Would you take your car half way round the world if it needed fixing?
Would you want to take on someone else’s problems after they have walked away from their responsibilities?
We’ve all heard the phrase “ buy cheap, buy twice”.
I was pleased to launch my new book called Mind Your Own Business – how to turn your medical practice in to a business rather than just a job ‘The P.E.C.A.N. Approach’ at the annual meeting of the British Association of Aesthetic Plastic Surgeons (the BAAPS) at the National Gallery in London on 27-28th September 2022.
It is for NHS Consultants who are trying to run a private practice but are looking at it as an extension of their clinical work. I share my experience of building a successful private practice and give guidance on the areas they should focus on to improve the service they are offering their patients.
Mind Your Own Business: How To Turn Your Medical Practice Into A Business Rather Than Just A Job ‘The P.E.C.A.N. Approach’
Order your copy at https://staianoconsulting.com/myob-book/.
I like using bars of soap.
I much prefer a bar than the liquid that comes in bottles.
When I am at the supermarket, I look for the best deals which inevitably involves a multiple pack of Palmolive.
My wife doesn’t like the supermarket like me, and I have noticed some different bars of soap turn up here and there.
This is a bar we have in the downstairs toilet:
It has been there for months and never really seems to get much smaller despite the fact we are using it daily.
Meanwhile I have been through quite a few multipacks of Palmolive.
I asked her where she got the soap from and it turns out that it was a present (a Christmas present!).
I bet it didn’t come from a multipack.
I have realised that buying cheap soap is a false economy,
I would be better off all round if I bought a decent bar as it would last longer and probably give a more pleasant washing experience.
It struck me that it is the same with good surgeons.
It is often the case that you don’t realise what you are paying for until after you have bought it and used it for a while.
I get messages from people all the time who have had surgery elsewhere and are unhappy with their result and the way they have been treated.
Often, the price they have paid for their surgery is significantly less and that is clearly attractive – just like the multipack of Palmolive.
It may look the same having surgery with one surgeon compared to another but it is important to see if there might be differences that are not immediately apparent.
The problem with a lot of quality products is that it is not always immediately obvious why they are more expensive.
It can be difficult to justify paying the extra price when on the face of it it might look similar to a much cheaper alternative.
It might be some time down the line when you realise the difference and it may often be too late to go back and start again.
I won’t be going back to my cheap soaps because I realise now that it is a much nicer experience buying better quality ones and it will probably work out cheaper in the long run.
Every day I hear patients talk about the risks of having cosmetic surgery.
They are worried that they won’t wake up from the anaesthetic and will leave their children motherless.
They tell me stories they have heard about someone who once died having a cosmetic procedure.
I sense that there is often a feeling of guilt particularly when parents are having cosmetic surgery because they feel that they should be spending the money on their children and it is selfish.
I can totally understand these feelings.
I think they are based on the notion that somehow cosmetic surgery is less worthy than other types of surgery.
I am the first to point out to patients the risks of having cosmetic surgery and I think it is essential that you are fully informed to allow you to make a balanced decision.
However the decision has to be balanced.
The fact that there is a television series called ‘Botched’ tells us that we love stories of when things go wrong and we love to see images of people who have come to harm having cosmetic surgery.
We have to appreciate that there are risks with any surgery and indeed with any undertaking in life.
Crossing the road, driving a car, having a shower or even putting your socks on is associated with the potential to come to harm and yet whilst we all know the risks we accept that they are small and so we can balance them against the decision of wearing socks or smelling nice or reaching our destination.
The other reason that I feel patients often make unbalanced judgements about having cosmetic surgery is that our society does not value mental health on equal terms with physical health.
You just have to see how someone is treated in the workplace if they return from having a period off for stress compared with if they return from having a period off following a broken leg.
Your colleagues will be forthcoming to make sure you can rest with your leg up and to see if they can get you any lunch if you’ve broken your leg and yet we struggle to engage or to know what to say when someone is suffering with a mental health problem.
