Plastic surgery may work - but it doesn't last for ever

Fat tissue taken out in breast reductions can grow back, eye-bags can re-form, and while that neck or facelift can turn back the clock, it doesn't stop ticking - with older, less elastic tissue, gravity is likely to quickly take hold.

And there are limits to how many times surgery can be safely and successfully repeated.

This will make alarming reading to the 35,000-plus Britons who went under the knife of British cosmetic surgeons last year, as well as the thousands who went abroad for treatment for operations and the hundreds of thousands more who opted for non-surgical treatments such as Botox and fillers. 

Anastasia Stephens

Line manager: Anastasia felt great after the initial operation to remove eye-bags ten years ago. But now, below, she is having the resulting wrinkles removed. Scroll down to read her story...

Anastasia Stephens

Last year we spent a stupendous £900million on rejuvenating treatments.

Yet, for successful and realistic results, you need to time your cosmetic procedures carefully.

Here, leading experts in the field Rajiv Grover, consultant plastic surgeon and secretary of the British Association of Aesthetic Plastic Surgeons, and Dr Dinesh Maini, cosmetic surgeon at the Nottingham Laser Clinic, suggest the best age for each procedure and estimate how long the effects are likely to last.


Frown lines and crow's feet

Treated with Botox, which reduces and prevents further wrinkling by paralysing muscles beneath the skin.

Best age: 30 and over. 'I wouldn't generally recommend Botox under this age as the skin hasn't wrinkled adequately to merit correction,' says Rajiv Grover, who is consultant plastic surgeon at the King Edward VII's Hospital in West London. 'Those offering the treatment to people any younger could be exploiting their patients' insecurities.' It could also lead to an unnecessary loss of facial expression.

Sell-by date: Lasts for between three and five months depending on the dose and individual sensitivity.


Eye lift

Excess skin is surgically removed from around the eye. Incisions are carefully made around the eyelid, becoming invisible on healing.

Best age: From 45 onwards gravity takes hold and the delicate skin surrounding the eye becomes increasingly slack.

Sell-by date: 'On average, this procedure will put the clock back seven years, but it won't stop the ageing process,' says Grover. 'You may need to "update" your eyes to remove more loose skin in about ten years.'


Eye-bags

Bags under the eyes can be hereditary or may form later with age, usually after 45. They're caused by a pad of fat pulling down on, and stretching, the thin layer of skin beneath the eye.

Best age: From 30 if you have hereditary bags. Otherwise, not until you're over 45 when bag removal is combined with an eyelift.

Sell-by date: Bags can re-form after about seven years, but to a lesser degree. 'The downside of removing under-eye bags when you are younger is that the skin beneath your eye can become looser,' says Dr Maini. 'Over the years, this may cause more under-eye wrinkling than usual. You may then need laser tightening to rejuvenate the skin.'


Cheek lift

Fillers such as Restylane rejuvenate the face and reduce wrinkling by adding volume. Alternatively, fat-transplants, where fat is taken from the thighs or buttocks and injected into the face, are also available.

Best age: 'This procedure is best begun around the age of 37,' says Dr Maini. 'At this point, people begin losing facial volume as collagen tissue which plumps up the face is lost.'

Sell-by date: Fillers generally last 12 to 18 months, then need replacing. Fat transplants last seven to ten years but are unreliable - up to 50 per cent of fat tissue dies and calcified granules can form beneath the skin.


Jowl and neck lift

Surgery can remove jowls around the jaw-line and reduce the appearance of a sagging ' chickenskin' neck by tightening the muscle layer beneath the skin as well as the skin itself. Incisions are made around the hairline and ear and are barely visible on healing.

Best age: 'The minimum age I'd consider this is about 48,' says Grover. 'You need to wait until gravity has really taken hold and enough muscle and skin can be removed to make a significant difference.'

Sell-by date: The procedure puts the clock back seven to ten years but the effects of gravity will continue. Clients may want to update the procedure in seven years.


Breast enhancement

Modern breast implants are made from a type of silicone gel that doesn't leak. They are implanted through small incisions made beneath the breast, which heal with minimum scarring.

Best age: They are most common in the early 20s or the mid to late 30s when women want to rejuvenate their bust after breastfeeding. 'I wouldn't give a woman a breast implant before 18, when the breast is still growing,' says Grover.

Sell-by date: Today's breast implants last 12 to 15 years, after which the surface of the implant develops hairline fractures and begins to harden. 'If this happens, you should get your implants replaced,' advises Grover.


Breast reduction

Women with large breasts may want a reduction to ease the backache and shoulder pain they can cause, and for improved proportion. During surgery, breast tissue is removed and skin is removed to give the breasts a lift.

Best age: Women generally have a breast reduction between 18 and 25 if their breasts are causing discomfort or after 40 when metabolism and hormonal changes mean breasts can become uncomfortably large.

Sell-by date: 'In a small percentage of women, the breasts can grow in size again following surgery,' says Grover. 'They may need to update the procedure in around seven years.'


Tummy tuck

This is designed to tighten the post-pregnancy paunch in women after childbirth. 'Two columns of abdominal muscles are pulled apart in childbirth and are permanently stretched, as is the skin,' explains Grover. 'In surgery, the skin is tightened and the tummy muscles are stitched back together.'

Best age: 35-plus, or when you know you've had your last baby. 'Some women, especially celebrities, are having this immediately after childbirth, but the body hasn't had time to recover and the results may not be as good,' says Grover. 'Ideally, wait for six months after childbirth.'

Sell-by date: None. The results are usually permanent.


Eye-job that left me with more wrinkles

Anastasia Stephens, 37, a writer and holisitic health expert, lives in West London. She says:

Almost ten years ago to the day, I underwent a surgical procedure to remove hereditary eye-bags that made me look haggard, even after a good night's sleep. After the cosmetic surgeon had scraped out two bags of fat from beneath each eye, I couldn't have been happier. Straight away I looked much fresher.

But ten years on, my eyes had prematurely aged. Having the fat removed had loosened the skin under them, and over time, this has wrinkled more than it would have, and in an unnatural way.

Lots of lines developed directly under each lower eyelid where the bags used to be. On the right side where more fat was removed, the wrinkles were noticeably worse, especially when I smiled.

Then, last year I discovered I could have my under-eye skin tightened with one of several new laser procedures. One of these, Fraxel, makes tiny perforations in the skin and heats the collagen layer beneath, which then thickens and tightens.

At the Nottingham Laser Clinic (www.nottinghamlaserclinic.com), Dr Dinesh Maini suggested I have five treatments, costing £300 each every two months. Afterwards, I could expect a wrinkle reduction of more than 50 per cent which would last for six to ten years.

Each treatment took less than five minutes. Dr Maini ran the laser over my skin, which had been numbed with anaesthetic, and I felt a hot prickly sensation beneath each eye; then it was over. For a few days I looked puffy and a little sunburned.

After three treatments the wrinkles have improved. I'm no longer self-conscious about them.

I don't regret having my eye-bags removed, even if the surgery led to more wrinkling in the long run. I'm just glad this new laser treatment has allowed me to give my eyes another nip-and-tuck without the knife.