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BOROUGH GREEN | SEVENOAKS | KENT 

Facial Aesthetics at Fourways Dental Surgery  We are proud to offer a range of facial aesthetic treatments here at Fourways Dental Surgery, administered by our specially trained clinician Dr. Avi Riley.   We are committed to helping each of our patients look after and make the most of their image through a choice of affordable, high quality and professional facial aesthetic treatments. 

Facial Aesthetic Procedures We Perform 

Blepharoplasty  
(Eyelid Reshaping) 
Ptosis Correction  
(Drooping Eyelids) 
Facial Surgery 
(Reversing Facelift) 
Cyst and Mole Removal/ Scar Revision 
Pinnaplasty (Ear Pinning)/ Repair of Torn Earlobes 
Botulinum Toxin 
(Botox) 
Dermal Fillers 
Skin Peel 

Blepharoplasty (Eyelid Reshaping) 

What is Blepharoplasty? 
Blepharoplasty is a surgery that corrects droopy eyelids and involves removing excess skin, muscle and fat. As we age, your eyelids stretch, and therefore the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes. 
A blepharoplasty can be done under a local anaesthetic injected into the eyelids. Your surgeon will make a cut in the natural skin crease of your upper eyelid or below your eyelashes in your lower lid. They will remove any excess skin and fat and close the wound using very fine stitches. 
Besides making you look older, severely sagging skin around your eyes can reduce your side vision (peripheral vision), especially the upper and outer parts of your field of vision. Blepharoplasty can reduce or eliminate these vision problems and make your eyes appear younger and more alert. 
Blepharoplasty could also be an option if you have: 
Baggy or droopy upper eyelids 
Excess skin of the upper eyelids that interferes together with your sight 
Excess skin on the lower eyelids 
Bags under your eyes 
Possible risks of eyelid surgery include: 
Infection and bleeding 
Dry, irritated eyes 
Difficulty closing your eyes or other eyelid problems 
Noticeable scarring 
Injury to eye muscles 
Skin discoloration 
The need for a follow-up surgery 
Temporarily blurred vision or, rarely, loss of eyesight 
Risks related to surgery generally , including reaction to anesthesia and blood clots 
How long does a Blepharoplasty last? 
The results of blepharoplasty (eyelid surgery) are generally long lasting. It's not uncommon for the longevity of results to vary slightly between patients, but you can expect the results of upper eyelid surgery to last about 5 to 7 years, and lower eyelid surgery results are essentially permanent. 
Do you want to know more about eyelid Reshaping? 

Ptosis Correction (Drooping Eyelids) 

What is Ptosis Correction? 
Ptosis, or drooping of the upper eyelid, can happen in one or both eyes. Ptosis can interfere with vision by affecting the upper field of vision. It may also cause eye strain, eyebrow ache or cosmetic concerns. 
 
What causes my condition? 
 
Ptosis can sometimes be present at birth; this is known as congenital ptosis and is usually due to a defect in the upper eyelid muscle. However, more commonly it appears later in life, as an acquired ptosis. This can be the result of long-term contact lens wear, trauma or following other eye surgery, which can all cause stretching of the upper eyelid tendon. Sometimes this stretching is just caused by age-related changes in the eyelid. There are a few other rare causes of ptosis which include other conditions that can weaken the eyelid muscles, such as myasthenia gravis or myotonic dystrophy, or which cause paralysis of the nerves supplying the eyelid. 
 
What is ptosis surgery? 
 
This is surgery to lift one or both of your upper lids. It is usually performed under local anaesthetic, although occasionally some sedation can be given during the procedure to help you to relax. You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution and sterile cloth will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds. The surgery should take approximately 45 minutes per eye. You may feel some light tugging on your eyelid during the surgery and you may also be asked to look up and down. At the end of the surgery, the skin wounds are closed with sutures (stitches), ointment is applied and a pressure dressing is placed over the eyelids. If you have both eyes done then one of the eye pads will be removed after about an hour. 
What are the benefits? 
Ptosis surgery can improve your field of view and brighten your vision. It can also relieve eye strain and brow ache or headache if these are caused by the eyelid droop. It should improve the symmetry of your eyes. 
What are the risks? 
Ptosis surgery is generally successful, with eight out of ten lids being in a good position after surgery. However, as with any surgery, there are some risks associated with it which include the following: 
 
Bruising and swelling is common and may persist for a few weeks after surgery. 
Infection in the wound is possible. 
As the eye is being opened up more, it may be harder to close it after surgery. Your eye may feel dry and gritty and you may have to use artificial tear supplements for few months 
The surgery is not absolutely precise due to the number of factors that can affect the final lid height. Under correction or over correction is therefore possible which may need revaluation and more procedures. 
Bleeding into deep tissue can lead to disturbance of vision and could lead to loss of vision in severe cases. This is extremely rare, and you should report any loss of vision to the hospital immediately. 
Do you want to know more about Ptosis Correction? 

