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Cosmetic surgery figures falling?

Last month, the British Association of Aesthetic Plastic Surgeons (BAAPS), of which I am a member, released their 2014 cosmetic surgery figures. Despite a general mood of cautious economic buoyancy nationwide, there was a drop in last year’s numbers compared to the previous year.

These figures are only based on the number of procedures performed by BAAPS members, all of whom have to be NHS-trained, consultant-level surgeons on the GMC’s plastic surgery register. This doesn’t, therefore, take into account the procedures performed by the big cosmetic surgery chains, but the conclusion drawn was that there had been a drop in ‘glamour model-inspired boob jobs and summer body-influenced transformations’, meaning the big chains are likely to have been similarly affected.

The phrase ‘tweaked not tucked’ was coined to describe the move towards more understated aesthetic procedures. Although I have seen no drop in my own private practice, I do think there is a move towards anti-ageing procedures, such as the eyelid lift, that produce subtle, naturally-beautiful results, rather than a transformation that shouts to all and sundry that you’ve been ‘done’. Certainly this conservative approach has always been the basis of my own plastic surgery philosophy.

Another trend I have witnessed that chimes with BAAPS findings is that patients are doing more research. The majority of patients attending my Leamington cosmetic surgery clinic have done thorough research before they arrive for a consultation; a change that can only be encouraged and embraced by any reputable and ethical plastic surgeon.

Other conclusions that can be drawn from these figures include:

The impact of changes to the National Health Service

BAAPS figures showed that while breast augmentations still came out on top, demand had dropped by a massive 23%, but breast reduction procedures saw a rise. Previously, breast reductions were commonly performed in my NHS practice, but more and more patients are finding themselves ineligible for this procedure on the Health Service so are forced to look privately.

Cosmetic surgery versus non-surgical procedures

In previous years, there has been much media coverage of non-surgical, minimally-invasive body reshaping or fat reduction procedures. The appeal is understandable; fantastic results without the associated downtime or possible complications. However, as in life, there is no such thing as a quick fix and if something sounds too good to be true it usually is.

The internet is awash with stories of disappointing results from these non-surgical procedures, so it is perhaps unsurprising that surgical liposuction has increased in popularity last year, with a rise of 10% for women.

If you’ve done your research and are interested in exploring a particular procedure further, book a consultation at my Warwickshire private cosmetic surgery practice. All patients are given in-depth coverage of both the benefits and drawbacks and an honest opinion as to whether cosmetic surgery is right for them.

Breast augmentation vs breast uplift

The breast augmentation operation is the most popular cosmetic surgery procedure, both in the UK and worldwide. Using breast implants, we can enhance the size and shape of the breasts, also enhancing the cleavage.

At my Warwickshire breast augmentation clinic, I have operated on a wide age range of women, although there are two distinct groups in which demand for a breast enhancement procedure is very high.

The first are young women who have always been dissatisfied with the size or shape of their breasts, either because they are very small or they suffer from breast hypoplasia where there is minimal or no development of the breast tissue. These young women are very keen to have a breast enhancement procedure, but it is always important to bear in mind that your breasts are not thought to stop maturing until your early twenties.

Also, my philosophy as a plastic surgeon is to consider not only the immediate results, but also to think about changes that can occur during the lifespan of the implant. Will the size and placement suit them in ten, twenty, or thirty years’ time. Ultimately, it is the choice of the patient but it is my role to present these considerations, so they are armed with all the necessary facts.

Is a breast augmentation or breast uplift suitable for older women?

The second distinct group of women who present at my Leamington breast augmentation consultations are those who have undergone childbirth and breast feeding or those whose weight has fluctuated. As a result of these body changes, they may have lost fullness, particularly in the upper pole of the breast. Many of these women just wish to restore what they once had, rather than go much bigger in size.

During the physical examination I always assess the degree of ptosis or sagging of the skin and breast tissues. This is achieved by comparing the position of the nipple in relation to your inframammary fold, underneath the breast. If you nipple is at the level of the fold or below, then a breast uplift or mastopexy is required. In these cases, a breast augmentation alone will just make the drooping worse and will not achieve more youthful-looking breasts which is usually the aim.

For women who have a degree of sagging, but also wish to restore volume in the upper pole of the breasts, then a breast uplift followed by the insertion of an implant can produce a really lovely result.

