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E-Newsletter launched to answer questions and keep you informed

There is so much happening in the world of aesthetics I have decided to start a newsletter aimed at keeping you informed of the latest events and trends in cosmetic and plastic surgery. I am hoping you may find this educational and interesting as, in due course, I also intend to relate some of my past and recent experiences concerning all aspects of my professional, cosmetic and surgical life.

I hope to stimulate dialogue and feedback, and encourage you to email me with ideas and suggestions of topics you would like covered on hiroshinishikawasurgeon@gmail.com

We are also starting a Question and Answer page on my website where I can answer your questions and you can read through others in the subject areas that most interest you. Here is a link to my answers of Frequently Asked Questions.

To sign up register directly on the home page of my website, or drop me an email. I look forward to hearing from you.

Hiroshi Nishikawa

Do you want to be on TV?

Remarkable TV is looking for people to take part in the primetime Channel 4 series BodyShockers with Katie Piper.

The programme is produced by Remarkable Television (part of the Endemol Shine Group and the makers of Supersize vs Superskinny and The House That 100K Built and Million Pound Drop). The previous series of Bodyshockers generated over one million viewers making it one of Channel 4’s most popular returning brands.

Bodyshockers is about body modification desire and regret and looks at the multitude of ways we choose to alter our appearance in the name or beauty or standing out. We are looking for people who are seriously considering dramatically changing their face or body using cosmetic surgery OR those who want a past body modification reversed. The types of procedures we are interested in featuring include: breast, buttock or pectoral implants or removals; labia reductions, nose jobs, chin or calf implants, lip enhancements or reversal, ear stretcher repair or any other interesting new cosmetic procedure.

Potential procedure the show would like to follow are:
– rhinoplasty, chin lift, facelift
– boobs and tummy tuck
– fat transfers on body and face

If this opportunity interests you and you are interested in working with the casting team please get in touch with the casting team on 0208 222 4050 or e-mail at imogen.gabony@endemoluk.com

Mr Nishikawa and The Westbourne Centre have worked with several television production companies on cosmetic surgery shows including the very popular Embarrassing Bodies. Promotion of this opportunity does not imply endorsement, we are simply providing the opportunity if a patient is interested.

Press Release – Creating Faces Around the World

July 2015 – Last month Hiroshi Nishikawa, a consultant plastic, reconstructive and aesthetic surgeon based in Birmingham, led a clinical team of surgeons, nurses and medical support staff on a mission to Ethiopia to provide developed healthcare to those in need through the charity Facing Africa.

This wasn’t his first mission. Mr Nishikawa has worked with Facing Africa for several years, travelling to Ethiopia to operate on children with severe facial deformity. “After several years supporting Facing Africa on their Ethiopian missions and UK-based fundraising activities, it was such an honour to lead the surgical team and provide direction and guidance to younger surgeons operating on these major deformities for the first time”.

Relating this surgical experience back to his NHS and private cosmetic practice in Birmingham, Mr Nishikawa states “The surgical expertise required when addressing severe facial deformity through to a facelift for completely aesthetic reasons are not dissimilar, I believe they are on the same surgical spectrum. You cannot operate on deformity unless you know the nature of normality, and vice versa”.

“Facial surgery, either reconstructive or aesthetic, carries the additional weight of personal perception. Our face tells the story of our life and identification, and there are many idioms relating to saving face. In reality it is training, experience, judgment, honestly and the interests of the patient which must remain paramount in any surgical situation”.

In Birmingham, Mr Nishikawa was one of the surgeons who pioneered the use of local anaesthetic and sedation for cosmetic procedures in the UK, along with a colleague at The Westbourne Centre. This anaesthetic technique allows surgical cosmetic procedures to be carried out with a quicker recovery time and fewer side effects.

Wendy Hughes from Walsall has had multiple cosmetic procedures by Mr Nishikawa with the impetus being an article she read about the procedures as a day case. “I didn’t really want to have a general anaesthetic, and when I saw it was possible to have a mastopexy (breast uplift) as a day case I immediately got in touch. I am so happy with the experience and the results. Every time I look in the mirror I feel I look my best”.

In addition to his charity work in Ethiopia, Mr Nishikawa is a lead member of the Craniofacial team at the Birmingham Children’s Hospital and Queen Elizabeth Hospital, and runs his provide cosmetic practice at The Westbourne Centre. His next trip to Addis Ababa, Ethiopia, is planned for early next year.

