(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) It's a book that I was in trouble with, but I am allowed on Facebook. So here, we're on Facebook as well. But anyway, we're back on, who knows why, but I'm back now, so that's good. Back on Instagram, Facebook, and all the other ones on YouTube. So I've got some questions. If anyone's got any questions specifically for me, then please feel free to ask them. But no fear, because I've got some already ordained here. This one here says, "My husband has a cyst on his back "that needs to be removed. "What are the chances of it coming back?" Yeah, well, the different ways of treating a cyst are sometimes people kind of like lance them. So sort of like, just kind of like get the stuff out of it and empty them, and that kind of looks like it's got rid of them. The problem is the cyst wall remains. And if the cyst wall remains, they do come back. So I would say the best way to treat them would be to remove that cyst wall, cyst with the wall. So, and if you remove all of the cysts with the cyst wall, then it won't come back. The problem is that there's the if, so there is a chance that when we remove it surgically, that we leave some of the cyst wall behind. And if that happens, it can come back again. So it has got a much lower rate risk of coming back if you have it removed surgically and have the cyst wall removed completely than if you just have it kind of lanced or something like that. So no one can ever give you 100% really success with any operation, really, to be honest with you, unfortunately. But in general terms, if it's kind of like a fresh cyst that's never had any infections, it's never been operated on before. There's a good chance, good chance. I'm not saying good, does it? I can't really figure, but there's a good chance it won't come back because it depends on how it goes during the operation. But if it's a nice, you know, clean cyst wall that comes out cleanly, and sometimes it does, then it should not come back again. And that there's reassurance on that one. But sometimes if it is not clean, if it is not easy, if it's a bit scarred, if it's a bit stuck, it's a bit difficult to get that plane between the cyst and the surrounding skin, then there is an issue that they, you know, you could potentially see cyst wall behind. And some people do try and remove cyst through very small incisions. I usually use an incision about the same diameter as the cyst, but you see people who try and remove it through very small incisions. And through a very small incision, you can kind of puncture the cyst to get the contents out. And then when the contents are out, you can just try and tease out the cyst wall, which is great because it's a smaller incision, but it's even more difficult to ensure that you've got all of the cyst wall out. And so the chances of the occurrence are higher. So it's always a balance about, you know, how you have it done. That's why it's always good to have a chat with a doctor at what have you, but to sort of balance up what the best way to remove it, you know, for you would be. Personally, I don't do that small incision and puncturing the wall and taking the sack out separately. I try and get the cyst out complete. Sometimes it does, sometimes you do breach the cyst wall. But, you know, and if you do breach the cyst wall, then you try and kind of keep hold of it to make sure you get the hold of the cyst wall out. So it's always the, it's always the idea. But, you know, you can never 100% guarantee it. So, you know, it shouldn't come back. The other, the personally, I always say, look, if it does come back, I'll do it again. In fact, I think I'll do one that came back, but I think she'd already, it was already her current moment or sort of first time. But anyway, nevertheless, it's not uncommon, just 'cause I'm happy to be doing one on the suite or maybe it's next week. But, yeah, so if it does come back, we'll charge you, but the aim is to get it out and with the cyst with the wall completely. So it doesn't come back again. And so I'm just, Terry, hi, I need to come and see you. Okay, Terry, come and see me then. You know what to do? Call me, Terry. Call me. You've got my number or email or message. Don't do it like this, Terry, 'cause I am, well, I will try to remember and I'll try and get Amy to give you a call tomorrow, but I cannot be relied upon. So don't rely on that. Give us a call or a message or some description. So, yeah, so what are the chances of coming back slim? If it's a one-time cyst that hasn't been operated on, if it's been operated on before, then there's gonna be scar tissue in the area. The plane's gonna be less easy to identify. So the chance of leaving some of the cysts for behind is increased. And so therefore the chance of recurrence or increased. So, sorry, Terry, I can't see the question. Yes, please, a lot has been happening. Oh, good, good. Right, Terry, can't wait. Make sure we block out a bit of time then. All right, Terry, can't wait to hear. Must be happening. So, can diastasis recti repair be done after gallbladder removal for incision sites? Yes, for show, full show. Absolutely fine. No problem at all for diastasis recti repair after gallbladder removal, particularly in this day and age, it's all done by laparoscopic technique since the four incision sites, so a tiny little stab incision. So there's no zero problem with that. The only potential problem with a, well, when you're saying diastasis for recti repair, that's kind of implying you're having a tummy tuck. And the only potential problem with a tummy tuck in patients who had a gallbladder removal is back in the old days when they used to do an open gallbladder removal with what's called a cockers incision, which is a big cut underneath your rib cage. So that was a relative contraindication to having a tummy tuck because that scar could kind of interrupt the blood supply of the skin and cause a problem with the healing. So, but you don't really see that scar anymore. So there is no longer an issue with gallbladder removal and tummy tucks. And certainly for the diastasis repair, there's no problem with doing that. If you've had a laparoscopic practice, it's that to me absolutely no problem, which is a word for a gallbladder removal who's demonstrating my prowess with the words there. What injections of how, sorry, will injections of high lower lower days get rid of a small lipoma? No, funny question. 