REVERSING FACELIFT – RHYTIDECTOMY SURGERY 

What is Rhytidectomy? 
If you are constantly pulling your skin back towards your ears when you look in the mirror, you are probably ready for a facelift. The passing years, sun exposure and stress, can cause your skin to lose its firmness and shows laxity, jowls set in and become increasingly prominent. Nothing matches the ability of a facelift to make you look more youthful and refreshed. While this process is normal, you don’t have to accept it. Instead, we offer an innovative local anaesthetic mini facelift procedure, 
suitable for women and men who choose to reverse the signs of ageing in a less invasive way. 
 
A 30 minutes consultation can help you decide if you are the perfect 
candidate for this treatment. This procedure is commonly performed in 
conjunction to a blepharoplasty to open out the eyes and give a complete 
rejuvenated look. 
Procedure 
The Mini Facelift is designed to reduce sagging in the lower face and neck and regain a more natural, rejuvenated appearance. The procedure differs from a traditional facelift as you will experience minimal bruising and swelling for a significantly quicker recovery period. A key benefit is that there is minimal scarring as the incisions are easily concealed within your natural facial contours and hairline. 
 
This procedure is developed for the patient that may not be sure about going under a general anaesthetic as it is performed under local which dramatically reduces the risks and eliminates the groggy disorientation associated with a traditional facelift. 
 
With the Mini Facelift, our goal is to turn back the clock, firming up muscle tone, smoothing the skin, and restoring your attractive facial contour. Facelift surgery is not designed to make you look like someone else, but to make you look and feel years younger. In most cases, this procedure can be done within 60-90 minutes. 
Recovery 
You are able to go home and rest straight after your procedure. There may be minimal swelling, bruising, tenderness and most people feel comfortable getting back to work within a week. If you have had liposuction carried out as part of the neck lift procedure, the recovery process will normally take longer than average. 
Although the Reversing Facelift surgery is less invasive than a traditional facelift the results are just as effective to give you the self confidence about your appearance and can make a tremendous difference in your quality of life. 
Do you want to know more about Apex Facelifts? 

Cyst and Mole Removal/ Scar Revision 

Eyelid Cyst Removal? 
An eyelid cyst is usually a lump or swelling on the upper or lower eyelid. While this type of cyst is usually painless, you may be unhappy with the way it makes you look and want it removed. 
 
An eyelid cyst is caused by an eyelid problem, such as a blockage in one of the glands that supplies fluid to lubricate the edge of your eyelid. Removing the cyst involves a minor operation under local anaesthesia. 
You may have decided you want this procedure because you’re unhappy with the way your cyst makes your eye look or because it droops down into your eye, affecting your vision. 
 
Removal is usually performed under local anaesthetic and takes roughly 30 minutes. The surgeon will numb the area in and around your eye, then turning your eyelid inside out they will cut or scrape the cyst away using tiny instruments. Finishing by washing the area with saline solution. 
 
The removal is usually performed as a day case meaning you will be able to go home the same day, although you will be unable to drive. The procedure itself is very safe and complications occur infrequently. 
Mole removal and scar revision 
When you want a mole, skin tag or other skin lesion removed for cosmetic reasons, you can be confident you are in the safest hands with Mr Coombes. His skill and expertise have resulted in barely visible to no scarring at all. 
 
Moles occur when cells called melanocytes grow in clusters instead of spreading evenly within the skin. Moles, particularly on the face can be unsightly and cause low self-esteem. Mr Coombes is well aware of this and will carefully listen to your concerns. 
Mole removal 
 
Mole removal is a simple surgical procedure that is undertaken with local anaesthetic. The technique Mr Coombes uses does not involve any stitches which minimises scarring. The mole is removed and a small adhesive dressing is placed over the skin site. Following the removal of the mole there is a slight dip on the skin site. 
Scar Revision 
 
When the skin is injured by a cut the skin commonly heals by scar tissue. Once a scar has formed it is impossible to completely remove and this can be a particular problem on the face. Scar treatment aims to blend the scar tissue with the contours and colour of the surrounding skin. Scar treatments include scar revision surgery and/or injection of steroids into the scar. These treatments intend to treat these flaws and increase self confidence. 
Do you want to know more about Cyst and Mole Removal? 

