An abdominoplasty ('tummy tuck') involves the removal of excess skin and fat from the lower abdomen. This results is a slimmer waistline and an improved body contour. Tightening of the abdominal wall muscles may be performed in conjunction with this, to enhance the abdominal contour.This procedure is frequently used on its own, but is also used in combination with other procedures, such as liposuction or buttock, thigh, and arm lifts in those who have lost large amounts of weight. The abdominoplasty may also be extended to a circumferential body lift to remove excess tissue from the flank and back.
With increasing age, the skin's elasticity is reduced and its ability to take up its former taught shape is lost. Despite diet and exercise, unwanted fat and excess skin may remain in the lower abdomen. Changes in weight and pregnancy (particularly those who have had multiple pregnancies) can also lead to excess lower abdominal tissue.Pregnancy can stretch the skin beyond its ability to return to the pre-pregnant state. If skin retraction has not taken place by one year then it is unlikely that this will occur. In addition to the skin being stretched, pregnancy can also lead to be separation of the rectus muscles, which may weaken the abdominal wall and in some cases produce bulging.
Abdominoplasty is not in itself a treatment for obesity. It may though be used as an additional part of a long term structured program to reduce weight and achieve a good end result.
Being overweight and smoking can increase the incidence of complications from an abdominoplasty. It may be wise to delay surgery until smoking is stopped or cut down, and a proportion of excess weight lost. It may not be wise to proceed if you have future plans for pregnancy. Previous abdominal surgery may not permit an abdominoplasty.
Aspirin increases the risk of bleeding by preventing blood from clotting. If you are taking aspirin, you will be asked to stop this for at least ten days before the procedure.
Abdominal wall reshaping by removal of excess lower overhanging skin. Risks include bleeding, seroma, infection, scars, asymmetry and lumpiness. At least an overnight stay in hospital with recovery taking 4-6 weeks.
Blepharoplasty is surgery to the upper or lower eyelid. Upper eyelid surgery involves making a judgment of how much excess skin can be surgically removed with or without a small amount of fat near the medial edge of the cut. The surgery can be done under local anaesthetic as a day case and takes about 30 minutes to perform. The closure of the wound usually involves a non-absorbable stitch that is removed at 5-7 days. Use cooling eye pads over the next 2 days to help with bruising and swelling. Mild painkillers only required. Risks are around bleeding, infection, red scars and managing the patient's expectations.
Lower lid blepharoplasty is a more complicated procedure comprising skin tightening and/or fat redistribution or removal. Skin excision is performed by a cut just under the lower eyelid margin, the excess trimmed and the remaining skin re-draped onto the lid. This excision can be skin only or include the underlying muscle.
The fat is either re-draped to camouflage the tear trough or excised. Occasionally a lid tightening procedure is required to compliment this procedure.
The operation takes about 90mins and the patient stays in hospital overnight, wearing cooling eye pads to help control the bruising and swelling.
Risks include bleeding, infection, and problems with the eyelid position. Blindness has been reported but is very rare.
This is where the consultation with the specialist is so important. The issues to explain to the patient about an upper lid blepharoplasty are that whilst eyelid skin will be removed optimally and safely this will not affect eyebrow position, which also contributes to the patient's appearance. An understanding of the risk benefits here is most important. Lower lid surgery whilst being more complex can for the right patient be a very rewarding procedure. The surgeon should ensure there are no medical problems, which might increase your risk as well as an examination of the tone of the lower eyelid and overall health of the eyeball.
Surgery to the excess skin and fat of the eyelids. Upper eyelid surgery, local anaesthetic, minimal risk. Some bruising for 1 week. Generally very good outcomes. Lower eyelid surgery under general anaesthetic or sedation. Overnight stay. Involves tighter patient selection, incision under the eyelid margin, moderate risk, very good outcomes.
Body lift surgeries are procedures that are used to remove excess, loose skin, which can result following marked weight loss. This is most frequently seen in patients who have undergone dramatic weight loss after bariatric surgery (gastrectomy bypass and gastric banding), but is also seen in those who have lost weight with diet.
In these patients, the skin has lost elasticity and is unable to reform the contours of the body. Body lift surgery removes this excess skin from the breast, arms, abdomen and thighs, and redefines the body shape. To achieve the final result more than one procedure is often required. In many instances a face and neck lift may be requested.
Body Lift surgery is considered radical cosmetic surgery, which unfortunately always leads to surgical incisions and scarring. The severity of scarring depends on the amount and location of the excess skin that is removed. For a full Body Lift, scars will be left in the groin crease of the inside of the legs, around the thighs, underneath the arms, across the lower stomach, on the breasts and possibly along the lower back and hips. However, whichever combination of procedures is selected, every effort will be made to insure that the scars are minimised and where possible hidden in the body's natural crease lines.
Despite achieving a substantial loss in weight people often remain unconfident and avoid social situations. Despite being thinner, smaller clothes can still be difficult to fit. This is due to the excess skin. Body lift surgery addresses this problem.
Being overweight and smoking can increase the incidence of complications from body lift surgery. It may be wise to delay surgery until smoking is stopped or reduced. Even though weight may have been lost, the patients weight may still be at a level that markedly increases their risk of complications. Those patients will be advised to persist with their weight-reducing regime prior to surgery.
Scaring can be substantial and occasionally more than one operation may be necessary to achieve an optimal result. Bleeding, infection and asymmetry can occur. A thorough assessment preoperatively is advised.
