Choosing Philip Guest As my Facelift Surgeon - the Biggest Mistake and Regret of my Life.

Nobody wants to end up as the “botched-up...

Nobody wants to end up as the “botched-up body” writing a bad review, but bad surgery happens to good people, even when their surgeon is supposedly at the top of his game, according to The Establishment. I have procrastinated for a long time, not wanting to relive the experience, but I owe it to the sisterhood (and brotherhood) to tell my cautionary tale. Perhaps writing it all down will also prove cathartic and bring some closure to a period of my life that I want to forget. How I wish it had just been a bad dream, instead of reality.

It's a long read, but, if you are considering surgery with Philip Guest, please read it and weep, then think again.

At the time of surgery I was an average 51 year-old woman, with the usual menopausal concerns of jowls and neck laxity. I'd noticed the jowls developing slowly but surely over the past few years, but tried to ignore them. Then seemingly overnight my neck deteriorated, and the combination was too unsightly to ignore. After investigating various non-surgical options, I decided that surgery was the only answer.
I went for 4 consultations, and decided that number 4 seemed the most experienced and qualified. What I would give to turn back time and choose number 1 instead (number 1 ended up revising number 4's work). Number 4 was Mr Philip Guest.

He advised a full facelift, necklift, platysmal plication (submental incision) and upper blepharoplasties (total cost £9,788). The surgery was performed under local anaesthesia with sedation.

SURGERY DAY

I arrived at the hospital for 7am, as instructed, and was shown to my room. I'd assumed I was first on the list, but maybe not as it was almost 2 hours until I was taken to theatre. During this time I was left more or less alone, not really knowing what to expect, and allowing plenty of time for nerves to build while pacing the room. Not a reassuring start.

Eventually, Mr Guest hurried in and sat me on the bed to mark up my face, barely looking at me. He had a form in his hand on which he scribbled “facelift and lower blepharoplasties”. I had to correct him that it was actually UPPER blepharoplasties (again, not reassuring). I asked if he was going to do the submental incision/platysmaplasty (as he hadn't written it on the form), but he said that he hadn't yet decided (even though at my consultation he had deemed it necessary, and it was written on the follow-up letter). It was as if he had not planned the operation or given it any thought at all – in retrospect, I was just another identikit woman on his conveyor-belt, whose facial features did not warrant a second glance before he took his scalpel and staple-gun to them. I was told more than once that I was “worrying too much”, as if I shouldn't be asking such impertinent questions about my impending procedures (why worry about ending up with the wrong eyelid procedure?).
He left 10 minutes later, and I was alone again.

After a while, the anaesthetist (Dr Sasada) came in and asked me why Mr Guest hadn't marked up my face yet. I told him he had, but apparently it was only the incision marks around my ears, and there were no other pre-operative marks. He expressed surprise at this absence of markings (more alarm bells ringing...). I tried to reassure myself that Mr Guest was so experienced that he didn't need to draw on my face or eyelids, or perhaps he would do it once I was in theatre? I daren't ask any more stupid questions.

At 08:50 a nurse came to collect me and took me to theatre. As surgery was completed, I came to with the sound of a staple gun at my temple. I was surprised to be back in my room at 11:00. A little over 2 hours seemed too short a time for all those procedures. The nurse brought me some gauze pads in a small dish of iced water for my eyes, but that was the only ice I was able to obtain from the hospital (and it only lasted an hour or so), despite asking several times. I therefore wasn't able to apply any ice to my face and neck until I got home the following day.

Later on that afternoon, Mr Guest came in to see me for a few minutes, and had a quick look under my bandage at my neck. I didn't get any feedback about how the operation had gone, and felt that I couldn't ask any questions in case I was “worrying too much”. I did manage to ask if he'd done the platysmaplasty – he had. I really wish he hadn't...

The next morning he came to see me after the bandages had been removed, and declared me fit to leave. When I looked in the mirror, I could see bulges in the jowl area, but hoped it was just swelling. After all, how could I still have jowls immediately after a full facelift? There was also a slightly ominous-looking egg-shaped bulge in my right neck, but as Mr Guest had just checked me over, I assumed it was just the expected lumps and bumps of swelling.

As I was getting ready to leave, Dr Sasada came by and I mentioned that the operation seemed very short. His reply was that speed is good as it causes less trauma to the body. Didn't sound logical to me, and I had an uneasy feeling that I was having my intelligence insulted. Dr Sasada seemed to be in awe of Mr Guest's skill as a surgeon, so I hoped he was right.

