Local Anaesthetic Surgery

After many years’ experience of doing Face lifts under general anaesthesia I have responded to the wishes of my patients and now offer this procedure under local anaesthetic. Using the same procedure and techniques I now perform this with patients awake but with a wide area of local anaesthesia, and a small oral pre-med which reduces anxiety but maintains full consciousness. Both myself and my patients have been delighted with the results and the convenience. Patients recover much quicker without the risks of a general anaesthetic.

The procedure is done to enhance and define the jaw and neck lines. Lifting the jowl and the under chin area to give the face a much more youthful shape without the fullness and sagginess of the mature face. It is done through a short scar in front of the ear, hidden in a natural crease and usually also through two tiny scars under the chin through which I access the neck. It is done as an outpatient procedure and most patients are back feeling on top form and socialising at two weeks. More patients now choose this option rather than being admitted to hospital and having a general anaesthetic.

The operation of face lift concentrates on the lower face and neck and is often referred to as this. I also perform other facial lifting procedures including those to the mid face, brow and temples.

A brow lift repositions the eye brows to the correct place and shape above the bony margin of the orbit (eye socket). The brow position is very important to the aesthetics of the eye and the nose. As we age the eye brows often droop particularly laterally creating extra skin and weight on the upper eye lids and shortening the distance between the eye lashes, upper lid and the brow. This contributes to making the eyes look smaller with hooding of skin and prevents people from wearing eye make-up.

Very careful assessment and minor adjustments can make a huge difference to the aesthetics around the eye. Most brow lifts I perform are complimentary to other procedures such as upper lid blepharoplasty or mid face lifts. Brows should never be placed too high, and the procedure may be better thought of as brow reshaping rather than lifting. It is usually the lateral one third of the brow that needs adjusting where both temporal and brow tissues have dropped.

I perform many different types of brow lift, but the simpler varieties can be performed under local anaesthetic and have a very quick recovery. It can also be performed along with other local anaesthetic procedures when required. Scars are hidden in natural contours and are rarely visible. Sutures are usually absorbable or removed at one week. Make-up if required can be immediately applied.

After many years of performing upper and lower eye lid blepharoplasty my patients now often ask for this to be performed under local anaesthetic. It is straight forward to do this for the upper eyelid but more difficult with the lower.

I perform the procedure as an outpatient in my own operating theatre so there is no need to visit a hospital and no need to have a general anaesthetic. You will only need to visit for a couple of hours on the day of surgery and most patients are suture free and applying make-up after 10 days.

I first draw on the skin and plan exactly how much skin and soft tissue needs to be removed. I then inject the local anaesthetic and perform the operation. This is all done without a general anaesthetic and without sedation. You will be fully conscious although I do give a very small dose of diazepam as a pre-med. This maintains consciousness but reduces anxiety. My team will look after you from start to finish.

I perform many different types of lower lid blepharoplasty. All consider the shape, fat content and both the quality and quantity of skin on the lid. Associated features of the lid must also be considered such as malar bags and festoons, although these really must also be considered in conjunction with the mid face. People have different degrees of bony support to the  lower lid and different structural integrity. All these factors should be considered when planning lower eye lid rejuvenation. If surgery is required then scars are usually hidden on the inside of the eye lid or just under the lash line.

Some forms of lower lid blepharoplasty can be performed under local anaesthetic, and some non-surgical procedures can also be very successful to correct some features. A full assessment and comprehensive understanding of your goals is required to decide what form of rejuvenation will suit you best.

Many things happen as we age and Plastic surgeons have for years been inventing procedures to reverse the cosmetic effects and defining what exactly changes as we age. One of the less understood effects of aging is the precise changes that happen around the mouth and the smile, but also the way we speak and communicate.

One of the things patients often say to me is that they feel they look sad or miserable despite feeling happy. A drooping mouth or downward crescent of a long upper lip is an older and sadder look. A significant change with age is the lengthening and thinning of the upper lip with gradually more show of the lower teeth and less of the upper. The lip thins and turns downwards and inwards revealing less of the pink vermillion. The corners droop and they thin.

