Category: Blog

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

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.