Example Condition

Hi, I’m Rhona Cameron. I’m an Aesthetic Doctor at McKeown Medical. Today I’m going to use the signature McKeown method to help restore Isabel’s ageing face. Isabel is 55, and this is my first time treating her. If we just stand back and take a look, I think it’s clear that Isabel’s an attractive lady who looks really well for her age. And I think it’s important to just start with that little bit of context before we delve into critiquing her appearance and thinking about how we can improve things for her. Isabel has had some filler injections before, about 18 months ago in another clinic. She had some in her cheeks and lips, and she thinks that’s gone, although I think there might be some of that still present. When I look at Isabel’s face objectively, there are a couple of things that stand out to me that could be improved. The first thing is that she has the classic signs of volume loss that we’d expect in someone of her age, resulting in the deeper lines around her mouth and chin. She also has some sun damage to her skin that we could perhaps improve with some laser treatments down the line. But for today, we’re going to focus on the volume loss. So let’s look at the volume loss in a little more detail so that we can understand what’s happened and work out what we need to do. If I start by asking Isabel to smile, we can see that she’s already quite full in the middle part of the cheek here. So I want to avoid adding volume here because if I do that, when she smiles after treatment, her face will look too full. If we look at the back of the cheek, however, the volume starts to drop off, especially in the lateral cheek fat. So that’s going to be the first area that we restore volume to. If we then come down to the lower face and look at the jaw angle, you can see that the angle of the jaw has started to move up, which happens as the bone is reabsorbed from the mandible with age. So we want to add some volume back here to restore the vertical dimension of the jaw. If we then have a look further forward, you can also see that the chin has started to shorten, and so I want to restore some vertical dimension to the chin too. When we’ve done that, that’s going to emphasise the already existing disconnect between the chin and jawline. So we’ll work along the sides of the chin and then finally soften the lines and wrinkles around the mouth. So I’m starting off with the lateral cheek. I’m just making a little hole in the skin with a needle that allows me to insert my cannula under the skin. The cannula is a brilliant tool, and it allows me to manoeuvre quite extensively under the skin, usually without causing pain or bruising. It’s ideal for augmenting the tissues, although less accurate than a needle in some areas, so I like to flip between the needle and cannula, depending on what I’m doing. I’m just gradually building out the lateral part of the cheek and getting the patient to sit up periodically so I can see how we’re getting on and reassessing if I need to change anything. Constantly adapting the plan according to what I see at the time is key to getting the best outcome. The two sides of the face are never exactly the same, but we want them to be close. So, moving down to the angle of the jaw, and this is an area where we need to be really careful on the female face. The last thing that we want to do is bulk out the jaw and make the face look more masculine, so I need to be careful to get the volume under the angle of the jaw in the areas that have lost volume without making the face look square. At the chin, I need more projection, so I’m going to use a sharp needle here and put the filler down on top of the bone. That sounds like it’s going to be sore, but most patients find it surprisingly painless. By restoring the projection of the chin, it does a couple of things. It first helps to improve the overall facial proportions, but it also helps stretch the chin and improves the angle between the face and the neck. Now that I’ve done that, you can see, however, that it emphasises the disconnect between the chin and the jawline. So I’m going to address that next by restoring volume along the sides of the chin. This is going to really help reduce the appearance of the jowls. Finally, I’m going to use my favourite cannula again to reduce the deep lines from the nose to the mouth. We never like removing these folds completely. In patients who have a full medial cheek, if you remove the nasolabial fold completely, you make the midface look too full and unnatural. And that’s us. Time for Isabel to have a look and give us our verdict. I hate that droop, and now it looks so good. Thanks so much. By following the principles of the McKeown method, what we’re doing is restoring the natural facial contours that have been lost through ageing and volume loss. The important part of the method is making sure that we don’t change the face, but simply restore it, taking account of each patient’s individuality. What we want to achieve is a look that’s youthful and rested, but completely natural.

The best candidates for a lip lift are people with excessive distance between the nose and the upper lip. It’s ideal for people who have a long upper lip or a noticeable distance between their nose and the upper lip, especially if you have too little tooth show when you’re speaking or smiling. Good candidates are also in good overall health with no underlying conditions that could impair wound healing. It’s also only suitable for patients who want permanent results. Patients should avoid having a lip lift if you have a gummy smile already, you should also avoid having this type of surgery or indeed any type of cosmetic surgery if you smoke or vape, since this may result in poor wound healing, which can lead to poor scarring.

The best candidates for a deep plane facelift are people who have moderate to severe facial sagging, especially around the jawline, the jowls, and the neck. To be a good candidate, you also need to be in good general health and have a desire for long-lasting natural results, and understand that to achieve that outcome requires an advanced type of procedure. The main contraindication to having a deep plane facelift is nicotine consumption through either smoking or vaping, or any other nicotine products. Nicotine constricts blood vessels, which impairs the healing ability of our tissues, which is crucial to achieve a safe result.

