As we age, we gradually lose fat, collagen, skin elasticity and even some of the underlying bone support that gives the face its youthful shape. The result is hollowing beneath the eyes, flattening of the cheeks, thinning lips, deeper folds around the mouth and a more tired or
drawn appearance.

Modern facial rejuvenation therefore focuses not only on lifting tissues, but also on restoring volume in a natural and harmonious way.

Understanding Facial Volume Loss

Volume loss affects different areas of the face in different ways:

• Hollow temples can create a gaunt appearance
• Loss of cheek volume can make the face appear tired or sagging
• Tear trough hollows beneath the eyes create shadows and dark circles
• Thinning lips and deeper lines around the mouth contribute to an aged appearance
• Loss of jawline definition can soften facial contours

In the past, traditional facelifts primarily addressed loose skin and tissue descent. While lifting remains important, it does not always restore the youthful fullness associated with a rested and healthy face.

Today, the best rejuvenation strategies combine structural lifting with careful volume restoration to achieve balanced, natural-looking results.

Surgical Volume Restoration

Structural Fat Grafting

One of the most effective surgical methods of restoring facial volume is structural fat grafting, also known as fat filling or fat transfer.

This technique involves removing fat from another part of the body — commonly the abdomen, thighs or flanks — using gentle liposuction techniques. The purified fat is then carefully re-injected into areas of volume loss in the face or body.

Fat grafting can be used to improve:

• Hollow cheeks
• Tear troughs
• Nasolabial folds
• Thin lips
• Temples
• Facial asymmetry
• Volume loss in the hands or body

One of the advantages of fat grafting is that it uses your own tissue, creating a soft and natural result. In experienced hands, fat transfer can provide long-lasting rejuvenation while maintaining facial harmony.

Facelift Surgery with Volume Restoration

A modern facelift is no longer simply about tightening skin. Contemporary facial rejuvenation surgery aims to reposition deeper tissues while restoring youthful contours and proportions.

For many patients, combining a facelift with fat grafting achieves a more complete and natural rejuvenation. The lifting procedure restores support and contour, while the fat transfer replenishes lost fullness.

The hallmark of excellent aesthetic surgery is not looking “operated on,” but rather looking refreshed, healthy and well-rested.

Non-Surgical Volume Restoration

Not every patient requires surgery to restore volume. In younger patients or those with early
signs of ageing, non-surgical treatments can achieve beautiful improvements with little or no
downtime.

Dermal Fillers

Dermal fillers are injectable products used to restore facial volume, soften folds and enhance
contours.

They are commonly used to treat:

• Tear trough hollows
• Cheek volume loss
• Nasolabial folds
• Marionette lines
• Lip enhancement
• Jawline definition

Fillers can provide immediate improvement but results last between 4 months and a year and the procedure will need to be repeated.

The key to successful filler treatment is restraint, precision and a thorough understanding of facial anatomy. Overfilled or poorly placed filler can create an unnatural appearance, whereas carefully performed treatment should simply make you look fresher and more rested.

Combining Treatments for Optimal Results

Volume restoration is rarely about a single treatment. The best outcomes are usually achieved
through a personalised combination of treatments tailored to the patient’s anatomy, skin
quality and stage of ageing.

This may include:

• Skin rejuvenation therapies
• Medical needling
• Laser resurfacing
• Botox for dynamic wrinkles
• Dermal fillers
• Fat grafting
• Surgical lifting procedures when appropriate

The goal is always balance, proportion and natural rejuvenation rather than dramatic alteration.

Natural Results Matter Most

The most successful aesthetic treatments are often the least obvious. Friends and family may notice that you look healthier, more rested or refreshed — without immediately identifying why.

Whether surgical or non-surgical, volume restoration should enhance your natural features while preserving facial character and expression.

My treatment plans are carefully individualised to ensure that every patient receives the most appropriate approach for their unique needs and goals.

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1. You’ve had any type of cosmetic surgery.