Aspirin increases the risk of bleeding by preventing blood from clotting. If you are taking aspirin, you will be asked to stop this for at least ten days before the procedure.
Reshaping the body by removing excess and sagging skin that occurs following weight loss. A variety of techniques. Scars can be obvious. Risks include bleeding, seroma, infection, skin loss as well as change in sensation, asymmetry and lumpiness. At least an overnight stay in hospital with recovery taking 4-6 weeks.
Botulinum toxin acts by interrupting the message between nerve and muscle. This results in temporary paralysis of the muscles of facial expression when used in the face. Such injections are mostly used for the upper third of the face to treat forehead lines, frown lines between the eyebrows and crow's feet. This can enhance the facial beauty of the patient if done with skill and precision. Over treatment can result in a frozen appearance and occasionally malposition of the eyebrow and eyelid.
The consultation with the specialist is critical in understanding the patient's concerns and whether injection therapy will help. Botulinum toxin injections affect the dynamic lines of the face. Repeated injections may soften the lines at rest but not fully. The best place to start treatment is between the eyebrows, to prevent the dynamic frown lines. The degree of paralysis can be varied according to need. The risk of eyebrow or eyelid malposition is small. The effect can take up to seven days to fully evolve. Review within that period by the specialist is recommended to determine whether the patient's expectations were met. Crows feet would be the next zone to be treated, followed by the forehead.
Botulinum toxin injections treat the muscles of the forehead and those around the eyes. The effect takes up to 7 days to evolve and should last for 3-4 months. The risks are small but must be fully discussed during the consultation with the specialist.
Brachioplasty is a surgical procedure to remove excess skin and fat from the inner surface of the upper arm. It is performed under general anaesthetic and takes about one hour. It can be done as a day case or an overnight stay. It leaves a long scar on the inner surface of the arms and these will need to be supported with a compression garment during the healing period. Recovery takes 2 to 4 weeks and you need to limit your upper arm mobility to afford the best chance of cosmetically acceptable scars. We will need to see you weekly for the first few weeks. Bruising and swelling will occur and can last for up to 6 weeks. Other risks include bleeding, infection, changes in sensation, asymmetry, poor scars and skin loss.
People normally undergo brachioplasty after weight loss as they find the skin in the area can sag, rub and be cosmetically unsightly. It can also make it difficult to fit into clothes even after weight-loss.
Brachioplasty can leave visible scars and you must appreciate this. It is also a good idea to achieve your target weight before embarking on this type of surgery. Losing weight following brachioplasty can have a negative effect on the cosmetic outcome. Being overweight and smoking can increase the complications from plastic surgery. It may be wise to delay the operation until smoking has stopped and a portion of excess weight loss. Aspirin increases the risk of bleeding by preventing blood clotting. If you are taking aspirin you will have to stop this for at least 10 days before the procedure.
Removing excess skin and fat from the inner surface of the upper arm. Risks include bleeding, infection, scarring, change in sensation and asymmetry. Can be a day case or overnight stay in hospital with recovery taking 4-6 weeks
A breast augmentation is a surgical procedure that enlarges the breasts by the insertion of silicone implants underneath the breasts. It is performed under a general anaesthestic. It takes about 1.5 hours and drains are often used which come out the next day. You will therefore usually need to stay in hospital for one night. Recovery takes 4-6 weeks and you need to avoid physical exercise and wear a support bra during this period. We will need to see you weekly for the first few weeks. Bruising and swelling will occur and last for up to one month. Other risks include bleeding, infection, changes in nipple sensation, asymmetry, implant malposition, capsule formation (scarring around the implant), poor scars, implant leak and recently an association with Acute Large Cell Lymphoma (ALCL).
Women undergo breast augmentation to enlarge the size of their breasts because they feel they are too small, and to enhance their body contour. Other reasons include loss of volume following pregnancy or weight loss; a significant difference between the size of the breasts or following surgical procedures for various breast conditions where breast tissue has been removed.
Breast augmentation is contraindicated in patients who have had radiotherapy treatment, are undergoing chemotherapy or are immunocompromised, have an active infection anywhere on the body, or have an untreated breast cancer. As a general rule patients should be over 18 years of age.
Women with breasts that are 'sagging' or have lost skin tone and elasticity may be inappropriate for breast augmentation alone and may require additional surgery to lift and reshape the breast (mastopexy).
Being overweight and smoking can increase the incidence of complications from surgery. It may be wise to delay surgery until smoking is stopped or reduced, and a proportion of excess weight lost.
Aspirin increases the risk of bleeding by preventing blood from clotting. If you are taking aspirin you will be asked to stop this for at least ten days before the procedure.
Implants can form scar tissue around them (capsules) over time that alters the appearance of the breasts and can sometimes be painful. Skin tone changes with increasing age and this can also change the appearance of the implants over time.
Volume increase of the breast with reshaping and tightening. A variety of techniques. Scars can be in the breast crease or around the nipple. Risks include bleeding, infection, nipple or skin loss as well as change in nipple sensation, asymmetry and lumpiness. Capsule formation, pain and changes in appearance over time can occur. An overnight stay in hospital with recovery taking 4-6 weeks.
When a woman has to undergo a mastectomy or a partial breast excision, in addition to the worry about the cancer and its treatment, it is a potentially devastating change to her body image that can have a huge psychological impact. Breast reconstruction can be offered at the same time as the cancer is removed or later once all the cancer treatment has been completed.
