Latest Trends & Innovations
Dr. De Silva practices cosmetic surgery with a continued focus for innovation to ensure his patients are receiving the best treatments to achieve natural looking results, are effective long-term. Over the past 5-years there have been large innovations in the treatment of facial ageing and surgical techniques. Dr. De Silva’s philosophy favours hidden incision techniques that enable natural looking results and avoid scars. In addition he invests in state-of-the-art equipment and machines to ensure only the best for all his patients. Dr. De Silva won funding to achieve specialist training in 3D High-Definition techniques that promote rapid recovery following cosmetic surgery.
Our doctor believes fat grafts persist longer than any other filler and does not involve any allergic reactions. With Our doctor’s microinjection methods and with his careful harvesting techniques done at low pressures to preserve the membranes of the fat cells, 50 percent of the injected fat can last for 5 years. Our doctor has specialized methods to get the fat cells to preserve its integrity which is important for longevity. Our doctor points out that it is not the fat that is important but the fat cell for longevity of the transplanted graft to last.
Platelet Rich Plasma (PRP) Therapy is at the forefront of new medical and surgical treatments. Many Professional sports starts have utilized this technology to enhance their recovery following injuries by natural stimulation of the body’s self-repairing mechanisms. Tiger Woods reportedly underwent PRP injections before all four professional golf majors.
What does PRP treatment involve?
For PRP treatment, a clinician removes a small vial of patient’s blood and spins the contents in a centrifuge. The components are then processed to isolate a growth factor concentrate that when re-injected into the human body stimulates the body’s own repair mechanisms.
How does PRP work?
The technology remains at the forefront of innovation, and the science behind the technology is thought to result from the promotion of body regeneration through growth factors. Body injuries and aging are characterized by a mixture of long-term inflammation and soft tissue damage through sun light, the growth factors are able to trigger healing and rejuvenation
What are the advantages of PRP?
- PRP is produced as a natural product from a person’s body, so this makes the technique very safe, one cannot get infections or allergies to one’s own blood.
- PRP has been used by professional athletes as it is natural body product and therefore is completely legal to use in professional sports.
- Dr. De Silva uses a modified PRP as a treatment for specific facial conditions such as acne scarring and dark circles. These conditions are very difficult to treat with traditional treatments and modified PRP offers patients an alternative treatment that can by highly effective in some patients.
What are the disadvantages of PRP?
- PRP is not a useful treatment for all facial ageing and has a limited effect on loss of volume and soft tissue decent.
- PRP is a relatively new technological innovation, as a result although it is being used by professional athletes has fairly limited availability in clinics and hospitals.
- The duration of effectiveness of PRP is not known, although their impact may be modified by processing before re-insertion into the body, there has not been sufficient scientific evidence at this time to predict how long PRP is effective for.
Fat Stem Cell Grafting
What is Stem Cell Surgery?
The use of stem cell technology aims to restore the youthful contours and shape of the face as well as an improvement in skin quality.
What are Stem Cells and why are they so important?
See this page, Stem Cells in Cosmetic Surgery.
The innovation is based on the regenerative capacity of a group of cells called adult stem cells. Stem cells are unique in the body in that they are specialized and have the potential to become a particular cell type and replace worn and damage cells. A large proportion of stem cells exist in fat. Stem cells are transplanted with fat to a different parts of their body, some of these cells then live in these new areas helping to form new tissue at the transplanted site. The regenerative properties of the stem cells along with transplanted fat provide a marked improvement of survival of these tissues. When the transfer is combined with other cosmetic surgery such as facelifts, the effect of the surgery can be enhanced. The use of stem cell technology is at the forefront of anti-aging medicine. There is good subjective evidence of improvement in results however some of the claims made are yet to be substantiated.
Sometimes the terms used can be made confusing as “stem cell facelift” may be used to describe the injection of concentrated stem cells into the face, without surgical lifting of the face. Dr. De Silva utilizes fat stem cell transfer in a number of specialised facial cosmetic procedures to improve the results as volume is lost in your face with facial ageing, the use of these techniques gives a natural looking result. All techniques are tailored to the individual’s face. This procedure avoids any incisions in the face however is not going to correct soft tissue laxity and band formation in the neck.
The use of stem cell technology as a method of rejuvenating the face remains at the forefront of scientific innovation and is increasingly been a central discussion in medical conferences and research. A team of researchers recently reported in The Lancet (one of the Worlds leading medical journals) that stem-cell enriched fat grafts had the power to transform plastic surgery, both improving the survival of grafts and also success of a more natural looking result.
