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Better protection for cosmetic surgery patients

The cosmetic surgery industry is growing year on year, yet the lack of protection for patients is of increasing concern for those plastic surgeons that do abide by the highest of standards.

This is why I welcome the recent proposals made by the Royal College of Surgeons. In 2013, after the cosmetic surgery industry had been rocked by the PIP implant scandal, the College established the Cosmetic Surgery Interspecialty Committee (CSIC), which last year published their in-depth report, Standards in Cosmetic Surgery.

Last week the College issued a statement calling for further action to implement the findings of the report, all of which I wholeheartedly approve of.

The first step of the Committee was to agree on the definition of cosmetic or aesthetic surgery and thereby the procedures it covers:

Operations and all other invasive medical procedures where the primary aim is the change, the restoration, normalisation or improvement of the appearance, the function and well-being at the request of the individual.

Cosmetic surgery proposals in-depth

The first proposal by the CSIC was that any patient undergoing cosmetic surgery should be able to check whether their surgeon is listed on an approved register.

Currently, patients can check if a surgeon is on the General Medical Council’s list of registered medical practitioners. This will also indicate if a surgeon is on the plastic surgery register; this guarantees that the surgeon will have undergone six years of plastic and reconstructive training and be qualified to hold a consultant-level position on the NHS.

However, there is no law to stop those who aren’t qualified plastic surgeons from offering cosmetic surgery as defined above.

Furthermore, matters have changed since I underwent my training on the NHS in plastic, reconstructive and aesthetic surgery. Then, many cosmetic surgery procedures fell within the remit of the Health Service, but the economic strictures it now faces has resulted in fewer ‘aesthetic’ procedures being offered, meaning future plastic surgeons will not be gaining that invaluable experience during their training.

I firmly believe the onus is on the surgeon to keep abreast of the latest developments in their field, but the proposal of the CSIC is to establish a certification system that demands surgeons meets a set of standards. These include:

  • a surgeon must undertake a minimum number of procedures
  • they have the appropriate professional skills to offer a specific procedure
  • they submit to an audit of their surgical outcomes

As a member of BAAPS, one of the UK’s leading independent plastic surgery groups, I already undergo an annual safety audit, so I welcome this procedure being insisted on across the industry as a whole.

During consultations at my Leamington cosmetic surgery practice, I ensure patients have all the information they need regarding the procedure in question, but I also make sure they know everything they need about me. Embarking on cosmetic surgery is one of the most important decisions you can make and it’s crucial you can trust your surgeon implicitly.

The more unusual cosmetic surgery questions I've been asked

Although there is masses of cosmetic surgery information available on the internet and in the media, patients that attend my cosmetic surgery clinics, held in Leamington and Coventry, are often confused as to what actually takes place or may have digested misleading, or sometimes downright incorrect, information.

Here are some of the queries that have come up during consultations for some of the more popular cosmetic surgery and non-surgical procedures.

If I have lipo can the fat ever come back?

Liposuction is a fantastic body reshaping procedure that I offer my Warwickshire patients as either a standalone procedure or combined with other surgical procedures, such as the tummy tuck, to produce the optimum results.

The truth of the matter is that fat cells removed during the liposuction procedure are permanently removed. However, if you gain weight then the remaining cells will simply get bigger and fat may be distributed around the body slightly differently.

In terms of permanent results, keeping a stable and consistent weight means your new body contours should be unchanging. However, liposuction does not stop the ageing process and there may be changes to your body even if you do not put on a single pound.

If I have Botox will I be injecting a poison into my face?

Botulinum toxin, which is commonly called Botox, is a toxin or poison. It works by temporarily paralysing nerves which instruct our muscles to work. Used for many years to prevent muscle spasms, an eye doctor found that patients treated for blepharospasm, an uncontrollable blinking and spasming of the eye and surrounding area, were reporting that an additional benefit to the treatment was that it smoothed the dynamic wrinkles across the forehead and between the brows.

