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Mr Nishikawa to head up Medical and Clinical Committees

Mr Hiroshi Nishikawa, a founding director of The Westbourne Centre and consultant plastic, reconstructive and aesthetic surgeon, is the new head of the organisation’s Medical Advisory Committee (MAC) and Clinical Effectiveness Committee (CEC).

The Westbourne Centre, a medical clinic in the centre of Birmingham, provides consultant-led care to over 1,000 patients each year in the areas of cosmetic surgery, dentistry, orthopaedics, ENT, Ophthalmology and more. The majority of patients self-pay, although a percentage use insurance or the NHS to cover the cost of treatments.

Both committees are part of the coordinated approach The Westbourne Centre takes to the delivery of care for patients, adherence to professional standards, and legislative requirements.

“Mr Nishikawa was a natural selection to head-up the MAC and CEC because of his extensive experience as a consultant surgeon, his on-going commitment to training and mentoring young surgeons, and unwavering belief in the safety of patients whilst delivering high-quality healthcare” notes Sarah Rush, general manager of The Westbourne Centre. “We are pleased to have his guidance and support”.

“The Westbourne Centre is dear to my heart” notes Mr Nishikawa. “As a member of the founding team, I am dedicated to ensuring the continued success of procedures using local anaesthetic with or without sedation, the high standard of cleanliness and infection control, and the overall well-being of our patients”.

The Clinical Effectiveness Committee (CEC) and Medical Advisory Committee (MAC) meet on a quarterly basis to review the clinical and safety performance of The Westbourne Centre.

Looking Good Naked

In the Western cultures, unless it is part of one’s professional life, there are relatively few times that the naked flesh is actually seen or is socially acceptable in its entirety.

Collection for Ethiopian Children

Mr Nishikawa travels to Africa twice a year to provide life-saving surgery on people who have experienced trauma (often from hyena attacks) or are suffering from NOMA, supported by the UK-based charity, Facing Africa.

In March 2016 he will visit Ethiopia on his first non-surgical mission, this time going to remote villages on the western side of Ethiopia and southern side of Sudan. An anthropologist will accompany the team to assist with translation and collection of information on the indigenous peoples’ preferences of the African face for a Facial Normality Study.

As a gesture of goodwill towards the indigenous people and their families, Mr Nishikawa and the team are collecting items that can be distributed to the children, specifically:

– colouring pencils
– crayons
– colouring books
– small toys
– pens
– stationery items
– pins for sporting clubs or teams
– badges
– baseball caps

A collection box for donated items has been set up in the lobby of The Westbourne Centre in Edgbaston, Birmingham. The collection is taking place between 10 February and 16 March 2016.

Any and all new or gently used items are greatly appreciated.

Facial Normality: Western vs African Perceptions

A possible definition of cosmetic treatment is the operative or non-operative change of a “normal” individual to another form that improves their quality of life, wellbeing and self-esteem. It does in fact raise the fundamental question of what we regard as normal?

The pictorial representation of normality, especially of the face, underwent several revolutions since the dawn of civilization. The renaissance was an intense period of re-discovery of the classical ideals of ancient Greek culture and sculpture. Genius artists such as Leonardo Da Vinci explored the rules of facial proportions. He understood the range of ratios between the width of the eyes and the width of the nose or the distance the eyes are apart. On a two-dimensional plane, he divided the face into horizontal thirds and vertical fifths, which helped him to draw a “normal” Western face (Fig 1).

Figure 1. Leonardo's study on facial proportions

Figure 1. Leonardo’s study on facial proportions

These basic concepts developed into modern sophisticated photographic and X Ray-based guidelines known as cephalometric analysis. Angles and lines are drawn to mathematically describe apparent proportions. These studies can certainly guide reconstructive and cosmetic surgeons towards the goals and boundaries of how much change would be aesthetically acceptable. However although much is known about the ideal proportions of the Western face, these techniques do not really tell us if someone is unattractive or beautiful. Indeed these subjective concepts are complex, personal, psychological and cultural.

I find it fascinating that Leonardo’s painting of the Duke of Milan’s mistress, Lady with an Ermine drawn 500 years ago, still resonates to European minds as a young woman of beauty (fig.2). We are conditioned, taught, educated or maybe genetically wired to appreciate her. In the twenty first century, the yardstick by which we judge aesthetic results are based upon our pre-conceptions, education, genes and exposure to mass media!