By the same token if you’re having surgery to improve your feeling of self-esteem, it is deemed somehow less worthy than if you are having surgery to improve a physical element such as a hernia repair or surgery for indigestion or headaches.
There are risks with any surgery yet we wouldn’t feel the same way about leaving our children behind or feeling selfish if we were having a hernia repaired which was uncomfortable and affecting our quality of life.
Yet if we are having a breast reduction which may be equally uncomfortable and perhaps even more so, we somehow feel that this is less necessary and are likely to experience more guilt over it.
There are always emotional and psychological elements and there is no doubt you can have a tremendous benefit in terms of improvement in quality-of-life and feeling of well-being.
I am passionate about raising awareness of the real side of cosmetic surgery and the real people that I can help.
I will be presenting a balanced view about all of the controversies and complications associated with breast implants to allow you to balance this with the benefits that you might hope to achieve by having breast implants.
The event is free and you be welcome to bring a friend. If you want to come along then please let me know.
Please comment below and I hope to see you there.
We are much better prepared this time and over the last few months, we have put measures in place to ensure the safety and protection of everyone at the clinic and we have robust measures which are over and above what you might expect in other public environments.
We are confident that we can continue to work safely and would be pleased to welcome you to the clinic.
However, we appreciate the need to avoid unnecessary journeys and encourage you to stay at home when possible.
If you can have a virtual consultation rather than an in person one, then we can arrange this and if you do have a consultation or a procedure booked and you prefer to cancel it or postpone it, then we completely understand and will be happy to reschedule or offer you a full refund.
Furthermore, if you were to have any sort of treatment with us and we were to go into a more restrictive lockdown period, we want you to be reassured that we would still be able to look after you.
Even during the previous lockdown when we had to close the clinic for 3 months, we were still doing virtual consultations and if anyone had a clinical problem, we would have been able to see & treat them at the clinic because that would be considered an urgent matter.
We feel comfortable with our safety measures to be able to work effectively and maintain our levels of service and hope that you will feel comfortable too.
We are trying to do the right thing and I am very conscious about striking the balance between maintaining a service to our patients and containing the spread of the virus.
If you would like more information, please leave a comment and we will get back to you or call us on 0121-454 3680 or contact us here.
The Coronavirus Crisis is likely to have a long lasting effect on many aspects of our lives – both good and bad.
“It is what it is, as my son would say”
…and so we have to try to see if we can take some positives from it.
It has certainly forced me to look at the way I operate.
The Private Hospitals have been taken over by the NHS in and are not accepting any Plastic Surgery patients until the New Year.
This has meant that I have had to look for other facilities to treat patients (either that, or shutting up shop for 6 months – or more!).
There are still some smaller Private facilities that are not big enough to be of use to the NHS, but are able to offer surgery under General anaesthetic and Twilight anaesthesia (local anaesthetic with sedation).
Until now, I had only done a small proportion of my cases under Twilight anaesthesia and only in those patients who specifically requested it.
…but I have to admit that it has been an eye-opener.
We have done quite a few cases under Twilight anaesthesia now and it works amazingly well.
The sedation is such that you are not really aware and usually quite relaxed with little or no memory of the procedure.
In fact, for most of the surgery, it is similar to a General anaesthetic.
The main difference comes in the postoperative recovery.
…it is a lot smoother following Twilight anaesthesia and you are pretty much ready to get up and walk out within an hour of finishing the surgery.
There are still the bigger cases that need General anaesthetic like tummy tucks or bigger breast reductions but even these can be done with twilight anaesthesia and so I think it is probably a matter of time before it becomes the standard.
We are very lucky to have access to surgical facilities during these challenging times and I can’t tell you how pleased I am to be operating again.
If you are thinking of having surgery, whether it is under General anaesthetic or Twilight, then please get in touch because we are lucky to have access to some really great surgical facilities.
If you would like more information, please leave a comment and we will get back to you or call us on 0121-454 3680 or contact us here.
If you are planning to have surgery, you may have some concerns about all of the measures in place around COVID-19 and might be wondering if it is safe to have surgery during coronavirus.
The risks of contracting the virus relate to the spread in an aerosol form hence the requirement for face masks and visors.
