(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) - What's that? So, Facebook is a live, sorry. - It's a Q&A, but it's not so cute. - Done the video recording on Instagram because it's still kind of, well, I haven't given up on it because I always try, but not working for some reason on Instagram. Anyway, it didn't matter because I've got all you guys on Facebook and YouTube. So hello, everyone. Nice to see so many people here tonight. I have got some pre-ordained questions. If there is anyone with a question, then for goodness sake, speak up because love to do it, love to answer it here and now, engagement, yeah. Don't know that I'll crack on until something happens. So here we go, what we've got here? Can we remove a baker's cyst? So yeah, I've said before that we can remove cysts from any part of the body. I shouldn't say that because people keep on coming up with all these cysts and I keep on saying no. So a baker's cyst is the other one, no. Baker's cysts, usually on the back of the knee. And it's orthopedics, it's not plastic surgeons. So we can remove skin cysts. I'm not even gonna say from any part of the body 'cause there's some parts where we wouldn't like eyelid, labia, sort of, you know, maybe around the anus, we probably be a bit dubious. Hope I don't get banned by, for saying using that word. Sorry, I might've got to use a different word, but anyway. So there are, yeah, I mean, and also cysts on the hand are often, they can be mucous cysts which are on the fingers which are from arthritis or ganglions which are around joints which we can do, we've got some Sam at the clinic who's a hand surgeon who does those sorts of things but they're a little bit more difficult, they're a little more complicated. So yeah, so we can't remove cysts. Well, yeah, we can't remove all cysts and baker's cysts is one we can't remove. We can remove a lot though, we have a lot of cysts but baker's cysts is one that would be a no. Carrying with cysts, okay, on the neck, that's another one, mainly yes, I mean, the problem with the neck is when you present with a cyst on your neck, let's be honest with ourselves, you're presenting with a lump on your neck, a necklump, there can be lots of reasons for necklumps. So necklumps is a thing, you know, there's loads of different reasons for necklumps. So if it is a cyst and the skin in your neck, no problem at all, but one aspect of it would be ascertaining whether it was a skin cyst as opposed to perhaps something deeper in the skin, a deeper behind the skin. So there's lots of reasons for lump sum, there can be lymph nodes, there can be glands, especially up here, salivary glands, there can be things like pharyngeal pouches and bits that come off your windpipe and your pharynx and what have you, so weird things. So you've got to be a little bit aware in terms of necklumps. But as I say, if it is literally a cyst in the skin, definitely we can, but it does need a little bit more thought than some other areas of the body. Yeah, I saw, I don't know if you're out there aiming, but I did see that message from that person, someone sent a rude message to us about Amelia. So Amelia, because I mean, what they, I think what they've done, they'd inquire about cysts and then we say, look, send us a photo and they sent us a photo of these Amelia and we say, well, we've probably better off seeing a dermatologist about that and then they get upset. So, you know, that's like, that's a bit, and they're like, why are you sending me all these emails? I mean, you can't do it. And so we'll send you email, that's cyst removal and this is Amelia. So Amelia, a little like spots and they are usually multiple. And one of the kind of problems with what we do is we do surgery, you know, we do kind of cut things out. And things like Amelia often don't need surgery. So there's a lot of things that actually don't get to us and it would probably be better seeing a dermatologist because a dermatologist might have some other treatment for them, some more less invasive if you like treatments. So if you've got sort of multiple lesions and multiple things, especially very small, perhaps we're not the best, to be frank. We're better at kind of bigger things. So if you've got lots of little things or like rashes and things like that, then a dermatologist is more of an expert in those sorts of conditions. Whereas when it gets bigger and gets to sort of surgery and things, that's where we come in. So sorry if you have feel misled, that person who inquired about the cyst and got told that it would be better to see a dermatologist, but we are, believe it or not, actually trying to be helpful. So that's what kind of happened there. What you got Bob, I'm in touch with your clinic about removing of a sedation cyst on the back of my head. If I go ahead, what's the chance of it reoccurring? Good question, Bob, the problem with cysts is that you need to remove the cyst wall. If you remove the cyst wall, that cyst should not reoccur. Now, some patients are prone to cysts. So you could get another cyst, I don't know if that's obvious or not, or maybe that, but certainly specifically speaking with that cyst, if we remove all of the cyst wall, then that cyst should not reoccur. So what we aim to do is we aim, so that's one of the reasons why surgical excision is kind of the final common pathway of the cyst removal, because if you burst the cyst or if you lance it or whatever, and the cyst wall remains, it just fills up again. So what we try and do, so that's one of the reasons we have to make an incision about the size of the cyst, rather than just making a little stab in it and like evacuating it, so we have to get that wall out. So we have to make an incision the size of the cyst, we have to make sure we get it all out. Now, sometimes