(continued)

 

 

 

 

 

We are very happy to welcome you as Doctor Philippe Chout’s private patient.
Please find attached this 40 pages information pack that you requested regargind our practice.
Its content is as follow :

P.2 : Credentials of Doctor Philippe Chout

P 3-4 : Price policy and price list: cost of cosmetic surgery procedures

P 5-6 : Information concerning anaesthetic methods

P.7 : Treatment for lines: muscle relaxing injections

P.8-9 : Skin mole or scar removal

P.40 : Beauty Design : a new concept of Beautyfication and rejuvenation

face :

P.10-11 : Temporal Lifting surgery

P.12-13 :Face lift ( neck lift and Facelift )

P.14-16 : Eyelid cosmetic surgery : blepharoplasty

P.17-18 : Esthetic surgery of the nose : rhinoplasty

P.19-20 : Ears pinning surgery : Otoplasty

P.21 : fuller or thinner Lips

P.22 : chin & jaw augmentation or reduction :genioplasty

body :

P.23 : Breast Augmentation, breast enlargment with implant

P.27: Breast reduction or breast uplift

P.29 : Fat removal by Liposuction or Liposculpture

P.30 : Fat transfer (filling)

P.31-32 : Tummy Tuck (abdominoplasty), arms or thigh lift

P.34 : Labiae Vagina (labiaplasty)

P. 37: The buttocks lift

P.38  :  General pre and postoperative recommendations

 

 

 

 

Dr Philippe Chout AIHP, ACCAHP, MD
Specialist in Plastic and Cosmetic Surgery
Registered with the UK General Medical Council n° 4783516.
Registered with the French Medical council n°64900
Email: mrchout@yahoo.co.uk
Tel: +44 207 193 8382     +447 947 022 907
www.doctorchout.com

 

 

 

TEMPORAL LIFT

 

You are about to undergo surgery for Temporal Lift done by Dr Philippe Chout. There is some information you must be aware of, you should save and remember it:

Surgery will be performed most often under neuroleptanalgesia, that is to say intravenous sedation plus local anaesthetic as a day case procedure.  Sometimes it is performed under general anaesthesia and will require 24-hour hospitalisation.

The principle of the temporal lift by Dr Philippe Chout is to make a more or less extended incision in the hair above the ear, behind the anterior hairline, and to detach (undermine) in depth the anterior portion of the forehead and temple skin, eyebrow area and malar skin areas. Then this area will be pulled and deep stitches will be placed. The incision and the scar are therefore hidden in the hair and not visible. It is then possible to lift them and place permanent stitches in depth therefore treating and adjusting as required:

1. Sag of the external end of the eyebrow
2. Sag of the upper part of the cheek and cheekbone fat
3. Marked nasolabial folds
4. Low position of the external part of the eyes  (with, if required, a small incision: canthoplasty)
5. Shape of the eyes and gaze (doe eyes)

 

The temporal lifting has no effect on a sagging jawline, nor to the oval of the face, jowl, neck and chin that require a face lift, nor on crow’s-feet wrinkles that can be treated by muscle relaxing injections (e.g. botox). It does not treat a skin excess to the lower eyelid.
The temporal lifting has some effect on the nasolabial folds, especially when a fat transfer is done at the same time (charged separately).
according to Dr Philippe Chout the temporal lifting is the proper procedure to correct a sad face for a patient as young as
30 –40 years old, and to provide improved, rejuvenated looks without revealing surgery as incisions are hidden.
Recovery time and after-effects are simple and of various duration depending on individuals. Usually a week off social life is enough. The small clamps in the hair-bearing scalp are removed on the 8th day. Swelling of the upper part of the face and eyelids due to postoperative oedema and ecchymosed will decrease gradually over the first 10 days, then the residual oedema will disappear in the next few months.
It is usual the first weeks to have a bulge in front of the hairline: this will disappear spontaneously.  Loss of hair is a rare event. Sensitivity, and subtle mobility of the scalp around the incision will return within a few months (with a possible pruriginous stage).

The Model Lift is a simpler version of the temporal lift for people in their 30’s. The incision is shorter, detachment is less extensive, and the results may be obvious though, and often quite spectacular, but may not last as long as a Temporal Lift (whereby a larger undermining and detachment is performed).  Again a fat transfer to the cheekbone area and nasolabial folds will give a more dramatic result. This excellent procedure can add some tension to the cheekbones and result in a more attractive gaze, as when one’s hair and temple is pulled back and up. It is usually possible to go public very soon after the operation.

