess fat, skin and muscle are removed before the wound is carefully sutured to ensure a natural aesthetic outcome.

Blepharoplasty surgery typically takes between 1-2 hours to complete. If the operation is performed on just the upper or lower lids, less time is needed. An overnight stay is often required to minimize post-operative swelling and bruising.

Typically, it takes approximately 7-10 days to fully recovery from Blepharoplasty surgery, however many patients have had the surgery and return to work within 4-5 days.

Blepharoplasty surgery is considered a permanent solution for the correction for drooping eyelids and bags under the eyes. Even though the peri-orbital wrinkling will improve, it will not completely eliminate these lines. Botox is a better option for wrinkling around the eyes.

Most side effects from Blepharoplasty surgery are temporary. It is normal to have blurred vision, which may last up to 2-3 days. Bruising and swelling around the eyes may also occur. Some patients have experienced dry and itchiness to the eyes and this symptom may last for approximately one week.

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Nose Reshaping (Rhinoplasty)

Nose surgery or Rhinoplasty is performed to improve the appearance of the nose and achieve better facial harmony.

Nose surgery is performed via incisions made inside the nose, so that no scars are visible afterwards. In some cases, better result can be achieved with a small scar on the columella (the area between the nostrils).

It is important to discuss your expectation of the outcome with Mr Ho-Asjoe. He will evaluate your bony structure and facial appearance and discuss with you what can be achieved and what is most suitable to your facial appearance. It is important to have a realistic expectation.

Rhinoplasty usually takes an hour or two but complicated procedures may take longer.

Recovery after nose surgery

The patient will leave the hospital the next day after surgery with a nasal splint. It is there to protect the nasal fracture from the surgery and to reduce the swelling. You will return for removal of the splint in a weeks’ time.

In the first two weeks after nose surgery, there may be nasal stuffiness. Also, the sense of smell may be diminished for a few days. There may be bruising around the eyes but this will usually settled within two weeks. The swelling of the nasal tissue can take up to three months to settle.

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Ear Correction (Pinnaplasty)

Ear correction surgery helps people who consider their ears to be too prominent. In many cases the shape and lie of the ears is inherited, and a family trend can be seen. The most prominent ears often lack a normal fold, and sometimes one ear is more prominent than the other. People with prominent ears are sometimes teased, particularly during their school years, and this can lead to a loss of self confidence. Ear correction surgery can resolve this very quickly.

Ear correction surgery is a simple operation which adjusts the shape of the cartilage of the ear to allow the ear to lie closer to the side of the head. During ear correction surgery an incision is made behind the ear. The cartilage is then reshaped, any excess is removed and then sutured into a more normal position. Ear correction surgery takes about 30 minutes. After ear correction surgery, the small scars are hidden behind the ears and are not noticeable.

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Permalip (lip augmentation)

One of the signs associated with aging or smoking is the loss of volume in the lips and peri-oral wrinkling. In some cases, patients simply have thin lips and would like to improve the appearance.

For a short term solution, non-permanent fillers can be used but the cost can add up over the years. If a more permanent solution is preferred, permalip is a great alternative. It is a soft silicone implant which can be inserted through the corner of the mouth under local anaesthetic. There may be some swelling and bruising for a few days but will all settle down within a week. Patients are asked to perform lip message for a few weeks.

The implant can easily be removed but so far, no one has requested the removal of the implant.

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Chin Augmentation

Chin protuberance is proportional to the projection of the nose and patient with a less prominent chin on a lateral view will feel that a rhinoplasty is what they required. In some patients, having a chin augmentation with or without a rhinoplasty will have a much more pleasing aesthetic result than simply have a rhinoplasty alone. Chin augmentation can usually be performed through an intra-oral incision therefore leaving no visible external scar. A silicone implant is inserted through the incision and patient can be discharged home on the same day.

Chin reduction / Augmentation is an effective way of dealing with the common problem of a receding chin or a prominent chin. It can greatly improve the profile of a person by making noses and overbites appear smaller and leave the face better proportioned, giving an overall balanced effect.

What does Chin Reduction / Augmentation Surgery Involve?

A jutting out chin can be reduced by removing some of the chin bone, while a recessive chin can be built out. In augmentation the surgeon uses a shaped implant to define the jaw. The implant is positioned beneath the skin through an incision made from inside the mouth or below the chin. Once the implant is in place fine sutures are used to secure it. The incision is made inside the mouth and so there will be no visible scar.