Stem cell technology is a technological innovation that is at the frontier for anti-Aging Medicine and is presented at International Conferences all over the World. Dr. De Silva commonly uses Stem Cell Technology in the form of fat grafting to support facial surgery. The use of fat stem cells technology enhances the result of eyelid, mid-face and face lifts by working at a macro and microscopic level. The macroscopic effect restores volume that is often a cardinal sign of facial ageing. Microscopically the stem cells are thought to produce growth factors that promote healthy revitalized and rejuvenated tissues.
Blepharoplasty fat transposition (No Hollowing Surgical Technique)
Operative technique: Fat repositioning is not so much a distinct operation as it is a different method of handling the bulging fat during a blepharoplasty. The fat pockets may be approached surgically from either a transcutaneous or transconjunctival route, after which they are dissected out of their thin “capsules” but not removed. The fat is then fashioned into a uniform layer still connected to its blood supply. Most typically, this layer is reflected over the rim of bone and advanced into areas of depression, a procedure sometimes called arcus marginalis release with fat transfer. The leading edge of the fat is usually tucked under a small flap of periosteum that has been elevated from the bone and anchored in place with removable sutures that exit the skin of the cheek.
- Limitations: (See “Comments” below.) Draping of available fat over the orbital rim is only effective in very mild cases of cheek descent and even then only partially. While the term “fat preservation – conservation” has a certain ring to it, such terminology can be misleading. Relocating orbital fat out of the socket, through the eyelid, and onto the surface of the cheek bone is not preserving the fat in its anatomically-correct compartment. As far as the eyeball and socket are concerned, transferring fat onto the cheek is no different than removing it.
- Care and recovery: Bruising may be increased due to the additional dissection out of the eyelid and onto the cheek. Swelling remains noticeable for at least several weeks longer than with fat removal alone. Less commonly, the fat may go through a period of “hardening” that can persist for 3-6 months and make the lid still look full. If the fat is anchored below the lining of the bone (periosteum) to hide its leading edge from view through the thin eyelid skin, swelling may be even slower to resolve and persist for several months.
- Risks and complications: See Chapter 28. Because of the transparent nature of lower eyelid skin, any uneven distribution of the repositioned fat may be visible as an irregular contour. There are reports of “granuloma” formation (inflammatory cystic changes) in the transferred fat as well as double vision caused by restriction of normal movement of the eyeball’s muscles.
Lower eyelid retraction is a risk when the technique is performed through a skin (transcutaneous) incision. The most common adverse outcome is the inadvertent creation of either immediate or late term eyelid hollowness.
Upper eyelid elevation (No Incision Technique)
Drooping of the upper eyelid, termed Ptosis, is a common eyelid condition that can occur with aging of the facial tissues. There is a small muscle behind the upper eyelid that opens the eyelid (the levator aponeurosis) and with facial aging or as consequence of genes, the muscle can slip or is weak resulting a droopy eyelid. Upper eyelid ptosis is often seen in conjunction with excess skin of the upper eyelid (termed dermatochalasis) where both a blepharoplasty and ptosis repair would be necessary. Ptosis repair can be repaired in two principal ways:
- Traditional skin incision technique (Trans-Cutaneous Approach). The most common method for repairing a droopy eyelid in the UK is by making an incision in the crease of the upper eyelid skin, reattaching the muscle and closing the skin with stitches. This method is used in over 90% of NHS Hospitals as the treatment of choice. It is notoriously unpredictable with a need for further surgery in 10-30% of patients.
- Hidden incision (Internal Approach) cam be performed from the undersurface of the eyelid leaving no visible scars. The levator muscle is reattached further down the eyelid in order to allow a wider opening of the upper eyelid. This surgical technique has a far higher success rate, with a need for further surgery in 3-10%.
- Ptosis could also be caused by a nerve problem or from birth and can require further investigations. Rarely if the muscle is too weak, a sling procedure is required that connects the forehead muscle to the eyelid muscle to help elevate the upper eyelid.
Hidden incision technique is relatively rare in the UK. Dr. De Silva completed fellowship training in Los Angeles, where the technique is used in 99% of patients.
