Less is not More. In Fact, Less is Usually Less.

We live in an age where everyone wants the best, the fastest, the tallest and the most expensive.

We want it now and we do not want to wait and we want it at the cheapest price. Of course this is natural. It is human nature to want to get the best deal. However, it is important to realise that often compromises will have to be made. This is very true in cosmetic surgery.

Everybody wants the least invasive procedure.

Of course they want the one stitch facelift or the scarless breast reduction or the mini tummy tuck. Less scarring, less downtime, less cost. This is fine, but it is important to realise that as with anything, there is a compromise.
A lot of plastic surgery involves removing skin in order to tighten the tissues and to combat the effects of gravity and weight fluctuations, whether it be in the face, the breasts or the tummy. If we are going to remove skin, then inevitably there will be scarring. Much of the art of plastic surgery revolves around placing the scars so that they are difficult to see and handling the tissues carefully so that when the skin has healed the scarring is just a faint line and blends in with the normal skin.

There is a big difference

between the scar you get from a cosmetic blepharoplasty compared to that when having an emergency appendicectomy, partly because as plastic surgeons we are fortunate to operate on the face a lot and the face tends to scar very well but also because the priorities of surgery are different. The whole aim of a blepharoplasty is to improve the appearance, so taking care over the scar is crucial, whereas an emergency appendicectomy can be a lifesaving procedure and quite rightly the quality of the scar will not be of paramount importance to the surgeon.
Despite our efforts to leave the best quality scars hidden in natural skin creases and shadows, it is important to realise that all scars are permanent and if you look hard enough you will be able to see them. For this reason, if it is possible to perform a procedure with less scarring then we will be all for it.
However, the problem with all of the minimal scar procedures is that if you leave less scarring then you can remove less skin and if you remove less skin, then you cannot tighten the tissues as much and if you do not tighten the tissues as much then you cannot give as dramatic a result as you might want to.
I saw a quote the other day:

Our service is cheap, fast and good quality but you can only have two of the three

By all means you can have a short scar facelift or a mini tummy tuck, but you would have to accept that the result would not be as dramatic as if you had a full facelift or a full tummy tuck. Now for many people this might be an appropriate compromise and they would be quite happy to have a slightly less dramatic result, particularly if the skin laxity preoperatively is not significant; in favour of the reduced complications and scarring. However, this is a conversation that you have to have and you cannot expect to get as impressive a result as you might have done if the surgeon is limited to the amount of scarring that he can leave.
Unfortunately advertising and marketing plays a major role in cosmetic surgery and there will always be those who will seek to use headline benefits like minimal scarring and minimal downtime to attract and seduce customers. However, I would caution you to be careful, to look behind the advertising and make sure that you see before and after photographs and even talk to previous patients to ensure that the headlines deliver on the expectations.

Managing expectations is crucial to our ultimate goal which is to deliver a happy patient.

We all know that these techniques exist.

You will often find that many surgeons do not perform these limited procedures as often as you might think given their stated and highlighted benefits. This is because if they do not deliver a happy patient, it does not matter how short the scar is, the operation will not be deemed a success.
You have to question why you are seeking surgery in the first place because the least scarring and the least downtime comes with no surgery at all, which of course is always an option. However, if you have significant skin laxity or a cosmetic problem, you need to find the best and most effective way to treat that and be guided by your surgeon rather than focus on headlines that promise scarless surgery or a lunchtime facelift.

Many plastic surgeons are against the concept of advertising in cosmetic surgery

and I can understand why but I do think that there are benefits in advertising when it is used to educate and inform the public about what is available. The problem comes when advertising is used to target vulnerable people, is insincere or inaccurate with its claims.
There will always be those who want to chase the sale and worry less about delivering the best service possible. I cannot help but think these people will have very shaky and short term businesses. Any individual surgeon in private practice is in it for the long haul and will put great emphasis on building a good reputation. There is no place for unscrupulous advertising.
It comes back to what I will always advise which is do your research and by all means look at and read advertising material but at the end of the day, ask your surgeon questions, look at the results and talk to previous patients to ensure that you are choosing the right procedure for you, not just the one with the shortest scar.

Hopes and Aspirations.