All breast augmentation and breast uplift options will be discussed in full at the consultation I offer at some of the leading private hospitals in the Warwickshire area. If patients wish to return for a follow-up consultation to ask more questions then I am always happy to provide this.

The Age Old Debate

When it comes to men and women and ageing the stereotypes come thick and fast; mainly that lines and grey hair make a man look distinguished and attractively mature, whereas on a woman they just make her look old.

So, what is the truth about male and female ageing? At my private plastic surgery practice, based in Warwickshire, I spend much of my time analysing lines and wrinkles and I’ve come to some conclusions over the years.

The first thing to note is that there has definitely been a change in recent years. When I first started my cosmetic surgery practice, men were less likely to seek surgical or non-surgical procedures aimed at turning back the clock. Women, on the other hand, have always been bombarded by messages from the beauty business to fight the signs of ageing as part of an all-round beautification process.

Cosmetic surgery choice

Often the first sign of facial ageing is the development of dynamic wrinkles in the upper part of the face. These are caused by the constant contraction of the muscles, causing lines to appear in the overlying skin and they are commonly found across the forehead, between the brows and around the eyes.

Traditionally, men have been less bothered by the formation of these lines as the perception is that it makes them appear more rugged or wise or both, whereas women are much more likely to seek treatment in the form of muscle relaxing injections, which I perform, that temporarily freeze the movement of the muscles thereby smoothing the overlying skin, or a cosmetic surgery procedure that will deal with a wide range of ageing concerns.

Many men arrive for a consultation at my Leamington cosmetic surgery practice, complaining that they look tired and stressed. They often believe this is adversely affecting how they are perceived at work, potentially damaging their careers because they aren’t seen as dynamic and thrusting. When we analyse the problem further it is usually found to be due to ageing of the eye area, so I find a more popular cosmetic surgery procedure for men is a blepharoplasty, a procedure to rejuvenate the upper and/or lower eyelids.

Listening to advice

Whatever your genetic make-up, there are some external factors that have been proved to have a deleterious impact on the skin; namely smoking, excessive sun exposure and poor diet. From the men and women who visit my Leamington cosmetic surgery practice, it seems that women certainly are taking these anti-ageing messages on board and are being proactive in protecting their skin.

All that Glitters is not Gold

Is ‘new’ the most dangerous word in the aesthetic’s industry? Product companies and less scrupulous practitioners compete to offer the latest, innovative cosmetic treatment in their quest to corner the market, but how is a patient able to decipher whether these procedures will work or, even more importantly, be safe.

At the least, these patients risk disappointment when the procedure fails to deliver on its claims, but sometimes they are gambling far more… their looks and even possibly their long-term health.

The scalpel versus the non-surgical

In recent years I have seen the rise of procedures which are deemed ‘minimally invasive’ and manufacturers and practitioners who provide these treatments argue their superiority to traditional surgical procedures, in terms of downtime and results.

Often, though, they are only suitable for a relatively narrow section of patients and many men and women would actually benefit far more from a surgical procedure, but because the practitioner is not qualified to perform cosmetic surgery, they offer the procedure regardless and patients are regularly left disappointed when expectations aren’t fulfilled.

More worrying than unfulfilled expectations though is when a product is launched to great fanfare, only to be speedily withdrawn after problems come to light. In the last five years, we’ve seen two injectable products hit the market – Macrolane for breast augmentation and Novabel for facial volumisation – that then had to be recalled by the product companies.

For my Leamington cosmetic surgery patients, I provide a number of non-surgical treatments, either as standalone procedures or as valuable adjuncts to a specific cosmetic surgery procedure, but I only offer treatments and products that I believe produce safe and effective results.

Tried and trusted products

Surgery is not always exempt from this drive for the new in terms of both product and procedure. In the late 1990s, Trilucent implants, which had a filling of soya bean oil, were offered to UK breast augmentation patients. The filling was less dense than silicone or saline so it was argued that they would interfere less with mammograms.

Within four years of these implants being on the market, the UK government was recommending that women have their Trilucent breast implants removed as a precautionary measure, due to concerns over the filling being possibly toxic.

Innovation is crucial but the job of the plastic surgeon is to balance this innovation with safety so it is not to the detriment of their patient.

