Category: Blog

Eyes can tell a story about a person’s life and depending on lifestyle and other factors, the eyes can be one of the first places to show signs of aging.

Many men and women try to keep off the signs of aging by using complex skin care routines, but unfortunately, just using creams alone isn’t always enough to keep your eye area looking as youthful as possible. There are many alternative treatments available for when you wish to take bigger steps.

 

Eyelash Enhancement

Eye enhancement does not need to be complex it can be something as simple as lash extensions or eyelash growth serum. Eyelash extensions are applied to individual lashes with eye-safe glue and is typically performed in a salon. Whilst they have amazing results, they are not permanent and require infills every two to three weeks for maintenance. Elongating the eyelashes can help to open your eyes more and hide the signs of sagging eyelids.

 

Anti-Wrinkle Injections

Lines at the sides of the eyes become more pronounced the older you get so in terms of combating this concern, anti-wrinkle injections are an ideal solution. These injections can also be performed as a preventative measure and may delay or prevent the crow’s feet from even appearing in the first place. To ensure this is maintained, we recommend having top ups every 4 to 6 months.

 

Eyelid Surgery

Blepharoplasty is becoming more and more popular recently, with many women opting for the surgery. Extra skin and fat on the upper eyelid can cause the eyes to look and feel tired. Some extreme cases have shown that the extra skin can hang so much that it can disturb vision and cause discomfort. Eyelid surgery combined with eyebag removal can effectively reduce the excess skin from the upper and lower eyelids to leave you with more youthful looking eyes. This procedure offers a more permanent solution to sagging and aging eyes, with the removal of excess skin opening the eyes up.

To find out about your options for eye rejuvenation surgery, book in for a consultation with Mr Ross.

Most patients wishing to undergo facial rejuvenation surgery want to obtain a long lasting result. Requests for long lasting minimal access procedures and non-surgical procedures continue to increase. Patients need to be taken through the pros and cons of all the various options. In terms of face lifting, patients need to be shown examples of results that can be achieved by the various facelift incisions.

Recently in New York Dr Antell compared the postoperative results from twins who were treated by different facelift incisions. One set had a short scar facelift and one a full facelift incision.

In the short term the study suggested that no difference existed between the different incisions. However, analysis of the long-term results revealed a significant difference and in particular in the neck. 

It is important for patients to understand that minimal access incisions only allow surgical access to certain anatomical areas and also the subsequent movement of the inner tissues of the face is limited to certain directions through a minimal scar access.

The study concluded that although a shorter incision is appealing to the patient and surgeon, the study suggested that the full incision may offer a superior long-term result in the neck.

Mr Ross uses a similar full-face lift incision as described by Dr Antell. He also believes that the full facelift incision gives better access to the area under the chin (submental area) and allows more movement for the SMAS and the platysma muscle. This is a particularly important in patients with skin laxity in the neck. The full facelift incision also gives more options in elevating the SMAS and lifting the face in a variety of vectors. Every patient requires an individualized technique to obtain the optimal results and a full facelift incision offers more options for patients. 

Patients are often concerned about the extent of the full facelift incision. Patients need to be aware that the only part of the scar that is different between the techniques is the scar that runs behind the ear and into the scalp skin. This scar is rarely visible when placed correctly. Patients also appear concerned about the possible increased recovery required for a full facelift incision. Mr Ross has not seen any increased recovery requirements for patients undergoing a full facelift incision as compared to short scar techniques. Mr Ross does not use surgical drains or dressings and patients undergoing a full facelift can eat and drink and mobilize immediately after surgery.  

Mr Ross is able to perform a range of facial rejuvenation procedures and is able to run through the pros and cons of the various options so that patients can make an informed decision as to whether to proceed. 

 

Reference

 

Antell DE, May JM, Bonnano MJ, Lee NY.

A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins. Plast Reconstr Surg. 2016 Jun;137(6):1707-14. 

Breast implants age just as our bodies’ age and with time there are changes that occur. Often these changes cause minimal disruption to patients but pain, discomfort and visible change to implants can occur.

The most accurate data available on implants from the FDA suggests that 30% of all primary breast implants will need to be removed within 10 years and that 50% of implants in revisionary breast augmentation need to be changed within 10 years. It is uncommon for implants to be removed or changed within weeks/months of surgery, although infection, extrusion and rotation of implants can occur.

