(upbeat music) - Welcome to the Stiano Plastic Surgery podcast with plastic surgeon JJ Stiano, the only plastic surgeon in the UK who owns a clinic specializing in breast and body contouring. (upbeat music) Good evening, all Tuesday night, 7 p.m. You know the drill, cues and A's going on all over the shop here. It's the 3th of January, unless I'm very much mistaken. And I think we can do away with the Happy New Year's and just get straight into it, can't we? So I hope everything's going okay in your week. Slash month, slash year. I'm very excited to have some questions on and I set up with a bendy phone. I can't see what's going on there, but I can kinda get an idea that there's a question on the Instagram, but the Instagram has providing me with two responses to my sticker, which is pretty exciting. So I'll do those first. I have also got other questions to go through. So I'll start with these ones. So can you have a toy tuck if you have internal scarring for Caesarean section? Yes, you can. In fact, it's quite common. As you might imagine, quite a lot of people having tummy tucks have had children, therefore they are quite a large proportion of those will have had a Caesarean section. So it's not unusual. Sometimes I see people who've kind of had two Caesarean sections, who've got two scars, never quite understood that, because if you're gonna give a scar in the same area, then we would tend to excise the scar that you've got. So if you have a Caesarean section scar, the idea is that we go below the Caesarean section scar and excise the Caesarean section scar with the tummy tuck. So you end up with one scar, albeit longer than the Caesarean section scar, but the Caesarean section scar disappears. But it's completely fine to have a tummy tuck if you have got a scarring on your abdomen. The, and actually the Caesarean section scar is fine. Slightly, only slightly more complicated if you have what's called a classical Caesarean section as opposed to a lower section Caesarean section, which is your classic one, but obviously it's lower section. So the lower section one is the one which goes horizontally in your sort of, in line with, in your underwear, which is your normal Caesarean section. But certainly if you need an emergency or rarely they will do it straight up and down. Or if you have to have a abdominal surgery for another reason, if you have a straight up and down scar, which goes from your belly button down to pubic area in a sort of vertical orientation, little bit more difficult, but still absolutely fine. The problems come when terms of scars on the abdomen and tummy tucks is for scars in the upper abdomen. So scars from the belly button up to your rib cage. In the old days they used to take gallbladders out with what's called a cockers incision, which goes along your rib cage. And that was a real issue if you were considering having a tummy tuck and you got one of those. But no one has them anymore 'cause everyone has their gallbladder out with a laparoscopically, with a telescope, with a keyhole. So very rare to see those scars anymore, but certainly scars in your upper half of your abdomen. So for me belly button up, they would be an issue, but scars in your lower abdomen. So things like appendix, things like he caesarean scars, absolutely fine, no problem at all. I mean, when you do the surgery, you have to go through scar tissue, which can be, you know, a bit of a thing, but it's fine, it's not an issue. So yeah, that's a sign. Thank you for that, stick a question. And the other stick a question, if you, if you, I've written it down, I'm not sure how I can see this stick a question at the same time as doing the thing. I've got to that level of Instagram prowess. If you were to explant, do you recommend a lift at the same time or waiting if you would have an explant? So if you have to have your implants removed, do you recommend having a lift at the same time or waiting? So that's a good question. And it's one of those ones, which many of the questions fall into this category, I have to say kind of heartache and hearts of directly. But I do have a view and I do, but I do, as with everything, I do try and discuss with patients to try and get a view together as to what we both want to have happen. But broadly, if you need a lift now, so if we, if we have a look at your breasts and your breasts are sitting low and you kind of need a lift now, then I would be thinking about having a lift at the same time. So I've got no problem with doing a lift at the same time as the next plan, as removing your implants. Because if you kind of need a lift when you've got your implants in, it's going to be even worse when you have those implants out because you can have even less volume and that's going to make your breasts sitting even lower. The problem comes when patients maybe don't particularly need a lift now or maybe borderline for it, but not really bothered about the shape and they just want to get rid of their implants because the breast shape will be worse when the implants are removed. And so the question is, how much worse will they be? So am I better off having my lift now or waiting? And that can often be a difficult one to answer because it's almost like the perfect crime if you did the lift now, because you never know how bad you're going to be because you do the lift at the time of the explant. And I think there's a lot to be said for doing a lift at the time of the explant because it's one operation. But having said that, if you kind of, I think the patient, I think the question was, what do I recommend typing? And I guess if I'm my view and I try not to impose it, but my view is if it's really on a life edge, I would probably be saying, look, why don't we just see what it looks like to avoid the scarring, to avoid the risks associated with a lift? 