Traditional closure of the facial tissues and skin with stitches is effective however may be associated with irritation, discomfort and scarring. The use of fibrin tissue glue in neurosurgery has grown substantially over the past 10 years, and there has been increased use of adhesives in other surgical subspecialties. The safety and effectiveness of tissue glue has been proven in numerous studies although there have been very few studies evaluating their use in cosmetic surgery. Dr. Julian De Silva evaluated their effectiveness in clinical practice through a randomized controlled study regarded as the best possible quality of study. The goals of facial surgery include the rejuvenation of the face, restoration of tissue structure and function while causing minimal downtime. The use of a fibrin glue that induces the normal body clotting and fibrin formation is appealing. On completion of the clinical study, the evidence showed tissue glue to be an effective technique for closing the skin following blepharoplasty. In some cases, there was a substantial enhancement of tissue healing with no evidence of surgery at 1-week post-surgery, no swelling or bruising. Dr. De Silva has pioneered the evaluation and use of fibrin tissue glue in the UK and uses it to reduce downtime following facial surgery. Tissue adhesive glue is tailored for use in various facial surgery patients to reduce bleeding, swelling and reduce the recovery time. Dr. De Silva has presented the novel findings at fibrin tissue glue in facial surgery at International Meetings including the British and European Society of Oculo-Facial Plastic and Reconstructive Surgery.
How does Fibrin Tissue Glues work?
Conventional skin closure after facial cosmetic surgery has been with sutures, these require removal and may cause discomfort and irritation. In addition stitches provide single point fixation with intervening gaps, in comparison to fibrin glue that provides continuous adhesion along the entire wound surfaces. Fibrin tissue glue provides an alternative method of skin closure that triggers your normal blood clotting cascade with potential advantages over conventional stitches including limiting both potential bruising and swelling. The fibrin glue contains highly concentrated fibrinogen and thrombin, and the mixing of these agents promotes fibrin cross-linking that triggers instantaneous wound healing, reducing bleeding and subsequent bruising. The adhesive has been used in specialist surgical subspecialties including neurosurgery and emergency surgery to reduce bleeding. Dr. De Silva uses fibrin adhesive glue in specific facial cosmetic procedures to reduce bleeding, swelling and to avoid the use of sutures.
Computer Imaging assisted Facial Analysis
The use of 3D facial analysis and computer imaging is use to evaluate the unique anatomy and complexities of an individual’s facial skeletal structure, underlying soft tissues and overlying skin. The use of High-Definition photography and 3-D imaging is used to demonstrate the results of cosmetic surgery. The benefits of this technology is that it enables a patient to voice their preference in the results of the facial surgery and the surgeon to communicate whether the result is achievable with the patient’s anatomy and suitability to give a natural looking result. Dr. De Silva utilizes high definition imaging and computer software analysis in some cases to enable clarification, predict results and patient expectations. Rhinoplasty is one surgical procedure that is suitable for surgical planning with this form of computer analysis, Dr. De Silva advises all his patients that the accuracy of such technology is approximately 80% as the human body has been millions of years in evolution and as a consequence healing of body tissues can be estimated and not predicted.
Laser Resurfacing of Skin
The evolution of laser technology has resulted in the latest generation of laser resurfacing machines being more effective and safe. The laser works by using a focused beam of thermal energy in minuscule areas of the skin to trigger skin contraction and encourage newer skin to grow. The benefits of the latest technology includes the control in depth of the laser, range of power options and effectiveness of results. The next generation of lasers are able to delivery the laser energy in a focused beam that avoids more sensitive areas of the face such as the eyelids. The treatment does require aftercare including sun protection and the use of skin ointments to aid hydration of the new skin.
Over the past decade the use of anti-wrinkle medication (Botox) and volume replacement (Fillers e.g. Juvaderm, Restylane, Sculptra, Radiesse) has become mainstream. They are very safe techniques that are effective in rejuvenating the face and winding the clock back several years. One of the most attractive qualities about these treatments are they by definition are “non-surgical”, and area at least delay the need for cosmetic surgery. As a consequent there has been an evolution in the marketing of non-surgical lifting techniques that offer to delay or avoid the need for face-lifting. These techniques include lunchtime lift, Y-lift, these offer a label to a combination of botox and filler treatments.
Why are fillers effective as a non-surgical lift?
Facial ageing is a combination of loss of facial volume, descent of soft tissues with gravity and laxity of tissues. The restoration of facial volume with the use of fillers is an effective way of restoring volume and instant rejuvenation of the face.
What are the drawbacks to non-surgical face-lifting.
The use of fillers to restore volume to the face is temporary and requires multiple injections of fillers long-term as the filler effects will subside over six to eighteen months. In addition although the fillers will have a limited effect in the treatment of soft tissue descent and laxity of the neck and jowls.
Dr. De Silva is skilled with the use of non-surgical treatments, and in patients who are unsuitable for surgery; the use of fillers may be used as an effective method to rejuvenate the face. Dr. De Silva uses modified facial volume replacement with supporting the elevation of tissues with titanium to hold the tissues in place and maintain the result. Rejuvenation takes less than 1-hour to complete and restores facial volume loss. In some patients where there is marked skin laxity, or severe volume loss, Dr. De Silva will advise cosmetic surgery as a more effective treatment for the removal of drooping skin and fat stem-cell augmentation of severe volume loss. Dr. De Silva is exclusively able to offer non-surgical or surgical cosmetic options as he is skilled in both techniques, clinicians who only perform non-surgical interventions often favour non-surgical treatment options.
