Brow asymmetry or heaviness mostly commonly result from natural ageing or unsatisfactory botox treatment. The patients typically complain of heaviness in the brows, which is worse by the evening. This heaviness can make them look and feel more tired and aged. They may also have difficulty applying their usual makeup. The heavy brows may also trigger a reflex in the forehead muscle in an attempt to keep the eyebrows lifted, which can in turn cause more tension and wrinkles in the forehead. The treatment options for heavy or asymmetrical eyebrows range from nonsurgical options like botox and skin tightening, to surgical procedures such as Accutite and brow lifts. This is a challenging area to treat and it is important to consult an experienced clinician for a careful assessment to diagnose the root of the problem and create an effective treatment strategy.
Skin laxity and hooding
As we age, our skin loses its collagen and elastic and becomes thinner. The skin of the upper eyelids is the thinnest in the body and so it is typically the first victim of the ageing process and the first to show the early signs of ageing, such as skin laxity, sagging eyelids and hooding which eliminates the natural creases of the eyes. The patients typically complain of looking tired and being unable to apply their makeup in the normal way. This is a very common problem in women and men and the treatments are relatively straightforward. In the early stages, botox and skin tightening treatments such as microneedling and morpheus8 can be effective at slowing down the effects of ageing in the eyelids. Ultimately, the best treatment for eyelid laxity and heaviness is surgical blepharoplasty, or eyelid lift.
Dark circles and tear troughs
The under-eye area is a cause of concern for many people and it can be affected by a host of different factors, such as weight gain or weight loss, tiredness and stress, illness, dehydration and hormonal changes. Dark circles under the eyes are a very common concern among women and men. They can make your face look tired, drawn and unwell. This darkness is usually caused by a combination of different issues, such as skin hollowing, pigmentation and skin thinning and laxity.
The tear trough is a natural anatomical groove created by a ligament which is situated under the eye, separating the fat of the eyelid from that of the cheek. This is present in all people, however it can become more visible in certain circumstances, if there is a particularly tight ligament or there is volume loss around the area, making the tear trough appear deeper and the shadows more pronounced. This can be effectively treated using specialised dermal fillers that help to reduce the hollowness and soften the dark shadows.
Pigmentation of the skin around the eye is extremely common. This can be caused by a number of factors, including hormones, sun damage, accumulation of fluids and heredity. This is usually treated with medical skincare and plasma (PRP) treatments. Furthermore, the unique ingredients found in some fillers can help with this discoloration.
Dark circles around the eyes are multifactorial and usually require a clever combination of treatments and self-help measures to completely eradicate them.
Crows feet and wrinkles
Crows’ feet has become a familiar term to describe the wrinkles that radiate outwards from the sides of the eye onto the cheeks, particularly with exaggerated expressions and smiling. Wrinkles that appear when smiling can be softened using botox. This helps to weaken the muscle but not completely paralyse it. The result will be a very natural smile with the eyes smiling as they should, but the skin will maintain its integrity and not crumple and collapse under the movement of the muscle. In cases where the wrinkles have become ingrained into the skin and are deep and visible even when not smiling, then other treatments such as dermal fillers may be required to improve their appearance.
Cheeks and midface
Loss of volume, asymmetry and ageing is a common concern for women and men alike. The midface and cheeks are the natural stores of fat in the face and volume here is what gives our face its natural lift and youthful plumpness. Loss of volume in the cheeks and midface can result from natural ageing, weight loss, extreme exercise or illness. The patient typically sees a loss of volume in their face, which makes them appear gaunt, drawn, aged or ill. The ideal treatment for this concern is to replenish the natural volume in its natural place. This can be done by carefully targeting the natural fat pockets and re-inflating them back to their original volume. This restores the natural shape and volume of the face, making you look fresher, younger and more rested, and avoids any unnatural or awkward results. This targeted and anatomical approach requires a very intimate understanding of the facial anatomy, which only comes with appropriate training and years of experience.
