Cosmetic surgery can also be very effective in the treatment of scars or other blemishes that are not related to ageing at all.
In addition, other problems, especially of the eyes, can arise as we age. The lower eyelids may start to turn in (entropion) and cause discomfort or fall away from the eye (ectropion) and cause soreness and watering. The upper lids may droop (ptosis). The eyes may water constantly. All of these problems are common. They can be uncosmetic and inconvenient and the surgical treatment is usually straightforward.
Early changes are barely discernable and few seek advice. Fine wrinkling of the skin may begin in the late 20s. At the same time the furrow between the cheek and the mouth - the nasolabial fold, a smile line - becomes apparent. The furrow between the cheek and the inner corner of the eye - the nasojugal fold, or 'tear trough' - also appears.
During the 30s fine 'crow's feet' wrinkles often appear at the outer corners of the eyes and other lines may appear in the forehead. By the 40s small folds of skin are often starting to appear, especially in the eyelids and prominent fat in the upper and lower eyelids may be creating a mild 'baggy' appearance. The facial skin becomes gradually less elastic and the fullness also becomes less as the volume of the tissues very gradually declines over the years.
The changes in the eyelids, which lead to so many seeking advice, are influenced by other changes in the forehead and the cheeks.
The forehead tissues relax very gradually with time and the brows drop a little. This pushes more skin into the upper eyelids. The cheeks also tend to sink as their deep attachments relax. This accentuates the nasolabial folds and eventually contributes to the jowls appearing below the jawlines and to lax skin in the neck.
All these changes can be treated. In general, early changes - fine wrinkles alone - are not treated surgically. One of the non-surgical treatments, or even careful make-up, can give the desired effect. Once folds of excess skin, fat prominence in the lids and sinking of the forehead and cheeks appear, surgical treatment has a definite role to play.
Eyelid ptosis correction. Ptosis is drooping of the upper lid. It is common and it can be corrected at the same time as blepharoplasty (or separately if blepharoplasty is not required). The approach may be through the eyelid skin with the scar hidden in the skin crease of the upper lid, or it may be from the back of the eyelid with no visible scar. A number of factors determine which approach is recommended.
Brow and forehead lift restores the brows to their correct level. There are several approaches to this. If the brows are not too low the endoscopic approach is usually recommended. Through incisions placed behind the hairline the forehead is lifted together with the brows. This approach can raise the hairline a little so if the hairline and forehead are already high an alternative approach such as the pretrichial lift (with the incision just in front of the hairline) or the direct lift (with the incisions just above the brows) may be preferred.
Cheek ('mid-face') lift raises the prominence of the cheek which sags with age. This also reduces the nasolabial and 'tear trough' furrows a little and supports the lower eyelid as well. At the same operation the outer corner of the eyelids can be raised slightly if needed.
Other procedures around the eyes. Other more subtle changes around the eyes can be corrected at the same time as the procedures discussed above. A filler, botulinum toxin or a chemical peel can be applied. Skin blemishes can be removed.
Face lift. There are many different approaches and variations to face lift surgery and the techniques have evolved over the years.
Mild laxity of the tissues of the face with limited jowl formation and neck skin laxity is often currently treated with a 'short scar face lift' or 'minimal access cranial suspension lift' also known as a 'mini face lift'. The scar is limited to the area in front of the ear and recovery is quick.
More marked laxity of the facial tissues often requires a more extensive face lift at a deeper plane in the face than the 'mini face lift'. The scar extends behind the ear and recovery takes longer.
As mentioned above, not all ageing changes are best treated with surgery; alternative therapies such as botulinum toxin, fillers (eg Restylane, Radiesse or fat) or skin resurfacing (eg chemical peels, laser or radiofrequency) are often more appropriate for minor changes. IPL (Intense Pulsed Light) may be helpful for minor skin blemishes. These treatments are frequently offered by therapists who are trained in non-surgical techniques but are not trained in cosmetic surgery and may not be medically qualified. These treatments are also offered by many cosmetic surgeons and their teams.
General plastic surgeons offer surgery for the lower face and neck while also offering surgery to the mid and upper face, including the eyelids. Plastic surgeons offering cosmetic surgical treatments will usually be members of the British Association of Aesthetic Plastic Surgeons (BAAPS).
The websites of BOPSS and BAAPS have lists of their members including their contact details and links to their personal websites with more details of their training and areas of particular expertise.
Your family doctor will know your local consultants and will be able to refer you.
Hospitals and clinics offering cosmetic treatments should be registered with the Healthcare Commission which inspects their facilities regularly to maintain standards.
It is always advisable to ask for a written quote, including the possibility of any extra costs before embarking on treatment. Ask also about potential further costs should complications arise after treatment. Would the surgeon or therapist make an extra charge or would management of any complications be covered by the initial fee?
Most insurance companies will not cover the cost of purely cosmetic surgery or other treatments. Sometimes, however, they may consider it if the treatment is needed for 'functional' reasons as well (see 'Is this type of surgery done only for cosmetic reasons?' above).
Surgical treatments for the effects of ageing can be expected to last for several years, often longer. Frequently no further surgery is felt to be needed even if some of the laxity has reappeared. By contrast, the benefits of surgery for other cosmetic blemishes such as scars or skin pigmentations are usually permanent.
Non-surgical treatments generally last for much shorter periods and need to be repeated at regular intervals. For example, the effect of botulinum toxin wears off in an average of about 14 weeks, depending on the preparation being used. The injections are then repeated. Fillers gradually absorb, reducing their filling effect over several months, depending on the particular filler used. Skin resurfacing also gradually loses its effect over a variable period of time depending on the modality used. The treatment then needs to be repeated for continuing effect.
Some people have a less clear idea of what they want from cosmetic treatment. Often it is possible with discussion to focus on the issues causing concern and to proceed to appropriate treatment. Sometimes, however, the surgeon may not be able to gain a clear idea of what his patient wants. In these circumstances the advice is usually to wait and think through the discussion then return later. Further discussion may then help to clarify the real issues needing treatment. Occasionally discussion with other professionals may help and the surgeon may suggest this in order to plan the best and most appropriate treatment.