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For more information please feel free to contact Mr Ramakrishnan's office:

Tel: 01245 463439

Fax: 01245 461569

Email: plasticsurgery@ramakrishnan.co.uk

or fill in the form on the right

Call Us: 01245 463439
Request a call back
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Providing expert care
in Reconstructive and
Cosmetic Surgery

Body

The skin of the abdomen is stretched by pregnancy or weight gain. Following childbirth or significant loss of weight the stretched skin becomes lax and overhangs the pubic area. No amount of diet and exercise can overcome laxity of skin especially if it has stretch marks. In this situation the excess skin and fat has to be removed by surgery.

Why do patients seek an Abdominoplasty?
Patients are embarrassed by appearance of the abdomen when the skin is stretched, overhangs the tops of trousers and skirts, causes a bulge under fitted dresses and is visible above and below bikini bottoms. Patients are also distressed by prominent stretch marks and a stretched bellybutton which they find very unappealing. They are inhibited about wearing swimsuits and bikinis and do not like to take their children swimming or go out on the beach on holiday. These problems can be corrected by an abdominoplasty.

What does an Abdominoplasty involve?
Patients should not be on blood thinning medication such as aspirin or warfarin and ideally should not take nicotine in any form for six weeks before surgery. The procedure is carried out under general anaesthetic and usually involves two nights in hospital. Plastic tube drains are inserted under the abdominal skin to remove any excess blood or fluid for the first 24 to 48 hours. These drains are then removed, the patient is able to have a shower and have the dressings changed before being discharged home. An appointment is made for removal of sutures a week following surgery and for a review in two weeks after surgery.

Are there any reasons for a patient not to have this procedure?
Patients who are actively smoking or on blood thinning medication such as aspirin or warfarin have a higher risk for postoperative complications such as bleeding, wound infections and delayed wound healing. It is advisable not to consume nicotine in any form for at least two weeks before this procedure and at least two to three weeks after. Medication such as aspirin or warfarin may need to be stopped if they are not absolutely essential at the appropriate time before surgery. This should be discussed with your Consultant and GP.

What is the normal postoperative course?
The abdomen feels tight for the first few days after the operation and patients are not able to stand fully erect. On the first postoperative day an elasticated abdominal binder is applied to the abdomen for support and gentle mobilisation is begun. By the second postoperative day most patients are mobile and discharged home.

It is advisable to have help around the house and with young children for the first couple of weeks after surgery. At the end of two weeks most patients are able to drive, carry light shopping and prepare light meals. At the end of four weeks patients are expected to be able to return to normal lifestyle including gym, sport and aerobics unless they have had tightening of the abdominal muscles or repair of an abdominal hernia at the same time as the abdominoplasty.

How much time do I need off work?
Most people are able to return to work which does not involve heavy lifting in approximately two to three weeks after surgery. It may take up to six weeks for some patients to return to normal work and leisure activities.

What are the complications of this procedure?
A very small percentage of patients who undergo a tummy tuck will have complications just like any other surgical procedure. These include bleedings, haematoma (blood clot under skin), seroma (fluid collection under skin) and infection. There can be delayed wound healing in the centre of the wound, slight asymmetry in the size and shape of the scar or the position of the bellybutton and a change in sensation over the abdomen. Sometimes patients may require a small secondary revision procedure to trim parts of the scar.  This is usually undertaken under local anaesthetic.

Before and After

1-b41-after

Video

Facts at a glance

Surgery time 2 hours
Hospital stay 2 nights
Anaesthetic assessment Possibly
Pre admission tests Yes
Reasonably mobile 2 weeks
Washing 2 days
Driving 3 weeks
Sport & exercise including gym 8 weeks
Full recovery 8 weeks
Time off work 2-3 weeks
Bras and garments Yes Abdominal binder
Long term issues May require scar management

Click here to download the Patient Post Op Care Sheet for Abdominoplasty

This procedure can be used with liposuction and liposculpture. The fat removed at the time of these operations can be harvested and injected into other parts of the body to improve contour. It is also feasible to be used in isolation i.e without liposuction.

Why do patients seek Lipofilling (auto fat transfer)?
This procedure is generally undertaken to improve body contour. It is not unusual for fat to be injected into small areas on the face such as the chin or hollows of the cheeks. It can be used in numerous anatomical areas including correction of defects from previous surgical procedures such as breast reconstruction or trauma sites.

