think Rishi

I Think Rishi Was Right

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I watched the debate between Keir Starmer and Rishi Sunak the other night.
They were asked if they would have private medical treatment.

Rishi Sunak said that he would, but Keir Starmer said that he wouldn’t because his family were ingrained in the NHS and he was very committed to it.

Like many of the things they were saying I feel that this was rhetoric.

Having worked in the NHS for 18 years, I’ve come to realise that it is not a normal business model.

You are not supporting the NHS by using it.
In fact, quite the opposite.
The NHS has a fixed amount of money and it has to make best use of that money and so the fewer people that use it, the better.
It is not the case that they get paid for each procedure that they do.
…and so they are not looking to increase the amount of work that they do.

I feel that if you want to support the NHS, then you will use it as little as possible.

Most of the procedures that I perform involve removing troublesome lesions like moles, cysts and lumps and bumps and I encourage patients not to bother their GP or the NHS with this as it is something that we can sort out.

I will let your GP know in terms of your medical record, but I do not think you need to take up a GP appointment.

Obviously there is a cost involved and not everyone will be able to afford this and the NHS is there to treat serious problems and it is there for all of us.

However it can’t cope with everything.
…and there are many things that it simply cannot cope with and I don’t think you are being helpful by saying that you would not consider private treatment.
I believe that if you are able to have private treatment, then you are actually helping the NHS by taking the pressure off it as the last thing it needs is more people using the NHS because they think they are supporting it.
I think we need to focus more on what the NHS is there for and let it do that effectively.
Because at the moment we are asking a lot more of it then it can deal with.
If you want to support the NHS, think about how you can take the pressure off it rather than using it more often.
You are not doing it any favours and I don’t think you are being particularly patriotic by flatly refusing to use the private sector.
In fact I think the opposite.

 

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The Fallout from Medical Tourism

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Would you take your car half way round the world if it needed fixing?

I very much doubt it…if you did, and a wheel falls off on your way home, what would you do?
OK, you may take it to a local garage mechanic who takes one look at it and they see the exhaust hasn’t been fitted correctly, one of the window seals doesn’t close , there’s an odd smell when you switch on the engine.
The mechanic realises they are faced with a whole list of problems left from the previous mechanic, before the car is safe to drive.

Would you want to take on someone else’s problems after they have walked away from their responsibilities?

This mechanic now finds themselves potentially in the firing line of blame for mistakes and errors, none of which were theirs in the first place.
It’s the same with Cosmetic Surgery- it’s much harder to take on someone else’s problems as the causes are not always obvious from the outside. There’s always potential for unravelling an even bigger problem.
Our lives depend on the good functioning of our amazing bodies, so why risk putting yourself in the hands of an unknown quantity for the sake of saving money.
Is it really worth it?

We’ve all heard the phrase “ buy cheap, buy twice”.

If something goes wrong you’re at high risk of abandonment by your Surgeon overseas- we’ve seen it time and time again. It’s upsetting, but it happens repeatedly. Is it worth that angst, when you could have peace of mind in the hands of a UK Surgeon from beginning to end of your
procedure?
Please think carefully before you get “fixed up” abroad.
The BAAPS have issued a statement about complications from cosmetic tourism and I wrote about this back in 2017 and we are still hearing stories of patients who are being left with poor aftercare.

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Mind Your Own Business – by JJ Staiano

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I was pleased to launch my new book called Mind Your Own Business – how to turn your medical practice in to a business rather than just a job ‘The P.E.C.A.N. Approach’ at the annual meeting of the British Association of Aesthetic Plastic Surgeons (the BAAPS) at the National Gallery in London on 27-28th September 2022.

It is for NHS Consultants who are trying to run a private practice but are looking at it as an extension of their clinical work.  I share my experience of building a successful private practice and give guidance on the areas they should focus on to improve the service they are offering their patients.

Mind Your Own Business: How To Turn Your Medical Practice Into A Business Rather Than Just A Job ‘The P.E.C.A.N. Approach’

Order your copy at https://staianoconsulting.com/myob-book/.

a quality bar of soap

A good surgeon is like a good bar of soap – it may be more expensive but it’s worth it in the long run.

