Month: November 2011

The number of men choosing to undergo cosmetic procedures has increased by more than 110% since 2000, according to a report from BAAPS (British Association of Aesthetic Plastic Surgeons). 

 

The most popular cosmetic surgeries undergone by men are the rhinoplasty and the male breast reduction (gynaecomastia). It is suggested that the improvement of these surgeries has a part to play in this increase in male patients. 

Mr Ross performs both rhinoplasty and gynaecomastia surgery and can help patients achieve the results they are looking for. Gynaecomastia can cause men to feel embarrassed of their body, and may lead some men to avoid taking their clothes off or swimming, for example. Mr Ross can treat mild gynaecomastia through an incision near the armpit and with liposuction only. More dramatic and obvious gynaecomastia is usually treated with an excision of the excess tissue directly in combination with liposuction. 

 

Mr Ross advises his patients to be at a stable body weight before considering cosmetic surgery, it is also important to have realistic expectations before proceeding with any procedure. Mr Ross will talk through the risks and complications associated with all of the procedures he offers in your consultation with him in order to make sure every patient is well informed on the procedure they will be going ahead with.

Rhinoplasty surgery is designed to change the appearance of the nose, this can be solely for cosmetic reasons, or it can be to solve breathing problems. One can alter the shape of the tip, the bridge or dorsum, the nostrils and the angle between the nose and the upper lip. 

Mr Ross will alter the techniques he uses in this surgery according to the needs of the patient and their desired goals. 

Mr Ross advises his patients wishing to undergo a rhinoplasty to have realistic expectations and be aware of the pros and cons of the surgery. Mr Ross will guide his patient’s expectations throughout the consultation process and will make his patients aware of the pros and cons of the surgery they wish to undergo. 

 

It is important for any person considering cosmetic procedures to be aware of the risks, and to have realistic expectations for the outcome of the surgery. Mr Ross will discuss every aspect of surgery with his patients and make sure that they are completely confident with the surgery they wish to undergo. 

Although the overall incidence of major complications after aesthetic procedures is low, it can result in a potentially devastating cosmetic outcome and pose significant financial burden on the patient and the surgeon. Surgical site infections (SSIs) remain one of the most commonly occurring postoperative complications. Often, they are dealt with in the office setting, however, more severe cases may require emergency room visits, hospital admissions, or even reoperations. 

A recent publication from USA looked at the occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. They looked at a total of 183,914 cosmetic surgery procedures performed on 129,007 patients. Univariate and multivariate analysis evaluated potential risk factors for SSIs including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. 

From a total of 129,007 patients, 599 (0.46%) had a major SSI. Increased Age, Increased Body mass index, smoking, diabetes and female gender were more likely to have a major SSI. Trunk/extremity procedures had a higher incidence of SSI compared to breast or face procedures and SSI’s were higher in patients that had multiple procedures at the same time. 

They concluded that SSIs following cosmetic surgical procedures are associated with numerous independent predictors, which should be taken into consideration when counseling patients undergoing aesthetic surgery. 

Mr Ross believes that it is important to maximize patients preoperatively to limit the chance of SSI. Mr Ross rarely will operate on smokers and those with a BMI of over 30. Prevention of an SSI is essential for all patients undergoing combination treatments especially mommy makeover procedures.

 

Reference

 

Kaoutzanis C, Gupta V, Winocour J, Shack B, Grotting JC, Higdon K.

Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthet Surg J. 2017 Jan;37(1):89-99.

In breast augmentation patients wish to obtain the best results possible. Patients often rely on the surgeon to obtain this result and surgeons often consider breast augmentation to be a simple procedure, concentrating on the size that patients wish for. With many different options available and patients becoming more informed the focus now has shifted to preoperative planning so that patients can understand the pros and cons of the various implant options. With different shaped implants there is now more of a focus on the ideal shaped result.

Many plastic surgeons utilize breast implant sizers in breast augmentation surgery to estimate the ideal implant volume and shape after creating the surgical pocket. A sizer is a device that mimics the permanent implant and come in different sizes and shapes.

Intraoperative breast sizers may be a valuable tool in a training program to allow the novice surgeon to visualize and dissect an accurate breast pocket. However, the routine usage of implant sizers may cause tissue trauma, augment contamination risks, and increase intraoperative time and may also be expensive. It does not allow the patient to be involved in the decision making process. 

