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Lockdown 2.0

So, we are in lockdown again.

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.

  • because we offer a boutique, bespoke service, we have never been about high volume and so we can limit access to the clinic to one patient at a time. This ensures that you will not be entering a busy waiting room and passing other patients in the corridors
  • we have screening measures in place that ensure that if you have had any contact or any symptoms, then we will ask you not to attend clinic. In this way, we can ensure as much as possible that we are what is known as a ‘clean site’.
  • we offer virtual consultations that can be held by phone or video call with the facility for a screen share to go through before and after photographs and talk about your goals or your progress. This avoids the need to attend clinic in many cases and saves on the stress of having to drive in to Birmingham!
  • because we are a medical clinic, we are used to using PPE and it is second nature for us to wear surgical face masks, gloves and gowns to ensure that we keep you safe. We will also ask you to wear shoe coverings and face coverings when at the clinic.
  • we are very lucky to have our own minor operating suite on site, and so we can offer procedures under local anaesthetic which can even be done on the same day as consultation by prior arrangement
  • the Private Hospitals that we normally work at are being used by the NHS, so we have not had access to the main operating theatres since March. However, we have not rested on our laurels and we have formed relationships with facilities that are not being used by the NHS and so we are one of the few clinics in the country that are still able to offer surgery under both general anaesthetic and local anaesthetic with sedation (twilight anaesthesia).

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.

The lockdown involves the closure of non-essential shops and services and medical clinics can remain open.

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.

As ever, if you have any concerns or questions, you can get in touch or find me on Facebook and Instagram every Tuesday night at 7pm where I will be available for a live Q&A.

View our COVID guidance for patients

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.

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Twilight Anaesthesia – A Change For Good?

The Coronavirus Crisis is likely to have a long lasting effect on many aspects of our lives – both good and bad.

  • Remote working has taught us that we perhaps don’t need to use our car as much and there can be benefits in reducing commuting and carbon emissions.
  • Regular hand washing and hygiene can help to reduce the spread of many infections, not just the coronavirus.
  • Spending more time at home has been welcome especially for those of us with young families.

“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.

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Cosmetic surgery is never just cosmetic

It’s good to see the news article about Simona Halep who has just won the ladies Wimbledon singles final.

She credits a breast reduction to be part of her success.

This was featured in an article in the Daily Mail in 2014 where one of my patients spoke about here experience – you can read it here.

You see, while she never liked the size of her breasts, it was also interfering with her ability to play tennis.

You see cosmetic surgery is never purely cosmetic, or at least not very often.

¦when it is done well.

We see patients who enjoy horse riding, running and we have a haute couture fashion model

¦but we also have mothers and wives who just feel uncomfortable or unhappy with their body shape.

Contrary to popular opinion most people don’t want to walk into a room and attract unwelcome stares and attention.

They just want to feel comfortable in their body physically and psychologically and that is what cosmetic surgery can do.

It brings psychological benefits as well as physical benefits.

You don’t have to be championship tennis player to understand the benefit of having 2kg of breast tissue removed from your chest or 3kg of an abdominal apron removed from your tummy.

It is good to see cosmetic surgery reported with a positive light because all too often, the media portrays cosmetic surgery as creating some freakish caricature of a body.

Most people who come to our clinic, walk out of the clinic looking the same or similar to how they looked when they walked in.

Perhaps they are not needing to wear ‘chicken fillets’ in their bra, or they don’t have to wear baggy jumpers anymore

¦or maybe they just look a bit less tired and more refreshed.

Their friends might think they have had their hair done or changed their make-up, when in fact they have had a blepharoplasty or botox.

It is about making people feel more comfortable, whether they are playing championship tennis or going out for lunch.

¦and that can only be a good thing, right?

If you have any questions about cosmetic surgery, I am available every Tuesday night at 7 pm for a live Q&A on Facebook.

Click here to Download our guide with Frequently Asked Questions about Breast Reduction

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Cosmetic Surgery App aimed at children

Cosmetic Surgery App aimed at children
 
I have read today about an App that has been made that is aimed at children
https://www.independent.co.uk/voices/plastic-surgery-girls-children-liposuction-nose-job-lip-filler-double-eyelid-surgery-body-image-a8270041.html

This is very worrying and is part of a growing trend to sensationalise plastic and cosmetic surgery.