Forehead plus Temporal Lift at the same time is quite a different and heavier procedure says Dr Philippe Chout.
It can be done by a keyhole procedure and is then called endoscopic forehead lift or with long Incisions, extended undermining; as a consequence recovery would be longer. It is possible to correct the forehead’s horizontal wrinkles, and vertical glabellas wrinkles (« lion’s wrinkles »), by performing a forehead lift in association with the temporal lift. This one-stage procedure, called a fronto-temporal lift, consists in combining incisions described above, followed by detachment of the frontal skin in order to diminish the activity of frontalis and supercilii muscles, thus resulting in a smoother brow.
Alternatively it would also be possible to work only on frontal area (forehead) with an endoscopic approach, and a  shorter according to the Doctor’s choice.

Additional Procedures
A number of additional procedures could be performed at the same time alongside the temporal lift, upon the patient’s request. They would be charged separately:

1. Excess skin or fat bulges in the upper and lower eyelids can be removed (upper or lower blepharoplasty).
2. Fat transfer to the cheekbone and nasolabial folds or to the chin to give a chiselled look.
3. Skin improvement with creams based on retinoic acid or peeling.
4. When performing a fronto-temporal lift, protruding bony rim above the eyes can be reduced. These arches can be attenuated, and forehead rounded prominence can be improved by grinding and rasping.
5. The position of the external  corner of the eyes (canthus) can be modified and lifted (canthopexy or canthoplasty). This can help to give the Doe eyes, which is a very feminine and attractive feature. The combination of these procedures is called a Mask-lift. Thisheavy operation, much heavier than a temporal lift plus fat transfer, is rarely carried out.
6. All these, if done at the same time, would result in major changes in facial expression and physiognomy and will require an extensive psychological preparation...

 

The possible complications of the temporal lift are rare:

1. Haemorrhaging, Haematomas and infection which may require an additional procedure and a specific medical therapy
2. Skin necrosis, and pain are very rare events
3. Poor scaring, adherences, fibrous scar, visible scar
4. Transitory palsy or paresis, or a paralysis of the frontalis or supercilii muscles
5.  Impaired mimic or asymmetrical mimic
6. Local alopecia, loss of hair local anaesthesia of the scalp, persistent asymmetry, itchiness
7. Psychological disorders (depression, psychosis)
8. Cardiovascular, immunoallergic or respiratory (sometimes lethal) complications of anaesthesia.

 

 

In conclusion, The Temporal lift is a simple and effective procedure that will give the patient a brighter and rejuvenated gaze and a younger mid-face appearance, with no visible scars, or barely visible scars and rather short recovery. Dr Chout believe that this is the best midface lift procedure.

 

 

 

FACE LIFT

 

Before the Operation
The purpose of the facelift doneby Dr Philippe Chout is rejuvenation by the reduction of face and neck sagging (ptosis) that is commonplace from about 50 years of age, sometimes earlier. This procedure can be performed under  intravenous sedation plus local anaesthetic or under general anaesthesia, which requires 1 or 2 nights hospitalisation.

The principle of a face and neck lift is to make incisions in front of and behind the ears ending in the hair) and to detach the skin, and in some cases also the underlying skin muscles, and stretch them to restore some tone to a sometimes prematurely sagging face. Face-Lifting improves the jowls, cheeks, deepened nasolabial folds, neck folds and turkey’s neck.

The Facelift treats a skin and fat excess but does not change the actual quality of the skin itself like a face peel would do. It will have no effect on the lower neck wrinkles, on crow’s-feet, on bulging lower eyelids, nor on smaller wrinkles around the mouth, which can benefit from other specific treatments.  Incisions are made into the hair-bearing scalp above and in front of the ear ; in the pre-auricular area ; behind the ear and then back into the hairline. Sometimes a small incision is made under the chin.  Drains may be placed on each side of the face, under the detached skin. A moderately compressive dressing is applied which will be left in place for 48 hours.  Sutures are removed on the 5th day and scalp clips on the 10th day approximately according to Dr Philippe Chout.
Work can be resumed after two to three weeks, depending on public exposure at work, and on your requirements.

