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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.

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.

Seeking treatment for skin lumps and bumps from a Plastic Surgeon

On discovering a lump or bump on the face or the body, either in or just under the skin, your first instinct will naturally be to make an appointment with your GP to check that there is nothing serious to worry about. Your GP will be able to assess the problem and, if appropriate, a biopsy will be taken and sent off for examination.

First of all, try not to worry

Most lumps and bumps aren’t cancerous – in fact, even the vast majority of lumps found in the breast aren’t cancerous – but instead are benign (harmless) growths that aren’t life threatening. The most common skin lumps and bumps that are benign include cysts, lipomas (fatty lumps) fibromas and angiomas.

The next step; removal

Even if the skin irregularity has been checked and determined benign, your decision might still be to have it removed for aesthetic reasons, which is usually when your GP will recommend you seek treatment in the private sector.

Most GPs won’t perform removals anyway, particularly on the face. Whilst they might think to refer you to either a general surgeon or a dermatologist, referral to a Consultant Plastic Surgeon, armed with the superior knowledge, insight and expertise to ensure the best cosmetic result, would be much more advisable in my view.

Why a Cosmetic Surgeon?

A cosmetic surgeon, holding the position of a Consultant Plastic Surgeon, will have the necessary anatomical knowledge, a mastery of all possible techniques and a thorough understanding of the skin and how its qualities differ from person to person. These advantages allow me to offer all my patients a bespoke experience, whatever the problem, tailoring the procedure to the individual.

Where the procedure is carried out is also a factor. By performing this sort of surgery at both The Nuffield Health Warwickshire Hospital in Leamington Spa and The BMI Meriden in Coventry, the best operating facilities, theatre lighting, instrumentation and suture materials are always available, accompanied by strict standards of hygiene and cleanliness.

When considering the removal of any skin lumps and bumps, as well as potential mole removal and scar revision, it is essential that you seek advice and treatment from a properly trained Consultant Plastic Surgeon for their first-class surgical skills and dedication to achieving the best possible result.

Why you should choose a highly experienced plastic surgeon to perform eyelid surgery

Eyelid surgery, known as a blepharoplasty, addresses ageing issues with the upper and lower lids and is very popular with both men and women as it can have a quite dramatic impact on the face. The eyes are commonly said to be the window to the soul, but it’s also true that they can let in a harsh light on the ageing problems around the eyes.

A blepharoplasty can tackle skin laxity on the upper and lower lids and fat bulges that appear under the eye. It is often described as a ‘simple’ or ‘straightforward’ procedure, but I believe strongly that this is a more complicated procedure than you might expect. To ensure the best possible result and management of any potential complications, choosing a highly experienced plastic surgeon is a must.

I have been offering eyelid surgery at the top private hospitals in the Leamington and Warwickshire area for many years and have performed many hundreds upper and lower blepharoplasties and below is some advice to anyone considering this procedure.

Make sure you’re a good candidate for eyelid surgery

Always fully disclose any health problems you have during your initial consultation so that your surgeon can take them into account. It doesn’t necessarily follow that you won’t be able to have the surgery, but the surgeon will have to plan for and manage any health concerns.

In terms of eyelid surgery, the one eye condition of particular concern is dry eye. For people with dry eye particular care is necessary when planning and performing this procedure, although the majority of dry eye patients are able to go ahead.

Take your time

The recovery rate is significantly slower than you might expect, especially with the lower lids. Plan for this recovery period rather than trying to squeeze an op in a particularly busy or stressful time. Often my Leamington eyelid surgery patients find they actually recover quicker when they allow themselves plenty of time.

Check out your aftercare package

Complications can ensue even in the most straightforward procedure, but the mark of a highly experienced and competent surgeon is how they manage these complications. Protect yourself by ensuring that attentive aftercare is part of your surgeon’s standard practice and ask how they deal with any complications that can arise. I always go through this in full at my Leamington eyelid surgery consultations.

Gynaecomastia Case Study

Name: Wayne
Age: 27
Occupation: Marine
Treatment: Gynaecomastia/Male Breast Reduction

What prompted you to have the procedure?

I can’t remember exactly when I became aware that my nipples were larger and stuck out more than normal, but I think they were always more noticeable to me than anybody else. I was self-conscious and didn’t like taking my top off in public.

I always knew that I wanted to have a gynaecomastia procedure at some point, but when I first considered joining the forces I knew I wanted the problem fixing before going in for training.

Who carried out the procedure and what was their opinion at the consultation?

I went to see Mr Richard Matthews at his cosmetic surgery practice in Leamington Spa for a gynaecomastia procedure about eight years ago.

I had done some research on local surgeons and Mr Matthews seemed very well qualified and experienced for the job. He was easy to talk to at consultation and made me feel at ease.

How was the experience?

After my first procedure, I was happier but I didn’t feel quite enough fat had been removed. I explained my expectations from a second procedure to Mr Matthews and so had the operation again a couple of months later at the BMI Hospital in Coventry.

Were you pleased with the results?

This time the results were great and I really feel he had listened to what I wanted.

Are you happy with the procedure?

I would not hesitate to recommend Mr Matthews to anyone considering a gynaecomastia procedure; eight years on and I am still very happy with the results.

Mr Richard Matthews provides the full range of cosmetic surgery procedures for both men and women, including gynaecomastia, otherwise known as male breast reduction surgery. He operates from the top private hospitals in the Leamington and Coventry area. For more information or to request a consultation, please click here.