'Cause it might look okay. And in my experience when you remove the implants, it kind of often looks better than you might think. I don't kind of want to say that to all patients 'cause sometimes it might not look better than you think, but it often does look surprisingly good and you think, oh, it's going to look terrible when I've had my implants out and it'll be all sagging, everything. And actually it does tend to response, but it depends on who you are, depends on your skin, quality, et cetera. But as a general rule, it often does kind of look okay. So if you're not that bothered about the shaving, you just want to get rid of your implants, I think there's a lot to be said for just doing one problem at a time and say let's get rid of the implants and let's have a look what the shape looks like. Having said that, if you've got a bit of a droop already and if you are quite bothered by the shaving, say, hold on a minute, I'm not going to pay all this money, family implants out and it looks worse than it looks now, then there might be a case to say, look, let's do a lift at the same time. So it's hard one to kind of give an answer to everybody. It is, as with all these things, case by case basis, but it is judged, but basically on how you kind of look now and some people are like, need a lift, some people are like, definitely don't need a lift. It's always those ones in the middle which are a problem who don't need a lift now, but when you remove the implants, are they going to look worse and they're not going to need a lift? So that's the problem with this whole party. It's you never know, we never know. So we have to kind of like, personally, I try and kind of like discuss with people so that we're hopefully on the same page and we're hopefully trying to make the best decision with the information we've got right now, which is never perfect 'cause we don't know how your body's going to react when those implants come out. And it's not only initially when the implants come out 'cause often the skin will recoil in the coming weeks and months. So you have to do it at a bit of a time. So it is a difficult one to know. No one will know before those implants come out what your breasts are going to look like. We can kind of have an idea, but no one knows. The more you get on in life, you realize no one knows anything. Really, we're all kind of just saying usually this or usually now the chances are this is going to happen. Whether you're the weatherman or whether you're the plastic surgeon. We show a lot of traits with John Fish. Michael, Michael Fish. Michael Fish and myself, we've got a lot of, we can't always get it right. We try our best to predict the weather, but we don't always know whether it's going to rain tomorrow. We can say it, good chance. And often we're right, but not always. But anyway, enough of my problems. I'm just going to have a look at this. What's, oh, is there questions? Oh, I've got to scroll, I've got to scroll. Okay, you wait, I waved at PNE. What do you think about teardrop for beak-up enlargement? Right, oh God, what do you think about teardrop? Oh, heck. Right, oh, that's better. Oh, that's good. Does that look all right? What do you think about teardrop for beak-up? That's a really, oh my, that's one of those questions, which is kind of like impossible. That's an impossible one. I don't know where to go on that. So what do I think about teardrop? Yeah, I think teardrop a good, particularly if you've got no volume, not no, no, if you're completely flat. Beak-up enlargement, that's obviously a, not a huge cup size. So it's, yeah, but, okay, I'll answer it. Yeah, it sounds reasonable, teardrop for beak-up enlargement. That sounds reasonable. Yeah, I think that sounds reasonable. Hard to kind of be too, I don't know if that's helpful. My keyboard has come up, how do I get rid of my keyboard? Oh God, oh God, sorry. Oh, heck, all right, how do you make the key, right? Anyway, let's just keep going. So teardrop, yeah, beak-up for a teardrop enlargement sounds reasonable. I need a jackie, I thought that was one else. Maybe not, all right, let's get back on track. I've got the keyboard up and, ah, that's gone, right good. All right, good. So, right, so in terms of what do you think a teardrop, a G, beak-up enlargement, I've got this question here that I've got from a patient might also kind of help enlarge on this because I've got a lot of times people kind of want to know what, you know, whether they have a teardrop or, you know, they want to be, be, beak-up, whatever. So, and this whole implant game is not very precise, to be quite frank, and let me explain. So could you explain the positive negatives of low profile and moderate profile, please? I understand the breast implant is chosen based on the diameter measurement first and then profile type second. Are there any differences other than projection? For example, is the creasing of the implant more evident in a low profile versus a moderate profile? Creasing the implant. I'm not sure what creasing of the implant is, does that mean rippling of the implant maybe? Or does that mean that when you get a bit of a crease, when you get a bit of capsule forming around the implant, we should produce breeders' poses to rupture. Not sure what that means, but I guess it doesn't matter. Well, it does actually, I suppose. So if that's rippling, if you mean creasing, if you