We are able to offer the full range of techniques available for cancer reconstruction. These include implant base reconstruction (implants only or implants combined with a pedicled latissimus muscle flap or dermal substitute) and autologous reconstruction, (where the patient's own tissue (fat) is used, usually from the tummy, buttock or thigh).
Breast reconstruction is a highly individual decision, and is based on the patient's circumstances, lifestyle, body habitus and medical history. We have comprehensive expertise, particularly in the field of microsurgery, allowing us to offer the most appropriate methods for a particular patient, allowing them to choose the one that best suits their individual needs.
To regain breast tissue lost when breast cancer is treated. It can be done at the same time as the mastectomy or afterwards. It can minimise the physical impact of breast cancer treatment and restore body image.
Being overweight and smoking can increase the incidence of complications from breast reconstruction surgery. It may be wise to delay surgery until smoking is stopped or reduced, and a proportion of excess weight lost if possible. Some pre-existing medical conditions, radiotherapy and your body proportions may limit which options are available to you.
Your breast surgeon may recommend finishing all breast cancer treatment before embarking on reconstructive surgery.
Scarring and asymmetry frequently occur and although good aesthetic results can be achieved it can often take at least 2 operations.
A frank and thorough discussion of all reconstruction options and outcomes is conducted prior to embarking on surgery with an opportunity to look at clinical photographs of results.
Rebuilding breast skin and volume following mastectomy. Various techniques with various outcomes are available. Scarring and wound healing problems can occur as well as infection, bleeding and a degree of asymmetry. At least 2 operations are usually necessary to achieve optimal results. The stay in hospital can vary from 1 to 7 nights with recovery taking at least 8 weeks.
Women may wish to have breast reductions for aesthetic reasons, or because large, pendulous breasts may be causing social embarrassment and lead to poor posture.
Women with enlarged breasts may suffer from neck and back pains, straps can dig into the shoulders, and women can suffer from repeated infections in the crease below the breast. Wearing fashionable clothes or swimwear may be difficult, and large breasts may interfere with sports activities.
Following the procedure, self-confidence and self-esteem are boosted, as women are able to wear more fitted clothes. Posture is improved, and taking part in sporting activities should be easier. Of all plastic surgery procedures, women undergoing breast reduction surgery experience the most satisfaction.
Volume reduction and breast reshaping with tightening. A variety of techniques. Scars can be around the nipple and vertically down as well as in the breast crease. Risks include bleeding, infection, nipple or skin loss as well as change in nipple sensation, asymmetry and lumpiness. At least an overnight stay in hospital with recovery taking 4-6 weeks.
Carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed on passing through a short tunnel at the wrist. The tunnel contains the tendons that bend the fingers and thumb as well as the nerve. CTS commonly affects women in middle age but can occur at any age in either sex. CTS can occur with pregnancy, diabetes, thyroid problems, rheumatoid arthritis and other less common conditions, but most sufferers have none of these. CTS may be associated with swelling in the tunnel which may be caused by inflammation of the tendons, a fracture of the wrist, wrist arthritis and other less common conditions. In most cases, the cause is not identifiable.
The main symptom is altered feeling in the hand, affecting the thumb, index, middle and ring fingers; it is unusual for the little finger to be involved. Many people describe the altered feeling as tingling, often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object, for example a mobile telephone or newspaper, especially if the hand is elevated. In the early stages the symptoms of tingling are intermittent and sensation will return to normal. If the condition worsens, the altered feeling may become continuous, with numbness in the fingers and thumb together with weakness and wasting of the muscles at the base of the thumb. Sufferers often describe a feeling of clumsiness and drop objects easily. CTS may be associated with pain in the wrist and forearm.
Non-surgical treatments include the use of splints, especially at night, and steroid injection into the carpal tunnel. CTS occurring in pregnancy often results after the baby is born. Surgery is frequently required. The operation involves opening the roof of the tunnel (the transverse carpal ligament) to reduce the pressure on the nerve. The most common method involves an incision over the tunnel at the wrist, opening the roof under direct vision. In an alternative keyhole method (endoscopic release) the roof is opened with instruments inserted through one or two small incisions. The outcomes of the two techniques are similar and your surgeon can discuss the most appropriate method. The surgery may be performed under local anaesthesia, regional anaesthesia (injection at the shoulder to numb the entire arm) or general anaesthesia. The outcome is usually a satisfactory resolution of the symptoms. Night pain and tingling usually disappear within a few days. In severe cases, improvement of constant numbness and muscle weakness may be slow or incomplete. It generally takes about three months to regain full strength and a fully comfortable scar, but the hand can be used for light activities from the day of surgery.
Carpal tunnel syndrome is due to compression of the median nerve as it enters the hand. Depending on the severity of symptoms there are a variety of surgical and non-surgical options to provide relief. Early assessment by a specialist is advised.
Labioplasty, also known as labia reduction, commonly refers to a group of operations performed to reduce the size of the labia minora. However fat grafting can also be used to rejuvenate and plump the outer labia majora giving a youthful appearance.
