(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) - Wow, I can't use live on it. It's too bad. Oh, I'm gonna take a screw. Right. So, my account is not eligible to lose live. Do you know what, that happened last week and I thought it was because there was a program with, there's a problem with Instagram. But obviously it's, well, maybe not obviously, maybe it is a problem with Instagram or maybe it's me. Maybe I've been, maybe I've been, maybe I've done something wrong. I get banned every now and I haven't been banned for a while from the social media platforms, usually revolving around nipple photographs. Now, this shows how tech savvy I'm live. Gonna post that as a story on Instagram. I keep on, so that's, I don't know. What I need to do is, oh god, story. Okay. (sighs) Can't, maybe this isn't thoroughly in for my viewers. Right, Facebook, my close friends on Facebook are here. So, can't seem to do five Q and A on Instagram. It's not wrong. So, well, Facebook and YouTube should be working. Exclamation mark. I am I've on Facebook and I've done capitals. I've gotta be honest, change the Samsung. I'm not convinced this, oh, it's gone capital. This key for the Samsung on Facebook. So, I've got some questions and if you have any questions, please do ask. I'm gonna write that pink away, but if you haven't got any questions, don't worry because. So, yeah, if you've got any questions, please ask away. If you haven't got any questions then just listen to what other people have asked. So, I'm gonna jump in a little bit disappointed because I've gotta be honest with you. Instagram is strong, I've got a loyal following on Instagram, quite the influencer on Instagram, I think you'll find. So, but still Facebook and YouTube are not to be sniffed at. So, what we got? Let's have a go at these questions. Can I have a tummy tuck after previous hernia and mesh repair? I was considering turkey because a friend of mine went for a tummy tuck. I saw a video of yours. It did state that patients have had unblockable surgery with mesh, can still have a tummy tuck, but it would depend on where the scar is positioned. Mine is above my belly button, which is the self. Which is the self with a mesh. Yeah, so the scar above the belly button's an issue with the tummy tuck. So, there's two things I guess. One is the actual mesh repair, which is what's going on internally. And the other is the fact that you've got a scar on the skin, regardless of what the scar's for. So, any scars in the upper abdomen above the tummy tuck are a problem if you're gonna have a tummy tuck. In the old days, they used to do gallbladder surgery with a large scar underneath the rib cage called a cockers incision. They all do it laparoscopic female, so you very rarely see that. But that was a real problem for tummy tucks. And if you've got a scar above your belly button, that's gonna be a problem. So, that really needs an assessment and a chat. If it's only a little bit above your belly button, and if you've got a lot of skin laxity, you know, we might be able to remove it at the time of the tummy tuck, and it won't be an issue. But if we can't remove it at the time of the tummy tuck, and we end up with your tummy tuck scar, and then your, your umbilical hernia scar surgery somewhere above it, then that's an issue for healing. That's a real issue. So, it's not a cosmetic issue, it's an issue for healing. Having scars above the belly button, because the blood supply is gonna be affected around that scar. And when we're putting that scar at that wound closed, to get the tummy tuck closed, if you've got some compromised blood flow, because of a previous scarring, you run the risk of wound healing problems. So, there's potentially an issue. The actual mesh itself. Not so much, no, the actual mesh itself is fine. We often need to do bring the muscles together. The diversification of the muscles together. So, your muscles are often split apart, and we bring them together as an integral part of the tummy tuck. It might be difficult to do that if there's kind of a rigid mesh in there. It might be more difficult to do the repair of the muscles. So, that will be something which, again, we'd have to discuss with you or your surgeon. We'd have to discuss with you whoever you choose to have it done with. And that might be compromised, the ability to do the muscle repair, which, you know, you could decide whether you want to accept or not. But the skin excision should be fine apart from the potential problems with the scar as discussed previously. I had breast implants three months ago with another clinic, but I want them removed, will you offer removal? Oh, God, put me on a spot here, what should I say? As a rule, we don't. As a rule, we don't do things like that. For two reasons, the first reason, is you're always best sticky with the original clinic. Now, I know you might say that there's a problem with them, but, you know, you