Wednesday 29 June 2022

What is the importance of being systematic when approaching facial rejuvenation?

Presentation made at the MIPSS meeting, Marbella 2022 by Dr. Gabriela Casabona. 


Thursday 16th June.


Systematic Approach to Minimally Invasive Facial Rejuvenation, by Gabriela Casabona. 


What is the importance of being systematic in your approach for facial rejuvenation? 


Systems are very important. I started to recognise the importance of a systematic approach many years ago when I began changing my toxin injections. Getting comfortable with a technique is so much easier - human beings are creatures of habit, we go with what we know, can already do, and quite often take the easier path. We can easily opt to use the same automatic technique for every individual. So, to tailor-make something is not as natural for us, it is out of our comfort zone. To get out of that comfort zone is when the magic happens - for each patient, we have to restart, think again, and apply something different. This raises the question as to whether there is a way to find a pattern or system for a customised approach? So then I learned how important it was to do this, because nowadays we also have all the artificial intelligence and machines to learn these algorithms and create patterns - what is the importance of being systematic, of bringing patterns? What we do is art, yes, a part of it is art, but every single painter or sculptor who studied their craft learned the basics and techniques before they could develop that art. You have to start somewhere, so asking the right questions is the first, most important thing - I have always believed that. So, I will introduce you to the following, important steps. Knowing your patients, understanding complexities, regions versus treatments, what to choose, where to start, combinations and anatomy, safety vs effectiveness. 


What does the patient really want?


“People talk without speaking, and others hear without listening!”


To find out what a patient wants can be really difficult. Sometimes a patient comes to you with a request, but they don’t know how to exactly translate what they want - so I have to learn to communicate suing a common ground in these instances. How can I really understand and extract what my patient really wants from what they have said? 


During a summer academy in Austria at a workshop for upper third facial rejuvenation, I had an experience with a model, who was a doctor. She explained to me that she wanted the MINIMUM amount of toxin; very very very little. During her combination treatment I showed her a scale on static lines of the forehead and asked the model where she saw herself at that time, and where she wanted to see herself according to that scale. Before treatment she pointed at the number 4 (on a scale of 0 - 4), to which I agreed. When I asked where she would like to see herself, she pointed at the scale relating to 0. This patient wanted the maximum effect without having to have the treatment necessary to achieve it. Had I gone along with her words, she would not have been happy with the outcome. This shows how far we can be from a perspective if we are not analyzing what the patient wants effectively. It is so important to translate the patient correctly. We normally go from where I am going to treat, to the product I am going to use and how I am going to use it. But we forget three things that add complexity to our treatments:


  1. Self perception - the patient that has an incorrect perception of their reality, good or bad is irrelevant, but we need to recognise what their self perception is to be able to gauge their wants. Is this a difficult candidate for aesthetic treatments? 

  2. Expectations - patients with high expectations are more complex to treat than those with low expectations. 

  3. Severity - We must take this into account before applying a technique or product - we can’t take the same technique, independent of the severity, and just change the amount of product required. Sometimes these small details can interfere with the outcome if not addressed properly.


Step 1. Expectations…one patient I did injectables for complained about her eye bags which I treated with fillers. Her main component was lack of volume and skin quality so I decided I could inject her. But she wasn’t happy with the outcome, why? Her main goal was not in fact what I thought it was - what she really wanted fixed was the bar code - so she wasn’t happy and it was my fault as I had not understood her. So I continued to treat her but there’s a limit to what I can do here, I cannot achieve a grade 0 using the procedures she was comfortable with. This is why I like to use images, and scales to be able to really see what a patient is expecting. To really understand and know what their expected outcome is. They have to point out what they are expecting, and then my job is to aim to achieve that outcome. What they say and what they point to can be very different things! This process also helps with recognising their self perception, where they see themselves on the scale is indicative of how they perceive their appearance, which could be very different from what we see. 


Another patient said she was not happy with her jowling (post treatment) but actually she was unhappy with her marionette lines. If you are treating laxity, for example, you have to take photos of before and after to be able to measure effectively at a particular angle. To standardize this I ask the patient to use their hand and rest their head on it, then remove it for the photo - keep a record. 


Step 2. What are other complexities I found? The levels, skin quality, physical conditions, high expectations - all this made that patient more complex. Another patient has skin problems, skin quality issues, physical conditions, and high expectations. Learning to deal with complex patients is essential, and complex does not always equal severity. 