it comes out really nicely, Bob, and we can say, look, happy days, it's all come out nicely, I know I've got all the wall out, you're fine. Sometimes it kind of breaks apart, and especially if it's been infection there, it's all scarred, the edges are a bit indistinct, and it's like, to be frank, you think, oh, craky, ah, you know, we obviously, we always aim to get all of the cyst wall out, but sometimes it's difficult, frankly, and sometimes you worry that you may not, I've got it all out, and sometimes it, if you don't get it all out, it comes back. So there's not a hundred, so pre-op, if you've got a cyst on your head, there's not a hundred percent guarantee that we can say that it's not gonna return. However, if it does return, we'll just, we'll do it again for free, and we have had to do that a couple of times to be fair. So sometimes, particularly if there's been infection previously, particularly if there's any sort of, if it's not a straightforward, nice sort of smooth cyst, if there's kind of inflammation in the air, that's why if it's infected, it's best not to have it removed, 'cause they'll have a nightmare to remove when they're infected. So we wanna do it when it's not so unquiet, and you know, when you do assist in your mind, or in my mind, I always think, oh, yeah, it's gonna be beautiful, get a nice plane between the cyst and the surrounding tissues, and you shell it out, and it all comes out as a nice cyst. But the reality of it is that wall can be quite friable, and you're grabbing it, and the forceps kind of break the wall, and the wall breaks up, and all the contents of the cysts come out, and it's a little bit more difficult then to see the plane between the cysts and the surrounding tissues, 'cause the wall is broken. You can often still maintain that, and even though you break the wall, you can try and still focus on that plane, and make sure you get all of the cyst wall out, even if it's come out fragmented. So it might look like a mess, but when you're doing the surgery, you can actually keep on track with that cyst wall, and make sure you get it all out. So even if it doesn't come out as one piece, if it comes out as one piece, then you've got it all out. But even if it doesn't come out as one piece, you can still be relatively confident, you've got it all out. So we aim for it not to come back, Bob, it's the answer. But there's no kind of hundred percent, 'cause we don't know how it's gonna go in the operation. But if all goes well, happy days. If it doesn't all go well, and it comes back again, as I say, we'll just remove it again for you. Can we remove a polynoidal cyst? Oh my goodness me, with all the questions of the cysts we can't remove. So that's kind of in the natal cleft, the pylenidal cysts. So it's the top of the natal cleft. And again, can we? That's the question, isn't it? We don't, we don't, we don't do those cysts. Pylenidal cysts are usually due to hairs on your back. They're usually male people, and if you've got a hairy back, it's a thing. And they fall into the crack between your buttocks, and then they kind of work their way in and form a little sinus and they can form an infected cyst. Cheap drivers bum is kind of what they call it. So it's people who hop and sweaty, cheap drivers or truck drivers or things like that. And they can be a very difficult street. They often get infected, and they open off and drag on for a long, long time. Exacerbating factors are being overweight and smoking. The really bad ones are always in it. People who are overweight and smokers, 'cause they reduce your ability to heal, and so it drags on and on, and if they get infected, they can form what's called a pylenidal sinus, which is like a connection between the cysts of the skin, and it discharges, stuff comes out, and it gets infected and it's very difficult to treat and very uncomfortable for patients to experience. And it often will involve laying open, which means often it means kind of cutting an X, and then cutting the corners off the X. So you kind of have a hole there so that all the evil humus can come out, you pack it, you put this pack in, and then the pack changes every day. This is something that I did when I was a general surgeon, the district nurse, whatever, we change the pack every day, and you just gradually put less pack in, and it's a difficult problem. And only when they're kind of really big or really complicated with a plastic surgeon, potentially get involved to sort of cover the defect, if there's a big hole there, but the actual management of pylenidal cysts are usually, if it gets to a surgeon, would be a general surgeon who would be involved in getting rid of the infected cyst, and maybe laying it open and packing it. So we tend not to do that one. So yeah, baker's cysts and pylenidal cysts is two other cysts in the density, but we do all the other cysts. Well, most of them, anyway, not eyelids, mambobium. And so the next one's gonna be, come on, someone asked me about mambobium cyst, easy for you to say, 'cause we don't do mambobium. Mambobium cysts, the bambobium cysts are on the eyelid. Where else don't we do say, I'll say labia, we don't do that, the gynecologist, your eyelid would be ophthalmologist. Give me a question, I can answer, come on. What's the difference between a shave and excision when having a mole removed? Okay, so, first thing, pretty much, I'm gonna use some sweeping statement that I'm probably gonna be proved isn't factually correct. But I think this is correct. Pretty much any kind of mole can be excised. So excised means cutting it out and stitching it up. So that's an excision. So an excision is valid for pretty much any mole. If it's a really big mole, it might not be able to excise, be excised and closed. So you might need