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Your treatment will be precisely guided using modern scanning techniques, under local anaesthetic and gentle sedation. Most patients are best served by laser surgery (EVLT) or foam injection (UGFS) and all modern techniques are employed when needed. All main leaking veins can be sealed in a single treatment session, although foam injections may be better spaced across a few weeks.
Thread / Spider veins
These are eliminated by administering a sclerosant liquid, using the tiniest needle to scratch the surface of the skin. Compression stockings are worn for a week. Multiple (2 or 3) treatments is the norm.
Red face / tiny vessels on the nose / face
Facial vessels are sealed with a tiny high-frequency electrical current, delivered precisely to the vessels under magnification. It is very easily tolerated (causes tingling sensation) and you may return to work straight after your treatment. Two to three sessions is usual.
Earlobe correction / repair
Over-stretched earlobes or a piercing which has pulled out can be repaired under local anaesthetic using very fine absorbable sutures
These will be quickly and comfortably removed using local anaesthetic. Cysts, warty growths / moles and fatty lumps (lipomas) are easily eliminated and I take pride in producing the best cosmetic results, using magnification to precisely place the finest stitches.
These sometimes distress patients for years before seeking specialist treatment – please do come for an assessment! Most leg ulcers are caused by circulation problems that can be improved and permanent healing achieved.
We all get nervous sometimes – I have been through major surgery myself and I understand what it feels like. I provide calm reassurance whilst guiding you through any treatment that will help you.
Specialists often refer patients to colleagues if their expertise is more appropriate - you may have been referred by another consultant. Welcome - I look forward to helping.
Sometimes, after my assessment, I feel that one of my colleagues would be better able to help you. If that is the case, I will introduce you by way of referral to a more appropriate colleague, either locally or occasionally further afield.
I am often asked by lawyers for impartial experienced specialist opinion on legal cases. Your lawyer will contact me directly if they wish me to help in this way..
Veins in the legs have non-return valves that allow blood to flow from the legs back towards the heart. Varicose veins cause these valves to fail which leads to excessive pressure in the veins. It is this pressure which causes the familiar throbbing and aching and can damage the skin, leading to ulceration.
Treatment of varicose veins depends upon accurately eliminating all sources of high vein pressure. A colour duplex ultrasound scan will be carried out by me personally during your consultation and I will show you on the scanner screen how all your veins are working (and which ones are not). We can then discuss how different techniques to treat your varicose veins would work for you and thus formulate a bespoke plan to deal with your pattern of varicose veins.
The two most common techniques that I employ are laser surgery (EVLT / EVLA) under local anaesthetic and ultrasound guided foam sclerotherapy (which does not require any anaesthetic).
Laser vein surgery
This technique involves passing, under local anaesthetic, a slim fibre-optic catheter into the vein to be treated. Ultrasound scanning locates the catheter within the vein. The vein is then anaesthetised with more local anaesthetic so that as the laser closes off the incompetent vein it does not hurt you.
The technique is usually supplemented by injecting the visible varicose veins which have been pre-marked before surgery. They can then be removed through tiny incisions.
Treating one leg in this way usually takes about forty-five minutes (depending on how many varicose veins are being removed).
Once complete the leg is bandaged and you will be able to go home.
A couple of days later you will be invited back for the nurses to remove the bandages, check the tiny wounds and apply a class 2 compression stocking. This stocking should be worn for two weeks continuously and can then be removed before returning to clinic for me to check your leg.
Patients often find the stocking frustrating – Tricks to keep it up include wearing the waistband over the opposite shoulder or wearing tight shorts (such as cycling shorts) or tights over the top of the stocking.
Discomfort in the foot at night time may necessitate making small cuts with scissors in the stocking so it is less tight across the broadest part of the foot (please also check that the double seam has not ridden back where it would compress the widest part of your foot).
It is usual for there to be some discomfort / pain, especially along the line of the vein which has been “lasered”. The most common site of this is along the inner aspect of the thigh. I recommend non-steroidal anti inflammatory drugs (nurofen, brufen, ibuprofen, voltarol diclofenac etc), which may be supplemented by paracetamol. The advantage of these drugs is that in addition to being pain killers they also reduce the inflammation around the treated vein thus aiding the process of the vein settling down and becoming comfortable once again.
If you experience swelling of the whole leg which is painful, please contact the clinic. There is a small risk of deep vein thrombosis associated with varicose vein procedures. Thankfully they are extremely rare (1:10 000 cases) but if a dvt was diagnosed then it should be treated promptly.
After a fortnight I will check your recovery in clinic. I will inspect the wounds and scan your leg if I have any concerns. At this stage the leg is usually still a little bruised and there may be lumps which are a little tender. Sometimes there are numb patches due to bruising of little skin nerves. These things settle down as time allows your body to heal.
Most patients are keen not to wear their stocking any longer than the fortnight that I recommend. Some patients feel that they like the support that the stocking gives and feel more comfortable wearing it – if you wish to wear it for longer please do so, perhaps just during the day- time until you feel able to dispense with it.