Some women are born with protruding labia minora. In other women, hypertrophy of the labia develops later in life and has been attributed to a multitude of causes. Childbirth can sometimes cause enlargement particularly if there has been vaginal trauma at the time of delivery. Chronic irritation is also a factor and this may be due to dermatitis or urinary incontinence. Mechanical irritation is also thought to be a factor. Pseudohypertrophy of the labia minora is also common particularly in thin women, where lack of fat in the mons and labia majora areas gives the appearance of labia minora protrusion. Ageing changes can also lead to volume loss and sagging of the outer labia majora leading to more visible labia minora. Symptoms can be functional, aesthetic and psychological. Functional problems include discomfort due to labia catching in clothing and during intercourse. It can also limit some forms of exercise, such as cycling and there can also be difficulties with personal hygiene. There are also aesthetic and psychological indications for surgery as there can be adverse effects on self-esteem and sexual relationships. However, the most common aesthetic complaint is that the hypertrophied labia minora are noticeable through tight clothing and swim wear and this in itself can severely restrict social activities.
Swelling can be quite marked following surgery and it may be necessary to avoid intercourse and tampons for six weeks. Bleeding and infection can occur as can asymmetry, over correction and under correction. Sometimes revisional surgery may be necessary. There is a limit to how much of the labia minora can be safely removed as it is important to avoid siting scars near the clitoris and posterior fourchette of the vaginal introitus. Fat grafting of the labia majora takes 3 – 4 treatments. You must have adequate fat stores for this. A realistic balance of what can be achieved must be appreciated.
Labial reshaping with skin reduction and tightening or volume enhancement. A variety of techniques. Scars are usually minimal but wound healing problems can occur. Risks include bleeding, infection, as well as asymmetry, swelling and rarely, change in sensation. Day case or overnight stay in hospital with recovery taking 4-6 weeks
There are a vast number of non-permanent dermal fillers. The most popular, trusted group which we use at DRG Plastic Surgery are the Hyaluronic Acid or HA fillers. We specifically use the range of Juvederm products. These are injected under the facial skin to volumise and optimize the existing facial shape. It is very good for tear troughs, cheeks and the area around and including the lips. The effect lasts up to 6 months and can then be repeated. Bruising, lumpiness and under/over-correction can occur. The real benefit of this particular type of filler is that there is a reversal agent that can be used to dissolve a visible lump in the unlikely event of its occurrence.
During aging, as well as descent of the facial shape, the facial volume also reduces. Dermal fillers, if used conservatively, can help to maintain volume giving the face back some of its fullness. The consultation with the specialist is essential to set realistic goals for the patient. A programme of injections to ease the patient into this type of treatment is essential to avoid dissatisfaction.
Hyaluronic acid (HA) fillers are the most widely used, safe dermal filler. They are non-permanent and the effect lasts for up to 6 months. Bruising can occur.
A DIEP flap involves taking the excess skin and fat from the lower abdomen and using it to reconstruct a new breast following (delayed) or at the time of (immediate) mastectomy. The skin and fat with its blood vessels are carefully detached from your abdomen before being reconnected to a new blood supply in your chest. It is called DIEP because the blood vessels taken from the abdomen are called the deep inferior epigastric perforator blood vessels. It is a complex operation that takes about 5 - 7 hours. DIEP flaps give warm, soft and pliable reconstructed breasts that resemble natural breast tissue, and are therefore considered the gold standard for breast reconstructive procedures. In addition, the removal of tissue from your abdomen results in a flatter tummy, as if you have had a tummy tuck (abdominoplasty).
Nearly all breast reconstructions require two or more operations. When using the DIEP flap, whilst as much of the reconstruction is done at the time of the main flap transfer operation, there is often a need for a second very small operation to refine and adjust the reconstruction, as well as undertake a nipple reconstruction. Despite the need for more than one operation, the result should be life-long and the reconstruction should age with you naturally. It should also change with your body weight in a similar way to your breast. This is one of the major differences between flaps and implants, as implant-based reconstructions frequently needed revision surgery as the years go by.
There will be scars on the lower abdomen and around the belly button similar to a tummy tuck scar. We aim to place these as low as possible so they can be hidden by underwear. Scar healing can be unpredictable and although most scars achieve a satisfactory appearance by 18 months some can be red, raised, stretched and uneven. Some can require revision in the second operation.
No abdominal muscle is removed in a DIEP flap operation and abdominal strength is maintained long term. Weakness of the abdominal wall after a DIEP flap procedure may result in a bulge but this is rare. Post-operative abdominal exercises can sometimes improve this over time. Very rarely, damage to the muscle may produce a hernia that will require additional surgery for correction. This is an extremely rare complication because the abdominal muscle is left intact, which is the great advantage of the DIEP technique compared to the previously used TRAM flap breast reconstructions.
The blood vessels that supply the piece of tissue being removed from the abdomen have to be carefully dissected and rejoined to blood vessels in the chest wall so that good blood flow is re-established. Any sustained disruption to this flow in the first few days can cause the failure of the reconstruction. This is very rare (less than 0.4%) and to ensure that this does not happen regular observations are maintained during your in-patient stay. If there are any concerns about the blood flow you may need to go back to the operating theatre to have the join checked. About 1 in 100 women who have a DIEP flap may need one of these 'second checks' in the week after their surgery.
Bleeding can occur with any type of surgery and is not specifically common to DIEP flap procedures. You will have 1-2 drains in your reconstructed breast and 2 drains in your tummy to help prevent any blood clots collecting. These will be removed before you go home.
The development of a serious infection is rare. Antibiotics are given at the time of the surgery to reduce the chances of this happening. Most infections resulting from surgery appear within a few days of the operation and require a further course of antibiotics.
A build-up of fluid under the wound site (seroma) happens in 10% women after the abdominal or breast drains have been removed, and usually gets better within a few weeks. The fluid can be drained at an outpatient appointment.
