Facial Aesthetics
Learn about facial rejuvenation options, common concerns and how a personalised treatment plan can help you achieve natural-looking results.
Whether you're considering facial surgery or non-surgical treatments, understanding your options is the first step towards making an informed decision. This guide explores the most common facial aesthetic procedures, what to expect and the key factors to consider before treatment.
In this guide you'll learn:
The difference between surgical and non-surgical facial aesthetic treatments.
Which procedures may be suitable for different concerns, including ageing, facial balance and symmetry.
The risks, benefits and expected outcomes of facial aesthetic procedures.
When to seek advice from a Specialist Plastic Surgeon.
The topic of today’s discussion is facial aesthetics. Katie, Can you give us a brief overview about facial aesthetics?
Procedures to improve the aesthetics or the appearance of the face like many aspects of plastic surgery originally started as reconstructive surgeries. Sushruta in 800BC India performed reconstructive surgeries for patients that had trauma including rebuilding noses that had been completely removed. Some of the skills and techniques started back then are still performed today to restore and improve the appearance and function of patients faces. What started as skills to return peoples appearances back to normal have evolved to techniques to craft and refine the cosmetic appearance of the face.
The earliest cosmetic procedures were described in the Edwin Smith papyrus dated to 2500-3000 BCE describing rhinoplasties to improve noses that were previously fractured, which is a common issue I still see today. Facelifts have been performed since 1901 although at the time the skin was just pulled taut with the excess removed which resulted in an unnatural appearance which is why modern techniques tend to address all the aspects of facial ageing such as laxity in the ligaments, muscles, and fat pads to achieve a more natural look.
Broadly speaking, facial aesthetics also can include non surgical procedures that you can use to alter the outward appearance of the face, these can include lasers or microneedling to address skin texture, pigmentation and fine lines, skin boosters to rejuvenate and achieve a glass skin appearance, radiofrequency devices or high frequency ultrasound for tightening and injectables like neurotoxins and fillers to alter the movement wrinkling and structure of the face to improve facial symmetry, facial balance or reduce the signs of aging.
How would a patient wanting facial cosmetic surgery typically present?
I find these patients tend that come to see me tend to fit into two major groups. Often many have a facial feature that has bothered them for a large percentage of their life, and they have been thinking about coming to speak to someone about cosmetic surgery for a really long time. And they just want to know what things can be done to change or improve that particular feature, whether it be their nose, their chin, or their eyelids.
Others were happy with their appearance, but have noticed signs of aging and would like to look rejuvenated and have some of their previous features restored and come to see me to see what we could do to help. I occasionally see people that have had scarring from trauma or cancer, and more recently a considerable number that have weight loss or medication related facial atrophy like ‘ozempic face’ that are looking to cosmetic surgery to correct these issues. There is no typical patient when it comes to cosmetic surgery everyone comes with different goals, different perspectives and I like to take my time to really listen to what they would like to achieve so I can do my best to help them get there.
What are the risks of aesthetic procedures?
Aesthetic procedures all come with risks. Same as non-aesthetics procedures. The common ones are generally bleeding, infection and scarring. For non surgical treatments like injectables, there’s a lot of risks that many people aren’t aware of like injecting Botox to the wrong area, can paralyse muscles to your eyelid impairing it opening and closing. Injecting filler to the wrong area can block arteries causing blindness or areas of skin loss, which is why its important to see a qualified practitioner.
For any aesthetic surgical procedures It is my responsibility as your clinician to educate you on what results are realistic and achievable. I like to gain insight into the image you have in your head of what you are hoping to achieve and make sure I have the same idea in mind so I can be sure we have mutual expectations. If I feel the results that are achievable are not the same as the expectations its important to talk through why that may be the case.
Other unique risks that patients should be aware of if they’re having facial aesthetic procedures can be specific to the procedure. So, if you’re having a blepharoplasty or upper eyelid surgery, one of the rarest but most concerning risks is blindness or issues with closure of the eyelids.
Rhinoplasty, a lot of patients aren’t aware that by reshaping the size and shape of the nose a less common risk is that they could have issues with breathing long term, often with swelling and oedema there’s initial issues with breathing out of the nose, but that should improve with time. But in some patients becomes an issue.
