(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) Right, that's it, yes. So we're live just talking to my Instagram followers there. Greetings to my Facebook and YouTube followers. You know who you are, I don't know who you are, but you know, of course I do, of course I know who you are. All of you, if you have a comment, if you have an opinion or a query, post it, why not? I'll do my level best to answer it here and now. If you, that is my coming out chair here, which is in my on the air sign, which setting's important, you know, a lot of thoughts gone into the setting here. It's a bit dark in here, doesn't it? Anyway, if you've got a question, then I'm here to answer it. If you're just here for the info, then sit back and enjoy the ride because there is gonna be some pretty interesting stuff discussed in tonight's program. Things like healing of a birthmark, factors, a factor birthmark. Okay, two birthmark things. A lipoma on a spinal source, moles, lasers. Anyway, all sorts, all sorts. And anything off the crops up. So anyway, let's guess, let's guess train it, 'cause time waits for no man. So what we've got here is a question that says something like this, how long is the average healing process with birthmark removal on the neck? This is, well, first of all, the word birthmark doesn't have to be there. So it could be how long is the average healing process for lesion removal on the neck? Because whether it's a birthmark or whether it's a mole or whether it's a tattoo, you know, it's removal of a piece of skin on the neck, basically. And secondly, I do, I won't say get criticized, but I can understand how people can get frustrated and say, well, how much does it cost to have a birthmark removed? Because the answer is it does vary. And birthmarks can be little things. They can be brown, they can be red, or they can be big. So basically they can vary in size and that will affect the healing time. If it's a big lesion and it's closed under a lot of tension, you know, the neck's obviously moving. So there's a risk that you can get issues. The good thing about the neck is there is quite a lot of skin laxity, but there is skin laxity there for a reason because you need to kind of move your neck around. So it's one of those. But you can remove a reasonable amount of skin from the neck without too much tension. So the tension is important in terms of the healing. So the less tension is under the better and the quicker the healing. But in general terms for removing a lesion from the neck, be it a birthmark or whatever, usually the skin's healed in about a week. So on places like the neck, we've probably put a little dressing on there and the dressing stays on for a week and then the dressing comes off and the skin's usually healed in a week. Now the skin's healed, which means that you normally don't need a dressing. I'll say usually 'cause sometimes there's little bits that aren't healed, especially if we use dissolved with sutures, there can be little bits where it hasn't dissolved properly and there's little red areas and raw bits. But broadly speaking, the skin will be healed in a week. So that means you can wash, you can shower and you don't normally need a dressing. So you normally need a dressing in for a week. Usually, well, I wouldn't say usually the next one of those ones where you'd often use dissolved with sutures, you might use removal sutures. If you use removal sutures, they would, again, come out half about a week 'cause that's around the time that the skin heals. So skin healed in a week, but it won't be full strength. So whilst the skin will be healed, you can't kind of go back to normal activities and start going to play rugby or whatever. So you need to take it easy for a few weeks. Now with skin, the scar is probably not gonna be up to full strength for a few months, but I would say you gotta take it easy for a few weeks and then gently get back into things. As a general rule, we normally say six weeks before you start massaging the scar, the scar's often quite firm at six weeks, more firm at six weeks than it was at one week because the scar is kind of strengthening. The more tissue is going in to reinforce the scar, your body is making that scar stronger, which is good, but it makes it quite red, raised and thickened. So it can look more unsightly when whilst it's getting stronger and then it goes through a process called remodeling, which is the redness fades, the thickness thins and it goes into a hopefully a fine white line. It takes several months to get there and massaging it in that time can help. And while it's going through that active process, you don't want to get sun tan on it 'cause it will leave you with a tanned scar. So a week for the, specifically for the skin healing, I would say a few weeks before you do anything too strenuous. A lot of this is guided by your body. If it feels tight, if it feels uncomfortable, don't do it. If it feels okay, it's okay. So listen to your body and a few months for the redness, the firmness of the scar to sort of fade to go more skin-coloured. Generally speaking, all under the umbrella of kind of depending on how big it is and how tight it is and how well it heals, some people heal better than others. And there might be some delayed healing and some issues that put, set things back so it can