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The benefit of a plastic surgeon over a cosmetic surgeon

I have just finished submitting my audit figures to the BAAPS (the British Association of Aesthetic Plastic Surgeons) which is something I have to do every year as a member of BAAPS.

This means that there is a central body that collects all of our data to look at the number of operations we are doing, our infection rate, and our re-operation rate.

People are always shocked when I tell them that the majority of cosmetic surgery done in this country is not done by plastic surgeons, and they wonder ‘how could this be?’

The answer is that there is no law that says that it has to be a plastic surgeon who performs a plastic surgery procedure and because there is a huge demand for cosmetic surgery such as breast implants and liposuctions, there are an enormous amount of surgeons and doctors who are offering these procedures who have not gone through the extensive and rigorous training of plastic surgery.

That is why I have written a book about it.

The truth is that if you are doing enough of a procedure then you are likely to start to get good at it, so many of these surgeons could say that they have done hundreds of cases and are now good at it.

The problem is that they are not regulated or monitored in the same way as a plastic surgeon would be.

We are bound by strict guidelines as members of BAAPS and we have a code of conduct we are accountable to.

If our complication rate or re-operation rate is very high, it will be picked up.

We have criteria around what we can say to patients in terms of advertising and marketing and we are not allowed to give time limited offers or any inducements to surgery, and so when patients ask us if there is any movement on the price it is not that we are trying to be difficult or aloof, we actually cannot give any discounts because this is after all a medical procedure, and the prices are set.

The situation would be different if you saw a non-BAAPS member because they would just be limited by the guidelines of the GMC, which are much more broad about how doctors treat patients in general and it is not uncommon to see special offers or inducements to have surgery within a certain timeframe.

As a plastic surgeon we also have to have medical insurance and no-one expects to need this just like you do not expect to need it with your car, but it is important that you are fully insured and that patients are protected.

We need to have insurance of between 5 and 10 million pounds of liability cover and other types of surgeons may not have this level of cover.

The area of cosmetic surgery covers quite a wide spectrum and includes doctors who are not trained in plastic surgery but are trained in other specialties, such as general surgery, or ENT.

It also includes doctors who are not trained in any surgical speciality at all.

I am sorry to say it also includes people who are not trained as doctors at all!

If you have any concerns you can always go to the practitioner’s professional association, and as I have said, BAAPS has strict guidelines and of course, we are also bound by the GMC.

As you get into the world of treatment done by non-medical personnel, and this is particularly common in the non-surgical area in terms of anti-wrinkle injections and fillers, if you are treated by someone who is not a member of any professional association you have no-one to go to if you feel that your practitioner is not working within adequate professional standards.

You will only have the law to fall back on and I am sorry to say this is very lax in the area of cosmetic surgery and you will not find much protection unless you can prove an actual assault.

As ever, do your research to maximise your chances of a good outcome.

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.

Tattoo Removal

Have you looked in to tattoo removal but don’t know where to turn?
Do  you have a tattoo that you no longer like? Or Regret? Have you tried laser but it just doesn’t seem to be working? Well we might be able to help.

If laser fails, we may be able to help

We perform tattoo removal by excision.  This is were a plastic surgeon  surgically removes your tattoo and it can be completely gone in as little as one session.
It involves removing the tattoo by cutting it out of the skin.
There is a couple of things that are important when considering whether your tattoo is appropriate for excision, the first is the size of the tattoo and the second is the location of the tattoo. If you want to find out more about this and whether your tattoo is suitable for excision watch Jonathan’s video:

To see further examples of our work and testimonials from patients check out our tattoo removal by excision page.
If you would like to know if your tattoo is suitable for removal by excision, then you can send us a photograph and we will let you know what would be involved and how much it would cost.
You can email us at info@staianoplasticsurgery.co.uk or you can call us on 0121 454 3680.

Why Choose a Plastic Surgeon for your Mole Excision?

