What are those post-nominals? (A brief guide to “qualifications” after the names of medical practitioners)

MRCGP – Member of the Royal College of GP’s  – has passed the specialty training programme and is on the GMC  GP Specialty register

MRCP Member of the Royal College of Physicians – has passed the specialty examination of the Royal College of Physicians

MRCS Has passed the Intercollegiate Membership examination of the Royal Colleges of Surgeons. Regarded as initial requirement to start specialty training – Is a trainee surgeon  – not  eligible to be on the Specialist register and not a specialist. Cannot use the term Mr / Miss

FRCS(XXXX) Has passed specialist examination in specialty is on the Specialist Register.  Can use the prefix Mr. / Miss Trained surgeon in that specialty – and can be appointed as a Consultant in the NHS. Specialty areas are:


General Surgery



Oral & Maxillofacial Surgery


Paediatric Surgery

Plastic Surgery

Trauma & Orthopaedic Surgery



No other subspecialties or groups are recognized in the UK

BDS: Dentists may use the courtesy title “Dr” in relation to their work in the dental area. The GDC does not prohibit the use of the title ‘Doctor’ as a courtesy title in the case of dentists. Dentists who choose to use the title must ensure that it is not used in a way which could mislead the public, for example by giving the impression that the dentist is a registered medical practitioner if they are not.”

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Reply to RJ

The use of language may infuriate many – The Keogh Report likened the provision of cosmetic services to be worse than buying a toothbrush . The issues in Aesthetic I think are more complex than a title – there are many abuses – when is someone a Dr / Nurse / Surgeon / Consultant. These terms seem to be understood by those in the profession – yet can be used to mislead others . Only a few days ago I saw a terms trained in “Surgery and Medicine” and “admitted to the Royal College of Surgeons (i.e MRCS – trainee surgeon) yet that may be misconstrued by the public to mean trained as a Surgeon and Dr (See the Blog shortly to find out more on the terms!).
Who should be doing various procedures comes down to competence and outcomes. Just performing a large number of procedures does not make one and “Expert”. We have found out during our Facial Anatomy Teaching sessions that many practitioners leave having discovered that the technique they have previously used may not be appropriate. The Recent HEE views that 30 non-surgical procedures a year will place a practitioner on an “expert” level. Practice does not make perfect – particularly when the practice is incorrect – it purely instills permanence..
We also need to address outcomes – an accurate logbook will demonstrate the numbers performed and record complications etc. Many surgeons have a Intercollegiate e-logbook (which also has provision for non-surgical procedures). My own view is all the associations should make it mandatory for their members to keep such logbooks which will allow their representatives to objectively state the number of procedures performed by their members per year etc. BAPRS and IPRAS provide a national and international perspective as their members contribute to this process. I remember speaking to senior members of a national practitioner association about this about 4 years ago– the response was that their membership was not keen to go down that route. Unless we have such figures that reflect the national picture it will be difficult for any group to be taken seriously.Ravi Jainhas accurate figures and some of the outcomes will be published shortly. Interesting another Ravi ( Ravi Jandhyala ignited this with the UKBTGA – would be interesting to see the progress of this).
Patient safety and practitioner performance has also got to be addressed – all practitioners would need to be independently appraised with regard to their performance and keeping up-to-date – we may all feel we do that but until its critically scrutinised and all practitioners are appraised and revalidated we will not have a level playing field within the speciality. Hopefully in the near future this will be the case for all medical practitioners.
Aesthetics as a speciality is a multidisciplinary field – the patients require a mixture of surgical and non-surgical procedures to get the best outcome. This could be delivered as a “Group Practice” or by those with adequate training to “…discuss all the options including not having the procedure..” A term used by the GMC regarding Good Medical Practice in informed consent. Turf wars are a disaster – look at the recent problem with Midwives and Drs that has got into the national press.
The RCS was specifically charged with the responsibility to oversee Cosmetic Surgery – the other Royal College Specialty groups (Royal College of Physicians , Royal College of GP’s ) have remained silent on the behalf of their members. I have maintained for a long time that there should be a “Faculty of Aesthetics” within a Royal College to maintain standards- there are multidisciplinary Faculties for Podiatry and Travel Medicine to name a few. Yet a Specialty of Aesthetics appears to be shunned – until an issue crops up and we get constructive reports likening the specialty to a tooth brush…and continue to infuriate ..

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Breform™ – The Internal Bra

Mr Dalvi Humzah is just one of the few practitioners and the first in the West Midlands to offer the breast treatment nicknamed ‘the internal bra’.

The science behind the ingenious surgical procedure – the Breform™ breast lift – works in much the same way as under-wiring on a bra.

A mesh device is simply inserted under the skin to physically – and permanently – lift up sagging breasts.

Already a hit in Holland, the procedure is particularly beneficial to those who have lost the buoyancy of their figure after starting a family, restoring the breasts to their youthful shape.

