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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP 1. - Cosmetic Surgery
RADIO 4
THURSDAY 24/11/05 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
SIMON WITHEY
PRODUCER:
NOT CHECKED AS BROADCAST
MYERS
Hello. Cosmetic surgery may be an optional extra but a facelift, a nose job or an eyelid correction is still an operation and it needs careful consideration, both from patient and professional. So whether you want to hold back the years or to change an aspect of your appearance that bothers you how do you make sure that you get what you want? Cosmetic surgery is on the increase, 65,000 operations were carried out in this country last year. While less invasive treatments like botox and collagen implants are often on offer in beauty clinics in the high street. So if you're thinking about a new look for the new year, what concerns might you have, perhaps you've had a procedure already - are you happy with the result? Do call us now - 08700 100 444 or you can e-mail checkup@bbc.co.uk and put your questions to Simon Withey, he's a leading cosmetic surgeon working in London.
We'll go to our first caller, Romy is on the line, she's phoning from London, Romy your question please.
ROMY
My question is that - to do with the lines around my mouth which I call my witch's lines and they drive me absolutely potty. I'm 55, many people say I look as if I'm in my early 40s but these lines absolutely, I mean really, really upset me every single day, every time I look in the mirror these great big lines pointing down towards my lips, particularly on the top but also on the bottom.
MYERS
I guess you're more self-conscious of them than anyone else or do other people point them out. But at any rate you're wondering if now is the time to do something.
ROMY
Yes, what is the possibility - what would I be able to do about it?
MYERS
Okay, well Simon, if you were to see Romy, of course unfortunately you can't, but she's describing these rather deep lines. I guess we all kind of know what she's talking about. Do you think there's anything you can do about them?
WITHEY
Yeah I do know what you're talking about, it is very difficult without seeing a photograph or seeing you directly and I think that's one of the issues which is important to stress when we're talking to patients on the radio. But effectively you're probably talking about the fine lines which run up to the nose from the lip, rather than the deeper lines out at the side. And probably the best things to think about is something which will fill these lines out a little bit, if they're really deep. I don't know if you're a smoker or you spend a lot of time in the sun because they're two of the things which contribute to these. But you can use fillers such as hyaluronic acid and collagen, which are probably things you've heard of.
ROMY
I have actually done collagen a couple of times, yes.
WITHEY
Has that been effective?
ROMY
It did, it just doesn't last very long.
WITHEY
Well that's one of the problems. I mean there are more permanent fillers, you can use your own fat and you can also grow up your own collagen and supposedly the long term results of growing your own collagen haven't been well reported so I couldn't say whether that really does have a long term effect but the manufacturers stress that it does have relatively long term efficacy. And you can also put your own fat in which doesn't quite fill the lines in the same superficial way but will fill the lips out a bit which will effectively fill the lines out.
ROMY
Right.
WITHEY
And then as well as that you can think about things which will smooth the surface layer out a little bit, such as laser and peels, which are effectively sort of rubbing the surface layer of the skin a little bit and tightening it up.
MYERS
Simon, you didn't there mention a facelift there and I had a feeling perhaps that would be an option.
WITHEY
Well it's an option for many other things in the face, funnily enough it doesn't really do an awful lot for these fine lines over the lip, it will pull tissues back into a better position, so the tissues which have dropped with gravity have - are affected more by a face lift than the areas of the skin which have been affected by the sun and smoking where the superficial layers have wrinkled and lost a bit of their elasticity.
MYERS
So Romy you've already dabbled in this a little bit, so where does this leave you, is there a way forward do you think from what ...
ROMY
Well one thing I don't smoke, I do love the sun but I'm usually pretty good about putting things on. To me they're not fine, there are a couple of them that are really big, well they feel it to me. I'm wondering how would I go about getting some recommendations of someone that I might try for collagen in London? I've done it in Australia and it really worked, I did it in America and it wasn't very good and part of the problem is knowing who to go to, that's one thing. And the second thing is if I were to investigate the own fat or growing your own collagen where might I go for - to find out about it?