This means that you will find measures in place when you come to the clinic to reduce transmission in the same way that you would when visiting other shops and services.
However if you are considering surgery during this time you may have further concerns.
There are risks to the healthcare professionals delivering the surgery as well as risks to yourself having the surgery.
In my field of breast and body contouring, I do not do surgery that would be classed as high risk in producing aerosol which would be more related to surgery around your mouth such as ENT or dental surgery.
There is however a risk during intubation and extubation at the beginning and end of a general anaesthetic, however there are robust measures to protect everyone around these times.
Private hospitals aim to be COVID-free environments which is why you will be asked to self isolate, fill in a questionnaire and have a COVID test before admission. It is also why, for the time being, visitors are being discouraged.
Unlike NHS Hospitals, Private Hospitals do not have an A&E Department and so do not accept direct admissions. This means that they have much more control over their environment as all admissions are planned.
Everything is being done to make the hospital environment a safe environment to be in for both the staff and the patients during these challenging times.
In relation to the risk to yourself if you are considering surgery then this is by no means clear.
There was a study which suggested that if you have surgery and go on to develop COVID-19, then your outcome may be worse than if you hadn’t had surgery.
This study seemed to affect patients who are in higher anaesthetic risk category rather than the sort of patients who have elective cosmetic surgery . It also seemed to be in patients having longer and more complex surgery. which is why this has been discouraged at the moment.
It has not been suggested that we should stop during surgery during coronavirus and the guidance is that for most elective cosmetic surgery, it is safe to proceed although we will ask you to fill in a COVID-19 specific consent form before your operation.
Following surgery, you will also be given a specific postoperative instruction sheet for COVID-19.
The main issue that we have at the moment is with accessibility to theatres as all of the major private hospitals in the UK have been taken over by the NHS and are offering limited access to plastic surgeons.
However we like to solve problems and overcome challenges and so have adapted and there are more and more clinics in the UK who are offering local anaesthetic and sedation which is suitable for many plastic surgery procedures.
My clinic is not set up for local anaesthetic and sedation at the moment, but we have access to other clinics to use their facilities.
This is something that we have been doing on a small scale before the coronavirus outbreak and will be doing more of moving forward and I think it is actually a positive step.
The recovery after local anaesthetic and sedation is much quicker and it can be extremely well tolerated by patients.
However it is not for everybody and there will still be some larger operations that require a general anaesthetic and we have some access to general anaesthetic theatres.
The information that we are getting from the hospitals is that we will be back to normal capacity after Christmas although this is of course dependent on how things progress with the coronavirus pandemic.
We are trying to keep everyone updated as well as we can but unfortunately, we are getting theatre lists on an ad hoc basis, so it is difficult to plan and give you a lot of notice if you are on the waiting list for surgery.
These are challenging times for all of us all, but I think it is important to recognise the significant benefits that can come from cosmetic surgery and I believe that it is safe to continue to perform surgery during coronavirus and still maintain our high levels of service given the limitations and restrictions imposed upon us.
I have never been a fan of reality TV. At least not in recent years.
I remember really enjoying the early episodes of Big Brother, that bit where Craig confronted Nasty Nick and I loved to watch The Apprentice the one with Stuart Baggs ‘the brand’.
But it’s not the same any more.
I heard Ben Fogle on the radio the other day talking about when he was in Castaway. It came out before reality TV was popular and the contestants were chosen because they wanted to escape from it all and were not looking for celebrity or limelight. The dynamic was completely different to the reality TV shows we are exposed to today.
When I see images of some of the ‘reality TV stars’, they demonstrate the media portrayal of what plastic surgery is supposed to be achieving.
…but I don’t recognise that body shape – the over enhanced breast implants and the inflated lips are not what most plastic surgeons are trying to achieve.
My waiting room is full of mums with small children who have lost volume in their breasts or have redundant skin on their abdomen.
They don’t want to look like caricatures and just want to look
I can’t believe I’m seeing this new TV so called Surjery where ‘contestants’ are chosen to compete for the opportunity to have plastic surgery.