RECOVERY

I returned home to begin my recovery. It was VERY painful in the neck area, but I assumed that was normal (I now know it's not), although I was surprised by the extent of the hard lumpy swelling in that area. I wore the compression garment as advised, and now that I was home I was able to ice my face and neck. Despite this, my neck continued to swell, and became harder (like lumpy concrete), black and blue.

Looking like Frankenstein's monster, I returned to Bristol on day 5 to have my eye stitches removed by one of the nurses at the hospital. I didn't see Mr Guest as he was in London for his monthly consultation-day at 10 Harley Street. Although I live in London, it was made clear to me that I would on no account ever be allowed to see Mr Guest in Harley Street for follow-up appointments, as he only saw new patients there. So, while I spent the day travelling from London to Bristol and back (with a painful, swollen neck), Mr Guest spent the day in his London consultation office. Seemed a bit “jobsworth”, but he is a very busy man, and can't be expected to spend 10 minutes on such a mundane task as removing a few eye stitches and checking that my painful swollen neck was nothing to worry about.

Back home, I could clearly see jowls, and the lumpy painful neck swelling increased, and looked and felt horrendous.

On day 12, I again travelled to Bristol for the removal of facelift stitches. Whilst the nurse was doing this, Mr Guest popped in to see me, so I asked about my neck, and he blithely said it was “blood clots” (ie. haematoma) and I should start massaging my neck the following week. He said I was “worrying too much” about the jowls, and it was just swelling. He did (reluctantly) say that if I was unduly worried about my painful lumpy neck, I could make an appointment for the following week to see him again in Bristol.
10 minutes later, he was hurrying off to attend to something or someone more important.
As I left, at the hospital reception I did make an appointment for the following week, but the day before the appointment I received an email stating that “Mr Guest would be unable to resolve anything other than advise your recovery will need patience”. As such, I cancelled the appointment, as clearly Mr Guest was not going to examine the progress of my haematoma or offer any treatment. It seemed pointless to make the long journey to Bristol again for a 5-minute patronising lecture from Mr Guest.

After being told that I had a haematoma I was naturally concerned at this complication, particularly after reading online that haematomas should generally be treated in some way (eg.aspiration, ultrasound) in order to help healing and not affect the final result.
A few weeks later, I asked if I could see Mr Guest in Bristol before Christmas, as I was getting increasingly worried about the hard and painful lumpiness under my chin.
The email reply (from his clinic manager Heather – direct access to Mr Guest was never permitted) in effect ignored my polite request stating only that “the lumpiness will disperse on its own. There is no treatment necessary at this stage but the frequent massage will help. Your final results will not be affected, you just still have swelling under the skin and it is still early days. Mr Guest also advised that about 1 in 500 of his patients maybe suffer with a haematoma but it will not need to be aspirated. It is just part of your own body's healing process. I will book you a follow up appointment to see Mr Guest in March”.

Incidentally, in a subsequent letter, Mr Guest mentioned that he has performed 2000 facelifts, which would mean that he has had experience of only 4 facelift-related haematomas, This seems a very low statistic. Perhaps the ignored, untreated haematomas like mine are not recorded?

The following months were very dark, lonely and reclusive. I was embarrassed to be seen, kept my head down, didn't make eye-contact, avoided social situations and shrouded my neck in wintery scarves at work. I was frightened that permanent damage had been done to my neck by the untreated haematoma.
I resorted to posting questions to the doctors on realself (I had long since given up on trying to get any help or reassurance from Mr Guest), but their answers just worried me more (“follow up with your surgeon” etc – fat chance of that).

There were plenty of other issues too, not least the undeniable fact that my jowls were still there, unimproved.

Not a single part of my face touched by his scalpel had escaped unscathed, and at 5 months, I was left with the following issues:

FACE & NECK

No improvement at all in my jowls – this had been my number one reason for surgery.
Cheeks flattened to the sides of my face, as if glued down to underlying tissue (skin tethered?). Still very hard and often burning.
Disfigured neck/under chin – fibrous, woody lumps, divots.
Vertical hard lumpy ropey cord (tender and painful, sometimes throbbing and stinging) where the platysma was seemingly roughly stitched together. Very ugly-looking.
Muscle/tissue felt pulled in random (wrong) directions. In constant discomfort.
Especially when swallowing, the whole area very unsightly and unnatural-looking (far worse than the pre-surgery bit of normal-looking lax skin).
Unable to tilt head backwards due to tethering of the neck skin.
Under chin area – fuller and heavier than pre-surgery.