In my Leamingon-based plastic surgery practice, I have always aimed to offer a choice of breast implant products that are safe and predictable and backed up by many years’ worth of clinical trials and safety checks, managing to avoid using any (cheap but unsafe) PIP implants on that basis, for instance. For more information on the surgical and non-surgical procedures I offer or to book a no-obligation assessment call my secretary Sally Bates on 01926 436341 to make an appointment.

The True Cost of a Tan

Although enjoying the sun’s rays and achieving a golden glow can make us feel and look good temporarily, this love affair with the sun is definitely not reciprocated.

In my busy Warwickshire Plastic Surgery practice I see a range of patients who have learnt to their cost that tanning can leave them with an array of problems, from a few wrinkles to skin damage that is potentially far more serious.

Should I avoid sun exposure totally?

The body uses sunlight to manufacture vitamin D which is essential for our bone development as it helps us to absorb calcium and phosphorus from our food. The amount of time you need to spend in the sun for your skin to make the necessary amounts of vitmain D is actually very short – there is evidence that suggests it can be just ten minutes or so a day – so that doesn’t mean abandoning good sun practice of using a high factor sun protection on any exposed skin.

What does the sun do skin?

Although we associate a bronzed complexion with a healthy and fit outdoor lifestyle, that golden glow is actually damaging the skin in profound ways. In fact, the Elizabethans got it right as a pale complexion was highly valued then, as most contemporary portraits of Queen Elizabeth I demonstrate.

In the skin cells is a pigment called melanin that works to protect the skin from the sun’s ultraviolet rays – the ones that cause all the problems. Your skin tans because the body produces more melanin to combat this increased exposure to the sun and you lose your tan because of the normal cell turnover that occurs over time.

Sunburn occurs when the ultraviolet rays of the sun have penetrated the outer skin and down into deeper layers of the skin causing great damage to those skin cells.

The ageing effect of the sun

As well as affecting melanin production, the sun also damages two essential proteins found in the skin’s fibres called collagen and elastin. These two proteins are what give the skin its firmness, shape and elasticity and, as they deplete as a result of sun damage, the skin will begin to sag and stretch, causing fine lines and deeper folds, as well as a general lack of tone and texture in the skin.

The overproduction of melanin also reveals itself in the form of sun spots, freckles and areas of the pigmented skin which appear mottled and discoloured.

These changes might not be evident initially but even damage caused in childhood is just biding its time before it is revealed. At my Leamington-based Cosmetic Surgery practice, I see many patients in their fifties, forties and even thirties, seeking aesthetic treatments to combat this damage and I offer a wide range of surgical and non-surgical treatments that can improve the condition and appearance of the skin.

The danger of sun damage

However unpleasant a few lines or sun spots may be, they aren’t deadly, but sun damage can have a much more serious side. The development of pre-cancerous skin lesions (called actinic keratosis) and cancerous lesions – known as basal cell carcinoma, squamous cell carcinoma and malignant melanomas – occur when the body cannot repair damaged cells and they begin to grow out of control, forming tumours.

Much of my surgical career has been devoted to the surgical management of skin cancer and through three decades as a Consultant Plastic Surgeon I have worked with very many patients, both privately and in the NHS, in the treatment of skin cancer. For more information on the cosmetic treatments I offer privately or for a private skin cancer check or treatment, call my secretary Sally Bates on 01926 436341 to make an appointment.

Common breast augmentation misconceptions

The breast augmentation is the top cosmetic surgery procedure both worldwide and in the UK. Popular with women of all ages who are looking to augment and enhance the size and/or shape of their breasts.

In light of this popularity and the amount of information that is available at the click of a button, I am always surprised at the misconceptions that surround this procedure and during the breast augmentation consultation that I hold at my Leamington cosmetic surgery practice, I often have to spend time addressing these misconceptions.

Myth # 1; A breast augmentation will be very painful.

The facts: Generally, the majority of my Leamington breast augmentation patients are surprised to find that, post-procedure, the experience is not very painful. For a short time after the procedure they report that they felt a degree of discomfort, but it was easily manageable by over-the-counter painkillers.

Myth # 2; I won’t be able to breast feed after a breast augmentation.

The facts: The breast augmentation procedure is popular with young women, in their late teens and early twenties,who have always been dissatisfied with their breast size. Obviously many of these young women have not started their family yet and they often worry whether a breast augmentation will mean they won’t be able to breast feed later.

Breast feeding to some degree after a breast augmentation is usually possible and I also reassure my Leamington breast augmentation patients that the contents of the implant will not get into breast milk and ‘poison’ the unborn child.