And with a facelift surgery, the scariest risk that is very uncommon is facial weakness or basically injuring the nerves that control the muscles of the face and that’s something that I always take a long time to discuss with my patients and I’m very careful to avoid during surgery.
What are the treatment options?
There’s lots of options out there to alter the appearance of the face. Some options for non-surgical are things that many people would have heard of like Botox to reduce your wrinkles, filler to replace loss volume in either your cheeks jawline, tear through or can be used to actually change the shape or augment the nose or the chin. Sometimes I might choose to do this in patients that are thinking about possibly having a genioplasty or a jaw surgery. Which is a bigger procedure, and occasionally patients aren’t really quite sure then I’ll put a bit of filler in see if they like it and if they do then they progress to a more permanent option.
Surgical options for changing the shape of the face. Some of them are specifically related to aging and other are just related to facial symmetry. Things like lifting the eyebrows, lifting the lips, obviously lifting the face to give a younger, more rejuvenated appearance. Neck lifts or platysmaplasty are when we reshape the neck and also as a previously discussed a rhinoplasty or genioplasty, our options for altering the nose or the chin to allow patient to have a bit more symmetry or a different appearance.
Have there been any developments in treatment in recent years?
There’s been a lot of changes in facial aesthetics. Obviously 10-15 years ago, without social media being such a big thing that it is now. Since covid when everyone was looking at their reflection all day in Zoom calls small subtle things that you may have only noticed getting ready in the morning or brushing your teeth at night before are highlighted and you are reminded of them with each new online meeting. Before injectables were being done, but were not really spoken about. With certain celebrities being very heavy in the media and influencer culture, certainly non surgical treatments like lasers, skin tightening, injectables of fillers, Botox, those sort of things, have a huge surge in popularity. Biostimulating injections to make your facial soft tissues rejuvenate themselves have increased in popularity as has skin refining injections when the glass skin facial took off in korea.
And then coming on from that, it’s become a lot more normalized to have facial aesthetic surgery to augment the face and that may be things like fat grafting instead of filler to have a more permanent volume replacement. Bony remodelling surgery has joined cheek implants, chin implants and rhinoplasty to change the shape of the face. They have all become a little bit more socially acceptable and discussed in the community.
Thanks to certain celebrities deep plane facelifts have soared in popularity recently even though as a technique it has been around for a long time. Previously many surgeons felt the risk of facial nerve injury wasn’t worth the benefit gained over other facelift techniques but have found that many patients are coming to them specifically requesting it. Obviously there’s always new developments with rhinoplasty, we used to only have the option of using the patient’s own rib if they needed a lot of structural support, and now we have cadaveric rib grafts that can be used if a patient doesn’t want a second donor site. And we now can do 3D custom implants using CT scans. To give the patient cheek or chin implant that is tailored to their face specifically.
Are there any red flags gps should be aware of in patients requesting cosmetic surgery referrals?
One of the recent changes in our field, I guess, is that AHPRA has cracked down on cosmetic surgery clinicians and that is for patient safety. There were a reasonable number of clinicians that were practicing without appropriate cosmetic surgery training, and now there is that stop gap that when a patient used to be able to just Google find someone’s name, make an appointment and go and see them, and then have a cosmetic operation, now GP referral is required for any cosmetic procedures, so GP’s should be aware that that’s something that patients will be asking for.
The safety guidelines have changed, such as you need to have two consultations with a patient prior to even considering offering them an operative date, which I think is good because it gives them the opportunity to go home and think about it, come back and ask more questions and it sort of stops the seeing a patient and then operating on them the next day before they’ve had time to really sink in that this is a permanent life changing body changing procedure that they’re going to undergo.
The other thing that AHPRA has updated with the new guidelines are a body dysmorphia screening survey, which they recommend a clinician to ask the patient questions regarding body dysmorphia. And that’s a condition where patients have an unrealistic expectation of their outward appearance. There are a lot of conditions that fall within that definition, which aren’t necessarily related to aesthetic surgery, but I think it’s important to do those screening tools because those are the patients that tend to have surgery and are very rarely happy with the result because they’re sort of chasing an idea which is unattainable or unrealistic.