While you may want to keep this one to yourself, it’s important to include every surgery you’ve had when you give your medical history. Your doctor needs to know if you’ve had a bad reaction to general anaesthesia/IV sedation or any other issue during surgery. This can prevent a repeat experience. If you’ve had the surgery recently, this might influence the treatment of other issues. For instance, if you take omega-3 fatty acids or vitamin E, the expected bruising after surgery could appear worse.

If you are consulting a plastic surgeon to fix a cosmetic surgery you are unhappy with, mention how many times the same area has been operated (especially rhinoplasty). A re-operated area can have compromised blood flow and scarring that needs attention. If your doctor is properly informed, he can plan your surgery to optimise your safety.

2. You smoke (even if it’s just ‘socially’).

Smoking can cause surgery-related complications, so if your doctor knows about your habits, he can take precautions to reduce your risk of having problems. Even the occasional cigarette, combined with birth control or hormone replacements, can increase your chance of developing blood clots or having a stroke.

5. You don’t follow all or any of your doctor’s instructions.

When you’re undergoing treatment, your doctor might think it’s not working and increase doses, which could lead to overmedication/more aggresive tests. Rather be honest about your reasons for not complying – you can’t afford the meds or you’re struggling to complete the exercises. Ask for an alternative solution.

4. You eat more junk food than you prefer to admit.

If there’s no clear lifestyle reason for your weight gain, prediabetic condition or high cholesterol, you may have to take drugs you don’t need.

5. Your ‘two glasses’ a week is more like ‘two per day’.

If you have certain risk factors for breast cancer, even one glass a day could be one too many. Your doctor might misinterpret the high level of liver enzymes in your lab results and prescribe unnecessary tests or treatment if he doesn’t know you drink. Alcohol also doesn’t mix well with many medications and your doctor can advise accordingly if you fess up.

6. You’re taking over-the-counter meds/supplements/hard drugs or a friend’s prescription drug.

Certain over-the-counter medications and supplements can interact with other treatments, for example, Saint John’s Wort and antidepressants or antihistamine and a sedative. Apart from the obvious dangers of taking medication prescribed for someone else, your doctor might misdiagnose symptoms caused by the drug. So it’s best to tell the truth about all the meds you’re taking, including the herbal ones.

If you confess to taking hard drugs (cocaine, cannabis or tik) or you are a recovering addict, the doctor will not necessarily refuse to perform your surgery, but he can give you pre-operative advice. This will also allow the medical team to be prepared for your symptoms post-operatively and prescribe pain meds that won’t interfere with your sobriety.

7. You’ve had more than one partner and don’t always use condoms.

If you keep this from your doctor, he might not screen you for sexually transmitted diseases (STDs) or HIV. STDs are easier to treat if detected early and it’s important to know your HIV status to prevent spreading the disease. Simply request a test from your doctor.

Source: Good Housekeeping, September 2017

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1. Aging in the Neck Is Often Linked to the Lower Face
   • Neck aging (loose skin, muscle banding, jowls) is usually connected to aging in the jawline and lower face.
   • A neck lift alone might tighten the neck skin but won’t fix sagging jowls or a poorly defined jawline — which are part of the same aesthetic unit.
2. True Neck Rejuvenation Requires Deeper Correction
   • A proper rejuvenation often involves tightening underlying muscles (platysmaplasty), removing or repositioning fat, and lifting deeper facial structures, not just skin trimming. Attempting to rejuvenate the neck by relying on “pulling the skin” alone will result in stretched scars and a very short-term result.
   • These deeper adjustments are usually done as part of a full facelift.
3. Skin Quality Can’t Be Fully Addressed with Lifting Alone
   • Wrinkled or sun-damaged skin may need laser treatments, peels, or skin care regimens in addition to surgical lifting.
   • A neck lift doesn’t treat skin texture or tone.
4. Isolated Neck Lifts Can Create Unnatural Results
   • If the neck is tight but the lower face remains lax, it can create a mismatch — making results look unnatural.
   • A full facelift provides harmonious rejuvenation of the lower face and neck.