The breast reconstruction flap will have little or no light-touch sensation. Over 12 to 18 months, the periphery of the reconstruction does regain some sensation and most patients can feel movement of the breast on the chest wall.
Just as skin can form a scar so can the underlying fatty tissue when it is healing in the new breast. This type of scarring is known as fat necrosis and is not serious. Usually they improve spontaneously with massage.
Most women's breasts are asymmetrical (not perfectly equal in either size or shape). With advancing age, the breast also tends to ptose or droop. Although every effort is made to create a new breast to match the opposite healthy one, it is rarely possible to achieve perfect symmetry. After discussion with us and depending on your wishes/needs it may be deemed appropriate to perform a mastopexy (hitching up) or reduction operation on the other breast in order to match the breasts.
Before your procedure we will arrange for a CT angiogram to look at the blood vessels in your anterior abdominal wall. This is a 15 minute scan that helps in the planning of the procedure and reduces the operating time.
You will also have a pre-operative assessment with one of our team who will go through some health check questions and examine you to make sure you are fit for surgery. They will also take blood tests.
If you smoke you should stop at least six weeks before surgery to reduce the likelihood of post- operative complications. If you are unwell before the operation, please call DRG Plastic Surgery on 020 8393 5160 as the date of surgery may need to be postponed. No aspirin or medication containing aspirin should be taken for ten days before surgery.
It is useful if you could bring a non-wired comfortable and supportive bra, like a sports-bra, that you do not mind being cut. After the operation, a hole is often made in the bra so that the DIEP flap can be examined without having to remove the bra frequently.
The procedure takes around 5-7 hours. We will be more than happy to call one of your relatives afterwards to update them on your progress. Visiting times will vary according to which hospital you have your procedure in.
When you wake up you will be in the high dependancy unit to enable close monitoring of the breast reconstruction. It is usual to feel drowsy and a little disorientated for some time post- operatively. If you have pain or feel sick, you should tell the nursing staff so that they can give you the appropriate medication. The breast(s) will feel a little sore after surgery particularly when the arms are moved, but this rapidly improves over the first few days. It is likely that your hips and knees will be bent, perhaps on cushions or with the bed bent in the middle, to take the strain off the abdominal wound.
You will be given pain relieving medication and the anaesthetist will discuss this with you before the procedure. A warming blanket is also usually in place for the first night to stop you getting cold, and some intermittent compression devices on the calves to keep the blood circulating in the legs and again reduce the chances of deep vein thrombosis. After the first night, you are then usually transferred to the ward for standard nursing care. On the first day following surgery, you will need help to sit out in a chair for a short time. You can usually get out of bed by yourself 2 days after the operation. You can normally take a shower on day 2 or 3.
On the day of discharge, you will be given an clinic appointment for approximately 7 days' time. At that appointment, the dressings will be removed by a nurse and the wound checked. We will see you again around day 14 or earlier if there are any concerns. You should continue to shower daily but it is not advisable to soak in the bath for at least 3 weeks.
After 2-4 weeks you may go back to non-physical activity and resume driving a car, but check this with your insurance company as some do vary in their recommendations. Four weeks after your operation you may resume gentle exercise, but violent movements, upward stretching of the arms and high intensity cardio vascular exercise are not advisable for 6-8 weeks.
There are many factors that can affect your individual operation, your recovery and the long-term result. These include your overall health, your chest and body shape, previous breast surgery, radiotherapy, any bleeding tendencies that you have and your ability to heal. Smoking and certain medications can can also have effects on the post-operative recovery period. Issues specific to you need to be discussed with Miss Rose and are not covered here. Please make sure you ask any further questions before you sign the consent form.
Dupuytren's disease (also referred to as Dupuytren's contracture) is a common condition that usually arises in middle age or later and is more common in men than women. Firm nodules appear in the fascia just beneath the skin of the palm of the hand, and in some cases they extend to form cords that can prevent the finger straightening completely. The nodules and cords may be associated with small pits in the skin. Nodules over the back of the finger knuckles (Garrod's knuckle pads) and lumps on the soles of the feet are seen in some people with Dupuytren's disease.
The cause is unknown, but it is more common in Northern Europe than elsewhere and it often runs in families. Dupuytren's disease may be associated with diabetes, smoking and high alcohol consumption, but many affected people have none of these. It does not appear to be associated with manual work. It occasionally appears after injury to the hand or wrist, or after surgery to these areas.
Surgery is not needed if fingers can be straightened fully. It is likely to be helpful when it has become impossible to put the hand flat on a table, and should be discussed with a surgeon at this stage. The surgeon can advise on the type of operation best suited to the individual, and on its timing. The procedure maybe carried out under local, regional (injection of local anaesthetic at the shoulder) or general anaesthetic. Surgical options are:
1. Fasciotomy. The contracted cord of Dupuytren's disease is simply cut in the palm, in the finger or in both, using a small knife or a needle (needle fasciotomy).
2. Segmental fasciectomy. Short segments of the cord are removed through one or more small incisions.
3. Regional fasciectomy. Through a single longer incision, the entire cord is removed. This is the most common operation.
4. Dermofasciectomy. The cord is removed together with the overlying skin and the skin is replaced with a graft taken usually from the upper arm or groin. This procedure is usually undertaken for recurrent disease, or for extensive disease in a younger individual.
5 Xiapex. Recently an injection technique had been introduced into the UK, which dissolves the cord in a discreet area allowing the finger to be manipulated into a better position. The results are very promising
Dupuytren’s disease is a chronic condition involving the hands. It results in a fixed flexion of the fingers. Early assessment by a specialist is advised to diagnose and determine an individualized treatment pathway. Surgical and injection treatments are available.
