(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) We live here, which is good. I just got to do my, yeah, so I'm just going to do, I had to do it with before 7.10, so in some ways you could argue, I have gone a little bit too soon on this because I haven't done my Instagram thing, so I'm going to do my Instagram thing. Good evening Instagram, so they're not live for the Instagram people. So, because I can't go live on Instagram, so it's another day, it's another non-live Instagram feed. I'm on the Facebook, I'm on the YouTube. I haven't checked my TikTok. When I get 1,000 subscribers or whatever, I will be on TikTok, I think. Here we go, anyway. Anyway, but I'm not on Instagram live, so if you want live questions answered, coming to Facebook or YouTube, we're talking about acne scars and moles, inverted nipples and TikToks and stuff like that, fascinating stuff. Can't say much more about it because I'm going to have to do it on the Q&A. So, yeah, sorry Instagram, I'm still not able to be live with you, but maybe one day we'll get that feature back up and running when the powers that be see the light. Okay, so I'll see you over there. At the Stoyano Clinic is, so, yeah, good evening everyone. Sorry to get your way in there for that Instagram thing. Kind of still a bit on holiday things, so just sort of rushing and doing this. I know I am working this week, so by rights it should be sort of okay to say that I'm doing this, and I did say that I did agree to do it, so I'm doing it. I hope if anyone is on holiday, I hope you make the time on holiday. But yeah, I'm in work tomorrow, so it's kind of like a work week. So, yeah, if you've got any questions, please do ask me directly, if you haven't got any questions, then let's see what other people have said. I had a mole removed and it needs to be done again. Does this mean it was done the wrong first time? Well, not necessarily. The question is why you're having it removed the second time, I guess. So, if you're having it removed because they've left a bit, and usually I guess that would be a shave excision where you haven't got it all down. I always warn people with a shave excision, if there's still a bump there, you might have to have it done again. And potentially with a shave, there might be a dent there, and you might have to have that exercise. So, you might need a revision, that would be classed as a revision. And does that mean they've done it wrong first time? I mean, you could call it that. I mean, it's a bit harsh to say done it wrong. But, you know, whenever we do surgery, we are always trying to make things perfect, but I think most slash all plastic surgeons and male surgeons, but certainly all plastic surgeons will factor in an element of potentially having to do revisions, call it what you will, touch-ups, and, you know, potential procedures to make things perfect if they're not perfect first time. So, if you want to say that's done wrong, I think that's harsh. I don't think it was done wrong, but there's often an element of that. However, with mole removal, there are situations where it might not be that there was a problem. It might be that you, so if you are happy with the scar, if the scar looks fine and you're being told you need to have it done again, there might be an issue regarding what the mole was. So, if it was a skin cancer, and if it wasn't completely removed when they look at it under a microscope, so what we do is we take a margin, often a skin, a normal skin, we often aim to obviously get the whole of the thing out, whether it be a model, whatever it is, you know, this mole or a skin cancer. Often we don't, you know, you're not 100% sure that it is a skin cancer, pre-operatively. So, we always aim to get the whole of the lesion out, but sometimes when they, and when you have it removed and you have the scar, you might look like there's nothing there. Sometimes when they look at it under a microscope, they say if it comes back as a skin cancer and it's not all out, if it's coming up to the edges of the specimen, if there's not a clear rim of normal skin, then you might need a further excision. So I wouldn't say that's necessarily it's done wrong. That would just be a consequence of it being a skin cancer, especially if they, you know, you weren't sure whether it was a skin cancer beforehand or not. The other type is a melanoma, which is a specific type of skin cancer, which is a little bit different to other types of skin cancer, mainly because it has the virtue of being able to spread to other parts of the body. And for that reason, we often want quite a large margin around a melanoma. So even if you think it's a melanoma, when you go to remove the mole, most of us would have just removed it with a little bit of a margin, just a few millimeter margin. And then we'd see the aspects of that melanoma, particularly the thing we're looking for is how thick it is, how deep it is, because the depth will dictate the margin of excision that we require. So it will be usually a one or a two centimeter margin around the melanoma that's required. And usually rather than just taking a, you know, just taking a one centimeter margin for the first bit of melanoma, we don't do that. We just take a little margin, and then we do a one or two centimeter margin around the scar because you, a one centimeter or a two centimeter margin is quite a significant margin. And that's a peripheral and deep. So it's quite a large piece of tissue that's removed. So you usually want to be sure, first of all, the diagnosis, and you wanna be sure whether it's a one or two centimeter margin. So you will kind of routinely require two operations. If it's a melanoma, it's kind of standard. So that's definitely not gone wrong. If they say, you know, it's another known one, you need to come back for a second excision. That doesn't necessarily mean the first one was done wrong. It just means the first one was just getting the lesion out