What I Might Recommend

For patients with significant neck aging, the surgeon might recommend:

• Full or lower facelift with neck lift
• Possibly combined with liposuction, platysmaplasty, or laser skin resurfacing
• Personalized approach based on degree of sagging, skin quality, and facial structure

Bottom Line:

A “neck lift” might sound appealing and targeted, but in reality, true rejuvenation of the neck usually involves more extensive procedures. What ever you may need, we have available at our privately owned day hospital Somerset Surgery. #laserreserfacing #liposuction #slimlipo #intenseskinrejuvination

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The good news is there are multiple ways to tighten, tone, and treat this area —and one standout option is SlimLipo, a cutting-edge laser-assisted liposuction treatment.

First Things First: Exercise & Diet

• Strength Training: Exercises like tricep dips, push-ups, bicep curls, and overhead presses help build lean muscle and reduce the appearance of sagging skin.
• Cardio & Diet: Fat loss requires overall weight loss, so combining strength with cardio and a balanced diet is essential. Spot reduction is a myth. You can’t “target” arm fat with exercise alone.

Sometimes, even with diet and exercise, there is little to no improvement in the area. That’s when medical treatments can be considered as an option.

SlimLipo: A Smarter Way to Sculpt

SlimLipo (short for Selective Laser-Induced Melting of Lipids) is a minimally invasive laser liposuction treatment designed specifically for stubborn fat and loose skin. It is especially effective for upper arms.

Here’s how it works:

• A tiny laser fiber is inserted under the skin via a small incision.
• The laser energy melts fat and stimulates collagen production.
• Melted fat is gently suctioned out, and the laser tightens the surrounding skin from the inside.

Results? More sculpted arms, less sagging skin, and a slimmer silhouette—with minimal downtime.

It’s important to note that SlimLipo works best for arms with minimal skin laxity. If there is significant skin laxity surgical removal of the skin may be your only option.

What’s Recovery Like?

SlimLipo can be a fairly minor surgical procedure and most people are back to light activity within a couple of days. Compression garments are typically worn for a few weeks to support healing and enhance results.

Bonus: Because of the laser’s skin-tightening effect, SlimLipo often avoids the need for more invasive surgical lifts. Minimal scarring.

Surgical option: Brachioplasty

A brachioplasty, commonly known as an arm lift, is a cosmetic surgical procedure that removes excess skin and fat from the upper arms, typically between the armpit and the elbow. If performed correctly it will improve the contour and tone of the arms, especially after significant weight loss or due to aging when the skin loses elasticity.

Key details:

• Goal: To make the upper arms look more toned and youthful.
• Procedure: Involves making an incision—usually along the inner or back part of the arm—to remove excess skin and fat. Liposuction may also be used.
• Scarring: Scars are usually present but are placed to be as discreet as possible.
• Recovery: Generally takes a few weeks, with swelling and bruising common in the early stages.

Brachioplasty usually requires general anaesthesia. You will have some down time and meticulous care of the surgical site and scar is needed. Compression garments are typically worn for a few weeks to support healing and enhance results. It’s advisable to have this procedure during the winter months as the compression garments can be hidden under long sleeves.

The Bottom Line

It’s best to consult with a Plastic Surgeon to discuss your options. Together you will find a solution that fits your lifestyle and goals.

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• Love Handles – The fat deposits on the sides of the waist, just above the hips. They can be more noticeable when wearing tight clothing.
• Muffin Top – Similar to love handles, but this term specifically refers to fat that spills over the waistband of pants or skirts, resembling the top of a muffin.
• Back Rolls – Folds of fat that appear on the upper or lower back, often visible when wearing a bra or tight clothing.

All three can be influenced by genetics, diet, and exercise. While spot reduction isn’t effective, a combination of overall fat loss and strength training can help tone these areas. “Back fat” can be incredibly resistant. When you have done the best you can with diet and exercise you can look to cosmetic surgery to help improve these areas.

The most common procedures for these areas include:

1. Liposuction – This is the most effective surgical procedure for removing stubborn fat deposits from the flanks (love handles), lower abdomen (muffin top), and upper/lower back. It sculpts the body by suctioning out excess fat.
2. Tummy Tuck (Abdominoplasty) – If there is excess skin along with fat, a tummy tuck can remove the excess skin and tighten the abdominal muscles, which can help improve the appearance of a muffin top.
3. Body Lift or Back Lift – This is beneficial for those with significant loose skin and fat on the back. It tightens the skin and improves contouring.

