Month: November 2011

A breast reduction is the removal of excessive breast tissue and is often associated with shoulder pain, backache, shoulder grooves due to bra straps and postural changes.  The excessive weight can interfere with exercise and sporting activities. Furthermore the psychological well-being and sexuality of women can be affected negatively by increased breast size.

 

With improved techniques breast reduction has become not only a functional operation but also an aesthetic operation. Various sizes and shapes can be obtained depending on the individualised needs of patients with surgical techniques varied to meet the needs of every patient. Although there are risks of the surgery often the benefits far outweigh the negatives and overall breast reduction is one the most rewarding plastic surgery procedures. Although not 100% guaranteed improvements in symptoms can be dramatic and lead to improvements in quality of life.

 

Patients need to be taken through the various options and shown examples of the variety of results so that they can be empowered to make a decision to proceed. Often results are related to patients anatomy and an experienced surgeon will be able to explain what is possible and give an idea of what can be achieved.

 

In a recent study from Iran the authors looked at the effect of breast reduction on patients and their partners. They assessed the sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF). 

The authors found that there was a significant improvement in the mean IFSF and IIEF scores after surgery in both patients and their partners. In addition, patients expressed high levels of satisfaction with the results of surgery in terms of physical and psychological scores. 


Reduction mammoplasty is one of the commonest and most rewarding breast operations and can have a dramatic effect on physical and mental health in women with large breasts. 

The results suggest that breast reduction surgery has a positive impact on the quality of life of the patients. In addition, sexual dysfunction in the women and their male partners improved after reduction mammoplasty. The postop analysis was performed after 6 months.

Mr. Ross offers a variety of different breast reductive techniques. He does not use any dressings or drains and patients can mobilize immediately following surgery. The improvements in surgical techniques have made the recovery from breast reduction surgery more rapid and often patients are able to get back to normal every day life almost immediately. Patients are advised to avoid sexual activity for the first few weeks postoperatively. 

Reference. 

Impact of reduction mammaplasty on sexuality in patients with macromastia and their partners. Emami SA, Sobhani R.J Plast Reconstr Aesthet Surg. 2016 Oct;69(10):1335-9. 

The term cosmetic has traditionally been applied to the cosmeceutical industry. Cosmetics are another term for make up and used to enhance the appearance or fragrance of the body (as per Wikipedia). 

The widespread use of the term cosmetic followed by doctor, surgeon, and surgery are terms that mystify patients. Advertising and marketing strategies utilizing these terms do not offer patients any reassurances as to the training, accreditation and regulatory framework for the treatments these patients wish to consider. Patients assume that those offering cosmetic surgery have suitable training. Unfortunately there is no specific training for “cosmetic surgery” and patients should take no reassurance from the use of this terminology in finding a suitable “cosmetic surgeon”. 

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It includes cosmetic or aesthetic surgery, reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. (As per Wikipedia)

Plastic surgery techniques have also been incorporated within many different surgical disciplines including ENT / Maxillofacial  / Ocular and Breast Surgery.

Patients must understand that training, accreditation and a regulatory framework exists for plastic surgery. Many of these surgeons offer “cosmetic surgery” within this regulated framework.

Training / Accreditation and Regulatory Framework in Plastic Surgery.

After finishing medical school, trainee doctors will spend two years gaining experience in a variety of specialties in order to acquire full registration with the General Medical Council. After a minimum of two further years surgical training, the trainee can apply for a plastic surgery training programme.  If successful plastic surgery trainees will undergo a minimum of six years plastic surgery training. 

Plastic surgery trainees are required to pass the Intercollegiate Specialty Examination (FRCS Plast). Those who successfully complete the training programme gain their Certificate of Completion of Training (CCT), and are then eligible to be placed on the GMC specialist register for plastic surgery. 

The training in aesthetic surgery (or more commonly referred to as cosmetic surgery) is overseen by the Royal College of Surgeons and recommends that consultants certify within their areas of specialism. It is anticipated that these areas of specialism will also become visible to patients via the GMC specialist register.  Consultants are appraised on an annual basis and revalidated on a 5 yearly basis.