Patients are left with a natural-looking result that does not diminish over time, meaning the procedure offers patient’s a permanent cosmetic solution.

 Reassuringly, the Breform™ meshing is made of polyester which is long established in the field of cosmetic surgery, having been used in surgical procedures for over 40 years.

The procedure marks a new era in breast surgery. “I like to dub this treatment ‘the eternal internal bra system’. The obvious benefit of the internal bra system is that unlike other breast lifting procedures, the results are permanent.

“It can be an excellent option for those women who feel really self-conscious about their bodies, especially after becoming mums.”

The Breform™ breast lift procedure takes between just two and three hours to complete.

 For more information on Breform, or other procedures offered please call 0800 084 2321 or visit www.pdsurgery.co.uk.

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Reduce those wrinkles – a brief guide.

The aging process results in many visible changes, for example, loss of skin tone, contour changes and wrinkles (“laughter lines”). Traditionally, these may be treated by surgical techniques, e.g. facelift, to tighten the skin, although some areas will not be treated by this procedure. However, now there are many non-surgical techniques that can achieve similar results without the risks, time for recovery and the costs associated with a surgical procedure.

Dermal fillers have become popular in treating contour defects and lines associated with aging. There many different types of dermal fillers available and it is important that you are aware of these differences before proceeding with any form of therapy. The person providing the therapy should discuss the different products available and explain which is suitable for you.
Types of dermal fillers
Broadly speaking, dermal fillers may be regarded as either temporary, long lasting or permanent.
Temporary fillers are injected under the skin and in general, will need to be topped up every 3 to 6 months. These fillers are produced from a variety of sources. Usually these products are injected by trained doctors and nurses. We use the FDA approved filers Restylane and Belotero in our practice.
Fat was first used in the late 19th century by Dr F Neuber to correct facial defects using the patients own fat. Currently fat is harvested using a technique of liposuction, purified and concentrated before injecting it back into the desired area. This may require repeated treatments to achieve the optimal result and is not applicable for everyone.
Longer lasting fillers will last from 1 year to 4 years and many longer lasting fillers such as Radiesse Ellanse are available. You should discuss these with your practitioner to understand the potential benefits and consequences of these.
Permanent fillers are a new group that have become available. New-fill and Bio-Alcamid have been introduced into the U.K. for the treatment of soft tissue defects. These permanent fillers are injected by trained doctors only. They are rarely used in general cosmetic procedures and may have long term consequences.
How is the treatment performed?
The doctor performing the procedure should explain to you the possible techniques used to correct the defects you are concerned with, as well as the possible complications. You should also have a medical history taken to ensure there are no potential problems associated with having the treatment, as well as an examination.
Photographs before and after treatment are taken, as part of the medical records, to enable comparisons to be made following treatment.
The injection procedure is commonly performed using a local anaesthetic injection, (similar to that used by the Dentist), to numb the area to be treated. This will result in the procedure being painless or only mildly uncomfortable. If a large area is to be treated the doctor may recommend a general anaesthetic and you may need to be admitted as a day-case for this. Antibiotics may also be given for you to take.
Once the skin is thoroughly cleaned with antiseptic solution, the filler is injected under the skin. Following this the puncture site is cleaned and may be covered with a small dressing.
Effects following treatment
The most obvious effect following the injection of dermal fillers is the bleeding around the injection site followed by some bruising under the skin. This should disappear after 5 – 10 days; it is common for the treated area to be swollen for this period of time.
You may be advised to use cold packs to reduce the swelling and pain-killers for a few days following treatment. I often recommend Arnica tablets and/or cream to reduce the bruising.
After the treatment you should be seen by the doctor a few weeks later to ensure that you are not experiencing any problems.
To achieve a successful result in your particular case, the person treating you should be able to discuss which implant best corrects a particular defect and explain how and when to intervene if problems occur. It is also important that you are aware of the effects of the fillers and what can actually be achieved.
Before the procedure you should be aware of the credentials and experience of the person treating you, have a proper medical history taken and be examined; the potential risks associated with the procedure should also be fully explained.

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Open your eyes

The eyes may be the windows to the soul, but as we age we see changes to the window that ages us dramatically. The appearance of the eyelids and surrounding  region are a key cosmetic focal area, suitable for a variety of surgical and non-surgical rejuvenation techniques.

Over time skin loses its elasticity and muscles slacken. For the eyelids this results in an accumulation of loose skin which collects as folds in the upper eyelids and forms deepening creases in the lower lids. At the same time there is slackening of the muscle beneath the skin allowing the fat, which cushions the eyes in their sockets, to protrude forward and give the appearance of bagginess. The brows also droop and become “heavier”. In some families there is an inherited tendency for bags to develop during early adulthood before any skin changes.