Myth # 3; Will my breast implants explode if I fly?

The facts: This is definitely an urban myth and there is absolutely no foundation to it. Neither high pressure (which you experience when scuba diving) or low pressure (as on an aeroplane) put the implant under such pressure or strain as to cause them to rupture in my experience.

The Government's Failure to Act

In a past blog post on the PIP scandal, I worried that the Government was failing to act on a potential health time bomb when they advised the many thousands of UK women affected by PIPs that there was no need to remove them unless there was a suspected rupture.

Out of the PIP scandal, Sir Bruce Keogh was instructed by the Government to lead a far-reaching study of the cosmetic surgery and aesthetics industry and there were high hopes that some much-needed regulation would be introduced.

Safety in cosmetic surgery should be paramount

Although myself and many of my plastic surgical colleagues did not agree with every recommendation set out in the Keogh Report when it was eventually published, there were some excellent ideas on how the Government could start to regulate the ‘Wild West’ cosmetic surgery industry.

Last month, the Government published its response to Sir Bruce Keogh’s report and, worryingly, it looks like this whole experience has been a wasted opportunity and that the public still aren’t being protected properly.

Dermal fillers are often seen as the next crisis waiting to happen and I have seen patients at my Leamington plastic surgery clinic seeking treatment for less than satisfactory or even botched procedures.

The Government has agreed to introduce legislation to make it illegal for anyone to inject dermal fillers without the correct training, but I don’t believe that this training will bring non-surgeon practitioners up to a level that properly protects a patient’s safety. Furthermore, the register of non-surgical practitioners will not be compulsory and those giving the injections only need to be ‘overseen’ by a practitioner with the necessary level of qualifications. I believe that allows a lot of scope for corner cutting and abuse.

One way to overcome the problem could be to make dermal fillers a prescription-only drug, just like Botox. This means that only medical practitioners with the necessary qualifications would be able to inject; this covers plastic surgeons, dentists, doctors and nurse prescribers. This was certainly the recommendation of many plastic surgeons at the time of the report, but this avenue of action has been ignored.

Advice from Leamington cosmetic surgeon Mr Richard Matthews

So, how can patients protect themselves? My advice is not to be seduced by cut-price deals or too-good-to-be-true offers. Be aware that it remains illegal for an injector to personally advertise their use of Botox to the general public. Seek treatment from a medical practitioner who has the necessary qualifications and experience to not only ensure you get the best results possible but also to manage any potential complications.

I often find that my Leamington dermal filler patients were previously unaware that dermal fillers and Botox are treatments that many cosmetic surgeons offer (the latter legally declared as a ‘wrinkle-relaxing procedure’), either as a standalone procedure or as an adjunct to cosmetic surgery. A consultant-level cosmetic surgeon with many years’ experience, such as myself, will definitely represent a safe bet to those considering an aesthetic treatment.

The dangers of cosmetic surgery tourism

Mr Richard Matthews is a highly experienced Consultant Cosmetic & Reconstructive Plastic Surgeon based in Leamington Spa, Warwickshire. In a series of interview with Cosmetic Surgery Today he discusses the changes he’s witnessed in the cosmetic surgery industry in the UK and abroad in recent years.

Recent years have seen an increase in medical tourism, also known as cosmetic surgery tourism. What is your view on this development?

Top of the list of why people opt for medical tourism is price. It certainly usually seems cheaper but, as the saying goes, you get what you pay for.

To my mind, the problem with medical tourism is that you don’t know what you are going to get. I’m not saying that some of the plastic surgeons that you see abroad aren’t absolutely excellent and do a fantastic job and some patients may go abroad, get a good result, have no complications and come back and say that was brilliant.

However, by and large, if you go abroad for surgery, you will usually not have met the surgeon in advance of the day of operation, often language is a barrier and you have no control or even sometimes way of checking the infection rates in a hospital abroad.

Furthermore, you won’t know till after surgery whether you will be fit to travel back and, usually, your return flight will have been booked in advance. If you get a problem or complication while you’re there, then it may be sorted, but if you have it when you return home, which will still be quite soon after surgery, what’s going to happen? Are you going to be able to go back to get it sorted? Probably not.

I see patients at my private practice who have had problems after undergoing a cosmetic surgery procedure abroad. Obviously if they are going down the private route then they will be spending more money which they could have spent more favourably in the first place. One may or may not be able to restore them to a level where they are satisfied.

