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/.
Lying on the bed in the clean, bright procedure room, I can’t bring myself to look down. The skilled surgeon and nurse chat to distract me and, thanks to a local anesthetic, I feel no pain, just an occasional pulling sensation.
I am in Birmingham, at a plastic surgery clinic chosen after hours of research online. But I’m not having a tummy tuck or a boob job. I am having a tattoo surgically removed. I want this throwback to my challenging 1990s youth gone.
The procedure is not for the faint hearted. I feel sick with nerves, in a way that takes me back 25 years to when I had the tattoo done.
It was 1997 and I was 17, my best friend gripping my hand as I lay on the plasticcovered bed. I felt vulnerable and traumatised, with my stomach exposed in front of a strange man who was covered in piercings and his own artwork.
Conversation was beyond me. When the tattooist asked one last time if I was sure, I nodded, mute. Then the buzz of the needle started. The first few seconds were fine, as if my body hadn’t quite registered what was happening. Then the pain hit — a burning, like a razor scratching deeply over and over. I am generally good with pain but it took my breath away.
Deep down I could also feel a sharp stab of regret, but I buried it. I brazened it out, breathing deeply, making jokes and trying not to look as the tattooist wiped blood and ink from the wound he was creating on my poor body.
I had chosen a black cat design, a nod to my name and my childhood moggy. It was four inches long, leaping to the left of my belly button, on the only patch of skin not covered by scars from the multiple surgeries I’d endured since childhood.
You see, while I know now that the decision to get a tattoo at 17 was foolish, it was not an act of typical teenage rebellion. It was an attempt to reclaim my body, to accept the scars I loathed after years of stomach surgeries. I was defiantly changing my appearance on my own terms, rather than being forced to accept changes because of my health.
I told my parents that evening. We were in the kitchen of our family home, a farmhouse outside Bath. I waited until both had poured a glass of wine before asking, my voice tight with nerves: ‘Do you want the good news or the bad news?’
My mother took a swig of her drink.
‘The bad news.’
‘I’ve got a tattoo.’
Mum looked pained before asking what the good news was.
‘It’s in the middle of my scars.’
She burst into tears and pulled me into a hug. Dad joined us.
They immediately understood the significance of my act. That I was trying to be brave and (if you like) wave two fingers at my ‘real’ scars.
Born with a plethora of problems, I’d had lengthy operations to save my life and spent many months in hospital. How could a teenage girl begin to like the body she felt had let her down? Instead, I raged against it.
Yet each year, it seemed, I outgrew the tattoo more. Yes, initially I felt ‘cool’ but over time I began to feel just a little bit foolish.
I grew furious that I couldn’t wear a crop top or bikini without inviting strangers to make judgments not just on my body but on my personality. Then, as tattoos became increasingly ubiquitous, I stopped feeling special or original.
Multi-millionaire celebrities can get away with having full-arm ‘sleeves’ of tattoos (David Beckham) or multiple body daubings (Angelina Jolie) but, in the real world, having an inking leaves you open to silent assumptions.
I made sure it was always covered up. And over time, that stab of regret became a constant nag of irritation. Now 42, I am more body-confident than I have ever been. I don’t give a damn about my scars — I’m proud of them because they show how much I survived. But did I want the world to see my tattoo? No!
Fading to grey and misshapen after my two pregnancies, it was more blob than feline. My children couldn’t understand why I had ‘drawn on myself’ and I didn’t like the example it set. I felt ashamed.
I am not alone — tattoo removal is at an all-time high. According to the British Association of Dermatologists, up to a third of people with tattoos regret them. One person in nine in the UK has undergone tattoo removal, while 38 per cent of those with tattoos have considered the procedure.
‘Tattoos are a statement of who you are at that point in time. But who we are changes as we go through life,’ explains Jane Ogden, Professor of Health Psychology at the University of Surrey. ‘So a tattoo can be a constant reminder of the past, which can cause anxiety and make people very miserable.’
In years to come, will Brooklyn Beckham still want the eyes of his new wife Nicola Peltz tattooed on the back of his neck? Singer Ariana Grande certainly regretted having ‘Pete’ tattooed on her ring finger when she broke up with comedian Pete Davidson.
As for me, I was certain removal was the only answer. But how? Most people are familiar with the idea of a tattoo being lasered off rather than surgically cut out, as mine eventually was.