One of the areas we have had a lot of growth in here at The Staiano Clinic is in mole excision. I think one of the reasons is that we are able to offer a ‘See and Treat’ service which not many clinics are able to. We have our own state of the art operating suite here on site and so should you decide to have your mole excised on the same day as your consultation, then we can go straight to the operating suite and remove it for you.
The other reason that I think we are so popular when it comes to mole excision is that all of the Surgeons here at The Staiano Clinic are fully trained Plastic Surgeons. When it comes to mole excision there is a very wide range of Doctors who offer this procedure right from General Surgeons or ENT Surgeons through to GPs or Dermatologists who may not have any surgical training at all. So why choose a Plastic Surgeon for your mole excision?
When it comes to getting a good scar, there are several factors to consider. Plastic Surgeons are trained to respect the tissues and are known for their delicate instruments and meticulous techniques. If ever there is a complex wound to close in sensitive areas such as the face, around the eyes or lips, in situations where tissues are fragile or friable such as in the elderly or young children, and in cases where there has been extensive tissue loss or damage such as in explosive injuries or major trauma, the Plastic Surgeon is called in to put things together again.
We spend time thinking about what sort of sutures we are going to use to close the wound and what techniques would give the best cosmetic result with the maximum strength. Priorities are different for other surgeons and you may have seen a classical laparotomy scar which is classically a straight line on the abdomen with dots on either side. This is because General Surgeons, when they are performing a laparotomy, have a priority to treat some intra-abdominal pathology in the quickest, most efficient and safest way. They are not focusing on the cosmetic outcome of the skin scar, and if I was having a laparotomy I would not want them to be too concerned about the cosmetic outcome because it is usually performed for a serious condition. Most Surgeons when they are performing operations open and close the skin as a means to an end which is to perform their core surgical procedure, but in plastic surgery often the core surgical procedure is the opening and closing of the skin. We only operate on soft tissues and are trained to contour the body or remove tumours and therefore the training revolves around excision and closure. Because we are all trained as reconstructive surgeons we are very aware of the need to completely remove the tumour in the most effective way to allow us to close and reconstruct the defect with a minimum amount of morbidity. We will often be called in to reconstruct a defect after another surgeon has removed a cancer; and in these circumstances, the surgeon who is performing the excision is solely focused on getting a clear margin for tumour clearance and they do not have to think about the reconstruction because they know the Plastic Surgeon will come in and be able to handle any defect that they find.
We are in a unique position as Plastic Surgeons of being able to remove tumours and reconstruct them afterwards and so we can find that balance between making sure we get the lesion out completely, but at the same time minimising the damage to neighbouring structures and giving the best cosmetic outcome.
Plastic Surgeons are able to deal with skin lesions of any size and any type. We treat benign skin lesions, warts, skin tags, xanthelasma’s (cholesterol deposits around the eyes), we treat skin cancers (BCC, SCC and melanoma) of all shapes and sizes and in all locations. For this reason, when it comes to simple moles and cysts there is nothing that can phase us and if something was to crop up it is very unlikely that we will not have seen it before and know how to handle it. It is perfectly reasonable for GPs and Dermatologists and other Doctors to be removing moles and cysts and they can get good outcomes too, especially if they have spent some time with Plastic Surgeons learning some of our techniques. So, if you do have a lesion that you would like to have removed, whether it is because you are worried about it, or whether because it is unsightly, or it might be that it catches on your clothes, or bleeds, or is a nuisance; you can come for a free consultation with one of our Plastic Surgeons and if you did want to have it removed on the day then we could take you straight to the minor operating suite so that you could be rid of it forever within the hour.
For more information of what to look out for in a mole, you can download our guide here, and if you want to arrange a free, no obligation consultation then please call or email us.
If you are not sure whether your mole or lesion is suitable for excision then you can always send us a photograph and you will get an opinion from one of our Surgeons as well as a detailed quote of what it would cost to have it removed. All surgery is performed under a fixed price package which means there is an all-inclusive fee which covers the after-care and all dressings as well as any follow-up appointments.
Furthermore, our Director Jonathan Staiano does a live Q&A every Tuesday evening at 7pm so feel free to join in by going to our Facebook page and asking questions live, or email Laura your questions beforehand.
We would love to hear from you.

Mommy Makeover, 1 Op or 2?

Mommy Makeover In Birmingham

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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.

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.

If all you have is a hammer everything looks like a nail

There are a lot of different surgeons who perform cosmetic surgery.

