Facial Plastic Surgery — Dr. med. Florian Bast
Highly skilled London-based ENT surgeon with a specialist interest in rhinology and facial plastic surgery. Working at Guy’s and St. Thomas´ Hospital and Harley Street London and main work is Rhinoplasties. Expert in dermal Fillers.
Florian Bast, FCRS, Otolaryngology, Rhinology, Facial Plastic Surgery, Rhinoplasty, Septorhinoplasty, Nasal Surgery, Septal perforation, Balloon Sinuplasty, Balloon Dilation, Eustachian Balloon Dilation. Sinus surgery, Chronic Sinusitis, Snoring, Sleep Apnoea, Blepharoplasty, Otoplasty, Pinnaplasty, Scar correction, Filler, Botox, Injectables, Harley Street, Harley Street Nose Clinic, quality, German
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Rhinoplasty

Correction of Form and Function of the Nose

Dr. med. Florian Bast

The main reasons for nose surgery are: improvement of nasal breathing (septoplasty); modification of the shape of the nose (rhinoplasty); or a combination of both procedures (functional septorhinoplasty). Possible reasons for a rhinoplasty include:

  • Fracture of the nasal bone or another nasal trauma
  • Hump or saddle nose
  • Bent or buckled nose structure
  • Nose too long or too short

There are two main rhinoplasty techniques: closed and open rhinoplasty.

Closed rhinoplasty corrects the structures through an incision inside the nose and visible scars are avoided. In open rhinoplasty the nose is operated on through an incision at the area between the nostrils (columella), combined with incisions on the inside of the nostrils. The skin of the nose tip is carefully lifted and the nasal cartilages and bones are surgically corrected. At the end of the surgery, the incisions are closed with fine suture material. The small incisions usually heal very well, and in most cases are barely noticeable after a few months.

Differences between open and closed rhinoplasty.

Most experts agree that excellent results can be accomplished with open as well as closed rhinoplasty. One advantage of closed rhinoplasty is the absence of visible scars; the advantage of open rhinoplasty is better intraoperative views and access. The choice of procedure is always based on the patient’s needs. Prior to surgery morphed photographs will be used during the consultation process to ensure we agree on the best approach to surgery.

The surgery takes place under general anesthesia. In some cases, small silicone wedges are sewn into the nose at the end of surgery for stabilisation and removed after 7-10 days. A nose plaster is also removed after 7-10 days. No tamponades are used. There is a risk of haematoma (collection of blood), after surgery, particularly in the area under the eyes. This risk can be reduced by the operating technique itself and by applying regular cooling packs to the area, which also helps to alleviate discomfort. A strict regime of self-care of the nose is required following surgery to ensure optimal healing. Patients will receive individual recommendations and check-ups.

Blepharoplasty

Surgery on the Upper or Lower Lids

Dr. med. Florian Bast

Blepharoplasty of the upper lid is one of the most frequent functional and cosmetic facial surgeries. The reasons for performing this surgery include:

  • Congenital factors and ageing can lead to excess skin of the upper lids, which can even hang over the lash line. In addition, deep tissue also becomes weaker, and the pads of fat protectively surrounding the eyes protrude becoming sack-like. Both phenomena lead to a tired and sagging facial expression, and can lead to pressure on the eyes
  • Asymmetric eyelids
  • Droopy skin of the eyelids restricting the visual field, in particular when looking sideways

Blepharoplasty of the upper lid is mostly commonly performed under local anesthesia in combination with sedation, or under general anesthesia. This relatively minor intervention may improve field of vision restricted by the eyelid, and rejuvenate ones appearance.

Firstly, the excessive skin is measured and the dissection lines are marked, then varying quantities of skin, soft tissue, muscle and/or fat are removed. The aim is to attain a fresh and youthful appearance of the eyelids, and improve any restriction of the visual field.

I use a electric very fine surgical needle for the lid surgery, resulting in less bleeding and post-operative haematoma. Sutures are removed 7-10 days after the operation. Very occasionally, a small haematoma may occur.

