Although Donald Trump doesn’t seem to believe in the efficacy of face masks, the majority of us are happily donning a mask to help prevent the spread of Coronavirus. One unexpected side effect of this pandemic preventative measure is that it’s putting all the focus on the upper face and making many of us more aware of ageing around the eyes.

Cosmetic surgeons from around the world are noting an increased demand in surgical and non-surgical procedures aimed at making us look more bright-eyed. However, eye rejuvenation treatments have always been popular – according to the figures released every year by the British Association of Aesthetic Plastic Surgeons (BAAPS), blepharoplasty is consistently in the top five most popular cosmetic surgery procedures.

We often notice the visible signs of facial ageing around the eyes before we become conscious of changes anywhere else on the face and body. Non-surgical and surgical treatment to rejuvenate the eye are, therefore, often the first procedure you might consider, and the results can be dramatic.

There are several reasons why our eyes and upper face are so susceptible to the ageing process:

  • The skin around the eyes, particularly on the upper lid, is very thin and more prone to laxity, making it more likely to sag and wrinkle
  • The delicate eye skin is easily damaged by sun exposure, breaking down collagen and elastin fibres in the dermis. This, combined with the physical act of squinting, can accelerate ageing around the eye
  • Repeated facial expressions results in the formation of dynamic wrinkles such as crow’s feet and frown lines
  • Sagging of the tissues below the eyes can cause the appearance of eyebags

What can be done to reverse ageing around the eyes?

A blepharoplasty or eyelid lift is the gold standard for rejuvenating the eye area. An upper eyelid lift focuses on the area between the eyebrow and the lashes. Excess skin is removed and a more youthful shape to the eyes is restored. A lower lid blepharoplasty targets the area from the lower eyelashes and the cheek. Excess skin is removed, the muscles are tightened and underlying fat is reduced or repositioned to achieved a smoother appearance.

During your consultation with Mr Juling Ong, he will advise you on whether an upper or lower lid blepharoplasty, or a combination of the two, is appropriate.

Non-surgical treatments, particularly Anti-Wrinkle Injections, will often be combined with a blepharoplasty for optimal results. Dynamic wrinkles are treated by injecting botulinum toxin to temporarily freeze the action of the muscles we use when making facial expressions. Crow’s feet and frown lines become smoother and more reduced as a result.

To find out if you’re suitable for a blepharoplasty procedure, call us on 020 7927 6528 to arrange a consultation with Mr Juling Ong.

It has long been understood that women who undergo facial rejuvenation surgery experience benefits in the way that they are perceived by others. And now a recent study has shown that men are also perceived to be more likeable – as well as more attractive – after undergoing various facial rejuvenation procedures.

How did the study work?

The study, which was carried out by a team of plastic surgeons at the Georgetown University Medical Center, in the United States, looked at 24 different men who had undergone one or more of the following procedures: facelift, brow lift, neck lift, upper blepharoplasty (upper eyelid lift), lower blepharoplasty (lower eyelid lift), rhinoplasty (nose reshaping), or chin implants.

All participants were patients of one of two plastic surgeons and had paid for their own surgery. They consented to have their pre- and post-procedure photographs used for the purposes of the study.

The surgeons then put together six different surveys, each containing eight photographs, four ‘before’ and four ‘after’ – although they were not labelled as such and no one survey contained two photos of the same individual.

The surveys were then sent to 150 participants, who were not told the purpose of the study. These people were asked to rate the personality traits (aggressiveness, trustworthiness etc) of the subject of each photograph, as well as their attractiveness and masculinity.

The results

Once the responses of the survey had been collated, it was clear that facial rejuvenation procedures overall were associated with attractiveness, trustworthiness, likeability and better social skills.

And specific procedures seemed to be linked to certain traits; for example, brow lifts increased the patient’s perceived extroversion and willingness to take risks, whilst upper blepharoplasty made them appear more trustworthy, and lower blepharoplasty less likely to take risks.

Male and female facial rejuvenation procedures – what’s the difference?