Another area of concern for the back is the “Dowagers hump”. A consultation will determine if the visible hump behind the neck is bone, muscle and/or fat. If it is a fat accumulation, this can be treated with liposuction (or in severe cases, it can be excised removing fat and excess skin). If muscle and bone is involved, cosmetic surgery will not improve the appearance of a Dowagers hump.

If you’re considering a procedure, consulting with a plastic surgeon will help determine the best approach based on your goals and body type.

Follow this link (Meet Our Surgeons | Somerset Surgery) for more information

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MASC Laser Clinic provides scientifically proven skincare treatments by expert skincare therapists in a spa-like environment. The MY MASC loyalty programme provides clients with a tailor-made skincare regime for an entire year – compounding the effectiveness of the treatments. MASC Laser Clinic continues to stay at the forefront of developments in the medical aesthetic industry to provide the most effective treatments in a safe and trusted environment.

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In my practice I’ve consulted patients (men and woman alike) ranging in age from their early forties to their late seventies for radical facial rejuvenation. What I know to be true is that an “early” face lift is more effective in keeping a person looking youthful for longer than trying to make a much older face look younger. I’ve always said ageing is like a marble rolling over a curve: It starts off slowly but gathers speed
as the years go by. Having an “early” (in your 40’s or 50’s) facelift seems to have the appearance of delaying the speed at which you age. You will obviously continue to age after your facelift, but your friends who haven’t had a facelift will appear to age more rapidly than you as time passes. A facelift delays the acceleration of the appearance of ageing as the “stigmata of ageing”** compound.

Consult with a plastic surgeon you trust and have a rapport with. They will assess your individual situation and help you determine if you’re a good candidate for a facelift and if it’s the right time for you. They can discuss your goals, expectations, and potential risks to ensure you make an informed decision that’s best for you.

*A facelift cannot improve the condition of your skin. A facelift removes excess skin, tightens skin laxity and repositions the underlying architecture of the face.

**wrinkles, drooping cheeks and eyelids, hollow eyes, neck and jawline laxity

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-Chemical peels: The use of alpha or beta hydroxy acids to aid in the removal of dead skin cells to target superficial pigment irregularities, uneven skin texture, leaving the skin renewed, refreshed and glowing.  Deeper chemical peels may be considered to further enhance results.  Our MASC therapists will advise you on the best option for your skin concerns.

-Medical needling:  A technique utilising micro-needle punctures to stimulate the production of collagen within the skin.  Combined with potent active ingredients, tailored to your skin, this treatment will assist with signs of ageing, textural and pigmentation irregularities and scarring.  Our needling options vary from Platelet Rich Plasma (PRP), SCCM (Stem cell conditioning media), AQ GFIT (Growth Factor treatment) and the ‘normal’ needling treatment with chosen active serums.

-Laser:  Our laser platform allows us to select a treatment wavelength suited to your concern, be it sun-induced pigmentation, fine lines and wrinkles, textural irregularities or vascular issues (fine broken vessels).  The modality used will be determined by the MASC therapist to achieve the desired result. Homecare ingredients to incorporate:

-Vitamin C: This potent anti-oxidant ingredient assists with skin brightening, protection against free-radical damage from environmental exposure and has the potential to stimulate collagen production within your skin.  At MASC, we have a wide range of Vitamin C rich products.

Our favourites are: SkinCeutical CE Ferulic, Lamelle Vita-C Lipid, Obagi Professional C- Serum, Neostrata Vit C+PHA serum.  (All Vitamin C serums are 15% off in the month of April)

View products here >>

-Vitamin A:  A potent ingredient that assists in reversal of skin-damage, refines skin texture, assists with pigment irregularities and forms a vital part of any anti-ageing routine.

Our Top pics: Lamelle RA serums, Neostrata Potent Retinol Complex, Obagi 360 Retinol 0.5, Environ Original and C-quence ranges.