Figure 2. Lady With An Ermine. Leonardo Da Vinci 1490

Figure 2. Lady With An Ermine. Leonardo Da Vinci 1490

When African art influenced Picasso, the artistic frame of reference was thrown out. This was partly because of the huge conceptual differences between the depiction of the African face and Western art, and also the known proportional studies of the Western face were invalid for the African one. Picasso (initially representing Western aesthetic appreciation) tried to explore this during his African phase of paintings. He eventually produced outrageous images partly based upon African art. I suspect, at the time, its primitive and alien nature must have inspired him (Fig.3)

Figure 3. Self Portrait. Picasso

Figure 3. Self Portrait. Picasso

For the major facial reconstructions for severe abnormalities I help to carry out in Ethiopia for Facing Africa charity missions, I will never achieve the classical ideals with which I have been trained. The yardstick by which I judge aesthetic results is based upon our pre-conceptions and exposure to a world that is distinctly not Ethiopian. I am very curious about the dissimilarities in cultural aesthetic and in the future intend to study whether my concept (which is Western) of a normal or a beautiful African face will be the same as that of an indigenous person. I hope that you will all help with this in due course with a photo questionnaire.

I am sure there also are a myriad of other factors that I have yet to understand. However, all this in relationship to cosmetic surgery, has made me appreciate that really understanding the patient’s aims and goals and the personal benchmarks that drive the wish for change are the most critical elements to enable the surgeon to understand whether cosmetic surgery is in their best interests. I believe that in many cases, unhappy outcomes arise because this critical part of the assessment was misunderstood or misinterpreted. We each carry around our own personal concepts of what is normal and beautiful. To appreciate this is part of the art of cosmetic surgery.

Schoolboy from Manchester youngest person in UK to undergo mastectomy

Lewis Deakin, 11, had right pectoral muscle removed in order to treat rare condition which causes tumours to grow in his chest.

Lewis’s mother states: “He is the only child in the country who has had a mastectomy. As he gets bigger they will be able to reconstruct his chest. He was a bit daunted by it all at first and he wouldn’t show anyone the scar. But now he tells all the girls at school ‘I’ve been bitten by a shark’. He says it’s a real pulling machine.”

Hiroshi Nishikawa, the surgeon who has led Lewis’s operations at the hospital, which specialises in such conditions in children, said his patient had been “extremely brave” but the road to recovery was not quite over.

“We are delighted with Lewis’s progress but we will continue to monitor him over the next few years,” he said. “He has been extremely brave.”

Nishikawa added that a team of doctors and surgeons had been involved in Lewis’s treatment.

Click here for the full story printed in The Guardian

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Cosmetic Surgical Training Requires Determination and Vocation

With the imminent and highly emotive clash between the government and junior doctors taking place, I thought it might be a good time to inform you about surgical training and what it takes to become a specialist consultant surgeon. A summary of the training is given below. It demonstrates that the process is lengthy and has many difficult hurdles. I think such a process will only allow those doctors who have the intelligence, determination, ability and also the sense of vocation to become a qualified surgeon.

  • Medical School, 5-6 years to acquire the basic knowledge to graduate as a medical doctor and gain provisional registration with the General Medical Council (GMC)
  • Foundation training for 2 years working and studying alongside senior doctors and surgeons
  • Basic surgical training for approximately 2 years followed by intense competition to enter a specialist surgical training scheme that may be anywhere in the country. Often this time prior to entry into formal training programs may involve a period of scientific research in order to boost the credentials of an aspiring specialist trainee.
  • Once accepted within a training rotation it usually takes 6 years, to earn the Certificate of Completion of Specialist Training (CCST).
  • During training there will be continual assessment of the trainee’s progress and ability, culminating in a final exit exam and become accepted as a Fellow of the Royal College of Surgeons (FRCS). The post-fix letters reflects the specialty. A doctor with FRCS Plast after his name means that he has been trained in plastic surgery but he or she would still have had to secure a senior consultant post and almost certainly will have undertaken further training in a surgical fellowship in a chosen subspecialty before appointment.

It is of interest that ENT (ear nose and throat), maxillofacial and plastics are the only specialties in the UK where cosmetic surgery is officially on the training curriculum. This week, I lectured to senior oral and maxillofacial trainees on cosmetic surgery. It was part of a three-day maxillofacial course on examination techniques. These trainees were all soon to take their final exit exams. I have been privileged to teach on similar courses run by ENT and plastic surgery faculties. One of the reasons I am asked to lecture for courses is that I am an examiner myself. Twice a year I examine for the intercollegiate exit examinations for plastic surgeons (FRCS plast). It gives me wonderful insights into the current state of training and each time I attend I learn a great deal clinically, too. It is a pleasure to visit the different venues over the years and meet some extraordinary patients who give up their time to help with the examination process. The examination itself is a life event for all trainees. Twenty years later I can still remember the questions that I was asked for my own examination. The clinical part runs over two days and during this time, the soul is bared and the candidate’s knowledge, experience, confidence, nerves, judgement and professional compassion are really tested. I believe that it remains very hard to become a consultant surgeon in this country.

