(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) - On paper off, not even off, but I'm on this week. So I'm doing it, Q and A, just had a rant on Instagram to explain my displeasure not being able to do this on Instagram 'cause I know a lot of my followers are on Instagram and frankly, they're suffering 'cause they're not getting my life on Q and A, but I'm sure that I'll pull some strings. I've just posted a video which I'm sure will have the desired effect. Also, hot on the heels is TikTok 'cause I do believe you can do live things when you've got 1,000 followers, just checked 600 odd, 24. Said plus 24, so that's up, 24 in don't appear at all time, maybe a week or a month or something, but not in substantial number, I think you'll agree. So clearly, the reach is getting out there and not to mention all my followers on Facebook and YouTube here tonight. So thank you all for being here tonight and giving up your time, it's lovely to see you all. So I've got some questions, if you've got a question then post away and I will do my level best to answer it. But if you haven't, sit back, relax and just see what comes your way. First things first, is that chair in the way? My own air sign, yes it is. That's my rotating chair that's been condemned. So I don't know why I have it there. It's all walking, I don't know why that chair. There you go. Is my, oh sorry, if my tattoo is not suitable for excision due to the size and laxity of skin, could you use a tissue expanded stretch of the skin? Good question, who are these people who are asking me sorts of questions? 'Cause that's quite an informed question, I would say. And good on you, whoever's asking that question. I kind of feel that's almost a plastic surgeon asking that question, not a pretty many answer. But so tissue expansion is a technique of covering large defects that don't have to be covered acutely, that don't have to be covered straight away. So obviously if you've got a big cancer that you have to remove or a big wound due to trauma or something, we have to cover those straight away. So we have to use certain techniques to do that. But if you have got time, if it's not an urgent or an emergent procedure, then there are other techniques you can use to import large pieces of skin and tissue expansion is one where basically you put kind of like a balloon, we'll call it a balloon for the sake of understanding underneath the skin, you blow the balloon up, that stretches that skin same as like what happens when you have a baby basically and your tummy skin gets stretched. And then you can take the balloon out and then you've got a whole load of stretched skin that then you can use to cover the defect. And so it is a technique to kind of grow more skin, I guess, because that's what happens when you put skin under tension, more skin kind of grows. It's called the stress relaxation phenomena. And it's a property of skin. When you put it under tension, it kind of grows more skin if you like. And so the tissue expander is a way of exploiting that. Now, so if your question is, could a tissue expander be used to expand the skin? So what you would do is you would put it next to the tattoo, you would expand the non-tattooed piece of skin, and then you would take the tissue expander out and cut this big tattoo out, and then use that expanded skin to fill the defect. So could it be done? Yes, simple answer, yes, it could be done. Would I do it? No, I wouldn't do it. For a couple of reasons, one reason is tissue expanders are not good on the limbs. They've got a high complication rate on the limbs, and often tattoos are on the limbs. There are certain areas where tissue expanders work really well. The breast, for instance, a breast reconstruction. So if someone has a mastectomy, they've got a flat piece of skin there because they've had the breast removed. Tissue expansion is a really good way of treating that. You can put a bag underneath the skin and you can blow the bag up. The kind of classic, I guess, area for the use of or the indication of tissue expansion is on the scalp. If you have a bald patch, if you have a car accident on an open top car and you take the top of his scalp off, and then you have to have a skin graft or something, then you can expand the hair-bearing skin and use it to cut out skin graft and put hair-bearing skin. Now, that's good because it's a specific quality of the skin next door to it, that it's got hair on it, and then you can use that. So a couple of areas where it's good, but it's not good on the limbs, but also it's quite a big deal. Tissue expansion, you might see these people with these weird sort of, they look like, sort of like these weird growths, basically, 'cause sometimes if you have a quite a large area, you can put two or three tissue expanders around the area. You have to come back to clinic every so often, maybe every week, maybe every couple of weeks, to have the, there's a little kind of buried port, usually. Sometimes they're externalised the ports, but basically there's a little port where you can put a needle and then inject fluid to blow the tissue expander up. So you have to gradually blow it up. It looks odd, and it's also actually quite, and then once you leave it throughout, and you take it out, it's also actually quite, often I find quite unsatisfactory the amount of skin that you get from a tissue expander, and you have often had big doggies, big bumps where you've turned the skin over to fill the defect. And it's quite an involved procedure. And in sort of answer to the question of someone says, would you use a tissue expansion? The expander, my art would be my preference, would be not to use a tissue expander. My preference would be to do a cereal excision. So you might have heard me talk about cereal excision before, where you cut a piece of the tattoo out as much as you can, you're really tight, you leave it for months, and then you can cut more out because it's not tight anymore. And that's relying on the same concept as tissue expansion. So it's utilising the same quality of skin that when you put it on detention, it grows more, but it's doing it in a different way, and it's doing it in what I would say is a more kind of less complications and sort of easier to deal with way than putting tissue expanders under the skin. It's