They range from plastic surgeons to general surgeons, ENT surgeons, maxillofacial surgeons and even people who are not surgeons at all such as GPs or dermatologists.
This is not a problem in itself as long as the doctor is working within their scope of practice.
It may be that an ENT surgeon will be just as competent to perform a rhinoplasty as a plastic surgeon would. The problem comes when surgeons start working outside of their scope of practice and this is something that The Royal College of Surgeons is trying to address by credentialing surgeons which means they will assess them to make sure they are only working within areas that they have been trained to be competent in.
The problem with this is that first of all it has not been launched yet and secondly, it is a voluntary process so unless you know to ask or check whether your surgeon has the appropriate credentials then

untrained doctors will continue to be able to perform procedures on unsuspecting patients who may not know or feel comfortable to ask the necessary questions.

I am always surprised when I talk to people about some of the topics in my book.

They are shocked when they hear that there are surgeons out there performing breast surgery whose formal surgical training may have been in ENT surgery or accident and emergency surgery.  While it might sound unbelievable, it is happening and there is absolutely no law against it.
Unfortunately many surgeons do not make what their area of specialist training is, if it does not fit with the more lucrative cosmetic procedures that they mainly perform. You cannot assume that just because your surgeon is working in a plastic surgery clinic and is talking to you about having breast implants that they are a plastic surgeon or have any specialist training in cosmetic breast surgery.
We are very fortunate that the complication rate of most cosmetic surgery is very low but this allows untrained surgeons to get away with performing surgery on patients.
However, the problem comes when there is a complication or if the patient has a complex problem such as a breast asymmetry or a chest wall deformity.
It is in these situations where a surgeon who has experience of not only cosmetic breast surgery but also reconstructive breast surgery will have the necessary skills and experience to be able to foresee potential problems and tackle any issues that may arise.

Cosmetic breast surgery is not easy.

All patients will have some degree of asymmetry to a greater or lesser degree.
It is about identifying this, managing the expectations and knowing when and what to do about it.
It may be putting different size implants in, sometimes to maintain the base width of the implant and different profiles of implants will need to be used in each breast and this requires skill and experience.
It may be the use of internal sutures to redefine the inframammary fold and to ensure that the placement of the implants are accurate.
It may require a combination of a breast lift or possibly surgery to address the chest wall.

This is why I feel it is important to see a specialist for your procedure and to Never Accept A Lift From Strangers.

Here at the Staiano Clinic we are all plastic surgeons who specialise in breast surgery.
We love seeing people who have done their research and welcome questions.
If you do not feel that you are in a position where you can ask questions of your surgeon in your clinic then beware.
If you want to know more, then you can get a copy of the 5 Questions To Ask Your Plastic Surgeon here.
If you have any questions, then you can tune in watch Consultant Plastic Surgeon and  our Director, Jonathan Staiano on Facebook Live every Tuesday night at 7pm for a live Q&A session.  You can join in live or post your questions in advance to laura@staianoplasticsurgery.estaging.co.uk using the hashtag #AskJJ.
If you want to know more about plastic surgery training and what it takes to become a cosmetic surgeon.  Check out Jonathan’s book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.  It is available to buy through our website or on Amazon.

B-Lite Implants – Should we be protecting our patients from them?

I was very pleased to see the arrival of B-Lite implants recently on visiting one of our plastic surgery conferences.
The concept of manufacturing an implant that is lighter than the standard silicone implant is something that I heard about some time ago.
I talk about them in one of my Facebook Live Q&A’s here:

When I discussed this amongst a panel of experts I was in a few years ago, we were uniformly agreed that it would be beneficial if there could be a lightweight implant.
My patients often comment on the weight of implants and although I am always quick to point out that they feel heavier when you hold them in your hand compared to when they are in your body (because of the moment effect, see below). Nonetheless, they do still have a weight and obviously the bigger the implant the heavier they are.

B-Lite Implants – The Moment Effect

The moment effect is something that you might have heard about from your maths lessons and it is the concept that when a weight is held further away from a pivot point it creates a greater downward force than when it is closer to the pivot point.

This is why when you hold a box out with your arms stretched it feels heavier than if you hold it close to your body and so when breast implants are held in your hand or placed in your bra they feel heavier than when they are implanted in your chest and therefore closer to your body.

There is no doubt that breast implants alleviate a huge amount of suffering and unhappiness by restoring volume and shape to the breasts.