Pinnaplasty and Ear Lobe Repair 

What is Pinnaplasty? 
Ear correction surgery, where the ears are pinned back, is known as pinnaplasty or otoplasty. The cosmetic surgery procedure is used to change the size or shape of the ears, or to pin them back if they stick out. It is usually carried out on children and teenagers but some adults may opt to have the procedure too. Children under the age of five are unable to have pinnaplasty as their ears are still developing and growing. 
Ear correction surgery, where the ears are pinned back, is known as pinnaplasty or otoplasty. The cosmetic surgery procedure is used to change the size or shape of the ears, or to pin them back if they stick out. It is usually carried out on children and teenagers but some adults may opt to have the procedure too. Children under the age of five are unable to have pinnaplasty as their ears are still developing and growing. 
What happens during a Pinnaplasty? 
Pinnaplasty is performed under local or general anaesthetic, depending on the age of the patient. The operation usually takes about one to two hours. The surgeon will make a cut to the back of the ear and peel off some skin from the cartilage. The shape of the cartilage is changed so that the ear is closer to the head. The doctor can also correct the symmetry of the ears too. The wounds are then closed with stitches and a dressing is applied. 
What happens after Pinnaplasty? 
Following surgery, the ears may be sore, tender or numb for a few days and the patient may need to wear a bandage around their head. They will not be able to wash their hair for a few days whilst leaving the dressing on to protect the ears from infection. It is useful to sleep upright for a few nights following surgery. 
 
There may be bruising for a few weeks and it is recommended taking the time off school or work to let these heal. The stitches may come to the surface and cause the ear to feel sore, which can be treated with over the counter pain medications. After 10 days the stitches are removed. 
What are the possible complications of Pinnaplasty? 
Complications are unusual. There can be a collection of blood between the skin and the cartilage, which creates 'cauliflower ear'. On some occasions, the skin may scab and the patient must be very careful with their dressings to ensure that underlying cartilage is not exposed, dried out or infected. If it does dry out then it can cause a misshapen ear and another procedure will be needed to repair the hole with a skin graft. If the area is red, swollen or painful post-operation, this may be a sign of infection and the patient should consult their doctor. 
Earlobe Surgery 
The earlobe is the lower, fleshy part of the ear that is sometimes pierced. The area consists of a delicate piece of skin that is made up of fat and skin. This area can be split or ripped due to heavy or over-stretched earrings. Split earlobes can be caused by trauma, which may occur if earrings are pulled through the piercing hole. Additionally, wearing earrings — especially heavy earrings — can lengthen the piercing hole and eventually pull through over time. People with thin earlobes are predisposed to this occurring. 
Earlobe repair or split earlobe surgery is a quick and simple minor surgical procedure to correct split, ripped or torn earlobes and/or stretched earlobes. It is carried out under local anaesthetic and is a short procedure. If you’re interested in having your split earlobe, widened piercing hole or stretched ear piercings reversed or repaired, arrange a consultation at The Private Clinic with our expert Consultant Cosmetic Surgeons who have expensive experience in ear correction surgery. It is a quick simple procedure with excellent results and no downtime. 
Earlobes should be fully healed in 4 – 6 weeks but heavy ear rings should be avoided for 6 months. Scars will fade over time with proper care. 
Do you want to know more about Pinnaplasty and Ear Lobe Repair? 

Botulinum Toxin (Botox) 

