Get to know Mr Kshemendra Senarath-Yapa | Consultant Plastic Surgeon
As he joins the Medbelle network, Kshemendra reflects on his experiences training at Harvard and Stanford, and explains how his NHS work in trauma reconstruction complements his cosmetic surgery
What attracted you to Medbelle?
Medbelle has a very good reputation amongst my consultant colleagues both in London and Manchester, where I trained. Ultimately, my main focus is on making sure that patients have a pleasant journey from the moment they decide to have cosmetic surgery through to completing their treatment and beyond. I think Medbelle really makes things easy both for the surgeon and for patients.
What would you say is the best part of your job?
Seeing patients who come to me with a particular problem, providing solutions to them in a safe and effective manner, and then following them through their journey and seeing the transformation is incredibly rewarding. That’s really what makes you want to do it over and over again, knowing you can have a huge impact on a patient’s self-confidence. So while I really enjoy the technical aspects of surgery, what gives me the most satisfaction is seeing that transformation from pre-op consultation to happy patients at the end of their journey.
Do you have a specific patient memory or an experience that sticks in your mind?
There are so many, and it can often be the really simple cases that stick out. Just one example is a patient who had a fairly small skin lesion on their face. It required a very simple procedure. But this small lesion had made him very self-conscious, and he’d grown a beard for many years to hide it. He was motivated to have the surgery because he was getting married. And he was in tears after the surgery because he was so happy. That just typifies the impact you can have as a plastic surgeon, even with the most simple of procedures.
Kshemendra also works in trauma reconstruction for the NHS. He was featured on the Channel 4 documentary series, Emergency, which followed teams of clinicians across London's network of frontline trauma hospitals during their busiest period.
Is this mental health impact something that can be overlooked when people think about cosmetic surgery?
Absolutely. Many people come for cosmetic surgery after living with something that is negatively impacting their confidence on a daily basis. So even if something isn’t seen as an immediate health concern, it can have a huge impact on their mental health and wellbeing.
You also work for the NHS performing major trauma reconstruction. How do you balance your different roles?
I enjoy both aspects of my work, and I think each side of my practice actually helps me improve the other. So being a cosmetic surgeon helps me with my reconstruction surgery because it is not just about function, but about form and making sure it looks as good as possible. And my trauma surgery makes me a better cosmetic surgeon too, because it gives me a greater understanding of the anatomy.
How does digitalisation change your job?
The best example is what happened recently during the pandemic when we could use technology like Zoom and other digital platforms for video consultations with patients who couldn’t come in person for clinic appointments. In many cases, that continues to be more convenient for patients even without the pandemic.
Where do you see healthcare in 10 years time?
I think one of the exciting things in plastic surgery is the development of new technology. There are various examples of that, and I think one of the key areas is around reducing scarring. I think in the coming years things that are currently being studied in labs will start to have an impact in the operating theatre and improve outcomes for patients. Things like improved post-operative care, the use of stem cells, our improved understanding of the basic cellular mechanisms of ageing: all of these studies will have a really positive impact on how we practise as surgeons.
Do you feel these developments are happening more quickly now than at the beginning of your career?
Yes, and I feel there is a greater willingness among clinicians to adopt some of this technology and research, and the communication between cosmetic surgeons and scientists is getting better all the time.
That's partly because many surgeons have a scientific background. I was lucky enough to spend some time in California doing three years of my PhD at Stanford. I was impressed by the pace of development there and how plastic surgeons integrate into the lab, doing science research but also practising clinically and performing operations. I think that model is something that will be reproduced elsewhere; in fact, it's happening more and more in the UK already.
Using the latest research to benefit patients
Kshemendra experienced the benefits of collaboration between researchers and surgeons while studying for his PhD at Stanford, where he co-authored a paper on stem cells.
It sounds like studying abroad was a positive experience for you. Would you recommend that to other surgeons starting out their careers?
Absolutely, I think it really opens your horizons. Most of our training happens under the NHS, which is a fantastic organisation, and one of the best healthcare systems in the world, but there is always a benefit of experiencing different ways of practising. There are always lessons we can learn, so it’s great when surgeons in training go abroad and bring back different skills and knowledge to the UK. And it happens both ways - there are many things that surgeons from the US and elsewhere learn when they come to train or practise in the UK.
With so many advances, how important is it for surgeons to stay up-to-date?
It's vitally important. New techniques and innovations are being developed all the time. So it's important not to stand still. Plastic surgery has always been an innovative speciality. We learn specific skills that we can apply in multiple places and operations, so it's not as prescribed as many other surgical specialities. That means we can be quite versatile, tailoring any operation for a specific patient. That requires keeping on top of things and staying open to innovation.
Was there one moment when you realised you wanted to become a plastic surgeon?
When I was at university, there was a very inspiring surgeon, Mr Lamberty, and I did some work experience with him and really enjoyed the attention to detail he paid during his operations and his general demeanour and manner with patients. Then I organised an elective with Harvard at Massachusetts General Hospital, and during that time, I saw a gentleman come in who had both of his arms amputated in a work accident. His daughter had just given birth, and I’ll never forget his last words as he was taken into theatre: ‘I really want to be able to hold my granddaughter.’
Plastic surgeons working as a team with orthopaedic surgeons, vascular surgeons, and others, managed to successfully reattach his arms, and he was able to hold his granddaughter. You can imagine what it felt like to experience something like that as a medical student, and from that day onwards, I knew that this was what I wanted to do.
What could be done in the healthcare industry to make it better for all patients?
I think in the past, forms of practice have suited doctors and healthcare professionals rather than patients. We need to focus a lot more on the patient journey and making sure it is convenient for patients from the moment they seek medical care, through to post-operative care. Digitalisation can really help with this, allowing patients to be in frequent contact with their clinician across multiple channels.
Also important is collecting information from patients, and especially patient feedback, which is the best way to really improve your service. It’s really simple things like: did we do the job well? Were you happy with our care? These questions haven’t always been asked, but patients are a vital source of information on how we can improve what we’re doing.
Asking patients for feedback
Collecting feedback from patients hasn't always happened in the private sector. Medbelle's PROMs project is looking to change that, using patient feedback to analyse the impacts of treatments and improve care for everyone.
You are based in London but will be providing consultations for Medbelle from a local clinic in Essex. What are the benefits of this?
Plastic surgery has always offered this sort of ‘hub and spoke’ model. Because we're a highly specialist service, you aren’t always going to be able to find every specialist in every single town. Using local clinics means this expertise is not only available to people who live in or near the major cities. And even if surgery is carried out in London, it is so much easier for a patient to be able to consult with their doctor closer to home. Really it’s about improving accessibility to top-quality care for everyone.
Do you have any advice for students who want to be plastic surgeons?
I think, first of all, you have to really enjoy it. And in order to know whether you'll enjoy it, you have to experience it, so you should shadow surgeons and see what it's like because it's a long journey. Training for plastic surgery can be very challenging, it takes up many hours of the day from your twenties until your late thirties or perhaps even early forties before you become a consultant. The good thing is most plastic surgeons are very happy to talk to medical students, invite them into theatre when appropriate and give them opportunities for research. So getting involved as early as possible, keeping an open mind, and working hard: these will all help you on your journey.
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