View products here >>

-Growth Factors:  Potent collagen stimulating ingredients that will enhance any ant-ageing routine.  Our top sellers: AQ skin Solutions Active serum, Dermaheal range.

View products here >>

-Supplementation: A healthy body leads to a healthy skin.  Incorporating anti-oxidants and anti-ageing ingredients into your daily routine will not only assist your body but will contribute towards skin health and enhanced anti-ageing.

We’ve seen noticeable results from:  NADplus, Ovelle D3, Pro-Active Collagen, Defiance Collagen. Our therapists can guide you on the best option.

By combining in-clinic treatments with a targeted homecare regimen and suplimentation, you can effectively address post-summer skin concerns and restore your skin’s health and vitality for the autumn season. Book a consultation with one of our experienced MASC therapists to customize a treatment plan tailored to your specific skin type and concerns.

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As 2023 draws to a close, I’m forced to pause and reflect on the year that has gone by.  2023 is a year I would not want to relive at any price but as we enter the festive season of thanksgiving and gift giving, I still am able to marvel at the gift 2023 has been to me.

Most of you know I was in a serious motorcycle accident in March. I had many broken bones and spent weeks in hospital and had numerous operations.

In May of this year I posted a Blog post where I made the declaration:

I will make a full recovery and I will be returning to the work, career, and team I so love within the next few months. I will use this recuperation period as a rare chance to reflect on life’s priorities and how to approach the future with the insights I have gained – insights you can only gain form such a life changing incident – so that through this whole process I, my family and all of those that I share my life with both professionally and personally can emerge from it better than before.

Now in December, I am able to confirm, that by the grace of God, this declaration has manifested. It’s been the toughest few months of my life to face the physical challenges I have and still perform on the top line to obtain the best results for my patients. I have been humbled by the faith and trust my patients have in me. The patience of those who waited for me to recover to the point that I was confident I could perform their surgery at full strength. My gratitude knows no bounds.

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Most commonly patients tell me they first became aware of a potential problem with their breast health when they felt a painless lump in their breast tissue during self-examination.  Another large group of women I treat received the dread diagnosis when a mass was discovered at a routine annual mammogram – sometimes these patients had no symptoms.  The vast majority of patients I see for breast reconstruction with mastectomy have been diagnosed in the early stages of the disease and they mostly have a very good prognosis and can look forward to a fulfilling, healthy life after treatment.  Less commonly, patients report to me that there were changes in their nipples that alerted them to the fact that “something was up”.  There is a lot of emphasis on lump detection, but there are other signs and symptoms that women and men should be aware of that could be early signs of breast cancer.

1. Nipple discharge
   It is obviously normal for women who are breastfeeding to have a milky discharge from the nipples.  Outside of this, any discharge that can be clear, milky, yellow, green or red should be investigated without delay.  The discharge can be from one nipple or both and can be thick or thin in texture.
   
2. Nipple retraction or inversion
   Cancerous cell changes behind the nipple can cause the nipple to invert, retract or the areola to appear indented. The size of the nipple areola can also change (shrinking or enlarging).  It is important that you observe your nipples during self-examination and note the differences in your nipples appearance due to monthly hormonal fluctuations.  If your nipples appear to have altered from your normal – seek medical attention as soon as possible.

   Any persistent, crusting, flaking or itching of the nipples should also be checked.

Nipples and breast reconstruction

If the type of breast cancer the patient has, does not affect the nipples AND does not have the potential to affect the nipples then it is possible to do a nipple saving mastectomy and reconstruction.

If however the nipples are affected and need to be removed at the time of mastectomy, there are many ways a plastic surgeon can reconstruct the nipple to make the breasts appear as normal as possible.

Options include:

• Nipple sharing (using the tissue from the unaffected nipple to reconstruct a nipple on the affected breast).
• Nipple creation using skin flaps or toe pulp and tattooing an areola to match colour and shape of unaffected breasts nipple.

I would like to encourage anyone who receives the diagnosis we all dread to investigate the options available to you for breast reconstruction. There is life after cancer diagnosis and it is my aim as a Plastic and Reconstructive surgeon, to make that life feel as normal and as “whole” as it was before the diagnosis.

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