Most of the reasons for removal or change of implants are related to the aging changes of the implants and the breast/skin. Age related changes of the breast or skin can lead to the skin drooping over the implants and the need for a mastopexy as a secondary procedure. Rippling or palpability can also occur with time due to thinning of the skin.

For implants ageing often leads to the development of capsular contracture. The capsule is scar tissue that surrounds any implant in the body and is a protective lining. Where this scar tissue changes and tightens it can cause changes that lead to pain, discomfort and visible changes. Leak or rupture of the contents of the implant can also occur.

 

TALKING IT OVER

 

When patients consult for revisionary breast augmentation it is important to discuss the pros and cons of implant removal only and removal and replacement with or without mastopexy and the use of autologous fat transfer. Removal only is often not the desired operation by many patients, as many women cannot imagine what it would be like to live without implants – especially where they have had implants for many years. They often perceive a loss of feminity, a need to change clothing or image, and interestingly they worry about how other people will react. Consultations for breast revisionary surgery are complex and the pros and cons of removal and replacing with or without lifting need to be discussed in detail.

The most important decision when considering removal is the benefit to the breast and the surrounding tissue. Removal of the implant and the surrounding capsule allow the breasts to recover from the stretching effects of implants and the possible effects that the implant and capsule have had on the body.

Personally, I have been surprised at patient’s reactions to having implants only removed when considering breast augmentation revision. Although they often feel that they will have no breast tissue after removal and they dread the result, this is often not the case. Often they are relieved, surprised by how good the result is and have not reacted in the negative manner psychologically that I initially suspected would occur.

 

WEIGHING UP THE OPTIONS

 

By removing implants only, the breast is able to settle and gives patients the opportunity to see what it would be like without the implants. I always would offer patients the opportunity to have a further breast augmentation with or without mastopexy at a second stage, but it is surprising that relatively few patients come back for a subsequent operation.

I believe that many women have breast augmentation at a vulnerable time in their lives and live with implants believing that without them they would be perceived unattractive. Years later, many women are adamant that they will have no breast tissue after and are frightened. I have found that in most cases there is sufficient breast tissue and that the results are very acceptable.

Often there is a sense of relief for patients; that actually having them re- moved is not as traumatic as they thought. For those that do decide to have further surgery it is much easier to plan and discuss the options with patients at this time, allowing patients to make an empowered choice.

There is no doubt that the informed consent process for revisionary breast augmentation is better for both the patient and the clinician and I have no doubt that the optimal results are obtained by treating patients in this manner. Patients treated in this two-stage manner may well behave more like primary breast augment patients rather than revisionary breast augmentation patients with potential longer longevity of the implants.

 

IMPLANTS V HEALTH

 

Throughout the years there have been many incidents of patients needing to have implants removed as a result of MHRA or DOH advice in relation to specific breast implants. Concerns regarding connective tissue disorders lead to a moratorium of silicone gel implants in the USA (no link has been proven). Links to rare conditions and cancers such as anaplastic large cell lymphoma remain under investigation and there is never going to be a breast implant that is 100% reliable and 100% safe. Patients must carefully consider removal of breast augmentation as a breast rejuvenation technique.

When considering augmentation removal one must consider the breast, skin and the capsule. It is often best to remove the capsule in its entirety and where this is removed with the implant this is called en bloc removal. It is often best to let the breast tissue and skin settle although one can try and elevate the tissue higher up the chest wall at the same time where appropriate. The operation is often not that painful and patients recover very quickly.

One usually uses the same initial scars to perform the operation and where an inframammary incision has been used one must try and elevate this scar so that on removal of the implant the scar sits near the crease/fold of the breast. There are always risks of irregularities but often there are more extensive irregularities before surgery and these are often well tolerated.

 

WHO CAN HELP?

 

Patients generally see removal of implants as a failure. It is important that all patients considering breast augmentation revision should consider removal only as an aesthetic operation. It may be that removal only is in the patient’s best interest in the revisionary setting and patients need to carefully weigh up the pros and cons and make an empowered choice. They must consult with a clinician who has experience in all the various different forms of revisionary breast augmentation surgery in order that their expectations for revisionary surgery are realistic. Ask to see before and after photographs at your consultation, and make sure you’re putting your surgery in the hands of an expert.