obviously chose them three months ago, so there must be something good about them. And it's always best to go with your original clinic, your original surgeon. Not only have they got a vested interest in getting things right for you, so they might give you a discount or, you know, do things without charge, potentially. But also, they know exactly what they've done. They know what's gone on in there. So, there's many reasons to stay with your original people, but I understand that sometimes people don't want to stay with the original clinic. And as a general rule, we don't like getting involved, certainly in the acute period in three months, would kind of still be killed the acute period, acute meaning sort of shortly after the surgery. And I think, personally, I would put three months down for that as being, you know, normally wait six, probably 12 months before doing any kind of revision kind of thing. But so, you know, it's not great to get involved with other people's work. Well, I don't like getting involved with other people's work. Well, I don't like getting involved with anything so much anymore, to be honest with you. I'm doing less of the GA stuff myself. I'm only taking a few patients on, so it might be one of the other surgeons, so I guess we should probably speak to them how they feel about it. But my feeling is that, I mean, obviously, we need to see why you're having removed. You know, if there's a problem, they acutely need to be removed, like, I don't know, infection or something like that. Or is it just, you don't like look at them kind of thing? So, if it's, you don't like look at them three months is a bit soon, longer you wait, the better, you know, 'cause it might settle a bit. And also, the scarring will be softer and easier to work with, so six, 12 months is kind of ideal, unless there's a sort of reason to do it sooner if you've got a problem. But again, your surgeon or your clinic will be best placed for that, so that's kind of where my first port of call of direction would be. How old has to be for the beauty mark removal? Well, for beauty mark removal in general, for beauty mark, for the word beauty mark substitute mole, you know, basically beauty marks or beauty spots are usually moles. So, moles can be removed at any age. You kind of, if you're doing it on a child, you probably want the child to be on board with it and to kind of ask to have it removed. So, you probably, I don't know, 10, 12 maybe. Maybe older, but there's no kind of, for me, that's the main thing, the child would want to have it removed. In my clinic, we can only treat people over 18. So, we can only treat you if you're over 18 in my clinic, but, you know, you can have a mole removed if you're younger than that, as long as you can find a place that treats children, because it's very difficult in this day and age to treat children. You have to have a lot of policies and training and procedures, et cetera, et cetera. Even if you're treating 15, 16, 17 years old children who are, you know, pretty adult sized, but still they are classed as children and you still need to have all these things in place. So, the clinic doesn't treat people under 18. So, we don't treat people under 18, but you can have a beauty mark removed if you're under 18. It's just, we can do it at our clinic, you know, if you find someone to do it, it can be done. Do you do micro liposuction for perioral fat deposits around the mouth? Well, no, we don't really do cosmetic facial work, so facelifts and what have you, and, you know, chin liposuction. Micro liposuction for, I mean, it must be a thing 'cause this, you know, someone's asked it. So, it must be a thing out there. Liposuction for perioral fat deposits are, I mean, goodness me, I'm not, I'll be honest, I haven't heard of it. Peri, I mean, perioral fat deposits around the mouth. Is that something specific to this patient or is that something that's out there in the world that lots of people have perioral fat deposits? Strictly speaking, perioral means around the mouth, so you don't really need to say perioral fat deposits around the mouth, so perioral fat deposits would suffice. But I can't see, I've actually heard of that. We don't do it anyway, so no, we don't do it 'cause we don't really do cosmetic facial work. So I guess someone who does facelifts right in the last season, cosmetic facial work would be the one to do that. Can we remove knuckle tattoos who had this on YouTube? I don't know if that's where it's come from, someone asked me that on YouTube. As a general, you can remove any piece of skin. When you're removing, so, you know, you can remove any piece of skin as plastic surgeons. We remove pieces of skin from all over the body. Ooh, it might as good funny there. The issue with knuckle tattoos, and in fact, hand tattoos in general, but particularly fingers, is the laxity of the skin. There's no spare skin on the finger, or at least there