In plastic surgery the national organizations of British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS) only offer full membership to those who have completed their training and are on the GMC specialist registrar for plastic surgery. All members are voted in by their peers and offer the public a means of locating surgeons within suitable training in aesthetic surgery. 

 

Patient Empowerment

 

Patients are often mystified as to how to access a suitably trained and accredited “cosmetic” surgeon. The popular press regularly documents the unfortunate plights of patients who have received substandard care, some of which have been placed in jeopardy because of lack of training and improper practices.

Patients need to empower themselves to do their due diligence on the individual they choose to consult with.  For patients, locating suitably trained “cosmetic” surgeons is difficult. Social media may divert patients to those that advertise and market the term cosmetic. The public need to look for those trained in plastic surgery that are listed in the GMC specialist register for plastic surgery.

 

Reassurance to Patients consulting with Mr Ross for “cosmetic surgery”

 

Mr Ross is a plastic surgeon who underwent specific training in plastic surgery. Mr Ross successfully completed his FRCS(plast), obtained his CCT and is listed on the GMC specialist Register for Plastic surgery (Number 4220633). Mr Ross has a vast training in aesthetic surgery throughout his plastic surgery training including  the  techniques utilized in “cosmetic surgery”. Mr Ross is a full member of BAAPS and BAPRAS and is regularly appraised on an annual basis. He has successfully revalidated and “cosmetic surgery” is an established part of his scope of practice. 

Sagging skin can be the result of many different effects on the body; weight loss patients can experience sagging skin, along with women who have given birth to their children. Sagging skin can also be a side effect of aging, as we age we lose the collagen and elasticity in our skin which can cause it to sag, and some patient’s skin sags more than others. This excess skin can be removed through body lift surgery.

Body lift surgery focuses on toning the body and helps to tackle those stubborn areas of fat and skin that you cannot shift through weight loss or exercise. The concept of this surgery is to remove, lift and reshape the body.

Consultant Plastic Surgeon Mr Gary Ross offers many different options to tackle your sagging skin and rejuvenate your body’s appearance.

 

Upper Body Lift

These procedures focus on toning anything on the top half of your body including:

Breasts –An uplift procedure (mastopexy) can be performed if you feel that you have a loss of volume in your chest area and would like to have a fuller, lifted chest.

Arms –If you are suffering with excess skin or fatty tissue in the inner arm area, (more commonly known as ‘bingo wings’) surgery can be performed via liposuction or a skin tightening technique called an arm lift.

Mid back – Via Liposuction.

 

Lower Body Lift

These procedures focus on toning the lower areas of the body, including:

Tightening of your tummy – This can involve either a full or mini tummy tuck depending on the amount of excess skin in the abdominal area. Mr Ross can also offer a Fleur De Lis tummy tuck, which tackles excess skin in the upper part of the abdomen.

Buttocks – Through Liposuction or lifting.

Thighs – thigh lifting surgery

 

 Full Body Lift

This can be considered if you are looking at toning areas in both the upper and lower body.

 

Mr Ross’s patients are treated on a case-by-case basis as everyone’s individual needs are different. If you were considering this type of surgery we would recommend a consultation with Mr Ross where a full assessment would be carried out on the areas in which you were looking to have rejuvenated.  To find out more about Body Lift surgery or to book a consultation, please call 0161 401 4033 or fill out an online enquiry form.

 

Liposuction is one of the procedures that has increased dramatically and there are many different options available. It is important to run through your suitability during a consultation, understand the pros and cons and be empowered to make a decision to proceed. By following these simple steps below you are likely to achieve desirable results.