and assessing the depth of it so that they can plan the second operation. So if someone has, if we know it's a melanoma, we will often discuss this with you prior to the first one to say, look, we're going to just take it off for the minimal margin or a few millimeters, five millimeter margin, say. And then we're gonna, if it does come back as a melanoma, based on the depth, you'll need another operation. So it's always good to have these conversations before the operation. So you don't get a shock and say, well, I need another operation and that's kind of standard. But, you know, not particularly, that's always standard, but especially if it's like a cosmetally sensitive area, you don't want to be taking one or two centimeter margins until you know, you know, first of all, you have to take a good margin and secondly the extent of that margin. So, yeah. So it doesn't necessarily mean it was done wrong. There are circumstances where you will potentially need another procedure if you have your moral mood. Some will be, for cosmetic reasons, I say, if it's a thumb for a dent, particularly after a shave excision. But if it's a formal excision, they will usually be due to the histological results once we sent it away as to what it was and how much of it, how much of a clear margin there is. If it's not a melanoma, if it's just like a BCC or an SCC or what we call a non melanoma skin cancer, you usually just need a clear margin. So we usually cut those out with a sort of three or four millimeter margin and hope just to get a clear margin. And as long as the margins are clear, usually that's acceptable, but they would normally be discussed at a multidisciplinary team meeting to ensure they're comfortable with the margins and the aspects of the tumour, but this is something to be discussed. So yeah, so it's not unusual to need a second operation. It doesn't always mean that something's been done wrong for the first one. In short, can CO2 improve a scar? Ooh, how do I say this? I would say that there's a lot we don't know. There's a lot we don't know and I know that. I know that I don't know a lot of stuff. So I know enough that I can't say this does definitely, particularly definitely not work or work. I mean, and I know that people do things like that and I've seen that these inject CO2 into scars and stretch marks and things and they propose that it does improve them. I'm not convinced is what I'm going to say. I'm not convinced about it. I don't do it and I don't offer it, so you could say I'm biased or you could, I suppose, someone who does it is biased. I don't know. All I'd say is do your research on that, but I'm not convinced of that. But someone somewhere has obviously thought it's a good idea and is doing it and someone has actually come to this and asked the question. So obviously it's sort of out there enough that this question has been asked. But as I say, I'm not convinced about it myself. All I would say is do your research if you could find someone with good before and after photos. When you're looking at scar improvements, you want a mature scar. So ideally really a year old. If you have a scar kind of less than a year old, if you have a scar three, four, five, six months and then they say, oh, we've injected all this CO2 into it and look at it at 12 months, it's so much better. I'd be like, well, it would probably got better anywhere at 12 months unless they've injected half the scar with CO2. So if it's not going to trial like that, then that might be valid. If they say, look, this half's been injected to CO2. This half hasn't. And look at the one that hasn't. It's a lot worse than the one that has. Then that would be convincing. But yeah, I would say do your research on it, but I'm not sure whether it does or not. But I do know that some people think it does. And so, you know, there's a beauty of this world. You know, we've all got, um, we've all got life experience and, um, we've all, I've used about things and, um, you just got to take advice or take stuff away and make your own decision. Not very helpful is it? I'm in a cool thing like this, but anyway, that's where I am. I'm not convinced myself. Can we correct congenital ear deformity for a child? Short answer, no. I'm not going to say probably, no. Um, two reasons. First of all, we don't do children. So that's kind of, um, sort of, uh, that's kind of, nipped that one in the butt. Um, you have to be over 18 to come to the clinic because the CQC, um, kind of, um, approval or have you for the clinic. We haven't got, um, approval for under 18s. It was quite a lot of extra work to get, uh, CQC, um, accreditation to treat children. And the sort of work that I do is not. There's not large numbers of children. There would be some moles. There would be some prominent ears and things, but not enough to, uh, warrant the amount of work that we acquired to get CQC registration for children. So I decided not to, um, go down that path. Um, so that's, that's that. Um, but the second part is that congenital ear deformities are usually quite complex, usually. Usually significantly, I mean, you could say a prominent ear is a congenital ear deformity, but they're usually more complex than a standard, uh, prominent ear. A prominent ear usually has pretty, um, kind of standard aspects to it. It's either a lack of an antelical fold, which is this fold here. So a lack of that. Or a deep, um, conical bold, which is sort of a bold bit of your ear, or a combination of the two. And so there are sort of procedures to correct a prominent ear. Um, congenital ear deformities will often have much more nuance, a much more, um, requirement for reshaping of the cartilage and would normally be done, uh, via ear specialists. There are a few in the UK, um, and, you know, they, that, that's sort of what they do. That's their specialty. Um, Mark Lloyd used to work at the clinic and was an ear specialist. Um, and, you know, they're dotted around