something else to cover the hole when it's removed, or you might need to see a excision or something. Most moles aren't that big. Most moles are small and are able to be excised, cut out and stitched up. Which is, I think what most people associate with a mole removed, they think that's what it is, you cut it out and stitch it up. So that's valid for any mole. Shave excision is only for a subset of moles. And the two criteria that need to be met are that the lesion has to be benign, or at least presumed benign, clinically benign. So if we look at it, and we think it's a cancer or potentially a cancer, we would not shave it. You shouldn't shave a cancer. If you're worried it's a cancer, you should excise it. So if there's any worry that it's a cancer, shave is off the cards. And it has to be raised. If it's not raised, you can't have a shave. So if it's benign, clinically benign, if it looks like it's not a cancer, and it's raised, a shave is an option. Now, excision is still an option. So as I say, excision is an option for everybody, but for flat ones or potentially cancerous ones, excision is the only option. For raised and benign ones, a shave excision is an option, or a shave, you shouldn't call it shave excision, 'cause that's a complicated terminology, but a shave is an option. So a shave takes it off at the level of the base of the lesion, that's why it has to be raised, 'cause if it's flat, you can't, I need to shave against this. So the difference is the shave will just sort of take the bit of the mold that's above the skin off. So it'll give you a flat patch kind of scarf as opposed to an excision, which gives you a line. And there's pros and cons. The shave is kind of less scarring, 'cause it's not as deep, it just goes the level of the skin flush with the skin. There's no stitches, it's just like a little dressing, 'cause it's like a gray, so we give you, and we put a little dressing on, and it heals as a sort of patch. Whereas an excision gives a bit more of an obvious scar, it's kind of a line, a line, an excision. So it's a bit more of a kind of obvious what you would imagine a scar to be, whereas a shave is kind of like a patch. So cosmetically speaking, probably a shave would probably look better, not always, but probably. Unfortunately, medicine is not a precise science, so you know, just have to say, usually it looks good, you can't guarantee everyone is gonna look good, but you know, usually it's good. And the bad things about a shave is that if it's pigmented, if it's got color in it, if it's a mold color, sometimes the color goes deeper than the level of the shave, 'cause it just takes off the level of the skin. So you end up with a flat patch with still color, so you end up with kind of like, still a mold really, but it's not raised. Now you might say that's fine, 'cause it's just the raised nature that bothers me, but you might be a bit cheese off with that, you might say, "Oh, hold on a minute." You know, the movement mold is still there. In which case, an excision would be an option. And the other bad thing about a shave or risk with a shave is that if it's got hairs, sometimes these raised moles have got hairs growing from them. If they've got hairs growing from them, often the hairs go deeper than the level of the shave. So again, you get rid of the raised nature of the mold, but you still have these hairs growing, at least can sometimes be dark hairs and a bit annoying. So if you're concerned about being pigment left behind, if you're concerned about hair follicles, then you might choose an excision versus a shave. Often, also, sometimes people don't like the thought of a shave. They don't like the thought that you're only removing the sort of proud of the skin. They don't like the thought of there being some mold left behind, 'cause they think it's gonna grow back. Or, you know, they just want it gone. They don't want the, you know, I don't know, psychologically, they just want it off, which is fair enough that they could have an excision. So as I say, anyone who's a candidate for a shave is a candidate for an excision, but it's a bit more of a thing, an excision, 'cause it's like a full thickness cut through the skin, and a stewardship to come back a week, eight to have the sutures removed. But it's six and two threes. I'll be honest with you. And the price is the same. And the procedure is similar, I guess a shave's pretty bit quicker, but, you know, it's similar, sort of led the procedures for a small, small, small, in any way. Some areas might be difficult for an excision on the nose where the skin's tight. So we might, you know, suggest a shave might be better, but, you know, maybe the orientation of the leash might be an issue if it might be favorable for a scar. So I'd say, well, you might want to have it removed. I don't know. We can talk about it. We can wrap about it anyway. But that's kind of what we talk about when we come to the clinic, those two options. As I said, assuming you're a candidate, not everyone's a candidate. Good questions, Amy. Well done. Thank you for the questions over those people who asked them. I will be back again next week, Tuesday night, seven o'clock, same time, same place. Bob asked a live question. So, well done, you, Bob. We should stamp your card for that. That's a loyalty scheme. We haven't got one. I just thought we just know. But if you have any questions, anyone, then do, by all means, message me. I will do my level best to answer them. And who knows? If you're lucky, it might get on next week's show. So, yeah, I'll be back next Tuesday night at seven o'clock. And without further ado, I'm going to say... That's it. Good night. And God bless. I'll get your feet up. 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. (gentle music) [BLANK_AUDIO]