• Be realistic- Do not think that liposuction will transform you from a size 14 to a size 8. Liposuction is generally suitable for individuals with stubborn fat deposits, such as ‘love handles’. Unfortunately for some of us no matter how much we diet and exercise we acquire fat pockets that just won’t budge. Be aware of the fact that although you may not drop 4 dress sizes, your clothes are likely to fit significantly better and subsequently your confidence levels are likely to rise. 

• Maintain an ideal weight- In order for liposuction to be effective it is advisable that you are at your ideal weight and have maintained that weight for some time. Remember that liposuction is not a weight loss procedure by any means and by entering into a consultation at your ideal weight you will mostly likely achieve the results you desire.

• Patience is a virtue- All good things come to those who wait, right? Therefore, there is no need to panic that you don’t look how you want to look in your bikini 3 weeks after surgery. The results of surgery can take numerous months and post-operative swelling can significantly cloud your results. In addition to the swelling you might want to hold off trying on your bikini due to the bruising, usually you can expect to be bruised for a good few weeks after surgery.

• Let yourself recover- Don’t expect miracles! Liposuction is an invasive surgery and thus requires a recovery period; generally, a week off work with your feet up and a cup of tea in your hand should be sufficient. Postoperatively you will also be advised as to when you can resume your physical activities such as swimming, going to the gym etc. 

• Importance of aftercare- Your surgeon will provide you with an ever so attractive compression garment which you will be required to wear for a good few weeks post-operatively. Such garments are all part of the recovery process and it is vital that you wear it in order for your body to adjust to its new shape. Try and remember that this garment will hopefully improve the final result and will help control the inevitable swelling.

• Liposuction is no quick-fix- I hate to be the one to tell you that weight gain is still a possibility following liposuction. Ultimately, if weight gain occurs you are significantly less likely to gain weight within the treated areas as the fat cells within that area will have been permanently removed. Therefore, eating clean and exercising should still be incorporated in order to maintain a healthy lifestyle.

 

There are many highly trained plastic surgeons across the world and often patients look to combine a holiday with their cosmetic surgery. This is often termed cosmetic or plastic surgery tourism.

The advent of the Internet and social media has made it even easier to access cosmetic surgery abroad. 

 

Patients may feel empowered to combine cosmetic surgery abroad with a postop recovery away from their normal country of residence. They feel that they can then return home having had not only a holiday but also with the ability to hide the fact that they have had cosmetic surgery. They rarely consider the choice of surgeon and even if this is considered it is often low on the priority list. Our previous article documents the importance of choosing your surgeon (Part 1). Patients however must also consider the provider, communication barriers, the preop assessment, management of complications, aftercare and the hidden costs.

 

Caution 2. The hospital / provider.

 

Patients must research the hospital where they wish to have a plastic surgery procedure. Patients must know whether the hospital facility is regulated, is certified / accredited and has appropriate patient safety standards. Patients should ask whether The World Health Organization (WHO) surgical safety checklist has been implanted within the facility and the rates of infection and complications within the facility should be easily available.

 

Caution 3. Communication

 

When considering plastic surgery tourism patients must ensure that they can communicate effectively with not only the surgeon performing the surgery but also the staff at the facility where the procedure is to be carried out. In order that patients can consent appropriately for treatment they must be able to understand the consent process and be able to be cared for peri-operatively. 

 

Caution 4 Preoperative assessment and Anesthetic

 

If patients are deemed suitable for surgery and happy to proceed within the UK they require a preoperative assessment prior to surgery. Patients must be aware that a preoperative assessment by a suitably qualified provider is essential prior to any plastic surgery procedure. In the UK patients have the opportunity to postpone / cancel without any / minimal financial penalty if they are deemed unsuitable after a preoperative assessment. In the UK if concerns were picked up following a preop assessment, an anesthetist would consult with the patient preoperatively and run through the pros and cons of proceeding. Within the plastic surgery tourism package. Patients need to clarify the preop assessment process, details of the anesthetist and the implications of abnormal findings on preoperative assessment.

 

Caution 3. Complications

 

The possibility of complications increases considerably with travel. These increased risks include deep vein thrombosis (DVT) and pulmonary embolism (PE), which are increased considerably when flying.