If you are also considering having thread veins treated please retain your stocking and bring it to subsequent appointments – I recommend a week wearing compression after thread vein injections.
Earlobes can be torn by children pulling on earrings for instance or a piercing may have elongated by wearing heavy earrings or enlarged through “gauging” using progressively larger rings in the piercing.
Whatever the mechanism, three main patterns tend to present to us as surgeons.
1. The ripped “fishtail” where the piercing has ripped through the free edge of the ear, creating a full split that may open as a little wedge.
2. An elongated slot which has not breached the free edge of the ear.
3. A huge hole with a snake like tube of tissue joint the free edge of the ear with the inner part of the ear lobe where it joins the head.
Of course there are variations but in my experience these form the majority.
Our aim is to close your defect, perhaps giving you an option for re-piercing and restore as far as possible the natural shape of the ear, trying to protect the natural curve of the outer edge of the lobe. It is this which contributes most to the earlobes aesthetic appeal.
All earlobe surgery is carried out under local anaesthetic (numbing the earlobe is straightforward and most people find it easier than the dentist administering a local anaesthetic).
You may drive home after your procedure.
I use very fine absorbable sutures to close the wounds (thus avoiding the need for stitch removal).
All operating and stitching is carried out under magnification for the most precise surgery and wound closure, thus giving you the best result that I can achieve.
I often incorporate a small “Z-plasty”; a plastic surgery technique designed to help prevent problems associated with scar contracture (a normal process but which can detract from a good aesthetic outcome).
Your journey starts with a consultation where we discuss any medical problems that you may have, together with how we might address your earlobe repair.
If yours is a straightforward case then repair may be at the same visit, although if you are able it is desirable to do the consultation a little time before surgery.
The repair is done as a walk-in, walk-out procedure and you may drive home.
Afterwards the wounds are often covered with a tape which is (not quite) waterproof but you may shower and dab the area dry.
Once the tape comes off after a few days, please keep the area clean. You may shower and dab the wound with an antiseptic such as savlon.
The wounds are not unduly painful and paracetamol is sufficient for almost everyone as pain control.
Stitches tend to fall out after a few weeks. These stitches are very tiny. If there is any redness please tell me. After the first 4 to 5 days please very gently rub bio-oil or “Sheald” cream into the area and massage (very gently at first). This helps to form the best scar which is as invisible as possible.
It is good to see people a few weeks after surgery but it is not imperative since the stitches do not need removal. If you are not returning, I would like to see a few photos to check on your healing. If you are willing to show your photos, it always helps people considering this surgery to see some before and after pictures and I am always grateful for the many patients who agree to show their photos anonymously.
I often get asked about re-piercing. Yes this can be done but it should be left at least three months before doing so. The new site should not go through the scar but be through normal tissue if possible (because the tissue is stronger than the scar). It is worth putting a little dot on the skin to mark it before you attend for your re-piercing.
I love these repairs which needs to be done meticulously (this suits my approach to surgery) and makes a big difference to peoples happiness.
Xanthelasma (fatty deposits in the skin around the eye) are not harmful but may be unsightly and people often request removal. They can be associated with a raised cholesterol so worth getting it checked although in many cases there is no association. Like many things they may be familial.
The most effective treatment for these deposits is removal of the tiny patch of skin bearing the deposit (the fat is within the skin). This is accomplished under local anaesthetic during a walk-in, walk-out procedure in clinic.
I will numb the area to be treated with local anaesthetic and carefully remove the affected area of skin under magnification. The wound is then closed with very fine (a hairs breadth) absorbable stitch using accurate precision instruments.
Antibiotic ointment is then applied and you will be ready to leave.
Driving home is permitted although there is a chance of the slight swelling from the local anaesthetic interfering with your vision.
Healing is very rapid - regular application of a gentle antiseptic cream such as savlon is advised as well as avoiding soap or make-up around the eyes until it is healed (usually just a few days). Stitches will dissolve within a couple of weeks, often earlier.
The removal of this tiny patch of skin is easily accommodated by the laxity of the skin in this area and indeed many patients are pleased to have a little bit removed.
What are lipomas?
They are tumours or lumpy overgrowths (…oma) of fatty tissue (lipo…). They are benign (harmless) in almost all cases (a rare exception is liposarcoma).
Are they common? Where do they form?
Lipomas can form anywhere on the body but the commonest places are the chest, abdomen, limbs and neck. They are very common and can affect anyone of either sex or any race. There are some people who form many lipomas – this pattern is often associated with mild tenderness of the lipomas. Some multiple lipomas run in families. It is not known what causes lipomas but since it is not a serious condition, the research imperative is not strong.
Do lipomas cause problems?
Lipomas usually do not cause any problems except for their appearance which may be unsightly. Sometimes they may press on nearby structures (such as a nerve) which can cause discomfort, especially if it is a pressure location.