After the Operation
Swelling (tumescence due to oedema) and bruising (blue face) is usual after this operation to an extent depending on each individual. It may sometimes be quite impressive.
Usually, the patient’s face is presentable between the 10th and the 21st day after an average face-lift, with the final result visible after a minimum of three months. Some individuals have a tendency to bruise easily and may have a longer recovery time.
Nurses give the first shampoo before the end of the second day, with subsequent shampoos by the patient. 
First colouring of the hair or first hair-set cannot occur before the 21st day after surgery. It is advisable to have any coloration done before surgery.

The patient should bring a scarf and large sunglasses to be worn when leaving the clinic.
In the case of a mini neck lift, the same incisions are made, but with a reduced sub-cutaneous detachment, thus resulting in simpler and shorter postoperative after-effects but also a less dramatic effect.

Some usual and transitory after-effects which can be of concern to the patient :
Primary swelling (oedema) and bruising will result in a very round swollen face, which is normal as an after-effect of lifting. These will regress downward over the next two to three weeks, i.e. at Day 10 the residual oedema is located around the lower cheeks and the neck. This secondary oedema regresses more slowly, over the next few months, and is variable depending on the time of the day. It can be asymmetrical, with no prognostic significance, most offten related on the side you sleep on.

Bruising of various shapes and coloration, often asymmetrical will eventually disappear completely within 10 to 21 days in most cases. Arnican mask, arnica pills, massage and lymphatic drainage improve the oedema rapidly and prevent the formation of adhesions.

Postoperatively, Mister chout waren patients that scars will be pink-coloured and itchy between the 4th and the 20th week, and partial make-up should be applied. They eventually become thin and barely visible, although their final aspect cannot be predicted. Keloid scars can occur in 5% of cases.
It is not uncommon to feel slightly numb in the area that has been treated. This may persist several months before disappearing. Sensitivity in detached areas will be restored progressively after the third month.

The serious complications of the face-lift are very rare. They can require further surgical or medical treatment:Haemorrhaging and oedema, which may in some cases, necessitate an additional procedure and an adapted medical therapy, as well as, exceptionally, a blood transfusion.
Infection caused by an untreated haematoma - Cutaneous necrosis, mostly seen in smokers.
This could require dressings for a month.
Permanent injury to a branch of the facial nerve, resulting in paralysis (palsy) or paresis of a muscular group affecting facial expression. Non permanent facial nerve palsy can be seen in relation with local anaesthetic drugs. Parotid fistula, local alopecia : loosing hair locally.
Localized scalp hypoesthesia (loss of sensitivity)  or an earlobe anaesthesia, chronic pain, thick scars
Cutaneous adhesions and protracted residual oedema are improved by prompt and frequent massage, large elevated and pink scars.
One should also mention the sometimes lethal or invalidating cardiovascular, respiratory or immune-allergic complications of anaesthesia, which may evolve independently.

 

When performing a Face and Neck lift, simultaneous surgery can be made for :
- Forehead and temple lift : This operation specific aim is lifting the eyebrows and temple area. The addition of a face and neck lift to a temple and forehead lift is called full face lift and the  charge is £ 9,000.00
- Cosmetic eyelid surgery in order to remove fat and skin excess to the eyelids is called upper and lower blepharoplasty, and charged £ 4,000.00 approximately
- Fat transfer by injection after liposuction from the thigh or abdomen area (lipofilling) to restore a certain fullness of cheekbone, chin and nasolabial folds and correct some contour anomalies is £ 3,000.00.
- Wrinkle filling by the same injection technique.
- Face peeling with diluted trichloracetic acid TCA for lines around the mouth (£ 500.00) .

In conclusion, the purpose of the face and neck lift is to improve the facial oval and to reduce muscular and cutaneous sagging of the neck and cheeks. It attenuates deepened nasolabial folds and « bitterness » wrinkles to the corner of the mouth. A face lift can remove a decade from your real age but it will never restore the exact face of your age , because not only do skin  and muscles alter with age , so does bone structures (cheekbones, jaw-line) which is impossible to change. Its effects are maintained for 10 years but a face-lift may be performed two times in the course of a lifetime.