Caution 4 Aftercare

 

When things go wrong abroad, patients have little opportunity to extend their stay and often pursue additional treatment at their own expense. Often they feel pressurized into returning to the UK even though they know something is wrong. There is also limited if any chance of redress following return to the UK.

 

Caution 5. Cost

 

Low cost is the main attraction for going abroad. However dealing with complications can be substantial and significantly higher than the original surgery costs. Furthermore infections contracted abroad may be atypical and resistant to treatment. Patients with minor problems requiring ongoing visits for weeks can be easily treated when the surgeon is nearby. A patient whose surgeon is thousands of miles away in a different country won’t have the same aftercare in place unless this is documented preoperatively. Even when surgery is properly performed, complications are a possibility. Patients need to know who will care for them when they return home and who will pay for any secondary or revision procedures.

 

Mr. Ross is a plastic surgeon that underwent specific training in plastic surgery. Mr. Ross successfully completed his FRCS(plast), obtained his CCT and is listed on the GMC specialist Register for Plastic surgery (Number 4220633). Mr. Ross has a vast training in aesthetic surgery throughout his plastic surgery training including the techniques utilized in “cosmetic surgery”. Mr. Ross is a full member of BAAPS and BAPRAS and is regularly appraised on an annual basis. He has successfully revalidated and “cosmetic surgery” is an established part of his scope of practice. 

There are many highly trained plastic surgeons across the world and often patients look to combine a holiday with their cosmetic surgery. This is often termed cosmetic or plastic surgery tourism.

The advent of the Internet and social media has made it even easier to access cosmetic surgery abroad. 

Patients may feel empowered to combine cosmetic surgery abroad with a postop recovery away from their normal country of residence. They feel that they can then return home having had not only a holiday but also with the ability to hide the fact that they have had cosmetic surgery. They rarely consider the choice of surgeon and even if this is considered it is often low on the priority list (Part 1). Patients must also consider the provider, communication barriers, the preop assessment, management of complications, aftercare and the hidden costs (Part 2).

 

Caution 1: – The surgeon

 

Patients need to enquire who the surgeon will be. This should be patient’s top priority when considering plastic surgery tourism. Patients should then have the ability to do their due diligence on the surgeon.

In the UK, there are easy ways to check the credentials of your plastic surgeon. Every plastic surgeon will be listed on the GMC specialist Register for Plastic surgery. Those who have successfully completed their plastic training within the UK will also have the FRCS(plast) exam and obtained their CCT. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS) only offer full membership to those who have completed their training and are on the GMC specialist registrar for plastic surgery. Their peers vote in all members and these organizations offer the public a means of locating surgeons with suitable training. The BAPRAS and BAAPS websites are a valuable resource for patients and patients to find full members with ease.

Outside the UK it is very difficult to judge a plastic surgeons credentials from afar. Many plastic tourism procedures are booked through third party agencies and even when booked directly patients often do not have any direct contact with their surgeon prior to booking their holiday. 

All patients must consult with their surgeon before considering surgery and have the opportunity to do their research on their plastic surgeon before considering surgery. They must have time to reflect on this consultation and have the opportunity to postpone / cancel without any financial penalty. This is unfortunately rarely part of the plastic surgery tourism package. It remains an essential part of the UK GMC’s guidance for plastic surgery.

 

Mr. Ross is a plastic surgeon that underwent specific training in plastic surgery. Mr. Ross successfully completed his FRCS(plast), obtained his CCT and is listed on the GMC specialist Register for Plastic surgery (Number 4220633). Mr. Ross has a vast training in aesthetic surgery throughout his plastic surgery training including the techniques utilized in “cosmetic surgery”. Mr. Ross is a full member of BAAPS and BAPRAS and is regularly appraised on an annual basis. He has successfully revalidated and “cosmetic surgery” is an established part of his scope of practice. 