I have a 13 year old daughter and I feel her pain and insecurities she has around her appearance and if I could give her just one gift it would be self-confidence, and I think this is something that we all lack at times.

Society, and particularly the media, does a great job of portraying idealistic lifestyles and no-one wants to hear if we are not really OK and see an image of someone who has spots or is slightly overweight, and it is a tragedy that these preconceived ideas are being indoctrinated at such a young age, as this App is clearly aimed at small children.

One of the great joys of seeing children playing together is that they do not care if one is fat or skinny, has a big nose or sticky-out ears, is black or white, is rich or poor.

They take them as they find them and this beautiful innocence and tolerance is gradually taken from them.

They do not care if their dad is a shop-keeper or the Prime Minister.

They pay no attention to the make of clothes their friends are wearing or the car that their parents drove them to the party in.

They take each other as they see them.

For some reason this is lost as we get older and we start to judge each other and feel judged and whilst cosmetic surgery can have a huge positive impact on people’s lives and I am very proud to be a part of that, I find it distressing that people can be so obsessed and unhappy with something that in reality is quite trivial, such as the appearance of their face or their breasts or their body, and the longer we can maintain the innocence in our children the better.

I should not be suggesting that there is a need to change how we look, and we should not be indoctrinating our children with the idea that it is preferable to have a certain appearance.

I know that people will look at me and think that I am part of the problem because I perform cosmetic surgery, but if only they could see the transformations that can be made and the lives that can be changed.

I am a great advocate of cosmetic surgery and I think it can be a great force for good, but I am very worried about how it is perceived by many.

I would like our children to hold onto their inner beauty and self-confidence for as long as possible.

If you have any questions or concerns then 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.

What Is The Minimum Age For Cosmetic Surgery?

How Young Is Too Young To Have Cosmetic Surgery?

We often get enquiries at the clinic asking what age patients can have cosmetic surgery.
There is a simple answer to that and a more complicated answer.
The simple answer is that we only treat patients who are over 18 due to the strict guidelines and controls over operating on children

…but the real answer is that there is no limit on the age for cosmetic surgery.

One of our surgeons at the clinic, Khurram Khan, is a specialist in paediatric plastic surgery and holds an NHS consultant post at the Birmingham Children’s Hospital.
Children undergo cosmetic surgery all the time.
Cleft lip deformity is primarily a cosmetic problem.  This is performed on babies.
Prominent ear correction is commonly performed around the age of 6.
It is not unusual to treat children with vascular lesions, moles, or birthmarks which are primarily a cosmetic problem.
It comes back to the image of cosmetic surgery – the public has a picture of a glamour model with enormous breasts and huge lips.
We are about improving quality of life and this is what we, as plastic surgeons, are trained to do.
Cosmetic surgery comes in many forms and it may be clearly ethical and justified to perform surgery on a child if it is in their best interest.
However, I think the question is often used when talking about breast surgery and in those circumstances there is a good reasons for waiting before having surgery.
It is important before operating on any growing organ, to wait until it has stopped growing before performing surgery, so it is completely reasonable to wait until around the age of 18 before considering having any breast surgery.
Having said that, there may be an argument to perform surgeries sooner in situations of significant asymmetries or extremely large breasts, but by and large, it is common practice to wait until puberty has finished and in fact, the longer you wait, the better.
This is particularly true if considering breast implants because these can have ongoing issues and the need for further surgery in the future, so will require detailed discussions with the patients and the family before embarking on any surgery.
So whilst the easy answer is that you should wait until you are 18 before having cosmetic surgery, like most things it really depends.
It is not so easy to give blanket answers to all-comers.

It depends on what your problem is, how that problem is likely to develop, and how that problem affects you.

It really requires a conversation, and perhaps several conversations with you and your family so that we can create a plan and give you the best result possible.
We are delighted to have Khurram Khan at the clinic, as he is one of only a very select group of plastic surgeons who specialise in paediatric plastic surgery and so he has experience of operating on children of all ages.
We are also very lucky to have close links with local private hospitals who have facilities in theatres and on the wards to treat paediatric patients.
So the headline answer is that you should wait until you are 18 before having cosmetic surgery, but if you think that you or your child might benefit from surgery before the age of 18, we would be happy to discuss it with you, and we always love to hear from you.
Call us on 01214543680 or e-mail info@staianoplasticsurgery.co.uk.
Our director Jonathan Staiano does a Live Q&A on Facebook every Tuesday at 7pm, so feel free to drop in there.