Today we are going to be treating Kathleen’s skin using our Halo laser, and like we often do when we’re using the halo we are going to start all off with a session of BBL. Kathleen has a history of excessive sun exposure, she has fair skin, and the extent of the sun damage is towards the more severe end of the spectrum. We see these brown spots and patches of pigmentation, there are broken capillaries, which is causing a bit of redness around the cheeks and the nose, there are open pores, there are fine lines, especially around the mouth area. Collectively, all of these signs are the absolute expectation we have of what sun damage looks like as you get on in life. One of the things that we like to do when we’re assessing our patients is just to stand back and look at the overall quality of the skin so that when we’re putting together a treatment plan we are creating something that is really going to achieve an effective rejuvenation for her so that what she ends up with is a really lovely healthy complexion that gives her the outcome she wants rather than just focusing narrowly on the pigmentation and isolation. If Kathleen’s main issues were just pigment or vascular changes with more minor texture issues going on in the background, we may well go for BBL on its own, but when the changes are more extensive like this, we need to start thinking about adding in other things, which is why we’re doing the halo today. We’re going to kick off with the BBL, so let’s just recap on what BBL is. BBL stands for Broadband Light, and it’s our go-to treatment for bursting pigments within the skin. It also has brilliant skin regeneration properties, which, over time, not only make the skin look more youthful but behave in a genetically more youthful fashion. I always want to add in some BBL because I know that it is going to give us some extra oomph to the results. First of all, we are going to do a couple of base passes where we are trying to get as much light and energy as we can into the skin, which just really helps to start that regeneration process. We’re changing the bandwidth of the light that’s going into the skin, we’re changing the amount of energy we’re using, the duration of the energy that’s going in, and the amount of cooling that’s going into the skin, and we’re targeting all of this in this next pass to really break up any brown pigments within the skin. This time, we’re targeting everything to anything that’s red within the skin, so all of the blood vessels, any areas of rosacea, all these things are going to be helped by the BBL pass. Halo, on the other hand, which is the next stage of the treatment process, is a more intensive treatment that is designed specifically for skin resurfacing. So this is when we’re thinking about things like the texture, the pores, fine lines, these sorts of issues is when we want to bring the halo on board. So the way the halo works is that it actually combines two different types of laser. We have one laser, which is an airborne laser which is taking off only some of the top surface layers of the skin, and the other is a fractional diode laser which is penetrating much deeper down. It’s the dual effect of that superficial treatment and the deeper treatment that gives Halo the edge in terms of the results. The halo laser is a little bit more uncomfortable, but we’re going to go at it pretty strong, and we’re going to do an extra pass, especially around the mouth area, to try and get us as much improvement in those lines and wrinkles as we can. And we really just want to maximise what we can get out of this for caffeine today. So after we’ve finished the BBL,  we’re applying the numbing cream to numb the skin before we then start going with the halo. One of the things I really love about this system is the level of precision that they are able to deliver. The system allows us to accurately determine exactly the level of depth of ablation we want to achieve, the exact depth of penetration we want to achieve, both at the surface and deeper down. It then allows us to measure precisely the size of the individual patient’s face so that it can calculate exactly the amount of energy that needs to be delivered in order to achieve those effects that we want to see. That’s a level of precision that I have never seen in any other laser manufacturer. Good. And then turn your head to this side. Yeah, I think you’re going to get a really nice result. So now that we’ve got it all marked up and measured out, it’s just a case of moving the probe backwards and forwards over the treatment area until we get to the end point. And one of the really cool features of this system is that it has an inbuilt sensor that detects how fast the doctor’s hand is moving. So if the doctor starts moving faster, it starts delivering the energy faster. But if you start moving slower, it slows it down, ensuring that we get consistent energy delivery to all different parts of the face. Now that we’ve done the face, we’re going to go back over the perioral region again, just to really target that problem area for Kathleen. And, you know, this varies from patient to patient. For Kathleen, her problem area is the area around the mouth. So we’re going to go super strong or round here. Other patients, it might be that actually they’ve got a lot of sun damage and crepiness on their neck or chest, or arms. And we can treat all of these different areas, too. When we start the treatment, the intensity of discomfort is pretty mild. So it’s like maybe a one or a two out of 10. The intensity does start to pick up, and it becomes a little bit more spicy as the treatment progresses. By the time you get to the end, I would say that the intensity of discomfort is probably around a six or a seven out of 10. It’s pretty uncomfortable, but it’s not an unbearable level of discomfort. And it fades pretty quickly after the treatment. Usually, within the first hour, your face almost feels back to normal, where there is no more discomfort. You just start to see the swelling and the redness begin to develop. It is bearable and totally worth the results. When the treatment is over, there is some discomfort. It’s a really intense warmth that probably lasts for maybe 30 minutes to 45 minutes. And I remember when I had this done myself for the first time, and the people from Cyton said, “It’s going to go really quickly.” And I thought, “There is no way this is going anywhere quickly.” And then all of a sudden, after about 45 minutes, it did disappear. So the discomfort that you experience afterwards generally is pretty short-lived. And then it’s just a case of waiting for the redness and the swelling to evolve. And what typically happens with that is that it gets worse in the second day, worse again in the third day, and then it starts to improve. The amount of downtime that you have will vary from person to person, depending on exactly what we choose to do. For most of our patients, I’m expecting you to have downtime of between five and seven days. Now you will see online, some people promote the halo laser as a two or three-day downtime. But the way you achieve that shorter downtime is by reducing the amount of energy you’re putting into the skin, which therefore means you’re also reducing the amount of benefit you’re going to receive. Our philosophy here is if we’re going to do this, let’s do it properly. Book out an adequate amount of time, and five to seven days, you should be good to go. When that initial healing period is over,  five to seven days,  you will notice some immediate improvements in your skin. They talk about the halo glow, and that is definitely something that we see, but the results do get better, and that’s actually something that I have noticed more with the halo laser than I have sometimes noticed with other lasers in the past. So you definitely do see that initial short-term improvement, but it does get better over the first two or three months. Patients are usually happy after a week, but they’re delighted at three months. After we’ve got you healed from your Halo laser and we’ve got your skin quality improved, we want to keep you at this new elevated level of skin quality, so we need to do some maintenance. And the way that we recommend you do that is by coming in maybe twice a year for a single BBL session. And that’s just a really nice, gentle way of maintaining the results that you’ve achieved and keeping your skin health at that level that you want to be at. Any questions or suggestions for future content, please pop them in the comments section, and don’t forget to like and subscribe to our channel. Thank you