It is in the news again about the need to protect patients from unscrupulous practitioners who may prey on the vulnerable and perform unnecessary cosmetic procedures on patients who may have an underlying psychological or mental health problem.
The concept of this is welcomed by our specialty and has always been welcome, but it is the implementation that is more difficult.

There are questionnaires and screening questions that we can use which can go some way to identify underlying psychological issues that may need to be addressed prior to any physical treatment, but it is a challenge to find something that can reliably score and identify a patient who may need some other intervention prior to their procedure.

If it were easy to do, I am sure most plastic surgeons in the land would have no qualms in adopting a pre-operative screening tool.

However, one of the main reasons for the lack of this, is that there is no simple and reliable objective tool that we can use, and most of us rely on our clinical acumen supported by some broad screening questions or surveys.

Plastic surgery is one of those specialties that remains an art rather than a science and the treatment of a cosmetic patient cannot be done by algorithm or pathways.
We do not have clearly defined outcome measures such as reduction in blood pressure or complete removal of a cancer, so our outcomes are entirely subjective and our treatment plans are bespoke and often unique to the practitioner.
There are many ways you can address a breast asymmetry or the aging face and it is a combination of the plastic surgeon’s skills with the patient’s desire that helps us to come up with a plan.

Plastic surgery relies on us as practitioners, to talk to patients and get to know them, so that we can make an assessment and judgement and this goes beyond the physical attributes we see before us.
We are taught to pick up on signs and symptoms that might lead us to request further intervention before proceeding with our treatments.
Things like an unrealistic expectation or a discrepancy between the amount that a physical feature concerns a patient and the degree of abnormality associated with that feature.

These are things that it is hard to score and put a number to in an objective way.

It comes from years of experience and talking to patients and dealing with the outcome.

The media love to portray plastic surgeons as being uncaring and only interested in the surgery rather than the patient behind the surgery.
But in fact, we all want to get good outcomes for our patients and operating on patients with an underlying psychological or mental problem is not only bad for the patient but it is bad for the doctor too, because we do not want to have people who are unhappy with what we have done to them.

We want people who are delighted with their results and want to tell the world.

I have no doubt there are unscrupulous practitioners who do not spend enough time and consideration with their patients, but I do not think it is simple enough to just say that they should be offering a questionnaire prior to have a procedure.
The problem goes deeper and it goes back to training and qualifications, and the fact of the matter is, that there is an enormous variety of doctors who treat patients with cosmetic problems, ranging from fully training plastic surgeons who have gone through an accredited and rigorous set of training and exams in order to achieve a place on the specialist register of the GMC and be awarded a specialist fellowship in the Royal College of Surgeons, to doctors who have no surgical training whatsoever, right the way through to practitioners who may have no medical training whatsoever.

I think this is the underlying problem.

The lack of training and experience resulting in bad decisions and poor patient selection.

This is not good for the patient or the speciality.
Pre-operative psychological assessment is essential but it is not as simple as filling in a questionnaire.
If there is anything I haven’t covered, then join me on Facebook Live at 7 p.m. every Tuesday night when you can pitch your questions directly to me, or you can e-mail here if you would prefer a more direct reply.

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We have just been planning how we would like to move forward with the STAIANO Clinic in 2019 and one of my big goals is to create a community for our patients where you really feel like you are being listened to and looked after.

This is something I have always tried to do and one of the reasons that we never discharge anyone is because we are much more about being in it for the long haul rather than just looking to get short term results (once you have been a patient of ours you will always have access to the clinic if you ever have any questions or concerns).

Any sort of breast or body contouring procedure takes time to settle and I am aware that you may have questions or changes many years after your surgery and we are always happy to see our old patients “ but I would like to do more.

I would like to create more of a community.

We have our closed Facebook group for patients with over 200 members, but I would like to utilise the wonderful clinic space and gardens we have here, and so in 2019 we will be hosting meetings and events at the clinic for our previous and current patients.

This will be an opportunity to get together and interact on a less formal basis than the normal clinical setting that we see you in.

I also want it to be a more holistic approach to looking after you and it does not necessarily need to be anything about plastic surgery.

I have got a few ideas myself about things I would like to cover, things like yoga, mindfulness, diet and nutrition, and general lifestyle because I have always wanted the clinic to be somewhere where we do the right thing for our patients.

I am committed to making patients feel better about themselves in whatever way we can, because I see this as our role as doctors and the fact that we are plastic surgeons just happens to be the specific niche we have skills in.

If you have got any suggestions for topics or speakers you would like to hear, then please let us know by getting in touch, either by email, leave a comment below or call us.

I am very excited about the future and watch this space for details of our next event.

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Times have changed and patients are becoming a lot more informed these days with the freely accessible wealth of information available on the internet.

There is no need to pay for information anymore and the days of people investing in the Encyclopaedia Britannica are long gone.
The value these days comes in the interpretation of information, because the more you know, the more you will see that life is not black and white.

Many cosmetic surgery patients go to several doctors before they settle on the final one and will often post questions online asking about the best procedure for them, or the best implant choice, or the best way to do something.
I understand how it is confusing when one doctor would suggest one thing and then another suggests something else.
It is usually not because one is wrong, they are just making a judgement on their own experiences and expertise, and this is what you are really getting from a doctor.

Patients are often seeking the answer as to what they should do, but there is no answer, particularly in cosmetic surgery because it is such a subjective area and there are no algorithms or standard pathways for us to follow.