mean seeing the creases of the implant through the skin, in general terms, for the given base widths, you're absolutely right, the base width is the first measurement. For a given base width, a low profile implant is gonna be smaller than a moderate profile implant and a smaller implant is gonna be easier to cover. You're always looking for a balance between the amount of implant and the amount of breast tissue you've got. Obviously the breast tissue you've got is set, that is a set amount and the implant volume is changeable. You can decide what size of implant you have, so the bigger the implant you have, the more implant there is in proportion to the breast tissue, the more risk of rippling, which is, I don't know if that's what you mean by creasing, but anyway, so the more risk of rippling, the more risk of being able to see it, the more risk of being able to feel it. So everything else being equal, a smaller implant is gonna be better in terms of being able to see it or feel it or getting complications like that. Having said that, you have to get the size you want. So there's no point in getting really small implants that you can't see or feel the edges of it and it doesn't give you the effect that you want. So as with all these things, you gotta get the balance right 'cause you don't wanna have a size that you feel is right. But if you're asking the question, is rippling worse with a low profile than a moderate profile for a given base width? As I say, the low profile is gonna be a smaller implant. So there's gonna be a less volume of implant to hide. So yes, there will be less risk of rippling with a low profile implant compared to a moderate profile implant of the same width because it'll be smaller. There's another, this same patient. I think I know, is it coming out later? No, so this same patient has also sent me a video of someone talking about profiles of implants and I think she was saying, how does this work in terms of my profile 'cause we were looking at a specific profile for her. And this is a patient, this is a surgeon talking about different profiles. And the problem when you talk about different profiles is that you kind of have to talk to, if you're gonna look at photos of people with different profiles, you kind of have to look at photos of patients that the surgeon has operated on using the profile of the makeup implant he's using. Very big around the houses here because the surgeon who is speaking obviously uses mentor and uses a motif or implant. So mentor have moderate, moderate plus high and ultra high profile. Motiva have funny names, low, demi, full, coarser. They call them funny names. Some companies have low, moderate high, extra high, so they don't have a moderate plus, but they do have a low. So the names vary is the point. So the names kind of don't matter because the dimensions matter. And for instance, I was talking to a patient a while ago and she was saying, oh, I'm not sure if they have a moderate or a high profile implant, which one should I have? And I'm like, yeah, if I have to think about it, we go over, et cetera, et cetera. And then she come back and said, oh fact, cracked it, moderate plus, other moderate plus. And I'm like, hold on a minute, no. 'Cause in her mind, she thought she cracked it. She got, hold on, I don't know if I had a moderate or a high and she's gone away and found out that there's a moderate plus. I'm like, what a moderate plus is a different make. A moderate plus is mentor. Mentor have a profile called moderate plus. And the implants we were talking about were, come and what maybe say, polytech, which do low, moderate, high and extra high. And actually, if you look at the dimensions, the moderate profile polytech had more projection than the moderate plus mentor. So just 'cause it's called moderate plus doesn't mean it's gonna have more projection than a moderate in a different make. Obviously in the mentor make it does. But, and similarly, just 'cause it's called high, a high profile in one make might have different projection to a high profile in another make. There's no standardization for what they're calling high, what they're calling low. And as I say, motif, I don't even call them low and high. They call them demi and coarser and all these other names. But what you gotta do is you gotta say, so I show slides, I say, that's a low, that's a moderate, that's a high, that's an extra high of the implants that I use. And that's the sort of look you get with the sort of profiles of the implants that I use. And so it gets, so I'm all four people doing research. In fact, most of my patients do do research and are very well informed. And I think it's very important to be well informed, but you can tie yourself up in knots by doing too much research, because you then get into this realm of like, what low, moderate, demi, coarser, where's mine? I'm like, doesn't matter where yours is, doesn't matter low, moderate, or we've looked at the photos, you've liked the moderate profile, the width is this, the volume, therefore, for that width, for that profile, that implant is one that fits your frame. And like, it's all on the measurements and it doesn't, it doesn't necessarily transpose to other companies when you look at, say, a moderate plus, isn't necessarily between a moderate and a high in another company, in mentories, but in another company, a moderate plus might actually have less projection than a moderate profile implant, because the companies haven't all agreed on what they're gonna call moderate. And then obviously, you know, a width of projection ratio, this is a moderate and a