Skin
Ultraviolet light (UV) damage, stress, smoking, gravity and ageing are not kind to the face. Some patients are genetically luckier than others but as we get older, the skin loses some of its elasticity, muscles sag and lines begin to appear.
For some of these problems surgery is the only solution. However in milder cases or if you do not like the idea of surgery, facial rejuvenation techniques can produce impressive results.
Fine lines are best treated with a resurfacing procedure such as a chemical peel. Lines that only appear when you smile (dynamic wrinkles) can be improved with muscle relaxing injections such as Botox®.
Permanent lines or furrows (static wrinkles) can be treated with fillers such as Restylane®. Deeper wrinkles may respond to a combination of procedures. Hollowing or sagging of the skin may be best treated by fat injections (fat transfer).
Acne Scarring
Acne is a very distressing condition and can leave unsightly scarring. Active acne is best managed by a dermatologist. Superficial scars may be helped by chemical peels or laser, however if you are left with deeper scars then these can be improved with a combination of surgical procedures. Acne scars can be varied from ice pick scars to box car scars to hypertrophic scars. If you have realistic expectations then Mr Rayatt may be able to improve the appearance of some of the scars. Mr Rayatt uses a combination of techniques including subcision, dermabrasion, punch grafts, dermal fillers and dermofat grafts. Most cases can be treated under a local anaesthetic and multiple procedures may be required.
Summary
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Anaesthesia |
Usually Local anaesthetic
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Hospital stay: |
Out patient or day stay
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Clinic check up |
7-10 days for suture removal
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Return to work / light duties: |
Usually 1-2 days
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Full recovery |
1-2 weeks
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After care |
Keep covered while healing, massage daily once healed. Scar maturation takes 12-18 months
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Possible complications |
Delayed healing, infection, hypertrophic scar formation.
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Anti Wrinkle Injections
Ageing and continuous muscle activity leads to lines or wrinkles. These lines can give an aged appearance and there a number of ways to improve the appearance. A combination of fillers and muscle relaxant injections (Botox®) can help to improve the appearance of wrinkles.
Botox® is a nerve toxin which is very safe in the very small doses used and paralyses the muscles injected. The effects take 24-48 to begin and are maximal at 2-3 weeks. They last from 3 -6 months but with repeated use can last up to 6-12 months. The injections are performed in the clinic and take about 10 minutes. Some mild swelling and bruising is inevitable and may last for a few days.
They are most useful for wrinkles around the eyes and forehead and neck bands. They can also be useful for increased sweating of the armpits and hands and feet.
Additional benefits of anti wrinkle injections that have been noticed and now proven is a decrease in tension headaches and migraine. if you suffer from regular migraines then you should consider this option.
Summary
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Anaesthesia |
Local
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Hospital stay |
Clinic Only
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Clinic Check Up |
7-10 days
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Return to work / Light duties |
Same day
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Full recovery |
1-2 weeks
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After Care |
No vigorous exercise
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Possible complications |
Bruising and minor swelling
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Chemical Peels
Ageing results in loss of elasticity of the skin, appearance of wrinkles and ‘age spots’. Topical creams and moisturizes help, but some patients may benefit from a chemical peel. This process was used regularly by women in ancient Egypt to improve the complexion of their skin. Weak peels are available commercially. Mr Rayatt uses Trichloroacetic acid (TCA). The process of peeling removes the top layer of the skin in a controlled manner. The desired outcome is generation of a new epidermis and dermal collagen remodelling. The procedure itself takes about 45 minutes and produces a burning feeling which can be uncomfortable. Topical ointment has to be applied after the procedure to minimize infection and keep the skin moist. If you suffer from cold sores, then a course of anti viral tablets is required. Some patients may benefit from pre treatment with a topical Retin creams (tretinoin) . The procedure may have to be repeated, and it is essential to wear sunblock during the healing phase. The procedure is best for patients who want to improve fine wrinkles, skin blemishes and uneven pigmentary changes (age spots).
Summary
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Anaesthesia |
Usually none required
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|
Hospital stay |
Out patient
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Clinic check up |
7-10 days
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Return to work / light duties |
Flaking of skin and redness lasts for 1-2 weeks.
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Full recovery |
2 weeks
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After care |
Sun block, may take several days to heal, stay in clean environment, no smoking.
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Possible complications |
Hyperpigmentation, infection, erythema, further procedure.
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Fat Transfer
Using fat to improve appearance has been available for many years, but one of the problems encountered had been variability of the outcome. However, recent advances have led to much more reliable results.