So now it’s our responsibility as a clinician to ask these questions of a patient to figure out if they do have body dysmorphia. And then direct those patients to get appropriate help for that. But it’s something that GP should be aware of as well. Now that these patients used to probably just be able to book an appointment with the clinician, they’ll now be coming to you and asking for a referral for cosmetic surgery.
What sort of longevity do you get from aesthetic surgery?
It’s varied, very dependent on genetics, lifestyle factors, how they do post operatively. Some patients will get a facelift in their 50s. And they’ll come knocking on your door in their 80s and go I’m ready for my touch up. And others have a rhinoplasty in their 20s and they never need another revision or aesthetic procedure done for the rest of their life. Same thing with prominent ears. If you’re doing an ear pinning procedure that tends to be lifelong as well, so it sort of is a bit dependent on that from a anti-aging perspective and from people that have had a rejuvenating facial aesthetic surgery, I generally recommend they get enough sleep, drink enough water, look after their skin, and they’re all things to keys to having a really good lasting result.
When should a GP refer?
Anytime a patient’s wishing to discuss cosmetic surgery referring to an ASPS accredited RACS plastic surgeon is a good start. That way you know that your patients in safe hands with someone that’s had appropriate surgical training. And even if a patient has had non-surgical procedures like injectables at a GP clinic and the GP that does the injectables feels that they’ve kind of hit their limit of what they can do to help the patient and then they need to take the next step then that’s a good time to have that discussion with the patient and see if that’s something that they want to undergo.
There’s certain aesthetic procedures that. Medicare rebatable things like blepharoplasty or upper eyelid surgery for people that have dermatochalasis, a which is a condition when where the upper eyelid skin is in excess, there are actually Medicare item numbers associated with that. So, there is coverage for the private health fund for patients that want to have those surgeries. And there may also be medicare items associated with things like rhinoplasty if a patient has issues with breathing or bimaxillary surgery, if their facial balance is out and they need a jaw surgery related to that.
What role does the GP play in the management of patients requesting cosmetic surgery?
The main thing is: Being supportive, being understanding a lot of patients that are coming to ask for this surgery are a bit anxious about it. Helping to pick up any red flags so things like body dysmorphia, eating disorders, anxiety disorders. Things like that don’t necessarily negate a patient from having treatment, but it’s important to be aware of it and make sure they’ve got the appropriate support prior to undergoing any cosmetic surgery.
I think it’s important for GP’s to be a port of call for these patients postoperatively as well. I’m always there for them, but I guess you see them longer than I do. And if you do notice anything or they notice anything that they need more help with or want discussion on, then I always encourage GP’s to send them back to me, even if it’s 10-20 years later.
And yeah, making sure that it’s my responsibility to make sure they have realistic, attainable expectations. And if a GP refers a patient to me for an aesthetic procedure and after discussion with the patient, I don’t think that that’s right for them or I don’t feel it’s attainable then I’m always communicating with the GP that that’s the case.
To sum up, could you please identify the three key take home messages from today’s podcast on facial aesthetics.
Three key things I guess would be everybody ages, it can be done gracefully and that’s with or without surgery. But if surgery is something that a patient is looking into, there is support out there for them, making sure that you refer to a board registered plastic surgeon that’s accredited with RACS, ASPS, ASAPS I think it’s important that way you know your patient is in safe hands because there are a lot of cosmetic physicians out there without the same level of training. And sometimes it is difficult to ascertain who belongs where, so just making sure that you do your research when you’re referring people.
And the third factor I guess would be making sure that patients are aware that these things are permanent and that there are non-permanent solutions out there, like injectables, if it’s something that they’d like a change, but they’re not really 100% certain that’s something that is out there for patients as well.
Considering facial aesthetic treatment?
Whether you're exploring facial rejuvenation for the first time or looking to better understand your treatment options, the first step is a personalised consultation.
Dr Katie-Beth Webster takes the time to understand your concerns, discuss your goals and develop an individualised treatment plan tailored to your facial anatomy and desired outcome. Every consultation focuses on providing honest advice, evidence-based recommendations and natural-looking results.
If you're considering facial surgery or would like to discuss non-surgical facial rejuvenation, contact our practice to arrange a consultation with Dr Katie-Beth Webster.