width projection ratio of this is a high. There's no kind of standard. So they just thought in their own minds or in their own labs what they're gonna call low and high and moderate, and it can be confusing when you are looking at photos as well, 'cause like I said, if they've had a moderate profile of a different make, that might have more or less projection than the moderate profile of the make that you're looking at. So it's an absolute nightmare and it's a minefield and it's difficult, and that's why we say, you know, stick with your surgeon, do do your research, be informed, but don't worry too much about these things because it can be very confusing if you start thinking, wait a minute of the course or this one sounds perfect for me. I'm like, you don't have to go to a different, you know, all the implant manufacturers, the dimensions will be there. If you look at the dimensions of the implant, you're looking at it. There'll be one in a similar one in a different manufacturer, but it might have a different name, as I say. It might be called a moderate, whereas it's called a high in another company. It might call it a low or it's called a high in the other. So it is confusing and I do appreciate that it is very difficult for someone who's thinking of having implants because not only is there a situation where we kind of don't know what it's going to look like, like I said earlier, a bit like a weatherman, but also when you do research, you will get on the internet and see things which may not be relevant to you if you've spoken to a surgeon who's talking about a different make of implant and you see someone talking about showing photos of look, this is a moderate, this is a moderate plus, this is a high, I'm like, we'll forget that because that's mentor, those are different implants, they're different dimensions. So the implants you're looking at, I've shown you photos of the sort of implants and the sort of projections of the implants that I use and that's what you want to focus on. So it is not straightforward. I do acknowledge and what I can do and what we can do in the clinic is do our best to help you to come to a reasonable decision. Basically, that's what you've got to get to, a reasonable decision and also remember the implants, only one aspect of the whole thing. So obviously it's an important aspect, I'm not trying to say it's not important, but it's not, do you know what, it's not actually as important as you might think. Certainly once you've gotten to a moderate and certain width and height and what have you, there's nuances between them and it's not as important. Some people think of it and it is difficult. People do get tied up and not, so what have you. So it's a different one. I think something's happened on, see what I can do here. Of course, people have been saying stuff haven't they? Sorry, I can't see it when I've got my phone bent. I thought this bent phone was a good idea, but now you're well, oh, oh, do you, hold on a minute, here's the projection, right key, where am I, what do you think my tear drop be? Okay, yeah, what do you mean by different profile implants, please? So yeah, so they come as different profiles. So profiles, there's gonna be two shapes around a tear drop, so there's two shapes and they come in different profiles according to how much they stick out for, as I say, for a given width, some implants account more than others. So you can have a low profile, moderate profile, high profile, extra height. As I say, that's one of the company's way of describing it. Other companies call them different names like moderate plus and high and ultra high and sort of extra high and they don't have a low. So the names are different, but the principle is some stick out more than others. So what you've got to look at when you're choosing an implant is the shape is really important, tear drop all round and the profile is really important. How much it sticks out? So look at some photos of people who've got them in with different, how much they stick out. And once you've got an idea how much you want it to stick out, you measure the width of your chest and if you want an implant that sticks out like a moderate profile, say, then that will come to a certain volume. So we don't focus on the volume first, whereas most patients do focus on the volume first. So that is the profile thing. It's the projection, how far you go. Okay, PNE is answering nice. That's what we want, bit of internal, good. This is what we want, do you, Dr., how much do you charge for consultation, please? And this, oh Christ, my keyboard's come on. No, sorry, hold on. How much do you charge? Oh, I said for a concert. And is there any technology you have where you can see a potential healed outcome before you commit to your trial and sizes? So how much do I charge? I think, I don't know. I think it's a couple of, I think it's 200, is it? Well, five, anyway, it's a couple of under pounds. I charge, to be honest with you, I'm not doing much anymore. It's mainly the other surgeons in the clinic. I'm trying to, like, support them. They're 100, I know they're 100. And do we have any technology? No, we don't. We have looked at the technology and the technology does exist. We take a photo and you morph the photo with the different sizes of implants. I don't, I mean, certainly, I don't think it's been to colleagues. I don't think it helps the surgeon choose, but it might help a patient to sort of get an idea of what they're going to look like. But it's never going to be like, you know, obviously, well, obviously, but it's never going to be like exactly what you can