As the face ages the skin loses its elasticity and the face its volume. The speed with which this occurs depends upon, genetics and environmental exposure. The consequences are eyebrow descent, lengthening of the lower eyelid, separation of the facial fat pads, deepening of the folds between nose and corner of mouth, appearance of marionette lines, loss of jaw definition with a jowl, and changes in the neck. Correcting this either in whole or in part requires repositioning of the facial skin and the layer beneath. Excision of the excess skin is done through a series of cuts in front of the ear and extending around the base of the ear into the hair behind. Facelift surgery is usually accompanied by upper and lower blepharoplasty. The surgery, under general anaesthetic, lasts between 3-5 hours and once dressings are in place the patient is returned to their room. Drains are usually used which come out the next day and the patient goes home wearing a chin support to return in a week for removal of sutures and change of dressings. Weekly visits for the first 2-3 weeks are essential to monitor the facial skin and scars and support the patient. Bruising and swelling can last up to one month following this surgery. There are a variety of facelifts based on scar patterns and the surgery relative to the anatomy of the midface. A full consultation with the specialist is therefore essential. The risks of the surgery include, bleeding, infection, skin loss, nerve injury, poor scar, lumpiness and asymmetry.
This is where a full consultation with the specialist is essential. They will make a decision with you as to the appropriateness of surgery based upon your overall health, what your specific concerns are, and a full discussion of the risks. The most appropriate facelift technique will be discussed. Your skin elasticity will also guide the surgeon as to how long the correction will last and therefore help you decide on the specific risk benefit for you.
Skin and soft tissue tightening. A variety of techniques. Scars in front and behind ear. Eyelids usually done at the same time. Risks include bleeding, infection, skin loss and nerve injury. Usually an overnight stay in hospital with recovery taking 2-3 weeks
With age there is loss of tissue volume, particularly in the cheek area, giving a sunken look to the face. Fat injection provides volume and can reshape cheek hollows and augment the areas over the cheekbones to give a more youthful appearance. It is also beneficial when used to treat lines and depressions surrounding the mouth and chin. In the breast it can offer an increase of 1-2 cup sizes and avoid the need for implants. It can also be combined with an uplift and address minor volume asymmetry. Fat grafting is also useful to correct scar indentations.
Removing fat from one area to increase and improve volume in another. Swelling and bruising are common but you need enough fat stores to have the procedure. It normally takes 2-3 sessions to achieve the desired result.
Classically ganglions can be related to joints or tendons in the hand. The most common involve the tips of the fingers, the bases of the fingers on the palmer surface and the both surfaces of the wrists. They contain the lubricant for tendons or joints. They are encased in a fine smooth covering. They are quite harmless although they can be unsightly and uncomfortable.
They usually occur late as a result of wear and tear or earlier secondary to a hand or wrist injury. Ganglions can be of varying size and can fluctuate. Patients complain of symptoms associated with these, which is more a reflection of the underlying injury. These can be managed conservatively if not too large, or surgically.
Ganglions are cysts which communicate with joints or tendon sheaths. They can be associated with a dull ache which is usually a reflection of the underlying injury. Surgery is an option.
This is only available with referral from a recognised Gender Identity Clinic. We perform both Female to Male (FtM) and Male to Female (MtF) chest wall reconstruction. The main information for MtF chest wall reconstruction can be found under the Breast Augmentation tab in the Cosmetic Surgery menu.
FtM chest wall reconstruction can be performed via two main approaches, either via an infra-mammary (in the breast crease) scar or peri-areolar (around the nipple) scar techniques. The most suitable one for you will depend on how much excess glandular breast tissue is present as well as how much excess breast skin is present. In both techniques the scars are intended to be as discreet as possible. It does however take 18 months for scars to fully mature thus the end appearance can improve during this period. The main aims of the surgery are to remove excess breast tissue and skin, reduce the size of the nipple and reposition the nipple to a higher and more lateral masculine position. The surgery requires a general anaesthetic and you will need to stay in hospital for at least 1 night. Drains are used and these will be removed before you go home. You will go home with dressings and a compression bandage and we will need to see you in the clinic at weekly intervals to check on wound healing. The specific complications that can occur are loss of the nipple sensation, loss of the nipple itself, asymmetry of nipple size, shape and colour, over reduction causing indentation of the chest wall, under correction leaving some breast tissue behind, asymmetry of scars and wound infection and bleeding. Swelling and bruising are also common and seromas can form when the drains have been removed. Seromas are fluid collections within a surgical wound that may require drainage in the outpatient clinic. We will be able to asses the most suitable method of reconstruction talking you through the procedure and recovery period as well as showing you clinical before and after photographs.
Being overweight and smoking can increase the incidents of complications from this type of surgery particularly loss of the nipple. It is always wise to stop smoking completely before this procedure and achieve your target weight. Weight loss following this operation can cause unwanted skin sagging.
Some men develop unwanted breast tissue (gynaecomastia) that causes social embarrassment. This can happen at any age but is more common in the late teenage years or later in life. Hormonal imbalance and a number of drugs also cause this condition.
Reduction of the male chest can lead to a flatter and more defined masculine chest. It will give more confidence when wearing clothes, and also with minimal scarring procedures, increased confidence when bare-chested.