 

 

 

 

 

BLEPHAROPLASTY

cosmetic eyelids  surgery

 

Cosmetic eyelid surgery, or blepharoplasty, is an operation to remove excess skin, fat and muscle from around the eyes to produce a more alert and youthful appearance. The blepharoplasty procedure can be performed on the upper and lower lids, at the same time or separately by Dr Philippe Chout.

Why have cosmetic eyelid surgery?

As we age, the skin around our eyes loses its elasticity. You may develop loose folds of skin on the upper eyelids and deep creases on the lower lids. At the same time, your muscles in this area may also slacken so that any fat bulges forward and looks baggy. Cosmetic eye surgery can remove the excess skin, fat, or both, from around your eyes. Sometimes you can develop baggy eyes in your 20s before your skin changes. You can inherit this trait from your family.  Cosmetic eye surgery may also improve your sight if saggy skin in the upper lids hangs over the eyelashes to obstruct vision. The surgery can also remove wrinkles, but only those in the skin that is cut away in the operation. It will not remove "crow's feet" and cannot change the colour of dark shadows under the eyes. It is important to discuss with your surgeon what you are hoping to gain from the operation, and the result you can realistically expect.

What are the alternatives?

 No other treatment can properly reduce a skin excess. In some cases, wrinkles around the eyes may be reduced using chemical or laser treatments, or by a forehead, or brow, lift. For more information ask your doctor for advice or see the separate fact sheets on Laser facial resurfacing and Facelifts. Many creams, gels and beauty treatments claim to be able to tighten the skin around the eyes. However, there is no scientific proof that they work on a permanent basis.

What happens before cosmetic eye surgery?

You will have a consultation with your surgeon Dr Philippe Chout before your operation. He or she will ask about your general health and discuss how to prepare for your operation. Your surgeon and your Ophtalmologist will examine:

• Your eyelids
• Your vision
• Your tear film (a layer of tears covering the surface of your eye)
• The front of the eye
• Your retina - an area on the rear wall of your eyeball
• Your whole face to see the condition of your skin
• The position of your eyebrows and eyelids, which will be measured

 

The Operation

The operation lasts one to two hours, less if just the upper or lower lids are being done.1, 3 it can be performed as a day case, which means that you can have the operation and go home the same day. However, you may need to stay one or two nights in hospital for observation.  The surgery can be carried out under a local anaesthetic, in which case the area around your eyes will be numb but you will be awake. It can also be done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Your surgeon may use either conventional or laser techniques.  For surgery on the upper eyelids, cuts are made:

• Into the natural lines and creases in your eyelid
• Into the laughter lines at the corner of your eye

For surgery on the lower eyelids, cuts are made:
- just below your eyelashes, which means the scars will run along your eye's natural folds, hiding them     as much as possible

Excess fat, muscle and loose skin are then removed, and the cut is closed using fine stitches. These are generally removed two days to a week after surgery. If only fat is being removed, the cut can be made on the inside of the lower eyelid, leaving no visible scar. This is called a transconjunctival blepharoplasty. You should remember the difference between:

• Cosmetic blepharoplasty, i.e. eyelid rejuvenating surgery, which consists in the removal of excess skin or fat from the upper or lower eyelid;
• Eye expression improvement surgery which consists in changing the position of the eyebrow external part, the shape of the external part of the orbital rim, the location of the eye’s external canthus, and, if necessary, in removing excess skin or fat from the upper or lower eyelid.

       The scope of blepharoplasty is not to change the eye expression but to make it look younger.

 

Lower eyelid blepharoplasty/Upper and lower blepharoplasty

This procedure is performed by Dr Philippe Chout under general anaesthesia or neuroleptanalgesia, and requires overnight hospitalisation, as well as all tests as described above.

The resection of fat deposits and wrinkles in the lower eyelid is made either internally, with no visible scar, or externally. In that case, there is a small scar along the lower eyelashes; this also permits resection of excess skin, or correction of a bulging orbicularis muscle.
There are no postoperative pains but rather discomfort. Suture threads are removed on the 5th operative day.
The after-effects are the same to upper blepharoplasty.

On the 10th day, both postoperative oedema and ecchymoses have significantly regressed, but final results are visible only after three months according to Dr Philippe Chout. Normally, work can be resumed after a week. For a few months, there may be a slight oedema, which can be asymmetrical, and can be attenuated by massage.