be like. But it might help, and I'm still on the fence with it, whether it helps or not, I'm not sure. But yes, we do use sizes. That's what we're doing. We use sizes to get an idea of the volume, but that just because you have an idea of the volume doesn't give you an idea of the shape and the shape is really important. That's why we've got photos of people that are done, totally different shapes. But the technology for me is not useful for me as a surgeon. Although it might be useful for patients to see. I don't know, I'm not 100% convinced on it, although I have for many years looking at it. For many, many years we're looking at it. You're welcome. Also, if it helps you, I was a C, and now I'm a double D with a teardrop, an extra high profile, and I'm really happy with my results. Two, three months post-op, there you go. Be any real person. So right, so yeah, extra high profile teardrop, good. Okay, good, see it's done with me, there you go. Up in the 100 pound concentrate for you, unless it's increased and no, but JJ will show you pictures, et cetera, to help along with sizes. Less increased and no, what's no? Oh no, for the technology, yeah. Show you pictures, and yeah, that's true, be any very true, very, very, very true. But yeah, for the other guys, I think I've found some more than that, but the other guys are brilliant. What's with, what's this with Stiano Pieney? What's JJ? I don't know if he's asked. I don't know if I'm behind on the chat. Have you had all this chat already? And I'm just recapping it all. JJ's me, it was, yeah, it was with Stiano, and this is JJ doing live, yeah, me, I'm JJ. JJ Stiano, that's my name. Oh, right, okay, thank you, really work together. No, I am JJ Stiano, I'm just saying, I'm both of them. I'm JJ and Stiano. Yeah, God, I think I'm behind, I think this is, I don't know if this is looking bad, 'cause I'm, oh, we're up to speed. You're welcome, we have, it's the same person. It's his practice, yeah, JJ Stiano is my name. But I've got other surgeons, not Piene, I'm only a Cali, I've got other surgeons, and I'm at least treating a small number of patients these days. So, yeah, but we do have sizes in the clinic. You know, I do, what's what, what's that? Yeah, you did my friend's mum, Maria Patti, yes, I'd like to have you personally, oh, yes, I know, yes. Oh, your friend's mum, that's nice. I have a right, okay, all right, so there we go. All right, that's good, isn't it? That's good, that's good one, good one. Good one, Omeo, Kiam. Can I have breast implants if I have COPD? So COPD is chronic obstructive pulmonary disease. I mean, usually, I don't know if I'm being, I don't know if the COPD community will backlash on me, but usually COPD is kind of like an older demographic, and so breast implants in patients with COPD is not a common occurrence, but just 'cause it's not common doesn't mean it shouldn't be done, so that's the first thing. What I would say is it kind of depends on how bad your COPD is. COPD can often be quite bad, you can be quite breathless, sometimes you need oxygen, and so it might be the case that if your COPD is bad, then you, it might be a no, basically, but it's definitely a might. I mean, there are a range of severities for COPD, so if it's quite mild and you've got quite good exercise tolerance, if you can kind of walk up a flight stairs and have a relatively normal life, you go to the shops, et cetera, then perhaps you could have it done. So it's not a definite no, but it kind of makes me think it might be a no to be quite honest with you, but we would definitely, and we could just torture you, we wouldn't have to have a consultation, we'll just torture you. The other thing I often say to people with medical problems in general is to talk to their doctor who looks after the medical problems. So if you've got a doctor who looks after COPD, maybe say thinking of having breast implant surgery, what do you think? 'Cause usually, if it comes to it, I would take advice from them, I would take advice from your physician who's looking after your COPD, and as well as an easterist to, I mean, he's really seen an easterist who would be kind of like the final judge on that, but I would say it's not a common occurrence. People with COPD having breast implants, but it never say never, but I would be a little bit kind of, maybe a little bit negative about it, thinking that maybe we wouldn't be doing it, but we might, probably not, but you can always give us a call and we can talk to you and stuff. I guess we can maybe get an assessment of how you bad you are and talk to the easterist if you want, even before coming to a consultation, so you don't have to pay for a consultation and stuff if you want to have an idea because you don't want your brain to do a consultation and paying for a consultation, and then that's telling me we can't do it. To be honest with you, if we did that, if you came for a consultation, paid for a consultation and we said we couldn't do it, we would refund you the consultation, because if we say we won't do it, then we will be on a consultation. But I previously had a breast lift and a Ariola reduction with another clinic in March 2021, but I am not happy. Would you offer Ariola reduction? Yeah, definitely. I mean, I watched 2021 a few years ago, isn't it? I mean, what I was going to say, this is always best to go with the original surgeon, regional clinic, because they might have a kind of incentive to do it for, you know, not charge you full price for it, whereas, you know, we would charge you full price for it, but it's been a few years ago, so it's nice to charge you full