EYES

Right eyelid – raised ridged and lumpy scar all along (too high) crease, and “pouch” of skin at outer edge.
Ugly web of very visible dark red broken capillaries all over lid (an oculoplastic surgeon later told me this is the result of the surgeon going in “like a bull in a china shop” - not what one would hope for in this particularly delicate area).
Left eyelid – not as bad, but small hard lumps along the incision line.
Asymmetric result with right eyelid having higher crease/larger lid than left.

EARS, SCARS & HAIRLINES

Scars behind the ears still lumpy, red and sore, and in a very visible position (horizontally from the mid-point of my ear into lower hairline, and this hairline now “stepped”). Incisions had been closed with staples (even in the non-hair-bearing skin) under considerable tension, so stretched and wide (and painful). Stretched vertical scars where the staples had been pulling down. Constant pulling and burning feeling.
Scars in temporal hair – wide and hairless “stripes” caused by use of staples under tension.
Raised temporal hairline (loss of sideburn tufts) due to placement of incisions in the hair, rather than along hairline.
Ear lobes attached too far forward, and very odd line/crease/fold where ear lobe attaches to cheek. Tragus blunted where cartilage removed, and pulled/stretched forward onto cheek, so natural pre-tragal sulcus lost. Both earlobes and the attachment to the face looked very “operated-on” and alien.

All the “stigmata” of old-fashioned facelift techniques were present and correct, without achieving any of the benefits of a facelift. Perhaps this was acceptable 20 years ago.

FINAL REVIEW

Almost 5 months after my operation, I had my review, and I was even offered an appointment at 10 Harley Street instead of Bristol. I hadn't requested this (I wouldn't dare!), and thanked Heather profusely, but was again reminded that it would be a one-off and I was made to feel suitably humbly grateful that Mr Guest was being so accommodating.

This was the first time I had seen Mr Guest since my 12-day appointment (and haematoma diagnosis).

Well, Mr Guest took one look at me, and immediately agreed that the surgery “hadn't worked”, and that there had been no improvement in my jowls, but he could offer no explanation for this failure. He didn't seem interested in any further examination of my face, neck, ears or eyes.
He then asked me what I wanted him to do about it (that was exactly how he phrased it) – did I want a refund or for him to do a revision at 12 months?
As he didn't know why the facelift “hadn't worked”, he couldn't guarantee a better result with a revision. I said I'd think about it.(Obviously there was no way I would have let him wield his scalpel anywhere near me again.)
After this, he seemed anxious to get rid of me, but I wanted him to look at the rest of the damage. I showed him my eyelids, and he agreed that the eyelid scarring was bad, and asked if I normally scarred badly (ah, of course, it was my fault).
He then looked behind my ears and declared that the scars there had healed normally (what, he considered that normal??). However he subsequently admitted in a letter that ”the scars behind your ears were more pronounced than usual”.

I then showed him the ugly hard ropey vertical cord and pea-sized lump where the platysma had been stitched together, and incredibly he seemed not to recall that he had even performed this procedure until I showed him the submental incision scar.
I told him that under my chin was somehow heavier/fuller/more jowly than before, and the whole neck/under chin area was fibrous, lumpy and woody, and his answer was “well I didn't add anything there”. I beg to differ – it was all the internal scar tissue resulting from the untreated haematoma.
When I talked about the haematoma, he asked if I had had a large haematoma (shouldn't he have known?). It was all quite disconcerting, as if he couldn't remember and didn't care what surgery he had performed.

He took the first and only set of post-op photos, and said he would write to me.

The review was cursory and disinterested, and as I was later to discover when I saw my revision surgeon, had underplayed the damage somewhat, thereby leaving me unimpressed both with Mr Guest's abilities as a facelift surgeon (in my case at least), and his honesty in not admitting to the full extent of the poor result.

10 minutes after I had arrived, I was being almost bundled out of the door, to stumble out into the spring sunshine of Harley Street, dazed and confused, and holding back the tears.

AFTERWARDS

As I sat on the number 27 bus home, I felt a strange mixture of relief that all my concerns had been valid (after being made to doubt my own judgement and sanity throughout) and anger that Mr Guest had dismissed them for the past 5 months.
However, it was both devastating and incomprehensible to know that the surgery had failed in every respect. I wondered whether Mr Guest had “lost it” and was now a danger to future patients. I couldn't (and still can't) understand how an experienced facial surgeon was unable to perform a standard facelift (and to cause so much destruction in the process).

