A beautiful Wednesday in November…
Husband wakes me up at 6:30. Light breakfast of toast and coffee. Out of the door by 7:30 to get to hospital for 7:55. See first two patients in their rooms, take photos, discuss surgery, mark on patients and obtain consent. Each taking about 10 to 15 minutes.
Change into theatre scrub-suits and start operating on first patient – autologous fat injection into cheeks, nasolabial fold (nose to corner of mouth line ), marionette lines (lines from corner of mouth to chin) and chin. Fat was harvested from abdomen, centrifuged and re-injected into above areas.
This is a very effective way of rejuvenation that is more permanent than synthetic fillers. Procedure took about an hour. I spend about 10 minutes typing the operating notes. The patient had a similar procedure some years ago under myself.
While the anaesthetist is putting my next patient to sleep, I nip out to see and consent the third patient so that when I return to theatre in about 10 to 15 minutes, the second patient is asleep, already cleaned and prepared by my regular scrub nurse, ready for me to start operating.
Second patient is having a minor surgery to improve the broadness of the tip of her nose. The surgery involves a small cut across the columella (part of the nose dividing the two nostrils) and trimming of the cartilage that determines the shape and size of the nasal tip. At the end of surgery, she has a pack in her nose to reduce bleeding and a splint over her nose to reduce swelling and bruising. The procedure takes about an hour.
The third patient has a full reduction of the nose, which includes reduction of her bridge prominence, reduction of her nasaltip and fracturing her nasal bone to narrow the whole nose. The procedure takes about an hour and a quarter, and patient has a splint and pack and a cold mask to cool the area around the eye and nose to reduce bruising and swelling. I have operated on this patient twice before. She’s delighted with the result after each treatment and her confidence has improved so much that she has lost two stone in weight, and looks really good.
The fourth patient had her implants changed to larger ones. The original surgery was by another plastic surgeon 10 years ago. Patient has developed capsular contracture (thickening of scar around implant causing it to feel hard) so the surgery involved removing the thick capsule and changing the implants from an original 300ml to more than 600ml.
I used special micropolyurethane coated implants as these have been shown to reduce the risk of another capsular contracture. This procedure took about an hour and a half. There is a minimal dressing and a sports bra is put onto the patient immediately.
It is now about 1pm and I eat the sandwich that my husband has prepared for me whilst I am typing up the previouspatient’s op notes. I do not take a formal lunch break but eat on the go, and by now I have had about four cups of coffee – busy day with caffeine inputs is usual!
The fifth patient has an abdominoplasty (tummy-tuck) which takes about two and a quarter hours. I am excited about the improvements I have made to patient post-operative care. Patients now no longer have drains in but instead a very small cannula feeds into the abdomen constantly infusing the wound with a local anaesthetic. This positive change now leaves patient more pain free, so they can mobilise earlier – which reduces the risk of DVT, pulmonary embolus, and chest infection.
I go into the ward to check on my first two patients. They are both doing extremely well so I send them home.
The sixth patient has a straightforward breast implants surgery. This takes me about 45 minutes and is one of my favourite procedures because it is short, effective, and has very little complications. Patient started as a 32B cup and went up to a D/DD cup.
The last patient has liposuction to the inner and outer thighs and inner knee area. Liposuction is almost always put as the last case, as it is quite strenuous work and best left to the end of the day so it doesn’t tire the hand too much.
These are excellent areas for liposuction and at the end of the session, patient’s shape is changed from an original pear-shape to one that is more proportional. The procedure takes about two hours, and patient is put into a pressure garment.
It is now about 8pm. I change back to my normal clothes and do a ward round of all the patients, giving them a run down of the procedure and findings.
Home after this – which is usually around 9pm. Dinner with husband (who does the cooking, bless him!) usually around 10pm. Shower, watch a taped X-Factor show from Saturday.
Check my diary for next day, which is another 8am start with a patient who is undergoing a mastectomy and a reconstruction with tissue from her back, followed by a clinic that starts at 1pm and usually ends at about 9pm.
Excited about this weekend which I will be spending in Berlin, attending a meeting with live surgery on autologous fat injection for cosmetic breast enlargement instead of silicone.
This is an exciting new procedure that is slowly gaining popularity in both America and Europe. Plus, it’s great to combine training and surgery education with a weekend in a beautiful city, too!
Another typical day in the life of busy, but very happy, Birmingham-based cosmetic surgeon.