price, but yeah, for sure. And the reason I say that is because it's a risk with Ariola reduction that it can stretch out. Now, having said that, if you have a breast uplift with Ariola reduction, the risk is less than if you're just having an Ariola reduction, because if you're having a breast uplift, that removes quite a lot of skin, including the extra Ariola skin, but also some skin surrounding it to tighten the skin of the breast. So the tension is kind of distributed a bit more. And if you're just having an Ariola reduction, which is to scar around the Ariola, which is all the tension is around that Ariola scar. So the risk of a stretch is more with an Ariola reduction than it is with a breast lift. So not that I want to kind of put you off, but when we do the Ariola reduction, there's different sort of stitches you can use when you do an Ariola reduction. So, personally, I tend to use a permanent suture as a per-string, it's kind of quite a wagon wheel design, but anyway, it's a stitch that goes all around the Ariola to take the tension off, you put it down deep. And that permanent suture makes it less likely to recur, because recurrence is a risk with Ariola reduction. It can stretch out, because it's closed under tension and there's a risk that it can stretch again. So that's always a risk, but we try and reduce that risk as much as we can, as I say, I use a permanent per-string suture to try and reduce that risk, but even so, there's always a risk of stretch with that. But I don't know if, having said that, I don't know yet, the answer is yes, we would be happy to see you and offer another Ariola reduction for you. Absolutely delighted to see you. That's the answer, that's a show answer. What is the healing time for a breast lift with implants and full tummy tuck with liposuction? Well, the healing time is, I mean, that's a big op, that's kind of big, isn't it? That's the sort of stuff that I do, that's kind of big. I was gonna say the biggest you can do, but I suppose getting all the way around tummy tucks is the biggest, but that's pretty big. It's up there, it's top end, top end that, breast lift with implants and a full tummy tuck with liposuction. That's top end. So at the end of the day, scars are scar, so the scars are all gonna take the same amount of time to heal than if you were just having like one on its own. But obviously there's more kind of length of scar, if that makes sense, so there's more risk of something breaking down because there's so much of it, whereas if you just had your breast done, there's less scarring to break down, if that makes sense. If your breast needs tummy, you've added another length which can break down. So it would be the same if you'd had them done separately, be just adding them together. Anyway, okay, so let's ask the question, stick with the program, what is the healing time? The healing time, so dressings are all sorts on for a week. First week, you're gonna be able to bend over 'cause of the tummy tucks. The tummy tucks probably gonna be the overriding thing. The breasts are gonna feel tight. You're gonna feel tight 'cause it's gonna be long anesthetic there. So yeah, tight, bent over, uncomfortable, and... What is it? So that's the first week. Second week, second week, you don't have the dressings off. Usually you don't need any dressings after the first week. Sometimes you do, but usually you don't. And then second week, you'll be doing stuff around the house. In fact, you'll be doing stuff, you'll be potting around the first straight away because you're not getting a DVT, clotsing your legs. So you're potting around straight off the bat. But second week, you'll be potting around a bit more. If you have to drive to work and normally say, well, two to three, for that, I'd say three weeks. Before you'd be starting to drive short journeys and things like that. So I'd say at least three weeks for driving. Mobilising, getting about after a couple of weeks. And then nothing heavy in terms of lifting for six weeks. And in terms of the shape and the scar and the et cetera, et cetera. Three months before it starts to settle or the shape, especially with the breasts, they look a bit odd when you do a breast lift within parts. And it takes a good few months for that shape to settle. So yeah, the healing six weeks, the shape and the scarring, six, 12, 18 months. So not a lunchtime job. I'm just gonna have a look, see if anyone's said anything on. Or sit, you did not, oh, I've done that. All right, okay. Mrs. Glow, I did your question earlier. Thanks for the question about the X-plon thing. I don't know if you were here, but. Do we offer hip-dip filler treatment? Yeah, someone asked this the other day. I don't know if that's why they put it on. There's stuff on the internet, you know. I think I'm, I don't know if that's on the internet. I don't know if people out there know what that is. Hip-dip filler treatment, I mean. But I guess the mere fact that I'm saying that kind of gives you an idea of the level of expertise I've got in hip-dip filler treatment, i.e., I'm not an expert in hip-dip filler treatment. I mean, at the end of the day, if someone's got a dip in their body and they want it filled out, you can fill out a dip in the body with a with fat graft. So you can fat graft a dip in the body or you can fill a dip in the body. But this hip dip, I said no, I couldn't help this patient. And I think I would say in general terms, if there's a, you know, if someone's searching for hip-dip filler surgeon, I don't think I'm going to come up. So, yes, you can, you can fat graft anywhere. I didn't even