might be a bit, but then when you make a fist, it all disappears. So, you know, we don't wanna cut it out, and then you go home and make a fist, and the wound opens up. So it's very difficult to remove knuckle tattoos. And so my, again, my default answer is no. You can always send us photos. You never look, and I guess it is kind of like a linear thing, potentially, but usually they're not linear things. Usually they're letters or things which are sort of end up being sized to the circle. And even though they're small, they are usually not suitable. That's the weird thing about tattoo removal. It's the size, but it's also the location. So, actually a small tattoo on the hand, we often say no to. But actually a big tattoo on the abdomen, for instance, might say yes to, 'cause there's a lot more spare skin on the abdomen than there was on the hand. So the hand is a really bad place for excision of tattoos. Because of the skin laxity, you need that lax skin. So it's not a great option. As ever, you send us a photo, but if you're asking the question, my initial response would be not no, not in tuck tattoos. Uncle tattoos are not conducive to excision. Why don't you offer penoplasty surgery to patients under the age of 18? Literally because the clinic can't treat people under 18. Simple as that. It is not unusual to do penoplasty, penoplasty being prominent ear correction. It is not unusual to do prominent ear correction or penoplasty on children. Again, you wanna wait for the child to say, please can I have my ears fixed? You don't wanna, you don't do it, just 'cause the parents don't like the look of the ears. The child has to request it. And usually for five, six, seven is kind of a normal age, I would say, for doing penoplasty. So it's got, again, utterly reasonable to do penoplasty on children. And it is widely performed. But several years ago, when we were going through the process of CQC approval, even though we had a specialist pediatric plastic surgeon, specialist pediatric nurse, there was so much other red tape to go through to get children to be able to treat children. And they made such a small number of the patients we saw at the clinic that we made the decision not to apply to the CQC for approval for treating children. So we haven't got approval at the clinic for treating children. We can only treat people over the 18, over the years of 18, over the age of 18, which is why if you're less than 25 or 21 of a convert, but we ask for ID and things like that, 'cause we have to ensure that you're over 18, simply because children, and you know, as I said, you can argue the 16, 17 year old, whether they are officially a child, children need specific requirements of the place where they're being treated. And the doctor who is treating them needs specialist training, and there needs to be special requirements fulfilled in order to be able to treat children. And we have chosen not to go through the process of that. So we personally can't do panoplasty on patients under the age of 18, although it can be done, as I say, if you can find a facility, an assertion who is approved for operating on children, it's quite normal to have a panoplasty under 18. As I say, 567 is quite normal for a panoplasty. How come we do not offer special discounts or special offers on our procedure as well? There's an easy answer to that, and the easy answer is that we are members of barps, barps, and bad parts of the plastic surgery association. So there's a couple of plastic surgery associations where fully trained plastic surgeons can be members of, and they have code of conduct, they have ethics, get ethical guidance, and so it's completely contributing that for a start off to do special offer or discounts. But secondary to that, it's just not good practice, it's not good medicine. At the end of the day, although plastic surgery and cosmetic surgery is kind of lumped into a cosmetic-y kind of like hairdresser type procedure, it is a surgical procedure just like a hernia repair or hip replacement or a cataract. These are all surgical procedures, and so if you need a surgical procedure, you go and see a doctor, see if you're assessed for the surgical procedure, you look at the risks, you look at the benefits, and you make a balanced decision, which is what informed consent is all about. And it is wrong to try and incentivize people to have a surgical procedure. You wouldn't expect it for your hip replacement or your cataract or your hernia, you wouldn't expect them to say, oh, have your open heart surgery this month and we'll do you a five-and-a-pound discount. If you need open heart surgery, you need open heart surgery. If you don't, you don't. And as I say, it's about weighing up the pros and cons. And so medical procedures should not be given discounts or special offers. It is not a thing to do, and it's not really in keeping with what we're all about at the clinic. We're about looking after