NP Aesthetics
Facial surgery in Zurich
Changes in the face rarely arise in a single structure. Skin, fat compartments, retaining ligaments, muscles and bone change at different rates — and the impression that brings patients to a consultation is usually the sum of these. The starting point is therefore an analysis of the regions involved, not the choice of a procedure.
What would you like to change?
Most consultations begin with an observation, not with a procedure: my eyes look tired even though I am rested; my upper lids hang over the lid margin; I have eye bags or shadows under my eyes; my brows have descended at the sides; my jawline has become less defined; the contour of my neck has changed; my nose bothers me in shape or breathing; my face no longer reflects how I feel.
Why a tired face is not always an eyelid problem
A tired expression can come from excess upper lid skin — but just as well from a descended lateral brow, from volume loss in the midface, or from a combination. If only lid skin is removed while the brow is the actual cause, the impression persists or even intensifies, because the distance between the brow and lid margin decreases further.
The examination therefore first clarifies which structure determines the expression: brow position, lid skin, fat compartments, lid tension, midface — and how they relate to each other.
What is assessed in the diagnosis
Skin
Quality, elasticity, sun damage, wrinkle depth and scarring behaviour help determine what a lift can and cannot achieve.
Soft tissues and fat compartments
Facial fat lies in distinct compartments. These lose volume unevenly and shift — visible as flattening above and heaviness below.
Retaining ligaments
Fibrous ligaments anchor soft tissues to the bone. Their position explains why contours bend at particular points and where tissue must be repositioned.
Brow position
The height and shape of the brow, particularly the lateral portion, shape the expression more strongly than the amount of lid skin.
Upper and lower lid
Excess skin, fat prolapse, lid tension and symmetry are assessed separately — each component has its own consequence for planning.
Midface
Descent and volume loss in the midface create shadows under the eyes and a lid region that appears longer.
Jawline and neck
Jaw contour, jowls, submental fat distribution and the platysma bands are assessed together; face and neck cannot be separated in planning.
Nose
Form and breathing belong together. External proportions and internal structures such as the septum and nasal valves are examined together.
An overview of the procedures
Upper eyelid lift
Removal of excess upper lid skin, with adjustment of the fat compartments if necessary. Appropriate when the brow is in a good position.
Lower eyelid lift
Treatment of fat prolapse, excess skin, tear trough and lid tension — depending on the findings, via an internal or external approach.
Forehead and brow position
Elevation or stabilisation of the brow via various approaches, tailored to forehead height, hairline and the extent of lateral descent.
Midface
Elevation of the midface is usually performed as part of a facelift or combined with eyelid surgery, less often on its own. Volume loss can additionally be compensated with the patient's own fat.
Facelift
Repositioning of soft tissues and the deeper tissue layer in the lower third of the face and neck, not primarily a skin tightening.
Neck contour
Depending on the findings, fat reduction, treatment of the platysma bands or a lift — often together with a facelift, occasionally as a separate procedure.
Rhinoplasty
Changes to the dorsum, tip, width and projection, as well as functional corrections.
Volume loss and fat transfer
Your own fat can add volume but does not replace repositioning of descended structures. The survival rate varies individually and cannot be predicted exactly.
Which procedures can be combined?
Combinations are the rule rather than the exception: brow correction with an upper eyelid lift, facelift with neck treatment, eyelid surgery with midface elevation, a lift with fat transfer.
A combination makes sense when the regions involved create the same impression. Longer operating time, longer recovery and accompanying illnesses speak against a combination. Both are weighed up individually.
How the appropriate treatment is chosen
First, the bothersome impression is described, then the structure that mainly causes it is identified. Only then does the procedure follow — along with the question of whether a smaller procedure is sufficient or whether a larger procedure can achieve the goal at all.
This also includes when surgery is not the right path: with expectations that surgery cannot meet, at an unfavourable time, or when non-surgical measures are sufficient.
Consultation and facial analysis
The initial consultation covers your concerns and medical history, a clinical examination at rest and in motion, an assessment of symmetry and expression, and standardised photographic documentation. Alternatives, limitations and risks are discussed, and you receive a written summary.
The medical consultation for surgical procedures costs CHF 250.
Recovery at a glance
Eyelid operations are usually socially inconspicuous after one to two weeks; brow lifts and facelifts take longer. Swelling and bruising mark the first few days; sport and greater exertion follow in stages.
Depending on the procedure, the final result becomes apparent after months — for the nose considerably later than for the eyelids. Procedure-specific timelines can be found on the individual procedure pages.
Risks and limitations
Possible risks include postoperative bleeding, infection, wound healing and scar problems, temporary or rarely permanent nerve irritation, sensory changes, asymmetries, and results that differ from expectations and may require revision surgery. Eyelid operations also carry the risk of dry eyes and lid malposition.
Limitations arise from skin quality, bone structure and previous findings. Surgery changes the starting position but does not stop the ageing process. Complete symmetry cannot be planned.
Individual information on risks is provided in the personal consultation.
Frequently asked questions
Do I need to know which procedure I want before the consultation?
No. The consultation first clarifies your concern and the medical starting position; the procedure follows from this.
Can several facial procedures be combined?
Often, yes. Whether a combination makes sense depends on the regions involved, the operating time, recovery and your health.
Treating physician
- Dr. med. Michael W. Payne
Specialist in Plastic, Reconstructive and Aesthetic Surgery
A good decision begins with a conversation.
The initial consultation is about clarification, not selling. It does not necessarily end with a surgery date — often it brings the realisation that a different approach, or no procedure at all, is the right choice.
The consultation process
- 01
Discussion
We listen to your concerns, medical history, expectations and what you would like to change about your appearance.
- 02
Examination
A careful clinical examination and assessment of your underlying anatomy.
- 03
Options
Possible procedures, alternatives, limitations and risks — explained clearly and without time pressure.
- 04
Time to reflect
You decide in your own time. Any outstanding questions can be addressed in a further consultation.
Request a consultation
Leave your contact details. Our practice team will call you back during practice hours to arrange a consultation at Klinik Selnau.