What I have learned by observation is that we can adjust and we can understand what to do when having a mild or severe patient in terms of layers and treatments. Every treatment can treat a different layer, I can use HA, for example, in almost all the layers, energy based devices to others, so I have to understand which layers to treat with which treatments. I realized that when a patient has a problem with skin quality - this is a game changer in priority - treat this first, always. HA, lasers, PRP nano-fat, whatever the treatment - treat the skin quality first.

 

When using injectables, and you have a bad level of skin quality,  It’s like a balloon effect - take a balloon, inflate with six puffs of air, tie it up…it’s tight, shiny, elastic, beautiful - in a week you release that air and then see if you can blow that balloon to the same tensity with the same 6 puffs of air. Not a chance, you’ll need at least double. It is the same with the skin. If you have loose skin of bad quality, that is not tight and does not give back energy to the bone, you are going to have to fill it more and more. 


Muscles of the mimic can be treated differently - I may sometimes block the muscle force (at muscle level) or maybe I will simply smooth the connections in between the muscle and the skin (by injecting above the muscle). Do I want to treat inside the muscle to block the function? Or do I want to treat it superficially just to block the connection and not the function?


I need to recognise that the same HA can behave differently depending on the layer in question, and take advantage of this. 


Step 3. Treat the layers. In the face, you often have to treat different layers in order to use less product. If you try to create a skin effect by only injecting the bone you will have to inject much more product. 


Understand the difference between the bolus and the retrograde. The bolus itself apparently has the same lifting effect as a retrograde, but if you massage a retrograde injection it will almost dissolve in the tissue. And the bolus stays where it is - so if you want to create a lifting effect with the filler, don’t use retrograde, you have to use bolus. If you start using retrograde, and I remember when I was a speaker promoting a product, other doctors were using so much more product than I was - they were using 3 times more product. Why? Because they were using retrograde that has a smaller lifting capacity than when you use a bolus.


Biostimulators: Technique makes a difference in the diffusion; I want to diffuse the biostimulator but if you use a needle you have very little diffusion, no matter the type you have used, the biostimulator will be concentrated along the needle injection. Whereas if you use a cannula you will be able to distribute everywhere - so technique is vital to outcome. 


Step 4. Where to treat. Once you understand the severity, what the patient wants, their expectations, etc., you know which layers are involved; whether it is a bone problem, a fat problem, a skin problem, what are the problems that need to be treated, which procedures you need to use in each layer, whether I need to combine treatments or not - where do you start? 


When a neck angle patient comes in, I would usually start with the chin, but because of the severity of the neck angle I need to bring a holistic approach - how do I give support to the lateral face so that I can get a better design, a tighter jawline, and so that I can use less product on the chin - I see that this is not only a chin problem but a combination. So what I did was grade her, understand what she wanted and the level of improvement she desired. So instead of treating her only on the lower face, I treated 3 regions to get the result she wanted. 


How did I get to this? Go beyond the area they’re complaining about and treat multiple regions of the face to give the effect you want to achieve. Especially if they are 3 - 4 on the scale. This is the result I achieved for her. Using only fillers and microfocused ultrasound, fillers in the points shown, using the posterior temple to give support to the jawline definition angle of the mandible. Where to treat is important so choose your regions according to the severity. If a patient has a high expectation or an added complexity you add a region to their treatment.This is how I classify my patients, it depends on whether they are mild, moderate or severe as to how many regions I treat.

 

Step 5. Patient combination procedures; after looking into 3000+ patients in 19 years, I understood that the jowling was only treated with one or two procedures, but if I have a severe jowling, I would treat 2 - 3 regions with 2 -3 procedures. The more severe, the more areas I treat, with more procedures. A mild case may only be the region shown. If more severe I go beyond and use combined procedures to get where I need to go. 


First things first - it is vital, when a combination of procedures is in play, to prioritise each treatment accordinlgy. If I am correcting a chin or a nose, for example, as well as lip fillers,I would not do the lip first. The chin and nose are landmarks for the lip and how it looks, if they are being changed they should be changed first. The lip can then be addressed. 


Step 6. How to treat? I never realized how many decisions I made before taking a cannula and injecting a patient - the cannula size, the product, is it bolus or retrograde? how far do I inject? which layer am I going to? - there are more than 15 decisions to make before beginning the treatment itself. 