If You Are Considering Cosmetic Surgery, Download My Guide With ‘5 Questions To Ask Your Plastic Surgeon’ To Make Sure You Are Treated By A Specialist

Mommy Makeover, 1 Op or 2?

Mommy Makeover In Birmingham

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DOWNLOAD OUR BREAST LIFT GUIDE

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The Mommy Makeover is a term popularised by our American colleagues (hence the ‘o’ in Mummy) and is used to describe plastic surgery operations of the breast and abdomen combined.
The abdominal operation would usually be a tummy tuck or a mini tummy tuck and the breast operation could be a breast lift, breast reduction, breast implants or breast lift with implants. It is so called because it is surgery that might be needed following pregnancy due to stretching and descent of tummy and the breast.

However, the Mommy Makeover is not limited to post-pregnancy women and may be required by anyone who has had significant weight loss, because this too will cause the tissues to stretch and descend causing a redundant apron of skin in the abdomen and droopy breasts that have lost volume.

A Mommy Makeover is a significant operation, that is something that we quite commonly perform here at The STAIANO Clinic. You would need a full and frank discussion with your Surgeon, in fact you would normally need more than one consultation to go over all the pros and cons of having a Mommy Makeover, rather than having a tummy tuck and breast surgery at different times. As is the case with most things in plastic surgery, there are no right or wrongs. It is a question of weighing up the benefits against the risks to see what would be right for you.

OPERATION TIME

Tummy tuck and breast reshaping operations done separately are relatively major undertakings, and so to combine them does make it into quite a big operation. Either operating time would be longer than either one separately, but it would be slightly less than the time taken for each combined. Much of the time during surgery is involved in setting up, prepping and draping and anaesthetic time, and so there will be economies in performing it all in one go. However, the length of time of anaesthetic for a Mommy Makeover is usually between 5 and 8 hours and so this can knock you back and you will need to factor in adequate time for recovery.

RECOVERY

Again, the recovery following Mommy Makeover is much less than the tummy tuck and breast shaping if performed separately because your abdomen would be healing at the same time as your breasts, so essentially there is only one recovery period which is not much longer than it would be if you were having a tummy tuck on its own. This means that the time off work following a Mommy Makeover would be much less than if you were to have two operations and it might be easier for your employer if you were to take just one period of sick leave.

COMPLICATONS

Tummy tuck and breast reshaping surgery are not without their complications and you must be aware of this before contemplating surgery. There will be several wounds to heal and so the risk of some wound healing problems is greater than each separately, but no more than them combined. In fact, if there is a minor wound healing problem in the tummy or the breast then they can both be healing at the same time and so while the rate of complications might not be less, if you do get a complication in both areas, it can be easier to deal with as complications usually involve things like minor wound breakdown requiring dressing. Clearly, if you had a major complication in both areas it would be difficult to cope with, but fortunately the scenario is rare. As I mentioned the anaesthetic is quite long for a Mommy Makeover, but from an anaesthetic point of view it is safer to have one slightly longer anaesthetic than two shorter ones. It is a bit like air travel where the danger times are take-off and landing, it does not matter that much how long you are flying for. Similarly, for a general anaesthetic, dangerous times are on induction and when waking up from an anaesthetic.

PSYCHOLOGICAL ASPECTS

The psychological aspects of cosmetic surgery should not be under-estimated and any time you are changing the shape of your body there will be an emotional element to deal with. It can be a rollercoaster because in the initial post-operative stages the tissues are swollen, the scars are fresh and it is not uncommon for one side to behave differently to the other giving asymmetry. Most of these things settle but can take many months to do so and so you need to work closely with your Surgeon for the support to get you through this period.

Breast reshaping or a tummy tuck can induce immense psychological and emotional changes usually very positive, but can be difficult to acclimatise to particularly in the early stages. You may struggle to cope physically or emotionally and it is always best to address these issues before surgery and here at The STAIANO Clinic we have dedicated Counsellors who can help to support you, as well as the office and nursing team who will be with you throughout your experience.

