Frequently Asked Questions

The word “plastic” in plastic surgery has, of course, nothing to do with “plastic” the material. In fact it actually predates its use for the material by a good couple of centuries. Both words have the same derivation - they come from the ancient Greek word “plastikos” which roughly means to alter the form/shape of something. And that’s pretty much what we do… as plastic surgeons we manipulate the body’s tissues (not just skin and fat, but muscle, bone and nerves too) to achieve three things:

1. Heal wounds – for example after burns, trauma or cancer excision
2. Improve function – for example reconstruct a child’s nerves that have been damaged during childbirth
3. Improve appearance – this can vary from what we would generally consider “aesthetic/cosmetic” such as breast augmentation, to the correction of birth (congenital or developmental) defects, for example Poland Syndrome, in which one side of the chest wall fails to develop properly.

The first two aspects of plastic surgery are generally covered by the NHS in the UK, as are most congenital defects. Currently, though, most of what we would consider "aesthetic" or "cosmetic" surgery is not, and tends to be addressed on the private sector. However, there is a grey area – for example, when an adolescent’s breasts mature asymmetrically, this is unquestionably a problem of development, but will often be considered as an aesthetic problem that the NHS will not fund, particularly in the current climate (although there are exceptions).

The simple answer is “it’s up to you”. And while that may sound evasive, it’s basically true. But, to avoid sounding like I’m dodging the question, let me expand. A good way of thinking of this question is to reword it as “are the upsides of having the surgery worth the downsides?”. The main problem with trying to address even this question is that while the downsides are relatively easily quantifiable and definable (the cost, the percentage risk of infection), the upsides to aesthetic surgery, while certainly there, are neither easily quantifiable nor objectively definable because they are subjective and individual – the commonest reasons are to improve confidence, have a more feminine or masculine appearance, or to feel more proportionate – how do you measure these things? Not clear, is it?

So, to go back to the question, how do you decide if you “should get plastic surgery”. If it was me, I would think about the following six questions…

• Am I doing this for myself? If you are doing it because you feel some kind of pressure from external groups (for example from your peer group, a partner), you are likely to regret your choice. That sounds very obvious, but sometimes the pressure is not actively or even knowingly applied, and so it’s not so easy to recognise. So just make sure that you have reflected on that question.

• Is surgery really the only way to get this result? If there is an alternative lower-risk way to get the result, then do it!  A good example of this would be weight loss – while, say, liposuction is a great way to remove excess fat from stubborn areas that just don’t seem to shift (commonly in women the outer thighs, or in men “love handles”) it’s not a good alterative to losing significant weight from all over the body. (see “Exercise and lifestyle changes vs plastic surgery")

• Have I really thought about it? If your decision to have surgery is something you’ve reflected on and investigated, while it doesn’t mean you should do it, it’s a good sign. However, if it is something you are doing spontaneously, then it’s probably worth taking a step back first to be sure – this is definitely something not to get on an “impulse buy”!

• Do I have realistic goals? This is not so easy for patients to judge. Social media, the media more generally (television, magazines) may give an unrealistic view of what is normal and what is achievable (and sustainable). And while the internet provides a wealth of information that you can use to inform yourself, the information can actually be overwhelming. So the answer to this question comes down to a brutally honest, no-holds-barred discussion with your surgeon.

• Do I trust my surgeon? Speaking as a surgeon, as someone who has been a surgical a patient and as someone who has had family who have had surgery, I think this is the second most important decision you can make after the actual decision to seek surgery. It’s more important even than the details of what surgery that you choose to have, because actually a good surgeon should be able to guide you to that decision based upon what your goals are. (see “How should I decide which surgeon to pick?”).

• Having weighed the pros and cons, do I feel it’s best to proceed? The “pros” are basically your goals, and the “cons” are the financial cost, the risks and the practical effects on your life (who will take care of the kids? Can I take the requisite time of work? and so on). Again, this is something that you can get some information on from Internet research (just like you are doing on this web page now), but the volume of material can be frankly bewildering and it is so difficult to find consistent information that you can rely on. So talk it through with a surgeon, and if you’re not ready for that just yet, maybe start with someone close to you that you trust…

…and if the answer to all those questions for you is “yes”, it doesn’t mean that you must have surgery, but maybe it is the right thing for you. So make an appointment with a surgeon, and see what you think.