So, really the question should be: is it safe to inject a toxin into the face? Although there are potentially serious complications associated with Botox, as with all cosmetic treatments, the incidence of these complications occuring is very low.

The amount that I use in treating wrinkles in the upper third of the face is minute compared to the doses required in alleviating muscles tension or spasms in other parts of the body. Botox is temporary and does not ‘travel’ between different muscles, meaning it should only work on the area where it is injected.

Can you become addicted to cosmetic surgery?

Although often overlooked as an addiction, I do believe it is possible for people to become addicted to cosmetic surgery; not a chemical addiction in the way of drug or alcohol addiction, but a behavioural addiction.

It usually stems from insecurities or unhappiness concerning some aspect of appearance and, although you could argue that is the case for anyone who wishes to undergo an elective cosmetic surgery procedure to change or alter their face or body, the majority of cosmetic surgery patients have realistic expectations and should be satisfied with the results of their procedure.
Whilst some people quite reasonably undergo several procedures to address problems in different areas of the body (following significant weight loss, for instance), others have repeat procedures on the same area, never being quite satisfied with the result. However, with each successive operation more scar tissue is created and a vicious circle may be set up making a happy outcome less and less likely.

Although I am not a trained psychologist, I have had many years’ experience treating patients at both my NHS and private cosmetic surgery practice in Warwickshire. As a result, I have become experienced at assessing both the patient’s clinical and emotional needs. If I feel that the patient is suffering from a body dysmorphic disorder or a potential plastic surgery addiction, then I can and will refer them to colleagues who are able to deal with any mental health issues.

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.

It pays to check your cosmetic surgeon credentials

Choosing the right practitioner is the most important decision you’ll make when embarking on a cosmetic surgery procedure and the eventual success of the procedure often depends on that choice. So it really does pay to research your cosmetic surgeon fully.

I find that many of the patients who present at my Leamington cosmetic surgery clinic have done their practitioner research in advance of their consultation. However, if they still have questions about my experience and qualifications, then these are the key points I cover with them and these can be a valuable guide to what you should look out for:

Are they are on the specialist register for plastic surgery?

There are seven specialist surgical registries recognised by the General Medical Council (GMC). By choosing a practitioner on the plastic surgery register you are choosing a surgeon that has over six years of training in the NHS, undergoing regular assessments and examinations, covering a wide range of aesthetic and reconstructive procedures under the guidance of experienced senior surgeons.

It is not against the law for cosmetic surgery procedures to be carried out by other medical practitioners in the UK, which is why some practitioners may call themselves ‘aesthetic surgeons’ or, indeed, ‘cosmetic surgeons’ without having had the necessary experience.

Also, the line between surgical and non-surgical procedures is not necessarily distinct; many non-surgical procedures carry serious potential complications and should really be administered by a highly experienced and qualified practitioner.

Are they a member of an independent plastic surgery organisation?

This can be a great indication of both the experience and qualifications of your surgeon. Leading independent plastic surgery organisations in the UK include the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic, Aesthetic and Reconstructive Surgeons (BAPRAS). I am a member of both.

Members of these organisations have to be fully trained plastic surgeons, registered on the GMC specialist plastic surgery register and eligible to, or have taken up, consultant-level positions as a plastic surgeon in the NHS.

Do they work/provide treatment at reputable hospitals and clinics?

Often your cosmetic surgeon will not have a standalone clinic per se, but instead work from private hospitals in the local area. This means that your consultation, procedure and aftercare will all be carried out at a private hospital chain such as the Spire, Nuffield or BMI. Or you may receive treatment at the private wing of your local NHS hospital.

It is possible to check this provider is registered with the Care Quality Commission (CQC) by going to the CQC website. This is the independent regulator of health services in England and you should not sign up for any cosmetic surgery procedure if the hospital or clinic cannot provide evidence it is registered with the CQC.