Being overweight and smoking can increase the incidence of complications from gynaecomastia surgery. It may be wise to delay surgery until smoking is stopped or cut down, and a proportion of excess weight lost.
Gynaecomastia surgery is not a substitute for diet and exercise.
Techniques vary and sometimes scars are necessary that can be visible, although minimal scars and removal of excess breast tissue by liposuction is the most common technique.
Asymmetry can persists and nipple sensation can be altered.
A pressure garment needs to be worn for at least 6 weeks following surgery.
Male breast reduction. A variety of techniques. Scars can be around the nipple and sometimes also in the breast crease. Risks include bleeding, infection, nipple or skin loss as well as change in nipple sensation, skin sagging, asymmetry and lumpiness. Usually an overnight stay in hospital with recovery taking 4-6 weeks.
Following an open lower limb fracture (broken bone and overlying skin damage) it may not be possible to fix the bone and close the overlying skin. In these situations we often work jointly with the orthopaedic surgeons to provide skin cover. This is normally done in an emergency setting immediately after the injury. Skin and fat can be taken from your thigh, your forearm, your tummy or your back and then transplanted to cover broken bone in your leg. These types of reconstruction are tailored for your specific injury and usually involve some form of microsurgery, so combined with the fracture fixation they can often take all day. The recovery period can often take months and involve intensive rehabilitation. This type of reconstruction can also in some situations be done later on if there have been problems with skin healing over a broken bone.
Normally there are not many options following high energy lower limb trauma when bones and skin are injured. You do however need to be fit enough for a general anaesthetic and prepared for intensive post-operative rehabilitation.
Normally there are not many options following high energy lower limb trauma when bones and skin are injured. You do however need to be fit enough for a general anaesthetic and prepared for intensive post-operative rehabilitation.
An assessment over the leg needs to be made to ensure that it will be viable following the reconstruction. Sometimes in severe limb injuries amputation may be a better and faster recovery. There are risks that this type of reconstruction may fail in the short term as well as the risk of scars, revisional surgery and bone infection in the long term.
Reconstructing alert after major trauma. Risks include failure, infection, scars, bone healing problems. At least a week stay in hospital with recovery taking 6-18 months
Liposuction (or liposculpture) is now one of the most popular cosmetic procedures performed. It is used to remove unsightly, stubborn areas of fat that fail to be removed through exercise or diet, thus reshaping the body. It is not designed as a treatment for obesity in general, but is very successful in removing fat from areas of the body such as the upper arms, abdomen, buttock, thighs, calves, chin and neck. It is used in men and women alike, to reshape a disproportionate figure, and is now widely used to treat the condition of male gynaecomastia (noticeable breasts).
Liposuction is used primarily to reshape the body, with the ideal candidates being at or near their target weight. It is not in itself a procedure to lose weight, but is often used to complement other surgical procedures. There are physiological limits to how much fat can removed with liposuction. A thorough clinical assessment will be performed including the BMI (body mass index) as an indicator. Liposuction is also reliant on good skin tone for the body to take up the new shape effectively. Some contour irregularities and lumpiness can occur and if skin tone is poor skin sagging can be an issue. Pressure garments need to be worn post operatively for at least 6 weeks.
For those seeking a large reduction in weight, rather than planning for immediate liposuction, advice on diet and exercise may be given, or if applicable, referral for weight loss surgery.
Smoking can increase the incidence of complications from surgery. It may be wise to delay surgery until smoking is stopped or cut down. Aspirin increases the risk of bleeding by preventing blood from clotting. If you are taking aspirin, you will be asked to stop this for at least ten days before the procedure.
Removal of fat from target areas through key-hole incisions. Swelling, bruising and contour irregularities can occur and there is a limit to how much volume reduction can be achieved. Good for specific problem areas but not a substitute for diet and exercise. Pressure garments are needed post operatively.
A breast lift (mastopexy) reshapes the breast and lifts it to a higher position. It attempts to reverse the effect of gravity and restore a 'droopy' breast, to leave a more youthful, pert breast shape. The volume of the breast is not changed. It takes about 2 hours and drains are usually used which come out the next day. You will therefore need to stay in hospital for at least one night. Recovery takes 4-6 weeks and you need to avoid physical exercise and wear a support bra during this period. We will need to see you weekly for the first few weeks. Bruising and swelling will occur and last for up to one month. Other risks include bleeding, infection, nipple loss or changes in sensation, skin loss, poor scar, lumpiness and asymmetry.
With age, the combination of gravity and the gradual loss of the skin's elasticity, the breast descends into a lower position, and consequently loses its original shape. The effects of pregnancy and breast-feeding worsen this problem.
Breast reshaping with skin tightening. A variety of techniques. Scars can be around the nipple and vertically down as well as in the breast crease. Risks include bleeding, infection, nipple or skin loss as well as change in nipple sensation, asymmetry and lumpiness. At least an overnight stay in hospital with recovery taking 4-6 weeks.
Surgery to the nose can be both cosmetic or functional. The functional changes to the nose are usually around breathing and involve improving the airflow through both nostrils. The cosmetic changes to the nose usually involve changes to the bridge of the nose, tip shape and width or the tip position relative to the nostrils. Surgery usually involves a general anaesthetic, overnight stay in hospital. Access to the nose is either up through the nostrils or through the skin between the nostrils. This is called an open rhinoplasty and affords much better exposure to the structures providing support and shape to the nose. Once the changes have been made the wounds are closed and a nasal splint is applied. This is removed with any sutures at the first post-operative consultation at one week. The swelling to the nose takes about 6 weeks resolve, small improvements continuing to occur over the next 6 months. Risks are around changes in breathing, sense of smell, surface irregularities, overall shape and meeting the patient's expectations.
