We have just appointed a full time videographer to work with us and to document the daily comings and goings at the clinic.

I know that to a lot of people, this might not be high up on the list of employees needed for a plastic surgery clinic, but it is something that I put a lot of importance on.

I remember a few years ago I saw a critical comment about the BAAPS (British Association of Aesthetic Plastic Surgeons), because it had a PR team working for it.

There seems to be an association of PR with something underhand or unethical, but when you think about it, PR is just public relations, and so there is actually nothing wrong with companies or businesses wanting to try and improve their relationships with the public.

For a long time I have tried to get across what the day to day reality is of plastic surgeons’ work because the media love to portray the extremes which usually involve freakishly-looking individuals with surgery that has gone terribly wrong.

As a result it is often considered to be unnecessary and unworthy surgery.

The reality of plastic surgery is that it can dramatically improve people’s quality of life and sense of well-being and self-esteem, and can be one of the most rewarding types of surgery to perform.

I think that video is a great medium to communicate with and the world we live in allows us to reach a huge amount of people with minimal resources, and in having a videographer at the clinic who can talk to the doctors, nurses, and the patients about their hopes, dreams, aspirations, and experiences, I hope that I can share what can and cannot be achieved by plastic surgery and that it should not be looked down upon nor should people be made to feel guilty for considering it.

Plastic surgery is not the panacea that can transform your figure and your life and bring you untold happiness, nor is it the evil and destructive pursuit of the cartoon caricature.

The majority of patients are normal, average members of the public who want to achieve a body that is more in proportion and in keeping with their frame.

I think that video has the ability to connect with people on a very personal level and whilst I know that many patients will want to maintain their privacy, I hope that some will not mind sharing their experiences to help others and to debunk the myths and false impression that many patients have of what it is about.

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.

We are in a society where patients want to be as well informed as possible, and so the onus is on us as doctors, to provide as much good quality information as we can.

That is why I go to great lengths to be open and transparent to make myself available for questions every Tuesday on Facebook Live, and we have extensive documents that we send out to patients when they enquire, and before and after the consultation, and their procedure.

I have just posted another set of before and after photographs on social media and it struck me that there is a tendency to only post the good results.

It is a fact of life that most people will get an average result, a few will get a very good result, and a few will get a very bad result.

That is how statistics work.

I go to great lengths when I see people in clinic to explain the limitations and complications of any procedure and the before and after photographs that I show there are of average results, because I do not want to raise expectations in patients.

The most important factor in getting a good outcome is to be realistic about what can be achieved.

One of the underlying principles of my clinic, is that we want to have happy patients, and so you will find that we are very honest about what can realistically be expected from surgery, so that you can make an informed decision as to whether it is right for you, and this includes seeing realistic results of the procedure.

Fortunately we are in a situation where I do not think we would do well if we started posting bad results on social media, although it is food for thought, and I guess the point in writing a blog post is to urge caution in what you see on the internet, as I think we are all guilty of a tendency to show off our good results.

This is always counter-balanced by the opportunity for patients to talk about their experience and post their own results, and so this can be a blessing and a curse because you cannot take one person’s results to necessarily reflect what could happen to you.

At the end of the day, the best bet is to find a surgical practitioner who you feel can trust will be honest with you about the results you can achieve, because most of us really want happy patients and realise there is no long term benefit in making exaggerated claims.

As ever, do your research.

If you have any questions then contact us on the website or on Facebook where our director 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.

I am reading the news stories about the NHS cutting down on what they call ‘pointless and risky operations‘ and they have released a list of operations that the NHS will no longer be providing and will save hundreds and millions of pounds.
I understand that the NHS needs to save money and so they cannot treat everything, but they should be honest with the public rather than pretending that they are stopping these operations because they are unnecessary.

The reason they are stopping them is because they cannot afford to do them.

If they were unnecessary, no doctor would ever do them in the first place. 
We had this some time ago when they called it procedures with limited clinical value, and breast reduction is often something that comes up in the list and is here in this latest list, along with carpal tunnel decompression,  people with Dupuytren’s contracture, treatment for haemorrhoids, and for heavy menstrual bleeding, amongst others.
I do not think it is fair to say that these operations are pointless and unnecessary, because they all carry with them potential for complications, and so patients need to be fully informed of the risks and benefits deciding on having surgery.
I do not think you will find a surgeon who would take a patient to theatre and perform a procedure that was pointless and unnecessary.
It is true that they are not essential and will have no effect on lifespan, and I think it is right that the NHS focuses on the most pressing and clinically significant problems, but I do not think it is right that they are labelling these procedures as unnecessary.

When I used to work in the NHS it was always difficult dealing with referrals for patients with breast reduction, because we had to go through several hoops and criteria and have their case passed through panels, and more often than not it was rejected.
We would often know early on that it was going to get rejected, but nevertheless there were long letters of appeal where patients would hope to be approved, only to prolong the rejection.

I think there is an argument to say that the NHS simply treats children, cancer,  and trauma and just accept that we have to pay for everything else, because it cannot afford to do everything.
It is not that the other things cannot significantly improve quality of life, but we have to realise how expensive surgery and health care is, and looking at this list of 17 operations https://www.bbc.co.uk/news/health-44665560 , I do not think anyone would argue that the NHS would be better spending its money elsewhere, but I would prefer if they just said that they cannot afford to perform these procedures, rather than suggesting that these procedures, which they say themselves are carried out 350,000 times a year, are completely pointless.
If that were the case, these doctors would be negligently exposing their patients to risk with no hope of any benefit.