About two years ago I did start laser treatment, naively thinking it would be straightforward. I was wrong. It hurt almost as much as getting the tattoo — and four sessions later (at about £80 a go) the only real change was more fading. It looked even worse.
So I researched tattoo excision, where the tattoo is cut out and the unmarked skin is joined together. It leaves a scar but one that will fade. Size and location are key factors but if your tattoo is small enough, it takes only one session under local anesthetic.
Although it is expensive — £1,400 — the certainty made it worthwhile for me. I got in touch with Staiano Plastic Surgery, the nearest clinic to my home in Bath to offer the procedure.
The clinic receives about three enquiries a day for surgical tattoo removal and does approximately three procedures each week.
Surgeon Jonathan Staiano explained in detail what would happen, warning me that the scar would be as long as the tattoo and would take a year to fade to my normal skin colour.
Jonathan drew an outline around the tattoo, then got to work. It took 45 minutes and I didn’t look until the end, when Jonathan showed me what he’d removed — the flap of skin with my sad little cat on it. It was gruesome but fascinating. Happily, I said goodbye. And that was it; the scar was taped up and I was free to leave.
I was warned to take it easy, but I didn’t listen and went back to my busy life. By day three I was very sore and had to spend a day in bed. The bruising lasted for weeks and I wasn’t able to return to my normal exercise regimen for over a month. But even though I was uncomfortable and my stomach looked as if it had been punched by a heavyweight, I felt overwhelming relief.
Four months on, my newest scar is still red but it will fade. Already I can look at my stomach and feel empowered, not embarrassed.
My husband, who diplomatically never commented on the tattoo, says he much prefers the new look, finally confessing (after 17 years together) that ‘the cat was a bit rubbish’.
I am now packing a bikini for my summer holiday, proud to show off the scars that tell my story of survival and no longer ashamed by the ugly, faded tattoo that held me gripped in the past.
There are many cosmetic clinics which offer breast implants but not all will treat patients with more complicated problems.
Patients with breast asymmetry will often present for surgery.
Are you happy with either of your breasts or do you want them both changed?
If we can just operate on one side then this will lower the risk of complications and be beneficial for all.
It may not always be possible to just operate on one side, particularly if one breast is sitting lower than the other one with uneven heights of the nipples.
It is possible to lift the nipple, but it is not possible to lower a nipple (at least not without leaving a scar where the nipple was). So we can raise the low one, but is extremely difficult to lower the high one.
Is there a problem with the shape, the volume or both?
In general terms, problems with the shape involve a breast lift and problems with the volume involve breast implants or breast reduction, (depending whether you want them bigger or smaller).
Surgery for breast asymmetry usually involves a combination of breast implants, breast lift and sometimes breast reduction.
Different things need to be done to each breast and so there is always a risk that they will settle differently and you may have to accept some degree of asymmetry.
What we aim to do with surgery for breast asymmetry is to bring your breasts and your frame back into balance and make it easier for you to wear clothes and bras without needing to use a chicken fillet or external prosthesis in one side.
If you have different size breasts with one sitting lower than the other (usually the bigger one), you could have them made the same size by using different size implants.
The implants come in set volumes and so we would be unlikely to make them identical and would usually need to use a sizer in theatre to work out the best match.
The implants would not do anything about the shape of your breasts and so one would still be sitting lower than the other.
In order to correct this you would need a lift of the breast that was sitting lower, which is usually the bigger one and so it would also be possible to perform a reduction at the same time as the lift to balance out the volume.
Then we could use the same size implant in each side.
This is something that we could discuss in the clinic and there is no right or wrong answer.
Some patients would prefer not to have breast tissue removed and then replaced with an implant and would prefer different sized implants.
Others would rather have a reduction to match the size and the same size implants so as you age or undergo weight fluctuations, it is more likely to have a symmetrical change in your breasts.
If you have a breast asymmetry and have any specific questions then I do a live Q&A every Tuesday at 7pm on Facebook and I would be happy to give my opinion.
If you want to come to the clinic for a consultation then you can contact us here or phone (0121) 454 3680. We would love to see you.
You can download my breast implant guide here.
Some patients put breast reduction into the category of cosmetic breast surgery and think of it in the same way as other operations like breast augmentation.
Any cosmetic surgery is a major undertaking both physically and psychologically because you are changing the way you look.
