Parting is such sweet sorrow!

Many of my existing patients will already be aware of this, but for those of you visiting my website for the first time, there is GOOD NEWS and there is BAD NEWS.

The Bad News first. On 31st March 2018, I shall be retiring from active surgical practice.  Very sorry about that but the time has come!

The Good News. Actually, two lots of good news!

Firstly, my immensely able and experienced colleague, Mr Alan Park, FRCS(Plast.), Consultant Cosmetic & Reconstructive Plastic Surgeon, will be taking over my surgical practice from 1st April.  He will provide continuing care and provide the contact point for all my existing patients and will be happy to accept new referrals (from now onwards) for all conditions (except Rhinoplasty*) via his contact points as follows:-

For new patients: 07468 418 419
Warwickshire Nuffield | 01926 436 351
BMI Meriden | 02476 647 000

Secondly,  I shall continue to offer a service for non-surgical cosmetics, such as Botox, dermal facial fillers and chemical peels.  Please contact Sally, my Secretary at the Nuffield Health Warwickshire Hospital, on 01926-4364341 or on Sally.Bates@nuffieldhealth.com in the usual way or directly off the website which will be getting a new facelift.

I should add that arrangements for my medico-legal practice through Sally Bates at the Nuffield will continue unaltered.

Lastly, to all my present and past patients, all of whom I have looked after to the best of my ability, it has been an enormous honour and privilege to provide care to you. Cases that could have worked out better have been few and far between and I thank you all for coming to see me in the first place and for allowing me to do my best for you, as well as your reciprocal kindness and good cheer.  I shall miss you all, of course, but will take comfort from the happy memories of your company and the pleasure of hopefully helping improve your lives in some small measure.

God bless you all.
Richard Matthews

As the party season is in full swing, beware the effects of smoking and drinking

cosmetic surgery benefitsThe festive season is in full swing and most of us might be eating or drinking too much as we celebrate not wisely but too well. Now, a new study has now proven what many of us have suspected. An unhealthy lifestyle, particularly drinking heavily or smoking, can drastically age us.

A large-scale Danish study, recently published in the Journal of Epidemiology & Community Health, questioned more than 11,000 Danes about their eating, smoking and drinking habits.

Four markers of ageing were identified – the formation of an opaque ring around the eye’s cornea, creases on the earlobe, plaques on the eyelids and hair loss.

“We wanted to study the signs of ageing because they seem to have some kind of predictive value for how long your life is going to be on average,” says Janne Tolstrup, the study’s author, who is research director of the National Institute of Public Health at the University of Southern Denmark.

The study found that heavy drinking – more than 28 drinks a week for women – resulted in a 33% higher likelihood of having grey rings around the cornea than those women who drank moderately. Heavy smokers also had a greater chance of developing these rings. In fact, the only ageing marker that wasn’t affected by lifestyle habits was male pattern baldness, confirming that progressive hair thinning is mainly affected by genetics.

How lifestyle factors accelerate the ageing process

Alcohol dehydrates your body, forcing your kidneys to remove excess water from elsewhere in the body. Your skin, the largest organ in the body, is therefore left parched after a heavy drinking session. As well as zapping the skin’s moisture levels, alcohol deprives the body of vitamin A which is essential for cell renewal and turnover.

Also, alcohol and, to an even greater degree, smoking speeds up the depletion of collagen levels in the skin, causing premature wrinkling and sagging skin. After a certain point, a facelift or other facial rejuvenation surgery procedure is the only way to address this ageing concern.

The good news is that the Danish study found that those who drank lightly aged at the same rate as those that didn’t drink at all, so you do not have to abstain totally this festive season but enjoy everything in moderation.

With best wishes for Christmas and the New Year!
Mr Richard Matthews

Demand for the Meghan Markle nose raises question of celebrity-inspired cosmetic surgery

Since her engagement to Prince Harry was announced, interest in Megan Markle has reached fever pitch and now a leading New York-based plastic surgeon has revealed that he has received a growing number of requests from patients wanting to copy her nose. This raises the interesting question of whether it is ever possible or advisable to emulate the facial features of someone you admire through cosmetic surgery.