Asymmetry and contour
Most faces exhibit some degree of asymmetry and this is typically seen in the cheek and jawlines areas. It is important to embrace mild facial asymmetries as a natural feature, which adds to the individuality and beauty of the face. However, more obvious asymmetries can be distressing to some people. Correction of moderate asymmetry can be effectively achieved using dermal filler injections, carefully placed to balance the natural landmarks of the face and cheeks. Furthermore, for patients wanting a more prominent highlights to their cheekbones or a more defined contour to their face, similar techniques can be utilised to create shape, highlights and shadows that accentuate the cheekbones and lift the face. This is undoubtedly an artistic endeavour and requires your clinician to be medically trained as well as artistically gifted.
Prominent ears are a developmental feature whereby the ears fail to fold back adequately. This can occur to varying degrees and usually noticed in early childhood. Patients typically present with prominent ears that stick out too far from the side of the head. Patients often report a long history of psychological distress, bullying and self consciousness that dates back to their early school years. Prominent ear correction is generally no longer treated on the NHS, therefore it has become more common to see adults with prominent ears seeking correction. Correction of prominent ears is surgical and it can be performed either by traditional open surgical methods or by using EarFold, which is a new and minimally invasive technique for permanent correction of prominent ears.
Stretched or split earlobes
Earlobes can become stretched either inadvertently by the long term wearing of heavy earrings or deliberately through the use of graduated rings. Furthermore, earlobes can also become split, usually due to trauma or accidental pulling. Patients often present to the clinic complaining of misshapen earlobes and a desire to restore the natural shape of the ears and to be able to wear earrings. Correction of the earlobe shape requires a meticulous surgical procedure that will repair the natural shape and contours of the ears and restore the position of the piercing if one is required.
Wrinkles, volume loss, laxity
Ageing of the face is a very broad term that encompasses multiple processes that occur simultaneously and contribute to the same overall result. Ageing of the face involves degradation of all the structures of the face, from the skin to the fat, ligaments, muscles and even the facial bones.
In the skin, the ageing process means that the natural stores of collagen, elastic and hyaluronic acid are depleted. This leads to dehydration of the skin and loss of its natural plumpness and glow. It also leads to gradual thinning of the skin and it starts to display the ominous and predictable signs of ageing, such as lines, wrinkles and laxity.
The fat layer of the face is a fundamental player in the ageing process. The facial fat is divided into distinct compartments which are separated by ligaments. This facial fat changes with the ageing process. The general trend is a deflation of the facial fat, which is typically why we start to see hollowing and shadows appearing under the eyes and around the mouth. However, in certain areas of the face the fat actually becomes enlarged and heavier, leading to the appearance of jowls, malar fat and eye bags. This is a complex process which is why a careful assessment is always required in order to tailor an appropriate treatment around you. Areas of the face that have seen a deflation can be effectively treated with reinflation with fillers or fat. Other areas that have become heavier will require treatments that reduce the fat, such as liposuction, FACEtite and Morpheus8.
Jowls, double chin, Jawline definition
The most common complaint concerning the lower face is that of the appearance of jowls. The jowl is an area in the lower cheek, which typically displays the early signs of ageing and weight change. The fat in this area becomes heavier with age and weight gain, and starts to enlarge and weigh down, giving rise to the typical appearance of jowling, ageing and squaring of the face shape. Heavy jowls can diminish the sharp contours of the mandible, producing a wavy and poorly defined jawline. The treatment for the jowls depends on the severity of the problem. Mild jowling can be softened with dermal fillers to restore the sharpness of the jawline. Moderate or severe heaviness of the jowls will usually require surgery, which may involve liposuction, facetite, and Morpheus8. Severe cases will require full facelift surgery.
Teeth grinding and facial slimming
The masseter is a large chewing muscle situated at the back of the jawline. It can be felt tensing through the skin when you clench your teeth. This muscle, like any other muscle can become tense and enlarged, due to repeated use, such as chewing gum, or naturally over years of normal chewing action. An overactive masseter muscle can become problematic for the patient, however, as it can lead to teeth grinding, tooth ache and tension headaches. Cosmetically, an enlarged masseter muscle can also create a widened and masculine jawline. This muscle can be effectively treated with botox injections to calm down its action and reduce its tension. This can result in a resolution of the symptoms of teeth grinding and headaches. Botox into the masseter may also be used for cosmetic purposes to reduce the bulk of the muscle and create a slimmer jawline and more tapered facial shape.