vary. That's a general whistle-stop tour of healing of a birthmark on the neck. I was also wondering, what's the same person in? Is there any factors that can affect having a birthmark removed on the neck? Oh, okay, so it's the same person, two-part question. Two-part question. I was also wondering, is there any factors that can affect having a birthmark removed on the neck, for example, weight, height, et cetera? So the main factors, as I've said, is the size of the birthmark. Height is not a factor. Weight is a bit of a factor. So if you're overweight in general terms, you are at a higher risk of complications, sticking into things like wound healing. Smoking will have an effect on wound healing and reduce the chances of it all healing up nicely. So it's increased risk of wound breakdown if you're a smoker. But height, not so much, weight, yes. But not massively. There are some operations where you're height, well, I'll say height, your height's never really an issue. It's your weight, it's an issue, but the height and the weight is combined in a BMI, body mass index, but it's the weight that's the issue because you're height, you can't really change. So, let's see, crouch down, I suppose. But so, yeah, if your weight is high, then you are at increased risk. And as I say, some operations, it is quite important. So we will measure your body mass index and we'll give you some advice about that. Maybe we would advise you not have surgery if your body mass index is high. Having a birthmark roof in your neck is not one of those operations. So it isn't something we would routinely focus on your body mass index as long as it was within sort of acceptable realms. But if you ask the question, would it be better if my weight was lower, assuming you're overweight, then yes, it would be better if you're overweight, but it's not a massive problem. And again, it goes back to how big it is. If it's a small birthmark in your neck, then less of an issue. If it's a big one and you're thinking God, there might be wound healing problems anyway. We've got to maximize our chance of wound healing, particularly if you want to lose weight. It might be an idea to lose weight first. The other thing you might find if you lose weight, you might have a bit of small skin laxity if you lose weight. So that might help us out if it is, again, as I say, it is a big one. I have a lipoma on my back and in my spine, you can pull the lipoma away and put fingers underneath. Well, where I need a scan before you can offer removal, this is a hard run. We often get patients. What we ask you to do, going back to the earlier point that it can be variable, kind of how big a birthmark or a lipoma or a lesion, if you like, is so it can be difficult to advise you. What we do and something that I feel is, I guess it's not unique, but it's something that we're kind of pushing as a thing at the clinic, is to ask you to send us a photo on WhatsApp first. So if you send us a photo on WhatsApp first, by first, I mean, before you even come to clinic, so don't charge or anything like that. Just send us a photo on WhatsApp and we can give you an idea from there. And sometimes we'll say, look, yeah, that's going to cost that much. Yeah, that's going to need a scan. That's not going to need a scan. That's going to be fine. But often, we won't be able to give you 100% based on the photo. We kind of have to see you. We have to examine you. And this is one of those. So, lumps on the back, especially central over the spine, could be several things. So you might be thinking, hmm, is it something else? But sometimes we can tell it's, for Princess Assist in the skin, you can tell it's assist in the skin, and particularly if it's not so big. And you might say, well, that's okay. I can tell what that is. And I'm happy to remove it, you know, without having any imaging of what it is and whether it's potentially connected to anything from deep or down. So this is one of those ones where, if you can send us a photo, that'd be helpful. And I know lipomas are often not visible on photos. So if you can take us a photo and perhaps circle around where it is, that will be helpful and give us an idea of scale. So don't try and, don't tell the photos too close up. Or if you do take a photo close up, take one close up and far away so we can just get an idea what part of the body of them. We don't even know what part of the body is. You know, you see you spine, it could be over your neck, it could be over your bum, you know, it could be anywhere. So, photos really helpful. I guess size will be important. If it's big, there'd be more likely to be concerned about needing a scan, if it's more or less likely. But ultimately, without seeing a photo of this, my general advice on this one would be, if you don't mind, we probably ask you to come to clinic, we'd see you. If you want, you might want to book a sea entry appointment. But we would reserve the right to say to you, look, I think I'm not coming to removing that based on the history and examination that I've ascertained here in the clinic. And I think it'd be better if you got a scan which we can help you arrange. Before hand, so I can't really say whether it is that or not. And, you know, it's one that we'd have to probably say to you, we might do it. Because there's some areas where you kind