Is there no depths to where the media will go to portray plastic surgery as being a vacuous commodity with no morals?
All plastic surgeons are doctors and as doctors we have to treat patients.
In my view there should be no difference to a patient who is coming for orthopaedic surgery, a heart operation or attending the doctor with chest pain.
We have to assess patients and see whether we can help them by medical intervention.
Plastic surgery is no different to any other and to suggest that it should be given away as a gameshow prize is beyond belief.
It feeds the media portrayal of plastic surgery being unnecessary and vain.
But this is not the case in my experience.
When asked if I would allow my family to have plastic surgery, I would always answer ‘it depends if they need it or not’.
In the same way that I can’t answer whether they would have orthopaedic surgery or heart surgery until the situation arose I would weigh up the pros and cons and make a judgement.
As doctors we are trying to improve quality of life whether we are doing a heart transplant or putting a hip replacement in or treating a patient for chest pain.
As plastic surgeons we are doing the same, and we do it very effectively and can improve and enhance patients’ lives tremendously.
The media portrayal of everyone seeking plastic surgery to be a vain and shallow person can only damage the portrayal of plastic surgery and feeds into patients feeling guilty and selfish who might otherwise benefit greatly from it.
Obviously I have are my own view on the subject which will not be shared by much of the general public because they are constantly fed TV shows about botched surgery or extreme cases.
The media are not interested in the ‘normal patient’
…who just wants to feel more confident and be able to wear the clothes that they want to.
I will continue my crusade to raise awareness for the good that plastic surgery can achieve.
I want people to realise that it is not any less worthy than any other medical or surgical intervention.
Yes, there are risks and potential complications as there are with any procedure and these need to be balanced against the benefits.
But we must not lose sight that the benefits can be tremendous and just because they are usually psychological benefits rather than physical benefits, they are given less weight and deemed less worthy.
If we can do something to improve someone’s psychological feeling of well-being then in my view this is no less worthy than improving their physical feeling of well-being.
The sooner we recognise psychological health in the same way that we acknowledge physical health, the better.
I would love to hear that the next reality show is about patients who had plastic surgery and feel a lot better about themselves and no one has really noticed except to say that they look younger or less tired or just different in some way, …but I can’t help but think that this will not take off because when it comes to entertainment, there is no money in the middle.
A barbed suture is a suture which has very fine barbs all the way along its length. This means that when you pass it through the tissues, the barbs catch and it will not pull back.
So that if you use it on either side of a wound and pull it tight, it will hold the tension and keep the wound closed without having to tie a knot in the suture.
I guess it is one of the benefits of the information superhighway – that we can all become experts with a few clicks and a couple of hours on Google.
I welcome this and encourage patients to do their research.
…but sometimes people do go in to details and start worrying about things that aren’t really important.
…like ‘will you use a barbed suture for my tummy tuck?’
What’s that all about?
Most people don’t even know what they are asking much less why it might (or might not) be a good thing to use.
Having said that, it is always good to ask questions because you will be able to gauge from the reaction whether your Consultant is approachable and comfortable to engage.
…but I wouldn’t hold too much store on the reply.
Like most things, there are pros and cons.
Some surgeons use barbed sutures a lot, while others never use them.
Personally, I am in the latter category and I never use them.
Not because I think they are bad, I can see the benefits
…but I also see the downsides.
The great benefit in using a barbed suture is speed.
…and it is better to be quick than slow when performing surgery.
If you have a large open wound, like with a tummy tuck or a breast reduction, you can pass a barbed suture and close it very quickly because as the barbs pass through the tissues, they catch and won’t pass back and this keeps the tension on the wound without needing to tie knots.
If you use a normal (non-barbed) suture, then you have to tie a knot in the suture to keep the tension on.
This means that you have to tie multiple interrupted sutures rather than just passing one barbed suture.
…and this takes time.
BUT there is a benefit in tying multiple interrupted sutures.
One of the challenges in closing tummy tucks or breast reductions is that we need to take care of the alignment of the tissues to prevent a dog ear and ensure that the closure is neat.
