Figure 1. A brow with a youthful shape has the outer end located at a slightly higher position from the inner end and the peak of the brow at about the junction of the inner 2/3 and outer 1/3 of the brow.
The AGING FORHEAD

Browlift

The brow and the forehead is an area of the face that is susceptible to age related changes. Several changes occurred in the upper face with aging. The forehead start to wrinkle and develop horizontal fixed forehead lines. The skin at the forehead becomes lax and the brow drops, this is especially apparent in the tail of the eyebrow. Frown lines also start to become prominent between the eyebrows and may even be present at rest. All these changes in the forehead and the brow may make you look tired, angry, sad or older than you feel.

BROW LIFT

A brow lift (also known as a forehead lift) reduces forehead lines and creases and improve frown lines that appeared between your eyebrows. Importantly the descended tail of the brow can also be repositioned into a more youthful position and shape.

THE PROCEDURES

Several procedures are available to address the aging forehead and the brow.

1. The Open Brow Lift
2. The Endoscopic or Limited Incision Brow Lift
3. Deep Temporal Lift

Each has its merits and limitations and selection is based on the patient’s request and specific needs.

The Open BROW Lift

The open brow lift uses an incision hidden in the hair-bearing scalp to lift and redrape the brow and the forehead. The open brow lift remains a relevant and effective technique for its ability to predictably and reliably reposition the eyebrow and redrape the forehead. This technique is particularly useful for patients with very descended brow, with significant excess skin and thick and heavy forehead skin. The disadvantage of this technique is the long incision required within the scalp. For patients not keen for this approach then, the limited incision or the endoscopic technique is a viable alternative.

Endoscopic or Limited Incision Brow Lift

The endoscopic brow lift is becoming the most popular technique in brow lifting. Because of the precise release and visualization possible with the endoscope, incisions can be kept to a minimum and as inconspicuous as possible

This technique is ideal for patients with early brow descent, with significant descent of the brow but not much skin laxity.

Deep temporal lift

This short incision brow lift is very useful and effective for patients with descent of the tail of the brow. Dissection required is minimized and recovery rapid.

Midcheek lift via the TEMPLE

With any of the above mentioned technique that access the temple, the incision also allows for a simultaneous access to the midcheek. Precise release of the midcheek retaining ligaments allow the midcheek to be lifted and an effeective midcheek lift be performed together with the brow lift without needing additional incisions.

RECOVERY

The incisions are meticulously closed. A light dressing is applied over the forehead overnight. Drains may be needed for one day to reduce bruising. The incisions are cleaned daily. The sutures are removed after a week. Minor bruising and swelling will resolve gradually over the next 3 – 4 weeks.

Numbness may occur over the top of the scalp. This is expected with the open technique but may also occur with the endoscopic/ short scar technique. The numbness usually recovers over the next few months. Please visit us for an in-depth discussion on your specific needs.

Dimples brighten and add character to your smile.

Dimple Creation

Anatomically, naturally occurring dimples are the result of a gap between the muscles around the mouth. As a result, the skin is attached to the underlying soft tissues and puckers with smiling (creating the dimples).

The Procedure

Dimple creation is a simple surgical procedure that aims to recreate this naturally occurring anatomy. The ideal position of the dimples varies from patient to patient. The decision as to where to place the dimple is made with the patient’s input and preference at the time of the procedure. The procedure can be done under local anesthesia in clinic with minimal discomfort. No cut is done on the cheek. A small incision is made in the mouth after the area is numbed with local anesthetic. The skin is then fixed to the deeper tissues with an absorbable suture and the incision closed. No removal of sutures is necessary.

Recovery and Expected Outcome

Healing is rapid with minimal swelling. Initially, the dimples is present all the time. After several weeks, it will only be present when you are smiling, just like a naturally occurring dimple.

Reconstructive Surgery

CROOKED NOSE

The crooked nose can broadly be due to 2 main causes, congenital or developmental (that is the patient was born with a crooked nose) or acquired (usually as a result of an old injury to the nose). The crooked nose is an aesthetic as well as a functional problem. Aesthetically the crooked nose perturbs the balance of the midface, bringing unwanted attention of the observer to the nose, detracting from other facial features. Once corrected, this balance is restored and a profound improvement of the overall facial aesthetics can be achieved. As importantly is the functional aspect of the nose. The crooked nose often results in partial blockage of the nasal passages, causing significant patient discomfort and difficulty breathing.

Figure 2: A saddle nose as a result of nasal fracture.
Correction of the crooked nose

Correction of the crooked nose is very challenging, with the need to simultaneously balance the need to straighten the nose with the equally important priority of opening the nasal airway. Other aspects that one wish to address at the same time can off course be address, such as a higher nasal bride or increasing the tip projection. From an anatomical point of view, the deviation is not located at one spot but involve several components of the nose. These must be precisely addressed individually to achieve the desired straightening. The nasal bone, nasal cartilages, the central support formed by the septum (which has a bony as well as cartilageneous component) and the turbinates inside the nose which regulate airflow in the nose must all be addressed.

The approach required therefore varies from individual to individual depending on the degree or severity of the deformity. of the injury. An open approach (which requires a small incision under the nose, in the collumella of the nose. This incision heals very well and becomes inconspicuous with time) is generally required as this access will give the precision needed to reposition the various components of the nose. If the bone is crooked, precisely fracturing the bone to reposition in the midline is needed. The central strut of the nose, the dorsal septum, as well needs to be re-positioned in the midline by various techniques. The nasal cartilages can be reshaped and repositioned as needed to refine the aesthetics of the nose. Often, especially in the ASIAN nose with thick skin and generally thinner cartilages, additional cartilages is needed to reinforce and secure the structures in the midline. The use of your own cartilage is often the best option over the long term for its safety and longevity (compared to foreign material like silicone). The cartilages when needed can be safely harvested from the ear (ear cartilage) or chest (rib cartilage) with minimal scarring. Finally, the turbinates needs to be addressed to ensure that the shifted nasal structures do not block the nasal passages.

The nose is placed in a splint to prevent structures from shifting in the early post-operative period. These can be taken down at a week and the stitches removed. Recovery takes 2 to 3 weeks, with the swelling gradually subsiding. The swelling generally reduces incrementally, more quickly at the top of the nose, taking just several weeks with the tip of the nose taking the longest as the skin is the thickest (up to 6 months).