Mr Rayatt uses this technique on patients for both aesthetic and reconstructive surgery. Fat transfer can be performed either under a general anaesthetic or local anaesthetic, depending on the amount needed. The fat is removed from a part of the body where it will not be missed, usually tummy or thighs, in a manner similar to liposuction but in a much gentler manner so as not to damage the cells. It is then concentrated using a centrifuge and injected carefully back into the areas to be treated using fine blunt cannulae. Smaller areas can be treated in one session but larger amounts may take another session, about 3 months apart. The best improvements on the face are for overall volume replacement, especially in the cheek area. Most patients also experience an improvement in the quality of the overlying skin following fat grafting. Deep wrinkles and scars can also released with a needle and filled with fat. The advantages of using your own fat is that it is not a foreign material and once it has 'taken' the results are long lasting. The most common use of fat is on the face, but excellent results can also be seen in other areas such as breast, buttocks, for scars and on the back of the hands.
Summary
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Anaesthesia |
General or Local
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Hospital stay |
Daycase
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Clinic Check Up |
7-10 days
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Return to work / light duties |
1 week
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Full recovery |
2-4 weeks
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After Care |
Dressing for 1 week. Avoid strenuous exercise during recovery
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Possible complications |
Bruising, Infection, swelling, further procedure.
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Fillers
Ageing results in loss of elasticity of the skin, appearance of wrinkles and loss of volume.Loss of volume and wrinkles can be filled in by the use of fillers. Many fillers are available on the market, Mr. Rayatt prefers to use a semi permanent fillers such as Restylane® and Juvederm®. These consist of a naturally occurring material called Hyaluronic Acid, a compound found in all living things. It consists of a clear gel, injected in tiny amounts with a very fine needle. It can give volume, fill deep wrinkles and make lips more full. Results last 6-9 months and side effects are rare and minimal. The procedure takes less than 30 minutes and no test injection is needed. No anaesthetic is normally needed but if you are particularly anxious, then arrangements to apply topical cream anaesthesia can be made.
Summary
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Anaesthesia |
Usually none required
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|
Hospital stay |
Out patient
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Clinic check up |
7-10 days
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Return to work / light duties |
Usually straight away
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Full recovery |
2 days
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After care |
Avoid vigorous exercise, avoid rubbing the treated area.
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Possible complications |
Swelling, redness, pain, itching, bruising, further treatment.
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Lip Augmentation
Ageing can lead to thinning and flattening of the lips and the purpose of lip enhancement is to give the lips a fuller and therefore more youthful appearance. Various materials are available and all have advantages and disadvantages.
Mr Rayatt uses both fat injections or temporary materials such as Restylane® or Juvederm®. The temporary materials can offer excellent immediate results and the results generally last 3-6 months. The injections are performed in the clinic and take about 20 minutes. Some mild swelling and bruising is inevitable and last for a few days.
Fat injections can give more permanent results and are usually performed as part of an overall facelift procedure rather that just for lips. The fat is taken from the tummy or thighs, and after special handling, is reinjected into the lips using fine cannulae. Mr Rayatt can discuss the options with you so that the best technique for your needs is chosen.
Summary
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Anaesthesia |
Local
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Hospital stay |
Day case
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Clinic Check Up |
7-10 days
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Return to work / light duties |
Next day
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Full recovery |
1 week
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After Care |
Soft diet for few days
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Possible complications |
Bruising, under treatment or over treatment
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Moles
Every adult has numerous moles on their body and this is perfectly normal. However if you are concerned about some of your moles especially if they are new or they have changed, then you should have them checked by a health professional. This person may initially be a General Practitioner (GP) who should refer you on to a skin specialist for an opinion. You are entitled under the NHS to have an urgent opinion on any suspicious mole to exclude cancer.
In his NHS practice Mr Rayatt is Lead Clinician of the Specialist skin cancer multi disciplinary team (SSMDT) which includes dermatologists, pathologists and oncologists. The team treats over a hundred cases of melanoma each year. Mr Rayatt would advise that you seek NHS treatment if you are diagnosed with melanoma. However, he would be happy to see you if you have any concerns about your moles or if they are a cosmetic problem and cannot be removed under the NHS. Following a consultation and close examination, he may recommend that some moles require removal with a minor procedure called a biopsy, under local anaesthetic. All specimens are sent to the Pathology laboratory for microscopic examination. This provides a definite diagnosis and can reduce worry and psychological stress. You can be assured that any moles on the prominent part of the body or face will be removed to leave the most cosmetic scar possible.
