Can I still have an operation if...
I suffer from any other medical condition?
It is very important to discuss any existing medical conditions with your surgeon and anaesthetist before undergoing surgery. Conditions such as hypertension (high blood pressure), diabetes and other chronic disorders, do not prevent you from having surgery, but need to be well controlled before the operation. If you have had a recent cold or sinus problem, you should also discuss this with Chris, as it may be better to delay the surgery until these have fully cleared up. This helps to minimise postoperative complications such as wound infections and chest infections.
If you have been referred, your family doctor should include a list of your current medical problems and your medications in his/her referral letter. Certain blood thinning drugs such as aspirin and warfarin will need to be stopped before surgery, to prevent excessive bleeding. In the case of warfarin a suitable alternative should be found. If you are taking this drug for only a few months, it would be advisable to wait until you are no longer taking it.
Chris and the anaesthetist will discuss the relative risks of surgery in relation to your medical condition with you before surgery is carried out.
I still smoke?
You should refrain from smoking before undergoing your surgery, ideally for a period of 2 weeks or more. Patients who smoke are more likely to have bleeding problems during surgery, and also develop postoperative problems such as chest and wound infections.
I am pregnant?
Unless strongly indicated, surgery would be extremely inadvisable and potentially dangerous to both mother and baby. Non-urgent surgery should be postponed until after the birth of your baby.
I am elderly?
There is no absolute upper age limit with most types of surgery. However, as you get older you may suffer from medical problems and these must be sorted out before your operation. Please inform Chris of any health problems and any medications you are taking.
Does Chris do insurance covered work?
Chris has been accredited by all the major insurance companies. You can book an appointment directly with him using your authorisation code, or pay in advance whilst awaiting confirmation. If you have paid to see Chris as a self-pay patient and your insurer decides to authorise a ‘new appointment’ payment, your fee will be refunded in full. Please feel free to email the clinic with details of your situation so he can advise.The refund will be made 5-7 days after the insurer has paid the invoice.
How can I prepare for surgery in the days leading up to surgery?
- Sleeping: Try and sleep well and feel rested. You are in good hands and being rested will help you recuperate from surgery.
- Gentle exercise: This helps our mood and allows some psychological preparation prior to surgery
- Eating and drinking: You will probably be admitted to the hospital or clinic either the night before, or the morning of surgery. You should have nothing to eat and drink for at least 6 hours before surgery.
How can I prepare for surgery in the weeks leading up to surgery?
- Smoking: Ideally, you should stop smoking 2 weeks before surgery. You can discuss this with Chris.
- Medications: You must discuss all medications with Chris and the anaesthetist. You should continue all your regular medications unless specifically advised not to. Such drugs that will need to be stopped include those that thin the blood (for example aspirin and warfarin). If you stop any medication also consult your family doctor first.
- Childcare: Think about childcare (if applicable), with particular reference to your mobility afterwards.
- Life events: Avoid undertaking major surgery when life is too complex, or immediately prior to a life event, such as a wedding.
- Post bariatric surgery: With surgery after massive weight loss, a stable weight that you are happy with is essential to achieve good results that last.
- General health: There is little preparation that you need to make before the surgery. Ensure that you do not have a cold or upper airway problem. If you think that you may be developing a cold please inform your Chris immediately.
How long before I can...
- Eat? Once you are awake and the team is content with your progress, you will be able to drink and then to eat.
- Bathe or shower? As soon as the main effects of the general anaesthetic wear off you can wash and get up to go to the toilet. It is not advisable to bathe or shower on the same day, After a local anaesthetic, showering can resume immediately, as the dressings are shower (but not bath) proof.
- Drive? You should arrange for someone to collect you after your operation and you should not drive whilst your face is swollen, or you are in any discomfort which may prevent you from making sudden movements if necessary. You can check these details with your insurance company.
- Play sport? You should not play sport for up to six weeks after surgery, as things heal and any minor trauma could undo the effects of surgery.
How much does the surgery cost if I pay myself?
A plan will be put together that best suits your medical and logistical requirements. This will always be devised with safety as the priority. You will also be sent an all inclusive quote with a breakdown of costs after your initial appointment. The cost of surgery will depend considerably on the type of operation you have.
I’ve made the decision that I would like Chris to do my surgery, what do I do next?
You can book an appointment with Chris by calling us on +44 (0) 20 3651 0547 or e-mailing the clinic to book an appointment. Alternatively, you can book directly into Chris’ diary through the website.
Chris will listen to the problems that you are having and ask you questions about your general health and any medication you may be taking. He will then examine you in order to build up a picture of the problems, as you see them. He will explain what can or cannot be done to overcome these problems and what type of treatment is appropriate for you. He may also take photographs and order some blood tests and investigations to make sure the operation can proceed safely.