We have to listen to patients, understand what their aims and objections are, taking into account where they are starting in terms of their body shape and tissue quality, as well as making allowances for the future depending on the patient’s age and lifestyle.
We often cannot answer the question:

what are the best implants for me?
or should I have a full facelift, a mini-facelift or just non-surgical treatment?

Different options will give different outcomes and there will be pros and cons of any treatment, so we will not tell you what the best way forward is, but we will listen to you and try to understand your expectations and advise you as to what the best way to get there might be.
There is and never will be any guarantees, at least in terms of a guarantee of what the outcome will specifically be.
We never guarantee the cosmetic results because we are dealing with tissues and scarring and the effects of gravity and ageing over time, so the results are always unpredictable.

However, what we can guarantee is that we will do our best, we will listen to you and we will try to understand what you are seeking to achieve.  We will give you our best advice and do everything we possibly can to get you there.

In the days of more and more information being available, it is even more important that you trust the doctor.
You may be able to find a contrary opinion or article on the internet, but taken in the context of your own body, it would be open to discussion because the internet will never give you the answer and can only give you information in the broadest sense and is subject to misinterpretation.

I think it is great that the internet exists and we work hard to put out information for patients to understand as much as possible about their proposed procedure.
This is why I will always say to patients that the choice of their surgeon is probably more important than any other choice, certainly in terms of the precise procedure you have or particular type of implant that you have.
You need to be comfortable and confident with your surgeon and to be able to ask questions.
You should be completely at peace that the operation is the right choice for you at the right time, and also comfortable that the surgeon and the clinic will be there for you after the procedure to help to get you through the post-operative period.
It is often difficult initially, with swelling and asymmetry, red tight scars, and pain and discomfort.
It is important that you feel nurtured through this period because it can be frightening and unsettling and you need to trust in your surgical team who have seen it and been through it countless times with previous patients and should be in a position to let you know when and when not to worry.

So, trust me, I am a doctor! 

I will give you the best information I can and I will do the best I can to make sure you are looked after.

I cannot guarantee that things will go well, but will guarantee that if they do not go well (a surgeon without any complications is a surgeon who does not operate), we will do everything we can to make things right.

If you have any questions, you can always join me on Facebook where I do a live Q and A every Tuesday at 7 p.m. and I will be available live to interact and discuss any issues.
Feel free to leave a comment below, or drop us an e-mail.
If you want to come for a consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

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We often see patients who are at the clinic who have a mole or a cyst or a lipoma, which they have never really liked the look of.
It may be in a prominent position such as the forehead or the cheek and they have finally decided that it is time to be rid of it.
One of the things we pride ourselves on here at the Staiano Clinic, is that all of your consultations will be with the surgeon who will be performing the surgery. 

I am amazed when I hear stories of patients seeing someone in the clinic, only to find on the day of the procedure that a different surgeon is going to operate on them who they have never met before.
This is bad practice and uncomfortable for the surgeon and I am sure that it does nothing to give confidence to you, the patient.

Because all the consultations are with your surgeon, you will find that we will give you an honest opinion about what can reasonably be achieved, because we will be the one who will see you after the surgery and be with you at each of your follow up appointments.
It is all too easy for a sales adviser or clinic nurse to gloss over the potential complications and promise a great result if they do not have to face you afterwards and justify the quality of the result that you have achieved.
This avoids giving patients realistic expectations so they can make an informed decision as to whether surgery is right for them.

Our goal is to see as many patients as possible and we are constantly looking for new avenues to spread the word to reach new audiences (please feel free to share this post).
¦but at the same time, when we see you we want to give you the best advice because the clinic is built on the foundation that we will do everything we can to give you the best result possible, and this might sometimes mean not operating on you.

It is better that you are prepared for the likely result that you will achieve, what the scar will look like, and what effect the surgery can reasonably be expected to have on you. 
However, if you do decide to go ahead with surgery it is far more likely that you are going to be happy with your result.

I think this is one of the reasons why we have so many happy patients.

We are so lucky to have a supportive community at different stages of their surgery who will freely talk and give advice to others.

I guess on the face of it you could say that the Staiano Clinic is a plastic surgery clinic, but that is not what we are really about.

We are about listening to people, understanding their concerns, their hopes and their fears, and talking about what can be done to address them, and going through the options to allow you to come up with a plan for what is right for you.
We are all about the long game and want to make patients for life.

I guess different clinics will have different values and while we do have company goals and commitments, I guess you can sum up our values in two words,
‘we care’.

Plastic surgery is a very personal thing and a personal choice but it has become synonymous with cowboy operators and botched bodies.
I think this is because it is increasingly commercialised and there are a growing number of non-fully trained plastic surgeons providing the surgery who are supported by a corporate backing which is focused on the most efficient and cost-effective way of delivering the service, which often involves the surgeon only performing the surgery and other members of staff dealing with the after care.

I believe the after care is crucial and is something we focus on here.

I guess different models will work for different people.

If you want all of your consultations with the surgeon, come to us.

If you have any questions and want to get in touch, then contact us on the website or on Facebook where JJ does a live Q and A on Facebook every Tuesday at 7 p.m.  Please visit our Facebook page if you would like to put a question directly to Jonathan.
Feel free to leave a comment below, or drop us an e-mail.
If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.