I awaited the promised letter, and was expecting a profuse apology and lengthy explanation of what had gone wrong, after he had had time to analyse and consider what I had assumed to be a very shocking and unusual result for him.
I was therefore extremely surprised and upset to receive a very brusque letter in which he neither apologised nor explained. It lacked any comprehension of what he had put me through (“apologies that you have had such a disappointment” - an apology for my disappointment is NOT an apology). Disappointment?? Devastation, more like.

I accepted the refund, and recently went back to surgeon number 1 for a revision facelift, necklift and platysmaplasty. I am currently healing from this second surgery, and apologising to my face and neck on a daily basis for having put them through 2 surgeries in a year, the first of which was way too brutal and aggressive.

I still need revision upper bleph surgery, a hair transplant for my raised and distorted hairline (and the wide white scars within my temporal hair), restoration of tragal cartilage (if that's even possible), and medical camouflage tattooing for the remaining scars near my lower hairline behind my ears.
Oh, and probably several sessions of PTSD counselling. I hope that doesn't sound flippant, and I mean no disrespect to shell-shocked soldiers, accident victims etc, but to have botched cosmetic surgery does cause mental trauma, made all the worse because it's elective (so there's also shame, guilt, regret and trying to forgive yourself for what you've done to your otherwise healthy, functioning body).

I hope my review will save others from the same fate. It's a jungle out there, and you can't necessarily trust *board-certified” surgeons. After my treatment at the hands of an “old-school, old-boy network” surgeon, I would incline towards the younger generation of surgeons who may not have 20 years experience, but are likely to have a far better bedside-manner and understanding of their patients' needs, more up-to-date skills, compassion, empathy, willingness to listen, and a less patronising attitude. Also, more desire to want to please their patients, especially with the power of the internet. Cosmetic surgery patients are becoming an educated bunch, keen to share their experiences, good and bad, on websites such as this, which will eventually sort the wheat from the chaff.

Philip Guest's own Forum - a warning

On Mr Guest's company website, there is a forum for patients, and it states "We do not edit or alter the content of the Forum or delete any adverse comments - you have our word on that".
Well, I recently posted a couple of comments, in response to other patients' questions, and they have been deleted ("This post has been removed following the advice of our legal advisors").
So much for his word!
Despite the promise, I had a feeling that my "adverse" comments (in fact, genuine descriptions of my treatment and outcome) would be deleted, so I took screen shots of them before they disappeared. There is nothing in the deleted posts that warrants them being removed by legal advisors, and I am happy to upload the screenshots here if any realself users would like to see them.
Thank goodness for realself - a genuinely open and transparent forum where good and bad (equally important for prospective patients) reviews and comments can be freely posted.

Incisions, stitches and staples - a comparison

There's another thread on the forum here on realself - a discussion comparing UK facelift surgeons:
https://www.realself.com/forum/surgeon-face-necklift-uk#comment-3795778

I commented on it and thought I'd copy and paste my comment here, as it's relevant to my review, and may be helpful for prospective patients:

"Having been the recipient of 2 facelifts within a year (I only wanted the one, but it didn't work out that way!) by 2 different UK specialist facial surgeons, I am in the unenviable position of being able to do a direct comparison. I can only compare the two, but there is no comparison - Dominic is in a different league, for all the reasons that BieneMaya has explained so well.
If we're just talking stitches, then my primary surgeon (Philip Guest, a supposedly top maxillofacial and cosmetic facial surgeon) left me with hideous scars from his techniques. The incisions were badly positioned and closed under tension (causing pain and stretched scars) with crude stitches and a lot of staples.
Instead of the careful incisions along the temple hairline (Dominic's superior but time-consuming technique), Philip Guest made incisions within my temple hair, which resulted in a permanently raised hairline (loss of sideburns). He then STAPLED the incisions, under tension, so that I now also have a hairless stripe within (what's left of) my temple hair.
I lost part of my tragus, and he did something weird when he reattached my lobes.
Behind the ear, the incisions were nowhere near the crease, and, halfway-up, they changed direction and went horizontally across bare skin into my hairline, and again were mainly closed with staples. Again, under tension, so the scars stretched and left visible staple marks. My posterior lower hairline was also permanently distorted.
He ruined my upper eyelids with visible scarring from crude stitches.
Dominic revised/removed/repositioned as much of this disfiguring scarring as possible when he revised my face and neck lift. Being half-awake during the procedure, I was aware of the time and care that Dominic was taking over the stitching (no stapling), and the difference was incredible. It was a work of art - neat, precise, tiny stitches, and no pain/stretching/burning during the healing process.
Dominic understands women (and men of course), and recognises that we want imperceptible scars as far as possible (as should all aesthetic practitioners). Philip Guest's attitude was that scarring was inevitable, so why even bother to minimise it? He offers scar revisions as a solution, but I'm not sure they are particularly successful from what I have heard from some of his patients. Here's a novel thought: why not just take the time and care to do a proper job in the first place (as Dominic does)?"