A recent study from Brazil, courtesy of the senior Author Ivo Pitanguy, has shown that the complications of infection, seroma, hematoma, and capsular contracture when using sizers were correlated with a higher complication rate. 

The authors recommend that surgeons spend more time preoperatively planning the operation. The bio-dimensional planning preoperatively can provide a suitable alternative for the inexperienced surgeon.

Mr. Ross uses bio-dimensional analysis in all his breast augmentation procedures. By using detailed measurements preoperatively, patients can be taken through the various implant options and be empowered to choose the correct implants for them. Mr. Ross does not use implant sizers and decisions regarding breast augmentation are always made preoperatively with the patient. 

In experienced hands any advantage of implant sizers are outweighed by the increased complications. Furthermore Mr. Ross believes that a change to the preoperative plan following the use of breast sizers may not be in the patient’s best interest. Patients are not involved in this decision making process and Mr. Ross would rather spend longer preoperatively with the patient to guide patients to be empowered.

Using bio-dimensional analysis helps patients to understand not just the size that can be achieved / expected but also provide more of a focus on the shape that can be achieved / expected.

 

Reference

 

Khoo LS, Radwanski HN, Senna-Fernandes V, Antônio NN, Fellet LL, Pitanguy I. Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution. Plast Surg Int. 2016;2016:6584810. 

Reduction mammaplasty or breast reduction is a common procedure that can give a functional and aesthetic improvement for patients. 

Patients often present with neck / back pain and discomfort due to the relative size of their breasts which can also affect posture. Reduction of tissue can be performed not only to improve symptoms but also to lift the nipple and provide a better aesthetic shape. 

It is important for patients undergoing breast reduction to remember that although surgery is a functional and aesthetic procedure there is an incidence of occult (undetected) breast disease / cancer. Breast screening is not 100% sensitive / specific and although rare even patients who have been reassured following breast screening may have occult disease. All patients undergoing breast reduction surgery need to be consented appropriately.

Women with benign breast disease, typically found in reduction mammaplasty specimens are at a higher risk of breast cancer and this has implications for patients in terms of breast surveillance.

A recent study from Finland analysed 918 women who underwent reduction mammaplasty from January 2007 to December 2011 and found abnormal histopathological findings in 88 (10%) patients. They found that patients with abnormal histopathology were older, and the specimens were heavier. 

They concluded that preoperative diagnostics and demographics did not sufficiently detect malignant or cancer risk and recommended that histopathological analysis of reduction mammaplasty specimens.

Mr Ross has always believed that any tissue removed from a patient should be sent for histological diagnosis. He routinely sends breast reduction specimens for analysis. On only one occasion has Mr Ross encountered an abnormal finding and in this scenario the patient required no further surgery but required ongoing breast surveillance. 

Mr Ross believes in providing optimal outcomes for patients but that any aesthetic or cosmetic surgery should not compromise patient safety. Having performed many oncoplastic breast cases including mastectomies and reconstructions Mr Ross always performs breast reductions and mastopexy surgery in a way that would not compromise patients long term should an abnormality be detected following breast reduction surgery.

 

Reference

Merkkola-von Schantz PA1, Jahkola TA2, Krogerus LA3, Hukkinen KS4, Kauhanen SM2. Should we routinely analyze reduction mammaplasty specimens? J Plast Reconstr Aesthet Surg. 2016 Nov 10. S1748-6815(16)30469-7. 

Revisionary breast augmentation is an increasingly specialised field of breast surgery.With all breast reconstruction one must consider the patients wishes for improvement in terms of size, shape and symmetry. Both clinician and patient need to establish what can be achieved and whether all expectations can be met.

 

The timing of revisionary breast augmentation must take into account the type of implants, the age of the implants, the associated changes of the implant, the capsule and the differences and changes of the breast. Many patients will have experienced mild changes and often reassurance is all some patients require. For some patients changes to the implants may require a more immediate treatment.The majority of patients will have seen a gradual change in the aesthetics of their breast over a period of years and the timing of surgery can be based on the pros and cons of what can be achieved.

 

Assessment of the implant for leak or rupture is imperative and may alter the timing of future surgery.

 

It is uncommon for these complications to occur and occasionally if doubt remains and there is no immediate decision to perform surgery a diagnostic scan is warranted. It is rare for patients to have associated lymphadenopathy but again if present the pros and cons of managing this surgically need to be discussed. Often implants will develop creases or ripples and these need to be separated from the more troublesome changes mentioned above. 