the UK. There's not a huge number of them, but you want to look for David Galt was always the main name. I'm not even sure if he's still working. I mean, he may still be working, but, uh, but yeah, there's a few names in the ear, ear deformity. And you'd probably be wanting to be treated in a sort of dedicated unit where there are specialists for that. So, uh, it wouldn't be, it wouldn't be hard for me. Do you offer tear trough fillers? No, we don't. So tear trough, the tear trough is this bit here where your tears will trough. Um, and some, and you can put fillers in those areas to facial rejuvenation. Um, nothing specific about tear trough. We don't offer fillers. Um, we don't offer Botox and fillers. And I know what you're going to say. I know you're going to say this obvious. We should do it in this big market and all those things. And we have done it in the past and we have been in and out of it. Um, I've never done it personally. I've never really done. I think that's probably the problem, really, because I, um, I've sort of produced most of the, uh, content for the website and the promotion of the emails we send to people and the information and things. So that's kind of been driven by me. And, uh, because I don't do Botox fillers. Um, I haven't really promoted it. Um, as I say, we have had people who do it and, um, the surgeons of the clinic do do it, but I don't really promote it in the clinic. Um, because I'm really promoting. And it's really what we're, is most of the stuff we do is minor surgery, moles, lumps, bumps, cysts, um, low flanathetic procedures. And, um, and we're not doing the, the, um, any, but any Botox fillers. So no, we don't offer teatroph. Yeah. If you've never done, I read on your website that in some cases after surgery from a inverted nipple correction, the nipple can go back and the surgery will need to be repeated. In this case, would the second surgery be free? Or will I have to pay for another surgery? It'll be free. Um, so if it goes back within a reasonable period of time, and I'm sure we've got a time scale on it, I think it's six or 12 months. I'm not sure. But within a reasonable period of time, as well as sort of a, sort of a second pathology, you have other children and your breastfeeding things, because these things can cause, um, fibrosis of the, of the, of the glands, of the ducts. And we said that if you've had an inverted nipple correction, you probably wouldn't be able to breastfeed. So that would probably be a moot, uh, argument. Um, but, uh, yeah, absolutely. I mean, I think one of the things about the clinic and one of the things that I always say to people who say, you know, perhaps, um, there's cheaper places to have procedures. Um, we do focus heavily on the aftercare. And if it's not right, whether that means, means you're inverting nipple, um, inverts or your mole, still got a bump there or a dent or everything's aren't quite right, you will not charge you to fix it. We will fix it free of charge. And it is something to kind of, um, be aware of with an inverted nipple correction, because it is not an unusual complication. It's not a usual complication. I mean, we always plan to get it so that it, that it's a permanent solution. But, uh, one of the risks of inverted nipple correction is that it can invert again. It can pull in again. And by all means, we will do it again. The problem with these things is you're often dealing with scar and there can be the law of diminishing returns. If it goes in, I mean, I have had patients where it's gone in again. Yep. Do it. No problem. It goes in again. Mm. Do I do it again? Do I do the second time revision? Um, probably have. Probably did. And then it goes in again. And every time you're doing surgery, you're getting more scar. So, I always say to people that we will do everything we can to give you the best result possible. Sometimes the best result possible may not be as good as you would want. You know, may not be 100% fully out. There might be the tethering still there. And we, you know, I'm not saying everything, but sometimes you get in this situation where you're fighting that scar tissue. And every time you do surgery, every time you do anything to anyone, we're causing scar. So, you know, you're fighting scar with scars. So, it's very hard when you, you know, you're desperate to have a happy patient, but, you know, sometimes when there's just a lot of scar tissue beneath that nipple, it just keeps on scarring and pulling down, you know, there's, it's like there's not that much you can do. Sometimes it's just, it's just a risk with inverting nipple, but certainly we will do everything we can to, to make it come out again. And if we feel that doing another revision, doing another pull out, you know, eversion procedure is right for you. We will not charge you for that. And as long as it's like five years later or something. But yeah, as I say, it's one of the things that I try and kind of build the clinic on. They're looking after you and, you know, no hassle, no quibble with revisions and stuff. That's a problem. We'll just get it right. And I'd rather sort of maybe charge a little bit extra at the front end to really look after people once they come through. And yes, we probably do lose people who will go elsewhere and understand that. But, you know, we're all about giving a really good service to the people that we do treat. That's kind of what we're after. What we're about. Do you do removal for nodular acne? Well, one of the thing about sort of treating, kind of treating acne and things, I mean, the treatment of acne is with a dermatologist and we're all plastic surgeon. So we wouldn't treat acne. So we would not treat your acne. So if you've got active nodular or any type of acne, then you would need to have the acne treated by a dermatologist. And that would probably more be like either systemic like tablet treatment or creams or, you know, general, general treatment