I'd also like to add that I didn't lose a single hair follicle under Dominic's care and skill (thanks to the position and angle of the trichophytic incisions and closures) - I couldn't afford to lose any more after the hair loss that resulted from Mr Guest's surgery.

A word in favour of Mr Guest (regarding reimbursement, not surgery)

Since I wrote my review almost 6 months ago, I have received messages from women (in the UK, France and the USA) who have been victims of bad surgery from various, sometimes unnamed, surgeons.

A common theme is that the surgeon refuses to admit that he/she has done anything wrong, usually suggesting that the patient has "unrealistic expectations" (even though expected results have been discussed at consultation) and/or needs psychiatric help, presumably for some kind of body dysmorphic disorder.
This latter behaviour (where the surgeon tries to persuade the patient that they have a good result, and they are just being irrational) is particularly unforgivable. It is actually a well-known form of mental abuse known as "gaslighting" (definition: to manipulate someone by psychological means into doubting their own memory, perception and sanity).
I think this attitude is completely unacceptable, and it would make the victim's post-surgery ordeal much easier to deal with if the surgeon would just admit that the outcome is not satisfactory, and without insinuating that the patient is somehow to blame.

Also, they should offer refunds at the earliest opportunity (for all or at least part of the surgery costs), to enable the victim to seek revision surgery elsewhere, and remove that extra burden of worry (ie. that they have just wasted their life savings on bad surgery, and cannot afford a revision).

In addition, even those who succeed in obtaining some sort of refund are often (usually) only able to do so if they agree to keep quiet about it and not post negative reviews online.

So I would like to commend Philip Guest for both admitting that the result was unsatisfactory AND offering an unconditional refund, at 5 months post surgery. Because there was no non-disclosure condition I was able to write my honest review of my experience, thereby helping prospective patients make an informed decision, and enabling unhappy past patients to contact me and know that they were not the only ones (which is somehow comforting). He also did not imply that I had "unrealistic expectations" or body (face) dysmorphic disorder.

In this respect, I think he is unusual amongst surgeons, and it shows some integrity.

However, I stand by everything I said in my review and comments, and would never recommend him for cosmetic surgery, based on my experience.
I just wanted to make the point that I am grateful that he gave me a full refund without question. I did mention this in my original review, but subsequently hearing about others' experiences of trying to obtain reimbursement, I feel that Mr Guest deserves some respect for offering a prompt, non-conditional refund to me.
Bristol Facial Plastic Surgeon

I did my research, and believed I was in safe, capable hands – Philip Guest is a UK “board-certified” NHS Consultant Maxillofacial Surgeon with over 20 years experience in facial cosmetic surgery, and has “an international reputation as an expert in aesthetic and facial cosmetic surgery”, according to his website. I cannot understand how this is possible, as my experience and outcome was so far removed from what these credentials should deliver. I am still incredulous that someone of such standing can perform so badly. He has changed my perception of the medical profession for the worse, and made me super-sceptical and wary of surgeons (with the exception of the London surgeon who has recently performed by revision facelift). In my opinion, Mr Guest should not be practising aesthetic surgery. I hope he is a better maxillofacial surgeon than he is a cosmetic surgeon, and that he treats his NHS patients with more care and skill than with which he treated me. In my case, the surgery was perfunctory, the outcome was appalling, and the aftercare was non-existent. The only positive comment I can give is that he refunded the full cost of my surgery (almost £10,000) without question when he saw my results at 5 months (the first time I'd been granted access to him since I'd had my stitches removed at 12-days post-op). Even he seemed dumbstruck (but not apologetic or concerned) at what he had done to me. My advice? Avoid him like the plague. He is keeping other surgeons busy with revisions of his work.

1 out of 5 stars Overall rating
2 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
2 out of 5 stars Phone or email responsiveness
3 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
1 out of 5 stars Wait times
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