The surgical use of the word “revision” implies more than repeat; it means going back to the site of a previous operation and performing another one, similar perhaps but not necessarily the same. The reasons are multiple – there may have been an anticipated or unanticipated complication, the patient may not be satisfied with a cosmetic result although there is no other issue, the procedure may need to be repeated because the implant has become worn or damaged (not only breasts, applies to pacemakers and eye lens implants).

In terms of revision of breast surgery, the patient may be dissatisfied with a poor result, or perfectly satisfied but now wants the breasts made larger or smaller; something may have happened to the prosthesis and it needs to be replaced; the prosthesis may not have changed but the patient wants a different type (switch from saline to gel); there may have been post-augmentation changes due to pregnancy, weight gain or loss, or advancing age.

Commonly called “Tummy Tuck,” the colloquial term makes it sound cute and rather trivial; an abdominoplasty is in fact in geographic if not anesthetic terms a sizeable procedure.

It is performed to rid the patient of excess skin over the abdomen. As such it is not performed while the patient is losing weight, nor after bariatric surgery until the weight has stabilised. It comes in degrees, the smallest changes are open to liposuction, the largest require excision of kilos of skin.

Translating from the Latin, this means “sucking out the fat, which gives the unfortunate impression that anyone can do it, and unfortunately some unskilled persons attempt it. It makes more sense to call the procedure lipoplasty for a degree of remodelling is usually required; there is more to it than merely sucking out the fat, the skill comes in knowing which fat, and how much.

In the live person, the fat is contained within a cell envelope (lipocytes) and is fluid; the procedure of liposuction removes the cells and the fat, so on a purely theoretical basis, the fat should not return if the cells have been removed.

The back, especially in the female, tends to have pads of expanded fatty areas, not a diffuse thickening of the tissues as will most males. These areas are: infra scapular; posterior axillary; posterior waist; lumbo-sacral; and the buffalo hump at the upper central spine.

Liposuction of these pads will improve the general appearance of the back, the greatest benefit is in the patient who is otherwise reasonably slender save for the padded areas. Liposuction only removes the fat, it does not tighten the skin, and where there are very large deposits liposuction alone may not suffice.

The upper, outer thighs are often the site of pads of excess fat in the subcutaneous tissue, known colloquially as “saddlebags.” They don’t disappear with either diet or exercise. The inner thighs also acquire bulky fat deposits, the thighs rub together and the skin may be chafed, quite apart from concern about the unsightly appearance. When fat needs to be removed from both medial and lateral aspects of thighs, it is inevitable that a degree of reshaping of the anterior aspect will also be required.

The region of the inner knee in some women is like the upper outer thigh, deposits of fat resist dieting and can be removed by liposuction.

Lipoplasty of the arms in the sense of liposculpture may be used diffusely when there is excess fat which possibly may have persisted in irregular areas after bariatric surgery.

With loss of muscle bulk and with advancing age the skin of the upper arms becomes loose, and if the arms are raised they are seen to have developed the colloquially described “batwing” appearance with folds dependent from the triceps area. When there is substantial loosening of the skin, liposuction alone will be insufficient, and excess skin will have to be excised, known as brachioplasty.

Known technically as Brachioplasty the procedure is undertaken when liposuction alone is insufficient to deal with the problem of unsatisfying excess tissue in the upper arm. This is commonly found (and unkindly called “batwing”) in the aging person, more often female, and in persons who have lost weight either by dieting or bariatric surgery. Further reduction in weight might reduce the volume of fat in the dependent posterior tissues of the upper arm but will not remove the loose skin itself which continues to hang down when the arm is raised.

The male breast is susceptible to the action of hormones, and commonly enlarges in infancy as a result of maternal hormone, at puberty as result of hormonal changes and at senescence as a result of decreasing testosterone formation. It may also be found in the patient who has undergone marked reduction of excessive weight, yet the fat deposits around the breast disproportionately persist.

The indication for surgery is the patient whose forehead has slumped down over the eyes &/or has excessive forehead lines &/or has excessive vertical lines between the eyebrows.

Essentially the procedure is to draw back the skin of the forehead into its previous position – the aesthetic surgeon has critical guidelines for designing how that should be achieved.

The endoscope (an illuminated telescope) allows the surgeon to perform his operation through several small incisions, but does not alter the principle of the procedure performed.