However, it is also true that carrying excess weight in your breasts can be uncomfortable which is why breast reduction surgery has such a high patient satisfaction rate.

The B-Lite implants are now available in the UK and you might think:

Great, we no longer use standard implants anymore.

However, you will find that we are very cautious about introducing new things, particularly in medicine.

This is particularly true in the field of breast implants with the recent PIP scandal although the PIP scandal was not created because a new implant was introduced to the market.

The PIP scandal was created because of criminal activity of an implant manufacturer in France.

Nevertheless, it has tainted the whole industry and made everyone even more cautious than they already were.

I am a believer in offering my patients all the available options which is why for some time now I have offered polyurethane foam implants where many of my colleagues do not even inform patients of their existence because they do not use them.

This is how I feel about the B-Lite implants.

They are new and I tell everyone that they are new and they are also more expensive than standard implants and so they may not be for everyone.

I also have to say that in my practice I do not tend to use very large implants as most of my patients are looking for a natural result in keeping with their frame.

I do not really see patients who have problems with the weight of their implants.

Having said that I am happy to talk about them although I do not necessarily recommend them because we do not have a large experience of their use and so we do not know what the results will be like in 5 or 10 years.

On talking to some of my colleagues, I know that they do not offer or mention these implants for this very reason because they want to see the long-term results.

This is perfectly understandable.

However, it does leave me to think whether we can be too paternalistic towards our patients sometimes.

As doctors go, I see myself as being on the conservative side.

I am not one to embrace new technologies or devices as any rep who has come to see me will tell you.

I certainly do not believe in trying to look for solutions to problems that do not exist.

In my breast reconstruction practice there are always new types of mesh or glue that are being introduced and claims that they will transform the operative time or the postoperative stay.

I have never been one to adopt them and would rather see the outcome through long term patient studies.

This is why I found it odd to be at the other end of the argument with the B-Lite implants and my colleagues were saying that they prefer to wait and see long term results.

I think the difference is that there is a significant element of patient choice when it comes to implant selection which is not true in breast reconstruction.

When it comes to selection of type of suture or mesh or whether glue is used or not with a reconstruction, I do not feel that the patient will have a significant opinion on this, so I feel I can make that decision on my own without involving the patient.

There are many patients who are happy to leave it up to the surgeon as to the type of implant too, but then there are also those who get very involved with the implant selection.

This is understandable because it is something that is going to go into their body for a very long time.

I do my best to facilitate the decision and present the pros and cons of each type of implant and I certainly have my own preferred makes and manufacturers but I am not tied to any particular make and so happy to discuss and offer any of the implants available as I have used most of them.

This is how I feel about B-Lite implants and I simply inform patients that they exist and give them as much evidence as I can so they can make an informed decision as to whether it is something that might be right for them or not.

It is not like they are a prototype or unlicensed, as they have all the relevant approval to be used in the UK. They are actually made in the Polytech factory which makes the polyurethane implants that we use.

I know that patients can be swayed by what we say and there is a lot of hyperbole used in breast augmentation surgery talking about the best method for this or the most advanced technique for that, but when it comes down to it, there is often no strong scientific evidence to support one method or technique over another and it is just an opinion, not facts.

Our job as doctors is to work through the opinion and look at the facts.

I also think our job is to pass those facts on to you to help you make a balanced and informed decision.

I will continue to mention B-Lite implants to my patients and give my opinion, but I will try not to sway you one way or another.

Download our FREE Guide: BREAST IMPLANTS – YOUR QUESTIONS ANSWERED






What to expect from your Consultation

When you arrive

at the Staiano Clinic we aim to give you a warm and relaxed welcome so that you can feel at ease during a time that we appreciate can be quite daunting as well as exciting.

Our address is

50 Frederick Road, Edgbaston, B15 1HN and we are situated close to the Five Ways roundabout in the heart of the Edgbaston Medical Quarter.  We are 5 minutes walk from Five Ways Train station, which is one stop away from Birmingham New Street.  You can find a map here.

We are located

on a quiet road which always has on street parking for up to an hour.  If you think that you may be more than an hour with us (such as a new consultation or a procedure), then you can park on our driveway.  Don’t worry if you would prefer to park on the road at first, you can always move your car on to the drive if it is coming up to an hour.

