(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, I'm live, it's seven o'clock. Hello Facebook, hello YouTube, sorry Instagram, I'm not able to do it on Instagram anymore. They just says you are unable to go live at this present time, I've Googled it, and it's other people have had the problem and say it just starts working again, so I'm hoping it's gonna start working again. Very hard to contact anyone at Instagram. To their credit, in fact, is Facebook the same? 'Cause you can contact them at Facebook, maybe I should contact them at Facebook, and say it's an Instagram problem, 'cause you can't, you post it, you're not post it, you kind of, there's a place where you can support place on Instagram, but nothing seems to be happening. Anyway, I'm on Facebook and YouTube, so what more do you want, well Instagram is the answer. And I've also got over 700 followers on TikTok, so I believe you can go on TikTok when you've got over 1,000, not sure if this sort of thing's appropriate for TikTok. I don't use that platform as a personal person, but I'm aware that people do, but I'm not sure if the target demographic is on TikTok, are they, is it just, anyway. I can't do it anyway, so it's academic. So any, I've got some questions, and I'm gonna go through them, and if you've got a question, feel free to post it here, and I will answer it if I can. Preferably, plastic surgery related, that is the most of the things that we talk about here. Well, we're a bit ready. So, no, no, no, no, one. Do we offer spider lane removal now? There's a general rule, I would say that we can remove anything, any skin lesion. So I would say that we can remove any skin lesion, I'm gonna go out on a limb and say that. Some things around the eyes, around the eyelid, mabobian cysts, for springs to mind. We're usually more suitable for an ophthalmic surgeon. Some things around the female genitalia, barfling cysts. Again, that would probably be a kind of ecologist. But, you know, by and a lot, "Pilon, oh my God, I've got a useless now, "pilonoidal sinuses, it will be a general surgeon, "we would only do them in the, like, "really bad, they need reconstruction." But, let's say most, then, most skin lesions we can deal with and we can move. And spider veins are usually little capillaries with branches coming off, giving that kind of a spider appearance. And they often just use a, they often just require a point diaphragm into the kind of feeding vessel, if you like. You can see if that's gonna work by getting a pen and kind of touching the center of the lesion. And if the whole thing empties and blanches, then you know you just have to quarterize that little central bit to get rid of it. So we can, I mean, I don't know, would the dermatologist do it more than us? I don't know, I mean, we can do it. Yes, we can, yeah, answer it, yes. So, I don't wanna, I mean, we usually do bigger things than that sort of more extensive lesions, but if you, you know, we can do it. So it might be a bit over, overkill maybe for us, maybe a dermatologist or someone or someone else who don't wanna be like, you know, but anyway, yeah, we can. Okay, I'll just say yes. I'll just say yes, but if you're kind of traveling a long way or some type of that, you know, you might find someone local, someone who might be able to do it locally, but if you live near us, then by all means, well, have a look at it for sure. So yeah. Oh yeah, I've set myself up for a fall here. I did read these questions before I came on. And so I started off by saying we can move anything now. We've got a thing about this fat fracture. Can you recommend any surgeon that deals with fat fractures? So this patient got in touch and has had a scan and they thought it was like a fat fracture. I think it's trauma, usually trauma. It's not so much can I recommend a surgeon that deals with fat fractures. So what my point was more that it's difficult to know what to do because when you do a lipoma, when someone has a lipoma, they have a discrete lump that you can make a cut in the skin, you come down and you find this discrete swelling, two more, which just means swelling, underneath the skin that you can then remove. And as a beginning and end, and they often come out quite nicely with a kind of border. If you've got a fat fracture, it's kind of difficult to know what to do. So it's not so much can I recommend a surgeon that deals with fat fractures. It's more like it's difficult to know what to do if you've got a fat fracture. So that would probably mean more like something like, you know, doing some liposuction to maybe try and contour the area. But it's difficult because you've always got issues in terms of liposuction with overdoing and underdoing it. There's not so much of a discrete beginning and end to it. So it would have to kind of be a case-by-case basis. And I think I said to the person who's asking it, well, if this is the same person who contacted us with a fat fracture, which I've got to assume it probably is, I think I said that we couldn't help them. And I'm kind of saying I don't think surgery can help you rather than the type of surgeon. So the type of surgeon would be a plastic surgeon. It would be someone who does liposuction and we do liposuction. So, I mean, you could always try another plastic surgeon for sure. You know, everyone's got different opinions. And, you know, we might say something or another surgeon will say something else. That's not uncommon, doesn't mean one's right or wrong. So the answer is, yeah, you could ask another surgeon their opinion, I'd be interested to hear what they say. But from my personal point of view, it was one of those ones where I didn't think that I could give a good chance of making it look better because there's always a risk that you A, don't make it look better, but B, making it look worse. I mean, obviously you never aim