After the Operation

After the operation, your eyes may be covered with gauze pads. The surgeon will apply some sterile paper tape to support the eyelids after surgery, which is normally removed after three to five days. Sometimes you will be advised to use the support for the lower eyelids for a week or so. An ointment will be applied to your eye area to prevent it from drying out.  You will be given painkillers to help with any discomfort as the anaesthetic wears off.  If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours. Before you leave hospital, a nurse will give you some advice about how to care for the eye area and you will usually be given an eye ointment to use at home.

Recovering from cosmetic eye surgery

Once you are home, you may take further painkillers if you need to.
You will put the prescribed teardrops four times a day in both eyes during eight days. Follow the hospital's advice. Applying a cold compress, such as an ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an "ice burn". There are some important things to remember while recovering from cosmetic eyelid surgery according to Dr Philippe Chout.

• Keep your head higher than your body by lying propped up on pillows, and avoid bending over for a few days. This will help to reduce swelling and bruising.1
• Clean around your eyes and use any ointment that the hospital staff gave you as they instructed.1
• Avoid wearing eye make-up until a couple of days after the stitches have been removed, or for as long as your surgeon tells you to.1
• Avoid wearing contact lenses for three weeks (they may still feel uncomfortable for a while after that).
• Avoid driving until your vision has returned to normal and your eyes have stopped watering.
• Most people are able to read or watch television within a few days. People usually feel like returning to work after a week to 10 days.

 

Deciding on treatment

It's important not to rush into the decision to have a cosmetic operation. And, it's sensible to discuss the issue with your GP. Cosmetic eye surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side effects and the risk of complications. Side effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having cosmetic eye surgery can also expect sometimes:

• Soreness around the eyes, which can be helped by taking painkillers
• Bruising and swelling for up to a month after the operation, which might make your eyes feel tight and difficult to close when going to sleep
• Sticky, dry and itchy eyes for the first week
• Watery eyes for a few weeks
• Sometimes double or blurred vision for a few days - you should contact your hospital or a GP if this lasts longer than three to four days
• Sensitivity to light for a few weeks
• Tiny white heads along the line where the stitches were - your surgeon can remove these with a very fine needle
• Pink scars for three months, but eventually they become almost invisible

 

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection, or an unexpected reaction to the anaesthetic.  Specific complications of cosmetic eye surgery are uncommon but can include:

A haematoma where a pool of blood collects under the skin around the eye, which may need to be drained in a second operation if it doesn't disappear on its own or if it is large
Swelling that pulls the lower lid away from the eye, which usually settles on its own after a couple of days, but occasionally another operation will be needed
Damage to the surface of the eyeball or the surrounding muscles. Are extremely rare
Acute glaucoma, an eye condition requiring treatment by an eye specialist.
Unusually red or raised scars (called keloid scars) which some people have an inherited tendency to form Sunken appearance if too much fatty tissue is removed.
A difference in appearance of the two eyes - they may not be identical due to your natural and intrinsic asymetry. Partial or complete blindness, as reported in books, is exceptional (0.02%) .
Haemorrhage, infection, diplopia, keratitis, conjunctivitis, ectropion, subcutaneous cysts
For information, cardiovascular, neurological, respiratory or immunoallergic complications of anaesthesia sometimes lethal or invalidating which may evolve independently.

As for all cosmetic surgery, extra costs, which may become necessary due to complications, as well as days away from work, are to be incurred by the patient. The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your doctor will be able to explain how these risks apply to you. Dr Philippe Chout.

 

 

 

 

 

 

RHYNOPLASTY & RHINOSEPTOPLASTY

Esthetic surgery of the nose by Dr Philippe Chout

 

Rhinoseptoplasty is the surgical operation that deals with either modifying the exterior shape of the nose and/or correcting a deviation of the nasal septum, which causes breathing discomfort.
Dr Philippe Chout think that it is possible to change the shape of the nose without changing the respiratory function and reciprocally. In the western people the rhinoplasty aim is to reduce the size of the nose, in the eastern and African nose it’s a reduction on the front view and sometimes and increase of the height of the nose bridge.

Reduction Rhinoplasty (frequent)

Dr Philippe Chout your surgeon will make cuts inside your nostrils to reach the bone and cartilage. Partially removing and re-shaping the bone and the cartilage will then create the shape of your nose. The skin over your nose is left untouched and due to its elasticity, can shrink down to the new shape. Making the nose smaller and narrower may mean it is also necessary to make your nostrils smaller. This is done by making further cuts in the skin of the nostrils, which leave fine scars on each side. Your surgeon will advise you whether you may need this procedure.