How long does Chin Augmentation surgery take?

The procedure normally takes between 1-2 hours depending on its complexity. This procedure is usually carried out as a day case and will involve an overnight stay in hospital. You can then normally return home the day following surgery.

What can I expect from a Chin Reduction?

Your expectations need to be realistic. Surgery should achieve an aesthetically balanced chin, mid-face and upper face helping to bring the face into balance and along the way, help to give you greater confidence.

Recovery after a Chin Reduction / Augmentation Procedure

It is normal to experience slight swelling and bruising which should settle down within two weeks of surgery. Any numbness will usually subside after a few days and talking, yawing, and eating may be uncomfortable during this time. All sutures will dissolve within this time. If they have to be removed the surgeon will usually do this around 10 days after the operation. Most people are able to go back to work within a week of surgery. However your surgeon may suggest you take 1-2 weeks off work. A soft diet is recommended for about a week and strenuous activities should be avoided for up to 2 weeks. Any situation which might involve facial contact should be avoided for up to 6

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Cheek Augmentation

Cheek Augmentation / Cheek Implants is a common procedure used to bring balance to the facial structure by way of correcting a deficient cheek area due to congenital deficiency, age-related bone resorption or facial trauma. A weak cheek structure can make your face appear drawn and sunken. It may also give the appearance of a 'fleshy' lower face. The end result should be a balanced relationship between the structure of the face. Cheek Implant Surgery involves inserting and positioning an implant that will depend on your preferences, age, anatomy and your surgeon's recommendation.

A patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance.

Cheek augmentation is an operation that usually takes 1.5 hours to complete using a general anaesthetic and normally includes an overnight stay at the hospital. In certain circumstances it can be performed as a day case. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months. Normal activity can discomfort can be controlled with prescribed medications. Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward.

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Liposuction and Liposculpturing

If you have ever despaired about those areas of fat that never seem to respond to dieting or exercise, then liposuction surgery may be the solution.

Liposuction become one of the most popular cosmetic surgery operations and is now an internationally approved method of safely removing unwanted fat.

Liposuction is carried out under general anaesthetic and the patient will usually stay 1 night in hospital. Smaller areas can be treated with liposuction using a local anaesthetic, on a day care basis. A pressure garment is worn around the treated area following the liposuction for about 21 days.

Individuals who are grossly overweight are poor candidates for liposuction, since it is not a treatment for obesity. It is recommended for those patients who wish to improve their body contour, by the removal of unsightly fat pad.

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Tummy Tuck (Abdominoplasty)

Tummy tucks, also known as an abdominoplasty, is a surgical procedure to remove excess fat and skin from the middle & lower abdomen and from the waist. Patients are rewarded with a toned and more youthful looking abdominal area and an altogether slimmer waistline. Midline protrusion due to split muscle or hernia can be repaired at the same time.

In patient with mass weight loss and skin laxity, it may be more beneficial to have a total body lift or circumferential body reduction. Mr. Ho-Asjoe will discuss with you about the advantages and disadvantages.

In a tummy tuck a long incision is made across the waistline in a broad U-shape. The skin is then lifted and separated from the underlying tissue and muscle of the abdominal wall. Excess fat is removed, sometimes by liposuction, and the muscles and associated tissue of the abdominal wall are drawn together to create a tighter waistline. Finally, the skin is pulled down tight over the abdomen, the navel re-positioned, excess skin trimmed and the incision sewn.

A tummy tuck takes between 2 - 3 hours to complete. The patient has to be under a general anaesthetic and an overnight stay in hospital is required.

A full recovery takes 2 - 4 weeks, although normal activity can be resumed within 7 - 10 days. Strenuous activity should be avoided for about a month after surgery. Abdominal support is advisable for 1 month.

Tummy tuck surgery is generally long lasting, but is very dependent upon the lifestyle, diet and exercise regimes of the patient. Eating fatty foods and not participating in exercise will lead to a gradual build up of fat in the lower abdomen area, destroying all of the good work a tummy tuck achieves.

Bruising, swelling and soreness of the stomach and hips is to be expected following surgery. All of these effects are temporary and will subside within a few days to a week. Occasional fluid accumulation will require drainage as an outpatient procedure.

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Massive Weight Loss Surgery (MWLS)

Massive weight loss surgery is an entity on its own encompassing all the above procedures. Patient who have successfully lost weight have excess skin around the body and loss of subcutaneous fat around the facial region. The excess skin can be removed and subcutaneous tissue repositioned with surgery. A thorough consultation is mandatory to discuss the pros and cons of treatment. Some patients will require a sequence of surgery therefore, it is important to plan carefully in advance for the health and safety of the patient.

