A vaccine for coronavirus is at least several months away. Therefore hospital surgeons and patients are having to adapt their practices and expectations to minimize the risk of inadvertent coronavirus transmission to patients. These changes are happening simultaneously in the NHS and private sector often with precedent-setting cooperation between the two as large swathes of the private sector have been temporarily incorporated into the NHS during the pandemic. As surgeons we are having to risk stratify our patients. This means that we are deciding which patients that are waiting for surgery are the most urgent and operating on them first. This is in contrast to the pre-Covid era when most operating lists would involve a combination of patients whose condition was urgent and those whose condition was not necessarily urgent but had been waiting a long  time for surgery. Most plastic surgery patients are being treated for a condition that is not life-threatening and therefore plastic surgeons are having to robustly defend their patient’s interests in order to gain access to sufficient operating lists both in the public and private sectors.
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Coronavirus has caused devastating effects on our health and our society and it almost feels vulgar to even discuss what effect it is having on the cosmetic treatment industry. But you can’t help but notice the plaintive posts on social media such as “when can I get my next filler treatment?” or “OMG my Botox has worn off!” The lockdown has led to the closure of non-essential high street establishments including hair and beauty salons and clinics offering non-invasive treatments such as Botox, fillers and fat freezing. The NHS has temporarily taken over private hospitals throughout the country in case of the NHS becoming overwhelmed by Coronavirus, thankfully it hasn’t, which means that there is no cosmetic surgery taking place. We don’t know yet when clinics will be able to reopen or when normal(ish) services will resume in private hospitals.  But we can expect cosmetic surgery operations to resume more slowly whilst the backlog of more urgent procedures is got under control. For those patients that are awaiting their cosmetic treatment who may have this open-ended postponement is no trivial matter. Multiple studies have demonstrated that many patients suffer genuine psychological anguish because of their physical appearance and gain a great deal in terms of quality of life from their surgery. For example, patients with very prominent ears or marked breast asymmetry. 

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Richard Baker Blog

Joint Replacements in the Hand and Wrist

There are many joints in the hand and wrist, and they are prone to developing arthritis just as other joints in the body. Arthritis means pain, swelling and reduced motion due to wear and tear within the joint, or more specifically loss of the soft cartilage surface of the joints. This occurs in all of us as we age, but in a minority of people it leads to pain. An effective way of relieving pain in joints is to remove the joint entirely and fuse the bones together. However, this means the joint does not move at all.

An alternative that preserves motion is to replace the joint with a mechanical device or prosthesis. There are some advantages to replacing joints in the hand and wrist. Firstly, the hand and wrist are not weight-bearing joints in contrast to the hip and knee, so they do not have to be as strong. Secondly, the hand is more resistant to infection than other parts of the body because of its excellent blood supply. The disadvantage of the hand as a site for joint replacement is that there are no muscles crossing the individual joints in the hand; for example, there is no muscle in the fingers. This means that the joints are inherently less stable than, for example, the hip and knee.

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Richard Baker Weekly Blog

Body Contouring in the Massive Weight Loss Patient

Massive weight loss is defined as when a person loses 50% or more of their excess body weight. For example, if a person weighs 100 kg but their ideal body weight would be 60 kg on the basis of their height, then their excess body weight is 40 kg and if they lost 20 kg or more, this would be massive weight loss.

Some people achieve this through diet and exercise and others through surgery, in particular gastric bypass, which is a very effective procedure and even cures type II diabetes. Inevitably, after losing a great deal of weight, there is excess skin which does not contract back down to its original size. This is because the skin is stretched beyond its elastic capacity; for example, an elastic band that is held outstretched for a long period will eventually lose its elastic recoil.

Unfortunately, it does not matter how much time elapses since the weight loss; the skin never regains the elasticity of normal skin. The skin also becomes much thinner. The excess skin tends to hang in folds and this causes problems with clothes, taking exercise, personal hygiene and affects people’s self-esteem and relationships. Therefore, removing this excess skin, so-called ‘body contouring’, is a very worthy endeavour.