Embed from Getty Images

One of the most important aspects of the cosmetic surgery consultation is a clear understanding between the patient and surgeon about what the patient wants to achieve. Often a patient will have an expectation of how they want a specific facial or body feature to look and that might be influenced by a certain celebrity.

Bringing in pictures of someone you admire can certainly stimulate the conversation but it is essential that patients are not fixated on achieving a specific look because there are a number of factors that can affect the outcome of cosmetic surgery, including the patient’s own facial structure or frame or individual skin thickness.

Realistic expectations about rhinoplasty

Typically, the rhinoplasty, or nose job, is the cosmetic surgery procedure that most inspires patients to want to emulate celebrities. The nose is the central feature on the face and men and women alike can start to think that copying a star’s nose may make them look more like their idol.

However, perceived attractiveness is based on facial balance and symmetry so it is not just Meghan Markle’s nose that makes her beautiful but how her nose complements her other facial features. Even if we were able to absolutely recreate someone else’s nose on your face, it might not be in in balance with your eyes or chin. More than likely, you will look worse than before surgery.

There are also limitations to what can be achieved with a rhinoplasty. If we are building the projection of the tip or bridge of the nose, there is a limit to how far the skin will stretch. If we are reducing the nose, the integrity of the nasal structure must always be balanced.

So, rather than bring in a picture of your favourite celebrity nose, I encourage patients at my Leamington rhinoplasty consultations to think of very specific factors they would like to alter, such as removing a hump or narrowing the bridge of the nose or tip.

A well-thought out and planned rhinoplasty procedure should always look natural and enhance a patient’s individual beauty and thereby prove a fantastic boost to self-confidence.

Don’t be vein: evaluating the risk of DVT

 

cosmetic surgery risks DVTAnother interesting topic arising out of last month’s BAAPS conference was the increased risk of developing Deep Venous Thrombosis (DVT), a potentially life-threatening condition, and the worrying lack of guidelines available.

Every surgical procedure carries risk and DVT or its more dangerous sequel, Pulmonary Embolism (PE), is one of those potential risks, particularly when the surgery is lengthy. Most cosmetic surgery procedures will extend beyond an hour, meaning the patient is more susceptible to this possible outcome.

A DVT is a blood clot that develops in a deep vein, typically in the leg. It can cause pain and swelling, although some people suffer no symptoms. However, one in ten people with DVT go onto develop a Pulmonary Embolism, which is where a part of the blood clot will break off into the bloodstream and may travel to the lungs or heart. It can cause breathlessness, chest pain and, in some people, result in fatal heart failure.

Increased risk of DVT in cosmetic surgery

Guidelines will help identify patients that have an increased risk of developing DVT after surgery; these include obesity, smoking, advanced age, use of oral contraceptives or HRT and a previous history of DVT.

In a 2014 study published in Plastic Surgery International, the authors stated the importance of identifying these risk factors in minimising DVT. A total of 1,254 patients were included in the study and the development of venous thromboembolism occurred in 1.35% of patients, which may seem relatively low incidence, but a DVT may be fatal. In those patients who developed DVT, it was more frequent in patients over the age of 40, who smoked, or were taking either HRT or oral contraceptives. Interestingly, the study compared types of cosmetic surgery – liposuction, breast augmentation, breast lift and rhinoplasty – and none of these procedures was isolated as a risk factor for this condition.

However, there is a slightly increased risk in surgery to the abdomen, buttocks and legs. The popularity of the Mummy Makeover, where various surgical manoeuvres to this part of the body are combined in one surgical procedure, meaning a longer surgical time, also demands close attention to ensure patient safety.

Prevention is key

There are a number of measures that can be taken to lower the risk of developing DVT. These include the use of compression garments during and after surgery, the use of sequential compression devices to the lower limbs during surgery and afterwards until mobilization has occurred, careful positioning of the legs during the operation and prescribing anticoagulation medication for patients at most risk.