quite an intensive thing to put user tissue expanders, say people have to come back to clinic regularly. There's a high complication rate. Complications make things like extrusion and things like that. Not to mention the physical nature of having a big plastic bag underneath the skin, or balloon, or whatever. And so I feel that cereal excision is a better way to remove most tattoos. I've certainly never used a tissue expander for a tattoo removal, and it's not high on my list of ways that I do it. And it's very personal, I think like last week or week before, sometimes I talk about skin grafts. You know, some people might do skin grafts. Personally, I don't do skin grafts. Personally, I don't do tissue expanders. You know, I do, I do excision, which is just cutting around and stitching them up, which is sort of the mainstay of it. It is too big for excision than cereal excision, which is taking as much as I can, and then coming back four months later. And as I say, it's the same concept of tissue expansion, but in my view, fewer complications, less kind of intervention and less, kind of a more manageable of it from a patient side of things, both in terms of the amount of times you have to come back to clinic and also in terms of the fact that you have a big bag, you have to deal with it. It's going to be a bit uncomfortable and can look odd. So for all those reasons, my preference is cereal excision rather than tissue expander. But as I went that beginning of the question, can you do a tissue expander? Yes, you can, it can be done. And there might be someone out there who's doing tissue expanders for large tattoos. But I'm not, I'm not him. So yeah, good question. I don't like that question, well done, well done you. How soon after eggplants surgery, can you have implants? So one must presume we're talking about breast implants, obviously, what other implants were we talking about? So, well, I guess it kind of depends on why you're having the implants out. I mean, if you're having an animal infection or something like that, obviously you want to make sure the infection is all cleared. But if you're just having them out because you want them changed, personally, I will do a change of implants. I will take them out and put the next ones in at the same time. So unless there's a reason not to do it straight away, 'cause kind of, if you're asking that question, I kind of, this is a patient who's, well, maybe they've already had an ex plant, but you know, if you haven't had the ex plant, I'd be like, I would put them out and put them back in again. At the same time, there might be a reason why you wouldn't do that and infection is kind of like the obvious one, but that's just, so that's the first thing. I would often do it kind of immediately in the same operation, but if for whatever reason there's a reason not, the pocket's not right or there's some issue or something like that, fair enough. I'll ask the question in that case. I was gonna say four months, it kind of depends a bit, you know, it depends on how things heal and everything. If it doesn't heal up properly, if it's, as I say, there's infection around the area or some of that, then you might want to leave it a bit longer, but four months, I say, it would be a good ballpark. And that would be kind of like a minimum because you want that scarring to settle, you want the scar tissue underneath the skin or to soften and settle from a surgical point of view, the longer you leave it, the better. So the longer you leave it, the more supple those tissues get, the more supple and soft that scar gets, the better. So really, from our point of view, we kind of want to leave it as long as possible. The surgery's a lot easier, the longer you leave it. You know, if you go in too soon, the surgery's not very easy. I used to do things around three months. I'm thinking more about serial incisions and things now, but it's the same concept, you know, going back into a surgical field. And it's just not, you know, four months as a ballpark, I think is a better ballpark, but it is a ballpark, you know, might be longer, might be shorter, hurting heels really well. It's lovely, soft and you've got reasons to get it, you know, get on with it, you know, might be three months, but I'd say four months is a ballpark for me anyway. As a general rule, can you repair an earlobe if it has not completely split all the way down? Yes, you can, for sure, you can. And it's not uncommon for people to have that repaired. So that would be like an enlarged earring hole, I guess, if it's not quite split. And people often, because of the sort of back of the kind of butterfly of a stud or something, they can fall through and the earrings fall out and things. So people often want earring holes reduced, should we say. And the ins and outs of how we do that would depend on each person. If there's kind of like a really, really tiny little bridge of skin, sometimes it's as easy to complete the split and then repair it as if it's a complete split. But if there is a fair bit of skin left and we can just reduce the hole, and that would be something we'd assess. But the principle is yes, you can repair an earlobe, it's not completely split, you can reduce the earring hole. And the principle we do is same as a split earlobe as to whether you would want to keep the hole or have it re-pierced elsewhere. And it's always easier to have it re-pierced elsewhere. Although if you really wanted to sort of keep using that hole and there are techniques you can use to mean you can still use that hole, although it'll always be weaker than kind of fresh piercing elsewhere on the lobe, but these discussions we can have. But in general terms, yes, you can repair it. And in last, earring hole or not quite fully split earlobe. Can we remove a fibrous papule? Yes, we can, I guess it depends where it is. Sometimes that kind of intraoral or on a mucous membrane that we might like inside your eyelid or something like that we probably wouldn't want to get involved with inside your mouth, probably say, look max facts for that. Eyelid may be an ophthalmologist. But the general thing and the way that we've structured this thing where we do this C and treat clinic is that what the reason we can do it, well, there's two reasons. The first reason is we've got our own minor operating room in the clinic, which is kind of just ours, just mine. It's not like a hospital which has got a minor operating room which on any given day could be used by any surgeon. So you can't just, usually you can't just go to an outpatient appointment and say, all kind of have this removed today because they'll be like, well, the operating room's been used for someone else, but in our clinic, we just got what, you know, it's our operating room. So we've set it up. So we're available to do the procedure on the day. So that's one reason we can do the offer the C and treat clinic, but the other reason which is we found really good is we asked people to send us a photo and a bit, maybe a bit of, you know, a bit of background as to what the lesion is, because then we can give you an idea as to whether we can do it or not. 