Patients seeking rhinoplasty usually have been thinking about it for a long time, and know exactly what they want. The skill within the consultation is to know whether what they want is something that is deliverable. This consultation more than any other will set these expectations. Multiple consultations are often needed to gauge the patient's understanding as to what they are being offered, and their buy in to this process. Time spent on the consultation process will result in a smooth operation and an acceptable outcome for the patient.
Surgery to the nose is called rhinoplasty. Used to correct breathing or shape. Usually a general anaesthetic. Overnight stay in hospital, splint worn for a week. Bruising around the eyes which resolves within 10 days.
The appearance of scars varies greatly. They can range from thin, skin coloured concealed lines to red, lumpy scars. Many factors determine the appearance of a scar; skin tone, age, the site of the scar, the age of the scar, and how a wound or incision was repaired. Surgical procedures can be used to remove, change or hide scars. For some patients, general scar management advice is all that is needed; for others injection with steroids are used to improve 'lumpy' scars. If these are not applicable, advice for camouflage techniques is given.
You may wish to try and improve the look of your scar for cosmetic reasons. Scars, as a result of either routine surgical procedures or more often from trauma injuries, can be unsightly. They may be raised, red, and lumpy, and or lie in a prominent position. Scars may also cause functional problems. At some sites on the body, scars may contract, pulling on surrounding skin and tissues, and in some cases restrict the movement of joints.
Not all scars can be improved or disguised with surgery and we will advise you if this is the case with your particular scar. Even with corrective surgery a scar will always be present and all surgery carries a risk of wound healing problems, infection, bleeding and unsatisfactory result.
Lots of techniques are available to improve the appearance of scars. We can assess your scar and give you the best advice on treatment. If surgery is indicated it can usually be done under a local anaesthetic as a day case depending on size and site
As well as facial descent with aging comes loss of volume. This is particularly visible in the midface. The result is lengthening of the lower eyelid, separation of the lateral and medial fat pockets in the upper cheek and a hollowing of the lower part of the cheek. The science behind this non permanent injection treatment is well demonstrated in the medical literature. The active ingredient is poly L lactic acid which incites the patient's own inflammatory response to lay down more connective tissue and thus to re-volumise the midface. This results in a fuller face, which helps to create a fresher look.
The treatment consists of a series of injections using cannulae spaced 6-8 weeks apart. The time for each treatment lasts 30 minutes and massaging the area for the following few days.
Risks include bruising, lumpiness and failure to match patient's expectations.
The success of Sculptra, whilst it cannot be guaranteed, is well reported in the literature. It gives a natural enhancement and also improves the quality of the skin. It is a non-surgical treatment that is rising in popularity. A full assessment by your specialist is essential in setting achievable goals during the programme. The results last up to 2 years.
A series of injections to add volume to the face. Treatment time at least 30 minutes and the patient often requires 3 to 4 sets of injections spaced 6 to 8 weeks apart.
Trigger finger is a painful condition in which a finger or thumb clicks or locks as it is bent towards the palm.
Thickening of the mouth of a tendon tunnel leads to roughness of the tendon surface, and the tendon then catches in the tunnel mouth. People with insulin-dependent diabetes are especially prone to triggering, but most trigger digits occur in people without diabetes. Triggering occasionally appears to start after an injury such as a knock on the hand. There is little evidence that it is caused by work activities, but the pain can certainly be aggravated by hand use at work, at home, in the garden or at sport. Triggering is sometimes due to tendon nodules in people known to have rheumatoid arthritis. It is not caused by osteoarthritis.
Trigger finger and trigger thumb are not harmful, but can be a really painful nuisance. Some mild cases recover over a few weeks without treatment. The options for treatment are:
1. Avoiding activities that cause pain, if possible
2. Using a small splint to hold the finger or thumb straight at night. A splint can be fitted by a hand therapist, but even a lollipop stick held on with tape can be used as a temporary splint. Holding the finger straight at night keeps the roughened segment of tendon in the tunnel and makes it smoother.
3. Steroid injection relieves the pain and triggering in about 70% of cases, but the success rate is lower in people with diabetes. The risks of injection are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection. Improvement may occur within a few days of injection, but may take several weeks. A second injection is sometimes helpful, but surgery may be needed if triggering persists.
4. Percutaneous trigger finger release with a needle. Some surgeons prefer to release the tight mouth of the tunnel using a needle inserted under a local anaesthetic injection, but others feel that open surgery is more effective. The needle method is not suitable for all cases and all digits.
5. Surgical decompression of the tendon tunnel. The anaesthetic may be local (injected under the skin at the site of operation) regional (injected in the armpit to numb the entire arm) or a general anaesthetic. Through a small incision, and protecting nerves that lie near the tunnel, the surgeon widens the mouth of the tendon tunnel by slitting its roof. The wound will require a small dressing for 10-14 days, but light use of the hand is possible from the day of surgery and active use of the digit will aid the recovery of movement. Pain relief is usually rapid. Although the scar may be red and tender for several weeks, it is seldom troublesome in the longer term. Recurrence of triggering after surgery is uncommon.
Triggering of a finger or thumb results in locking in flexion and tenderness usually in the palm or base of finger/thumb. There are a variety of treatments that can be offered to resolve this condition. Early assessment by a specialist is advised.