I was taking the dog for a walk one morning after dropping my children off at school. It was the end of term and they were looking forward to moving on next year. I have three small children aged 6, 9 and 11. I see them grow up with hope and expectation for the future, mainly along the lines of I hope there will be some new girls next year or when is the iPhone 7 coming out and I think about my hopes and aspirations for my children. It is really quite simple and can be boiled down to one thing: I hope that they are happy. As long as they are happy, anything else is a bonus. People talk about health, wealth and happiness but health and wealth are no good without happiness. If you have happiness then health and wealth would be an advantage, but happiness is the key.

Benefits of Plastic Surgery.

This led me to think about cosmetic surgery because I am promoting my new book at the moment and it is quite common for people to suggest that cosmetic surgery is not worthy and for patients to feel guilty for having it. It upsets me to hear this view because I know the tremendous benefits it can bring. Admittedly the benefits are psychological rather than physical. Of course there are physical changes, but the real benefit comes in the improvement in quality of life and self-esteem.

Cosmetic Surgery is not about the unnatural enhancement of people.

The people I see in clinic are not the people you may see on the television or in the newspapers. Cosmetic surgery is not about the unnatural enhancement of people. It is not about putting overly sized breast implants into patients or too much Botox giving a frozen or startled look or too much lip filler creating a trout pout. These are the images portrayed in the media but people walking out of a good plastic surgeon’s clinic will look normal and if you did not know what they looked like before, then you would have no idea that they had any surgery done. That is the majority of my patients.

It is about improving and enhancing…

natural features and it can bring tremendous benefits. I am always touched by the length patients go to with thank you notes and gifts. Perhaps the most rewarding thing is when a patient who has had an arm reduction comes in wearing a vest top on a hot sunny day and tells me she would never have been able to wear this before. Or the patient with a prominent ear correction comes with her hair tied up when she would have always had it down in public. Or the patient who had a breast enlargement who has just been on holiday at the beach with her daughter and had an amazing time because she for once felt confident with her body.
There is no doubt that this surgery can bring happiness and after all, is that not the most important thing?

Cosmetic surgery has no less value than other types of surgery.

It is just as worthy to improve a patient’s psychological well-being as it is to improve their physical well-being; although for some reason our society does not see things this way. On a wider level, mental health issues are not given the attention or the investment that is required because it is not seen as important as cancer treatment or heart disease, yet it is a major cause of mortality and morbidity. More worryingly, it tends to affect younger people.

Mental illness is silent killer that pervades our society.

I am very happy with the course that I have chosen.

I spent years performing cancer reconstruction and I have perfected some of the most complicated and intricate microsurgical operations during my time as a reconstructive surgeon. However, now that I focus on cosmetic breast surgery, I do not feel that my time is any less well spent because I see the outcomes and I see the changes in people’s lives and I know that what I am doing is worthwhile. It is not unnecessary, it is not vanity and it is nothing to feel guilty about. The patients having this surgery know this and I just wish the public at large would accept it and the media would start to portray a more positive image of cosmetic surgery.

Team GB and the Man in the Arena

John Major of Course

The achievements of Team GB at the Rio Olympics and Paralympics were spectacular. For any athlete to be able to achieve the level of getting into the National Squad and participating in an Olympic or Paralympic Games is an amazing achievement. To go up the ranks from local to regional and then national teams is very impressive.

However, when you get to the level of the Olympic or Paralympic Games you realise that you are competing against the rest of the world and I cannot imagine how daunting it must be to come up against athletes from every nation. The concept of competing against the best that the world has to offer and then win a gold medal is hard to grasp and when you look at the sheer number and diversity of athletes in Team GB who have gone on to do this, it is truly awe inspiring.

The Man In The Arena

There is a wonderful quote by President Roosevelt called The Man in the Arena:

“It is not the critic that counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

I like this quote because it stands up for those who are trying to do the right thing and make a difference.

Give Credit To The Policy Makers

When I look at this quote in terms of Team GB and the Olympics and Paralympics it is not the athletes that I think about when they talk about the man in the area.

There are few occupations for which this quote is more relevant to than politicians. It is all too easy to criticise ideas and policies but it takes a strong character to be able to stand up to the critics and push ahead with your plans.