Frequently a patient will come in with a specific idea of what result (say fuller breasts) they want and what operation they want in order to achieve it (for example breast augmentation), and often they will be right – that’s the best way to get the result they want.  But not uncommonly a patient will have an idea of what result they want, and what operation they want in order to achieve it, but without knowing that the operation they want is not the best way to get the result they want.

For example, breasts with a lot of sag will often be much better served with a breast uplift with or without an augmentation than an augmentation alone. So what’s the best thing for you to do here? Well, I still think it’s good that you have a very clear idea of what you’d like to achieve and how to achieve it, and by all means get as much information as you can about the options, but then really it’s the surgeons job to make sure that you choose the best route to your desired destination.

So when you talk to your surgeon, do so with an open mind.  Ultimately, a good surgeon will be willing to listen to you and understand your goals, and use their experience to advise you on what the best way to achieve them, and be able to explain to you why it’s the best course of action to take.

After deciding you want to consider plastic surgery, I think this is the most important decision you can make about your surgery (see the “Should I get plastic surgery?" section), and it’s not always easy.  Naturally, what you will want is “the best” surgeon, but what makes someone the best surgeon? Results? Experience? Complication rates? Word-of-mouth?  These things are undoubtedly important markers, but actually even those of us who are plastic surgeons have very different opinions about who is better than whom. In fact I would say that most of the surgeons I have worked with and seen the results of are basically pretty competent, and they are good people who care for their reputation, their results and most importantly their patients. So how can you decide? It’s a bit tricky.

One thing I would say is that there is probably not a mythical best surgeon for everyone, but there will be different surgeons who work better for different patients.  So don’t look for the mythical “best surgeon” – you’ll be disappointed. Look for the best surgeon for you.

So, if I was trying to find the best surgeon for me, before seeing a surgeon I would look at …

1. What are their membership and qualifications? I would want my surgeon to be a Fellow of the Royal College of Surgeons (“FRCS Plast” for plastic surgeons and “FRCS Gen" for general surgeons). The exam to get FRCS is pretty rigorous and while it doesn’t guarantee a surgeon is good, I feel it increases the chances. Similarly, being a member of a professional organisation like BAPRAS and or BAAPS, or ABS, is important. These organisations (along with the Royal College of Surgeons) have governance structures and also a reputational interest in making sure that their members are surgeons of “good standing” – again not a guarantee of anything, but at least providing a degree of reassurance.

2. What are their results like? This is a pretty obvious thing, that you’ve no doubt already thought about. Here’s the problem – most surgeons are going to primarily show their good results? So how do you judge? Well, it's tough, but if you don’t even like their “good results” then that’s probably not the surgeon for you. And also, it’s not necessarily that they are “bad” surgeons, just that perhaps they cater for a different group of patients and different expectations.

3. Word of mouth a personal referral for a surgeon from someone you know who has had surgery with them and has had a good experience is invaluable. Again this does not guarantee that the surgeon is right for you on its own, but taken together with the other considerations, it certainly provides you with an extra evidence and reassurance that this is the right person for you.

…and then I would meet the surgeon. And when I did I would think about…

1. Do you feel you’re being listened to? Feeling like you're not being listened to is something of a red flag.

2. Their manner Do they seem like they care? Do they seem honest – specifically, if there’s something you may not want to hear would they be willing to tell you?

3. How thorough are they? Not only in terms of understanding your needs and background, but explaining what they think needs to be done in a comprensive and easily udnerstandle way.

4. How do they manage complications? If I was going to have surgery I think the thing I would be most worried about would be “what if something goes wrong?”, so I would talk to the surgeon about how many complications they have,  and (I would suggest more importantly) how they manage complications.

And then I would put all of it together and go with your instincts. Why? There are simply too many factors, many of which you won’t have even considered, and even if you have it’s pretty tough to make an objective judgement about them. So what do we do in life when a question can’t be resolved with a truly rational conclusion? Well, we do our due diligence, look at the facts, use them to help guide our intuition and, as I said before – we go with our instincts.