to try and dampen down that inflammation and try and improve the acne. And that would be the first thing to do and the right thing to do rather than treating one specific area of the acne. So we do get into treating things once the acne has all been treated and all sorted and all fine. But you might not need anything because that's the whole point of when acne is all sorted and fine. Sometimes you get, like, pits. You get a little nice pick scars. That's a lot of dense and picks where the acne has been. And we can certainly do things to try and help those things. But the mainstay of acne treatment is medical, is not surgical. So although you might feel if you've got nodular acne, you've got lumps. You know, we say, oh, yeah, we'll remove your lumps and bumps. You feel that you've got lumps. It kind of will be wrong of us to start cutting those lumps out because it was the underlying acne that needs to be treated, not that specific lump or those specific lumps. The underlying acne needs to be treated. And once the underlying acne is treated, often that's it. The lumps go and you're better. If you have any sequelae once the active acne has been treated and you finish your treatments and you're all sorted from that perspective, by all means we will get involved. But the majority of people don't need us to be honest with you. You probably think you do if you're in the active stage. But once it's all settled, you usually don't need anything. It's pretty marginal, what we can do to improve things. So if you've got active acne, then really it's a dermatologist or your GP you need to see to look at treatments for that, rather than worrying about one or two specific areas that might be causing you concern because you wouldn't really want a surgeon going in and trying to treat those areas in the presence of active acne. So it's a medical treatment that you would require, which would be your GP or a dermatologist. So not for us. And these sorts of things, you know, when you've got areas or issues, this is why we often say to people that do this, you know, put in a question first, send us a photo, really help us get a lot on what's happening, email it, whatever, send us a photo. So we can give you these opinions, these ideas, rather than you having to come to clinic and then kind of get told this and then you come having to think of getting self-sourced out and then we can kind of say that we can't help you. So this is really helpful to ask these questions and we kind of encourage it to ask the questions before coming to clinic because it helps you to get an idea of whether we can help you at the clinic, we always your time. So it also helps us because we are doing these C and tree appointments now where we're booking out big lengths of time within the clinic to actually see you and treat you. So if you're not appropriate for treatment on the day, it kind of helps us. If we can talk to you before coming to clinic, say look, you're not really suitable. That's why the photos are really good. You're not really suitable. You need to see a dermatologist, you need to see a GP get things sorted out. Once this is sorted out, come back and talk to us. So that kind of helps us as well. Because then we don't book out two or three hours in diary to tell you that. So it's a win-win really. So that's kind of how I want the C and tree to work. It's not quite giving you a consultation but it's kind of giving you an idea of what can be done for you and whether it's right for you and how much it's going to cost, importantly, before you even come to the clinic so you can make a judgment of whether it's worth your time actually coming to clinic. And when you do come to clinic, potentially we can do the surgery on the same day as the treatment. What's this? We've got some weirdo on the hand, maybe. You're always going to get one, aren't you? There's always one. We can't, you can do your best to block these people but they're going to get through whatever happens. I don't even know. I don't even know. I don't speak Japanese, so I'm quite sure what that is. Anyway, let's just, we're a professional here, professional outfits. We're going to rise above that. We're going to ignore that. Anyway, thanks for the comment. Simon, VR by. Very kind of you to leave a comment because that is the lifeblood of the outfit. So it is always nice to have a comment. Even if it is marginal in terms of healthfulness, but the first step is to get the comments, second step to get healthfulness. I mean, we're halfway there with that one. So if anyone else wants to do a helpful one, now's the time. But I understand that you're all busy and you're all busy people. You've got homes to go to and things to do. So if that's all, if it's just Simon, VR by comment, then I think we'll call it a night. And I mean, is this the handpink waving? Is this what he's all about? I don't know a lot of that. Maybe I am. Maybe I'll roll back the VT and have a look. Anyway, yeah. So have a good evening. And I'm actually on holiday next week for disclosure. I haven't booked anything. Arguably, I am discovering that I have left it a little bit too late. So you could argue that would be an argument. Say I should have booked something before now. I think that'd be quite a strong argument. But anyway, we are where we are. So I haven't actually booked anything. But I probably won't be doing this. I'll probably be. I will have probably find a last minute. I'll bear. All inclusive. So, I'll be on the sun lounger. Week after. Oh, that's looking into the future somewhat. But week after. Quite possibly I will be here. If you've got any questions, you know what to do. Yeah. Don't need to say it by now. Yeah. Leave a comment. Call me. What's at me? Um, usual. Whatever, you know, sort of ways of contacting. And I'll do my level best to answer it. So yeah, see you in probably two weeks. Have a good evening. 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 PLAYING]