If you feel that a Mommy Makeover is too much to take on then do not worry, it is very common to have the procedures in two stages, and to simply deal with the area of most concern in the first instance and recover and then consider having the other area done. This can be months or even years later depending on how you feel.

COST

There is a cost saving to having a Mommy Makeover compared to having the operations separately. It may not be as dramatic as you might think. The time spent in the operating theatre is very expensive and so the fact that the operating time is slightly reduced does have a bearing on the final cost. However, there is often not a dramatic difference in hospital stay as the tummy tuck usually has a 2 night hospital stay and breast reshaping a 1 night hospital stay, whereas a Mommy Makeover would be a 3 night hospital stay on average. And so, whilst there is a reduction in the overall cost this will probably not be the sole reason for choosing a Mommy Makeover. The other thing to consider is that payment is all required up front, whereas if you were to stage the procedures you would have time in between to prepare for the cost, although the hospital’s do provide 12 month interest free credit to help you spread the payments for any cosmetic procedure.

In summary…

I think it comes down to the individual as to whether you think a Mommy Makeover might be right for you. If you want one period of recovery and feel mentally and physically prepared for the changes that will take place, then there are definite benefits in having one period off work and one period of recovery and healing. However, if you are unsure or have one overwhelming area that you would like addressed then it might be worth having this addressed first and seeing how that heals and how you recover from it before considering having the other area dealt with.
If you want more information then please visit our pages on:

Breast Reduction, Breast Lift, Breast Augmentation and Tummy Tucks

Or, if you have any questions, then Jonathan is on Facebook Live every Tuesday night at 7 pm. Or you can email the Clinic or give us a call on 0121-454 3680 with any questions, we would love to hear from you.

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Jack Of All Trades Or Master Of One?

People are often surprised at how diverse a plastic surgeon’s skills extend.
We are one of the only medical specialities that can operate on any part of the body.
We are trained in:

  • Cancer reconstruction in the head and neck, breast and skin
  • Treatment of burns
  • Hand injuries
  • We treat congenital birth defects including cleft lip and palate
  • We manage any soft-tissue defects such as lower limb trauma after a road traffic accident or management of pressure sores or ulcers

We can literally operate from the head to the toe.
All plastic surgeons will sub-specialise in a particular field and his or her practice will be limited to that area while working in the NHS.
However, in the private sector, where most plastic surgeons perform cosmetic surgery, there is no limitation to the area that they operate on.
Any fully trained plastic surgeon will be able to do a facelift, a nose job, put in breast implants, do a tummy tuck and do liposuction as well as the range of non-surgical injectable treatments available.
When I was in the NHS, my practice was limited to breast reconstruction following cancer and now that I work in the private sector, I limit my work to breast and body contouring.
This is very rare and most plastic surgeons will at least offer facelifts and botox, even if they specialise in the breast.

In fact, there are only a handful of plastic surgeons that specialise in the breast, and so pretty much every plastic surgeon will offer breast enlargement even if they are trained as a hand or a burn surgeon.

I certainly have a lot of patients who request botox or a blepharoplasty and I am capable of performing the procedure, but the ethos behind my clinic is to provide a world-class service delivered by the most highly trained professionals.

I have been very careful about who I choose to work with me at the clinic to help me expand and grow.

It is great to have Khurram Khan on the team.  He is a Consultant Plastic Surgeon at the Children’s Hospital and he is focusing on all of the local anaesthetic work. His main area of interest is in facial plastic surgery, so he is the perfect complement to the team to allow us to expand the range of treatments that we can offer.

We also have Azzam Farroha, who is a Consultant Plastic Surgeon at the QE Hospital in Birmingham and he specialises in skin surgery and treats benign and malignant skin lesions with a special interest in skin cancer.

I have been very careful how I expand the clinic because it can be tempting to just take on as much work as possible.

However, early on, I set out our Brand Values and I will stay true to these and will always aim to do the right thing.

Ethics and delivering the best results to our patients will always be the core focus of what we do.