This is easier when doing interrupted sutures where you can adjust and correct as you go.
Once you have passed the barbed suture, you can’t adjust it.
The other worry that I have with the barbed suture is that the whole integrity of the wound closure is held on that one suture.
With multiple interrupted sutures, if one knot fails, it will not have a significant effect.
Furthermore, if you are unfortunate enough to get an infection, then we may need to remove the suture.
This is bad enough if it was just one deep suture, but if you are unlucky enough to get an infection in a barbed suture, it is very hard to treat because they are difficult to remove.
At the end of the day, a barbed suture is not going to be the difference between a good and a bad result.
The are good surgeons and bad surgeons and there are surgeons who use barbed sutures and those who don’t – they are not mutually exclusive.
It is more important to look for a good surgeon and that depends on a variety of factors.
The ins and outs of the techniques they use is a minor factor.
Yet some patients give disproportionate weight to it because it is a lot more tangible than these other attributes.
I still think it is good to be informed and to ask questions about your treatment about how and why something is going to be done.
…but try not to get too hung up on it.
Barbed sutures have a place, but in themselves, they will not give you a good result (or a bad result).
If you need help finding a fully trained plastic surgeon, you can get my book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.
It is available through amazon or my website .
If you have any questions, feel free to get in touch or leave a comment and I would be happy to get back to you.
I often see patients who have been given conflicting advice by previous doctors.
They can’t all be right, can they?
You can understand why it can be confusing and in my Facebook Live Q&A every Tuesday, I often have patients who are beside themselves and don’t know what to do.
As a surgeon, I can see why they are getting conflicting advice
…and as a human, I can see why this can appear to be contradictory.
I think it is good to get different opinions from surgeons, but sometimes, the more opinions that you get, the less clear it can become!
The fact is that, in many cases, they are all right.
You see, there are pros and cons of most of these decisions.
Putting implants under the muscle will make it less likely that you will get rippling
…but it is more likely for the implants to sit high or wide and the possibility of animation deformity.
Combining a tummy tuck with a breast reduction will get it all done in one go with one recovery
…but it is a big operation and it will knock you back.
There is no right answer.
It is about being aware of the pros and cons so that you can make an informed decision about what is right for you.
Teardrop implants might be right for one person, but round implants might be ideal for another.
I think that some surgeons will portray the situation as black and white.
These are the best implants
It is better to have the implants under the muscle
But the truth is that if there was one best way of doing something or one type of implant that was the best, we would all do it that way or use that implant.
…but we don’t
We all have our own opinions and experiences that lead to our judgements about what might be best for you.
I always say that the most important decision for you to make is to choose your surgeon.
Do your research about the surgeon and the clinic or facility that you are going to be treated in.
This is much more important than going in to minute detail about nanotextured implants or different types of liposuction.
There are often many different ways to get a good result.
One surgeon might use VASER liposuction while another uses power-assisted liposuction.
The results might be exactly the same.
…or more importantly, the results will be better in the hands of the better surgeon.
It is more about the skill of the surgeon than the technique used.
You can spend months researching the ideal shape, profile and model of breast implant, but if the pocket is
You will get a poor result.
Some of my patients will go backwards and forwards with an implant choice, giving themselves sleepless nights convinced that their decision will be the difference between a good and a bad result.
…when in reality, their decision will have very little effect on the outcome.
The difference between the implants they are trying to choose from is often millimetres and I could use either and they would not notice.
However, if I am not careful to place the implants properly.
They will be unhappy, regardless of the implant they have chosen.
So beware of anyone who tells you that they know the ‘best’ way to do it (especially if they are not actually the person who is going to be doing it).
…and spend you time researching your surgeon rather than the procedure.
Of course you need to educate yourself about what you are having done.
…but you don’t need to know the minutiae about the difference between a dual plane type I and a dual plane III submuscular placement of breast implants.
Good luck and if you want to know more, get in touch or jump on to one of my LIVE Q&A’s on Facebook every Tuesday night at 7pm.
Hope to see you there!