WITHEY
Well I think this is one of the issues which everyone finds increasingly difficult, it's a minefield knowing exactly who to go to. First of all there are I suppose what are legitimately called trade organisations, the British Association of Aesthetic and Plastic Surgeons is in the eyes of the College of Surgeons the legitimate representative of the aesthetic surgery and they will have a published list of surgeons who are all fully accredited - so have all the right qualifications - and are practising in your area and they'll be able to tell you who will be able to give you good advice.
ROMY
Okay. Sorry about the beeps by the way it's somebody calling in.
MYERS
Not at all, thanks for the call. You mention that association - BAAPS - of course I'm thinking well something more superficial, doesn't - and you've said a facelift isn't perhaps the right thing - so would a surgeon on that list really want to deal with collagen implants if that's what it might be?
WITHEY
He may well not but he will certainly be able to tell you who will if he doesn't feel it's his area of expertise. The trouble is if you go to someone who just specialises in one area you will be offered that treatment, possibly be offered that treatment as the answer to your problem, whereas it might be something more sophisticated that's required. So it may be if you are in a sort of a bit of quandary to go to - it maybe worth going to someone who can give you all the answers and direct you towards someone else if it's not what he or she feels they would like ...
MYERS
And a reputable surgeon, professional, will do that?
WITHEY
I would hope so. The idea of BAAPS is that they would do that.
MYERS
And you'd pay for the privilege, you shouldn't go for a free consultation, that wouldn't be reasonable?
WITHEY
You do pay for the privilege and that's quite an important - important point. I mean I suppose every surgeon who's doing this is spending a lot of his time consulting with people. The British Association of Aesthetic and Plastic Surgeons and many of the other professional bodies do view free consultations as a sort of - I suppose as drawing someone in to surgery and very often you find that you meet with a cosmetic adviser. You have to draw a line between being a clinician and giving people advice and being a marketeer. We're not here to sell cosmetic surgery, we're here to give impartial advice. If they then want to come to us for surgery that's different, the first consultation is really about giving advice.
MYERS
Let's go to another caller who unfortunately didn't get the best advice, certainly didn't get the best outcome and had a facelift that went wrong. Wendy's phoning, she's in North Wales. Briefly Wendy, how's that left you feeling and looking I suppose?
WENDY
I'm very badly scarred, I've got a white patch which is necrosis, death of tissue, and I've also got quite a lot of red discoloration on my neck. And I'm possibly going to go ahead with a revision facelift when I've got the courage.
MYERS
Who do you blame as it were, how did it go wrong?
WENDY
I was discharged with a two inch blister on my neck beneath the surgical wound and the surgeon didn't inspect the wound before I left, he was actually a member of the British Association of Aesthetic and Plastic Surgeons. And ...
MYERS
So things can go wrong, they do go wrong, the best qualified people if they're not doing what they need to do, in this case checking Wendy before she left, but you talked about the possibility of a revision, do you have some good hopes that that will sort things out and who's going to do that?
WENDY
They will create some improvement, they won't be able to completely get rid of the white patch of tissue.
MYERS
And of course this is what everyone I guess listening to this when they're electing to have a procedure, it's not life and death after all, very often, it is to make us feel a bit better, there is that concern that you might end up being rather worse off. Simon, on that, how many people suffer that kind of bad effect from their procedure?
WITHEY
Necrosis of skin flaps in facelifts is a recognised complication in certain groups of patients. And all patients should be warned about this and it should be something that's discussed beforehand. I'm very sorry you've had this experience Wendy and particularly with someone from the British Association of Aesthetic and Plastic Surgeons and I obviously can't comment specifically on your case. But I think it perhaps isn't terribly appropriate if a wound hasn't been looked at before a patient leaves hospital. There are a number of reasons for skin flap necrosis, one is, as we talked about before, the patient who had the lines, is smoking - smoking affects the blood supply to the tissues. And another is a collection of blood under the skin which is compromising the blood flow in the tissues. When it happens you will be left with a scarred area which can be improved by revisional surgery. There may be other things which can't particularly - I mean I would have thought the red lines on the neck probably won't be improved dramatically by revisional surgery but there may be other things which could be done to modify those.
MYERS
And a good surgeon will do that without further charge I'm assuming?