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I like using bars of soap.

I much prefer a bar than the liquid that comes in bottles.

When I am at the supermarket, I look for the best deals which inevitably involves a multiple pack of Palmolive.

My wife doesn’t like the supermarket like me, and I have noticed some different bars of soap turn up here and there.

This is a bar we have in the downstairs toilet:

a quality bar of soap

It has been there for months and never really seems to get much smaller despite the fact we are using it daily.

Meanwhile I have been through quite a few multipacks of Palmolive.

I asked her where she got the soap from and it turns out that it was a present (a Christmas present!).

I bet it didn’t come from a multipack.

I have realised that buying cheap soap is a false economy,

  • it wears out more quickly, so I have to keep buying more
  • this means that I need to keep a supply in the cupboard
  • and there is all the packaging that is wasted

I would be better off all round if I bought a decent bar as it would last longer and probably give a more pleasant washing experience.

It struck me that it is the same with good surgeons.

It is often the case that you don’t realise what you are paying for until after you have bought it and used it for a while.

I get messages from people all the time who have had surgery elsewhere and are unhappy with their result and the way they have been treated.

Often, the price they have paid for their surgery is significantly less and that is clearly attractive – just like the multipack of Palmolive.

It may look the same having surgery with one surgeon compared to another but it is important to see if there might be differences that are not immediately apparent.

The problem with a lot of quality products is that it is not always immediately obvious why they are more expensive.

It can be difficult to justify paying the extra price when on the face of it it might look similar to a much cheaper alternative.

It might be some time down the line when you realise the difference and it may often be too late to go back and start again.

I won’t be going back to my cheap soaps because I realise now that it is a much nicer experience buying better quality ones and it will probably work out cheaper in the long run.

 

The risks of cosmetic surgery

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Every day I hear patients talk about the risks of having cosmetic surgery.

They are worried that they won’t wake up from the anaesthetic and will leave their children motherless.

They tell me stories they have heard about someone who once died having a cosmetic procedure.

I sense that there is often a feeling of guilt particularly when parents are having cosmetic surgery because they feel that they should be spending the money on their children and it is selfish.

I can totally understand these feelings.

I think they are based on the notion that somehow cosmetic surgery is less worthy than other types of surgery.

I am the first to point out to patients the risks of having cosmetic surgery and I think it is essential that you are fully informed to allow you to make a balanced decision.

However the decision has to be balanced.

Unfortunately we are fighting against the media who can portray an unbalanced view.

The fact that there is a television series called ‘Botched’ tells us that we love stories of when things go wrong and we love to see images of people who have come to harm having cosmetic surgery.

However in the day-to-day practice of cosmetic surgery and certainly in terms of the complication rates of this sort of surgery, the actual risk of coming to harm is extremely small.

We have to appreciate that there are risks with any surgery and indeed with any undertaking in life.
Crossing the road, driving a car, having a shower or even putting your socks on is associated with the potential to come to harm and yet whilst we all know the risks we accept that they are small and so we can balance them against the decision of wearing socks or smelling nice or reaching our destination.

The other reason that I feel patients often make unbalanced judgements about having cosmetic surgery is that our society does not value mental health on equal terms with physical health.

You just have to see how someone is treated in the workplace if they return from having a period off for stress compared with if they return from having a period off following a broken leg.

Your colleagues will be forthcoming to make sure you can rest with your leg up and to see if they can get you any lunch if you’ve broken your leg and yet we struggle to engage or to know what to say when someone is suffering with a mental health problem.

By the same token if you’re having surgery to improve your feeling of self-esteem, it is deemed somehow less worthy than if you are having surgery to improve a physical element such as a hernia repair or surgery for indigestion or headaches.

There are risks with any surgery yet we wouldn’t feel the same way about leaving our children behind or feeling selfish if we were having a hernia repaired which was uncomfortable and affecting our quality of life.