Augmentation Rhinoplasty (rare)

Your surgeon will make a cut inside or between your nostrils and re-shape the bone. Additional bone or cartilage may be needed to build up the nose. Bone may be taken from: your hip ,a rib ; this is called a bone graft. If cartilage is used it may be taken from: your ears, spare cartilage inside your nose sometimes artificial implants are used. The skin over your nose will probably not need to be cut as it stretches over the new shape.
After reduction or augmentation rhinoplasty, the cuts inside or between your nostrils will be closed up with dissolvable stitches. Your nose may be filled with surgical packing to help control any bleeding. You may also have small pieces of soft plastic inside your nose to prevent scar tissue from forming.

You will be undergoing a Rhinoplasty

The principle of this intervention done by Dr Philippe Chout is to re-shape the nose partially or totally. It will modify the bone and cartilage skeleton of the nose, which determines the shape, and the replacement of the skin.
The modifications could concern part of all the elements of the infrastructure:  the point of the nose, the nostrils, and the bridge of the nose, the nasal septum.
The modification of one of these elements often automatically lead to the modification of another even untouched, or change its visual perception.  The final modification sometimes of large magnitude is however limited by the quality of the skin and the cartilage of the patient, by the scaring reactions rarely predictable as well as the anatomical and functional realism. Therefore the patient will have to limit his wishes of improvement to realistic expectations. You will never get the nose seen on someone else’s pictures. The goal of the operation is to improve the overall shape not to give “the perfect nose” says Dr Philippe Chout.

Before the Operation
Some photographs will be taken by Dr Philippe Chout before and after the intervention, on these photos the surgeon will outline the plan of operation. The preoperative drawings, the computer study or diverse plastic shapes are not contract but only means of study.
The intervention will take place for the most part under a general anesthetic; a consultation with an anesthesiologist, before the operation, is, therefore necessary. 
You won’t breathe spontaneously during the operation but through a machine.
Do not take aspirin or any medication containing aspirin within the eight days that precede the operation and that follow the hospitalization, due to the fact that this form of medication increases the risks of hemorrhaging.  
The intervention lasts one to two hours in regard to the extensiveness of the operation Dr Philippe Chout says. The hospitalization lasts between 24 hours.
The intervention is performed by passing essentially through the interior of the nostril where a reduction of the size of the nostrils is sometimes carried out. The incision is placed on the threshold of the nostril, which leaves an external scar that is barely visible. The modified pictures on the computer are just study, not contract pictures.

After Surgery
 The intervention is generally painless but uncomfortable because of the plaster to wear on the nose and difficulty to breathe through it.
The operation brings about, during the first week, a feeling of discomfort from the edema to the haetatoma (bruising and swelling) and to the ecchymosed of the eyelids, all of which is customary resulting in nasal fosse as well as the need to wear a nasal plaster for the duration of one week.
Under no condition should you remove the plaster yourself, any manipulation is excessive due to the fact that the nose is extremely fragile during the first week and might possibly risk deformity .You may have a runny nose during the first two weeks, and relative obstruction during the first six month .You should wipe your nose and avoid blowing it. You should put drops into the nasal fosse each day for two weeks and clean the nasal openings with an antiseptic and Q-tip.
After eight days the plaster is removed, the nose does not yet appear shapely as the post-operative edema (swelling) masks the details, and gives to the eyes a strange look. This will disappear within a few weeks. The remaining edema of the tip will decrease in six to nine months.  Professional activities may be continued, normally eight days after the intervention.
Exposure to the sun is possible after one-month minimum.
Sports that expose the nose to any form of trauma should be avoided for two months until the nose become solid. Post-operative intermittent nasal obstruction during a few months is related to the swelling of the mucosa (mucus membranes).

