Month: November 2011

Blepharoplasty surgery is a great way to rejuvenate your facial appearance. Blepharoplasty surgery can do this by freshening up the appearance of your eyes and can also provide some people with an improvement in their vision.

Loose skin and fullness around the upper eyelids can fold over the upper eyelid and can affect vision and interfere with work-related activities. Eyelid surgery often requires removing loose skin and lifts the weight from the upper eyelid, improving both the appearance of the eyelids and vision. Blepharoplasty is a procedure which extracts excess skin by removing and repositioning soft tissue, fat and muscle to more naturally suit your face and so can correct vision.

Mr Ross provides a customized approach based on the patient’s unique facial composure and proudly utilizes all of the latest technology to provide natural results. Mr Ross will always ensure that his patients are fully informed and aware of the risks surrounding any procedure to ensure that each patient is 100% satisfied with their results.

 

Four benefits of undergoing Blepharoplasty

 

Rejuvenated appearance: 

Excess amounts of loose skin on your upper eyelids can cause droopiness and a sagging overall appearance of your eye area. Excess skin and fat can also come forwards and form a bulge underneath your eye, and this requires lower eyelid surgery to correct.

All eyelid surgery needs to be tailored to the individual person, and Mr Ross ensures each patient received a tailored and personalised plan to ensure the best possible results for them. Blepharoplasty reduces the amount of skin, resulting in a more youthful and refreshed appearance. Although many patients try creams and potions to try and improve this appearance, often the changes require blepharoplasty to make a true difference.

 

Reducing fine lines: 

During eyelid surgery, a remarkable thing happens. The skin surrounding your eyes is lifted, which reduces the amount of lines, wrinkles and creases evident on your face. Mr Ross specializes in the art of facial cosmetic surgery and incorporates advanced techniques into each treatment.

 

Headaches related to vision: 

In certain circumstances, the excess skin can weigh heavily on the upper eyelids resulting in headaches. In some patients removing the loose skin and opening up the eyelids can relieve the weight on the eyelids and treat the cause of the headaches.

 

Improved vision: 

Drooping upper eyelid skin can affect the edges of the vision. Excess soft tissue can reduce visibility, Mr Ross can therefore improve some patients vision by removing this excess skin.

 

It is imperative to note cosmetic surgery can provide you with impressive results but isn’t the solution for major medical concerns. If you have a significant ophthalmological condition including diabetes, glaucoma or dry eyes it is important you notify your plastic surgeon before undergoing surgery so that the necessary precautions can be taken, meaning some patients may require additional safety tests.

 

Defensive medicine (DM) is defined as medical practices carried out primarily to avoid malpractice liability rather than to benefit the patient 

A recent study from Israel has highlighted the increasing trend for DM that seems to be dictated geographically by litigation prevalence. 

This study states that “DM entails referring patients for superfluous consultations or tests, performing unnecessary medical procedures or treatments, avoiding patients who are considered high risk, and refusing to perform procedures that may increase the chance of litigation.” 

Clinicians may be pressurized by the threat of personal litigation but also by provider regulation and the possible implications of not conforming to provider and regulatory guidance. The motivation to avoid litigation however is difficult to separate from the desire to enhance patient safety. Enhancing patient safety and creating optimised results undoubtedly will lead to a reduction in litigation. 

 

The practice of DM in relation to additional referrals / tests can only be addressed through the patient / doctor consultation and can only be circumnavigated by the patient having been given sufficient information to make an empowered decision. 

Often unnecessary treatments / referrals and tests are performed as screening tools. Patients need to understand the reason for these tests and be able to make a decision to have these tests. A clinician can only decrease the practice of DM by engaging the patients in this decision making process.

Interestingly this study has highlighted an increasing trend towards a more robust consent process. This is undoubtedly a great benefit of DM for both patients and clinicians and is imperative for patient safety. This in Mr Ross’s eyes does not demonstrate a practice of DM. 

In this study clinicians in private practice, where the litiginous risk is higher, the consent process was more robust with 43% of clinicians in private practice obtaining written consent twice before surgery compared with 24% in public practice. 

Additional visits / additional time to develop a doctor/patient relationship is in Mr Ross’s opinion the most important aspect of delivering high quality patient care. Mr Ross provides all patients with detailed information during the initial consultation, a detailed consent information sheet at a second visit and reconfirms this consent for patients preoperatively. All patients are given the opportunity to discuss the pros and cons of additional referrals / tests that could be considered necessary by protocols and regulatory guidance and given sufficient information to be empowered to make a decision as to whether to proceed or not.

Patient derived empowered care is essential in optimizing results. Although Mr Ross does not actively practice DM he does spend significant time informing and empowering patients. Allowing patients to determine their own preoperative and postoperative regimes delivers individualized care. Although time consuming the benefits for patients and doctors alike are essential in optimizing care and enhancing patient safety.

Clinicians need to be aware that standards of care are continually changing and that the evidence to support change in practice is also changing. All advice given to patients to empower them to make decisions needs to be supported by evidence based medicine.  

Reference  Silberstein E, Shir-Az O, Reuveni H, Krieger Y, Shoham Y, Silberstein T, Bogdanov-Berezovsky A. Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel. Aesthet Surg J. 2016 Nov;36(10):NP299-NP304.