However when it comes to the extent of surgery, breast reduction can be a significantly bigger procedure than breast augmentation.
Breast augmentation surgery takes about an hour in theatre whereas breast reduction takes three hours in theatre.
If you have ever seen the inside of an operating theatre (check out my video), you will see that there are 5 to 10 members of staff at all times all of whom have specific areas of training and expertise.
Not to mention what goes on in the background to keep a hospital running with all the administrative costs and overheads.
There is usually at least a one night stay in hospital and this will all be covered in the one-off cost that you pay.
I sometimes notice that my colleagues think that we as plastic surgeons get paid a lot because they see the headline rate that we receive when doing surgery.
However there is a big difference when working in the self-pay market compare to the insured market.
My colleagues who do insured work get paid for every intervention.
If they see you in the clinic, if they perform an x-ray or other tests, or if they have to perform any other procedures “ they will be paid at every stage.
After performing a breast reduction, we will see you in the clinic on a regular basis to ensure that your wounds heal, your scars soften and the shape of your breasts settles.
We want to make sure that you are happy with everything.
Furthermore, we will continue to see you in the clinic if you ever have any problems or concerns at any time.
There may be some patients who need very little input from us but there are others for whom this will be invaluable.
It comes down to how much value you get from a procedure as to whether it is worth the cost.
Breast reduction can be life changing on several levels:
I understand that breast reduction cost is a major determinant when someone is choosing surgery but I don’t think it should be the only one.
Here at The STAIANO Clinic, we are very aware that many other clinics offer the same procedures and we need to be competitive.
I have built the clinic so that we can compete on a worldwide scale when it comes to the qualifications of us as plastic surgeons, the level of care and treatment that we give and the time and space that we give you as an individual patient.
Not to mention the aftercare that we offer.
It is hard to do this and still be able to compete on price and so I realise that if you shop around, you will be able to find surgery cheaper elsewhere.
If you want to find out more you can download our guide with some frequently asked questions here or call us on (0121) 454 3680
You can also read more by visiting our Breast Reduction page.
If you want to know what a breast reduction costs at The STAIANO Clinic, then click here and we will send you not only how much it costs but also what we offer for that cost.
As always feel free to comment and if you have any questions you can find me on Facebook with a live Q&A every Tuesday at 7 pm
The muscle in question is the rectus abdominis muscle which is the six pack.
Although the six-pack looks like horizontal lines across your abdomen, it is actually a vertically orientated muscle that goes from your rib cage straight down to your pubic bone.
At intervals along the length of the muscle there are ridges called tendinous intersections. It is these that create the appearance of the six-pack.
These muscles can be spread apart when the intra abdominal contents increase and swell up.
When the swelling goes down, sometimes the muscles don’t come back together again leaving a gap between them.
This is known as divarification of the rectus muscles.
If you are wondering whether you need to have your muscles repaired or not then you can demonstrate divarification of the rectus muscles by lying flat on your back and performing a straight leg raise.
This will tense the rectus muscles and if they are not sitting next to each other, you will be able to see a bulge or feel a gap between them above your belly button.
It is routine to repair the rectus abdominis muscle when performing a full tummy tuck or a fleur-de-lis tummy tuck.
This is because the operation involves releasing the skin and fat all the way up to the rib cage, so the whole length of the rectus abdominis muscle is exposed.
This means that we cannot repair divarification of the rectus muscles when performing a mini tummy tuck.
Patients sometimes ask specifically to have the muscles repaired when requesting a tummy tuck but this is something that we will assess and repair routinely for anyone having a full tummy tuck or a fleur-de-lis tummy tuck.
If you are having your rectus abdominis muscles repaired, it can be a little bit uncomfortable and so do not be surprised if you wake up after surgery with discomfort centrally above your belly button and it can be uncomfortable to cough because this will put tension on the muscle repair.
Sometimes people think that they have a hernia but divarification of the muscle is not strictly a hernia in itself.
A hernia is a defect in the abdominal wall whereas divarification is a weakness in the abdominal wall.
Most plastic surgeons will be comfortable repairing hernias or divarification of the rectus muscles and so whatever the cause of the weakness or bulge in your abdominal wall, we should be able to fix it for you.
I perform a live Q&A every Tuesday at 7pm on Facebook and so you can catch me there if you want to ask a question.
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.