Yet if we are having a breast reduction which may be equally uncomfortable and perhaps even more so, we somehow feel that this is less necessary and are likely to experience more guilt over it.

Cosmetic surgery has a bad name, but it is never just cosmetic.

There are always emotional and psychological elements and there is no doubt you can have a tremendous benefit in terms of improvement in quality-of-life and feeling of well-being.

The media portrayal of what cosmetic surgery involves is nothing like the day-to-day practice of most plastic surgeons in the UK.

I am passionate about raising awareness of the real side of cosmetic surgery and the real people that I can help.

On Wednesday, the 29th of January I am holding an event in my clinic in Birmingham where I will be talking about breast implants which have come under a lot of scrutiny recently.

I will be presenting a balanced view about all of the controversies and complications associated with breast implants to allow you to balance this with the benefits that you might hope to achieve by having breast implants.

The event is free and you be welcome to bring a friend. If you want to come along then please let me know.

You can leave a comment on this post or email me at [email protected] or call (0121) 454 3680.

Please comment below and I hope to see you there.

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Lockdown 2.0

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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?

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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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Is it safe to have surgery during Coronavirus?

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Surgery During Coronavirus Crisis

If you are planning to have surgery, you may have some concerns about all of the measures in place around COVID-19 and might be wondering if it is safe to have surgery during coronavirus.

The risks of contracting the virus relate to the spread in an aerosol form hence the requirement for face masks and visors.

This means that you will find measures in place when you come to the clinic to reduce transmission in the same way that you would when visiting other shops and services.

However if you are considering surgery during this time you may have further concerns.

There are risks to the healthcare professionals delivering the surgery as well as risks to yourself having the surgery.

Risks to healthcare professionals

In my field of breast and body contouring, I do not do surgery that would be classed as high risk in producing aerosol which would be more related to surgery around your mouth such as ENT or dental surgery.

There is however a risk during intubation and extubation at the beginning and end of a general anaesthetic, however there are robust measures to protect everyone around these times.

Private hospitals aim to be COVID-free environments which is why you will be asked to self isolate, fill in a questionnaire and have a COVID test before admission.  It is also why, for the time being, visitors are being discouraged.

Unlike NHS Hospitals, Private Hospitals do not have an A&E Department and so do not accept direct admissions.   This means that they have much more control over their environment as all admissions are planned.
Everything is being done to make the hospital environment a safe environment to be in for both the staff and the patients during these challenging times.

Risks to you

In relation to the risk to yourself if you are considering surgery then this is by no means clear.

There was a study which suggested that if you have surgery and go on to develop COVID-19, then your outcome may be worse than if you hadn’t had surgery.

This study seemed to affect patients who are in higher anaesthetic risk category rather than the sort of patients who have elective cosmetic surgery . It also seemed to be in patients having longer and more complex surgery. which is why this has been discouraged at the moment.

The Royal College of Surgeons has produced this information leaflet.

It has not been suggested that we should stop during surgery during coronavirus and the guidance is that for most elective cosmetic surgery, it is safe to proceed although we will ask you to fill in a COVID-19 specific consent form before your operation.

Following surgery, you will also be given a specific postoperative instruction sheet for COVID-19.

The main issue that we have at the moment is with accessibility to theatres as all of the major private hospitals in the UK have been taken over by the NHS and are offering limited access to plastic surgeons.

However we like to solve problems and overcome challenges and so have adapted and there are more and more clinics in the UK who are offering local anaesthetic and sedation which is suitable for many plastic surgery procedures.

My clinic is not set up for local anaesthetic and sedation at the moment, but we have access to other clinics to use their facilities.

This is something that we have been doing on a small scale before the coronavirus outbreak and will be doing more of moving forward and I think it is actually a positive step.

The recovery after local anaesthetic and sedation is much quicker and it can be extremely well tolerated by patients.

However it is not for everybody and there will still be some larger operations that require a general anaesthetic and we have some access to general anaesthetic theatres.

The information that we are getting from the hospitals is that we will be back to normal capacity after Christmas although this is of course dependent on how things progress with the coronavirus pandemic.