We’re all a little guilty of sticking to our trusted make-up routine throughout the years that we most likely developed in our early 20’s or even late teens. As you age, you can suddenly find that your go-to look is no longer cutting it and that your eye makeup is now hidden under your eyelids. It might be time to reconsider your options.

Beauty is in the eyes – are you unhappy with your eyelids?

Are you finding applying your make-up more difficult due to sagging eyelids? You’re not alone. The once perfect winged eyeliner and eyeshadow you loved so much is not only difficult to apply, but once you’ve finished, it disappears under the additional sagging skin on your eyelids that seemingly appeared from nowhere. So, what are your options?

Non-Surgical option – change up your technique

Is your over liner disappearing under sagging skin or your winged liner drooping instead of soaring? Tight lining your eyeliner is a technique where you apply eyeliner by pushing it up gently in between the eyelashes, giving you a depth of colour and definition to your eyes that is both subtle and will not be hidden by sagging skin.

 

Surgical option – Upper eyelid Surgery

This can be a more permanent fix if you want to restore your eyes to their former glory and continue with your favourite eye make-up routine. Upper eyelid surgery can make a big difference to the appearance of your eyes and can give you a more youthful look. Upper eyelid surgery removes the excess, sagging skin to lift your eyelids and rejuvenate their appearance. 

 

Surgical options – Brow Lift

A brow lift procedure can be performed to reposition the brow area. It is often performed alongside eye rejuvenation surgery for optimum results. A brow lift can also give your overall facial appearance a more youthful and rejuvenation look. 

 

To discuss your options, book in for a consultation with Mr Ross where he will explain all of the techniques he can perform to give your problem area a more youthful and rejuvenated appearance. It is always important to be aware of surgical limitations and to manage your expectations. Take a look at Mr Ross’s patients’ before and after pictures to view their results.

There are many methods described by surgeons to select the breast implant for breast augmentation and determine the best outcome for patients. 

In Mr Ross’s opinion the only person who can determine the optimal outcome is the patient. In order that patients can understand the pros and cons of the various options patients must be educated as to the many different options available to them. Through this decision-making process patients need to be given sufficient information to be able to be empowered to make the decision. 

Mr Ross uses both tissue planning and dimensional analysis alongside 3D analysis and virtual reality technology to help patients. Education involves not only written information but also a series of detailed consultations to look through preop and postop photos of previous patients. 

Mr Ross uses patient outcome related outcome measures and patient feedback to constantly analyse his results and this can also help guide patients through the decision making journey.

Where patients wishes are either not realistic or have the potential to do harm it is important that patients are educated as to the reasons why. There are often a range of implants and pockets in a range of sizes that patients can choose from and almost every implant and pocket selection will have some form of compromise. Variations in size and shape will all have implications in the longer term. Patients need to accept that the result is most importantly determined by their own anatomy and where expectations are deemed unrealistic the avoidance of surgery may be an outcome that needs to be discussed.  

Recently Dr Adams has published a review of the various methods used by surgeons to help patients make these important decisions. 

Measurements, sizing, tissue based and bio dimensional planning are all essential tools for both the surgeon and the patient. As described it is essential that surgeons continually audit and analyse their results in a consistent manner. 

Mr Ross agrees with Dr Adams conclusion that the selection of the best implant for breast augmentation can only be determined by the detailed comparison of patient outcome measures and comparing these against the surgical related outcome measures.

 

Reference Adams WP Jr, Mckee D.Matching the Implant to the Breast: A Systematic Review of Implant Size Selection Systems for Breast Augmentation. Plast Reconstr Surg. 2016 Nov;138(5):987-994.

Cosmetic surgery is all about making an improvement in your quality of life. Once one has had cosmetic surgery it is important to understand that the confidence that this gives must not be relied upon to last for ever. It is not uncommon for patients to see the benefits and see cosmetic surgery as a quick fix. It is important that patients do take care of their scars and work at improving these. Rather than further cosmetic surgery being seen as a way of maintaining results patients should focus on a healthy diet, regular exercise and a healthy lifestyle. 

 

The scar

In order to maximum your cosmetic surgery results it is important to focus on the scars and the postoperative swelling. Although scars are often well hidden and fade with time patients can often help this process. Massage whether superficial or deep can help the lymphatic drainage and improve swelling by developing additional lymphatic channels. Massage also helps the body to adapt to the scars and helps improve the sensation around the scar. It is important to avoid certain exercises in the immediate postop phase to avoid stretching of the scar and it is important to protect the scars in the sun. Hydrating the skin and looking after ones skin especially following facial surgery is very important. 