The cosmetic surgery procedures you may never have heard of: bra line backlift

Fat is a funny thing. We all know that it can creep up on you, particularly as we get older, but fat cells can also be deposited unevenly and often in the most unlikely of places. Many of my Leamington cosmetic surgery patients – particularly my female patients – exercise regularly and work hard on achieving a flat tummy or taut thighs, but get downhearted when they check out their back view in the mirror and see rolls of fat and skin below and above the bra line. This excess skin can make a woman appear heavier than she actually is.

Tissue on the back is of a slightly different composition to elsewhere on the body. The skin is much thicker, there is minimal ‘deep’ fat and the superficial fatty tissue is much more dense and fibrous, all of which makes it very difficult to shift this problem with exercise or diet.

Also, if your weight has fluctuated over the years, then this will have increased the amount of fibrous tissue and you will usually have developed skin laxity that appears as ‘rolls’ on the back.

Recently, I wrote about one of the less well-known procedures I offer clients called a trunk reduction; this week I’m reviewing another, more unusual, cosmetic surgery procedure known as the bra line back lift.

I perform the procedure under a general anaesthetic; first, following a careful preoperative mark-up, an incision is made all the way across the upper back and into the upper armpit area on each side. The back skin is then separated from the underlying muscles down to the lower back area, before it is pulled tightly upwards, the excess removed and the skin closed with dissolvable stitches. This produces a smoother contour to the back area.

The trade-off is the scar extending across the upper back from armpit to armpit. Scars on the back tend to fade less well and may also stretch in response to normal bending movements, so that they are not a completely fine line.

However, at pre-planning, the best position for the scar in regard to the standard bra strap line is considered and marked accordingly to try to minimise visibility and the majority of my patients are comfortable accepting the scar in exchange for a much-improved body contour.

The cosmetic surgery procedures you may never have heard of: trunk reduction

Reflecting the ever increasing rise in plastic surgery in the UK, the internet has become a vast resource of information – often excellent, but sometimes misleading or sketchy. I find that many prospective patients that arrive for a consultation at my Leamington plastic surgery practice are fully conversant in the pros and cons of breast augmentations, tummy tucks and liposuction, but it can also mean that they have fixed ideas on which procedure is best for them.

I offer a range of cosmetic surgery procedures and sometimes a patient may require something less straightforward to achieve the results they are hoping for. Here I look at some of the less well-known cosmetic surgery procedures I offer.

The tummy tuck or abdominoplasty is a very popular procedure and many men and women arrive for a consultation at my Leamington cosmetic surgery practice believing that this is the procedure for them.

For some, excess skin and fat continues round onto the flanks and into the middle of the back. Unfortunately, this is a common side effect of losing a great deal of weight. The remedy is a trunk reduction.

What does this involve?

The surgical procedure involves a careful mark-up before surgery and, during surgery, includes all the essential steps for an abdominoplasty. So, the incision on the front runs horizontally across the top of the pubic area and, staying low, out onto each side. This allows access to the tummy muscles all the way up to the lower chest area so that these can be tightened up if they have weakened and spread, following pregnancy or excessive weight gain, for instance. Excess skin and fat is then removed low down and the tummy button repositioned as necessary.

With the patient on his or her tummy, I focus on the pre-marked area and make the incision from the point low on each side, continuing across the upper buttocks to meet in the mid-line low in the lumbar region of the back. Excess fat and skin are removed and the entire surgical wound is closed with dissolvable stitches. In practice, the ‘face-down’ part of the operation is generally done first.

The benefits of a trunk reduction

Most patients want smoother, tauter contours and, although they may have fixated on a particular problem area, such as their paunch, it is my responsibility to highlight areas of skin and fatty excess which will be made much more obvious on the low flanks and back if just the tummy tuck is done and to advise on the surgical procedure most likely to achieve overall satisfaction, even with the trade-off of a more extensive scar.

Is There a Link Between Breast Implants and Cancer

In the past there have been reports possibly linking a very rare form of cancer with textured breast implants, which have become increasingly popular in recent years as they lower the risk of capsular contracture.