About Hiroshi Nishikawa
Mr Hiroshi Nishikawa, consultant plastic, reconstructive and aesthetic surgeon, leads a multidisciplinary team managing vascular anomalies and is part of the plastic and craniofacial teams at Birmingham Children’s Hospital and The Queen Elizabeth Hospital. His private practice is located at The Westbourne Centre, a private day hospital he helped create, where he performs a full range of cosmetic surgery procedures using local anaesthetic with or without sedation. More information is available on the website www.HiroshiNishikawa.co.uk

About Facing Africa
Since 2000, Facing Africa has been working closely with its European partners raising funds to send teams of volunteer surgeons, nurses and anaesthetists to Children’s Hospitals in Ethiopia. The funding covers air fares, hotel accommodation, ground transportation, medical equipment and supplier, hospital fees, scans, surgical instruments, capital expenditure, training schemes and many other essential expenses to assist people suffering with NOMA. It should be noted that less than 6% of Facing Africa’s turnover is spent on administration. More information is available on the website www.FacingAfrica.org.

Celebrity Breast Implant Explosion Causes Concern

A colleague of mine showed me a recent alarming newspaper article with the headline below concerning an unfortunate celebrity.

Tina Malone rushed to hospital for emergency surgery after her breast implant explodes due to an infection

I understand she needed emergency admission. She undoubtedly had a very serious infection and I can only speculate that a gas-forming organism had somehow contaminated the implants, which led to a very unusual infective complication. I would have thought that the treatment would have been intravenous antibiotics and removal of the implant along with thorough debridement of any contaminating or infective material within the cavity where the implant had been inserted.

In my experience breast implant infection is very rare.

Breast implants can be contaminated either at the time of surgery (which is the most common way) or more rarely from internal blood borne organisms. Because implants are man-made and do not have their own blood supply, they will initially be vulnerable to bacterial colonization. Therefore, operative and implant handling techniques are important.

However, I believe just as critical are patient selection and thorough pre-operative counseling regarding possible complications, both rare and common, so that the relative risks one takes (both short and long-term) with elective surgery are fully understood. The final decision for cosmetic surgery made by the patient should be based on informed consent.

Thankfully the complication suffered by this unfortunate lady is very unusual and rare.

A new face for Samaya

One of the great challenges in surgery and medicine is when doctors are called upon to treat a condition they have never encountered before. It can raise significant ethical and clinical dilemmas. Objective decisions can only really be made if we have some understanding of the natural biological behaviour of a disease entity and of the prognosis with or without treatment. However the surgeon can feel forced into operating if it is clear that the disease will kill the patient if left untreated, even if the operation itself maybe as dangerous as the disease itself. During the last mission in Ethiopia with Facing Africa we were challenged by such a dilemma.

Sumaya was an eight-year old girl who had a six-month history of a rapidly growing midface tumour. She came from a remote part of Ethiopia. She is a patient I will never forget as long as I live. She presented with a gross deformity, which made her look like a pony. The tumour had obliterated her nose and stretched it outwards. At the same time her eye sockets were propelled forwards and sideways. She was still able to eat but the tumour had filled and stretched her entire nasal cavity so she was no longer able to breathe through her nose. Clearly it was only a matter of time before the tumour would start pushing her palate downwards and also obliterate her mouth. This would mean certain death from starvation or asphyxiation. A previous biopsy had shown this to be a mass known as Osteofibroma. This is a locally obstructive, benign but aggressive expansile tumour. I had never encountered such an entity. Scans had demonstrated that the tumour had not yet eroded through the skull base and into the brain. If the scans had shown that the brain was involved then it would have been classified as inoperable.

We had a serious and very enlightening meeting with the whole team about whether we could possibly treat Sumaya. Although she was eight years old she was quite emaciated and had the physique of a five-year old child. There were significant surgical and anaesthetic uncertainties about whether such a gigantic facial mass could be removed without killing her. As far as we knew, this tumour was potentially curable based on close inspection of the scans and some very old medical articles published decades before. However we were not truly sure whether the surgery would be cure or palliation. Also the operation would leave still leave her very disfigured. Would that be an ethical or justifiable end-point?

Facing Africa is a charity that has to be very pragmatic about what we can practically treat. However it was the human element that truly swayed us. It was Sumaya’s charm and joy and thirst for living. (She loved to play and I wondered how on earth she could catch a ball or draw when her eyes were in such odd positions on her face?). Without treatment there was certainly no future at all. How could we ignore this? She had a life force about her and there was also the quiet, dignified strength of her father who wanted us to give her a chance. His attitude transgressed all barriers of language. We were certain that he understood that Sumaya had a high chance of dying through our treatment but his courage and consent gave us the determination to give her this chance.

After most of the day in theatre and with much teamwork, the tumour came out and she survived. We managed to bend the bones of the face so that the eyes looked forward and we found her old nose. She looked more human again. Quite miraculously she was eating and drinking the day after the operation. She could still see although her voice had totally changed as a result of the huge dead-space in her now empty nasal cavity. I will never forget her father’s joy of hope when he learnt that she had survived.

A month later after the mission, Sumaya is doing well. It has reminded me of the strength of teamwork. The power and mystery of nature and the challenges that sometimes we have to take on against the odds. Above all it is the human factor in medicine, which often has the greatest influence in how we ultimately reach a clinical decision.