 

A healthy diet and lifestyle

It is important prior to surgery for patients to be at their ideal weight. However postoperatively it is also important to maintain a stable weight. Weights can fluctuate a little in the weeks following surgery as often ones weight increases slightly following surgery. Recovery can be a challenge and regular exercise routines can be affected. It is important to take advice on the amount of exercise one can perform postoperatively and build up gradually. Patients will not be able to perform the same exercises at the same intensity as preoperatively and should not get demoralized. Just as putting on additional weight can be detrimental, losing additional weight postoperative can also be detrimental. In body contouring procedures this can lead to excess skin, in breast procedures additional breast emptiness and in facial procedures loss of volume. 

Not only is maintenance of weight essential but diet also plays a big part. Keeping your skin well hydrated with appropriate fluid intake and a well balanced diet is essential. 

 

Cosmetic surgery can give improved self confidence but the long-term results are reliant on patients taking time to focus on their recovery.  

 

Everyone loves to catch a lovely golden tan when the sun comes out, or when on holiday. But it’s really important to tan safely, as the sun can be extremely damaging to our skin. 

Fun Fact: Peeling as a result of sun burn is due to damaged cells committing mass suicide. 

Here we’ve listed our three top tips for achieving a golden tan safely:

 

1. Always avoid sunbeds

Sunbeds give out the wrong UV to achieve a healthy tan – tanning beds pump out huge amounts of UVA and virtually no UVB (which stimulates vitamin D), and can increase your risk of skin cancer by 75%.

 

1. Seek some shade

 

Don’t sit out all day, make sure you take regular breaks as taking breaks reduces your risk of sunburn and means your tan will be healthier and longer lasting. 

 

1. Apply the right Sun cream

 

Don’t just rely on SPF. Keep a look out for the UVA logo on the bottle and the term ‘high’, this means that the sun cream offers a high UVA protection. 

Also, when using higher factors, make sure you don’t fall into a false sense of security. Sun cream must be re-applied every few hours in order to maintain an adequate level of protection.

 

Our top tips for picking the best sun cream for you:

 

1. When buying sun cream, the label should have :

 

• A sun protection factor (SPF) of at least 15 to protect against UBV
• At least four star UVA protection

 

1. Make sure the sun cream is not past its expiry date. Most sun creams have a shelf life of two to three years, so be sure to check the dates on your old sun creams before using them. 

 

1. If you have fair skin, its important to use a high factor sun cream, such as factor 50. However, it is also important that the UVA rating is high and that you apply the sun cream every few hours.

 

1. If you have darker skin, it is also important to apply sun cream even if you don’t burn. Even though your skin may not burn in the sun, it is still important that your skin is protected from the strong rays of the sun. We recommend a factor of at least 15 to protect the skin. 

 

It is important to remember all of these tips when spending time in the sun or buying sun cream. Everyone is keen to get out in the sun after spending all winter in the rain, yet it is so important to protect your skin from the harmful rays of the sun. following our top tips will help you to give your skin an adequate protection from the strength of the sun.

Keeping an eye on your moles is a great way of increasing your confidence about what’s going on with the skin on your body. 

Moles can become cancerous over time and so it is important that we keep an eye on our moles so that any changes are detected early. 

The acronym ABCDE is really helpful when trying to remember what to look out for when checking your moles. We are looking for 5 different factors that may indicate that a mole needs reviewing to exclude melanoma.  

Asymmetry: if one half of the mole is noticeably different to the other

Border: if the mole has an irregular or undefined border

Colour: if the mole is an uneven colour or has many colours within it

Diameter: if the mole is bigger than 6mm in size

Evolving: if the mole is changing in size, shape or colour

These 5 factors are a really helpful way of keeping track of the moles on your body and can help you to feel confident about your moles. Looking out for these 5 factors means that you know what is going on with the moles on your body, and any changes you are likely to notice right away and if a mole does turn out to be cancerous, you have the best chance of catching it early. 

If you are concerned about your mole or feel that it is unsightly or wish simply to discover more about the mole removal techniques used by Mr Ross, please give us a call. We’ll be able to arrange an appointment for you at your earliest convenience to have your mole assessed.