What does the procedure involve?
Auto fat injection is usually carried out under general anaesthetic but small areas may be treated under local anaesthetic with sedation.

What is the normal post operative care?
The procedure is usually a day case and the patient is provided with a tight fitting elastic garment to help reduce the swelling.

What is the normal post operative care?
Patients can take paracetamol for any discomfort but this is usually minimal. It is advised to rest for a few days but going back to work can be between one day and one week depending on the employment type. Bruising and swelling will occur but should settle down within seven to ten days.

What are the complications of this procedure?
Auto fat injections can have complications just like any other surgical procedure. These include bleeding, haematoma (blood clot under the skin), seroma (fluid collection under the skin) and a change in sensation in the skin over the area that has been created. There can be asymmetry or rippling of the skin overlying the treated area. Very rarely do patients need a revision procedure following lipofilling.

Facts at a glance

Surgery time Dependant on area treated
Hospital stay Day case
Anaesthetic assessment No
Pre admission tests Yes
Reasonably mobile 2 weeks
Washing 1 day
Driving 2 weeks
Sport & exercise including gym 4 weeks
Full recovery 4 weeks
Time off work 2 weeks
Bras and garments Dependant on area – if required worn for 2 weeks
Long term issues Re absorption of fat
Gynaecomastia is a condition that affects men of all ages, right from teens to late 60’s. It is the result of accumulation of fat in the male breast and also of the enlargement of the breast disc.

What are the causes of Gynaecomastia?
The most common cause of gynaecomastia is idiopathic (meaning that there is no obvious disease which causes this). It can also result from hormonal changes or from the intake of certain medicines.

Why do men seek treatment for Gynaecomastia?
Men with gynaecomastia are very embarrassed by their appearance. They do not like to take their shirts off in company or to go swimming. This affects their social and family life as they are unable to participate in family activities with their children due to their embarrassment.

How is gynaecomastia treated?
Gynaecomastia can be dealt with by a procedure which involves a combination of liposuction of the fat accumulated in the breast and excision of the breast disc if required. This procedure is carried out under general anaesthetic and usually involves a stay of one night in hospital. In the event that liposuction alone is required it may be possible to have this procedure carried out as a day case.

Following surgery there is some discomfort which is more than adequately treated by painkillers. There is bruising and swelling in the breast. There may not be a significant change in the size of the breast following surgery in the first few weeks as the fat that is removed is replaced by fluids . In approximately six weeks this fluid will be absorbed and a reduction in size is then visible.

Are there any reasons for a patient not to have this procedure?
Patients who are actively smoking or on blood thinning medication such as aspirin or warfarin have a higher risk for postoperative complications such as bleeding, wound infections and delayed wound healing. It is advisable not to consume nicotine in any form for at least two weeks before this procedure and at least two to three weeks after. Medication such as aspirin or warfarin may need to be stopped if they are not absolutely essential at the appropriate time before surgery. This should be discussed with your Consulatant or GP.

What is the normal postoperative care?
Following surgery a small dressing is applied to the site of the incisions for liposuction or for removal of the breast disc. Sutures are removed a week after surgery. A pressure bandage or binder is applied around the chest to decrease the swelling. This is normally worn for a week after the procedure.

How much time do I need off work?
Most people are able to return to work, which does not involve heavy manual labour in approximately two weeks. It may take up to four weeks for certain individuals to be able to resume normal activities at work and for leisure.

What are the complications of this procedure?
Treatment of gynaecomastia can have complications just like any other surgical procedure. These include bleeding, haematoma (clot under the skin), seroma (fluid collection under the skin). There is a change in the sensation over the breast and in the nipple. There can be asymmetry (difference in size) or rippling of the skin. Very rarely is it necessary for patients to have a revision procedure following treatment of gynaecomastia.

Before and After

1-b41-after

Facts at a glance

Surgery time 2-2 1/2 hours
Hospital stay 1-2 nights
Anaesthetic assessment Possibly
Pre admission tests Yes
Reasonably mobile 2-3 weeks
Washing 2 days
Driving 2 weeks
Sport & exercise including gym 4 weeks, contact sports 6 weeks
Full recovery 4-6 weeks
Time off work 1-2 weeks
Bras and garments Yes, worn for 1 week
Long term issues May be some scar irregularity
Why do patients request this procedure?
Patients request this procedure for treatment of excessive skin on the inner aspect of the thigh.

Why does this occur?
Patients develop sagging or wrinkling of the skin on the inside of the thigh as a result of excessive weight loss or as part of the normal process of ageing.