WITHEY
Yes they will. I mean a good - most surgeons will sort out any problems which occur from surgery and feel responsible for sorting those out without charging. There may be extra charges from the hospital because the contract you have with the hospital is different from the contract with the surgeon. But most hospitals also appreciate that they have a responsibility to ensure that patients have walked away without significant problems and if they have had problems they are - they're sorted out before they're given an extra fee.
MYERS
Okay thank you for that and thanks for your call Wendy, a bit of a warning there of course and there are others who've had better experiences and I expect we shall hear from them. We'll go now though to Cecille Stokes who's in Glasgow, concerned about a stroke ...
STOKES
I'm 51 years of age, I'm a diabetic and I had a stroke three and a half years ago and I'm wondering if plastic surgery or cosmetic surgery would restore symmetry to my face.
MYERS
Sort of an implicit question there as to whether there's a difference between plastic surgery and cosmetic surgery - are we talking about the same thing, do we know what we're talking about here?
WITHEY
I suppose they're all part of the same sort of - the same spectrum with aesthetic surgery being at one end and full reconstructive surgery being at the other. And plastic surgery really covers them all - plastic surgery is the manipulation of soft tissues. There are various things which can be done, I wouldn't necessarily call them cosmetic procedures, if you're symmetrising a face we largely refer to the most reconstructive procedures. They tend to be based sometimes on some of the procedures you will do in cosmetic surgery but there'll be sort of subtle differences between a standard facelift and a soft tissue lift to symmetrise a face.
MYERS
So are you saying to Cecille that you can do something that would improve this asymmetry?
WITHEY
I can't say I can, one of the difficulties is people who have strokes aren't necessarily good candidates for further surgery, particularly for general anaesthetics and I think it's important that she seeks the appropriate advice if she's interested in looking into this further. But there certainly are things which can be done.
MYERS
But because this is the result of a medical problem - a stroke - does that mean that this might be something that would be done within the NHS because after all this is not about vanity at all in that sense, it's about getting a reconstruction because of the medical deficit due to the stroke?
WITHEY
Yeah, no you're quite right. I have an NHS practice and I specialise - one of the areas I specialise in is facial reconstruction and facial deformity work and very often we will look after patients who've had full strokes, who've had things called Bells Palsy - I don't know if you know that word - but one side of the face has dropped. And we'll symmetrise the face as a result. And it's something which the NHS is prepared to consider and it be worth seeking advice from your GP.
MYERS
Hope that's encouraging Cecille, thank you very much for raising the question with us. Want to mention a couple of satisfied customers, both have had nose jobs - very happy with them - Jason? Jason in Manchester - you're okay with your nose job?
JASON
Totally yeah, absolutely.
MYERS
What was wrong with it and what does it look like now?
JASON
Well quite a lot of years ago after an accident of some sort I had the septum removed and I for some reason discharged myself from hospital early, I had a salon opening or something back then. And it was fine but over time with no septum the end of my nose was starting to droop a little bit and I was looking more and more like Jimmy Nail all the time.
MYERS
With respect to him.
JASON
Well he was great. I quite liked how I looked to tell the truth but it was going out of shape more and more. And although I was quite happy with it I just find that when you're talking to people and you're trying to interpret just what it is that people are looking at, are they looking at you because they find you interesting or what, and if your nose is a bit strange it's not unlikely that you're going to think - well maybe they're looking at me because they think my nose is a bit weird and so on. And all that stuff is sort of going on at the back of your mind whilst you're trying to hold a conversation with someone that perhaps doesn't know you and it's distracting...
MYERS
You make a very good point there and if I can just go to Jennifer, who's rung in from Oxford, again is it a similar thing that because your nose is now good or suits you then you feel confident about yourself?
JENNIFER
Absolutely, it's completely changed how I feel and I really didn't think it would have such a drastic effect on how I would feel about myself.
MYERS
And had other people commented or was it all your mind?
JENNIFER
Ah no, well basically if you change something else about yourself at the same time, so I changed my hairstyle, people have noticed something is different but they can't put their finger on it.
MYERS
And you feel like you're just a new person?