There is a wide variety of different facial rejuvenation procedures available today, and what works best for you will depend not only on your individual facial characteristics, but also to a large extent on your gender and there will be certain differences which your cosmetic surgeon will take into account when planning your procedure.

Anatomy

There’s no getting away from the fact that men and women are built differently. While women tend to be fine boned, with weaker ligament and skeletal structures in the face, men often have larger features and thicker skin.

This makes men’s facial surgery a slightly trickier prospect, as surgical manipulation of the facial structures is not so easy. Men’s skin also has a lot more blood vessels in it, which can lead to a higher risk of excess bleeding during surgery, or scarring afterwards.

Aesthetics

Where women often seek softer, more delicate features from facial surgery, the ideal in men tends towards producing stronger lines, particularly around the chin and jaw.

In a male facelift, therefore, the emphasis is often on tightening the skin around the jawline, whilst women are frequently looking for more of an overall softening of the face, with volume added around the cheekbone area.

Whilst these are broad ideals, specific surgery choices will of course depend on the individual. During your consultation with Mr Juling Ong, he will discuss in full what you are hoping to achieve from surgery and he will take into account your unique facial characteristics while carefully planning your procedure. Call 020 7927 6528 to arrange a male facelift consultation with Mr Ong.

I am often asked about a condition called plagiocephaly which affects many babies and is a real concern for parents. Here are some of the questions that I am asked in clinic, which may be useful for parents who think their baby may have a ‘flat head’ also known as deformational plagiocephaly.

What is plagiocephaly?

Plagiocephaly is the name of a condition where the shape of a person’s head is flatter at the back. This is usually more so on one side and but can cause a significant asymmetry. This head shape can develop in the womb or during prolonged labour, but most commonly develops in the first 6 months of life. There are many conditions that can cause an abnormal head shape and each one will need a different treatment.

What causes plagiocephaly?

As the bones in babies heads are relatively soft in the first year of life, they can become flatter on one side, if they spend a lot of their time lying on their back. As babies start to become more mobile and are able to roll over on their own, this flatness will usually resolve on its own. Some babies have a preference for looking to one side, and these will tend to develop a flatness on the back of one side of the head.

Stiffness in the muscles of the neck called torticollis is one of the common causes of this, but there are other conditions such as anomalies of the spine which can also cause difficulties in turning the neck. Rarely, a squint (or ‘lazy eye’) can result in a preference for an asymmetric head posture which can also result in plagiocephaly. Craniosynostosis is a rare condition affecting a few babies which can cause an abnormal head shape in babies. A craniofacial surgeon will be able to help you distinguish this serious condition from the more common condition of positional plagiocephaly.

How do I know if my babies head shape is normal?

Most parents will be able to instinctively see if their child’s head is a normal shape. If you are concerned over your child’s head being asymmetric in any way and particularly if the condition is getting worse rather than better, then you should seek the advice of a paediatric plastic surgeon who specialises in Craniofacial conditions. In the majority of cases, this review will be able to diagnose positional plagiocephaly from craniosynostosis without any further investigations. Rarely an X-ray or CT scan will be required to make a diagnosis.

You can measure the size of your child’s head and plot this in your babies Red book in the charts in the section at the back. This will help your craniofacial surgeon see how the head is growing and will help at the appointment.

Can plagiocephaly cause brain damage?

No, it is not likely that positional plagiocephaly can cause brain damage. This condition is often worse in children who have a developmental delay, but it is not the cause of this delay.

Children with craniosynostosis have a risk of developing a condition where the pressure inside the head is increased. If this is not recognised at the right time, then there is a chance that they may have an injury to the brain from this being left untreated. If you have any concerns about developmental delay then you should request an opinion from a developmental paediatrician.

Can plagiocephaly be treated?

Although most children who have positional plagiocephaly will get better on their own, there are some, with conditions such as torticollis who will benefit from early intervention. There are very good treatments for torticollis which include exercises and in some children, surgery is beneficial. If your child has craniosynostosis, then a review by a paediatric plastic surgeon with expertise in craniofacial surgery will be required as early as possible to ensure that all treatment options are available to you and your child.

What about moulding helmets?