 

The quality of the capsule needs to be assessed to determine whether the capsule should be removed in its entirity (en bloc resection – total capsulectomy), whether part of the capsule needs to be removed (partial capsulectomy) or whether the capsule needs

to be released (capsulotomy). Capsules develop in all patients and are a protective barrier. Over time however they can have a detrimental effect on the breast implant and can result in pain and visible changes. The visible changes are related to the squeezing of the implants in a confined space.This can compress the implants and make them feel hard and alter the position on the chest wall. Implants can move upwards creating an upper fullness or double bubble effect, downwards (bottoming out), outwards or inwards. During surgery it may be necessary to place the implants in a different pocket ie where patients have implants above the muscle a new pocket can be made under the muscle.

 

Often with time the breast tissue will drop and one must determine whether a lift or mastopexy should be performed at the same time as implant replacement or whether it is advisable to perform the augmentation first and then a mastopexy at a second stage if needed.The need for mastopexy is dependent on both the quality of the skin and the breast tissue with particular importance taken to assess the height of the nipple areola complex on the breast and the breast’s position on the chest wall. Depending on the quality of the implant, the capsule, the skin and breast tissue one must consider the pros and cons of separating the removal of implant / surgery on the capsule with a second definitive operation. It is often possible to remove / replace implants at the same stage and mastopexy can often be performed at the same time.The pros and cons of each of these options needs to be addressed by a plastic surgeon with experience in revisionary breast augmentation.

 

Patients often do not appreciate the complexity of

the decision making process and what is involved in revisionary surgery.All patients should have the details of their previous implants available. From this information one can determine the width of the current pocket and adjust implant size and shape to improve any deformity that has occurred.There are pros and cons of using different implants, sizes and shapes in breast augment revisionary surgery and patients must be informed of the pros and cons of these and be part of the decision making process.

Anyone considering cosmetic surgery need to be have minimal stress and anxiety in their lives before considering surgery. If you have suffering with stress and anxiety here are some recommendations: – 

 

1. Speak to your GP
   If you are feeling overwhelmed with stress and anxiety and this is impacting your health, then the most important thing you can do is to speak to your GP. Your GP will help you define the cause of your stress and could refer you for further treatment, such as counselling or support group help, or prescribe medication if this is appropriate. 

 

1. Schedule in some ‘me-time’
   Whether this is going for a coffee with a friend, reading a chapter of a book, going to a yoga class or treating yourself to a beauty treatment, just taking time out of your regular schedule will help you relax and gain some much-needed rest and relaxation.

 

1. Ask for help
   Often this can be the hardest thing to do but asking for help can really help to relieve the pressure and stress from your life. If you’re struggling to juggle work and home life, you could ask a friend or family member to help out with childcare; speak to your employer about changing your work contract to flexitime or employ a cleaner to handle your household chores while you spend more quality time with your children.

 

1. Learn how to combat your problems
   If there’s a certain person or activity which triggers your stress, then one way to tackle this is by learning a new skill to help you handle the stress more effectively. If a person at work consistently treats you like a doormat, then attending a course on assertiveness could be a way to combat this. If money worries are stressing you out, book in a session with a financial advisor for help and advice on handling your money or sign up to a bookkeeping course. Working in a job you don’t like can be very stressful, you can find out what areas you might want to focus your career on by doing volunteer work or taking a course in a subject you’re interested in.

 

1. Have a break from technology
   Studies have shown that excessive use of technology can cause sleep disorders and symptoms of stress and depression and as many as 1 in 5 people say they feel depressed as a result of using social media sites. Try a technology detox, whether this is not checking social media for a week or not reading online news sites after 7pm so you can avoid traumatic stories before bed. Doing something to cut down on the time you spend online should help to reduce stress levels.

Looking after ourselves can help to diminish feelings of stress and anxiety. If you’re busy with commitments at work and home, taking the time to look after yourself can soon slip way down on your ‘to do’ list. It’s so important to take a holistic look at your health and pin point exactly what factors in it are causing you to feel so stressed. There are options open to you and people who can help you feel in control again, whether this is something as simple as booking in for a pampering or cosmetic treatment to gain some valuable ‘me time’ or something more in depth such as a counselling sessions to get to the root of what is stressing you out.