to make it look worse, but that's always a risk there. And so I thought the balance of risk was too great for that case. But, yeah, in terms of what surgeries would deal with the fact fractures, it would be a plastic surgeon, would be the source surgeon. What is the downtime of having a large lipoma removal? Well, it depends what you mean by large. I've just sent out an email to the patients on my database with lipoma saying, hey guys, we can remove large lipomas with a photo of someone who'd had a large lipoma removed, which is kind of like that big, like tennis ball, I suppose, size, which I thought was big. And then someone's going to have to do with a massive one, even bigger, so absolutely huge. So, and, you know, I stand by the thrust of the email was we can remove the lipomas of any size and we can remove the patient who's got in touch with a larger one, but that would need a general aesthetic. It's intramuscular lipoma, which makes it more difficult. It's kind of around the spine, so it's a difficult one, but we can remove a large lipomas. And so the downtime just depends on like, if it's a really large one, it needs a general aesthetic, which is very rare, even big ones, as I say, this one was like the size of a tennis ball. We did it in the clinic under local assets, because the majority had done a low plant aesthetic. And when it's done under a low plant aesthetic, that means you kind of walk in and walk out. So you're in the clinic for a couple of hours, but it's like walking and walk out, go home. You will be uncomfortable and you will have, often have a dent to start off with, whether the lipoma was, and then you can have swelling in the area, so the first week or two, I would say you love a dressing one for a week. So I would say you don't want to get hot and sweaty. So in that first week, the dressing's on. So if you get hot and sweaty, it's like a greenhouse, because it kind of doesn't breathe. Usually lipomas are, well, not usually, always lipomas are underneath the skin, so you don't have to take any skin out, which is good. So you normally just make an incision in the skin, unless the skin has been stretched a lot by the lipoma, which you might take a bit of skin out, but either way, when you're closing the skin, it's not under tension. So it's different in that respect than when you're doing a mole removal or a tattoo removal, or some other lesion that a large skin lesion would mean that the skin would be closed under tension. So you'd have to be very careful and you'd have to take it a lot more easy than you would if you're having a large subcutaneous lesion removed like a lipoma or a cyst, because those ones don't take out much skin, so the skin's not under a huge amount of tension. So in that respect, the downtime's a little bit easier, because no skin's removed, but nevertheless, you have an incision there and you will have surgery, which can make you feel knocked about, that's some brew. So the first week you don't want to get too hot and sweaty, you can watch and shower with the dressing on, after the first week you, so you'll be able to walk around and do stuff. So in terms of downtime, it's what you mean by like, you won't be down, you won't be in bed, you'll be walking around and you'll be up and about, and if you're not too sort of manual in your work, you'll be able to go to work, but it will be a bit sore. After the first week the dressing comes off, you can watch and shower normally, and then you, I would say take it easy for another week, I'd say two weeks to get that wound knitted together, and then you can start getting back into things, gently getting back into things, exercise, and what have you, depending on how it's all healed, hopefully it's all healed beautifully by that stage, sometimes not, sometimes a lot of it's all healed up properly, in which case we say it'll take it a bit easier, 'cause you've got a bit of wound there that's not quite right, or there's a bit of desirable stitch there, that's got a bit red, so take it easy. So it does vary on a case-by-case basis, but that's kind of a generator, the general gist of things. Do we offer high menoplasty? No. That would, so I said at the beginning, we can kind of pretty much remove anything, not that high menoplasty is removing something, but we can kind of remove anything, but that's kind of cutaneous. We are cutaneous surgeons, we work on the skin, and we work on pretty much any part of the body, so this would be sort of the general area, so this would be a gynecologist, so this would not be a plastic surgeon. Well, I wouldn't. There are some plastic surgeons who do kind of specialised in sort of genital area, possibly there are some out there that would, but it's not standard for a plastic surgeon. I think it would be mainly a gynecologist, or a plastic surgeon with a special interest in that. None of us have got a special interest in genital plastic surgery, so no, we wouldn't doing that, so that would be a gynecologist would be doing that. If you've had an unblockable hernia repair without mesh, is it possible to have a tummy tuck with my sore hair and liposuction? There's a lot of this. It's just the same person I wonder that keeps on asking this, well, these different people ask this, 'cause a lot of questions asked about unblockable hernia repair, meshes, tummy tucks, there's no problem even if you've had a mesh. So the mesh, I think I'm sure we had this last week, and maybe even the way you thought, when the thing about the mesh is it'll splint the abdominal wall, so it makes the rectus abdominis repair, the diversification of the recti, the recti a little bit apart. They're brought together as part of the tummy tuck. Makes that aspect of the surgery a little bit more difficult if there's a mesh there. So even if there's a mesh there, you can still do a tummy tuck, and you can still do