Moulding helmets are used to encourage a more rapid improvement in head shape with increased symmetry. As most patients with positional plagiocephaly will get better on their own, it is not clear whether moulding helmets do make a significant difference in the long term. It is more important for children with positional plagiocephaly to be assessed early for the causes of positional plagiocephaly so that the appropriate treatment can be carried out early. Your craniofacial surgeon can advise you on exercises that you can do with your baby at home and whether any further interventions such as moulding helmets would be useful or not.

Any interventions for positional plagiocephaly should ideally be carried out within the first 18 months of life to have the most effect. There may be some children who would benefit more from moulding helmet treatment and your craniofacial surgeon will be able to help you decide whether this would be beneficial for your child.

What should I bring to my appointment?

You should bring along your baby’s Red book so that the craniofacial surgeon can assess the growth charts at the back of the book. He will be particularly interested in the head circumference measurements. He will also be interested in your medical history, how the pregnancy and labour progressed as well as your child’s development.

For more advice on plagiocephaly and the most suitable treatment option for your baby, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

A haemangioma is also often called a Strawberry birthmark. It is one of the most common birthmarks and usually appears within the first few weeks of life. A haemangioma is actually a tumour of blood vessels which is not cancerous. They will typically grow quite rapidly over the first few months and so this is often a very worrying time for parents. Usually, they will then stop growing and then slowly decrease in size over the first few years with many going away completely.  Once they have stopped shrinking, which can take a few years, there will be a soft, fatty lump of loose tissue left behind.

Although many haemangiomas will resolve on their own without any problems, some will need the advice and treatment of a specialist. Haemangiomas which affect vision, breathing, swallowing or hearing need to be assessed quickly and your paediatric plastic surgeon working together with a paediatric dermatologist will be able to help with these birthmarks.

As they grow quickly they can push on the skin and sometimes result in ulcers which may bleed and be uncomfortable for your baby. It’s important that if your baby has a birthmark like this that you see a specialist paediatric plastic surgeon or paediatric dermatologist who knows how to assess and treat these common birthmarks of infancy.

What happens if a haemangioma bleeds or ulcerates?

When a haemangioma ulcerates through the skin, the wound can bleed and become infected. It is important to have specialist wound care to ensure this is treated during this phase. If the birthmark has bled or ulcerated in the past, it is likely to have formed a permanent scar.

Is there anything I could have done to prevent this?

Most birthmarks like haemangiomas just occur by chance and there is little that can be done to prevent them

How is a haemangioma treated?

Some haemangiomas require no treatment at all and can be simply monitored closely by a specialist. However, your specialist will often advise treatment of haemangiomas which are particularly large, ulcerated, or affect functioning. If there are multiple haemangiomas then further tests will be required.

Initially, treatment with a medicine called a beta-blocker may be recommended. This often works very well to slow the growth of the haemangioma and can reduce the complications such as bleeding associated with these birthmarks.

Can the birthmark be removed?

Each haemangioma is different, and I will tailor my surgery based on the exact location and size of each haemangioma. As many haemangiomas seem to occur on the face, it is very important to plan the position and orientation of any incisions so that the final scars are in the best possible location. Part of this planning process involves understanding how each surgery will affect the delicate nearby structures such as the eyelids, mouth and nose, and to try and avoid distortion of these important facial features.

Although each surgical plan will be tailored for your child, the final aims are to use a range of techniques that will be able to reduce or remove the appearance of the birthmark. This should be done in a way which is gentle on the child from both a physical and psychological point of view and causes minimal distortion of the normal tissues.

If you think your child has a birthmark and would like to know more about the options for treatment please contact info@julingong.com or you can call 0207 927 6528.

One of the more common lumps I see in new patients is something called a dermoid cyst. Very often these are found near or underneath the outer part of the eyebrow and feel like a rubbery pea-shaped lump underneath the skin. These particular dermoid cysts are often called angular dermoids, or peri-orbital dermoids.

They are usually first noticed when the baby is a few weeks old and generally grow quite slowly within the first year or so of life.