 

To help combat anxiety, ask yourself these questions to help bring some logical thought to your problems:

• Will this problem I’m worrying about matter in 2 months’ time? 

If the answer is no, then you can bring some grounding to your anxiety and realise that this problem is really not that important, and in two months’ time this worrying will have been for nothing.

• Can I do anything about the problem I’m worrying about?

If the answer is no, then again you are realising that this problem is not worth worrying about and you must let the worry go. 

 

Questions like these will help ground your anxiety in logic and will help you combat your worry and stress.

 

Mr Ross will always give you an honest and open opinion regarding the pros and cons of cosmetic surgery and will only offer surgery when you are empowered to make an informed decision about the pros and cons.

Ask questions

 

One of the biggest things you can do to keep anxiety levels at bay when heading towards surgery is to ask your surgeon questions. When you come in for a consultation with Mr Ross you will discuss your surgery at length and your desired results. 

Mr Ross will explain the whole procedure along with any risks the surgery may involve and will make sure you are fully informed regarding the pros and cons. 

 

Take time out to reflect

 

Before going ahead with your procedure, take a couple of weeks to think about exactly what you want and what you would like to achieve with your chosen surgery. Also take a look at reviews from real patients on the RealSelf website. Before going ahead with any surgery, it is important that you are 100% confident in your chosen procedure and your surgeon. Reading Mr Ross’s reviews on RealSelf.com will enable you to get a good feel of the quality Mr Ross provides.

 

Have a good night’s sleep

 

In preparation for your surgery ensure you get a good night’s sleep. We understand you may be anxious so getting to sleep and staying asleep may be difficult – this is one of the main factors of inducing stress and worry. Try to keep busy during the day and perhaps have an early night if you think you may struggle to stay asleep throughout the night. 

 

After surgery

 

It is important not to do too much too soon following surgery. Some women are keen to get back to their daily routine and exercise, but is important to allow your body to have plenty of time to recover. After a couple of weeks, you can start to get back to your routine and back to work. It is important to maintain a healthy lifestyle following surgery in order to maximise the longevity of your results. 

 

Mr Ross is always available via email, and you will also receive the nurse’s mobile phone number should you have any questions following surgery. Mr Ross and his team will do everything they can to ensure you have a smooth and uneventful recovery.

 

If you are considering a cosmetic procedure, make sure you book in for a consultation with Mr Ross to discuss all of your options.

It’s well known that gym membership signups spike at the turn of the year. 

Although many patients make decisions over the Christmas period to proceed with plastic surgery in the new year, these decisions should not be influenced by gifts received over the Christmas period.

The “gifting” of plastic surgery appears to be an increasing trend that potentially exploits patients at a vulnerable time. 

The increasing `commoditization` of cosmetic procedures, eg Christmas gift vouchers has also been highlighted by the Royal College of Surgeons and the General Medical Council. It is clearly stated that marketing must be responsible and must not trivialize interventions and must not exploit patients vulnerability. 

This “gifting” trend is a concern for patient safety and the British Association of Aesthetic Plastic Surgeons (BAAPS) has cautioned the use of Christmas gift vouchers, denouncing them as a cynical marketing ploys. 

Patients who receive plastic surgery gifts will have received them from someone on their behalf – whether it be a friend or family member. This is one of the fundamental problems with gifting as the motivation for the gift is propagated by the family member or friend. 

All patients need to make their own decision of whether to proceed with plastic surgery and they must not be incentivized or influenced by others in making this decision. This self motivation for patients is violated by gifting and places patients under pressure to use these gifts and proceed with treatments. They may feel that if they don’t proceed that they will be insulting the person who has given them the gift. 

All plastic surgery treatments have pros and cons and the risks of treatment need to be discussed prior to any decision to proceed.  This discussion must occur between a suitably qualified plastic surgeon and the patient and should not be influenced by gift vouchers. The risks are rarely provided with the gift voucher and rarely will these plastic surgery gift vouchers be refundable. 

Patients must make their own decision to proceed and must consult with a qualified plastic surgeon in order to determine whether plastic surgery is recommended and whether it can meet their expectations. Only after a detailed consultation can patients be empowered as to whether to proceed. 

Those who feel that the provision of plastic surgery gifts / vouchers is a caring and worthwhile Christmas present need to be aware of the implications of their actions and that they may be actually harming those that they have gifted plastic surgery to.