I was very pleased to see a tribute to John Major whose decision it was to launch the National Lottery which has gone on to put significant investment into elite athletics. It is also interesting to see how the allocation of the funding has been instrumental in achieving the successes. I am sure at the time there were plenty of critics but look at what elite athletics has done for the country. It has swelled national pride and given a huge boost of morale to the whole country, particularly in these difficult times with our relationship with the European Union.

I do not think I could be a politician because I would find it hard to deal with the constant negativity they get, often from people who will only criticise and not put forward their own ideas or plans as to how things should be done.

Most People Are Trying To Do The Right Thing

I think that most people come to work and want to improve matters and no one is trying to deliberately make matters worse or bring harm or unhappiness to people.

The cosmetic surgery industry has a negative image that is often portrayed in the media, full of patients who want enormous boobs or massive fake lips who are being treated by cowboy doctors. I see a different side.

It has taken enormous personal investment to set up a clinic that provides the high level of service it does. I am trying to do the right thing and to provide a service to patients that can both enhance their quality of life and improve self-esteem.

So while there will always be people who will watch the strong man stumble I think we should perhaps spare a thought for the man in the arena.

By all means criticise and point out areas that need improvement but also give credit where it is due. Praise the accomplishments and the good deeds of those who are out there trying to make a difference.

So thank you John Major and very well done Team GB.  Let us not forget the policy makers who are behind these monumental achievements.

The tagline of our clinic is

‘Everyone Deserves Body Confidence’

The reason for this is because this is what we try to achieve here in the clinic.

We went on holiday to Tenby and we had beautiful weather and spent most of the time on the beach.

When the sun comes out the immense diversity of body shapes becomes very apparent on the beach.

It is very clear to see that the reality of the average person’s physique is so far from what is perceived to be ideal.

It is actually great to see fathers and mothers playing with their children on the beach.

In the real world, most people have a big belly, man boobs or cellulite.

It is completely normal.

Obviously there are health benefits in being slim and fit but I do think the lengths that some people go to to achieve a perfect figure can be counterproductive to their mental health because they perceive that they should look like something that is not realistic.

Now obviously I am a plastic surgeon and you may say that my business relies on people wanting to achieve an ideal figure but in fact what I would really like to achieve is body confidence.

It is about being able to take the children to the swimming pool or to be comfortable playing catch on the beach without having to wear a T-shirt.

I have a young daughter and I worry about the pressures and the perceptions of what we should all look like.

I do not want to promote this and I would rather that our society was less obsessed with air brushed celebrities and models in glossy magazines.

The majority of my patients do not want to look like celebrities and just want to look normal and have their confidence back.

In fact, often people will never know that they have had surgery because they are not doing it for others, they are doing it for themselves.

Fortunately we can all wear clothes and this can cover up and hide a lot of imperfections.

It is only at the swimming pool and the beach that these become more apparent.

Surgery may make you more confident on the beach but it can also make you more confident in your daily life and this is what I love to hear.

It is the 18-year-old man who comes for a follow-up from his gynaecomastia correction and walks into the room without his parents and will happily take his shirt off to let me examine him.

He looks like a new person from the one that I met a year ago who would not maintain eye contact and his life was crippled by his modest excess breast tissue.

An hour or two in the operating theatre and I have transformed his life and allowed him to get on with doing all the things that he should be doing whether or not that involves taking his top off.

You see, everybody deserves body confidence.

Not necessarily an ideal body but the confidence to feel good about themselves.

I wish the media would portray a more positive image of the human body in its various forms.

It was great to see an article on the Women’s Rugby Team who posed naked to promote body confidence.

They discovered their body shapes were suited to the sport of rugby and they have worked on them and trained to become elite athletes.

They are confident with their bodies because they use them to perform a task which they do to the highest level.

Most of us do not use our bodies to their full capability and while we need to be healthy, we do not necessarily need svelte thighs or a scaphoid abdomen.

I am all for healthy living and I think we should all be keeping an eye on what we eat and how much exercise we do.

The goal should be to be healthy and happy.