Before and after photographs are an essential means for plastic surgeons to show patients realistic outcomes from “cosmetic surgery”.  Mr. Ross gives patients some tips in viewing preop and postop images.

 

Tip 1 Are the pictures you are viewing the surgeons you wish to consult with?

 

Look at the before and after pictures for the surgeon you wish to consult with. It is imperative that you do not look at generic images or images from clinics / group practices where you do not know who has carried out the procedure. Often these pictures are best viewed on a surgeons individual website. Images from clinics / groups / websites may include the surgeons details although this not commonly practiced within the cosmetic industry. On Mr. Ross’s website all surgery depicted within the preop and postop image gallery has been carried out by Mr. Ross.

 

Tip 2: Quantity 

 

Every surgeon will take photographs of every patient he/she operates on. In Mr. Ross’s practice over 50% of patients are happy for these images to be shared on line. Mr. Ross updates his before and after images on a regular basis with limited selection bias. In the modern era of openness and transparency, the sharing of pictures is an essential part of patient education and one must question why a surgeon would not post his/her before and after pictures. If a surgeon has relatively few pictures there is a good chance they do not have results to show. Patients must look for a surgeon with a large selection of preop and postop pictures. 

 

Tip 3: Look for images that go together

 

Always check that the before and after image are from the same patient. Looking at moles, freckles, eye/hair colors are a good way of checking this. Always check at what point postop the images are taken and also whether there are a mix of photos at various time frames. Visualizing long term results is very important as it not only demonstrates a surgeons experience but also that he/she follows up his/her patients on a regular basis. 

 

Tip 4: Quality

 

Make sure the position of patient in the pre and postop images is standardized. Ideally the lighting should be similar and the image quality similar. Beware if the photos look out of date and always look at the date the images have been posted on the website. Mr. Ross updates his images on a monthly basis and the dates of posting are easily visualized.

 

Tip 5: Look for images similar to you preoperatively.

 

Try not to look at the best postop results only. You are best to look through the preop photos and find those that are most like you and then look at what has been achieved. If the surgeon is experienced you should be able to find a range of results like you. From this you can discuss with your surgeon what you like / don’t like about his/her work. This often helps empower you to make the decision as to which procedure to proceed with. It is useful to let your surgeon know what you desired look although this should not be the priority when you look through an image gallery.

 

Tip 6: What if your surgeon does not show you any preop and postop images?

 

Walk away

Blepharoplasty, or eyelid surgery, is a common cosmetic surgery that can revitalize the eye area and rejuvenate your overall facial appearance. Although it is considered a safe procedure with few risks, there are some steps you can take before and after surgery to support healing and speed up your recovery.

 

Before Your Eyelid Surgery

If you are in good health, you can significantly reduce the possibility of complications during or after an eyelid surgery. A balanced diet can also help to ensure that your body recovers as quickly as possible. In addition, lifestyle adjustments, such as reducing late nights and controlling sleep deprivation can help strengthen the body’s reserves.

• Quit smoking. Smoking can inhibit the body’s ability to transport oxygen and nutrients, which can affect the body’s ability to heal. Surgery can be a great opportunity to quit for good. Mr Ross always advises his patients to have stopped smoking a number of weeks prior to surgery. 

• Monitor blood pressure. Stable blood pressure will reduce the risks of bruising.

• Discontinue certain medications. Aspirin and some herbal supplements increase the possibility of bruising and swelling. Mr Ross will be very clear on what medications must be stopped prior to surgery.

 

After Your Eyelid Surgery

After a blepharoplasty, the average time for recovery is about 2 weeks. Depending on your profession, it may be necessary to take more than two weeks off before returning to work.

• Avoid certain medications. To help keep bruising and swelling under control, you should continue to avoid blood-thinning medications and herbal supplements for about 2 weeks after the procedure.

• Avoid exercise. It is highly recommended that you avoid vigorous exercise or strenuous activity in the first few weeks following your surgery. This will allow your body the rest it needs to ensure that you heal properly and achieve the best possible results.