Early ambulation is also essential; the risk of DVT is highest in the first two weeks after surgery so getting out of bed and moving around as soon as possible, balanced with the necessary rest, is extremely important. 

Cosmetic surgery is purely elective so it needs to be as safe as possible for patients, which is why guidelines on identifying patients at risk and the optimal preventative measures to follow are mandatory.

The true cost of cosmetic surgery tourism

cosmetic surgery tourismCosmetic surgery tourism is on the rise as more and more people seek the best deal possible.  But what’s the true cost, both to the patient and to the NHS? As I mentioned in last month’s blog post on the increase in revision surgery, one of the main driving forces behind this surge is men and women undergoing botched plastic surgery procedures abroad and then returning to the UK, often requiring urgent medical treatment on the NHS.

Cosmetic surgery tourism and patient safety

Financial uncertainty in the UK, partly as a result of Brexit, makes the ‘cheap deals’ offered by cosmetic surgery clinics in other countries very attractive. Yet conveniently, there is no mention of the many possible complications as a result of having cosmetic surgery abroad.

Sales-driven surgery: often patients will see a representative of the clinic in the UK and believe that gives them a degree of security. However, this representative is usually a broker or salesperson, driven by financial considerations alone.

A common reason that people are left unsatisfied or in a worse state after cosmetic surgery is that they were medically or psychologically unsuited for a particular procedure – the broker has neither the professional ability or desire to evaluate patients properly. A UK plastic surgeon should have the training and experience required to evaluate a patient properly and turn that patient away if they feel that surgery is not the best option for them at that time.

Informed consent and time to consider: in the UK, we are duty-bound to give patients enough information regarding the procedure that they can make an informed decision about whether to go ahead. No salesperson or non-medical professional can provide that. And, once the patient has committed to surgery and flown to another country, the pressure on them to go ahead often means that they proceed with misgivings.

Paying for peace of mind: the price of cosmetic surgery in the UK may seem more expensive at first glance than the deals offered by clinics abroad, but do you know what you’re paying for? A reputable plastic surgeon in the UK will typically be a member of the independent plastic surgery organisations that charge membership fees – these organisations carry out annual safety audits and are committed to ensuring patient safety.

Your UK surgeon will also be performing your surgical procedure in a private hospital and this makes up a significant part of the cost. These private hospitals and clinics are under a legal obligation to meet certain standards of quality and safety and they are inspected by the Care Quality Commission in England and similar bodies in Scotland, Wales and Northern Ireland.

Furthermore, your UK plastic surgeon will be paying for medical insurance that covers potential complications arising from surgery. Cosmetic surgery tourism patients often find that there is no recourse if something goes wrong and no provision for follow-up care or further surgery.

Aftercare and follow-up: I’m a firm believer that the recovery process after a cosmetic surgery operation can be as important as the surgery itself in terms of patient satisfaction and optimal results. Any surgery carries risk, which is why it is essential to have your surgeon and their team on hand to deal with any possible complications. Infection is a common complication, often compounded by flying too soon after surgery, and needs to be carefully monitored, which is just not possible from abroad. If you do need to return for further surgery, then those costs are usually not included.

The burden on the NHS

Presented at the BAAPS meeting, was a study of patients presenting at one NHS hospital in London, with injuries resulting from cosmetic surgery abroad. Half of the complications treated at the Royal Free Hospital, London resulted from infection, with breast augmentation patients losing their nipples or tummy tuck patients requiring massive skin grafts as a result of dead and dying tissue. The cost to the hospital, from just 21 patients, was in excess of £282,000, with an average cost of £13,500 per patient.

An increasingly cash-strapped and over-burdened NHS may decide to make patients pay for any procedures arising out of botched surgery overseas in the future, meaning that ‘cheap deal’ could come with a significant and unwelcome additional cost.

Eyelid surgery patients are rated as younger, more attractive and more energetic

It’s all about the eyes – eye contact is one of the most powerful forms of communication and your eyes can express a wide range of feelings and emotions. Unfortunately, the delicate skin and powerful muscles around the eyes also makes them one of the first areas of the face to show the visible signs of ageing. Patients at my Leamington cosmetic surgery clinic often complain that their eyes are making theeyelid lift benefitsm appear older, more tired and less attractive than they actually feel.