Prevention of Scarring: Use of Anti-Scarring Agents (Anti-Inflammatory & Anti-Metabolite Treatments)
Facial scarring is a very common occurrence and can result from any wound or injury to the facial skin. Injury to the skin, results in wound healing, however if the body produced too little collagen this results in a depressed or atrophic scar. Less commonly too much collagen is produced which results in an elevated mass termed hypertrophic or keloid scarring. The greater the inflammatory process during the period of healing following injury the increased likelihood of a visible scar. Dr De Silva works with other super-specialists to combat the undesirable effects of facial scarring. Often a multiple modality treatment is favoured.
There has been an evolution in the available treatments for scarring, with the availability of new anti-scarring agents that prevent scar formation. Dr. De Silva is one of very few UK surgeons to utilize this technology to both prevent and treat facial scarring. These techniques are not used in the NHS or UK Hospitals, and are used in the World Renowned Cosmetic Surgery of Beverley Hills in the United States.
In nose re-shaping surgery (rhinoplasty), Dr. De Silva uses a combination of anti-inflammatory and anti-metabolites to reduced swelling and speed up recovery. With the use of this newer technology post-operative swelling can be made to resolve in half of the normal time. In the past, the use of traditional anti-inflammatory agents (i.e. steroids) as a standalone treatment carried a risk of thinning of the skin and “depigmented” pale patches of skin that are very difficult to treat. With the use of agents such as 5-FluoroUracil, Dr. De Silva has effectively eliminated the risk of skin lightening while reducing post-operative swelling. FluoroUracil is a medication that blocks DNA replication and has effectively been used to combat cancer. By giving a focal course of treatments to a specific area, Dr. De Silva has been able to prevent scar formation in a desirable and effective way.
Some patients as a consequence of ethnicity and skin type are more prone to facial scarring. Dr. De Silva has effectively used a combination of scar revision surgery and anti-scarring agents to effectively treat facial scarring. Such agents are effective in preventing recurrent scarring by preventing skin thickening and elevation, avoid changes in skin colour and reduced tissue swelling.
Facial Plastic Surgery with Google Glass
The latest innovation and advances in technology enables surgeons to view photographs and patient information during surgery. This enables surgeons to access key information relevant to a patient’s surgery during the surgery itself including digital x-ray images, photographs, related anatomical information with voice recognition during surgery. Although the Google Glass technology is only available in the US, some specialists have been invited to use, develop and advance the uses of this ground braking technology. Here is how the technology works:
According to Dr. De Silva, “I am always keen to use the latest techniques and innovations that may provide patients either with an improved result or faster recovery. Google glass enables me to access photographs of my patients’ during surgery, I can look at the preoperative photos, look at relevant x-ray or CT/MRI imaging, evaluate specific anatomy during the surgery and potentially fine tune and tailor the surgery with the most accurate information. Fifteen percent of the surgery I perform is revision facial cosmetic and plastic surgery from other clinics and offices, if there is something unusual I can instantly record the findings and show patients the findings after the surgery. Where the anatomy has been changed with previous surgery, it enables the use of scans and imaging to be superimposed during the surgery, enhancing the surgery and results.
In the future this may revolutionize surgery as we will be able to see beneath the skin with the use of this technology. With facial cosmetic surgery millimeters and artistry make the difference between a natural looking result”
Dr. Julian De Silva was the first surgeon in the UK to utilise this technology in blepharoplasty, rhinoplasty and face lifting procedures.
Practice Processes: Electronic patient records
Dr. De Silva has been an early adopter of technological innovation to improve patient care, quality and service. The use of electronic medical records (EMR) has become available in the top medical centres in the World over the past 3-years, e.g. University of California Los Angeles (UCLA). In the UK very few medical organisations have adopted this technology owing to resource and infrastructure limitations. Dr. De Silva has invested in the latest high-tech EMR system in order to provide every one of his patients’ with the highest standard of care. The benefits extend beyond waiting for misplaced written notes and reduced waiting times, with higher level of patient safety through reduced hand written human errors. Dr. De Silva’s philosophy is that to invest in the latest state-of-the-art technology to provide a premium level service and consistency.
Trust your Face to an Expert
Centre for Advanced Facial Cosmetic & Plastic Surgery
Dr. Julian De Silva MBBS MD FACO FACS BSc PGc DIC
The Centre, 89 Hammersmith Grove, London, W6 0NQ, UK
Phone: 020 8748 2860