What is botulinum toxin? 
Botulinum toxin is a chemical produced by bacterium clostridium botulinum. Botox is a protein derivative of the toxin, which when injected into a muscle, causes it to become weakened or inactivated. It stops the muscle from functioning by blocking neuromuscular transmission – i.e. it stops the chemical messages from the nerve to the muscle. 
How does it work? 
By using facial muscles repeatedly throughout a lifetime, the skin is creased in areas of greatest use. The aging process causes the slow down of collagen and elastin production in the skin so that as we get older, these areas of over-use become damaged and the lines become more permanent. By reducing the movement of muscles in these areas, the skin stops being creased and is allowed to recover, causing the lines to soften or even fade away. In the areas treated, the muscles are temporarily inactivated (always reversible), during which time the patient can break the subconscious habit of overusing these muscles. Depending on each individual and the dose used, the response to treatment can vary from a relaxation of the muscles to an inability to move the muscles. 
For the first couple of years, frequent treatments are required to ‘re-educate’ the facial muscles. Thereafter, treatments would be less frequent until a yearly maintenance treatment is normally all that is required. 
How long has Botox been in use? 
As long ago as 1978, Botox was used as a treatment for patients with eye squints by weakening the overactive eye muscle. Since then, it has been used in a variety of therapeutic areas such as a spasmodic neck, writer’s cramp, tics, multiple sclerosis, facial spasms, Parkinson’s Disease and cerebal palsy, to name but a few. In more recent times the use of Botox for cosmetic therapy has become more widespread. 
What happens during treatment? 
The procedure takes about 15 minutes. The practitioner will ask you to use certain muscles of the face to observe how they work. An extremely fine, short needle is used to inject the Botox into the appropriate area. This may cause some slight but brief discomfort. The area may have some slight redness and swelling, which normally resolves in an hour or two. After treatment, you should not massage the injected area. injected area. You should not lie down for four hours after treatment. 
The treatment normally starts to take effect after 4 – 14 days, but this may vary slightly with some individuals. The effects will normally last between 2 and 6 months, when you will start to notice an ability to move the muscles more freely. 
Areas that can be treated 
Forehead wrinkles 
Crow's feet 
Under-eye lines 
Frown lines 
Gummy smile 
Marionette lines 
Top of the nose 
Jaw Angle (teeth grinding — bruxism) 
Lipstick lines 
How safe is Botox? 
In high concentrations botulinum toxin is a potent poison. However, Botox used in minute doses, as it is in cosmetic therapy, has a very high margin of safety. 
Are there any side effects? 
Side effects of this treatment are rare. Most people find that the injection causes only mild discomfort. Immediately after the injection there may be mild swelling, which usually subsides in 48 hours. 
Occasionally a temporary drooping of the eyelid can occur. This may last a few weeks, but will always resolve. Special eye drops can be prescribed during this time to help lift the lid back into the normal position. In extremely rare cases patients have developed an allergy to the treatment, while others have shown resistance, i.e. it causes little or no effect on the treated muscles. 
 
The most common reported side effects: 
 
Tenderness 
Bruising 
Temporary headache 
Drooping of the eye lid or brow 
Excessive watering of the eye 
Mild inflammation of the surface of the eye 
 
Less common side effects include: 
 
Inflammation of the surface of the eye 
Eversion of inversion of the eyelids 
Light sensitivity/double vision 
Dizziness, rash, tiredness 
Facial weakness/droop/asymmetry 
Allergic reaction 
 
Uses of Botox: 
 
Smoothes out wrinkles 
Helps relieve Migraines 
Gummy smile correction 
Excessive sweating 
Eyelid spasms 
Jaw clenching and grinding 
Frown correction, laugh lines and forehead wrinkles 
Treatment is not recommended if you are pregnant or a nursing mother. 
Do you want to know more about the use of Botox? 

Dermal Fillers 

What are dermal fillers? 
Dermal fillers are injectable products either synthetic or natural which are used to help restore volume or fill in various lines around the face. They are injected under the skin to give a more youthful or enhanced look. 
How are they applied? 
Dermal fillers are administered by a trained medical practitioner and are injected around the face using various techniques. 
What happens during the treatment? 
Dermal fillers generally take around 30 – 45 minutes to administer. Your medical practitioner will discuss your thoughts and assess your face to decide on the best treatment plan for you. They will then determine the injection site to achieve the best results for you. Topical anaesthetic is generally applied 30 minutes before the treatment. Your practitioner will then administer the dermal fillers through several injections. You can usually feel the initial injection but the procedure shouldn’t be painful as most dermal fillers contain lidocaine products. You can return to work or day to day activities immediately. 
Areas that can be treated 
Naso-labial folds 
Marionette lines 
Lips & vermillion border 
Smoker’s lines 
Cheeks 
Mouth corners 
Tear troughs 
Chin augmentation 
Are there any side effects? 
If they do occur, they are: 
 
Temporary/mild to moderate 
Most common are slight bruising and swelling from the injection sites 
A detailed list of side effects can be obtained from the practitioner at your consultation. 
When can you see results? 
Dermal fillers work instantly. Following treatment, the area should be left alone to settle. 
How long does it last? 
Dermal fillers on average last around 4 – 8 months but this can differ for each individual. 
 
How much does it cost? 
 
Dermal fillers are generally charged per syringe and vary depending on the strength and longevity of the filler. 
 
Do you want to know more about Dermal Fillers? 

Skin Peel Procedure 

What is Skin Peeling? 
Medical skin peels with TCA are used to treat ageing skin, photo-ageing of the skin, to improve problems of abnormal pigmentation caused by the sun and to give the skin a younger, fresher appearance. They are also very effective in the treatment of active acne and can arrest even severe cases of acne for 6-12 months. TCA peels are not beauty treatments; they are medical aesthetic procedures with the potential for adverse side-effects. 
 