of think there's several things. This could be the neck, lumps in the neck, as I say, lumps over the spine. Other areas, you kind of a bit more certain that there's not a lot going on. There's not a lot of other things it could be. So you'd be less concerned. The forehead, for instance, they've just got skin and bone. There's not many things it could be, you know, things on the arm and what have you there. You're often thinking, we have got an idea what that is. But over the spine, there's certain areas like here and here. You kind of worry because there's things called dermoises, there's certain particular areas that you would be concerned. So it's something that's kind of worth a discussion first, which I guess is what we're doing. We're discussing it, aren't we? So, you know, that's one of those areas where I think you'd want to have a, we'd want to leave it open as to whether we need a scare for that one or not. But that's the whole point about this, the WhatsApp settings photos. So we kind of avoid too many of the situations where you come, perhaps, refuse to treat or revved up to have it done on the day. And then suddenly we tell you something or you find something out on the day and you think, well, I don't want to have it done now, so we try and get things and try and be as transparent as we can, about costs and what's involved in this stuff. Before we come to clinic to save you a journey and to save us, you know, a missed appointment, sort of thing, not a missed appointment, but a appointment where we've blocked out a seeing treat by you not having it done. So we try and avoid that as well by giving you as much information before you come so you can be sure that you want it done. But even so, we always say to people with this, any doubt and you're not, you know, you're not sure, there's no problem at all if you want to go and have a think about it if you do, because book a seeing treat, which I won't be quite relaxed in that regard, because it is a big deal with having these sorts of procedures. How do we remove molds? Do we offer laser removal? No, we do not remove molds by laser. I've done a blog about this, which if I could, I'd put it in the post, I'll be, yeah, put it in the whatever comments, I probably can't, but I don't know how. So we remove molds with, so not laser, not laser, with surgery. So with, like, the cut out basically, so you excise them, we cut them with a knife, we can do some type of shapes or cure it harsh, depending on if it's like a separate keratosis, you can scrape them, or if it's some kind of raised benign mole, you can shave them, or we can excise them, cut them out and stitch them up. We don't do laser. Laser is good for multiple molds, we've got loads of molds. But I think why are having loads of molds removed, because it will leave a mark or a scar or whatever. The problem with laser is you can't send the lesion off of the histology, it's only for a pigmented lesion, for a brown mole, it's good practise to send it off histology, even if you think it's benign, it's good practise just to send it off histology, where they're looking at the mouse code to make sure that there's nothing wrong with it. But we do not offer laser treatment. In my view, I don't think laser is the first line for a mole removal, but, as I say, I don't do it, we don't do it at the clinic, so you better off speaking to someone who does it, if you are interested in laser removal, 'cause we don't do it. And one of the things about that we're encouraged to do as doctors is to talk to you about all the options, whether or not we offer them. So, we're happy to talk to you about laser removal, and hopefully the laser removal, people will talk to you about excision. But, as I say, if you want a full view on it, you should probably talk to a laser person about it. But I've got my view about laser. Mole removal, which I've done a blog about it, and I don't think it's a first line for pigmented lesions myself. But, you know, it's a free country, so you can meet your own decisions on that one. And I know, I know why it's not popular to me. I know everyone's getting revved up for the football, so it's no other, no, it's not a personal slur on me, I understand that, so I understand you are watching a football tomorrow, you'd all be watching this week, this replay, I'm wondering where everyone was. Well, I'll tell you that's where they were, they were watching a football. So, I guess there's a pretty match handle, is it, 721? So, yeah, I mean, I'm busy by myself, I'm gonna go and watch the pretty match handle myself. So, with us all, I'm at our questions, I'll be honest with you, that's the end of my questions. I will, obviously I've got a lot to do, so I will go and do that then. But, next Tuesday, yeah, you heard me, same time, same place. Facebook, YouTube, obviously you've got a huge following on those platforms, so that's great. Instagram's still a work in progress, but yeah, I will catch you, same time, same place, you've got the questions, post them, and I'll do them next week. And yeah, hopefully we'll, you know, we'll be watching the football tonight and having a good, good time. Yeah, let's all have a good time. All right, yeah, come on. See you then, next week that is, yeah, 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. (soft music) [BLANK_AUDIO]