muscle repair. It just makes it more difficult, 'cause it kind of splints that muscle repair. So you can definitely do it if there's not been a mesh there, although the same kind of principle applies that there will have had surgically abdominal wall, and so that abdominal wall will have scarring around the area. So it will be a little bit splinted, but not as bad as we're having a mesh there. So the answer is yes, you can have a tummy tuck if you've had a hernia repair with or without mesh. You can still have a tummy tuck, and you can still have muscle repair if you've had a hernia repair. It is, however, more difficult to bring those muscles together if you've had a hernia repair, and it's more difficult if you've had a hernia repair with mesh than if you've had one without mesh. But either way, we can do our best to bring those muscles together, but it might be that we couldn't get them perhaps quite as close as we would want if you've had a hernia repair compared to if you haven't had a hernia repair, but it is what it is, you've had a hernia repair. So what can you do? And as I said before, the main thing that I would be worried about if someone says I've got a hernia repair is not, well, obviously mesh I would be kind of wanting to know about it, but is more the skin incision that has been used for the hernia repair, that's an issue. So we want to know where the skin incision is, where the scar on your abdominal wall is, because if your scar is above the belly button, that's an issue. So it doesn't matter what they've done down deep, whether they've done her meshes or not, how have they made the cut on your abdomen? If the scar's below the belly button, that's fine, because all that skin gets removed. If it's above the belly button, that's not fine, because that skin remains and gets pulled down. And if it's got a scar on it, it's not going to pull as well. And there's a risk that the healing won't be as good. So it is so the wound can break down. So that is an issue. The skin incision is probably more of an issue than the mesh and the non-mesh thing, to promise with you. Yeah, I think the skin incision is more of an issue rather than what they've done down deep. So you might not know if you've had a mesh or not, in which case, you know, it's fine. You can examine feels, yeah, it feels scarred. Is it possible to remove a forehand band tattoo, which is two inches broad covering the arm? I just said, I did read through these questions before, and I did read that question before, and I did think at the time, what's a forehand band tattoo? And I still think it now. Should I go, is that a typo, or is that a thing? A forehand band, I'm assuming it's just a band. Is it just those sort of lying tattoos? Two inches. Two inches, a bit more. Two inches is quite a lot, isn't it? I can't imagine the other one. Well, I don't know. I think two inches is quite a lot. I don't need to show you what two inches is, do I think we all know what two inches is? We're all adults here. I'm going to tell you what two inches is. I think what's two inches is quite a lot. I think that's probably too much. I have removed those tattoos from the arms. The answer is send us a photo. What's better than saying two inches is sending us a photo? What's better than sending us photos coming and seeing so we can pinch and squeeze your arm? We'll give it a go with just the words two inches, but it's even better if you send a photo and even better. If you can come into the community in real life because we can give you a proper opinion because it depends on how much give there is in the skin. If there's enough give, then the answer is yes. I suspect the answer is no. I suspect what we can do is get a lot of it out. Get most of it out. Take a chunk of it out, then it becomes one inch or half inches. One inch or half an inch with a scar in the middle of it. Then you leave it for months and we do a serial decision. We do a second stage to get the rest of it out. If we can't get it all out in one go, we will warn you that pre-operatively. We always do our best to get it all out in one go. Sometimes it's a bit too tight and you can't get quite as much skin as you might think in your mind of the arm. It's not got a great skin laxity, so we can do our best. But you might end up with a scar with still some tattoo on either side. So it would be a smaller band, but if you wanted it all completely gone, you'd have to come back four months later and we'd have a go again. And remove it for you. Have I done that a bit too quick? That's it. Good to meet you. People would talk if anyone got anything. No, I am a busy guy. Don't get me wrong. I am busy, busy, busy. I've got things to do. I've got to watch TV next door. So if you've got any questions, you can ask them. Or if you do ask them, I've gone, then I will get on to them next week. I'd like to say, master, thank you to all the people who ask questions this week. You know who you are. And I will be back, same time, same place. And I hope I'll be able to go on Instagram as well. But I'll say that. But I probably won't because it's been weeks to haven't been able to. But hey, we're okay on Facebook and YouTube. We don't need no Instagram. So, yeah, so let me see you. Oh, my God, Jackie. Guys is here. How are you, Jackie? You look great in your photo or is that? Oh, right. Nice to see you. Jackie, sorry. I can't be on the on the ground. But, you know, what can you do? Thanks. Nice to see you. Nice to see you, Jackie, right? Someone's here, Jackie's here. Good to see you, Jackie. I am going to check myself out here. Jackie, I'll suggest you do likewise. And, yeah, catch you next week if I'm going back to do. And if you have, I completely understand. I believe you haven't. So, I'm going to talk on this Tuesday. See you then. 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] [BLANK_AUDIO]