What are the chances?

The first thing we need to do is put this cancer and the chances of developing it into perspective. Anaplastic large-cell lymphoma, also known as ALCL, is extremely rare and is more likely to affect children and young adults and is more prevalent in males. It is caused by abnormal T-cells building up in the lymph nodes. In the USA, the incidence rate of ALCL diagnosis is 3 in 100 million per year.

The British Association of Aesthetic Plastic Surgeons (BAAPS), the UK’s leading independent plastic surgery association, of which I’m a member, carry out audits of all their members’ work. In the last ten years, their surgeons have performed almost 80,000 breast augmentation procedures and in that time, there has not been one case of ALCL reported.

The study itself that first highlighted a potential link actually is only based on 150 cases out of a potential 15 million women worldwide who have breast implants. Furthermore, recent clinical studies have not been able to prove with certainty whether breast implants will increase the risk for developing ALCL.

What are the risks associated with breast augmentation surgery?

This is not to say that this procedure is risk-free and I always ensure that my Warwickshire breast augmentation patients are well aware of all the potential complications before deciding to go ahead.

Beast augmentation surgery risks include all of the usual problems associated with a surgical procedure performed under a general anaesthetic. Furthermore, there are complications specific to this procedure which generally relate to the insertion of a foreign body – the breast implant.

These include capsular contracture, where there is an encapsulation around the implant which can harden and compress the implant overtime. Rates of capsular contracture vary but it is thought that up to 10 per cent of women over a ten-year period will experience capsular contracture, although the use of polyurethane-coated implants appears to lower this significantly.

For patients in the Warwickshire area who have undergone a breast augmentation procedure and may be worried by reports in the media, I am always happy to have a consultation where we can discuss this further. I would also advise any breast augmentation patient who notices a change in their breasts or any lumps or swellings to seek immediate medical advice.

3 Reasons Why You Should Have Cosmetic Surgery

As a trained plastic and reconstructive surgeon, who has held a substantive post as a consultant in the NHS for many years, I’m always disturbed when I read articles with titles such as the above.

The difference between plastic and cosmetic surgery

First of all, it is important to understand the difference between plastic and cosmetic surgery, as there can be much confusion in both the media and patients’ minds. Plastic surgery is a surgical speciality that corrects congenital abnormalities, treats burns, skin cancer and hand injuries and disease, as well as repairing soft tissue defects from trauma, disease or secondary to surgery.

I would define cosmetic surgery as an elective procedure that aims to improve physical appearance with psychological gain. It can be performed on the face or body and the focus is on aesthetic enhancements and improvements in symmetry and proportion.

There are many reasons why a patient may need plastic and reconstructive surgery. The fact that these procedures are, for the most part, available on the NHS indicates they are important for the mental and physical well-being of the patient.

I would argue that no one ‘needs’ cosmetic surgery: by definition, being neither to relieve severe pain nor to prevent death, it is not essential, however desirable and appropriate it may be. However, that is not to underestimate what a positive and beneficial effect that well considered cosmetic surgery can have, but my philosophy is that it must always be the right patient and the right procedure at the right time.

What do I look for in a cosmetic surgery consultation

The consultations I offer at my Leamington cosmetic surgery practice are necessary for establishing whether cosmetic surgery is right for you. I aim to create a calm and unpressurised period of time where the patient and I can discuss their feelings, concerns and expectations and then both myself and the patient can decide whether going ahead with a procedure is the right decision.

Reasons why you shouldn’t have cosmetic surgery

Timing is often a major factor in whether or not you should proceed with cosmetic surgery. If you’re going through a period of emotional upheaval, such as job loss, divorce, death of someone close to you or immediately after having children. Pressure from a partner or family member is also a no-no.

However, if there has been something that has always concerned you about your appearance and you’ve considered the potential pros and cons, then the best advice is to book a consultation with an experienced and qualified plastic surgeon to discuss your options in more detail.

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.