Medical tourism is a booming industry, particularly when it comes to facial plastic surgery. The promise of a more affordable procedure, combined with a pleasant backdrop for a restful recovery, can lure patients outside of their country limits. But what are the risks?

 

The biggest danger is quality of care and safety. Some countries do not have regulations in place that protect patients from experimental treatments or outdated equipment. If something goes wrong during the surgery, you may be stuck with little or no legal and financial recourses.

To attract patients some surgeons may present a laundry list of expertise. However, this may not be the case and so it is vital you conduct extensive research before proceeding with any surgeon. This includes reading countless patient reviews to get an overall feel for the surgeon and the way they treat their patients. Mr Ross’s reviews speak volumes about the quality with which he performs surgery and the way he treats his patients before and after surgery.

 

Finding a Reliable Surgeon Abroad

Generally speaking, it is better find a local cosmetic surgeon. However, you may want to consider consulting a surgeon abroad if they have specialized knowledge and unique qualifications. Cities like Manchester, Liverpool, London and New York, for example, tend to attract highly skilled surgeons.  This clustering of talent, coupled with reliable surgical standards, makes these places top destinations for individuals who are seeking the best-rated plastic surgeons. If you are contemplating travelling for a procedure, you should keep the following in mind as you choose a surgeon:

• First and foremost, you should review the surgeon’s academic and specialized training. Confirm any degrees, certifications, and institutions mentioned.
• Activate your personal network and ask for recommendations. Although it may be challenging to ascertain a surgeon’s reputation from a distance, you do have tools at your disposal. A simple online search can help you uncover any complaints or concerns that may have been logged about a potential surgeon. Do not be afraid to ask for photos of the surgeon’s work or ask for patient referrals. Mr Ross makes his reviews readily available for any future patient, and there are plenty of before and after pictures of his previous patients that are also available on the website. 
• Ability to communicate. Can the surgeon communicate flawlessly in your language? This will prevent any miss-communications and will ensure 100% patient satisfaction.
• Where will the surgery be done? Does the surgeon use state-of-the art technology and equipment? Mr Ross performs his surgery at the BMI Alexandra Hospital where he utilises the best equipment available, this will ensure your surgery is performed to the best possible standard.

 

Mr Ross is a cosmetic plastic surgeon whose credentials are recognized in both Europe and the United States. If you are considering a cosmetic procedure and would like to know more about your options, contact his office today to schedule a consultation.

 

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.

So, why do people get plastic surgery?

Some people ask for plastic surgery in order to reverse the effects of time. They want to get their body back to its previous, youthful shape. Ageing, weight change, pregnancies – these all take their toll on our bodies. Some of these changes can be reversed by exercise, a healthy lifestyle and non-surgical treatments. However, there are those that can’t be corrected without surgery.

The majority of patients seek plastic surgery to correct an aspect of their body that they don’t like. These patients usually tinker with the idea of having surgery for a long period of time before they actually request it.

 

Is there anyone who shouldn’t go under the knife?

A classic example of someone who shouldn’t have plastic surgery is a patient with body dysmorphic disorder (BDD). These patients experience obsessive worry about some aspects of their physical appearance. The flaw they perceive is usually minimal and not noticed by others. These patients will never be satisfied with plastic surgery because they will continue to notice small abnormalities and asymmetries. They will typically benefit far more from psychological help than surgery.

 

Another example of a patient who shouldn’t have surgery is someone undergoing it to please someone else, like a partner or spouse. Surgery is invasive and has short and long term consequences and should be purely the patient’s choice.

 

How do you mentally prepare for plastic surgery?

If someone is considering plastic surgery I advise them to learn about the procedure by reading and talking to people who have had similar procedures done. There are many social media platforms where patients can discuss their experiences. It’s also easy nowadays to find information online.

However, the pure volume of online information can be overwhelming. It can also sometimes be inaccurate or irrelevant to a particular case, which often causes confusion. For this reason, patients need to speak to a professional to sort the fact from the fiction. 

 

Mr Ross can advise his patients on all of the risks involved in a patient’s desired procedure and can offer expert advice on the best possible surgery options for that individual patient. Mr Ross tailors all of his surgeries to each individual patient in order to ensure that each patient achieves the best result they can. It is important to book in for a consultation with Mr Ross before considering any surgery in order to ascertain what surgery you wish to proceed with in order to achieve your desired results. 

 

During your consultation with Mr Ross, he will ensure that all of your expectations regarding your chosen surgery are reasonable and can be achieved. It is really important to be well informed before proceeding with any surgery, and Mr Ross ensures that all of his patients are well informed and have reasonable expectations. 

 

Mr Ross also offers an additional service to his patients requesting breast surgery. Due to the latest technology, Mr Ross can provide his patients with a virtual reality experience of their desired results. This software is called Crisalix and enables patients to view their body after it has been digitally altered to mirror their expected results. This is an excellent way for patients to mentally prepare for surgery. 

 

Any words of advice for people considering surgery?

• Your body is unique and so should be your surgery – in plastic surgery, one size doesn’t fit all.
• Make sure your surgeon is familiar with various techniques and modifications of the procedure you are interested in, as Mr Ross is.
• A good surgeon is one who adapts and tailors various aspects of the procedure to meet the unique shape of your body and your specific needs, Mr Ross will ensure that each surgery is tailored to each specific patient’s needs.