Although they are usually found near the outer eyebrow, they can also occur between the eyebrows and elsewhere over the face and head. They can also occur elsewhere in the body, but this article will concentrate on the ones in the face.

So what causes a dermoid cyst?

Dermoid cysts occur when collections of cells that make tissues such as hair and skin, form underneath the skin in the wrong place. They often occur near the small joints between bones, such as near the joint between the bone of the forehead and the bone that makes up the side of your eye socket. These cells can continue to grow, and as a result, the lump will slowly increase in time.

Are dermoid cysts dangerous?

Dermoid cysts don’t usually cause any problems, and if left alone, will slowly increase in size. Your baby will not usually notice them as they do not usually cause any symptoms, although they can press on surrounding structures if they become very large.

These cysts have been known to become infected which then requires treatment with antibiotics and sometimes surgery.

Can they be removed?

As there is a risk of infection, and because these lumps tend to slowly get bigger with time, most parents choose to have them removed.

The best approach to remove the dermoid cyst will depend very much on a number of factors, including, the exact location and how mobile it is. With the dermoid cysts which are closer to the eye, I like to use an incision which passes along the fine crease in the upper eyelid. This usually results in an excellent scar which is well hidden in the eyelid crease. These little scars heal up quickly and are really a good approach for many of angular dermoid cysts.

When the dermoid is slightly further away from the eye, then I find that either an endoscopic or keyhole technique enables me to remove these cysts through small incisions just behind the hairline. Although this is technically more challenging, it means that I can avoid placing a scar above or near the eyebrow.

There are some cysts which are best suited to a direct approach, and with a lot of care and some delicate suturing, often these incisions will heal well with a very acceptable cosmetic result.

What about a dermoid cyst between the eyebrows?

These ‘midline dermoids’ are more commonly associated with a connection which can pass through the forehead or nasal bones into the head. If your baby has a dermoid cyst in this location, I would generally request an MRI or CT scan to assess for this possibility.

If the scan does show that there is a connection to a part of the dermoid cyst inside the head then I would always work together with a neurosurgeon to safely remove the part of the cyst on the face as well as that inside the head and the connection between.

What is the best age for my baby to have dermoid cyst surgery?

As many of these lesions, grow very slowly, I would generally recommend that any surgery is carried out after the first year of life when babies are a little bigger and stronger. Although most of my patients are between the ages of 1 and 2, surgery to remove these cysts can be performed at almost any age

Can the cyst come back?

There is a small chance that the cyst may reform. This is more likely if the cyst is ruptured during surgery or if there has been an episode of infection in the past.

During surgery, being meticulously careful to tease away the cyst from the normal surrounding tissue is the best way to reduce the chance of recurrence.

However, if the cyst does recur, surgery is often curative.

What are the risks of surgery?

The vast majority of dermoid cysts can be removed as day case procedures under a short general anaesthetic. The surgery usually takes less than an hour and children are often back to their normal selves within a day or two.

Surgery for the more unusual intracranial dermoid cysts will take about 4 hours, and your child will need to stay in hospital for a few days.

There will be a scar, which although may be very fine, is permanent. The exact location of this scar will vary between patients.

As with any type of surgery, there is a small risk of a wound infection, and antibiotics will be used to reduce this risk during the operation.

I may prescribe a week of antibiotics in some cases, such as if there is a deeper part, such as an intracranial part, or a history of infection or the cyst has a connection called a punctum to the surface of the skin.

All small children will require a general anaesthetic to enable me to remove the cysts carefully and completely in the best way possible.

If you think your child has a dermoid cyst and you would like to make an appointment, then please contact info@julingong.com or you can call 0207 927 6528.

Consultant paediatric plastic surgeon, Mr Juling Ong was recently interviewed on the use of 3D-printed models when planning complex paediatric surgery cases. He focused on their use in the successful separation of craniopagus twins, Safa and Marwa which was carried at the Great Ormond Street Hospital in London.

Endoscopic strip craniectomy is a minimally invasive procedure that is used to treat craniosynostosis. The operation is performed under a general anaesthetic through small scalp incisions about 3cm long.  The exact location and number of incisions depend on the type of craniosynostosis and the individual suture that is affected. Often only one incision is required and this is hidden within the hair.