As plastic surgeons, we are trained to be ‘Jack of all trades’ and this is one of the great appeals of the speciality, but I feel that we are moving in to an age where the specialist is becoming more important and certainly in the niche of cosmetic breast surgery, there is a need for surgeons who are experts in the field to help to bring the speciality away from some of the negative publicity that it receives.

The variety of surgeons who offer breast enlargement is vast.  In fact, I have written a book about it!

“Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery”

As is the case with most things in life, it is not enough to be doing excellent work and the success or failure depends on getting the message out there and getting the world to listen.

Please help me to get the message out – share this on Facebook, email your friends and Tweet it on Twitter.

I am always happy to receive comments and feedback, so it would be great to hear from you and if you want to chat with me live, you can find me on Facebook Live at 7pm every Tuesday night, so like our page and I will see you there.

Has She or Hasn’t She?

I am often asked to comment on photographs by the media.

‘Have they had surgery?’
‘Have they had a nose job?’
‘Have they had breast implants’
‘What size implants do you think they have got?’
‘Have they got round or teardrop implants?’

I get this all the time.

I understand the media’s obsession with wanting to know whether celebrities have had a boob job, a facelift or Botox.
There is a feature in this week’s New magazine where I have been asked to speculate as to whether someone has had their implants changed. You can read it here: https://www.staianoplasticsurgery.co.uk/in-the-media/ I am always happy to help journalists with their requests. Whenever they ask me questions like this, I have to point out that I often cannot tell whether someone has had surgery or not.
In fact, it is very often the case that the result that I am trying to achieve is not one that is going to be noticeable immediately when the person walks into the room and often no one can tell they have had their boobs done or a tummy tuck but they can often tell that something has changed.
They may get a comment like you look well or have you lost weight? The aim is so that people cannot quite put their finger on what it is that has changed but all of a sudden you are walking taller and you have more self-esteem and feel better about yourself.

Not many people want to walk into a room for people to say: My goodness, look at the size of those!

Of course some people do and it is possible to accommodate that sort of look too. However, I think the general public and particularly the media, seem to think that everybody with breast implants has got enormous boobs that are bulging out of the bra and look totally out of proportion along with their facelift which makes their face look so tight they have a permanent grin and Botox which means that their forehead does not move.

This paradigm of what a plastic surgery patient looks like could not be further from the truth and can actually be quite damaging for the normal patients who are considering surgery.

Many patients feel guilty at the prospect of having plastic surgery and feel that they are among this group of vain and inflated looking subset of the population and they do not really want to tell anyone about it because they feel uncomfortable being associated with the stigma.

If only they knew the truth, which is that the vast majority of patients having plastic surgery just want to look refreshed, less tired and more in proportion.

They often feel deeply unhappy with the way they look.

It could be a female who has always had small breasts or a male who has always had excess breast tissue. It could be a mother who has had children and has lost the volume and shape of her breasts. It could be someone with significant functional problems like neck pain and back pain and bra straps digging in due to very large breasts. Or someone who has difficulty finding clothes and has problems with hot and sweaty rashes in the fold of an abdominal apron, after significant weight loss or pregnancy.

The majority of patients seeking plastic surgery have got valid and reasonable indications to want treatment.

They are not vain and you cannot say there is nothing wrong with them.

As a result the majority of results from plastic surgery, certainly in my hands, can be hard to tell when looking at someone walking down the street or in a photograph. To some degree, if you can tell if someone has had plastic surgery from a photograph then you could argue it is not very good surgery, unless of course the person wanted to be noticed. It is particularly difficult in this day and age with push up bras, chicken fillets and slimming pants to know whether it is a bra or a breast implant causing the D cup.

Of course I understand the media’s obsession with the extremes and how we love to watch embarrassing bodies or botched up bodies.

I guess the TV programme called Making people feel better about themselves or Improving bodies so that they look more natural would not go down so well. As you can see https://www.staianoplasticsurgery.co.uk/in-the-media/ I engage with the media a lot and I am always putting forward positive stories about plastic surgery and how it can dramatically impact on patient’s lives, but they still seem to want to report on the one case where it has all gone wrong.

I guess it is human nature.