JENNIFER
Completely, absolutely. I was teased when I was a teenager, I was bullied, I've always hated my appearance, I very - lacked self-confidence, completely lacked self-confidence and it's completely changed how I feel. And I wish I'd had it done when I was 20 instead of waiting till I was 40.
MYERS
Okay, well there's a commendation. I mean Simon is this what you find when people come to you, that although it might seem a small physical thing objectively, if you can be objective, to the person concerned it is important enough that they will go to the time and trouble to have a procedure and really it will make a big difference for them because psychologically they feel so much better.
WITHEY
Yeah I think this is exactly what you're looking for in a patient. You're looking for someone who has a particular problem which has a particular effect on them and usually it reduces their self-confidence and it has to be something which surgically is amenable to surgery. And if you've got that you've got almost the perfect patient, as long as they're fit for surgery. More worrying are patients who assume surgery will do something very much more than make them feel self-confident, if they come in thinking it's going to change their life dramatically then there are concerns. And I think one of the concerns we've had recently is the sort of bloom in TV make-over shows where the sort of formulaic transformation of the ugly duckling into the beautiful swan whose life changes in accordance with their physical changes and who is much happier and much more successful does lead people to have the wrong expectations of what surgery can achieve. It's very powerful and as you've heard very, very eloquently it does change people's lives but you have to have the right end point in mind when you're going into this.
MYERS
Okay, thank you very much. We'll go to Gavin, he's in Edinburgh. Gavin, concerned with having a tummy tuck. You're wanting to have a tummy tuck - why?
GAVIN
Well the background is I'm a 34 year old male and I've lost about five stone in weight over the last two years, which was prompted by having high blood pressure, my doctor advised me I needed to do something about it.
MYERS
So you've done well.
GAVIN
I've done a lot better than I thought I would yes. So I've gone literally from a 44 inch waist to a 32 but the skin around my stomach hasn't shrunk in the same way that you know the weight loss would indicate, so I've got quite a lot lose skin around mostly the front of my stomach and it just kind of makes me feel very self-conscious - you can poke it and it kind of wobbles, basically because it's lose.
MYERS
I think we're getting the picture, that's quite graphic.
GAVIN
I've asked my doctor and he said that over time it should just sort of correct itself but that's been a good six months and it really hasn't improved at all and I am exercising regularly and doing sort of aerobics and weight training and swimming and I feel the rest of me is in really good shape but I'm feeling very self-conscious about this part.
MYERS
Well Simon what do you think, is this - is Gavin a suitable candidate for tummy tuck?
WITHEY
Yeah, congratulations on the five stone weight loss. I think one of the messages to take from this is GPs have been very successful over the last few years about advising people on weight loss and making sure that people are aware of the health consequences of being overweight, particularly things like blood pressure. But it has resulted in a group of patients who've lost a lot of weight who now have aesthetic changes as a result. I mean if you - if you were five stone heavier, you had five stone more of fat under the skin, it stretched the skin out, possibly for other reasons the skin has lost a bit of its elasticity and hasn't then shrunk back, so you've effectively emptied the bag without the bag shrinking back and you're left with this excess. And you won't get rid of it, you're quite right, exercise isn't going to get rid of this any further. And so it's really either something which you have to accept or you have to look towards surgery to deal with.
MYERS
And very briefly can you say Simon what would be involved in having that removed, is it a major operation, would you be out of commission for some length of time?
WITHEY
It depends what the level of expectation is. I mean a full abdominal plasty or going further a full body lift, which is something which you do for people who have absolutely massive weight loss, are both pretty significant operations. Whereas ...
GAVIN
The rest of my body seems to be absolutely fine in coping with this - I mean my arms don't display the same lose skin, it is purely around my stomach area.
WITHEY
You may find you can just take out a little strip of tissue along the bottom of the stomach without doing anything as extensive as moving the position of the belly button or undermining all the tissues up to the ribs - which some of the other operations need. But again it's difficult to be more specific.
