(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) Plastic surgery, patient group of the world. Basically, there isn't a group, it's just a piece of people who've got questions about plastic surgery, they're asking questions. So I've listed them here. And if you've got any questions, I would be very happy to do my level best to answer them. So do we offer skin treatment for green veins and stretch marks? - No, we did have Alok Chiwari, who is a vascular surgeon. This is years ago, actually, came to the clinic and was talking about doing working with varicose veins and doing vein surgery at the clinic 'cause that would have been quite a good thing to do at the clinic, but it never really happened. So we don't do vein treatments, but I believe Alok Chiwari still works at the primary, I think. So I would recommend him as a vascular surgeon. So if you have veins, I know it's a kind of a cosmetic problem, but the thing about cosmetic surgery that there are different types of surgeons who will perhaps do different things and certainly veins, Fred veins and what have you, it would be a vascular surgeon and Alok Chiwari is a vascular surgeon, but we don't have a vascular surgeon at the clinic at the moment. And stretch marks, no, we don't have any treatments for stretch marks simply because I don't know of any good treatments for them. I know people do offer treatments for them, but I don't know of any good treatments for them and therefore it's hard to get behind any treatments for stretch marks. It's a really difficult area, which I would love to have an answer for. But I haven't because it would be great if there was something we could offer for stretch marks, but sadly, I don't know of anything that's particularly effective. It would probably be more of an aesthetic doctor who would probably be involved in that arena anyway, but I don't know of anything and we don't offer anything at the clinic. So that's a, so no, don't offer the treatments for those things, I'm afraid. I have sickle cell beta thalassemia trait. Can I get a 360 liposuction with a Brazilian buttlet? Right, well, so specifically about your sickle cell beta thalassemia trait. So that whenever someone has a medical problem, I always say the same thing, talk to the medical doctor who's looking after your sickle cell. And certainly sickle cell trait versus sickle cell disease is better. So sickle cell disease, particularly if you've had some sickle cell crises or had problems with your sickle cell would be a problem, but sickle cell trait is less of a problem. Nevertheless, we still have to make sure that we optimize your treatment because we don't want you getting hypoxic or in pain or, you know, these things that can precipitate a sickle cell crisis. So it would involve a history with you because I'm presuming you've never had a sickle cell triumphed crisis and never had a problem with it. Most people would trade our asymptomatic. So if you're asymptomatic from it, then we would still talk to your hematologist and what have you. But in sickle cell training itself is not a absolute contradiction. Sickle cell disease might be. So that's the sickle cell part of it. 360 liposuction with a Brazilian butt lift wouldn't do that at the clinic. So if you're asking in general, can you get it? Well, yeah, you'd have to talk to someone who does it. I don't do that. Quite a big deal if you're talking about 360 degree liposuction. So liposuction all the way around your body and the butt lift, that's quite a big operation, positioning is an issue. So that's quite a big deal of a procedure. So you're adding that into the fact that you've got sickle cell tray. So yeah, so it's a dubious one. Either way, it wouldn't be me doing it because I don't do that procedure. So I guess the answer is speech your surgeon who would probably liaise with your hematologist. If you don't want to waste invert commas a consultation with your surgeon, because then I would say speech your hematologist first. If you get a chance and just say, look, I'm thinking of having this procedure, what have you got a view on it? But yeah, it's quite-- yeah. So good luck, good luck with that one. How long will recovery take from a 3.5-inch tattoo excision on the forearm close to the hand, like on the middle of the arm front, up a side? That's specific, isn't it? Forearm close to the hand, like on the middle of the arm, front-- what's front? It's from that way. Anyway, front, upper side. OK, well, I guess the answer is the same answer for any kind of surgery, I guess, 3.5-inch. Darula here, 3.5 inches on the arm. So is it 3.5 like that long? 3.5 wide, is it? I always say the thing about a tattoo excision is the main determinant is the kind of diameter in the shortest-- the shortest diameter, if that makes sense. So it is 3.5 inches long, but only, you know, a few millimeters wide, happy days. Because it's a few millimeters bit that matters. 3.5, the longest one means the length of the scar. The shortest one means how tight the scar will be. So that's why a round one is bad, because obviously both distances are the same, the width and the height are the same. But if you have a long thin tattoo, that's fine. If you have a short fat tattoo, that's a problem, because it's the distance in the shortest diameter that matters. So 3.5 inches is quite long. But if it's actually quite narrow, then that's less of a problem, because it's the tension that's going to affect the recovery. So if it's really tight, if it's quite wide and really tight, then that's going to make the recovery potentially longer. But essentially, the skin will be healed in about a week. And so we usually are addressing for a week. But as I say, it is quite tight. You might have little areas which maybe don't come here as well as we'd like. So a week for the stitch, for the-- well, we usually use dissolved switches on the arm. But a week for the skin to heal and addressing. But it will feel quite tight for a few weeks if you were to do things like lifting, if your job involves lifting, if you do