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Circumferential body lift and abdominoplasty

For massive weight loss patient, there is a large amount of excess skin around the abdominal area. This is exacerbated with buttock ptosis, mons ptosis. This is extremely troublesome for patients both socially and physically with recurrent skin infection and unable to buy clothing. The treatment of choice is to have a circumferential body lift. The surgery encompassed the excision of large volume of skin and loose tissue around the mid-torso (belt lipectomy) and lifting the buttock and mons upwards (trouser lift) and tightened the abdominal region (abdominoplasty). The combination of the above will re-shape the mid-trunk area.

This is a large operation and patient is required to stay in hospital for 5 days. A circumferential scar is formed at the level of the hip bone and this will required a longer period to heal. In some cases, abdominoplasty can be performed in the first instance and the remaining circumferential lift can be performed as a staged procedure.

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Thigh lift (Thighplasty)

If you have experienced a loss of skin elasticity of the thigh, hip, or buttock areas you may be a candidate for a thigh lift. You may also desire this procedure if your skin in the thigh area is saggy, has an orange peel, flabby and/or dimpled appearance. The procedure may also be indicated if your thigh appearance improves dramatically when you lift the lax skin. If you are self-conscious about your lower body appearance you may also want to look into this procedure.

The procedure is intended to produce tighter, more attractive thigh and buttock skin with improved contours. It is also intended to decrease irregularities in skin surface.

The procedure takes 2 hours to perform under general anesthesia on an outpatient basis unless otherwise advised by the surgeon. Wide variations in the design of the incisions to meet clothing or personal desires are possible. Lifting the inner thighs requires only short incisions extending from the anterior part of the thigh/groin crease around to the buttock crease. Lateral or anterior thigh lifts can be performed as separate procedures if desired. The buttocks can be lifted with upper or lower scars. Mr Ho-Asjoe will show you what specific procedures are available to solve your particular problem.

A compression garment is provided at the end of surgery to reduce swelling and assist in the natural shrinking and tightening of the skin. With smaller thigh lifts, initial discomfort is usually easily controlled with prescription pain medication. With larger thigh lifts, one or two nights care in a skilled nursing facility or hospital are usually required. This allows for pain injections, intravenous catheters, etc. Bruising and swelling usually subside within a month, strenuous activities are usually possible in 6 weeks and almost all symptoms are gone in 4-6 months.

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Out

Moles and skin lesions

Introduction

Scarring is unavoidable when skin is cut or damaged through its full thickness. Some people naturally make better scars than others. We cannot accurately predict this, but in general we are aware that patients with black skin and, at the opposite end of the spectrum, patients with fair freckled skin and red hair will tend to produce poor scars, including hypertrophic scars and keloids. Most scars will mature and improve with time except for keloids which will require treatments such as steroid injection and silicone therapy. More severe hypertrophic scars can also benefit from treatment.

Removal of skin lesions

Most skin lesions such as moles, skin tags and cysts are non-cancerous. You may be concerned of some changes such as colour or size or simply dislike the appearance. The lesion can be removed under local anaesthetic and if there is any concern, the specimen can be sent to a laboratory for examination under a microscope.

Post operative pain is usually minimal. Sutures are usually removed in 4 to 6 days from the face and 7 to 10 days from other parts of the body. Scars may be red and lumpy initially, but eventually soften and fade with time.

Most of the above procedures will be covered by health insurance. Mr Mark Ho-Asjoe practises within the limits of the major insurance companies.

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SCAR REVISION

Scar revision is the name given to a group of surgical techniques used to alter the appearance of scar tissue, blending it in with the surrounding skin area. Whilst scar revision cannot completely remove evidence of a scar, it can be used to remove keloid scars, hypertrophic scars, contractures and facial scars, regardless of whether the scars were caused by injury or previous operations.

How does it work?

Keloid scar removal - Thick, puckered and itchy dark red scar tissue that grows beyond the boundaries of an incision during the healing process associated with a previous operation can be removed by scar revision. A surgeon cuts out the material, normally made of hard fibrous collagen, and then the skin is sewn back together. After the procedure it is very important to monitor the scar for signs of keloid recurrence as preventative measures can be instituted.