After breast enhancement, the blepharoplasty procedure or eyelid lift is the UK’s most popular cosmetic surgery procedure for its ability to transform and rejuvenate the face and this has now been confirmed by a new study that appeared in the JAMA Facial Plastic Surgery Journal.

In the study, called A Dual Approach to Understanding Facial Perception Before and After Blepharoplasty, 401 participants were asked to rate the before and after photographs of ten women who had undergone a blepharoplasty procedure, comparing the perceptions of observers with patient reports. Observers were asked to focus on age, attractiveness, energy levels and overall health. Over 150 blepharoplasty patients were also asked to respond and rate their own experiences.

Overall, the results indicated that eyelid lift patients appeared 1.04 years younger. The post-op women were also deemed to be more attractive, healthier and energetic.

Cast your eye over these considerations

Although the eyelid lift is quite rightly a very popular procedure there are always important considerations you must take into account before decided to embark on surgery.

  1. What are the risks of an eyelid lift? All surgery comes with a degree of risk and these will be explained in full during your blepharoplasty consultation. Risks of eyelid surgery include problems associated with the anaesthetic, infection, dry or sensitive eyes or other eyelid problems, scarring, injury to the muscles around the eyes, temporary problems with vision and – very rarely – a loss of eyesight.
  2. Can I have eyelid surgery if I have dry eyes? The eyelids are essential for keeping the eyes moist and one of the risks of surgery is the onset of ‘dry eye’ or worsening of a pre-existing condition. This will be assessed before surgery and, if it is deemed safe to proceed, then a conservative approach in terms of how much tissue is removed must be adopted.
  3. Will I have to hide behind dark glasses for weeks after a blepharoplasty? Patients are often surprised to find that recovery from upper eyelid surgery is typically quicker than other forms of facial surgery. The skin on the eyelid is thin so usually heals very well. Lower eyelid surgery is often more complex with a correspondingly longer recovery time, requiring a greater degree of patience. Some initial bruising and swelling and bruising should be expected anyway, but the full resolution of swelling takes longer, particularly in lower lids. Avoidance of make-up at first and of exposing the eye area to direct sunlight to start with (use those shades!) is important for most rapid wound healing.
  4. Can eyelid surgery deal with the tear trough? The tear trough is the name for the hollow between the nose and the lower eyelid that is formed by the weakening of the lower lids and descent of fat in the cheek area. There are non-surgical treatments such as dermal filler injections which may be more suitable than surgery to improve the appearance of the tear trough.
  5. Is an eyelid lift the correct surgical approach? Often patients fixate on the eyes as their problem area, but I always assess the whole of the face. The brow typically descends as we age and that can be contributing to that tired or angry look around the eyes; in this instance, a lateral brow lift can make the eyes more open and rejuvenated.

Interestingly, the eyelid lift patients in the study themselves reported an increase in their perceived energy levels after they had undergone an eyelid lift, so the benefits of a blepharoplasty are not just in the eyes of the beholder. Upper eyelid lift in people with marked sagging of lid skin, in whom the eyes feel increasingly heavy and difficult to open as the day goes on, always experience a great sense of physical relief that is truly energising, as well as being able to see upwards and outwards much better as their physical ‘blinker has been removed. Very rewarding all round.

Worrying rise in botched plastic surgery needing revision

revision cosmetic surgeryThis month saw the annual scientific meeting of the British Association of Plastic Surgeons (BAAPS) take place. Among the many interesting topics for discussion was an important message that the general public should be made aware of. BAAPS had polled its 230 or so members, of which I am one, and found that four out of five surgeons have recorded a rise in patients needing revision surgery for procedures that had been performed by less able surgeons.

Reasons why revision surgery may be required

All cosmetic surgery may require further revision work – small adjustments may be needed to achieve the optimal result or the body may heal in an unpredictable way – and this will be explained during your consultation so you’re aware of all potential outcomes before making the decision to go ahead. But, in this instance, BAAPS is focusing on botched surgery which falls drastically short of the patient’s expectations and is often unsightly or worse.