Once a website only reported good news for a day and lost two thirds of its readers http://www.independent.co.uk/news/world/europe/website-reports-only-good-news-for-a-day-loses-two-thirds-of-its-readers-9905916.html

So yes, if you are a reporter and you want an opinion on whether the latest celebrity has had something done feel free to give me a call

and I will give you my opinion, but the best plastic surgeons will be operating on the people who you never think to ask me my opinion on, because you just think they have had their hair done or are just looking a lot happier these days.

Loose Women in their Underwear!

Did you see the photograph of the presenters of Loose Women in their underwear?

This is what real people look like.

Everybody looks like this.

We all feel comfortable in our clothes and can dress up to make ourselves look more attractive and often quite stunning, but underneath it all we all have dents and wrinkles and moles and folds.

I love being a plastic surgeon and I can produce some amazing results that can transform people’s lives.

But probably the biggest challenge in my job is managing expectations.

I see people who bend forward and don’t like the fold of flesh created in their abdomen.

This is natural and indeed necessary.

If that fold wasn’t there when you bent forward, you wouldn’t be able to stand up straight!

I get patients sending me photographs taken at odd angles and in certain positions to demonstrate a bulge or a dent. Yet when I see the patient in person, there is nothing to be seen and they have to bend over or get the angle just right for it to be visible.

It is all about expectation.

I think that a lot of people don’t realise what a normal body looks like out of clothes because the only pictures they see are of models with extremely toned bodies and even then, they are usually airbrushed.

I read recently about a photograph of Kim Kardashian that had been released that had not been airbrushed and caused her to lose 100,000 followers on Instagram.

Kim Kardashian is in the public eye and obviously takes care of her figure but even she was picked up on some minor dents on her buttocks which are quite normal.

I know that the public perception of a plastic surgeon is someone who operates on vain people who do not need surgery and creates monstrosities that look much worse than the preoperative state (bride of Wildenstein springs to mind).

But if this is what you think, you would be very disappointed if you came to my clinic.

I operate on normal men and women who feel uncomfortable and out of proportion with their figure.

I do not put enormous breast implants in all day long and I will tell you all of the risks and complications associated with your procedure.

If you are put off by this, then it is probably better that you do not have surgery.

As I said, one of my biggest struggles is to convey what is achievable with surgery and as a rule, the media doesn’t help.

It is not normal for skin to be smooth as silk with no blemishes or lines.

It is not normal for breasts to bulge out of your bra or for your nipples to be perfectly level.

It is not normal for thighs to be perfectly curved and free from cellulite or visible veins.

The Loose Women have show us that underneath it all, we are all different shapes and sizes and yet we can still be beautiful.

If the media could portray this image of the body form – the real image, it would make my life much easier.

Contrary to popular opinion, I do not want to propagate the image of the perfect body.

It is not realistic and I do not think it is healthy.

I think that it is fine for people to be more aware of their bodies and we should encourage body awareness.

But we have to realise that we are all different and unique and we all have curves and dimples in different places.

I see my job as restoring the form, particularly following the effects of weight loss or pregnancy, or reconstructing the body contours if there have always been disproportion or imbalance in the breast or body.

Believe it or not, I would not be out of a job if everyone suddenly stopped looking at pictures of beautiful models on Instagram and they realised they were happy with how they looked.

In fact, I would be delighted.

I think we put far too much attention on trying to achieve a shape that is often not even real in the first place.

Don’t forget, I have a 12 year old daughter and I am worried about what she is exposed to.

I don’t want her growing up looking at photos of airbrushed Barbie doll lookalikes thinking this is natural beauty.

Natural beauty is what we have all been given and that is what the Loose Women have shown us.

Celebrate your curves and give yourself a break with that bulge when you bend forward.

Be proud and let’s encourage our children to aspire to be happy and healthy regardless of how they look in their underwear.

Just because they look like a plastic surgeon and they say they are a plastic surgeon, doesn’t mean they are a plastic surgeon!

One of my passions is to raise awareness about cosmetic surgery to try and change perceptions so that it is not portrayed as being a branch of medicine that is somehow less worthy than other branches of medicine.

There is an image that all plastic surgeons are unethical, money grabbing cowboys but the reality is very far from that (well I would say that wouldn’t I?).

One of the problems is that for many plastic surgical procedures, patients look for a surgeon by going on the internet or look at advertising and marketing in glossy magazines, rather than the traditional route of going to see a GP and being referred.