'Cause obviously we say always max bags or technology or some other surgeon or we might not be able to do it, then it saves you having to come, you know, for a C and treat appointment. And also the, so the, if you send us a photo, it gives it, we can give you an idea whether we can do it or not, and also a price. So you don't have to, you know, think, oh my God, what's we gonna do? So therefore, if we can give you an idea whether we can do it or not, and we can give you a price, then you, oh, usually got a pretty good idea where you want it done or not. So it saves you having to come for a consultation to discuss it, and then come back to have it removed. So that's kind of the, I'm not gonna say revolutionary because I mean, if C and treat clinics do exist, but it's one of the things we're really pushing. And I actually heard it here first, I'm making a new website. I'm in the process of it. I've been a bit set back because of the those IT problems and all the internet problems and things, but it's called C and treat.co.uk. And it's focusing on, 'cause what I wanna do at the clinic is to more, we're moving more towards, you know, the minor, the clinic, the Moles assist the, that's kind of what I'm transitioning to. I'll be honest with you. I'm doing more of the Moles assist, the low-clanesthetic cases, and that's something I wanna try and focus on at the clinic. So yeah, fibrous papules is up there with a lamp and bump, but as I say, we'd have to see where it is. Get a little bit of history, send us a photo, and then we give you a bit of an idea of what it would cost you if we did do it or whether we could do it at all. (scissors snipping) Bit of a breather there. Halfway in, not quite half way in. It's the last question, I'll be honest with you, so if could, if you've got a question, get it in, 'cause this is the last one, right, this way. Can we correct styles, Batteries? So Batteries, terrible name, I know. It's not great, is it? But a style ear deformity, should we say it's started? So ears is one of those things, one of those operations, they're kind of like, a bit like breast implants in a way, I suppose, that all plastic surgeons do it, really, yeah, no matter what your specialty is all plastic surgeons do it. There's very few ear specialists in this country. There's like a handful of people who specialize in ears and they'll do ear reconstruction for people who've born without an ear and quite significant things. And so, kind of like a prominent ears is a very common complaint and we do prominent ear correction. I say we, I don't do it. The other surgeons at the clinic do it, but it's a standard, I used to do it, but it's a standard thing that pretty much all plastic surgeons will do. But a style ear deformity is not a standard prominent ear. It's a deformity of the cartilage of the ear and it's more complicated and it's probably gonna be a ear specialist. So it's another one of those ones where I'd say, "Look, set us for whatever, look." And we'll get the guys who do the ears to have a look at it, but just in general terms, a style's prominent ear or a style's ear deformity is, I would say that's usually an ear surgeon. The one we have here in Birmingham is Mark Lloyd, used to work at the clinic, doesn't work at the clinic anymore. Not sure how, I think he's compound time and things like that, but he is an ear specialist. That is his kind of subspecialty. And I say he's one of the few in the country that actually specializes in ears. But there are others, literally dotted about this. And I would suggest a style's ear deformity would be best treated by an ear specialist. But as I say, if you have, I mean, you might not know, you've got a style's ear deformity, you might just say, "I don't like the look of my ears," sort of thing. You know, it's always best to step down and say, "Look, what we can do is say, "Look, that's fine. "We can do that, that's fine. "You just need to reshape the cartilage "and do what we do with the prominent ear correction." If it's a style's ear deformity, that's a little bit more complicated. And probably will be an ear specialist, I would suspect, if it is a style's ear deformity, but there's ranges with all these things. So, that's it. Well, thanks for your time. Next week I might be away. So, being in the next couple of, I don't know when, but I'm sure Chef Bezos would have seen my message about Instagram, so no doubt, I'll probably be back on Instagram by then. And, who knows, might have 1,000 or 1,000, whatever you need, TikTok. 1,000 TikTok subscribers or followers or whatever, in which case, I want to be on TikTok as well, but I've done enough devices to TikTok and Instagram. But anyway, we'll get the ID department looking at it. If you have any questions, just put them in the comments, I suppose, or email us, or contact us somehow, and do my level best to apply to them. But, if not, then you haven't got any questions, so just be happy that you come to all your life and you haven't got any questions. So, we can only envy you. But, this is really for those out there, we've got questions really. So, if you haven't got questions, what are you doing? Yeah, that's my question to you. You know, I've got a question to you, what are you doing? So, we've all got questions on me. Yeah, okay. So, maybe I've got to work on how I envy these. But, yeah, that's it. And so, I'll bid you goodnight, and I will see you next time. (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]