There were three main reasons identified as to why revision surgery of this type was on the rise:

  1. In 40% of cases, surgeons believed that the patients should never have undergone the initial procedure, either because they were medically or psychologically unsuitable. Plastic surgery is elective so it is never necessary and an important part of our role as surgeon is to identify patients that have unrealistic expectations, possible body dysmorphia or medical conditions that make them unsuitable for surgery.
  2. Nearly a third stated that the original procedure fell far below the expected standard and must have been performed by someone that didn’t have adequate training or experience. New legislation introduced by the Royal College of Surgeons is aimed at tackling this “cowboy proliferation”, as BAAPS describes this worrying trend.
  3. Another third found that they had been required to treat patients who’d taken advantage of cheap plastic surgery deals abroad with disastrous consequences. Cosmetic medical tourism is on the rise in response to these times of financial uncertainty where price often becomes the major deciding factor. However, the fine print in these ‘deals’ don’t cover the increased risk of complications, lack of patient protection and issues with aftercare or follow-up treatment that are inherent in having plastic surgery abroad.

Unfortunately, despite my level of experience, training and surgical skill and that of my fellow colleagues, it’s usually not possible to produce the results the patients were hoping for when performing revision surgery of this nature.

BAAPS is committed to the education and advancement of cosmetic surgery and conducts annual safety reviews of its members to ensure that high standards are always maintained so membership of an independent surgical association such as BAAPS should be an important factor in choosing your plastic surgeon… certainly it should always be placed above price.

Cosmetic surgery may even help patients quit smoking

cosmetic surgery benefitsThere are many benefits – as well as cons – to consider when deciding whether to embark on cosmetic surgery and now it seems that quitting the habit could also be one.

Prior to undergoing a major cosmetic surgery procedure, such as a tummy tuck, facelift, breast reduction or breast uplift, I insist on patients stopping smoking for at least eight weeks before the procedure and during the healing period afterwards. Now, a new study published in the September issue of Plastic and Reconstructive Surgery, has followed up on cosmetic surgery patients and found that many actually quit smoking in the years after their op.

The lead author of the study, Dr Aaron C. Van Slyke of the University of British Columbia in Vancouver commented, “Our results show an association between cosmetic surgery and smoking cessation at long-term follow-up.” The study interviewed patients who had been smokers prior to their plastic surgery procedure performed five years’ previously. About 40% of patients no longer smoked cigarettes on a daily basis and nearly one-fourth had not smoked at all since their operation.

Dr Van Slyke also pointed to the important role that the cosmetic surgery can play: “Surgeons who request pre-operative smoking cessation may influence patients’ long-term smoking status.” Seventy percent of patients interviewed in the study agreed that discussing the increased surgical risks associated with smoking influenced their desire to quit or reduce smoking.

Other benefits of cosmetic surgery

Increase in confidence: when a physical feature that may have bothered you for many years is altered or enhanced, it can greatly boost self-esteem. For most patients at my Leamington Spa cosmetic surgery clinic, it has been an issue for many years and surgery is a carefully considered option. However, if it is a sudden or recent dislike, then my advice might be to delay surgery at this time.

Improved physical health: although cosmetic surgery is purely elective and not required for medical reasons, there can also be a great improvement in health. Women with overly large breasts, for example, can experience excruciating back and neck pain and this can be greatly reduced or abolished by breast reduction surgery.

Positive lifestyle changes: this research into smoking cessation and cosmetic surgery is one of many recent studies into the potential benefits of cosmetic surgery. In 2013, one study looked at patients undergoing a tummy tuck and found that there was significant and lasting weight loss particularly for those patients that were overweight prior to surgery.

There are many potential pros to cosmetic surgery, but there are also risks to consider as well. During consultations at my Warwickshire cosmetic surgery practice, I always ensure that patients are fully aware of all the possible implications before they make this important decision.

