Ask the Doctor - August Scotland on Sunday column

Sunday 28th August - Youthful Looks

Mr Awf Quaba is a Consultant Plastic Surgeon at Spire Edinburgh Hospitals.

Ageing is a complex process driven by a number of factors including our genes, sun exposure, smoking and the stresses and strains of life. The facial skin may feel dry, look dull with uneven pigmentation. This may be combined with deepening lines and folds. Reduced skin elasticity leads to sagginess and loss of firmness. Changes in the structures under the skin, such as the fatty tissue and the muscles of facial expression, can result in unwanted bulges such as eye bags,  loss of fullness of the cheeks and jowling.

Facial rejuvenation could be achieved in a variety of ways ranging from simple procedures to complex surgical procedures requiring hospital stay. There is nothing like a face to face consultation with an expert who is familiar with the various options, which include injectables (fillers and Botox) lasers, chemical peels, volume restorations by fat/stem cell grafting as well as surgical procedures such as face, neck, eye and brow lifts.

Rejuvenation can be achieved entirely by nonsurgical means. However, certain ageing features
such as advanced hooding and jowling can only be effectively solved by surgery.

Sunday 21st August - Abdominoplasty

Mr Ken Stewart is a Consultant Plastic Surgeon at Spire Edinburgh Hospitals.

Loose abdominal skin is very common after multiple pregnancies. The skin has often been stretched to apoint that the natural elasicity is lost. This is often combined with a separation of the abdominal muscles and an apparent overhang due to tethering of the section scar.

Unfortunately once skin has lost its natural elasticity, no treatment is effective in restoring this property. The gold standard remains a “tummy tuck” procedure. This surgery, also called an abdominoplasty, involves an incision along the bikini line and removing the skin excess to tighten the tummy. At the same time the muscle layer can be tightened and liposuction is often used in addition to contour the silhouette. Abdominoplasty has a very high patient satisfaction rate. On average, patients would be in hospital for two nights and off work for two to three weeks.

Sunday 14th August - Knee Pain

Mr Paul Gaston is a Consultant Orthopaedic Surgeon at Spire Murrayfield Hospital, specialising in hip and knee-joint surgery.

The knee is one of the major weight-bearing joints, and over the years is subject to a lot of wear that can lead to osteoarthritis – the commonest cause of knee pain in older adults. As the joint wears out there is nothing that can reverse this process, but there are steps that can help.

Reducing the load on the joint by reducing impact and weight can make a big difference to the pain. Your GP can prescribe painkillers, starting with simple things such as paracetamol, and then trying stronger ones later. Cortisone injections can be very useful in some patients.

Once the knee wears out completely (as in the above X-ray), knee replacement is usually required. This is now a very common procedure, although it requires admission to hospital and intensive rehabilitation. It gives a good outcome for the majority of patients with a good relief of pain and subsequent improved function.

Sunday 7th August - Tonsillitis

Mr Ray Kelleher is a consultant ENT Surgeon at Spire Murrayfield Hospital.

The tonsils are two lymph glands on the side walls of the throat just below the soft palate. While they have a role in the development of the immune system, this is not regarded as being very important and they have no other function.

Viral infections cause inflammation of the throat (pharyngitis). This may affect the tonsils inducing a bacterial tonsillitis. Pharyngitis does not require antibiotic treatment but infected tonsils often do.
Severe tonsil infection may lead to an abcess(quinsy) or more rarely spread to other areas of the throat. Glandular fever often presents with sore throat and enlarged tonsils covered with a white membrane.

Tonsillectomy is performed for recurrent acute tonsillitis, repeated quinsy and unexplained differences in size or unusual appearance. It is a painful procedure requiring a recuperation period of two weeks.