However, if the complication is life-threatening and the patient has to seek treatment from the NHS, then it is a completely different ballgame. In the first place the focus is purely on survival and achieving the least possible damage is very much a secondary aspect. There is also the separate issue of whether it is fair for the NHS, and therefore the UK taxpayer, to pick up the tab for problems arising from your decision to go abroad for surgery.

My worry is that people go into cosmetic surgery abroad without their eyes open and they leave themselves exposed to danger. I certainly would certainly do my utmost to dissuade any of my relatives and friends from travelling abroad for medical tourism purposes.

Consultant Plastic Surgeon Mr Richard Matthews discusses the need for a breast implant registry

Consultant plastic surgeon Mr Richard Matthews has a busy private and NHS practice in Leamington and throughout Warwickshire. He talks to Cosmetic Surgery Today about the report by Sir Bruce Keogh into the aesthetic industry and the recommendations of the report.

One recommendation of Sir Bruce Keogh’s report is that a breast implant registry should be re-established. Has it happened and why do you think it is so important?

We used to have a breast implant registry in the UK but unfortunately the funding ran out for that in 2004 and it’s not been re-established since and still has not been full re-established despite the recommendations of Sir Bruce Keogh.

A breast implant registry needs appropriate funding and it wouldn’t be very expensive, but its value shouldn’t be underestimated. We have a National Joint Registry (NJR) that was set up to collect information on all hip, knee, ankle, elbow and shoulder replacement operations and to monitor the performance of the implants which runs very successfully.

The reason why it is so crucial has been fully illustrated by the PIP implant scandal. We have no way of accurately tracing the women who have had these implants, let alone where or by whom. The exact date is very important in relation to PIPs as it is possible then to determine whether they were inserted during a period where the implants were possibly safe or, subsequently, when the fraudulent manufacturing took place.

If we’d had the implant registry we would have been able to get in touch with these women and recall them, in much the same way as if a fault is detected in the manufacturing process of a car you can get in touch with the owners to prevent accidents happening.

Then we could examine the implants and consider whether something should be done at once or whether the women should return for periodic evaluations.

Cosmetic Surgery Today Interview with Consultant Plastic Surgeon Mr Richard Matthews

Cosmetic Surgery Today talks to Leamington-based plastic surgeon Mr Richard Matthews about recent developments in the cosmetic surgery industry.

In your recent presentation to an international surgery conference you spoke about the PIP crisis. The big cosmetic surgery chains were responsible for the majority of the PIP implants inserted in the UK. How do you feel that they have cared for their patients?

The paper I gave was to an International conference for plastic surgeons in Santiago, Chile, and I presented a survey I had done with my Consultant Plastic Surgery colleagues in the UK into their experience with these implants.

My colleagues and I have been pretty horrified by the rupture rate of these implants. Clearly, the cases that came to us were slightly skewed in terms of the general population, but nevertheless we were seeing quite a lot of patients in whom an undetected rupture had occurred in one or both implants and, furthermore, the appearance of the silicone that we were finding outside of the implant was really horrible. Some patients had been experiencing side effects since having these implants inserted that had been causing them quite a lot of problems.

We know perfectly well that these implants are going to rupture sooner than standard implants and my view is that they should all be removed sooner rather than later.

With regard to the big four cosmetic surgery chains who are responsible for implanting the majority of PIP implants in the UK, one of them first liquidated and then reinvented itself as a different company but with more or less the same name. This has been done mainly to avoid its responsibilities to its patients. The other three Companies have been more responsible by removing the implants and offering reasonable terms for re-augmentation.

The Department of Health has stated there is no cause for concern unless there has been a rupture or suspected rupture. Do you share the government’s views?

I have some quite strong reservations about this and that’s not just confined to myself. Quite a lot of my colleagues – us guys at the sharp end who are taking these implants out of these poor women and seeing the devastation they’ve caused – have found on removal that, first of all, even when it hasn’t been detected pre-operatively on a scan, that some of the implants have ruptured. Some of them are producing grossly altered silicone which looks offensive and even sometimes smells offensive. Women are also reporting symptoms secondary to this.

There is a study going on at the moment, the aim of which is to evaluate this in a rather more extensive and scientific way than we feel the Department of Health, through the MRHA, have achieved so far.