Size and shape
Lips and lip enhancement need no introduction – they are at the forefront of female cosmetic products and aesthetic treatments. Lips of course come in all shapes and sizes and they are completely individual. The size, shape and symmetry of the lips can be affected by genetics and development, ageing, dehydration and the shape and structure of the teeth. Patients who desire a fuller shape or more definition will be familiar with the concept of lip fillers. These are injectable treatments using hyaluronic acid fillers that are used to improve the volume, plumpness and definition of the lips. There are many scare-stories regarding lip fillers and plenty of unnatural looking results that might make you very nervous about this treatment. However, we believe that the best lips are the ones that look beautiful but you don’t notice the filler and can’t decide if they have had treatment or not. This is the kind of result we always strive to achieve within our clinics.
Ageing lips and vertical lines
Your lips can give away a lot about your age and lifestyle. Loss of volume and definition, smokers’ lines and downturning lips that make you look sad are all unwelcome developments and common complaints. Smokers’ lines are the vertical lines that radiate around the lips. Despite their name, they are not necessarily due to smoking. They are the result of weak and thin skin that has lost its collagen and strength, and an overactive lip muscle. Treatment of the ageing lips has to target the different visible signs. Volume loss is corrected with filler. Lip definition is restored with precise placement of filler into the border of the lips. Downturning lips can also be corrected using a mixture of dermal filler and botox to relax any tension that is pulling down on the corner of the mouth. Finally, vertical smokers’ lines in the skin around the lip can be softened by a combination of botox and fillers as well as treatments that will strengthen the collagen in the skin, such as Morpheus8 and laser resurfacing.
The appearance of an excessive amount of gum when you wmile, is sometimes termed a “gummy smile”. Your perception of your gumline could be affected by: the height and shape of your teeth, the way your lips move when you smile, or the angle of your jaw compared with the rest of your face. Generally speaking, over 3 to 4 millimeters of exposed gumline is considered to be disproportionate, resulting in a gummy smile. A gummy smile is extremely common and is a normal variation. However, if a gummy smile is causing a cosmetic concern for you, then this can be helped with a simple injection. Botulinum Toxin (Botox) is used to relax the overactive muscles that raise the lip. This can be highly effective in most patients and the results should last around 3-4 months.
Sagging skin, neck lines and bands
The neck is a troublesome area for many people, with skin laxity issues, double chins and deep neck creases or “necklace lines”. The appearance of a double chin can be due excess fat, loose skin and loose muscle layers – usually it is a combination of all these factors. Patients typically complain of a visible double chin that is obvious from the front and obliterates the sharpness of their jawline. Double chins aren’t necessarily related to body weight or obesity. In fact, fat in this area can be extremely stubborn to shift, despite physical exercise and weight loss. The fat in the double chin area can be reduced using liposuction or facetite. Facetite has the added benefit of tightening the skin as well as removing the fat. Skin laxity in the neck area also afflicts many patients, typically over the age 40, when then collagen and elastic content of the skin starts to diminish, leaving it loose and unable to spring back to its original shape and tone. Improving the tightness and contour of the skin on the neck requires the use of energy based devices such as Morpheus8 and Forma. More severe skin laxity may require interventions such as FACEtite or even a surgical neck lift.
Face shape, slimming and balance
Often it is difficult to pin down one thing that we dislike and we often don’t know the best place or treatment to start with. Patients often complain of a general dissatisfaction with their side profile, which they may want to appear more feminine and less harsh. This may be due to imbalance of the chin, lips, nose or forehead and one or all may need to be addressed in order to achieve a more harmonious profile. It is a similar story for whole facial balancing when a generalised rejuvenation is desired, to lift your face and make you look generally more rested and fresher. When it comes to facial slimming, this can sometimes be effectively achieved by reducing the bulk of the masseter muscle in the jawline. However, when the problem is that of a round face, which lacks definition then this requires a more sophisticated approach. A combination of dermal fillers strategically placed to create a more heart-shaped faced with beautiful contours and a slimmer appearance.