know it was a thing. I'll be completely honest with you. I didn't even know it was a thing until a patient asked me and I'd say, what do you mean? And then she showed me, I'm like, okay, there's a bit of a dip there. I guess I could fat graft it, but it's quite a big deal to fat grafting. And, you know, I wasn't very positive. Basically, there's probably people out there, maybe there's people out there who do fit hip-dip filler, specialists, I don't know, but clearly it ain't me. So, I guess the answer to that is no. I would say I don't do hip-dip filler treatment, although having said that, if there's a dent somewhere, if there's a contour regularity, you know, the fat grafting is quite a main part of the practice. Well, it's not, it was, used to be, but it's not at the moment. But, you know, it used to do a lot of fat grafting. So, fat grafting can be done. Let's just say no, we don't do a few hip-dip filler treatment. Nicola, what you got, do you recommend lip-hathedrine massage after a tummy tuck? So, how soon after and how often? Good one, Nicola, that's a good one. I would say, I don't know. I don't know. People talk about it and they say it's good. And I could imagine it being, so do I recommend it? So, ask question, do I recommend it? No. I don't not recommend it, but I don't say routinely to my patients, you've got to have lymphatic drainage massage. And that might be because we haven't got a link with a practitioner. I don't know if there's any evidence to say there's any long-term benefit in it. There might be a short-term benefit in it. And I can imagine that it is quite nice to see someone and to have some kind of treatment. I don't want to belittle lymphatic drainage massage people, to say that they don't have any effect, 'cause I'm not saying they don't. But I think the fact that you're just seeing someone and there's kind of laying hands on you, I don't think we should underestimate that benefit. But I'm not sure if there's any scientific evidence for the long-term benefits of it. Short-term maybe, maybe there's some short-term benefits in terms of swelling. So, I've got no problem with it. And if someone says to me, should I have, or can I have it, I'd be like, yeah, go for it. Let me know how you get on. For sure, I don't think there's any harm in it, it's pretty like that. I think, I mean, obviously you have to pay for it. So, there's that element. How soon after, and how often, that's the people who provide the treatment are, I have varying opinions on that. But I think there's something to be said for straight away. Day one, day two. Obviously, it's going to be uncomfortable, so it's going to be very gentle to start off with. But, you know, that's certainly going to be swelling around that time. But, as I say, I'm not, we don't routinely have a practitioner that we work with, and we don't routinely kind of recommend it or send people to it just because, if there is a cost associated with it, and I don't know of any long-term evidence to say that, you know, long-term, you're going to have a better result from it, although you might say, well, I'm happy just having a short-term benefit, and I'm happy to pay for that short-term benefit. Okay, well, fine. But, so I don't know. I don't have a lot of experience of it, so I don't really, I can't really, I don't feel that I can say, yes, it's really good. I certainly can't say, yes, it's very bad, 'cause I don't know bad things about it. But I don't know if it's, the problem with us is you've got, sometimes, especially in the cosmetic world, I feel like you've got to kind of bridge a bit, the gap between the doctor and the science and everything, and just kind of helping people and giving them advice. And I think sometimes as doctors, we maybe are a little bit giving people a disservice by being a bit too much like, now, evidence for that cannot recommend that at all. You know, which I've just been with the lymphatic drainage question in hindsight. Because, you know, sometimes, I think it helps. Like, when people want to massage scars, we say, like, use whatever you want. We got some stuff, we got some QV cream and stuff we sell, but you don't have to use that. You can use Niviri 45, you know, whatever. There's no evidence to say one's better than other. From a kind of medical point of view, that's kind of good. But is that good from a patient point of view? Is it better to say to a patient, what you're going to do to massage it three times a day, in this way, and we've got to use this QV cream, we've got, it's actually brilliant cream, it's fantastic. It really helps to moisturize that scar. And, you know, and if we're a bit more positive, rather than being lower evidence, or any cream being better than another, you know, I wonder if, so I wonder if I should have done that with the lymphatic drainage question, well, that we don't offer it. But, yeah, probably do. If we start offering it, probably have to be more like that to say like, yeah, it's really good. But, anyway, just reflecting on my own inefficacies there. So, thanks for that, Nicola. So, yeah, go for it. And if you do go for it, let me know how you get on. No, we don't routinely recommend it, but that's probably more out of ignorance is the wrong word. Lack of knowledge than any other knowledge to the contrary, not that. 