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Richard Baker Weekly Blog

What is Buried Penis Syndrome?

Obesity causes many problems including arthritis, high blood pressure, heart disease, diabetes and difficulty exercising, but in men it causes another problem that is rarely talked about – buried penis syndrome. This occurs in men who put on weight because the fat underneath the skin pushes the skin outwards to eventually bury the penis, which is attached to the underlying bone of the pelvis and therefore cannot expand outwards with the skin. The problem can reach such a point that men can no longer see their own penis. It makes passing urine difficult with dribbling and this can lead to another condition called balanitis. It is thickening and tightening of the foreskin and the end of the penis (or glans) as well as narrowing of the water pipe. It predisposes to cancer of the penis but also, because of the increased pressure required to pass water, leads to problems with the kidneys.

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Richard Baker Blog

What is arthritis of the thumb?

Arthritis at the base of the thumb is very common particularly, in women over the age of 40 years old. It’s probably caused by weakening of the ligaments over the years through exposure to estrogen which is the female hormone. Weakening of the ligament means the thumb partially dislocates from its joint on the hand leading to wear and tear of the cartilage which is essentially what arthritis is. It leads to new bone formation, causing spikes of bone which can dig into the surrounding flesh and causing inflammation of the tissues around the joint. This leads to pain but also to deformity of the joint and reduced range of motion, strength and function. In many patients it’s painful for a few years and then burns it’s self out. In other patients, it’s persistently painful and these patients require treatment. The main treatment is avoiding activities that cause pain but also wearing splints at times of exacerbation of pain, taking pain killers, both tablets but also creams and gels which can be applied to the skin, steroid injections where the steroid is injected directly into the joint under a local anaesthetic, sometimes it’s necessary to use ultrasound on an x-ray machine to ensure the needles are in the right place, very often this can be administered in clinic. Often the joint is more painful after a steroid injection for a day or two and it can take several days for the steroid to kick in and can last up to six months. Steroid injections can be repeated over time and tend to last for shorter and shorter periods. We’re not quite sure why steroid injections work but steroids dampen down inflammation and inflamed tissue is painful.

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Richard Baker Blog

Who are seeking breast uplift and implants?

This week I’ve seen several patients who are seeking breast uplift and implants. Otherwise known as augmentation mastopexy. It strikes me after seeing several different types of patients requesting this surgery, that there are two main groups of patients who request this but actually need slightly different operations. The first type of patient is a woman who’s had children and has breast fed and has lost volume, such that the breasts have then become deflated and droopy. These patients require a small implant to restore lost volume particularly in the upper part of the chest as well as a lift to tighten up the skin and reduce the droopiness. As a small implant is being used and no breast tissue is being removed, this can be safely performed in one procedure.

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Richard Baker Weekly Blog

My Thoughts on Facial Rejuvenation Surgery

This week I have been doing a bit of reading and thinking about aesthetic surgery of the face. By ‘face’ I mean the skin and underlying fat and muscles of the face and neck, but I am not really talking about the eyelids, the nose or the mouth as such because these areas have very particular anatomical features and require a discussion of their own. The tissues of the face consist of skin, fat, muscle and the underlying bone, and all four of these structures give the face its overall shape. Furthermore, all four of these tissues change with age and contribute to the changing facial appearance.

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Mr Richard Baker – Weekly Blog

Understanding the different type of wrist injuries

This week I have seen a number of wrist injuries and I have been thinking about their natural history of and my approach to them. There are two general mechanisms of wrist injury which divide the patients into two groups.

The first group tends to be young men involved in a high energy injury such as coming off a motorcycle, coming off a bicycle at speed, falling off a skateboard, throwing a punch of falling from a height such as a ladder at work, for example.

The second group tends to apply to women and children in particular and is a lower energy injury, typically tripping over and landing on the outstretched hands.

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