The NHS is in crisis with a terrible funding shortfall and that is the only reason they are cutting these operations.  I just wish they would be honest and say it like it is.

If you have any questions then head to Facebook where our director 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 me.
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.

GDPR (General Data Protection Regulation) has come into force and we have all been inundated with e-mails talking about the updated privacy policy and asking us to opt into email lists that we are on.
When you actually look into it, it may be that not all of those emails were required because most of the email lists that we are on have got our data because we freely gave it at some point.
However, I must say I have chosen to ignore most of the requests to opt in, because I am quite looking forward to a cleaner in-box.

I have sent emails to all of my patients who have not specifically opted in to ask them if they want to opt in, not because I have to but because I feel that I have ‘legitimate cause’ to contact the people on my database.
Everyone is a patient or a previous patient or has enquired at some point, and so the law says that I can send unsolicited emails as long as they are relevant and give the opportunity for the person to unsubscribe at any time which I always do.
The reason I have written to everybody to ask for a formal opt in is because I really do not want to be hassling people and sending an unwanted email.
I realise that when people enquire into my practice, it is often for something that is troubling them at the time and the hope is that once they have had a consultation and possibly a procedure, then it will no longer trouble them and so the emails may no longer be relevant, and I understand that people might feel bad about unsubscribing, because it can look like you are angry or upset.

For this reason I have chosen to stop sending emails to anyone who has not specifically consented and opted in.

My database is purely for my own practice and there is never any question about selling data or giving data to any third party.

It is only to communicate my values and what we can offer at the clinic and give information to patients about plastic surgery training and relevant information about procedures that you might be interested in.
If you are interested feel free to opt in but if it is no longer of any interest and maybe it never was, then feel free to ignore all the emails and you will not be bothered any more.
I have to say I welcome GDPR and I think it will be a good thing in the long term, although it has created quite a lot of work in the office over the last few weeks.
Hope to see you in the next email or maybe you want to receive our newsletter, or perhaps you could just subscribe to the Blog.
If you have any questions, our director, Jonathan Staiano, does a LIVE Q&A on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

What goes around comes around “ why some people are using smooth implants again
 
I was recently at a meeting in London and I was chatting to some of my colleagues and it is interesting to hear that some people are going back to use smooth silicone implants.
If you look at the history of breast implants, the very first breast implants were smooth silicone implants, but they found that they had a high rate of capsular contracture and polyurethane foam implants were developed which dramatically reduced the risk of capsular contracture.
However, then there was the controversy about polyurethane implants (you can read more about this in my blog here), and so they needed to find a way of mimicking polyurethane foam which is when they came up with textured silicone implants.
In fact Mentor, which is a large American manufacturer of implants, actually make the texturing by making an impression of polyurethane foam onto a smooth silicone implant whilst the silicone is wet to give the texturing effect, which reduces the risk of capsular contracture compared with smooth silicone implants.
Ever since then, the textured silicone implants have been the most commonly used implant and certainly in the UK, smooth implants have hardly ever been used.

However recently a very rare type of cancer called ALCL has been discovered, which is a cancer of the capsule around the implant.
The numbers of described cases are very small in comparison with the number of patients who have breasts implants, but it is clearly something that the plastic surgery community is very concerned about.
One of the statistics of note is that there have been no cases of ALCL reported in patients with smooth silicone implants, and this is the reason that many doctors are now recommending smooth silicone implants for their patients.
The worry however, is that we will start seeing an increasingly high rate of capsular contracture which carries with it its own problems and potential morbidity.

I do not think there is an answer, certainly at the moment, as we do not really know what causes ALCL and so are only speculating that having a smooth silicone implant is protective.

It might simply be that the number of patients with smooth silicone implants is small and so no cases have been described yet.
We have always done our best to try and inform patients as well as we can to make the best options for themselves when it comes to having surgery and this involves giving information.

I really do not know what to recommend because there are pros and cons with smooth implants, textured implants, and polyurethane foam implants.
We are about giving patients the information that is currently available to allow them to make the best decision as to what is right to be into their body.
We tell everybody about the risk of ALCL and perhaps most importantly, anyone with breast implants should look out for any swelling or lumps associated with their breasts and seek help and investigation in order to rule out this rare but potentially serious complication.

It is certainly an option to have a smooth silicone implant if that is your wish and one of the great things about the Staiano Clinic is that we are independent and not tied to any implant manufacturer and so we can use any type of implant that you would like.
Obviously you would have to be aware of the increased potential of a capsular contracture associated with smooth implants, and so this would need to be balanced against the potential benefits.

I am sorry it is not clear cut, but I would be careful of any surgeon who suggests to you that it is clear cut and tries to tell you that one implant is better than another.

Certainly amongst all the major implant manufacturers they are all made to a very high standard of safety and quality and there is no clear evidence that one is safer than other.
I know it is sometimes easier to hear that you should have this implant because it is the best and if you were to have any problems and then researched it and discovered that there is no best, you may have preferred to have had all the information so that you could make an informed decision yourself.
If you have any questions we’d love to hear from you.  You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.info@staianoplasticsurgery.co.uk.