Cosmetic Surgery
Keepin up appearances
As we age, gravity starts to work against us as everything faces, bottoms and breasts – start to head south. Dr Ayham AI-Ayoubi of the London Medical & Aesthetic Clinic, one of the UK’s leading laser surgeons, introduces a brand new concept in breast reshaping utilising cutting-edge laser technology
Although breast augmentation is the most requested surgical procedure in the UK, many women actually need a breast uplift to regain the youthful shape once age, pregnancy or weight loss has impacted on their cleavage.
That sinking feeling
In your early thirties you begin to lose elasticity as levels of collagen and fibroblasts in your skin begin to deplete. Pregnancy and breast feeding can make process work much faster it is very rare to see a woman who has had children has escaped intact.
Weight loss is another factor that contributes to sagging breasts as you commonly lose fat from the face first, secondly from the breasts and, only then, the buttocks. There is also a hereditary element – if a mother or grandmother has a tendency to sagging breasts it is very rare for a woman to avoid her genetic fate.
The surgical option
Breast uplift (also called mastopexy) surgery is usually required to correct this problem but it is a very serious operation that often results in more extensive scarring than results from breast augmentation procedures. During the operation, the breast is lifted by removing excess skin, tightening the muscle and recontouring the breast. The nipple can also be repositioned to a more aesthetic position. The advantage of surgery is that it can deliver great – and permanent – results. In about 60 per cent of cases, implants are inserted to ensure a permanent shape.
But there are disadvantages; this is major surgery under general anaesthetic and the recovery period is tremendous three to four weeks of total rest. It is also not suitable for women who still wish to have children so it is usually done on older patients.
Another problem is the risk associated with all major surgery, such as infection or scarring, which is often a big stumbling block for women contemplating this procedure.
Over the years, surgeons have tried many different techniques to improve breast uplift and surgical techniques are continually evolving. Smaller incisions were attempted but the problem is that the more you try to lessen the scar, the less you’re able to achieve in terms of the uplift.
The energy effect
Dr Ayham Al-Ayoubi: I have developed many different laser procedures utilising Cynosure’s advanced SmartLipo MPX machine but when patients requested breast reduction I always refused. There is nothing to say that you can’t laser breast tissue, but I would worry about possible health implications in the future. However, when a patient came to me requesting SmartLipo on other parts of her body she asked me if it was also possible to remove fat above the breast tissue. I introduced a huge amount of laser energy to the area above the breast tissue and realised that it was possible to achieve a breast lift.
A small incision is made under the arm, which will not be visible afterwards, and then the patient lies on her side and we insert a small amount of local anaesthetic. Laser energy is applied, piercing the fat cells in the deep fat without damaging the tissue and then the setting is changed and we target the superficial fat under the dermis. By applying a large amount of laser energy we can produce a skin tightening effect through the process of inflammation and this lifts the breasts.
I have done 38 cases so far and I have managed to achieve a lift between a minimum of three cm and a maximum of six cm, With the patient in an upright position, I measure the difference between the nipple and the clavicle bone -I measure it before the procedure, straight after, three weeks later and, finally, three months on, In most case, a lift of approximately 2 cm is achieved immediately and then further lifting takes place over the next few months.
Safety rules
I use the Cynosure machine because I like to deliver the best to my patients. It is a very safe laser with special devices that protect the patient; Smart Sense measures the amount of energy used so even an inexperienced surgeon cannot introduce too much laser energy that could cause burns or other side effects. Another safety feature is the thermal guide – at the end of the cannula a thermal device measures the temperature under skin so the moment you reach a certain temperature the laser cuts out.
Achieving symmetry
Two patients presented with difference in nipple height and we were able to achieve symmetry by introducing more laser energy on the side that needed it, In terms of ensuring balance for patients where there is no pre-existing asymmetry, this is not possible to guarantee 100 per cent, We introduce the exact same amount of energy to both breasts to ensure the breasts are raised to the same degree but sometimes tissue can react differently. I did have one case where there was a small difference present at three weeks, but the patient hadn’t even been aware of it herself and at three months it had corrected itself.
Long-term forecast
I have been doing the procedure for fifteen months and all my patients still have the same uplift. I believe the results should last for a few years unless pregnancy, breast feeding or further weight loss occurs. However, what is great about this procedure is that it can be repeated.
This is a great procedure for younger women and can achieve fantastic results for women with an A to C cup, With much larger breasts it can have some effect but for them a breast uplift/ reduction surgical option is probably best. As always, patient selection and the consultation process is crucial so the patient is not left disappointed.
To view Dr Ayoubi in the Media click here.