It would be dishonest to say that aesthetic plastic surgery always goes perfectly. It doesn’t. And sometimes complications will happen. And you must ask yourself “And what if they do happen…?” The answer is - you will not be turned away, and you will be taken care of…

The complications can broken down into those urgent problems that happen soon after the operation (for example a bleed after surgery) and those that happen further down the line (for example poor scarring).  The urgent problems will be taken care of rapidly – be that organising for a return to the operating theatre to deal with bleeding, or antibiotics for a skin infection, or special dressings for a wound healing problem. The longer-term problems (for example lumpy scarring) will generally be initially managed in a clinic environment, where you can express your concerns and we can discuss the management options with you to work out what solution works bet for you. Sometimes the solution is non-operative, and sometimes the solution is surgical – whatever it is, we will be there for you.

This is in some ways very easy to answer and in some ways very difficult…

There are lot’s of different, relatively objective criteria within the literature for what makes a good breast, a good scar and so on. And of course your surgeon will have his or her own opinion too. But actually, despite attempts to quantify a good result, these measures are quite imperfect for various reasons, not least because they are so influenced by factors such as what sort of body images are being portrayed positively in the media at a given moment, what is technically possible, and even which cultural background you happen to be from.

But actually, in the real world, they don’t matter. What matters is what you think makes a good result – your expectation. And that’s why your pre-operative consultations are so important.  It is at the consultation that the critical exchange occurs between myself and my patients – I find out exactly what the patient is expecting, and where I explain honestly what is safely possible to achieve.  The the real key is getting the two to match.

This is essentially a no-brainer. Generally speaking, if exercise or eating healthily is likely to be able to get you the result you wanted, then that is the way to go! You’ll save money on surgery, have less risk, feel better in yourself, reap the health benefits and have the satisfaction of knowing you did it off your own back, with your own will. BUT…

…there are somethings exercise won’t help with. Loose skin, for example, does not shift with exercise. Some anatomical areas cannot be built up with resistance-training (e.g. breasts). Sometimes, also, there are patients I see who have lost a lot of weight but find one or two stubborn areas that simply won’t shift without losing an unhealthy amount of weight. And there are occasions when a problem is actually impairing the ability to exercise, which we sometimes see in ladies with very large breasts (macromastia, gigantomastia). And in these cases surgery is often a great option.

First and foremost, you are my patient, not my customer. To me, the term customer over-emphasises the transactional nature of the relationship. Whereas my duty of care to you extends beyond that – to encompass your health and general well-being. Which sometimes means saying “no” – if I feel that something is too much of risk, to your health as my patient, or won’t get you the result you want, it’s important that I am able to say that I can’t do it. 

The question is not so much where to get on-line information - there is an overwhelming abundance of it - the question is where to get good quality on-line information. The problem is that the "good" information resources for patients  can often be drowned out by the not-so-good, misleading and sometimes frankly dangerous ones. 

I am a member of BAPRAS (the British Association of Plastic, Reconstructive and Aesthetic Surgeons), and if you're looking for some pretty unbiased and useful information prior to considering plastic surgery, they have a particularly good website.  Their patient information section has downloadable documents with extensive, reliable details of many of the procedures that I perform. https://www.bapras.org.uk/public/patient-information

The skin edges of your wound, like most cuts, will seem to have been healed within a week or so.  However, the wound and the deeper tissues still lack strength at this point – about 5-10% of the strength of normal skin.  It takes about 6 weeks before the strength of the scar returns to even just 50% of the original strength of the tissue and skin.  It’s very important, therefore, that even if you “feel OK” before that time (which the vast majority of people will) that you wait before exercising till the 6 weeks to prevent complications.   However, in general, the majority of people today do jobs that do not place a significant physical strain on them. As a result of that, people usually need to take a week or two off from work to get over the surgery itself, but can often return to work sooner than they can get back to exercise.  This of course varies according to your job, and if your work does require a lot of physical effort, then it will take longer before you can return, or a phased return may be needed.  I will discuss what would work best for you in your personal circumstances at the time of consultation.