Transcultural reality of aesthetic body concerns

Recently on a surgical charity mission to Ethiopia a tall young handsome man turned up at our mission on the last operative day in Addis Ababa. There is no doubt that he had travelled from a great distance from a remote part of Ethiopia just to see us. He complained about some relatively minor post-traumatic scars on his face. He said that he was sixteen years old. Communication was possible through a chain of interpreters. I agreed to carry out a simple surgical revision under local anaesthetic but just before the operation he revealed the true cause of his anxiety. He had a small but well formed breast on one side. His posture, embarrassment and demeanour reminded me how universal personal psychological frailties and aesthetic physical concerns can be.

The psychological effects of gynaecomastia are often significant and the presence of breasts in males (mild or severe) can affect the core of gender identity. I believe this is transcultural.

Gynaecomastia is the presence of excess breast tissue in males and can be confused with the fatty breasts of excess weight and obesity. True gynaecomastia cannot be treated with just diet alone. I believe that surgery required for excess skin on the chest after successful and significant weight loss is a different type of “breast problem” in males and may require techniques different from those used in gynaecomastia correction.

Gynaecomastia can affect both sides of the chest (bilateral) or just one side (unilateral). Hormonal changes during puberty in boys, is the most common cause of true gynaecomastia. However less frequently certain drugs (spironolactone, cimetidine, marijuana) and rare pituitary tumours in the brain (prolactinoma) can cause either unilateral or bilateral gynaecomastia. There is a range of severity from mild mounds of breast tissue (which can be easily disguised under a loose T shirt ) to severe when the breasts are difficult to hide.

Therefore the clinical history and examination for a patient with gynaecomastia needs to be thorough and accurate in order to understand the cause, the severity and the treatment strategy. Most gynaecomastia has both fatty and breast tissue components of varying proportions. Provided the skin has enough elasticity, liposuction is a very effective form of treatment as the skin re-moulds and shrinks over the subcutaneous spaces left after the fat has been removed. Less easy to treat is the hard breast tissue element and if there is a significant amount this usually requires some form of open surgery via an incision that can remain within the nipple. Sometimes in older patients, when the gynaecomastia has been of long-standing or if the gynaecomastia is particularly severe, excess skin also has to be dealt with. This can result in more extensive scars similar to those of a formal breast reduction.

Read some commonly asked questions about gynaecomastia on my FAQs page:  gynaecomastia frequently asked questions.


New anaesthethic approach ‘the way forward’ for surgical cosmetic procedures

THE FUTURE Local anaesthetic with sedation is a pioneering anaesthetic technique which allows surgical cosmetic procedures to be carried out with quicker recovery time and fewer side-effects.

Cosmetic Solutions Guide covers the topic of local anaesthetic for cosmetic surgery featuring the opinion of consultant surgeon Hiroshi Nishikawa MA MD FRCS(Plast)

Here is the link to the article in its entirety:

New Anaesthetic Approach article in The Independent

Tony Greenway of The Independent newspaper asks What is “local anaesthetic and sedation”? Mr Nishikawa’s response? “The way forward” for surgical cosmetic procedures and healthcare, generally.

Most patients who undergo surgical cosmetic procedures – such as nose jobs or liposuction – will, in the UK at least, usually undergo a general anaesthetic. This is medication which causes a loss of consciousness and means that patients will be completely unaware of the surgery they are having.

Many general cosmetic procedures can be carried out under local anaesthetic with sedation, including eyelid surgery, nose jobs, facelifts, breast surgery and liposuction. Click the link below to read the entire article in The Independent, published Tuesday, 30 June 2015.

New anaesthetic approach “the way forward” for surgical cosmetic procedures

Mini-Facelift: A Bit More Than Myth or Magic

The Huffington Post recently ran an article from NYC plastic surgeon Robert Tornambe, M.D., discussing the different types of facelifts and claims that surgeon can get “carried away” with claims of spectacular cosmetic results. Mr Nishikawa weighs in.

Robert Tornambe’s remarks are interesting and thoughtful. It is based on observation and experience. I too believe that the various techniques of facial rejuvenation, ranging from non-surgical to surgical, should always be tailored to the needs of the patient. It is equivalent to choosing the correct tool.

Problems arise when there is a mismatch between what is planned and what patients expect.

As Dr Tornambe points, out when fraudulent claims are made, no one wins. He states that surgeons becoming “carried away” may cause this. In fact, I think that it is more than this. The financial pressure of cosmetic competition can turn operations in to a kind of a product, which must be sold. As in manufacturing industry the marketing forces try and dictate that the operation is superior and unique to all others in order to make the patient walk through the doors of the clinic.

In reality it is training, experience, judgment, honesty and the interests of the patient, which must remain paramount in cosmetic surgery. This is no different from any other form of healthcare delivery and the only way a practice will ever be sustainable in the long term.

Click the link to read the entire Huffington Post article by Dr Robert Tornambe.

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    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


About Mr Nishikawa