This has allowed a huge growth in practitioners who are not fully trained to set up and practice plastic surgery (practice being the operative word).

Whenever I talk to people about this, they are always shocked and alarmed to discover that there are so many untrained doctors performing surgery.

They think that surely there is a law against such a thing and that it should not be allowed, but I am afraid there is no law against this and it is allowed and it is going on all over the UK.

I feel so strongly about it that I have written a book called ‘Never Accept a Lift From Strangers: How to choose the best plastic surgeon for your cosmetic breast surgery’ and it is available from Amazon.

One might ask why I have had to write a book about this as you would have thought that it was obvious to see which surgeons have been trained and which haven’t.

Unfortunately, it is not obvious.

I talk about cases in my book of high profile people, both here and abroad, who have had complications following plastic surgery performed by non-trained plastic surgeons, people like Colin Hendry the Premier League football player and the pop stars, Kanye West and Usher, have all had family members who have been affected and I am sure they thought their plastic surgeons were fully trained.

The problem is that when someone asks me to tell them what to look out for, it is not so clear cut.

That is why many doctors and surgeons have very impressive sounding biographies and you may be fooled into thinking that they are properly trained, but only when you delve deeper do you realise that they have no formal training in plastic surgery or that they may have started it but not completed it.

To be honest I blame us, the professionals. I think that we make it too difficult for people to seek and understand what all the credentials mean.

You see, there are a lot of associations and qualifications that do not count for much, although there are others that mean a lot and stand for many years of specialist training in a very competitive environment and yet to the outside eye, they can all look good.

I do not think it is a problem unique to doctors either.

I talk in the book about a problem I had finding an accountant and only later realising that there are many advisors out there who sound credible but are not qualified chartered accountants.

The same is true in the legal profession as I was talking to a friend of mine who for many years I thought was a lawyer, but in fact I discovered he was neither a solicitor nor a barrister and actually had a paralegal qualification, and I have to be honest I still do not quite understand the difference which leads to the next question:

Does it matter?

Well in surgery, yes it does matter because surgical training is very long, very competitive and very hard.

It is an extended apprenticeship which takes many years, it took me thirteen years of training after becoming a fully qualified doctor (which in itself takes 6 years) to finally finish and receive my certificate for specialist training in plastic surgery, FRCS (Plast).

There are exams to take, culminating in a final exit exam which tests whether you are safe and skilled enough to be put in charge of patient care independently once the training is finished.

If you are accepted to become a full member of the BAAPS, The British Association of Aesthetic Plastic Surgeons, then there is an audit every year where we must submit our figures on the number of operations we have done and any complications or revisions we have had to perform.

We have a strict code of conduct to which we must adhere and we have a peer group that we are accountable to.

However, there are many doctors out there who are performing plastic surgery who are not a member of one of the plastic surgery associations (BAPRAS and BAAPS).

Not only does this mean that may not be fully trained in plastic surgery, it also means that they will not be held accountable to the same rules and ethical guidelines which they are bound to practice within.

I don’t think we are going to solve this problem overnight because I think there must be something inherent with people in a profession that they keep it shrouded in mystery to make it look impressive and worthy of their stature.

I would love to be able to say to you look for this one thing to be certain that your doctor is fully trained in plastic surgery and surely that would make sense.

It might help to stop the horror stories you hear about rogue practitioners working out of their front room.

The media love to pick up on these stories and report how terrible it is, but I think the real piece of news is that they are usually not doing anything wrong and it is perfectly within the law for people to perform treatment and practice out of their front room, even people with no qualifications, that is the real story.

I don’t think we will be seeing any legislation any time soon. We cannot rely on the Government to protect us from this, certainly not at the moment, so I see my job as a plastic surgeon to do what I can to inform and educate people as much as possible.

So, what should do if you are thinking of having plastic surgery?

Unfortunately, there is no easy soundbite but I would say do your research, look for reviews and ask for a personal recommendation for anyone who is a full member of BAPRAS or BAAPS, anyone who has FRCS (PLAST) after their name and anyone who is a consultant plastic surgeon in the NHS will be fully trained in plastic surgery.

I am always happy to answer questions and to help and advise. You can see me on Facebook live every Tuesday night at 7pm and you can get hold of a copy of my book here.