'Cause that is kind of, whenever people ask questions, I always think what a son told you that it would with my sort of question yourself. I would hire on a days, get rid of a lipoma. I've never heard of high lower on days being used for a lipoma personally. High lower on days is used to dissolve filler, usually. If you put too much, so maybe that's it. Maybe you've had, you associate it with being used for filler. So if you have too much filler, then the high lower on days will dissolve the filler. So we'll kind of dissolve the lump in that situation. But it won't, that's because the lump is filler. So if you have a lump, which is a lipoma, then that lump is fat. So high lower on days will not dissolve the fat. So high lower on days is not a thing that we use for lipomas. Not one I've ever heard of. So I don't know. As I say, I always sort of question myself with it when people ask this question, 'cause if they've read somewhere that it can be used for lipomas, I didn't know it could be used for lipomas. But I am very prepared to be to stand corrected. I might be wrong, God knows I've been wrong before. So, but yeah, I don't think higher on a days will get rid of a small lipoma. I don't think it'll have any effect from a small lipoma, personally. What have we got? Why am I finally difficult to find a surgeon to close my lip piercing scar? Yeah, I mean, yeah, I don't like it. I don't like doing this sort of thing. It's difficult because I guess, well, for me anyway, it comes down to sort of patient expectation. 'Cause I think the problem with a lip piercing scar is it's like a tiny, tiny little hole and completely understand why people don't want it anymore. The problem is you can't not have it anymore. You've done damage to the skin, which has caused that hole. So you're gonna have to have something. And if we could get rid of it and cause nothing, then fine. But in order to get rid of it, you have to kind of like core out that hole, 'cause that hole is kind of lined with skin. That hole is kind of epithelialized. So that piercing has made that hole line with skin. So you have to kind of like core out that hole hole front to back, so full fitness. And then close it somehow. Usually like a stitch, but a stitch to close it. So it kind of causes a little scar. So the little scar will be a bit red. It will fade and hopefully it will be better than the hole, 'cause it won't be a hole, but it could kind of dent in. And because you're kind of coring out the hole, the scar will be bigger than the hole. So you're creating a scar that's bigger than the hole. Now I'm not talking about massive amounts here, but still, that's why I think, I don't know what other surgeons are like, but personally, I'm a bit kind of, not massively kind of positive about closing piercing holes, because the resulting thing that we leave is often similar to the piercing hole, and it's kind of like, what's the point? So that is the point. I mean, you can close up the hole, but as I say, you'll leave the scar and the scar will be slightly longer than the hole, and might look similar to the hole. Obviously it won't be a hole, but it'll be a mark, and you've currently got a mark there now. So you'll be trading one mark for another mark, and you might feel that the scar will be preferable to the hole. Great, but as I say, it could sort of tether in and cause a bit of a dented scar, and you might be like, what was the point in that? So that is the issue, sorry, I can't, I've bent my phone. I've got to bend, bent phone, and I, oh, I guess we're in Tony. Tony's joined, Tony, long time no see. How I, Sam Van has joined, wow. Oh God, I don't know, I had to comment that. I had to comment. Or maybe if I leave it like that, I'll see who's joining, nice to see you all blasts from the not too distant past. I hope you're all well. Sorry that I haven't seen you recently. Yeah, piercing scar thing. So why can't a keto scar be surgically removed? Well, it can, a ketoid scar can be surgically removed, but it wouldn't necessarily be the first line of treatment for a ketoid scar. And the reason for that is because a ketoid scar is caused by an abnormal, your body, your body is reacting abnormally to the trauma, whatever it was, and has scarred excessively. So the ketoid scar is a problem with a person's physiology. Normally there are some situations which can predispose to really hyper-traffic rather than ketoids. There's a bit of a spectrum of hyper-traffic and ketoid scars, but certainly with a hyper-traffic scar, sort of a bit of a nuance, the difference between the two, but basically a hyper-traffic scars, a bit like a ketoid scar, but not as bad. But certainly with hyper-traffic scars, there are certain things like, for instance, if it takes a long time for the wound to heal, is an increased risk of the scar becoming hyper-rich feed. So if you've got a reason for the scar to basically be lumpy, which is what we're talking about, lumpy scars here, there will be more, more positivity about removing it surgically, because you could say, right, well, if it took a long time to heal, that's why it's lumpy. If I can remove it and make it heal without taking a long time to heal, there's a chance it won't be