The problem often seems worse in the morning, particularly with prolonged stress and lack of sleep. Drooping of the eyelids is also an effect of the ageing process and aggravates the accumulation of the skin in the upper eyelids. Sometimes so much skin accumulates in the upper lids that it hangs over the eyelashes to obstruct vision.

Following a detailed consultation and assessment we assess and recommend appropriate treatment strategies based upon your concerns. In addition to, or instead of, non-surgical wrinkle refining injections, we may suggest a combination of specialist skin care products, designed to improve and refine skin tone and texture around the eyelids and prepare you for the eyelid surgery.

An eyelid reduction (blepharoplasty) is a plastic surgery procedure that removes the surplus skin and protruding fat to produce a more alert appearance and reduces the morning swelling.  The scar is left in the skin creases of the eyelids. You may also benefit by combining blepharoplasty with other plastic surgery procedures such as a brow lift. Mr Humzah Consultant Plastic Surgeon will advise you regarding the options for you regarding blepharoplasty.

A brow lift is a cosmetic surgery procedure to remove excess fatty tissue and skin from the forehead resulting in a firmer and less wrinkled brow and forehead. Different techniques are available to achieve a brow lift for example a minimally invasive procedure using a special implant – Endotine may also be used to achieve a brow lift. Mr Humzah Consultant Plastic Surgeon will explain these to you and discuss which technique would be suitable for you.

Both upper and lower eyelid surgery can be carried out under local anaesthesia or under general anaesthesia in a hospital. In a typical procedure the incisions following the natural lines of your eyelids; in the creases of upper lids and just below the lashes in the lower lids (see illustration). These incisions are extended a little way into the crow’s feet or laughter lines at the corner of the eyes. Through this incision surplus fat is removed and excess skin and sagging muscle removed. If you have a pocket of fat beneath your lower eyelids without surplus skin then the fat may be removed through the inside of the lower eyelid.

The eyes appear watery after surgery, partly because of swelling under the conjunctiva (chemosis) and partly because the tear ducts are swollen and do not drain as readily. This will last a few weeks. Although there is bruising it can quite readily be disguised with make-up and dark glasses. The scars will be pink for a few months, but eventually they become almost invisible.

What are the risks?

All surgery carries some uncertainty and risk. You can reduce the risks by closely following your Mr Humzah’s instructions both before and after surgery. You should tell him of any thyroid disease, high blood pressure, diabetes or eye disorder such as detached retina or glaucoma. It may be that he will wish you to be checked by an Ophthalmologist. During your consultation all the risks will be discussed with you.

The fee quoted will cover costs related to your total care (pre-operative assessments, accommodation, medications, routine investigations), theatre, surgeon and anaesthetic fees. It also covers all required post – operative visits and any necessary management of clinical complications. It does not include the initial consultation fee of £110.

For further information on all procedures, please contact us on 0800 084 2321 or email info@pdsurgery.co.uk.

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Breform Procedure attracts international interest

The breform procedure where a soft mesh is inserted to support the breasts from the inside is proving a popular alterntive to the traditional mastopexy or breast uplift.  So much so that we have had patients travelling from as far afield as Dubai and Australia to have this procedure performed by Mr Humzah.   A stay of at least a few weeks in the UK is required to allow time for an initial consultation, two weeks to take time to consider and some recovery time after the operation.  Most visitors combine having the procedure with the chance to visit friends and relatives. As a recognized trainer for the Breform Procedure Mr Humzah has surgeons attending from the UK and abroad to learn this technique.

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Cheltenham/Halesowen/Midlands Plastic Reconstructive & Cosmetic surgeon Dalvi Humzah has won Training Initiative of the Year in the annual national Aesthetic Awards 2014.

Mr Humzah, whose private practice – Plastic and Dermatological Surgery (PDS) – is based at (Nuffield Health Cheltenham Hospital/Ramsay Winfield Hospital /West Midlands Hospital, Halesowen) – was judged as providing the “Training Initiative” of the Year, one of the most sought-after of 23 categories in this year’s awards.

Organised by Aesthetics journal, the Aesthetic Awards is the premier awards event for the aesthetics industry, recognising excellence and the outstanding achievements of practitioners, surgeons and suppliers.

Mr Humzah was recognised for his training event facial anatomy training at the Royal College of Surgeons of England and Facial Anatomy Technique Teaching.

The last 12 months has seen Mr Humzah give keynote speeches at many top industry events, including the Facial Aesthetic & Endoscopic, Oculoplastic Surgery and Rhinoplasty, Coventry and the a key note speaker on Facial Anatomy in Berlin.

He said: “As a regular campaigner for improved standards for patients, it is an honour to be recognised for achievements in teaching Facial Anatomy . The awards do a fantastic job in celebrating high standards and excellence in the industry.”

The winners – who were voted for by patients and colleagues in an online voting process – were announced recently at the Aesthetic Awards at The Park Plaza Hotel, London.


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