You will then be sent a full package detailing the care advised and you have as much time as you need in which to think about the surgery. During this time Chris is happy to discuss things further and answer any additional questions you may have. If you decide to proceed, there will be the opportunity to have another appointment (free of charge) to finalise details. If you would prefer, this can be done by e-mail or telephone. Chris will then arrange for a suitable time for you to be admitted to a hospital or clinic where he operates.
Is surgery safe?
Safe surgery is the key priority for Chris and his team, from deciding at the outset whether surgery is the best route for you, the type of surgery best suited to your situation, to the anaesthesia used; your medical history and unique set of circumstances will be taken into consideration.
Prior to surgery it is important to understand that surgery is never completely without risk and Chris will go over all reasonable risks and potential complications. Some problems can be foreseen and can therefore mitigated against before surgery, whilst other problems, however rare, arise by chance and must be dealt with promptly.
Chris will detail steps that need to be taken to reduce risks in surgery and to ensure a speedy recovery time. This may include, for example, reducing or giving up smoking, losing weight and improving diabetic control.
At the time of surgery, the risk of any infection will be minimised by checking the sterility of the equipment before any intervention, preparing the surgical site with antiseptic solution and where appropriate prescribing antibiotics. Dressings will be used to protect the surgical site after the operation.
If any complications do arise, Chris and his team will be on hand to support you and will provide you with everything you need. The vast majority of complications can be treated without further surgery.
Is there a consultation fee?
Yes. Chris charges £350 for the first (longer) appointment. For minor surgery, Chris offers a second complimentary telephone consultation. For complex surgery, you should plan to discuss the surgical plan and/or quote in more detail in person. This follow up appointment is chargeable. There may be additional charges for clinic procedures such as injections. These fees are detailed in a package of care quote which is provided to you after your initial appointment.
What about after I have recovered from the surgery?
Long term follow on care and screening is valuable in picking up early signs of recurrent symptoms and identifying new, similar or associated issues. There are guidelines in place relating to the frequency certain conditions should be observed for and this is recommended in certain conditions, for example if you have had surgery for cancer.
The added benefit is that you will have continuation of care from Chris who knows and understands your background. He will advise on best evidence-based practice for your condition and organise x-rays, specific investigations or clinical photography where necessary.
Chris would be pleased to talk through options and the packages available to you.
What happens after surgery?
After surgery care is as an important factor as the surgeon or the surgery itself and following your Chris’ instructions accurately can make a big difference to the result. You will be given full written instructions on how to care for your wound after your surgery, bathing, compression garments and physical activity. You will also be provided with details of possible complications together with a list of contact details in the unlikely event of a problem.
In the first days following major surgery – as Chris will discuss with you – you should ensure a friend or family member is available to care for you after you have been discharged. Follow up appointments are necessary to check your wound is healing properly, change dressings and remove stitches. At these appointments, Chris will advise you about returning to work, physical activity and driving as well as options for follow on care and screening if that is felt necessary..
Unless there are special circumstances, Chris will write to your GP summarising the treatment that you have received.
What happens now that I have decided to see a specialist?
It is essential that you see someone fully trained and qualified. The GMC registers all doctors one year after finishing their medical school. It then takes a much longer period to gain entry onto their specialist register for a subspecialty. You can check the GMCs website very easily. Each UK specialty has their own specialty exam. In surgery this is the FRCS and in plastic surgery, this is the FRCS (Plast). Further postgraduate training (such as a diploma in aesthetic surgery) shows added qualifications. Membership of nationally accredited surgical societies (such as the Royal college of Surgeons of England, British Association of Plastic and Reconstructive surgeons and the British Association of Aesthetic Plastic Surgeons) is also important and implies a greater level of professional vetting by collegues.
Once you have selected a surgeon, you will need to make an initial appointment with them. Prior to this appointment, you should have thought carefully about the problems you wish to address. It is useful to write a list to help you remember. It is also helpful to take along photographs of yourself, especially if you are looking to address a body part which has been affected by injury or ageing. We advise you to bring a partner or friend with you, if you feel this would be useful.
What happens on the day of surgery?
Usually, you will be admitted on the day of surgery. You will see an anaesthetist who specialises in administering sedation or general anaesthesia so that you sleep through an operation comfortably and without any awareness, whilst administering pain relief. They will also examine you to ensure you are fit for an anaesthetic. You will be asked again regarding any medical problems and any recent major illness, as this may have an effect on the medication they give.
The surgery is carried out under an appropriate anaesthetic, which will have been discussed and agreed at your initial appointment. You should feel no pain during surgery, apart from the discomfort of any injections necessary.
When the anaesthetic wears off, the operative site will feel swollen. It is usual to have a small amount of bleeding and a dressing will be in place to catch any of this and to protect the site of surgery. This usually stops within a few hours. For most surgical procedures, a little swelling and bruising is normal and this will settle within a few days.
The anaesthetist will prescribe regular painkillers, and it is usual to be discharged home the same or following day. Occasionally a longer stay is necessary, especially when surgical drains are necessary. You will be seen within the week to check how the surgery is going and to screen for any signs of infection. At this stage, removable sutures will be taken out.