A solution of trichloroacetic acid (TCA) is applied to the face (neck, décolleté and hands may also be treated) by your medical practitioner. This will sting for a few minutes but is tolerable and most patients do not require any anaesthesia. 
 
A fan is used to relieve any stinging and further layers are applied until the correct depth of penetration is achieved, as judged by the experience of the medical practitioner. The peel is then finished by the application of a post-peel cream and the patient takes home a prescribed cream to apply to the treated area for the next few to seven days (as directed). 
 
Immediately following the peel, the treated skin may look red and for the next 24-48 hours the treated skin looks smooth and quite tight. It is not uncommon for the face or treated areas to swell for a day or so. 
 
The skin then becomes tighter, drier and sometimes darker as any abnormal pigmentation comes to the surface. On about the third day, the skin will start to peel and this is similar to the peeling sometimes seen after sunburn. The post peel cream can be liberally applied and the skin must be allowed to peel naturally without any pulling-off of loose skin. On the fifth to seventh day, the peeling is complete and the skin looks fresher and smoother. 
 
Depending on the peel you choose your face (or treated area) may be significantly peeling for 5 to 
10 days so you may experience social pressure or wish to remain in doors during this time – away from normal social and work activities. 
 
Depending on the type of TCA peel chosen and discussed with you, the peel may need to be repeated. For lighter (superficial) TCA peels this will usually be a course of 3 to 4 peels spaced about 2 weeks apart. For a deeper (medium or deep medium) TCA peels you may need only one peel but another may be required after about 6 weeks. 
 
The final results can be seen and assessed over a period of 4-6 months after the (final) peel, - not before. During this time the skin will produce more collagen and will become younger in structure, tighter and more elastic. 
What should you do after a peel procedure? 
It is very important that you carefully follow the advice given by your practitioner following a peel treatment to help to improve the benefit of the procedure and reduce the risk of complications or side effects. This includes; 
 
Using all the crèmes as directed and using a high factor sun protection crème every day. 
Cleansing the face gently with a soap-free cleanser, pat dry with a towel, and moisturise twice a day; 
Don’t pick off any dead/peeling skin as this may cause bleeding & discoloration, or even mild scarring; 
Not exposing yourself to the sun without a sunscreen for at least 6 weeks after treatment to reduce the risk of hyperpigmentation (brown blotches on the face) A high factor sunblock 
should be used daily to protect the skin (even on a dull or cloudy day). 
If itching is severe during the healing phase, antihistamines may be recommended to help stop this. 
Avoiding scratching or picking at the skin to reduce the chances of scarring; 
Contacting my practitioner immediately if I notice any signs of infection, scarring or pigment changes 
Who should not have a chemical peel? 
If you have a history of problems with keloid scars (raised scars that grow out beyond the original site of injury) or other types of scarring of your skin; 
If you have facial warts or any current facial infection; 
If you have used the anti-acne treatment isotretinoin (brand name Roaccutane) within the last 
12 months; 
If you have darkly pigmented skin, or red hair with freckled skin. In such cases, you would generally be unsuitable for the deeper peels owing to the potential for skin bleaching. 
Afro-Caribbean or Asian skin is often not suited to facial peels because of the risk of bleaching the skin. This is particularly the case with the deeper peels where the top layers of skin are removed 
Summary of risks from medical skin peels 
Peels are a commonly used form of skin rejuvenation and the vast majority are carried out with no complications. Adverse effects from TCA skin peel are extremely rare. However, you do need to be aware of the risks, which can be summarised below: 
 
Burning sensation and stinging 
Redness – can last for a few weeks 
Peeling – it is important that you do not pick at or peel off the skin 
Sensitive skin after the peel 
In rare cases, patients may experience an infection in the skin or an out-break of cold sores. 
This normally only occurs in patients who have a history of such complaints and anti-viral medication may be recommended if such complications occur. 
Mild transient swelling of the face 
Hypo or Hyperpigmentation – patients must use all after care products as directed and remember to use a high factor sunscreen (factor 30 or more) 
In rare cases scarring or keloids may occur. 
Do you want to know more about Skin Peels? 
 

Testimonial 

"So delighted that I had this procedure done. I initially went to see the team at Fourways dentist surgery as my lower face was sagging where Sue Mitchell suggested I went to see Dr Darryl Coombes who advised me on the Apex Face lift. Dr Darryl Coombes was so professional and explained everything to me that I decided to go ahead at Fourways dental practice for the procedure. Dr Coombes and the team made me feel completely at ease throughout and I would recommend anyone thinking about having this done to go ahead as he is such an amazing surgeon and I'm so thrilled with the results. From the consultation to the after care I have been very well looked after and have had no problems at all." 
K.Gunner 
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