For our high profile clients

we have a discreet car park and a private entrance to the rear of the clinic, which you can use by prior arrangement with us.

On arrival you will be

offered a hot or cold drink and given a moment to relax in our comfortable reception.  We will ask you to fill in an admission sheet to confirm your personal details and your GP information, so please bring details of your GP with you.  If you are lucky enough to look under 18, we will ask you for proof of age as we are only able to treat patients who are over 18.

We will give you a short questionnaire

asking some basic questions about your medical history and we will also ask for permission to send correspondence to your GP following your consultation.  There is no obligation for you to agree to allow us to correspond with your GP, although it is good medical practice to do so.  We do ask for your permission to write to your GP in the event that you go ahead with a procedure but please be assured that any communications or correspondence is strictly confidential.

If you are coming for an initial consultation

you can expect the consultation to last for about an hour, although we do not watch the clock and so you can sometimes find that it may be more or less than this.  We never charge for follow up consultations and will always encourage you to go away and consider things before making any decisions about your surgery.  We welcome you to come back for a second, third and fourth consultation if you need because we realise that surgery is a major life decision and not one to be rushed.  We would much prefer that you came back to the clinic to go over things as often as you need rather than having any unanswered questions or doubts when going ahead with your surgery.

If you are having a procedure

under local anaesthetic such as mole removal, cyst removal, tattoo removal, inverted nipple correction or areola reduction, then we do offer treatment on the day of consultation by prior arrangement.  However, even if you have arranged this, there is never any obligation to proceed and you will be free to cancel or postpone your procedure if you feel that you need more time, with a full refund of any deposit paid.  Click here for more information about what to expect for Your Minor Procedure at the Staiano Clinic.

If you are coming to one of our free consultation events

then you will have the opportunity to meet with the clinic staff and have a chat with one of our surgeons about your chosen procedure.  There is never any obligation and it is simply a means for you to be able to visit and meet us to see whether you feel we might be a good fit for you (see blog post free consultations).  You will not be examined during the free consultation event, so you can relax and take time to get your questions answered and find out more about our services. We do not use salespeople or patient coordinators, so you will not be pressured or coerced in any way “ we just want to let you know who we are and what we can offer so that you can make an informed decision about whether it might be right for you or not.

We know that coming to a cosmetic clinic

can be a daunting undertaking and we do not underestimate the faith that you put in us when visiting.  We encourage patients to make a list of questions and bring this to the consultation as it is all too easy to forget that crucial thing when sitting face to face with the surgeon!  We really don’t mind if you bring out your list halfway through the consultation, in fact we positively encourage it.

It is also helpful to bring a friend or relative

with you for moral support and also to act as another pair of ears to help you to take in everything that is said and to ask questions on your behalf that you may have forgotten or not have thought of.

It can be difficult

to retain all of the information that you will receive during your consultation, so we will always provide a comprehensive summary of your consultation, which we send to your GP (with your permission) and also send a copy to you.

We aim to give you all the information

that you need about your chosen procedure, but give all of our patients the contact details of the clinic so that you can get in touch with any questions or concerns following your consultation.  Of course, you can always come back for another consultation to go over things, but if it is a simple query that we can answer by email or over the phone, we will be happy to do this.

Finally, following your consultation

we invite all of our patients to our closed Facebook group which is only open to people who have been to the clinic.  This is a place where you can ask questions and connect with other patients for support and guidance.  We also keep an eye on the group and so that if you have a question directed at one of our surgeons, we will be able to get a response for you.  Our director, Jonathan Staiano is also on Facebook Live every Tuesday at 7pm doing a live Q&A, so if you have any questions, you can always email us in advance or you can join in live and ask any questions that you may have.

We work hard to provide an experience

in which patients can feel listened to and looked after and will ask for feedback following your visit to the clinic.  We are constantly trying to improve our service, so it would be a great help if you could take a moment to let us know how we are doing.  It is only a short survey of 3 questions and will be sent to you by text after you leave the clinic.
Here is a response we have just received:

An excellent customer experience.
My initial email enquiry was answered promptly followed up with an informative telephone conversation.
My consultation was professional without being too formal, unhurried and I left feeling extremely confident with my choice of surgeon.

Click here to arrange a consultation.

We look forward to welcoming you to the Clinic and hope that we can help you.

Less is Not More

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.