Some complications that are possible but very rare they could delay or alter the final result:
Hemorrhaging, haematoma and infection that can require a surgical intervention are some
 rare complications. Secondary shifting of osteocartilaginious structures after the removal of the plaster, in cases of traumatism.  Obstruction of the nasal valve, the retractile scaring fibrosis, corbin deformity
Skin necrosis, poor scaring, unwanted scar the belated gradual resorbption of a transplanted cartilage graft, Hiposmia, anosmia, and nasal hydrorrhoea,
Psychological disorders (depression, psychosis)
For the record, vomiting, respiratory complications, neurological cardiovascular or allergic complications, sometimes lethal or invalidating due to anesthesia. They can evolve unto themselves.

After the removal of a bump, the aesthetic result is not perceivable when the plaster is initially removed, as the process is not finished until at least six months later.  Actually, the post-operative oedema (swelling) which initially gives a ‘ski slope’ look (round, high and large appearance of the nose tip and a wider space between the eyes) disappears in two weeks to three months approximately.  The scarring of the internal tissue is indeed not predictable and could alter the cosmetic result and therefore a touch up under local anaesthetic 6 months post-operatively could be necessary.
Often, small injections are made in the tip during consultation after the first month (hyaluronic acid). Sometimes when an augmentation rhinoplasty is performed, a cartilage graft will be taken from the posterior part of the ears.
The rhinoplasty can be surgically associated, at the same time, with the modification of the shape of the chin; the combination of these two procedures is called a profiloplasty , a procedure often done by Dr Philipe Chout.

An enlargement or reduction of the lips, the correction of excess skin or fat of the eyelids can equally be performed at the same time.

 

 

 

 

 

OTOPLASTY

Ear-Pinning back Surgery

Ear surgery or otoplasty, is usually performed to set prominent ears back closer to the head or to reduce the size of large ears.  For the most part, the operation is done on children between the ages of   four and 14.  Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.   

All Surgery Carries Some Uncertainty and Risks

Some complications are possible. A small percentage of patients may bleed excessively or develop a blood clot on the ear (haematoma). It may dissolve spontaneously (naturally, on its own) or can be drawn out with a needle.  Occasionally, patients develop an infection in the cartilage, known as chondritis. It can cause scar tissue to form and a deformity to the ear. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area. 
The final quality of the scar is not predictable and may be permanently thick, red, elevated and keloid.
Other Complications include:
A prolonged lymphoma or lymphorrhagia.
The disunion of the scaring contours is a minor complication, but not rare, that regresses with simple repeated dressings done by a Registered Nurse. Excess of Fibrous tissue, chronic pain, loss of sensations and sensitivity.
A defective scar, keloid or dystrophy of intrinsic origin can alter the cosmetic results and call for retouching.  The definitive aspects of the scars are not predicable.
For the record cardiovascular respiratory or neurological complications of general anaesthesia, deep vein thrombosis, thrombo-embolism or immunoallergic, sometimes lethal or invalidating from anaesthesia which can evolve independently according Dr Philippe Chout.

Planning for Surgery 
In the initial consultation, I will evaluate your condition and recommend the most effective technique. I will also give you specific instructions on how to prepare for surgery.

About the Operation
Ear surgery is usually performed as an outpatient procedure in the clinic.  Occasionally, if the procedure is performed as an inpatient, you can plan on staying overnight in the hospital.  For adults, we use local anaesthesia, combined with a sedative, so you will be awake but relaxed.  Ear surgery usually takes about two to three hours.  The technique will depend on the problem.  The most common technique consists of making a small incision in the back of the ear to expose the ear cartilage. The cartilage is then sculpted and bent back toward the head. Non-removable stitches may be used to help maintain the new shape.  Another technique involves a non-scar procedure. The ear is bent with buried stitches and no skin is removed. The technique is simpler and mainly indicated for minor anomalies. The disadvantage is that stitches can loosen and therefore a classic technique should be used in this case.  In most cases, ear surgery will leave a faint scar to the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears in order to achieve a better balance.   

Getting Back to Normal 

You are usually up and about within a few hours of surgery, although you may prefer to stay overnight in the hospital until all the effects of the general anaesthesia wears off.  The patient's head will be wrapped in a bulky bandage immediately following surgery in order to promote the best moulding and healing. The ears may throb or ache a little for a few days, but this can be relieved with pain medication.

Within a few days, a lighter head dressing, similar to a headband, will replace the bulky bandages. Be sure to follow the directions for wearing this dressing, especially at night.  The stitches are usually removed, or will dissolve, in about a week.  Any activity in which the ear might be bent should be avoided for at least one month. Most adults can go back to work about five days after surgery.