At these courses, I do try to explain and reassure all the potential candidates that the examinations are fair and that the examiners themselves are examined. Assessors monitor the technique, impartiality, fairness and behaviour of examiners, so I too feel the spotlight when examining! There is no doubt that the stress levels are high but I believe that the exams are not about intelligence. All surgical trainees have been through a rigorous selection process and are highly intelligent and motivated. I believe that the examinations concern the trainee’s experience and the diligent application of everything that has been learnt to become a safe, skilled and responsible consultant. The exam is therefore not only testing a candidate about what he or she might do but also what not to do or what not to take on. This is because during training it is very difficult to cover all the subspecialties within a specialty. Usually, as the trainee becomes more senior, he or she will compete for a fellowship in a chosen subspecialty (for example, for plastic surgery, there are fellowships in craniofacial, cosmetic surgery, breast reconstruction, hands, lasers, head and neck oncology and microsurgery).

The training that surgeons receive for cosmetic surgery in this country is inevitably haphazard. This is not the fault of trainees, the surgical colleges or even the government. It is due to a number of factors and a major one is the type of surgical healthcare delivery that is permitted under the NHS. Quite naturally, priority is given to emergency trauma, obstetrics, cancer and chronic disease involving transplant, cardiac and orthopaedic problems. Trainees are by and large exposed to NHS hospitals during their training, whilst the vast majority of cosmetic surgery is carried out in private hospitals or clinics. Therefore the type of surgical exposure for training will reflect the case mix of present NHS hospitals. The exposure to cosmetic surgery will be relatively limited for most trainees unless they participate in a cosmetic fellowship or have diligently attended during out-of-duty hours to gain experience at cosmetic clinics. This is in practice difficult for modern trainees because the culture of training has changed with the onset of European Work Regulation rules.

I think that I was very fortunate to have had a craniofacial fellowship, during which I was intensively trained in both aesthetic and deformity surgery. I also trained in an era when a significant amount of cosmetic surgery was carried out in NHS hospitals. However at the very least, the modern trainee is exposed and taught that that cosmetic surgery should be no different from any other form of healthcare delivery. Many surgical trainees are in fact in a good position to enter cosmetic surgery, such as those who have been trained in facial deformity and trauma and breast surgery. Surgeons who have undergone a rigorous training regime will have the insight that cosmetic surgery is within the same demanding surgical spectrum of technique and governance, and requires as much skill as any other surgical specialty.

To progress, a surgeon will require further dedicated training to achieve the experience and judgement that cosmetic surgery requires. The government has in fact recognised this and the Keogh report was written as a response to the practice of cosmetic surgery by doctors who may have had no formal training in cosmetic surgery or sometimes even in any branch of surgery. I believe that a practitioner who has not undergone the discipline of a true surgical training should not be participating in any form of cosmetic surgery. Rigorous surgical training will be the only way a doctor will gain the insight and the eventual maturity and experience needed to practice cosmetic intervention safely and responsibly. It is amazing how unregulated cosmetic surgery in this country and for most of the rest of the world truly is. The Keogh report was in fact a review of the regulation of cosmetic interventions in the UK. It discovered that there was in fact very little and therefore recommended the following:

• Professional Regulators
• Appropriate training
• Monitoring of interventions and products
• Breast implant registry
• Patient Access to information for consent

It may be a surprise to many who seek cosmetic intervention that such regulations are not already in place or those surgeons who have not been trained or even non-surgeons, can actually carry out cosmetic surgery! Undoubtedly many foreign surgeons who fly into the UK and carry out cosmetic surgery are technically capable and trained in cosmetic surgical provision. However this remains unregulated and whether their training is in anyway equivalent to that of the UK is unclear. I also believe that from the point of view of clinical governance this type of “fly-in-fly-out” surgical provision cannot be correct. Who then is truly responsible for aftercare and complications? This cannot be the responsible paradigm of care that as doctors we have been trained in.

It is probable that some of Keogh’s recommendations will be implemented in the future but there is no guarantee of this. However, until then, it would be wise for all those who are thinking of undergoing cosmetic surgical intervention to enquire carefully who really is actually operating on them and what the true nature of their training has been.

  • Hiroshi Nishikawa on LinkedIn

    Hiroshi Nishikawa

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    Reconstructive, craniofacial and cosmetic consultant surgeon, my principal work is with the Birmingham Children's and Queen Elizabeth hospitals and the Westbourne Centre, a private medical centre in Edgbaston.

  • British Association of Aesthetic Plastic Surgeons

  • Royal Society of Medicine

  • Plastic Surgeon

  • BAPRAS

About Mr Nishikawa