MRHA releases a statement on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

breast augmentation risksLast month, the Medicines and Healthcare products Regulatory Agency (MHRA) released a statement on breast implant associated-Anaplastic Large Cell Lymphoma (ALCL).

 What is ALCL?

Anaplastic Large Cell Lymphoma is a very rare sub-type of non-Hodgkin’s lymphoma and last year the World Health Organisation defined a specific type which is breast implant associated.

The most common symptom in women with breast implants seems to be a collection of fluid, known as a seroma, which accumulates six months or more after surgery has taken place. Typically, though, cases develop many years after surgery.

Currently, there is an ongoing investigation by the MHRA into this new form of cancer and their advice is being continually updated as more information is gathered.

Patient safety is always of paramount importance

The MHRA has formed an independent expert advisory group – the Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG) – who are reviewing the risks associated with breast implants in relation to BIA-ALCL. Their advice will help to guide the actions of the MHRA.

Another important step is the Breast and Cosmetic Implant Registry (BCIR) which was launched in October 2016 in the wake of the PIP breast implant problem. By capturing data on breast implants, this will aid in the early detection of potential issues and provide a mechanism for contacting and managing patients in event of a problem.

Should I be worried about ALCL?

ALCL is very rare but the advice from the MRHA is to seek advice from your plastic surgeon if you develop a seroma or lump in the breast or a swelling around the implant. Currently, the MRHA continues to collect and analyse information on this issue to provide more extensive advice for UK breast implant patients.

The problem seems to be almost exclusively associated with textured surfaced implants and more with one particular type of textured implant than the others. Nagor, the implant brand I use, seems to have an extremely low incidence rate.

As a plastic surgeon, we have received alerts from the MHRA regarding the potential risks of ALCL. Their advice is in line with what I already tell my Warwickshire breast implant patients: regularly check for symptoms relating to your implants, whether that’s lumps, swelling or any changes to the breast, and seek advice immediately if you have any concerns.

During your breast augmentation consultation, we will discuss all potential risks and complications associated with the procedure, so you are fully-informed before making your decision to proceed.

BAAPS weighs in on lip filler debate

lip augmentation problemsSocial media has been named as the chief culprit behind the rise in young people seeking aesthetic procedures such as Botox and dermal fillers and now the British Association of Aesthetic Plastic Surgeons (BAAPS), the UK’s leading independent plastic surgery association of which I’m a member, has been moved to comment on the situation.

Last month, a study published by the Nuffield Council on Bioethics called for the UK government to provide greater protection for young people. In particular, they pointed out the vast amount of makeover apps and online cosmetic surgery games that were accessible and even aimed at very young children.

Furthermore, the rise of social media platforms that focus on ‘selfies’ which can be digitally manipulated before being posted for likes or negative reviews combined with a celebrity culture that portrays an unrealistic lifestyle and airbrushed images, contributes to a spike in anxiety and impact on self-esteem.

Professor Jeanette Edwards of the University of Manchester, who chaired the Nuffield Council’s research into ethical issues and cosmetic procedures, said: “There is a daily bombardment from advertising and through social media channels like Facebook, Instagram and Snapchat that relentlessly promote unrealistic and often discriminatory messages on how people, especially girls and women, ‘should’ look.”

The Council were focusing on those under the age of 18 that might be being pressured into these kinds of procedures and BAAPS agrees that there are serious concerns over how these treatments, particularly dermal fillers, are being marketed to Millenials.

A recent poll by WhatClinic.com found that almost half of traffic to web pages about lip augmentation were from visitors in the 18-24 age bracket and those clinics surveyed said that although they wouldn’t treat under 18s, they would provide fillers to those under 21.

Dermal fillers remain unregulated in the UK and, as a result, plastic surgeons are increasingly being called upon to treat complications arising from treatment. Despite many calls for the Government to introduce more stringent regulations of fillers and a whole host of other ‘minimally invasive’ procedures, patients still remain at risk.

Until new laws are introduced, the best advice is always to see a medically qualified practitioner such as a plastic surgeon that has the necessary experience to both produce the aesthetic results you’re hoping for as well as deal with a problem if it was to arise.