Other Ear Problems
Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: "lop ear," when the tip seems to fold down and forward; "cupped ear," which is usually a very small ear; and  "shell ear," when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles.  Sometimes, however, the correction can leave a scar that's worse than the original problem.  The effectiveness of surgery for your specific case will be discussed during consultation.   

More Natural-Looking Ears 

Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is improvement, not perfection. Don't expect both ears to match perfectly, as perfect symmetry is both unlikely and unnatural in ears. If you've discussed the procedure and your expectations with the surgeon before the operation, chances are, you'll be quite pleased with the result.

 

 

 

 

 

FULLER LIPS

 

You are about to undergo a surgical or non-surgical procedure to obtain fuller lips, i.e.

• By surgery, which can be combined with another procedure. It consists in making a V or W-shaped incision in the oral mucosa, then making a Y-shaped closure, thus rolling the lip and increasing moderately the visible vermilion portion. The scar, which is internal, is invisible. For the first three months after surgery, the mouth and the mimic is slightly different warn Dr Philippe Chout.
• As this is a surgical procedure, it involves the usual risks of surgery (such as delay or contracture scar, haemorrhaging, infection and the risks of anaesthesia);
• Or by non-surgical methods, i.e. Dermalive Injection (an association of acrylic hydro gel and hyaluronic acid) or Restylane under the labial mucosa and into the labial muscle. Upon injection of this product, under partial anaesthesia, there is an initial increase in the volume of the lips, followed by a reduction, and finally another increase.  The final volume can only be judged after the 3rd month. An additional injection, at the patients’ expense, may be required after the 3rd month. It is a well-tolerated product, which may involve rejection or allergic reactions only in exceptional cases. There are very rare cases of infection after these injections.

 

Medical and surgical procedures in order to obtain fuller lips are not reversible. A combination of both methods is possible.

 

The signature below indicates that the patient has read and consented to the information given on this page and the preceding pages, has accepted all the conditions stated above and all risks and precautions and is aware of and accepts the limitation of results.

 

 

THINNER LIPS

 

You are about to undergo surgery in order to modify the aesthetics of your lips (by increasing, reducing or curling them). The principle of this surgery is to perform an excision of the mucosa and of a strip of the lip’s orbicularis oris muscle, sutured with an absorbable thread. Post-operative oedema (swelling) and subsequent scar evolution will not permit to appreciate the final results until three months after surgery.  Motility and mimic will be modified.

Risks involved are those inherent to any surgery: hemorrhagia, infection, suture non-union, scar contracture, immunologic complications of medications, cardio respiratory or immunologic complications (sometimes lethal or invalidating) of anaesthesia.
This simple procedure can be performed under local anesthesia.

 

GENIOPLASTY

Cosmetic Modification of the Chin/Jaw

 

According to Dr Philippe Chout Cosmetic alteration of the chin can be:

• A Reduction : either by intraoral incision (in the mucosa) or external cutaneous incision, reduction of the osseous mass or projection and/or of the soft tissues anterior to the bone. Results are visible after a minimum of three months. The risk in this type of surgery is represented by geniolabial anaesthesia, due to stretching of the mental nerve. Other risks are those of surgery (hemorrhagic, infections, scar problems) or anaesthesia (immunologic complications of medications, cardio respiratory complications of anaesthesia, which can be lethal or invalidating).

 

• An Augmentation: through an incision in the mouth or external approach, either osteotomy + metal osteosynthesis, or silicone implant. The Silicone implant is often the best option . It is permanent says Dr Philippe Chout.

• The risk in this type of surgery is represented by chin or lips permanent loss of sensitivity anaesthesia, due to stretching of the mental nerve. Other risks are implant moving creating an asymmetry, those of surgery (haemorrhaging infections, scar problems) or anaesthesia (immunologic complications of medications, choking,cardio respiratory complications of anaesthesia, which can be lethal or invalidating). Normally, prostheses are very well tolerated and become part of the profile, which means that the patient in most cases forgets about it completely.
• In both augmentation and reduction, the relationship between lips and teeth and the motility and mimics are modified due to scarring and volume modifications.

It is not possible to modify the lips without modifying these relationships. The scarring process is not totally predictable, therefore the patient will have to limit their wishes to realistic expectations.

 

 

 

 

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