What if I need an injection in the clinic?
Occasionally injections are recommended as a treatment for your problem. If you feel comfortable with this and Chris feels it is beneficial to do immediately, he can offer you the injection in the initial consultation. Whether you have had injections before or not, each administration may feel different to the previous. This is due to a number of factors such as changes in your body temperature, the blood flow going to your skin, your levels of anxiety (outside the clinical episode), tobacco and caffeine use and varying sensitivity of various parts of the body.
If administered in the clinic, Chris advises that you plan to stay in the clinic for 30 minutes after your injection, to allow any side effects of the injection process to subside. It will also allow any pain relief taken enough time to start working. Often the area around a site of injection aches and can throb for 48 hours afterwards. It is advised to have amended your working and social diary accordingly if injections are proposed.
What is an Initial appointment?
An initial appointment is the opportunity for you and Chris to meet in person. This appointment lasts for 40 minutes and during this time Chris will ask you about your medical concerns/requirements, your general health and any predisposing factors that might affect the treatment options available to you. This of course, is also an opportunity for you to ask Chris any questions or concerns you have.
You should also expect a brief examination of the relevant body area/s. For any facial assessment, we request that all make-up is removed prior the consultation to enable to accurately assess the skin pigmentation, texture and quality.
After this appointment, a plan will be constructed that best suits your medical and logistical requirements. This will always be devised with safety the priority. An assessment by a consultant anaesthetist is occasionally necessary. It can usually be decided how best to control your current medical situation to reduce the risks around the surgical date. If a decision cannot be made, more information from your other specialist doctors will be sought, with your permission and/or an anaesthetic assessment organised.
If you feel comfortable having minor treatments in the clinic on that day (such as a steroid injection or BOTOX) and Chris feels that it is appropriate, then this can be arranged.
Most commonly, following the initial appointment, a ‘cooling off’ period of time is left in order for you to reflect on the options available and make a decision. If you do decide to proceed with the surgery a second appointment is advised and offered, but this can occur by telephone if more convenient.
What possible complications are there?
- These are fortunately rare. It is important that you inform Chris and the anaesthetist of any major health problems and any medications that you take. Of particular importance are any drugs that thin the blood such as aspirin or any anticoagulant drugs. This can lead to prolonged bleeding, which can be serious and can also affect the results of the surgery.
- If you smoke then this can also cause prolonged bleeding and you stand a higher chance of developing postoperative complications including a chest infection.
- At time of surgery? It is important to inform Chris of any previous surgery you have had. This may affect the subsequent surgery that he carries out. There is also a small risk of excessive bleeding during the surgery. This is more likely in those people who smoke or take blood-thinning drugs. Occasionally the procedure itself may have to be abandoned, or delayed to a second operation.
- Immediately after surgery? The main problem arising immediately after surgery is bleeding. This may be in the recovery room or a few hours after surgery. This can occur because your blood pressure will rise when the general anaesthetic wears off, allowing small blood vessels to open up. Also during the operation local anaesthetic is used for its vasoconstrictive action (to reduce bleeding). As this wears off after surgery, again bleeding may start. Often these problems can be overcome by special dressings, but occasionally a second operation is necessary. Postoperative pain is not usually a big problem, as the anaesthetist will prescribe effective analgesia which you will be given regularly, but the procedure is not usually too uncomfortable.
- Late problems after surgery? These are rare. One of the main ones is infection, and this can manifest in several ways. It may present as delayed bleeding, at about 7-10 days after the surgery. It is important to contact Chris immediately. If the infection is not treated rapidly then there may be damage to deeper structures. Moderate to severe infection may need hospitalisation for a few days. Infection can also present with pain, a temperature or unpleasant taste or smell. If you experience any of these symptoms, you should contact Chris immediately.
What qualifications does Chris have?
Chris is a fully qualified consultant plastic surgeon and has passed the FRCS (Plast) exam, which is a higher qualification that all plastic surgery trainees obtain in the UK before they can join the General Medical Council’s specialist register and take a position as a consultant in the National Health Service. In addition, Chris is a member of BAAPS (The British Association of Aesthetic Plastic Surgeons) and BAPRAS (British Association of Plastic, Peconstructive and Aesthetic Surgeons). Being a member of both of these organisations signifies Chris has had specific training in plastic, reconstructive and aesthetic (cosmetic) plastic surgery. Chris has higher training on cosmetic surgery (diploma) and fellowships in craniofacial surgery from Great Ormond Street Hospital and Cosmetic surgery from HCA Wellington Hospital.
Where is the surgery done?
The surgery is carried out in a hospital or clinic. This may be a NHS hospital with private in-patient facilities, or a private hospital or clinic. This will be discussed with you when you have your initial appointment. It is usually somewhere that is convenient for you which offers all the facilities for your surgery and follow-up appointments.
Who will do my surgery ?
Chris will always perform your surgery himself and will be supported by a team of specialist nurses and occasionally a surgical assistant.