 

Christmas is a time for giving and no harm is the best present that a family member / friend can give.  

Around 15 million people in the UK are over 60 and this will increase to 20 million within the next 10 years. The number of people over 65 is anticipated to increase by 40% in the next 20 years. Mr Ross has seen a 200% increase in new referrals in his practice of over 60’s as compared to 5 years ago and it is likely this will continue to increase. The commonest procedures being requested are eyelid rejuvenation and facial rejuvenation.

Just as there is a lot of information about cosmetic surgery is available, there is even more information and awareness about improving diet and lifestyle. As such the current over 60’s are looking after themselves better than their predecessors. They feel younger than their predecessors and want to look as young as they feel. Many have looked after their skin for many years – have healthy diet and lifestyle, rarely overweight and they understand the risks more than younger patients. If anything, they are more concerned about the risks and their own safety in comparison with younger patients.

 

The biggest driver of the over 60’s when looking for cosmetic surgery or advice about cosmetic treatments is that they want safety and quality. They don’t want to consult with a sales team, can see through marketing and wish to consult with an experienced consultant that they can trust. They want to be given information and have time to decide rather than rushing into a treatment. Unlike younger generations the over 60’s are not looking to have cosmetic surgery for others, their expectations are realistic and they are able to weigh up the pros and cons of procedures. It is uncommon for patients in this age group to have underlying body image issues.

 

If they wish to proceed with cosmetic surgery, they want to be provided for in a safe environment and know that they will be looked after following surgery.

 

Mr Ross works in one of the largest private hospitals in the UK. All patients undergo preoperative assessment prior to surgery to make sure they can be optimized prior to surgery. 24/7 care is available throughout and Mr Ross and his team are available throughout the perioperative journey. All consultations are with Mr Ross himself and there is never any pressure or obligation to proceed at any time. Mr Ross will only offer surgery in less than 50% of patients who he consults with and aims to provide optimal care and advice to all patients to allow them to be empowered to proceed or not.

 

After a cosmetic procedure, it is normal to feel tired and worn out, your body has undergone a huge change and needs time to rest and re-charge; and it’s important that you let it. Many patients want to accelerate the recovery process so they can go out and enjoy these new changes to their body. However, this can be detrimental to your health, and your long-term result. The following tips are a few things every patient can do to increase their chance of a successful recovery. 

 

1. NO SMOKING

 

Patients of Mr Ross are advised to stop smoking before any procedure, and so just because the surgery is complete does not mean it is time to start again. Smoking prevents successful healing and can lead to serious complications. It is important for patients to stay healthy after surgery, and so avoiding smoking is an absolute must. 

 

1. INCREASE MOBILITY

 

It is important to get lots of rest in the immediate period following surgery, however, you must not lie around for days doing nothing. It is important to get up and about, even just to step outside for a breath of fresh air. Moving around helps the body to heal and may also reduce pain, so try to increase your mobility each day after surgery.

 

1. SKIP THE WORKOUT

 

While it is important to increase your mobility after surgery, for the first 48 hours it is also important not to be too active. Many patients are eager to get back to their routine, but it is important to do this in a safe manner and allow the body the healing time it needs. Too much too soon can compromise the results of the surgery, for this reason, in the weeks following surgery it is important for patients not to partake in rigorous exercise. The amount of time after surgery one can return to exercise varies with each surgery. Mr Ross will be there every step of the way with each patient following surgery and will let each patient know when it is safe to return to exercise. 

 

1. HAVE A POSITIVE MIND-SET

 

For the body to heal successfully, it must be paired with a positive mind-set. It is important following surgery to be positive about your results and manage your pain effectively with the pain medication provided. The first couple of days can be tough for some patients but it is vital to maintain a positive attitude throughout the healing process.

Every procedure and patient is different, and so healing time will be different for each individual. Following Mr Ross’s advice after surgery is our biggest tip, as his instructions will be crucial in ensuring a healthy and speedy recovery that allows your body to heal properly. 

 

5. DON’T PUSH THROUGH THE PAIN BARRIER

 

It is really important to take the pain medication prescribed by Mr Ross. Some patients will try to ignore and push through the pain they experience, however this can be detrimental to your recovery. Blood pressure can increase as a result of pain and so managing this as Mr Ross has explained is crucial for the healing process.