patients, giving the best service that we possibly can. We're not kind of trying to be the budget area of the plastic surgery world. We try to be the service and aftercare area of the plastic surgery world, where we will look after you and we'll do everything we can to give you the best result possible. And the whole concept of discounts and special offers are not aligned with that. And to be honest with you, I'm really happy that we don't and we haven't and we never have, because I don't know what would happen if you did. And then someone didn't ask for a special offer or something 'cause some sort of discount for cash. I feel like saying discount for cash. I want to pay more for cash. Cash is a nightmare. But what if we did give a discount to someone and then they spoke to someone else who hadn't had a discount and it's like, oh, that doesn't look good. Does it only, or do you want to ask for this and that? So it makes it easier for the team. It makes it easier for Amy and Nicola and all the people in the office because if someone asks, we say, look, really, sorry. You know, we can't and we don't offer any inducements or special offers. So yeah, it kind of makes it a lot easier from the staff when you, they don't have to say, oh, hold on a minute. I can't speak to the manager, like when you've got a technical road and they still do it, they come back with a calculator, you know, or use car salesman, they say, oh, let me speak to the manager and you know, they walk back in again with a calculator. I can do it for none of that. The price is the price. It's, you know, we very much encouraged to be transparent with pricing, which is why we offer WhatsApp and what have you for people with moles and cysts and things, 'cause we always say from. A tattoos is classic. The price is from, I'm gonna say older a minute. What's this from? What's this from thing? I'm gonna like, well, you know, that's 'cause it depends on the size and what have you. So we will, if you can send us a photo on WhatsApp and we can give you a more accurate idea of price 'cause we're not, we don't want you to come in and then upsell you, you know, and say it's gonna be like this and upsell it load of money, which I think is what people think we're gonna do. So we will, you know, try and be as transparent as we possibly can. So look, just send us a photo. Will Kelly tell you if it's a girl or not? And if it is a girl, how much it's gonna cost? So we don't have to waste your time, you know, just whether it's worth you coming or not. That also ties in with the C and treat service we do for the models and the cysts 'cause, you know, if we've already seen it and we think, yeah, it's a goer, if you want it done, you can come and have it done on the same day. If you want, again, there's no hard sell on that. If you change your mind, that's fine. Lynn's got a question. What you got, Lynn, how much is your consultation? Do you offer finance? Consultation is, well, I'm not, well, I guess it depends on what you're having done, Lynn, because for minor ops, we do, you can do a 35 pounds for virtual consultation, or you can just come in for a C and treat, which is a 100 pound deposit, but you get that back if you don't have a C and treat. That's a mole cyst tattoos, things like that. But if it's a bigger procedure with a consultation with a surgeon, it's 100 pounds for the other surgeons. I'm doing only a few people a year myself, so most people are being seen by those surgeons. And I think it's a pretty basic question. Is it, I'm pretty sure it's 100 pounds, almost certain it's 100 pounds. Do you offer finance? No, we don't. We used to, through the hospitals, we used to offer finance, whilst we work out and now doesn't offer finance. And so we looked at offering finance ourselves, but the problem we found was that we couldn't beat a high street, basically. You've got a money saving expert, I don't know, whatever, or some website, and you look at finance that's offered in the high street, and it's much better than what we could do. So we just thought, well, it's no point, because we couldn't give us good enough, a good a deal as those dudes. So we don't now, because the hospitals don't, and we couldn't beat those. So we have looked at it on and off, and we looked at it the other day as well, actually, because people often ask for it. So it's obviously a thing, isn't it? People want, 'cause I think it will make things streamline, but we don't, at the moment. The answer is simple, after is no, Lynn. We do not offer finance, so it's something like that. I hope that's not a deal breaker. Right, so that's what we need. That's the sort of publicity we need. Lynn commenting, well done, Lynn, thanks for keeping the figures up. So, well, lastly, if you're watching this from Instagram, apologies for the lack of Instagram. It's not, if anyone knows anything about Instagram, help me, 'cause I'm saying it's not, I don't know if