The problem is a lot of people are trying to achieve a body shape which may be unachievable or at least not sustainable in the long term.

I would like to say thank you to England Women’s Rugby Team for showing a different side to body confidence.

We need to move away from the image of a perfect body and understand that there is room for all different body shapes in the world.

Our goal at The Staiano Clinic is to help people to restore their confidence and we do not promote the media’s image of an ideal body.

I hope this message comes through in everything that we do both in terms of the message that we are trying to put out to the world and in the way that you are treated if you come to visit us.

Please share the message and help us to spread the word.
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Should we allow cosmetic surgery on our children?

I read an article that an advertisement had been banned by the Advertising Standards Authority because it could be seen to be promoting cosmetic surgery in children and young adults under the age of 18. I completely understand the ruling and I am sure that to most people this would seem perfectly reasonable. However, I cannot help but feel a little disappointed in the continuous negative portrayal of cosmetic surgery.

I sometimes get asked by people if I would ever consider cosmetic surgery for my wife or my children or one of my family members. I find this quite an odd question because I look at cosmetic surgery the same way that I look at any other type of surgery. As a plastic surgeon I have been trained in all aspects of plastic surgery before I specialised in both cosmetic and reconstructive breast surgery. I see myself as a doctor who sees patients in the clinic and tries to help them if I can.

Would I consider cosmetic surgery?

If I needed it, then yes but if I did not, of course not. I see it in the same way as whether I need surgery for a hernia or polyps in my bowel or aching or painful joints.

If I had a problem and surgery could help me with that problem, then I would definitely consider it. If I did not have a problem, then of course there would be no need for me to consider surgery. I hear so often that cosmetic surgery is unnecessary.

Again I understand the statement but I would argue that it is always necessary in that there is a patient who feels that they would benefit from it in some way. It may not be essential but then hardly any surgery is essential.

Should cosmetic surgery be performed on children?

Going back to cosmetic surgery in children, if you ask me, should cosmetic surgery be performed on children, I would answer in the same way. If it is necessary and in the best interest of the child then definitely yes, if not, then no.

Cosmetic surgery in children is actually quite common and is performed every day. Children born with a cleft lip often suffer no functional problems and do not need to have it repaired except for the cosmetic consequences. In fact in many countries where access to medical treatment is more limited there are healthy adults with unrepaired cleft lips. Similarly prominent ear correction is something that is frequently performed on children aged between six and ten.

This is quite normal practice. I often see children who may have large and unsightly moles or skin blemishes and are teased at school and again, no one would question the benefits in removing these.
It comes back to the perception of cosmetic surgery as being breast implants being put into shallow and vain women to make them look out of proportion and like a cartoon character but this is not what cosmetic surgery is about.

Yes, the news stories always feature individuals like this because if the media reported on a vast majority of patients, normal mums or anxious young women who have always felt uncomfortable and out of proportion, then there would be no news story at all.

Cosmetic Breast Surgery

When it comes to cosmetic breast surgery I would not be inclined to operate on someone under 18 for practical reasons rather than ethical reasons. The breasts may not have stopped growing and ideally you would want to minimise the number of operations the patient has and would want to operate on a stable playing field. Furthermore, breast surgery often involves implants and these are a long term commitment and one that I would not advise anyone takes lightly, especially a young person with many years ahead of them.

I do not think we need to protect our young people from cosmetic surgery but I do think we need to protect everybody, young and old, from having surgery if it is not in their best interest. We should be promoting lengthy in-depth consultations with the surgeon who will be performing the procedure.

We should be educating patients to understand the qualifications and experience of a surgeon to make sure that they are working within their scope of practice. We should be encouraging access to the surgeon to make sure all questions are answered and all alternatives have been discussed prior to undergoing any procedure and we should be doing this for everybody. I do not necessarily think we need to protect our children from cosmetic surgery or cosmetic surgeons.

Plastic surgery and cosmetic surgery is an amazing force..

for good and can transform lives and relieve great pain and suffering. Just because it is often psychological pain and suffering does not make it any less worthy. I do not think we need to protect patients from cosmetic surgeons but we do need to protect patients from unethical or poorly trained surgeons and we need to empower them so that hopefully they can tell the difference.