MYERS
Gavin, thanks for that. If it helps you to know we've got an e-mail from Sonia who says that she had very horrendous - that's her word - horrendous tummy, mainly due, in her case, to having two very big babies and two caesareans. She said she couldn't spend her whole life in magic knickers and so in fact she had this operation and it's been very successful, there is a scar but she feels that she now is herself again, rather than being a frumpy 40 year old. Another e-mail though, Lucy's asking the question: she'd like a tummy tuck or if you can have a tummy tuck as part of a caesarean. So she's obviously anticipating getting very big and maybe getting two operations for the price of one. Is that something you've come across Simon?
WITHEY
The answer - it's something we come across a lot, people do ask for it a lot. The answer is generally no, it used to be done quite a lot, I think people now feel that it increases the risk of infection and therefore the risk of significant complications of abdominal plasty to do it at the time of a caesarean section. So it was something I certainly wouldn't do. Modifying abdominal scars at the time of caesarean section is different but to do a full tummy tuck where all the tissues are lifted up, is potentially very dangerous because one of the significant problems with this operation is having a very serious infection and tissue loss as a result and it does increase the risk of that.
MYERS
So that's a no, no, although in fact you can have breast reconstruction following mastectomy, that's done at the same time.
WITHEY
You can but the wound is very much cleaner. Having a caesarean section isn't registered as a dirty operation but is a contaminated wound.
MYERS
I mention breasts because I've got an e-mail asking whether some breast implants for breast enhancements are better than others. And is there any danger of implants becoming unsafe as you have them for a length of time?
WITHEY
It's a long question.
MYERS
Is there a short answer?
WITHEY
That's about an hour's worth of consultation to go through. There is a short answer. I think there's been a lot of controversy regarding breast implants and we're now left with two implants which have been looked at very thoroughly by independent agencies. And that's a silicon implant which has a silicon gel filler, which is no longer liquid silicon but is more of a sort of a flexible solid and it's called a cohesive gel. And then there's a saline implant which has a silicon outside and saline in the middle. Aesthetically I think most surgeons feel that the silicon gel implant gives you a better result and both are felt to be as safe as anything you put into your body can be really. I mean there are always implications of having anything put in and potential complications.
MYERS
So it behoves you to find out just as much as possible before you go for this.
WITHEY
It needs a long involved consultation.
MYERS
Amy wants to know if breast implants affect your ability to breast feed.
WITHEY
Probably not, you can't promise someone they don't, breast feeding is a result of many things in the breast but the breast implant won't disrupt the breast tissue itself. Some people find that their ability to breast feed is changed a little bit but there is certainly no danger in breast feeding, if you have silicon implants.
MYERS
Okay back to the callers very quickly. Kathleen in Aberdeen, yes Kathleen - concerned about eyelids?
KATHLEEN
Hello yes. I've had [indistinct word] twice in the past 18 months and I've decided at my age, 57 now, that I would like something more modern and I went for a consultation and the first question which he asked me was did I smoke and I said no, he said well that's good because he doesn't really like doing smokers. And - but the thing is I had my consultation and I've found that I'm going to have a eyelid lift under the eye and a slight tuck behind each ear, which will pull my face slightly.
MYERS
Okay, let me cut to the chase here, we're very short on time.
KATHLEEN
Okay sorry, sorry.
MYERS
No that's fine, so what - you're interested to know what would be the result, what kind of eyelid surgery would work, is that the ...
KATHLEEN
No, no it's not that, the thing is I'm quite confident in what I'm going to have done, I'm just - I'm getting a bit - it's happening next month and I'm getting sort of cold feet.
MYERS
Ah okay right.
KATHLEEN
And also I'm worried - when you go in you're very light hearted and you go in but then your surgeon will tell you that it really is major surgery.
MYERS
Okay what consolation or reassurance are you going to quickly offer to Kathleen and anyone else who might actually anticipating an operation?
WITHEY
Well actually I think the best reassurance she can have is that her surgeon has told her it's major surgery, he's been honest with you. I mean that does show someone who is trying to make sure you're aware of the implications of what's being done, the potential complications and possibly the limitations as to what it will achieve and that's exactly what you want to hear with a consultation.
MYERS
Okay thank you very much. We're going to have to draw a halt there but thank you Simon Withey, thank you for all your calls and there is a list of contacts which you can see on our website.
ends
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