Your craniofacial surgeon will be able to explain where these will be for your baby. A small strip of bone is then carefully removed from the area where the fused suture (craniosynostosis) is. As this operation is performed within the first few months of life, the growth of the brain and skull can be guided by a helmet back into a more regular shape.

What age is best for this type of surgery

Babies less than six months of age seem to gain the most benefit most from this procedure. If you suspect that your child has craniosynostosis, or are concerned about their head shape, you should request a referral from your GP or paediatrician to be seen by a craniofacial surgeon as soon as possible.

What type of craniosynostosis can be treated with this condition?

Endoscopic strip craniectomy has been used to treat craniosynostosis of the metopic, sagittal, coronal and lambdoid sutures. It is also suitable for some children with more than one suture affected.

How long will my baby be in hospital?

Most children having an endoscopic strip craniectomy recover very quickly after surgery and will be ready to be discharged after one night in hospital. At home, simple pain relief such as paracetamol and ibuprofen is all that is required to keep your child comfortable after this surgery.

How long does endoscopic strip craniectomy take?

The operation itself usually takes less than hour, although with anaesthetic time, positioning the patient on the table and application of dressings the whole process can take up to 2 hours before we call you to see your baby in the recovery room.

What are the risks of endoscopic strip craniectomy?

Endoscopic strip craniectomy is a very safe procedure when performed by an experienced craniofacial team. You should always be made aware of the rare problems that can occur even in experienced hands. As your surgeons will be operating near the brain, there is a small risk of injury to the brain and the blood vessels in this area. Rarely, a transfusion may be needed. There have been deaths and brain injury reported with this technique, although these are extremely unusual (<1%). Other complications include CSF (Cerebro spinal fluid) leak, poor scarring, and some children have a residual deformity that can be changed by further surgery.

What happens after this surgery?

After the surgery, you will be seen by your craniofacial surgeons. Your baby will have a bandage on their head to protect the wound and they will be transferred to the ward.

Patients tend to recover rapidly after this type of craniofacial surgery

You should arrange to meet the helmet company about a week after surgery when the swelling has subsided, and normally the custom made helmet will be ready in another week (2 weeks following surgery. In the first few weeks and months after surgery, you will need to visit the helmet team regularly to monitor the fit of the helmet. Adjustments to the helmet will be made at intervals as the shape of the head starts to improve over the course of treatment. The helmet needs to be worn at all times (except for when bathing) and treatment continues to around 18 months of age.

For more advice on endoscopic strip craniectomy, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

Macroglossia is the medical term for an unusually large tongue. Enlargement of the tongue can cause cosmetic and functional difficulties while speaking, eating, swallowing and sleeping. It’s quite uncommon and generally occurs in children.

Mr Juling Ong, a craniofacial and paediatric plastic surgeon based in London, talks about why the tongue becomes enlarged and what can be done about it.

The tongue can become larger than normal due to a number of conditions. These include conditions that you may be born with or that you develop later in life. Overgrowth conditions such as Beckwith-Wiedemann syndrome and vascular anomalies of the tongue can lead to its enlargement.

Other conditions such as Down syndrome, trauma, inflammatory conditions, primary amyloidosis, and congenital hypothyroidism may also be associated with a large tongue.

What are the signs of macroglossia?

A large tongue may result in problems with drooling, speaking, eating and breathing. Over the long term, a large tongue can result in abnormal growth of the jaw and teeth. If the tongue is very large, it can be difficult to keep it inside the mouth, resulting in drying out or cracking and ulceration of the tongue itself.

How is macroglossia diagnosed?

This condition can be diagnosed with a combination of clinical examination and specialist testing. Your doctor will look at your family history and determine the underlying cause.

Does it require treatment in every case? How is it treated?

Treatment depends upon the underlying cause and severity, so may range from speech therapy in mild cases, to surgical reduction in more severe cases.

Medical therapies can be used when the cause is both identifiable and treatable, as in the case of hypothyroidism. In cases where the cause isn’t clear, medical therapies haven’t been useful.