How to treat is a very important factor - what will I use? How many syringes will I need? What amount am I injecting for each bolus? So those are the things that are severity dependent on the amount and the sessions and the technique is goal dependent, so I want to loft, I want to contour, what am I doing with this particular patient. Am I using bolus, mini bolus or retrograde injections? 


The next question is the amount, how many syringes of filler am I using? If there are more than 6 syringes in one session, the session would be divided into more than one. Choose the depth of the toxin injection according to the goal; are you blocking the muscle or simply smoothing the skin? Choose your filler technique according to the goal; lift or contour or smooth? 


Customize your treatments, don’t be too automatic when you do things, don’t lose the view of the different needs, muscle mass and symmetries each patient has. Choose safety first, always. There is no 100% safe place for any procedure on the face in my opinion, but there are more effective places to put procedures, so we bear in mind what we already know, what means lateral face and medial mid face behave differently with different procedures, so we must correct something medial by starting laterally, note the effect, and then go medial. Keep the results with the least amount possible. 


Don’t forget areas - the posterior temple is an area we don’t see, we don’t see an immediate effect, because we are not trying to affect the temple itself, though it can have a great effect on many other areas of the face - I personally love the posterior-superior temple to achieve an effect on the brow and the interior temple. I love the posterior-inferior temple to get an effect on the mid face and also the lower face. Whenever I don’t have space on the bizygoma to expand more, I go for the posterior-inferior temple to give support, for example. To create the foxy eye effect on the brow, I used the posterior-superior temple. These combined procedures create a more natural, holistic look. If you treat only one area, the trouble area, the rest of the face can look worse. You are smoothing just one area and creating a gap between there and the rest. 


Skin quality is a game changer - for one patient I treated her skin quality (in order to inject life into it) six months prior to injecting her with fillers. The amount of product, I had previously calculated, intended to use on her during a teaching session, was completely different to what I actually used. Her skin quality had improved so significantly in the 6 months I only needed to use ⅔ of what I had planned. 


Take home messages -

  • Try to understand what the patient wants objectively

  • Take quality before and after pictures with correct positioning

  • Be aware of complexity points that can interfere with the outcome

  • Start by impact zones - towards a holistic approach

  • The more severe the condition, the more regions to combine; starting from top to bottom

  • The more severe a condition, the more procedures you need per region: start from deep to superficial unless bad skin quality) 

  • Choose technique according to the layer and the goal 









Wednesday 22 June 2022

Team Building and Leadership - how to maintain a highly functional private practice

HOW TO CREATE A HIGHLY FUNCTIONAL PRIVATE PRACTICE 

About Me: Dr. Kai Kaye...

Plastic, Aesthetic & Reconstructive Surgeon, 22 years in the Plastic surgery specialty, 15 years as consultant in private practice


Academic training in Germany at TU Munich, Berlin and  Aachen University RWTH


Microsurgical Internship at UCLA and PhD thesis on prefabricated microsurgical flaps at TU Munich


Fellow of the European Board EBOPRAS,  licenced consultant specialist in GER, SPAIN and UK


13 years running my own private clinic in Spain,  incorporating an international fellow training program


International lecturer and Instructor / KOL for Venus, Human Med and Merz




Dr. Kai Kaye, speaking on the topic of team building and leadership within a private practice and how to create, and maintain, a smooth running, successful business. 


Speaking on this topic brought up the question, why would there be a need to create a brand as a plastic surgeon?


  • Efficacy in the decision to spend
  • Offers Reputation and reduces risks
  • Creates a social image / demonstration of affluence 
  • Has to have a unique selling point /proposition
  • It has to  be recognisable and singular
  • It should offer emotional identification beyond the rational decision


☑ A patient will choose you over other comparably gifted colleagues if the experience your clinic delivers is better! 



It is important to create a unique selling point - why should a potential patient choose you? 



When it comes to elective private medicine, the patient does not choose only the medical expertise, he chooses a certain setting, a unique personal touch that fits him or her! 


Reputation, skill, expertise, knowledge, longevity, standards, ethics, aftercare, attentive staff, comfort and getting that feeling that this is the right place as well as the right doctor. All these elements combined are necessary for a strong, reputable practice to succeed. And how a practice gets that positive reputation to the public is just as important. Quite often it is word of mouth, but the way a practice represents themselves is vital to its success. 