Some young patients will also benefit from a lip lift if their natural proportions are to have a long upper lip.

A lip lift reverses many of these changes. Upper lip lifts have become very popular since they shorten the upper lip exposing more of the upper teeth and less of the lower teeth, and often lift the corners of the mouth and can roll the lip out exposing more vermillion. Combined with conservative lip fillers the rejuvenated effect can be powerful. The procedure contributes a lot to transforming an older sadder mouth to a brighter happier one.

An upper lip lift can be performed under local anaesthetic as an out-patient. Recovery is quick and people are often back socialising within 10 days. All scars are hidden within natural creases around the nose and are usually very difficult to see or find.

Like its big brother micro liposuction uses aspiration cannulas under the skin to remove and reshape fat. In micro liposuction the difference is that the equipment is much finer, and it can be used to reshape small areas often on the face. Lower eye lid and midface signs of aging can often be improved such as festoons and malar bags, jowls and nasolabial folds may also respond.

This procedure removes fat from under the chin. It helps to redefine the angle between your neck and your jawline. It can have a powerful and natural effect improving the appearance particularly in profile in the right people. The blunting of the cervico-mental angle (neck-jaw angle) happens with age but can also be present in younger people who have a smaller chin or just deposit more fat in this area. This is often familial.

The procedure of submental liposuction removes the superficial fat from under the skin in this area and can be done without a general anaesthetic and without visiting a hospital. I perform the procedure in my own local anaesthetic operating theatre having infiltrated a wide area to numb it and then aspirate the fat with low pressure suction. This is done through two tiny incisions under the chin and there is no need to be admitted to hospital or have a general anaesthetic. It is performed as an out-patient procedure.

Bruising can be variable but is often minimal and most people are back socialising at one week.

This procedure used to be offered very commonly on the NHS but is now very rarely offered even to children. I still perform ear reconstruction on NHS patients, but purely cosmetic procedures are now very rare.

For those who have ears that are too big or stick right out, setting them back, reshaping them and/or reducing the size can make a dramatic improvement to the appearance. For those who are self-conscious about their ears it can be a completely confidence changing procedure. Some patients who come to see me have spent years with long hair carefully draped over the ears to hide them and are fearful of going outside in the wind, swimming or participating in sport.

The procedure in adults can be performed under local anaesthetic with no need to visit a hospital or have a general anaesthetic. I perform this as an out-patient procedure in my own local anaesthetic operating theatre. Setting the ears back is all done through incisions at the back of the ear,  re-sculpting the cartilage and setting the entire ear angle back the right number of degrees towards the head. 

Ear reduction surgery can also be done under local anaesthetic surgery but may involve a scar at the front of the ear hidden in one of the natural curves. This can reduce the height but also the width of the ear.

A head bandage will need to be worn for one week to help keep the ears in place while the incisions heal. After that people return to their normal lives but will need to avoid significant exercise and contact sports for longer.

Scars can be caused by many events. Trauma, scratches, accidents, acne or surgery. Whatever scar it is if it bothers you, it is likely that it can be improved . With many established Plastic Surgical techniques scars can either surgically or non-surgically improved. Often removing a scar completely and either reshaping or repositioning it can make a big difference. Sunken, stretched, thickened, hypertrophic or keloid scars can all be improved. With lots of tricks up our sleeve and the best resurfacing lasers we can usually help.
Find out what technique can help you.

At the clinics own accredited minor operating theatre all kinds of local anaesthesia procedures can take place, including the removal of unwanted lesions and scar revisions.

Treatments

Skin tag removal

Lumps bumps and moles

Wide awake surgery

We define 3 types of acne scarring. Two of them are best treated with minor surgery, Ice pick scars which are deep pits which need to be removed and subdermal scarring that needs to be released from underneath. The other type mid-dermal scarring responds best to laser resurfacing.

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Using 2-3mm diameter aspiration cannulas small areas of fat can be removed and sculpted under local anaesthesia. Areas that work well are the submental region (chin and neck) and in slimmer people the lower abdomen, muffin tops, upper thighs and knees.
Larger areas or larger people may need a general anaesthetic.