Many patients like to know how long an operation will take. Perhaps a better question for patients to ask would be “how long will it take to obtain an optimal result without compromising my care?” 

A study from Dallas has shown that after 3 hours of plastic surgery that the risks of complications start increasing. The chance of complications increased by over 50% by 4 hours and over 300% by 5 hours. There is no doubt that a prolonged operative time compromises patient care.

 

The time an operation takes is related not just to the surgeon’s ability but also to the surgical team, operating room staff and the anaesthetist. There are also inherent patient factors that affect surgical time and complex cases are often performed by more experienced surgeons with longer operative times. It is important that assessment of operative times includes some form of risk adjustment. Operative time is also not a simple refection of a surgeons technical skill but is also a reflection of his/her ability to manage the operative / surgical team. 

 

The term meticulous has been attributed to those surgeons who often spend longer in theatre than others. Another term would be slow. Those surgeons who are deemed to be quick are often labelled with being slapdash and not spending enough time obtaining the optimal result.  

 

The only way to assess optimal outcomes results is through patient derived outcome measures and validated on line reviews. Clinician related outcomes must compare these against their own revision rates / take back  / complication rates. 

 

Although operative time should not be a primary concern for patients – if a prolonged operative time increases complication rates then both patient and clinician outcome measures will be affected.  Therefore the question of how long an operation will take is a very pertinent question.

 

In Mr Ross’s cosmetic practice which includes combination surgeries, all surgery is performed in under 5 hours, >99% within 4 hours and >95% is carried out within 3 hours. In order to limit the surgical time Mr Ross has a surgical team, which may include other consultants and surgical assistants.  

 

Mr Ross’s validated on line reviews can easily be accessed by patients. Mr Ross’s patient / clinician feedback and revision and complication rates are also easily accessible through his website. A sample of Mr Ross’s average surgical times include: – breast augmentation 45 minutes, breast reduction / mastopexy / mastopexy implant 90 mins, facelift 120 mins, upper blepharoplasty 30 mins, rhinoplasty 75 mins, arm / thigh lift 75 mins, abdominoplasty 90 mins bodylift 165 minutes. 

 

Reference

 

Hardy KL, Davis KE, Constantine RS, Chen M, Hein R, Jewell JL, Dirisala K, Lysikowski J, Reed G, Kenkel JM.The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.

Aesthet Surg J. 2014 May 1;34(4):614-22. 

Summer has arrived and with the hot weather comes t-shirts, shorts and skimpy bikinis. For many of us, the summer months mean fad diets and skipping meals in order to shed the pounds we’ve gained while snuggled up inside over winter. 

Achieving the perfect body is no easy task, we all want to look great, but sit ups alone aren’t going to get rid of that muffin top. There are many studies that suggest that fad diets don’t work and that diet and exercise are the only way of truly keeping your weight down. But achieving results through diet and exercise takes time; it is not a quick fix. 

There are two types of fat that are typically found in the abdomen region, these are visceral and subcutaneous fat. Visceral fat is the fat that surrounds our organs and can lead to dangerous problems such as cardiovascular disease. The amount of visceral fat we have usually reflects how healthy and active we are, a person with a healthy balanced diet who partakes in regular exercise should have little visceral fat. Subcutaneous fat is found below the skin and again can be tackled through diet and exercise. 

Getting rid of abdominal fat is no quick fix, at least not without liposuction or a tummy tuck. Trying to get rid of fat build up requires a lifestyle change: reducing portion sizes and increasing the amount of exercise you do. 

A study conducted by the BBC’s ‘Trust me I’m a doctor’ team suggests that diet and exercise really is the only way to reduce the amount of body fat we have. Increasing the amount of exercise you do, alongside reducing your portion sizes is bound to achieve results. This will, however, involve patience and consistency in order to achieve the results you want. 

Body rejuvenation techniques such as abdominoplasty and liposuction, which are the commonest plastic surgery procedures to improve body contour, should not be considered as an alternative to diet and exercise.

Visceral fat cannot be removed by plastic surgery techniques and plastic surgery can only address subcutaneous fat. Although the abdominal wall can be tightened which can improve the abdominal contour and skin excess can be removed, patients should consider diet and exercise as a critical part of all body rejuvenation surgery.

The best candidates for plastic surgery are those that have a healthy lifestyle and are weight stable and Mr Ross always advises patients to be at their ideal weight before considering plastic surgery.