Why do patients seek treatment for this condition?
Patients with this condition are self-conscious and embarrassed about the appearance of their thighs. They do not like the wrinkling inside the thigh and the excessive skin and fat just above the knee. In addition they also suffer physical discomfort as the insides of the thighs rub against each other causing chafing. The condition is also uncomfortable in hot weather due to sweating.

Are there any reasons for a patient not to have this procedure?
Patients who are actively smoking or on blood thinning medication such as aspirin or warfarin have a higher risk for postoperative complications such as bleeding, wound infections and delayed wound healing. It is advisable not to consume nicotine in any form for at least two weeks before this procedure and at least two to three weeks after. Medication such as aspirin or warfarin may need to be stopped if they are not absolutely essential at the appropriate time before surgery. This should be discussed with your Consultant or GP.

What does surgery for this condition involve?
This condition can be treated by surgery, which is carried out under a general anaesthetic. It involves removal of excess skin and fat on the inner aspect of the thigh. The resulting scarring is usually well hidden in the groin and in the inner aspect of the thigh.

What is the aftercare following this procedure?
Following the operation the surgeon may put a drain (a plastic tube) underneath the skin which stays in place for approximately 24 hours. An appointment is made for removal of sutures a week following surgery and a review appointment is arranged approximately a fortnight following the operation. Most patients are mobile within a couple of days following surgery and are able to return to work approximately a fortnight following the operation.

What are the complications of this procedure?
Just like any other operation this procedure has complications such as bleeding, haematoma (a blood clot underneath the skin), infection, visible scars, a change of sensation in the skin and asymmetry. A small percentage (usually less than 5%) of patients may require a secondary revision.

Facts at a glance

Surgery time 2 1/2 hours
Hospital stay 1 night
Anaesthetic assessment Possibly
Pre admission tests Yes
Reasonably mobile 3 days but rest for 10 days
Washing 2 days
Driving 2-3 weeks
Sport & exercise including gym 4 weeks, contact sports 6 weeks
Full recovery 4-6 weeks
Time off work 2 weeks
Bras and garments Pressure garment day and night 2 weeks
Long term issues May require scar management
The labia minora (inner lips of the vagina) differ in size and shape. Patients may find very large labia physically uncomfortable or aesthetically displeasing.

Why do patients request Labial Reduction?
In some patients the labia may be too large and cause discomfort with underclothes and fitted jeans, difficulty with maintaining hygiene during menstruation and pain during and after intercourse. In some cases large labia may be visible through underclothes and swimwear. The two labia may also be visibly different and cause embarrassment.

What does labial reduction involve?
The procedure is usually carried out under general anaesthetic as a day case. Surgery involves very careful reduction in the size of the labia by trimming of excess skin followed by repair with fine dissolving sutures. Patients are discharged home the same day.

What is the normal postoperative course?
The labia are slightly bruised and swollen for a few days after the procedure. The sutures normally dissolve within two to three weeks, leaving a fine well-healed scar.

How much time do I need off work?
Most patients are able to return to work within a couple of days following surgery.”]
The labia minora (inner lips of the vagina) differ in size and shape. Patients may find very large labia physically uncomfortable or aesthetically displeasing.

Facts at a glance

Surgery time 45 minutes
Hospital stay Day case
Anaesthetic assessment No
Pre admission tests Yes
Reasonably mobile 3 weeks
Washing 1 day
Driving 2 weeks
Sport & exercise including gym 4 weeks
Full recovery 2-3 weeks
Time off work 1 Week
Bras and garments No
Long term issues Pain and tenderness
Fat that is deposited in the body during periods of weight gain is usually lost by exercise and dieting. However, the type of fat that is deposited in certain areas of the body such as the outer thighs, inner thighs, buttocks, flanks and abdomen is different and does not respond to these measures. These fat deposits are known as areas of lipodystrophy and have to be treated by liposuction or surgery or a combination of the two.

Why do patients seek Liposuction?
Patients who have undertaken exercise programmes and diet regimes remain unhappy with unsightly bulges even after significant weight loss. They find that they are unable to get clothes that fit, they have unsightly bulges in fitted skirts and trousers or their thighs rub or chafe in the middle, especially in hot weather. The lower abdomen and flanks bulge and are visible above and below the waistline in skirts and trousers and swimwear. Patients are self-conscious about their appearance on social occasions, on holiday and on the beach and seek advice about the possibility of having liposuction to correct the problem.