We are trying to keep everyone updated as well as we can but unfortunately, we are getting theatre lists on an ad hoc basis, so it is difficult to plan and give you a lot of notice if you are on the waiting list for surgery.

These are challenging times for all of us all,  but I think it is important to recognise the significant benefits that can come from cosmetic surgery and I believe that it is safe to continue to perform surgery during coronavirus and still maintain our high levels of service given the limitations and restrictions imposed upon us.

If you have any questions or would like to talk about any of the issues around this please feel free to get in touch or join me on my Facebook and Instagram live Q&A every Tuesday at 7pm.

Resources:

The Royal College of Surgeons information leaflet
Specific guidance sheet for COVID-19
COVID-19 specific consent form

Reality TV is not reality

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I have never been a fan of reality TV. At least not in recent years.

I remember really enjoying the early episodes of Big Brother, that bit where Craig confronted Nasty Nick and I loved to watch The Apprentice the one with Stuart Baggs ‘the brand’.
But it’s not the same any more.

I heard Ben Fogle on the radio the other day talking about when he was in Castaway. It came out before reality TV was popular and the contestants were chosen because they wanted to escape from it all and were not looking for celebrity or limelight. The dynamic was completely different to the reality TV shows we are exposed to today.

When I see images of some of the ‘reality TV stars’, they demonstrate the media portrayal of what plastic surgery is supposed to be achieving.

…but I don’t recognise that body shape – the over enhanced breast implants and the inflated lips are not what most plastic surgeons are trying to achieve.

My waiting room is full of mums with small children who have lost volume in their breasts or have redundant skin on their abdomen.
They don’t want to look like caricatures and just want to look

  • in proportion,
  • how they used to be
  • with a figure that is more in keeping with the rest of their body.

I can’t believe I’m seeing this new TV so called Surjery where ‘contestants’ are chosen to compete for the opportunity to have plastic surgery.

Is there no depths to where the media will go to portray plastic surgery as being a vacuous commodity with no morals?

All plastic surgeons are doctors and as doctors we have to treat patients.

In my view there should be no difference to a patient who is coming for orthopaedic surgery, a heart operation or attending the doctor with chest pain.

We have to assess patients and see whether we can help them by medical intervention.

Plastic surgery is no different to any other and to suggest that it should be given away as a gameshow prize is beyond belief.

It feeds the media portrayal of plastic surgery being unnecessary and vain.

But this is not the case in my experience.

When asked if I would allow my family to have plastic surgery, I would always answer ‘it depends if they need it or not’.

In the same way that I can’t answer whether they would have orthopaedic surgery or heart surgery until the situation arose I would weigh up the pros and cons and make a judgement.

As doctors we are trying to improve quality of life whether we are doing a heart transplant or putting a hip replacement in or treating a patient for chest pain.

As plastic surgeons we are doing the same, and we do it very effectively and can improve and enhance patients’ lives tremendously.

The media portrayal of everyone seeking plastic surgery to be a vain and shallow person can only damage the portrayal of plastic surgery and feeds into patients feeling guilty and selfish who might otherwise benefit greatly from it.

Obviously I have are my own view on the subject which will not be shared by much of the general public because they are constantly fed TV shows about botched surgery or extreme cases.

The media are not interested in the ‘normal patient’

…who just wants to feel more confident and be able to wear the clothes that they want to.

I will continue my crusade to raise awareness for the good that plastic surgery can achieve.

I want people to realise that it is not any less worthy than any other medical or surgical intervention.

Yes, there are risks and potential complications as there are with any procedure and these need to be balanced against the benefits.

But we must not lose sight that the benefits can be tremendous and just because they are usually psychological benefits rather than physical benefits, they are given less weight and deemed less worthy.

If we can do something to improve someone’s psychological feeling of well-being then in my view this is no less worthy than improving their physical feeling of well-being.

The sooner we recognise psychological health in the same way that we acknowledge physical health, the better.