What does macroglossia surgical reduction involve?

Macroglossia surgical reduction is performed to enable the tongue to function properly within the mouth. The tongue is reduced in size during a procedure which lasts approximately one hour. This operation is performed under a general anaesthetic and most patients will start drinking on the first or second day after surgery and be able to be discharged from hospital after four or five days.

It is recommended to follow a diet of puree consistency for about four to six weeks after surgery to allow the tongue to heal properly.

For more advice on the treatment of macroglossia, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

Facing the World is a children’s charity that provides reconstructive surgery to children in the developing world suffering from severe facial disfigurements. The occurrence of these defects is thought to be ten times higher in Vietnam that its neighbouring countries and many believe this is the result of the dioxins used in Agent Orange during the Vietnam War.

Mr Juling Ong has been involved in the work of Facing the World since 2008 and has been on three overseas missions to Vietnam. During these medical missions, Mr Ong and his fellow surgeons and doctors will operate on a wide range of facial deformities including craniomaxillofacial trauma, cleft lip and palate, vascular malformations and haemangiomas of the head and neck.

Their mission over the next five years is to establish a series of craniofacial centres in Vietnam, continue to train Vietnamese doctors and perform 40,000 life-changing operations

To find out more about the important and necessary work that Facing the World carries out, please go to their website and find out how you can support them.

Deciding to go ahead with a cosmetic surgery procedure can be one of the biggest decision you make and you’ll naturally have some concerns about the safety of the procedure and whether you’ll be happy with the results afterwards. Choosing a member of the British Association of Aesthetic Plastic Surgeons, also known as BAAPS, can give you much-needed peace of mind during this challenging time.

BAAPS is one of the UK’s leading independent plastic surgery associations and all members are rigorously vetted prior to joining to ensure they have the necessary experience and expertise. A commitment to patient safety is also the guiding principle of the organisation and all surgeons have to submit an annual audit of the procedures they have performed.

Here are ten reasons why you should choose a BAAPS surgeon:

1 Level of training

All BAAPS members have to be fully trained plastic surgeons on the GMC specialist register. This means they have completed a six-year specialist plastic and reconstructive training programme to become a plastic surgeon.

2 Registered with GMC

The GMC or General Medical Council is an independent organisation that protects patients and you can use it to check whether your surgeon is on the specialist register for plastic surgeons. However, to be a member of BAAPS, you must be on this register.

3 Breadth of knowledge and experience

BAAPS members are encouraged to continue to train and learn and have made a commitment to continuous personal development, so you can be assured that they are aware of the latest developments.

4 An unbiased and expert consultation

In your consultation with a BAAPS member such as Mr Ong, he will always provide you with honest and expert advice and this may mean that he will advise you not to go ahead with a surgical procedure at this time if he does not feel that it will benefit you or will not fulfil your expectations.

5 Consultant-level

All BAAPS members must be eligible to take up a consultant plastic surgery role in the NHS. Mr Ong is currently a Consultant Plastic Surgeon at Great Ormond Street Hospital for Children.

6 A commitment to ongoing training

BAAPS members must demonstrate an ongoing commitment to training and learning and they regularly attend meetings, seminars and lectures, both nationally and internationally, in their field.

7 Recognised by UK insurance providers

BAAPS members are recognised by BUPA, PPP and many other major health insurance providers.

8 Operate from reputable clinics and hospitals

BAAPS members will only work in reputable hospitals and clinics, ensuring the best patient care possible. For example, Mr Ong performs procedures at leading London private hospitals including The Portland Hospital, The Wellington Hospital and The Weymouth Hospital.

9 Member of a recognised professional body

BAAPS is recognised as the legitimate professional body representing the field of cosmetic surgery by The Royal College of Surgeons of England, The Royal College of Surgeons of Scotland and The Royal College of Surgeons of Ireland.

10 Following a code of conduct

BAAPS has a code of conduct that follows the Good Practice Guidelines issued by the GMC and members must follow this. BAAPS Members adhere to a code of conduct which follows the GMC Good Practice Guidelines.