How do you know if you have a lipoma?
A patient will notice a lump which is usually painless, it is under the skin but the skin can be moved over it. The lump itself has a firm rubbery consistency and will be movable with respect to underlying structures.
Your doctor will be skilled at examining these lumps and will have seen many of them before. If there is any doubt a scan may provide more information. Ultrasound scanning will usually be sufficient since this will provide a clear image of the lesion and will detect any unusual features which may suggest another diagnosis. The scan will also show the location, in case your Surgeon needs to check when planning surgery. Sometimes an MRI (Magnetic resonance imaging) scan may be requested if an ultrasound is unable to provide sufficient information (eg. if the lesion is deep).
How are lipomas treated?
Firstly, not all lipomas need treatment- they are benign and usually cause no problems.
They cannot be treated with drugs or lotions, removal will be some form of surgery.
Small lipomas on the limbs or trunk are easily removed by numbing the area with local anaesthetic, placing an incision over the lump and extruding it through the wound. The wound is then closed with stitches (I use dissolving stitches, thus avoiding “removal of stitches” visit). Although it is rare for lipomas to be worrisome, if I am removing them I send them to the lab for checking as a routine. The back of the neck / between the shoulders is more fiddly for the Surgeon but easily accomplished under local anaesthetic.
For large lipomas, many Surgeons would stipulate a general anaesthetic. This is to ensure that if extensive access is required, there is no discomfort to the patient and thus the Surgeon may work effectively.
As an NHS Consultant however I have spent decades carrying out huge, intricate procedures to deal with the brains blood supply under local anaesthetic. Thus I sometimes deal with lipomas that have been “declined” by colleagues under local anaesthetic on account of their size. The local anaesthetic technique for these is known as “tumescent anaesthesia” and involves using very dilute anaesthetic in significant volume. Once the anaesthetic is injected I then wait a few minutes and will massage it to ensure it has adequately reached every area required. In this way very large lipomas may be removed through comparatively small incisions.
Are there any post-operative complications to consider?
As with any surgery, the consent process provides the opportunity to discuss possible complications. Of course general issues might arise such as fainting, allergy to local anaesthetic (I have never seen a case!). If your lipoma is near to any structures at risk your Surgeon will discuss this with you. After the surgery it is possible to get a wound infection – if you develop redness of the wound or increasing pain (the wound discomfort should subside as days go by) your surgeon will need to know and consider prescribing antibiotics.
Having said the above, almost all patients find the whole process fairly easy and are pleased with the outcome of their surgery.
Varicose veins - ultrasound guided foam sclerotherapy
Another popular method for treating varicose veins is ultrasound guided foam sclerotherapy. As the name implies this sclerotherapy (injection of a chemical to destroy an incompetent vein) is guided by ultrasound scanning.
There was a wave of popularity for sclerotherapy about 40 years ago, however this was using a liquid sclerosant and was not guided by ultrasound. The method proved less effective than surgery and fell into disfavour, to be resurrected by the Spanish doctor Juan Cabrera. He cleverly realised that by mixing the liquid sclerosant with air to form a foam, the resultant mixture displaced blood within the vein - thus acting much more effectively since it remained in-situ for longer. The foam was also easily visible on ultrasound which was by then in common use amongst those surgeons particularly interested in venous treatments. This made the treatment much more accurate since the injection may be guaranteed to be into the vein and the amount of foam injected may be carefully monitored with the scanner.
This treatment is carried out in the out-patient clinic as a walk-in, walk-out procedure. Please bring with you a pair of full length class 2 graduated compression stockings (eg duomed soft available from the medi-uk website). The nurse will help you get in the right position on the couch and I will scan your veins again to determine the best places to inject the foam. The foam itself is then injected using small needles or cannulas (smaller than a blood test needle). Sometimes the foam stings but most people feel nothing during the treatment.
Once we have completed the treatment and I am happy with the location of the foam on scanning, we will put the stocking onto your leg.
After the treatment, before you get into the car, please walk around for 5 - 10 minutes. This is to encourage blood flow in the deep veins (thus reducing the chance of a deep vein thrombosis).
Please wear the stocking day and night for two weeks (taking off or swapping for showering) and then leave it off. If you are more comfortable wearing it for a longer period, then by all means do so. During the recovery period, plenty of gentle walking is good. Avoid long periods of standing still. Most people take little in the way of pain-killers, paracetamol or ibuprofen should suffice. Ibuprofen gel rubbed on only particularly tender areas may be especially useful. Long haul flights should be avoided for about six weeks although short flights a couple of weeks later should be safe.
Complications (or side-effects) include brown skin staining (common and usually fades over weeks - months), deep vein thrombosis (very rare), thread vein formation (rare), tender clot formation (occasional and easily treated in clinic), visual disturbance (temporary, very rare and almost always in migraine sufferers) and recurrence (25 - 30%).