What does the procedure involve?
Liposuction is usually carried out under a general anaesthetic but small areas may sometimes be treated under local anaesthetic with sedation as a daycase. Liposuction of large areas or of multiple areas involves a hospital stay of one night.

The procedure is carried out through multiple small incisions (a few millimetres in length) in areas that are hidden. These are closed with one or two very fine sutures which give rise to scars which are almost invisible in the long-term. Following surgery patients are given an elasticated garment which helps to reduce postoperative swelling.

What is the normal postoperative care?
Patients can usually have a shower the day after the procedure and reapply waterproof dressings over the sutures. Sutures are removed a week later and an outpatient review appointment is usually made for two weeks after the procedure.

An elasticated pressure garment is worn for four to six weeks after the procedure to help swelling to resolve.

What is the aftercare following this surgery?
Most patients experience slight discomfort following liposuction. This is adequately controlled with painkillers for the first few days after the procedure. The treated areas are bruised and swollen for seven to ten days after the procedure. The final result of liposuction is usually not visible until approximately six to twelve weeks after surgery.

How much time do I need off work?
Following liposuction for a single area or a small area most patients can return to work within a few days. For multiple areas of large areas of liposuction one to two weeks is a reasonable time to take off work.

What are the complications of this procedure?
Liposuction can have complications just like any other surgical procedure. These include bleeding, haematoma (blood clot under the skin), seroma (fluid collection under the skin) and a change in sensation in the skin over the area that has been created. There can be asymmetry or rippling of the skin overlying the treated area. Very rarely do patients need a revision procedure following liposuction.

Facts at a glance

Surgery time Dependant
Hospital stay Day case – 1 night
Anaesthetic assessment Possibly
Pre admission tests Yes
Reasonably mobile 1-4 days rest
Washing 1 day
Driving For small single areas 3-4 days, for large or multiple areas 2 weeks
Sport & exercise including gym For small single areas 1 week, for large or multiple areas 4 weeks, contact sports 6 weeks
Full recovery For small single areas 2 weeks, for large or multiple areas 4-6 weeks
Time off work For small single areas 3-4 days, for large or multiple areas 2 weeks
Bras and garments Dependant on area
Long term issues Contour Irregularity
What is Upper Arm Reduction?
Arm reduction is a procedure for removal of excess skin and fat from the inside of the upper arm.

What are the causes of excess skin in the inner aspect of the arm?
Most patients who have this problem develop this either as a result of ageing or due to significant weight loss.

Why do patients seek treatment for this condition?
Most patients are embarrassed by what they call a “batwing” appearance of the arms. This refers to the sagging of skin below and on the inside of the arms when the arms are held up. They are embarrassed to wear clothes which are either sleeveless or have short sleeves and are inhibited about wearing swimwear.

Are there any reasons for a patient not to have this procedure?
Patients who are actively smoking or on blood thinning medication such as aspirin or warfarin have a higher risk for postoperative complications such as bleeding, wound infections and delayed wound healing. It is advisable not to consume nicotine in any form for at least two weeks before this procedure and at least two to three weeks after. Medication such as aspirin or warfarin may need to be stopped if they are not absolutely essential at the appropriate time before surgery. This should be discussed with your Consultant or GP.

What does the surgery for this condition involve?
Surgery for this condition usually involves a general anaesthetic. It may be done as a day procedure or may require an overnight stay.

What is the normal postoperative course after this procedure?
There is swelling and bruising of the upper arms and the inner aspect of the elbows which lasts for a period of one to two weeks. The sutures are trimmed at the end of the first week and patients are encouraged to massage the scars to help them soften and fade. Most patients are able to carry out light activities after a week and are able to return to work within a fortnight of their surgery.

What are the possible complications of this procedure?
Like all operations this procedure can have complications such as bleeding, haematoma formation (blood clot underneath the skin), infection, a visable scar and asymmetry. A small percentage of patients (normally less than 5%) may require a small revision procedure to improve the scar.

Before and After

1-before1-after

Facts at a glance

Surgery time 2 hours
Hospital stay 1 night
Anaesthetic assessment Possibly
Pre admission tests Yes
Reasonably mobile 3 days but rest for 10 days
Washing 1 day
Driving 2 weeks
Sport & exercise including gym 4-6 weeks contact sport 8 weeks
Full recovery 4-6 weeks
Time off work 2-3 weeks
Bras and garments No
Long term issues None