lumpy. But if it would heal with no problems, and if it is really properly a ketoid scar, then the worry is that we'll cut that scar out and give you a worse ketoid scar. So that's why we don't like cutting out ketoid scars. So often a ketoid scars comes from a little thing. So you have a little thing, sometimes like an injection, blood test, tiny little thing, tiny little, which will make acne, ear piercing, tiny little scar, which goes massive. And then if we cut that massive scar out, we'll give you a bigger scar than what the original thing that caused the ketoid was. And if that scar goes, ketoid, it goes even bigger than the first one. So that's why we are anxious about removing see if ketoid scars surgically and would try to do other means first. Things like massage, things like pressure, things like silicone sheets or silicone gel, things like steroid injections. Those sorts of things are usually done first, and surgery is reserved for really big ones. Which we don't think are gonna respond, or at least respond significantly to those non-surgical methods, or in situations where those methods have failed. But if you do surgery, as I say, we're always reluctant to do surgery because there's a risk that it could come back worse. So the way we mitigate that risk is we do what's called an interleasional excision of the ketoid scars, which means you don't actually cut into any fresh skin all the cuts are actually in key-load scar. So you're kind of debulking this key-load scar. You're making it smaller. So the aim is really to make a big key-load scar into a smaller key-load scar, which can then potentially be addressed with a non-surgical method like pressure and steroid injections to maybe get rid of the last part of it. So that's how I do it. I try to don't make any cuts in normal skin so I do an interleasional excision. So it gives you a much smaller key-load scar, which we can then treat with steroid injections. But as I say, it usually is a last port of call with trying the other things first, if we can. What is the recovery time for pinnoplasty going to the gym and going on holiday? So you've got to be a bit careful with pinnoplasty. It is, it does involve quite kind of, you're kind of changing the shape of the cartilage of the ear. And it is a little bit fragile in the first stages because you want to keep the shape that we create when we do the surgery. Now, a person I don't do pinnoplasty anymore, other people at the clinic do. And it is a little bit fragile, as I say, to start off with, and you can potentially pull the ear back out of shape if you are too aggressive. So you've got to be very careful. Now, in terms of going to the gym, now you're not going to actually put sort of pressure on the rear going to the gym, are you? Unless you wear a helmet and do boxing sparring. But I don't think many things are going to... So basically going to the gym, that is going to be mainly getting hot, sweaty. So you want the wound to be healed. So after a couple of weeks, I would say the... Well, first thing I'd say, check with your surgeon 'cause I don't do it. So check with whoever does it. But in general terms, I'd say, you want the wound to be healed. So a couple of weeks, you can start doing kind of exercise and things like that. You don't really want to be doing anything too strenuous, and you certainly don't want to be doing anything where you could get trauma to your ear in terms of any kind of sports, or anything like with any contact, or anything where you could actually traumatize your ear. For at least a month, probably six to eight weeks, let's say, six to eight weeks before you're thinking about anything where you're potentially going to get any kind of rubbing or whatever on your ear. And then just gently because it will still be fragile. For the first couple of months, it will be fragile. Simply going on holiday, no real problem going on holiday, except for the sun on the sky. Now, the sky's pretty well hidden. The sky's in the fold behind your ear, and it's usually pretty well hidden, but it will be very inactive for the first three to six months. So you don't want to get a tan on it for the first three to six months. So if you're going on holiday involves tanning, then either don't go on holiday for three to six months, or keep it covered, wide brim hat. I mean, it's quite hard to get a tan on that part of your ear to be nice with you, so I wouldn't over egg it. But that's the only thing I'd be worried about, really about a holiday unless you're doing a adventurous holiday where you're, I don't know, wearing a helmet or something, I don't know, which again, goes back to this sort of couple of months before you want to be sort of putting anything that can kind of rub or contact your ear ear. But, yeah, holiday to somewhere not hot and not wearing a helmet is fine after, you know, six weeks is normal for going on holiday for most operations. So it's really just making sure that first of all, the wounds healed, so that's the first couple of weeks, and then it's not traumatising the year for the first couple of months. You know, in a nutshell, I would say, that's it. So that's it, that is it. So, yeah, nice to be back on the gram, and that is, I'm out of questions. So if you've got any questions, please message me, phone me, or probably the main way is actually messaging of phoning me. And I will, actually, yeah, I'll probably will be back next week, I think. Yeah, yeah, I will be holiday, and it's the holidays is kind of over now, isn't it? Yeah, so we'll be back. So, same time next week then, in God willing. So, see you then, even in all. (upbeat music) - Have a question, not covered in today's show, then send it over to info@styanoplasticsurgery.com. Go to co.uk using the hashtag #askjj. We'd love to hear from you. (gentle music) [BLANK_AUDIO]