I would love to hear that the next reality show is about patients who had plastic surgery and feel a lot better about themselves and no one has really noticed except to say that they look younger or less tired or just different in some way, …but I can’t help but think that this will not take off because when it comes to entertainment, there is no money in the middle.

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The Barbed Suture

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What is a barbed suture?

A barbed suture is a suture which has very fine barbs all the way along its length.  This means that when you pass it through the tissues, the barbs catch and it will not pull back.
So that if you use it on either side of a wound and pull it tight, it will hold the tension and keep the wound closed without having to tie a knot in the suture.

These days patients ask a lot more detailed questions than they used to.

I guess it is one of the benefits of the information superhighway – that we can all become experts with a few clicks and a couple of hours on Google.

I welcome this and encourage patients to do their research.

…but sometimes people do go in to details and start worrying about things that aren’t really important.

…like ‘will you use a barbed suture for my tummy tuck?’

 

What’s that all about?

Most people don’t even know what they are asking much less why it might (or might not) be a good thing to use.

Having said that, it is always good to ask questions because you will be able to gauge from the reaction whether your Consultant is approachable and comfortable to engage.

…but I wouldn’t hold too much store on the reply.

Like most things, there are pros and cons.

Some surgeons use barbed sutures a lot, while others never use them.

Personally, I am in the latter category and I never use them.

Not because I think they are bad, I can see the benefits
…but I also see the downsides.

The Pros and cons of barbed sutures

The Pros Of Barbed Sutures

The great benefit in using a barbed suture is speed.

…and it is better to be quick than slow when performing surgery.

If you have a large open wound, like with a tummy tuck or a breast reduction, you can pass a barbed suture and close it very quickly because as the barbs pass through the tissues, they catch and won’t pass back and this keeps the tension on the wound without needing to tie knots.

If you use a normal (non-barbed) suture, then you have to tie a knot in the suture to keep the tension on.

This means that you have to tie multiple interrupted sutures rather than just passing one barbed suture.

…and this takes time.

BUT there is a benefit in tying multiple interrupted sutures.

The Cons Of Barbed Sutures

One of the challenges in closing tummy tucks or breast reductions is that we need to take care of the alignment of the tissues to prevent a dog ear and ensure that the closure is neat.
This is easier when doing interrupted sutures where you can adjust and correct as you go.

Once you have passed the barbed suture, you can’t adjust it.

The other worry that I have with the barbed suture is that the whole integrity of the wound closure is held on that one suture.

With multiple interrupted sutures, if one knot fails, it will not have a significant effect.

Furthermore, if you are unfortunate enough to get an infection, then we may need to remove the suture.

This is bad enough if it was just one deep suture, but if you are unlucky enough to get an infection in a barbed suture, it is very hard to treat because they are difficult to remove.

At the end of the day, a barbed suture is not going to be the difference between a good and a bad result.

The are good surgeons and bad surgeons and there are surgeons who use barbed sutures and those who don’t – they are not mutually exclusive.
It is more important to look for a good surgeon and that depends on a variety of factors.

  • Qualifications and experience
  • Attitude and empathy
  • Surgical expertise
  • Aftercare

The ins and outs of the techniques they use is a minor factor.
Yet some patients give disproportionate weight to it because it is a lot more tangible than these other attributes.

I still think it is good to be informed and to ask questions about your treatment about how and why something is going to be done.
…but try not to get too hung up on it.

Barbed sutures have a place, but in themselves, they will not give you a good result (or a bad result).

Spend timing choosing your surgeon, this is the most important decision for you to make.

If you need help finding a fully trained plastic surgeon, you can get my book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.

It is available through amazon or my website .

As ever,  if you have any questions, you can always join me on Facebook where I do a live Q and A every Tuesday at 7 o’clock or call us on 0121 454 3680 if you would like to have a chat.

If you have any questions, feel free to get in touch or leave a comment and I would be happy to get back to you.

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Jonathan is on a one man crusade to revolutionise the image of cosmetic surgery and is passionate about spreading his message about cosmetic surgery training.
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