Private medicine comes as a package that has to fit the customer, so what is needed to create this? Time, money, dedication, perseverance, curiosity - "what can I do better or differently to others in my field?” 


When setting up a private practice, as Dr. Kaye did himself 16 years ago, he had to ask himself all these questions. It took time and focus and he found that leadership, team building and organisational skills were vital aspects of the practice running well as a whole. 


Finding the right setup, the right people in each environment. All environments are different and rely on varying factors - the right place can be different from one city or country to another - analysis of the conditions in the place you are choosing and how best to structure this is one of the first things that must be addressed. To know your audience. 


  • Choice of city (or even country) based on market analysis or personal preference?
  • Choice of location within a city (Social value or reputation of the location, accessibility, Parking / Transport, Quality of building, Visual impression / ambience)
  • In-depth analysis of local and regional /state conditions for licensing at the planned location
  • Decision between independent structure or semi dependent structure with admission rights at hospitals 
  •  The requirements for what kind of staff you need will be very different depending on your setting!
Next the analysis of your environment is essential to the understanding and connection made to the community: 


  • Analysis of the market (Population structure, net available income, acceptance of your services in society, 
  • Analysis of direct competition ( Services / Focus / Training, reputation, flaws or non covered service aspects, Unique Selling Point)
  • Analysis of supply and demand
  • Analysis of economic markers like tax, human resources, wages
  • Analysis of resources / planned investment / ROI
  • Analysis of which kind of minimum staff you need to start


To create the most efficient work force analysis of the market, income, supply & demand; how many competitors are in the vicinity, minimum staff needed, economic markers, etc. are some of many factors to be addressed and understood. 


A good office manager is the backbone of every successful practice, this can be difficult to find but once in place a most valuable asset to the company that should be treated as such. Ocean Clinic Marbella has the wonderful Vanessa who is undeniably a huge asset to the excellent care and running of the practice. 


The front desk staff are equally important in knowing how to manage the clients with the right level of attention, detail, organisation. They need to be swift, creative and calm as well as reliable and competent problem solvers with initiative and insight. 


The nursing team represent the practice and offer the frontline care, they must know everything there is to know about each patient and care for them accordingly. Deliver excellent after care and make sure the level of attention aligns with that of the clinic as a whole. 


A team needs to be mindfully composed, it needs to be a unit of like minded people working together towards a common goal. There needs to be solid structure, rules and limits in place and each member needs to have a clear, meaningful role and know their task and skill set.


The team leader needs to be a role model; you can’t expect something of your employees if you do not set the right example yourself. Be a role model, inspire, coach and innovate. Be someone the team can identify with; walk the walk, be admired and command respect. Also, very importantly, a leader must live and act the way they expect their team to be. Lead as you wish to be followed whilst promoting a healthy working environment. 


Within a staff, within its systems, rules and structure there needs to be space for colleagues to speak up, if something feel like it needs to be said it should be an open forum to do so. A strong safety culture needs to be in place to ensure that employees feel they have a voice. 

Team building is essential, including the team in activities or social events, and ensuring that there is schedule one on one time with each member of staff each month makes for a happy and “heard” workforce. Offering positive reinforcement and actively paying attention to workers is vital to their performance and continued incentive. And, speaking of incentives, it is highly effective to offer non-monetary incentives in the work place to provide more effective team building. 


Following his own advice over the last sixteen years has driven Ocean Clinic to become one of the most successful private practices in the region. With over 1000 procedures being carried out per year by top surgeons just goes to prove this. Reviews from patients show that the team function effectively as a whole, each member of staff has their valued position and serve as a cog in the excellent care given, and smooth running of the overall performance of the practice. There is a family, close-knit feel to the clinic as the head of each department are in fact happily married, Kai and Gabriela have incredible leadership qualities which naturally command respect and dedication from their co workers. Vanessa provides the backbone to the company and alongside the nurses, reception and all staff, work together to create a welcoming, safe and comfortable environment where patients feel secure and trust they are in the best hands. Ocean Clinic’s reputation exceeds them. 





To learn more about Ocean Clinic and their services please visit the website or call for a consultation. 



Saturday 11 June 2022

What is PRP - Platelet Rich Plasma, and how does it work?





What is PRP? 

The use of PRP spans various medical fields from dermatology to trichology and aesthetics as it has a big role in aiding the body's healing process. PRP is often used in combination with other treatments to aid with optimal recovery. If we consider the other treatments to be the 'injury', the PRP is administered as a restorative treatment. 