the gym and things. I would say you don't really want to be putting any power through your wrist for about a month, four to six weeks. So you'd be back to work if you do an office-based job. You can do that pretty much straight away or feel tight and uncomfortable. But you can get back into normal life pretty much straight away. But nothing like any heavy lifting, or as I say, gym with your upper body and particularly on your wrist for about four to six weeks. And you'll be able to have quite a red scar there for a few months. Normally says starts to settle about three months. Can take six, 12, 18 months, which are properly settled. So it does take a while for it to settle down. So yeah, that's kind of recovery right there. Do we offer face and neck lifts? No, we do not. We do not. I pretty much specialise in breast and body contouring, which basically means breast and tummy tuck, essentially. So breast, tummy tuck, liposuction. Those are the things that I do mostly. Obviously we do moles, cysts, lumps and bumps. And in fact, to the meeting today, we're going to be looking at really growing that low-pranesthetic work that we do. So we're really going to push that. And in terms of the GA procedures that you get put to sleep, it's just breast and breast, breast, any kind of lifts, reductions, implants, lips and implants, and tummy tucks and liposuction. But we don't do any face and neck simply because that's not my special interest in it. So yeah, so now we don't offer face lifts or neck lifts, I'm afraid, kind of specialising in the breast and body. What is the recovery period for unilateral breast reduction? So you know what? Similar to the risk, the tattoo on the wrist. Having said that, breast reduction obviously will maybe not be obvious, but it's obviously a bigger operation than a tattoo removal. And there's quite a lot of scarring with the breast reduction. And anytime two scars meet, there's a risk of wound healing issues. So with a breast reduction, if a scar around the nipple, scar straight down, so where that sort of, there's a T-junction at the bottom of the nipple. And then there's often a scar in the fold as well. So there's another T-junction at the bottom. So there's kind of like two places where there's T-junction. And so they can have problems with the healing there, particularly the bottom one, the bottom T, that can give you issues with the healing. So again, aim for it to be healed in a week and usually for pretty much all the operations I do, it's dressings for a week, whatever operation you're having. The bigger operations are just more risk of healing problems, but hopefully you don't get healing problems in any operation. But the risks are greater with the bigger ops. So a unilateral breast reduction is kind of, you know, it's good because it's one side, obviously a bilateral breast reduction. You've got a doubling of your risks of complications without simply because you're doing both sides. But yeah, we weren't here in a week. And then again, scars were in obvious few months. And then they settled after a few months. So, and in terms of driving, these people are out driving, two weeks, it depends on how big the reduction is really. You know, sometimes people are OK after a week. It's hard to be too kind of like, what's the word, like, wide about, you know, you can drive after one week with a breast reduction. Because there's breast reductions there, breast reduction. So it kind of depends on the person. So kind of two to three weeks is normal. But if it's a unilateral and it's just a little balancing one, it might not be too bad. It might be one week. So, you know, it's hard to know in terms of driving and returning to work. Similarly, it depends on what you do. And if you actually have to drive to work, then it's, you know, going to be that same sort of time before you can drive. So, yeah, that's kind of overview, but it would be on a case-by-case basis. So, it could be a bit more specific when we know you're in that case. Is it normal for a scar to be roost up? Good, spelling of the word, roost. Is that how you spell roost? How you spell roost, but that is a good spell. I don't know if that's how you spell it, but that looks good. I wouldn't have known how to spell roost up for your tummy tuck. Yes. And I'll be honest with you, I probably don't make this clear enough to patients pre-op because, yes, it is the way the tummy tuck is designed, we're always trying to limit the length of the scar, even though it's quite a long scar, always trying to make it as sure as possible. And if you look at it, it's a big one at the top and it's one at the bottom. If you look at it when you're doing the surgery, there's often a discrepancy of length, there's more length at the top and the bottom. So if you just, for instance, started at the middle and worked outwards and just did it exactly as it is, you get massive dog ears, basically. Dog ears are bumps at the end of the scar. And so, personally, what I do is I start on the outside. I don't start in the middle, I start on the outside to try and make sure there's not a dog ear. So I make sure there's not a dog ear at the ends and then I work in, but as you start to work in, sort of robbing Peter to pay Paul on the outside, but you've got to pay Paul at some point. So as you get to the middle, you've got to start paying Paul because you've robbed Peter, or you've robbed Paul. Anyway, you've robbed someone at the outside, so you've got to start paying back as you get into the middle. And as you get to the middle, you have this big long, big, big distance scar at the top, little distance on the bottom of it on my Lord, and you've got to start correcting it in. So what you do is you kind of pie crust it. So it looks pucker basically or roost, and you deliberately do that, or I deliberately do that in order to minimise the length of the scar. If you make the scar longer, you will balance out the discrepancy in the length between the top scar and the bottom scar. The longer it is, the more that kind of discrepancy