I've breached Instagram's terms of conditions, I wouldn't be at all surprised if I am, but that one told me that I have, knowingly. Usually they send me an automated email saying I've breached something like that. Here we go. Can I send a picture of the scar at the top of my belly on what's that? Of course you can. Are you the tummy tuck with the scar above the belly? Of course you can, Lynn. Do you know how to do that, then? Because if you don't, I can put the link in the thing. Just put what you're putting this, is it for scar revision, or is it because you're thinking of having a tummy tuck and you're wondering if the scar's a problem, just so we know which, what we're commenting on the scar for. I'm just gonna, very, put the link to the WhatsApp. The WhatsApp's been brilliant. We used to have a live chat, and I'll speak to all the doctors about this. But it was just really frustrating when we missed the live chat. So I was on holiday and I saw this website and it had a WhatsApp, but I don't know if that's a good idea. WhatsApp feels sort of less intrusive than the live chat. And I came home and I changed our live chat to WhatsApp. And it's been brilliant, absolutely brilliant. So you can send us a photo on WhatsApp. So of course you can send us a photo on WhatsApp. That link works. No, no, tuck, tuck, tuck, tuck, tuck, tuck, tuck. There you go, come up twice. Yeah. So that's the, yeah, the tummy tuck. Yeah, send us a photo on WhatsApp and we'll have a look and give you a, that's the link. I don't know if that works. There's a hyperlink, but you click on that link and put in your web browser or your phone or something and it will go to our WhatsApp. That's basically the phone number. That's basically how it works. But yeah, send us a photo of it and we'll basically have a look. It's always, it's not 100% on photographs because there's no substitute to seeing someone, but it gives us an idea about whether we'll be able to do the tummy tuck, which will again save you having to come if it's a complete no-go. But also what I would say is, is then if it comes to the situation and we say, yes, we think it's possible. Please do come and then we charge you, whatever we're gonna charge you, it says 100 pounds. I think it is 100 pounds for consultation. And then you come for consultation and we say, oh, actually, no, I don't think it's a goer. We'll give you 100 pounds back. Okay, so don't worry. We don't really make money from the consultations. We used to do free consultations going back a bit now, but we don't anymore. But I was gonna say that. So that's right. So most of the money's made from the operation. So we're not trying to make money on the consultation. We were just doing that to say DNA. I think that's what I was gonna say. Yeah, but which is did not arrive. People often don't arrive when you do things on, when you do free ones. That's, it was very inefficient. That was the mate, which we just, you and me, that was kind of our main reason for not doing free anymore because I think people, well, I know people don't kind of value it as much. And so they didn't arrive. So we don't do free ones anymore. But we do say to you, if you come and you want some enormous breast implants or you're not suitable for a tummy tuck or you're not suitable for surgery, for whatever reason, we'll give you the money back. So you don't, you know, 'cause you're wrong, they're not paying all this money. And then they're gonna say they can't do it. So I was like, yeah, that's fine. So, yeah, thanks, Lynn. So it's only boosted the comments on this. Thank you, thank you for that, Lynn. But I'll look out for the photo. Just have a look to see if you are, see how much of an issue the tummy tuck. Ska's gonna be, but as the other thing, as I said to you, Lynn, it might splint a rectus, muscle repair as well that the mesh might make it more difficult for us to repair your muscles, but we can certainly talk about that in the clinic. So, yeah, thanks for getting in touch. Probably good of you to, okay, touch. I have questions now. So if Lynn or anyone else has got anything, then we're pleased to feel free to ask me. But in the absence of anything, I will be back next week. There's no, it must be due for all day soon. Would you follow day? Is it half-term or anything? Well, we had half-term. Easter, is it Easter next week? Anyway, if there's not half-term or Easter or anything, I'll be here next week, which I don't think it is. So I probably will be here next week. So in that case, we'll see you next Tuesday and have a lovely week, have a lovely evening. And who knows, maybe Instagram will be working next week and my Instagram followers. They must be missing me terribly, we'll be there. But anyway, we've got the Facebook and YouTube team. So thanks for viewing in, Lynn, basically, thanks, Lynn. All right, then, take it easy, bye. (upbeat music) 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]