What are Platelets? 

Platelets are cytoplasmic fragments of megakaryocytes  (large cells found in the bone marrow) which contain over 30 bioactive proteins. These proteins have a fundamental role in homeostasis (restoring the body' natural balance / healing), i.e. the healing of body tissue.  

The necessary protein growth factors for healing any type of wound or injury are secreted by platelets, as well as three particular proteins which cause cell adhesion; fibrin, fibronectin and vitronectin. 

 




How does PRP work?

PRP is a regenerative medicine, it can be applied in various ways and formats bringing restorative treatments into a new era. It is based on the stimulation of the regenerative process via the administering of growth and regulatory factors, and plays an important role in healing processes of any kind. Platelet Rich Plasma, PRP, is a fluid rich in the growth and regulatory factors extracted from prepared blood samples. The yellowish fluid, or plasma, can be used in treatments as a healing booster or to stimulate collagen production. PRP can be used in combination with many treatments including surgical procedures, fat grafting, microneedling, alopecia treatment, post ablative laser or RF and deep peeling. 


TECHNICAL TERM : PRP 

DURATION : 15 minutes

ANAESTHESIA : Numbing cream

SESSIONS NEEDED : 1 - 10 (condition dependant) 

DISCHARGE TIME : Same day

FIT FOR NORMAL LIFE / WORK : Same day

AFTERCARE : None required

MAINTENANCE : 2 months



PRP - What to know beforehand :  No Preparation is required for PRP and the rate of complication is very low. Aftercare only depends on the combination of treatments being applied. PRP can be carried out as a multiple procedure for hair growth stimulation (10 sessions) but is mostly used in combination with:

Microneedling (Dermapen) - as drug delivery

Fat Grafting

Skin Boosters


Or, as a post procedure healing booster for: 


Ablative RF Venus Viva

Non Ablative Laser Fraxel


How can blood be used to rejuvenate your face? Discover PRP -  Platelet Rich Plasma - Therapy 


1. Platelets are rich in growth factors which can trigger natural rejuvenation of the skin.

2. Platelets are extracted from the blood using a centrifuge to create a plasma. 

3. The plasma fluid is injected into the superficial layers of the skin to repair damage and reverse aging. 

4. At Ocean Clinic we use PRP to boost results of other procedures.

5. PRP speeds the healing process after plastic surgery.

6. PRP enhances laser, radio frequency and microneedling treatments.

7. PRP can be used to treat hair loss, substantially boosting hair thickness and length. 

8. Following PRP treatment, hair and skin quality continue to improve for several months. 

9. Results from PRP last up to 18 months at which point patients can return for a top up. 


Contact us at OCEAN CLINIC to find out more about PRP Therapy.  



Wednesday 8 June 2022

BREAST RECONSTRUCTION - Know your options...

 Losing a breast is, for many women, one of the most traumatising aspects of breast cancer. Mastectomy patients often report feeling less feminine, which can lead to a loss of confidence and sexual well-being.


However, advancements in breast reconstruction techniques mean there are a variety of options for women who want to restore their figures.
Ocean Clinic Marbella specialises in breast surgery, including enhancement, reduction, and reconstruction. Read on to discover the treatment options available or book a consultation for personalised advice.  
Not about vanity
The decision to have breast reconstruction is a highly individual one; lots of women do decide to “go flat” and avoid further surgery. For others, breast reconstruction is an important part of their treatment and recovery.
Opting for reconstruction can minimise the psychological impact associated with losing a breast, especially if performed immediately after mastectomy. One study, which compared patients who had undergone breast reconstruction with those who had a mastectomy without reconstruction, found they were significantly more satisfied with their appearance and fared better psychosocially and sexually. Furthermore, they functioned better physically, experiencing less pain and fewer limitations.



Reconstruction without implants

In some cases it is possible to reconstruct a breast exclusively with a patient’s own tissue. Known as “autologous flap” surgery, it involves taking a section of skin, fat and sometimes muscle, from elsewhere on the body and transplanting it to the breast.

So-called “flaps” can be taken from the tummy, buttocks, upper back, inner thigh or upper hip. They can be cut completely free or left partially attached to the blood supply (pedicled) and moved up to the chest from within the body. With “free flap” reconstruction, the blood supply is re-established using microvascular surgery techniques.