gets less if you make it infinitely long and then that discrepancy is less. So shorter scar, bigger discrepancy and more roosting or puckering of the scar. So it's normal to have a pucker scar. And personally, what I try and do is I try and make doggier as small as possible. And I'm OK with having it roost because the roost is the roost, roost, or the puckers settle. So the roostness settles. That's the big, big point. The roostness does settle. So you're better off giving a shorter scar with roosting. And try not to say to patients, don't worry about the roosting because it will settle rather than the longer scar and the length of the longer scar. So you'd rather have a short scar or a short-term roost than the longer scar. So yes, the roosting is normal. Don't worry about the roosting or puckering or whatever you want to call it, pie crust. I don't know if that might be, you know, like a coinage pasty. It looks like it's not been stitched well, basically. Same with the area reduction and same principle. Big circle to small circle. So it's all roosted up or pucker up. And it looks like it's been stitched badly, but it's just because you've got size discrepancy. So you have to kind of tail attack it in and it looks like that. But that is completely normal. Do not panic. It will settle after a few weeks. We'll get your massage in and get you working on it. Make sure it settles, which brings me to my next question, which is why is skincare so important following surgery. So yeah, it is input. So in terms of skincare, kind of scar care, if you like. So we talked about skin and scar management. It normally starts the six weeks post-op. So that's assuming there's no healing problems. The first six weeks is the healings. We have to get the wounds healed. And usually in the vast majority of cases, it's dressings for a week and then no dressings. And as I say, the wounds should be healed in a week, but it'll be quite fresh. And so we normally leave it alone for six weeks. So you don't do anything for the first six weeks. You can wash, shower, get it wet and all those things. But nothing in terms of managing the scar. After six weeks, that's when we start scar management. We will work with you with this. But the majority of cases, it's moisturizer massage. It's the regime for scar management. Depends on where it is as to how often you can do it. But if you can, moisturizer massage to break down that scar tissue. And when we see you at the six week mark, often the scars are quite red. They're quite active. They're quite firm. They feel quite firm. And you can tell that there's still quite a lot of activity, quite a lot of scar tissue there. So we get your massage and tell breakdown that scar tissue. And it does take time. Takes several months back to happen. And in that time, we always talk to you about avoiding sun exposure because if you get a tan on that scar, while it's red and active, it will give you a pigmented scar. You'll end up with a tan scar. You'll lose the tan the rest of your body. But the scar won't lose the tan. If you get a tan on a scar, well, it's red and active. So you have to be really careful with that skin while it's active and while it's healing. The majority of cases are, it's moisturizer massage. If they have a problem scar, then you can look at other things. A problem scar being a hypertrophic scar, or even a kiloid scar, which you've got a raised red scarring. If you have a problem with the scarring, there are other things we can do. Things like silicone, which can come as a gel or a tape, steroid injections, those are the kind of two mainstays of treating hypertrophic scars. But the majority of the majority of scars do not need that. It's only if you have abnormal scarring, a lot of people talk about steroid or not steroid silicone for normal scars. And we tend to advise massaging for a normal scar and vert commas, and it's only ready for the red, raised, hypertrophic, overly active scars that we talk about, silicone and possibly steroid injection. But we'll talk you through it and we'll work with you through it because one of the main things I say about the practice is the optic care is as important as surgery. It really is important to maximise the scarring, get the best scar you possibly can, because obviously that's a huge part of this sort of surgery because all of the surgery pretty much has got big scarring and kind of often prominent scarring if you're doing moles, cyst, lumps, and bumps are often on the face, because that's where you're going to be more bothered by them, so more likely to have them removed. So we've got to make sure that we make those scars as good as we possibly can. And so post-op scar regime is really important and I will work with you, Vicki, will work with you to guide you with that scar management to make sure it settles satisfactorily. Well, that's it. I am out of a question, Joneys. If you have a question, then please feel free to message me on the Facebook, on the gram, on the YouTube. Are we on YouTube? Or on the YouTube? Yes, we are on YouTube. You know, I think I'm a bit behind my eyes on YouTube having said that I do get quite a lot of questions on YouTube and I try and keep it up with them. But please feel free to message me if you have any questions and I will do my level best to respond A to them. But in the absence of any more questions, I will go and have a lie down, and I suggest you do likewise. And we'll see you safe. Hold on a minute. Wait a minute, it's after next week, isn't it? Yes, after, yeah, we'll see you next week, week after, week after, I will see you same time, same place, whatever the week after, the next week is assuming the next week is after, which I'm pretty sure it is. So yeah, see you then. It'll be a rollover week, heard me, a rollover. So, complete your feet up and I'll see you then. Stop the stream. I'll see you then. Have a question, not covered in today's show? Then send it over to info@stionoplasticsurgery.co.uk using the hashtag #AskJJ. We'd love to hear from you. [MUSIC]