• Cold compress. To help reduce swelling, apply a cold compress to the eyes for the first 3 days.

 

It is important to follow any post-operative instructions you are given by Mr Ross and his team. To learn more about your options for a blepharoplasty, book in for a consultation with Mr Ross.

 

Enlarged breasts can causes important physical and psychosocial discomfort.  Breast reduction surgery is one of the most commonly performed cosmetic surgical procedures. 

During a breast reduction there are often a number of wounds that require suturing. The breast tissue not only needs to heal in an aesthetic shape but the skin envelope and the scars on the breast need to heal appropriately in order that patients obtain the optimal outcome. 

It is well known that surgical site infections will alter the healing process and can affect the quality of the scars and the final outcome. Reducing the chance of surgical infection has led many surgeons to consider the use of prophylactic antibiotics to reduce the incidence of surgical site infections in breast reduction surgery.

A recent study published in the Journal of Plastic Reconstructive and Aesthetic Surgery (Ref 1) has looked at the evidence and shown that antibiotic prophylaxis lowers the incidence of surgical site infection in breast reduction surgery.

Of 584 patients the incidence of a surgical site infection was 10.5% in those patients that were given prophylactic antibiotics compared to 18.7% in those who did not have prophylactic antibiotics.

Mr. Ross is a member of the American Society of Plastic Surgeons and a survey of 5112 plastic surgeons, who were members of the ASPS (response rate: 52%), 93% use preoperative antibiotics and 74% use additional postoperative antibiotics in this procedure (Ref 2).

Mr. Ross recommends that all patients have antibiotics as part of the perioperative journey for breast reduction surgery. Mr. Ross also recommends patients to have postoperative antibiotics. Patients do need to be aware that there are downsides to antibiotic use and need to run through the pros and cons during a consultation and make an informed decision.

 

References

 

1. Zapata-Copete J, Aguilera-Mosquera S, García-Perdomo HA. Antibiotic prophylaxis in breast reduction surgery: A systematic review and meta-analysis.J Plast Reconstr Aesthet Surg. 2017 Aug 16. 

 

2. Okoro SA, Barone C, Bohnenblust M, Wang HT. Breast reduction trend among plastic surgeons: a national survey. Plast Reconstr Surg 2008;122(5):1312e20.

A recent study from the University of California has suggested that if you wish to look more attractive in a selfie that you should snap yourself from the front rather than the side.

The use of selfies and its propagation in social media has led to a change in the general perception of beauty. As highlighted in this study it is very important when considering plastic surgery that both patients and plastic surgeons analyse the profile as well as views from the front when considering any aesthetic treatment. 

Computer imaging and 3D analysis are increasingly being used to help patients to visualize how changes in one area will affect other areas and how changes can be viewed from different angles. 

Potential patients must be happy with all views and the range of results that can be achieved. Results from plastic surgery are never guaranteed and when looking through preop and postop images patients need to be able to see improvements in all the images shown and plastic surgeons should provide a range of results for patients to visualize rather than selecting only the best results. Patients need to be shown complications and be taken through all the pros and cons and risks in order to be empowered to proceed or not.

For those wishing to undergo plastic surgery Mr Ross advises patients that they should not concentrate on selfie images and the reactions of others to these images which could have the potential of creating unrealistic expectations.

We have seen a rapid increase in patients bringing images of others into clinic and it is very important that patients are realistic in their expectations. Increasingly patients do not bring images that realistic and Mr Ross suggests that potential patients should look through preop and postop images of patients that have similar anatomy to get a better idea of what can and cannot be achieved.

 

Reference.

Association of Frontal and Lateral Facial Attractiveness 

Gu JT, Avilla D, Devcic, Z, Karimi, Wong BJF

JAMA Facial Plast Surg. Published online August 3, 2017.

 

This article was published by the Daily Mirror http://www.mirror.co.uk/news/uk-news/scientists-reveal-how-take-perfect-10992642