'Cause like everything kind of doesn't work until it's been proven to work. You know, nothing works. The default position is like nothing works until you prove it works. And that's where I am with this. You know, someone say, oh, you got to have this, got to that. I'm like, okay, well, it sounds good. Sounds nice. But can you prove to me that it works? Can you get 100 patients? And well, inpatic drainage, half of their abdomen and not the other half? And say that they're going to get a better, you know, you can't, can you? We're going to get that kind of proper randomized controlled trial, which is what kind of doctors are looking for. But, you know, maybe as a patient, you don't really, you're just happy to have something that might be beneficial kind of thing. And as long as we put it like that and might be beneficial, you might say, oh, well, yes, please. Right, okay, so there we go, full circle. So yes, go for it, isn't it? (laughs) Thank you. You're welcome, you're welcome, Angela. Good luck with that, let me know. Right, what would happen if you don't stitch the skin after a tattoo excision? What the heck question is that? What's that? That smacks with someone who wants to cut this tattoo out and not stitch the skin. Well, so if you do a tattoo excision, so if you actually cut that full thickness of skin out, as opposed to some like dermabrasion where you kind of just get an angle grinder or dermabrader, but you know, kind of like, just take the top layer of the skin off. So if you're just taking the top layer of the skin off and you're leaving some skin behind, then that skin will heal a bit like a skin graft on a side heals, you just take the top half of the skin off and that skin will heal. But if you're doing a proper tattoo excision, so you're taking the full thickness of the skin, which is what you do with a tattoo excision and you don't stitch it, then it will heal by what we call secondary intention, which basically means healing from the sides across. So when you do a partial thickness injury or wound like a dermabrasion or as I say, a skin graft harvest or a burn, for instance, a not a full thickness burn, because there's some skin left behind, that skin will heal from what the skin that's left behind. So it will heal relatively quickly, you know, heal in a week or so that that skin will be healed. Whereas if you've got, so, and it doesn't matter how big that injury is, really, you know, skin graft on a side theoretically, a very small skin graft on a side versus a very big one should heal in the same amount of time. Now, obviously, a very big one's gonna have more areas where you're gonna prone to little bits of downhill, but on paper, theoretically, they should heal in the same amount of time, 'cause they're healing from the base up, whereas a full thickness wound, a bigger wound is gonna take a lot longer to heal than a smaller wound, 'cause it's gotta heal from the sides across. The skin's gotta come from the sides across, it's not coming from the base. So, heal by what's called secondary intention. Now, small wounds can heal quite well from the secondary intention. Sometimes if you take moles off or something like that, where you do some kind of skin excision and the wound opens up, and the patient goes, "Oh my God, it's over there, it looks terrible. "You've gotta restitch it," and all that. Personally, I pretty much never restitch it, because you worry about stitching infection and stuff. You usually leave it, and it often heals really well, and you think, "Well, what about the stitching before?" Now, it takes a bit longer to heal, but it can heal really well for a small area, but tattoo excisions are not normally small areas, but small areas can heal quite well. You have to keep them moist, keep them clean, and let the table for the wound to heal. But yeah, that is what would happen. It would heal by secondary intention. The other thing about healing by secondary intention is that volume of scarring will be greater. Now, again, when these wounds, when these moles and these breaks down and open up, the scarring can be pretty bad to start with, but it does actually shrink, and it does contract, and it's often not as bad as it looks to start with. So, not that I'm encouraging people to excise tattoos and not stitch them up, but for small wounds, they can actually not look that bad, but for a bigger wound, you would not want to leave it. Like, what normally says anything bigger than a 50P piece is just going to take absolutely ages to heal. So, you wouldn't really want to not stitch them up. It's going to, because if you stitch it up, it should be healed in a week, should be, not always, but if you don't stitch it up, then it can take literally months, absolute months, if you have a big wound, and it's completely not. Worth it, cause there's a risk of infection and all sorts, and you have to address things during that time, so there's all sorts of issues with it. So, not recommended. So, that, you see, IML, what's happening on the gram, is the gram gone quiet. Yeah. Good. Right. So, what we're saying now is we're saying that, oh, that's how you get rid of the keyboard. Your life's in the wild, but we are reasonably, is it nine o'clock is on, right? So, a bit of dinner, a bit of new lives in the wild, I don't know what you're doing, please write in, please text us with what you're doing this evening, and I will see you here, same time, same place, next week, and it's February next week. So, yeah, thanks for joining, thanks to Nicola, thanks for Penny, thanks for everybody who contributed. Omia, Omia, Kiam, as well. All your contributions are very gratefully received, and not underestimated. Bless me. Anyway, see you next week. Stop the stream, take it easy and strum. Have a question not covered in today's show? Then send it over to info@styanoplasticsurgery.co.uk, using the hashtag #AskJJ. We'd love to hear from you. [MUSIC PLAYING]