Prominent lower lids are caused by either excessive skin of the lower lid or protrusion of the fat tissue of the eye socket, often due to age-induced weakening of the tissue, or a combination of both. The surgical intervention has to be adapted to the individual. In cases of combined excess skin and fat prolapse, the blepharoplasty of the lower lid is performed via an incision just below the lashes. In cases with solely fat prolapse, the incision is made on the inside of the eyelid. During surgery, the structures of the soft tissue are strengthened, regardless of the access path, and the lower lid is tightened by a suture at the outer corner of the eye. The surgery is aimed at rejuvenating the eye area and eliminating the impression of tiredness.

Post-operative cooling considerably reduces the possible formation of haematoma. The sutures are removed seven days after surgery. For the surgery with an incision at the inside of the lower lid, absorbable sutures are used requiring no removal.

Otoplasty

Correction of the External Ear

Dr. med. Florian Bast

One of the most common facial cosmetic complaints is protruding ears, mainly caused by insufficient ear cartilage development, or/and an incorrect position of the ear in relation to the skull. This can lead to emotional distress, especially in children, as they may be bullied for it. Therefore, surgical correction is necessary for cosmetic reasons. Although this surgery can be performed at any age, it is preferable to complete the surgery before school-starting age in children if possible.

The surgery is performed via an incision to the back of the pinna which is barely detectable afterwards.

The shape and position of the exterior ear and the ear cartilage are altered. Once the cartilage and the ear is in the desired position it will be fixed and closed with absorbable sutures requiring no removal. Finally, an elastic bandage is applied for protection.

Apart from wearing a headband, no specific aftercare is required so that the surgical intervention will be forgotten after a few weeks; helpful for children undergoing the procedure.

Scar Corrections

Dr. med. Florian Bast

In general, the type of injury (depth of the wound) and tissue characteristics (integrity of the skin, wound location, and blood supply) determine the appearance and colour of a scar. 

This in turn influences if the scar may be corrected surgically, or if a non-operative approach would be best.

The objective of surgical scar correction is to adapt the scar linearly alongside the skin’s natural lines. In most cases surgery may be performed under local anesthesia.

Keloid scarring can occur in patients predisposed to it. These hypertrophic, pronounced scars may be treated with surgical and non-surgical measures.

Chin Augmentation

Dr. med. Florian Bast

Surgery to augment the chin is also known as genioplasty or bone advancement surgery. It’s purpose is to rejuvenate or reconstruct the chin and enhance the contours, shape and balance of the face by increasing the projection of the chin and strengthening the jawline. The surgery can be performed either by using an implant or by advancing the bone. If only minimal augmentation is required, injection with dermal fillers in the clinic may suffice.

Chin implants are a frequent solution to aesthetically enhance a receding chin. It is a simple surgical procedure that will add volume and structure to the jaw, without changing the natural-given anatomy of the face. Chin augmentation may be performed as an isolated procedure, or combined with other surgeries such as rhinoplasty (nose reshaping) in order to provide symmetry and to create a balanced rejuvenation of the face.

During your consultation, you will learn about the surgery, its limitations and risks, and discuss your needs and concerns. This will help Mr. Bast understand your expectations and determine whether they realistically may be achieved. He will evaluate your face, including the skin and underlying bone, and take medical photographs in order to discuss options using morphed pictures at a second subsequent consultation.

How is the surgery performed?

For chin implant surgery, Mr. Bast will make a small incision near where the implant will be placed, either in a crease below the chin or inside the mouth at the gum/lip junction. A pocket is then made in the facial tissue, the implant inserted, and the incision sutured. The sutures are removed after 5 to 10 days (sutures placed inside the mouth will dissolve in a similar period of time).

For bone advancement, a small incision is made on the inside of the mouth, the bone is cut on either side of the jaw and advanced forward securing it with small plates and screws. This type of surgery is typically performed on patients who require 10mm or more advancement of their chin.

Recovery is usually uneventful and most patients go home the day of surgery. Immediately after surgery, a dressing is applied that will remain in place for two to three days. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week. Transient paraesthesia (numbness) to the chin or lower lip is normal and typically resolves within weeks.

After approximately six weeks, most swelling will have settled, and you can enjoy the results of your procedure. Rigorous activity may be prohibited for the first few weeks after surgery. Normal activities may be resumed after approximately ten days.

Facial plastic surgery makes it possible to enhance your natural features and reduce the signs of premature ageing.