Mr Rayatt recommends you wear sun protection at all times especially on holiday in sunny locations and use a daily sunscreen to block both UVA and UVB with a sun protection factor of at least 40. Annual mole examinations are advised for most individuals, but more frequent checks should be done if you have a history of skin cancer. Please see your GP or call us for a consultation if you have any concerns.
Scar Revision
There is no such thing as an invisible scar and all scars are permanent. A plastic surgeon is specifically trained to minimize the appearance of a scar. While scars cannot be completely removed, Mr Rayatt can improve their appearance and make them less obvious. Many factors affect the severity of scarring, such as the size and depth of the wound, the blood supply to the area, the thickness and colour of your skin, as well as the direction of the scar. So, if you are considering scar improvement it is important to consult a qualified plastic surgeon who will help you determine the procedure that is best suited to you.
Some scar revision procedures may be covered by insurances policies especially if they are the result of reconstructive or cancer surgery. Mr Rayatt will support you if it is indeed a reconstructive procedure by contacting your insurance company on your behalf.
Types of Surgery
There are several effective procedures for scar revision. The specific procedure used will depend on the type of scar and the results you wish to achieve. For instance, keloids or hypertrophic scars are initially injected with a steroid injection. This is repeated 3-4 times and usually improves appearance and symptoms of itching and burning. If this fails then surgery may be appropriate. A tight or contracted scar is usually excised and replaced with a skin graft or rearrangement of the local skin, called a local flap. It can also be treated with Z-plasty, a surgical technique that repositions a scar to more closely conform it to the natural lines and creases of the skin. Facial scars can also be improved with dermabrasion and laser resurfacing.
Skin grafting and flap surgery can be more involved than other methods of scar surgery. They are more likely to need treatment in a hospital under general anaesthesia rather than in the clinic. Grafting involves transferring healthy skin from another part of the body to cover the injured area. Flap surgery, in contrast, is more complex and involves moving skin and fat, and sometimes blood vessels and muscle. Mr Rayatt can help you decide which procedure is best for you.
Summary
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Anaesthesia |
Usually Local anaesthetic
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|
Hospital stay |
Day stay
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|
Clinic check up |
7-10 days for suture removal
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Return to work / light duties |
1-3 weeks
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Full recovery |
3-9 months
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After care |
Keep covered while healing, massage daily once healed.
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Possible complications |
Delayed healing, infection, hypertrophic scar formation
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Skin Lesions
If you are bothered by benign skin lesions such as unsightly moles, large warts and cysts, then these can be removed under a local anaesthetic as an outpatient procedure. You will have to accept a small scar but in most cases these heal extremely well. Usually the procedure is no more disruptive to your normal routine than a visit to the dentist for a filling. Mr Rayatt recommends that all excised tissue is sent for analysis.
Summary
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Anaesthesia |
Local anaesthetic
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|
Hospital stay |
Out patient
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|
Clinic Check Up |
7-10 days for suture removal
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|
Return to work / light duties |
Next day
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Full recovery |
1-2 week
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After Care |
Keep covered while healing, massage daily once healed.
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Possible complications |
Delayed healing, infection, hypertrophic scar formation
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Split Ear Lobes
If wearing heavy earrings or an accident has caused your ear lobes to split, then these can be repaired with a simple procedure under a local anaesthetic. Simple suture repair may leave notching of the scar and Mr Rayatt uses special plastic surgery techniques to avoid this occurring. You are advised to leave the earrings out while the tissues are healing. It may be possible to repair the split as well as leave your original piercing hole.
Summary
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Anaesthesia |
Local anaesthetic
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|
Hospital stay |
Out patient
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|
Clinic Check Up |
7-10 days for suture removal
|
|
Return to work / light duties |
Same or next day
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|
Full recovery |
1-2 week
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|
After Care |
Keep covered while healing, massage daily once healed. Scar maturation takes 12-18 months
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Possible complications |
Delayed healing, infection, hypertrophic scar formation
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Contact
Please contact Mr Rayatt at the mentioned hospitals to make an appointment or alternatively, leave your query online and it will be answered promptly.
Queen Elizabeth Hospital, Birmingham
Mindelsohn Way
Edgbaston, Birmingham
B15 2GW
Tel:
0121 627 2000
NHS Secretary:
Beverley Chambers
North Staffordshire Nuffield Hospital
Clayton Road
Newcastle-under-Lyme
ST5 4DB
Tel:
01782 625 431
(ext 330)
By appointment only
BMI Edgbaston
22 Somerset Road
Edgbaston, Birmingham,
West Midlands B15 2QQ
Tel:
0121 456 2000
By appointment only
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