Hypertrophic scar removal - Often confused with keloid scars, hypertrophic scars are thick red and protrusive. But, unlike keloid scars that grow outside the initial incision area, hypertrophic scars remain within the original incision boundary. A surgeon will remove this excess scar tissue, and may re-position the original incision line, so it heals in a less-visible fashion.

Contractures - Loss of substantial skin areas through burns or other injuries results in scar tissue pulling together outlying skin areas, sometimes restricting muscle movement. Scar revision can help release that ‘ pull’ by replacing the scar tissue with a skin graft.

Facial scars - Although facial scars cannot be completely removed, it is possible for a surgeon to re-position a scar to match with natural facial contours and lines, making the scar less visible. To do this a surgeon will use a scar revision technique known as z-plasty. This involves the surgeon removing the scar tissue and then cutting the skin to create triangular flaps at both ends. The flaps of skin are then laid across the original scar area at angles, often creating a ‘ z’ shape. The flaps are then sewn over the area, reducing the visual impact of the original scar.

Scar revision may take anywhere from 1 - 3 hours to complete, but is very dependent upon the amount of work required. The patient will normally be under a general anaesthetic. Overnight hospital stays are rare.

Recovery time is largely dependent upon the amount of work required, and also on the position of the scar. It may take as little as 3 days to return to normal activity or as long as 2 weeks.

Scar revision is a technique that can be used on scar tissue anywhere over the body. People typically elect to have this surgery where scar tissue is highly visible, such as on the face, hands or forearms.

Scar revision produces permanent results.

Some initial swelling and bruising may be experienced around the incision area, but this will quickly subside. New scar tissue should form in a less-pronounced fashion than that of the old scar. Scar revision produces no long-term side effects.

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Split ear lobe

Split ear lobe can be complete or simply an enlarged ear-piercing. This is usually caused by heaviness of the earring or accident. Superficial skin will grow over and prevent closure. Repair of split ear lobe requires a minor operation. The surgery is carried out under local anaesthetic and the repair is carried out after the skin is excised. The repair involved placing a 'Z plasty' along the repair to prevent scar contracture and notching.

It is advisable not to re-pierce at the same spot or wait at least 6 weeks. There is no problem with piercing on either side of the scar. This is because scar will always be weaker than normal skin and will require at least 6 weeks to achieve reasonable strength. However, if the tear is due to heavy earring, it may recur if the same type of earring is used.

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Non Surgical Procedures

Facial Rejuvenation

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.

In your initial consultation, Mr Ho-Asjoe will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. Your surgeon will help you select a treatment option based on your concerns, your anatomy and expectations.

He should be able to offer you advanced treatments ranging from cosmetic surgery, refinishing techniques, and the use of injectable fillers. Together you may determine that a single procedure or a combination of procedures is the best choice for you.

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Injectable Fillers

As we age the underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can. The most important fact to remember about injectable fillers is that the results are not permanent.

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Sculptra

Soft-tissue fillers, such as Sculptra, Restylane and Radiesse, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks.

• Restylane link - www.restylane.com
• Sculptra link - www.sculptra.com
• Radiesse link - www.bioformmedical.com
• Permalip link - www.surgisil.co.uk

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Botulinum Toxin Injection (Botox)

Botox has been proven to smooth and even eliminate forehead lines, frown lines, crows feet and neck bands and is also used in conjunction with forehead lifts, facelifts, and eyelid surgery.

Botox is injected directly into the muscle with a tiny needle and works by relaxing targeted muscles. Patients may experience a slight discomfort when the needle is inserted and the Botox® is injected. The entire treatment is performed in 10 to 15 minutes with no recovery time. Patients can immediately resume normal activities, although, it takes a few days to see the results of the Botox injections. Typically the effects of Botox last three to six months and must be repeated to maintain results.

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Asian Aesthetics

Asian aesthetic is not about "westernization" but more about improving the harmony and facial balance. Maintaining and understanding ethnic features is vital to Asian cosmetic surgery. Mr Ho-Asjoe has as special interest in Asian Aesthetics with his training taking him to both Taiwan and Shanghai where cosmetic surgery is extremely popular but not publicized.

Double eyelid surgery and nasal augmentation are by far the two most popular cosmetic surgeries in Asian community but uncommon in Caucasian population. Both surgeries can be carryout under local anaesthetic as a day case if so wish. More recently, there is an increase in the popularity of non-invasive procedures such as Botox, fillers and radiofrequency and laser. They all played an important role in facial and body aesthetic and it is important to have a detail consultation to identify the best treatment.

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