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The New Doctors Contract NHS England – a brief summary

This is intended to provide a quick summary of recent events, an outline of the current problems, including the contract, and whistle-blowing, and what we can do to address them. BackgroundIn November 2015, after a new contract was proposed, 98%...

Gross Negligence Manslaughter in Healthcare: The medico-legal dilemma (part 5) - Who is the Judge?

I wonder what Vanessa is thinking right now. If she can even think. A torrent of images, regrets, what ifs. The onslaught must be so great, no wonder the normal response is for the mind and the body to shut down? Depression.

How I Do It - Primary rejuvenation upper blepharoplasty – tips from an oculoplastic surgeon

Preoperative For me the preoperative stage is actually the most important part in the patient’s journey and can take much longer than the actual operation itself. It takes me about 45-60 minutes to assess, counsel and consent for a primary...

How I Do It - Contouring the lower jaw (surgical)

It is essential to clearly understand the patient’s needs so I usually see patients three to four times prior to operating if major changes to appearance are planned. You must also be able to manage expectations and postoperative outcomes; for...

How I Do It - Postoperative care following aesthetic breast surgery – augmentation, reduction / mastopexy and augmentation mastopexy

The first aspect of postoperative care is to prevent or pre-empt potential problems; two main concerns are bleeding and infection. Towards the end of the procedure, I always undertake an antiseptic or saline washout before closing and check the blood...

How I Do It - Practical guidance on avoiding adverse events following soft tissue augmentation – some tips

Complications following soft tissue augmentation range from the mild to the serious, e.g. blindness due to occlusion of the branches of the ophthalmic artery to the eye. Much of the literature reviewed appears to indicate that no treatments were found...

How I Do It - Thin lips – remodelling with hyaluronic acid

Volumetric changes in treating thin lips remain a challenge for all aesthetic medical practitioners. Obtaining an optimum result requires a good knowledge of facial anatomy, an excellent injection technique and adequate and careful patient selection. With inappropriate patient choice, even...

How I Do It - Treating skin flaccidity with the Fotona V-SMOOTH protocol

Unwanted fat, cellulite and flaccidity are three of the top reasons for consultation in aesthetic medicine in relation to body contouring. After the age of 30, the production of collagen and elastin decreases, so our skin starts to loose firmness...

How I Do It - Scar treatment with sequential combination of short full beam and photo-acoustic fractional 1064nm QS laser

Wound healing takes place by two distinct mechanisms. The first involves cellular proliferation and migration resulting in regeneration. This occurs in the epidermis and leaves no scarring. The dermis is a collagen-rich connective tissue and when this is damaged the...

How I Do It - Wound closure

Looking to upskill? Professor James Frame and a host of co-authors share their tips and tricks so you can benefit from their experience. I recently saw two wound closures exhibiting poor technique and contributing significant morbidity, including suture site inflammation,...

Hymenoplasty and virginity – an issue of socio-cultural morality and medical ethics

This article reflects the increasing complexity of the modern world, where the rich diversity of culture, morals, the law and religion, can have profound effects on medical practice. Sometimes there is considerable debate which is not in fact appropriate. This...

An open letter to young plastic surgeons (from an old UK plastic surgeon)

You are in a specialty that is second to none – you can use your skills to improve the quality of life of your patients, whether they have cancer, congenital abnormalities or damage caused by trauma. Most (90%) plastic surgery...