The most popular autologous flap method uses the tummy as a donor site. This method has the unintentional benefit of providing patients with a tummy tuck at the same time, due to the relocation of abdominal tissue and subsequent skin tightening.

It can be performed either as free or pedicled, but free flap (DIEP flap) is preferred because it means the rectus abdominis muscle can be spared, helping to preserve abdominal strength.

The reconstructed breast can be further filled and shaped through fat transfer, which involves removing fat from another part of the body via micro liposuction and reinjecting it. Like the transplanted abdominal tissue, the fat regains a blood supply and becomes permanent.  

Providing a patient has enough donor fat and tissue on their body, autologous flap surgery can offer an all-natural way to restore the shape and size of their breast. The tissue ages naturally and changes volume corresponding to the patient’s overall body weight. While the patient will be left with scars on the donor site, when the flap is taken from the abdomen, these scars are well concealed below the bikini line.



Reconstruction with implants
If a skin-sparing mastectomy or lumpectomy is performed, where much of the breast skin is preserved, an implant can be immediately implanted under the pectoralis muscle. If the mastectomy leaves the skin too tight, a two-stage implant process is necessary.  

Firstly, a tissue expander (essentially a silicone pouch) will be put in and slightly expanded with saline solution. Over a period of several weeks, the expander is expanded via the injection of additional saline solution. This gradually stretches the skin and creates a pocket for the implant.

A new type of expander called AeroForm uses carbon dioxide instead of saline solution. It is needle-free and is expanded by the patient, at home, using a wireless, handheld dosage controller.

When the breast tissue expands to the desired size, the expander is replaced with a permanent implant. The benefit of using implants over autologous flap is that scarring is restricted to the breast itself and the procedure does not rely on the patient having sufficient donor tissue. It is therefore the best option for thinner individuals.


Timing for a breast reconstruction

The best outcomes can be achieved when breast reconstruction is carried at the same time as mastectomy or lumpectomy. Not only does it reduce the number of times a patient must undergo surgery and minimise scarring, deciding on immediate reconstructions enables patients to opt for a skin-sparing surgery.

Most women are eligible for skin-sparing mastectomies (unless the tumour cells are close to the skin). During skin-sparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. Then the surgeon removes the breast tissue through the small opening that is created. The remaining pouch of skin provides the best shape and form to accommodate an implant or autologous flap. It enables patients to get the most realistic and pleasing results from breast reconstruction.
If a patient does not opt for immediate reconstruction, a skin-sparing mastectomy is not usually performed. The surgeon will most likely remove as much skin as is required to make the scar and the surface of the chest flat.
If a patient decides to wait and have reconstructive surgery later, they may still choose between an implant or autologous flap. The incision will be made along the scar of the previous mastectomy. In the case of implants, an expander will be used first, which does require the patient to have two operations.

Breast reconstruction and radiotherapy
Radiotherapy can reduce the likelihood of a successful breast reconstruction. This is because radiation kills normal tissue as well as cancerous tissue. It is therefore recommended to delay reconstruction until after treatment has been completed.
Radiated skin is hard to stretch and often becomes discolured. In addition, because radiation therapy significantly increases the risk of capsular contracture (the formation of excessive scar tissue around an implant) delayed autologous flap reconstruction is recommended over reconstruction with implants.
The good news is that, whatever a patient’s treatment plan, reconstruction is almost always an option. And although immediate reconstruction is preferable from a surgical point of view, breast reconstruction can be carried out months or even years after surgery. This means patients can take as much time as they need to recover, whether that’s physically or mentally.
Achieving the best aesthetic result possible
Achieving symmetry between a patient’s breasts is a key goal. To this end, a reconstruction can be carried out in combination with surgery on the remaining breast to ensure they are as close in size and shape as possible.
If the mastectomy has included the removal of the nipple, this can be reconstructed three to four months after surgery. This can be done by creating small flaps at the site where the nipple would have been and forming them into a nipple mound.

Micropigmentation tattoo is then used to simulate the natural colours. Alternatively, micropigmentation alone can used, with colour skillfully applied to give the appearance of a three-dimensional nipple.
While your new breast will never look or feel 100% like your old breast, breast reconstruction surgery can help you feel like your “old self” again, making you more confident to be intimate, on the beach or in the changing rooms.

If you are facing the prospect of mastectomy or have already undergone breast removal and would like to discuss your options for reconstruction contact Ocean Clinic Marbella.