Interviewer: 60 Minutes presents a live interview with Dr Mohammad Jawad.
Interviewer: Dr Jawad thank you for talking to us tonight, in our live online chat room.
Dr Mohammad Jawad: Thank you for having me and I look forward to answering your questions. Hello Australia.
Interviewer: Now we will go to the questions from our guests.
Bonded asks: How long have you been a plastic and reconstructive surgeon?
Dr Mohammad Jawad: I started my training in 1993 - so 16 years. I have been consulting since 2001 so for 8 years. I have been based in London at Chelsea and Westminster hospital since 2002 and also visit London Welbeck Hospital where I do my private work.
ryanred asks: Is Katie the worst patient in terms of injuries that you have ever had to treat?
Dr Mohammad Jawad: Yes. Because of the complexity and the challengers it required, the answer is yes. Although it was not a life threatening situation but the quality of life and mobility associated with such a huge injury made it extremely complex.
ashnaonline asks: Hi Sir, may i ask. How long did it take you to complete this task?
Dr Mohammad Jawad: Following three sessions to check everything was ok the fourth time was the major surgery which lasted 6 hours.
Bonded asks: Working with Katie seems to have been a team effort - you performing the surgery and Katie the rehabilitation working with hospital staff and physiotherapists - was this team work vital for such an amazing result?
Dr Mohammad Jawad: Absolutely. Surgery played a role but a lot of kudos goes to our staff who looked after her so well, the intensive care unit who looked after her in an induced coma. Our psychologists - intensive in-house programme and enormous support from her family. Katie herself came out fighting, we were lucky it was Katie's personality which helped her to not settle for anything else than what was required. We used a silicone gel called Kelocote and that was very helpful. We also botoxed her neck muscles so the muscles stayed relaxed during the period of her recovery. I don't believe this has been done before. We took a very aggressive proactive approach.
kristie.f asks: Did you expect such a good outcome when you first saw the extent of Katie's injuries?
Dr Mohammad Jawad: The surgical techniques we have over the last many years made me not expect a great result but using this new technique I knew it would only improve more outcomes and I was very confident at that stage. But did we expect this wonderful outcome? No, I am surprised and very happy with the results.
NikT asks: How many more operations does Katie have to go through?
Dr Mohammad Jawad: Katie will require some correction of bone around her neck. We have to improve her control. We plan to use some microfat grafting to improve the overall facial contour and the quality of the skin. To replace almost like with like, so the way Katie was is the way she will be.
silviasanche asks: How long will it take for Katie to completely recover?
Dr Mohammad Jawad: It's been 18 months since she had the injury - we are talking 3 to 6 months before she is recovered. She may need some smaller touch up work at a future stage, but nothing is planned other than the fat grafting in the near future.
silviasanche asks: You have done a magnificent job with Katie. Do you think there are any new techniques that will help with her recovery?
Dr Mohammad Jawad: Thank you very much for the compliment. Scientists are actually working on it, to take it a stage further to almost create a skin substitute. These results have been very encouraging because it stabilises a problem, but to improve on it further, people are already working on it.
kristie.f asks: How important are the pressure bandages and masks to aid the healing of the scarring?
Dr Mohammad Jawad: Very important and the pressure which we recommend is a constant pressure that is required to stabilise the scars in all forms of surgery but when you have a much larger surface area to cover then you have to use the special mask so you can see the progress. At night time she had to wear the balaclava type of mask which she couldn't use during the day. The mask could be used for 12 months to up to 2 years to provide pressure support.
Sardonista asks: Are you aware of any extensive psychiatric counselling Katie may have required?
Dr Mohammad Jawad: Yes we have a clinical psychologise in our unit who helped her from the beginning so she had support all along. It was necessary to help her come to terms and overcome the scarred face, I think it was very helpful. She did require extensive psycho-therapy with a psychologist and she is not taking any anti-depressants which is wonderful. She is very upbeat.
silviasanche asks: How did you make her skin look so close to the real skin Katie had prior to the horrible attack?
Dr Mohammad Jawad: That is the magic of the surgery.
fismeats asks: How long after the acid attack did the treatment start for Katie? Is a delay a major factor in the severity of the injuries?
Dr Mohammad Jawad: We did not do anything other than wash it but there are product available now to neutralise the acid but they weren't available then. It's difficult to say if the delay of a couple of hours or so had much effect on the outcome really. There are new products available now that if used immediately can minimise the damage.
carrie asks: Was this the most complicated reconstruction you've done so far?
Dr Mohammad Jawad: Katie Piper has been the most complex patient I have come across.
rosanaimo asks: Did Katie required any bone or cartilage grafting?
Dr Mohammad Jawad: No she didn't.
Sarah1 asks: I was also wondering did you use a tattoo technique for Katie's lips? They look so natural.
Dr Mohammad Jawad: Katie has semi-permanent makeup artist who helps her with the makeup yes, but it's not a permanent tattoo at the moment. We do use that and use camouflage makeup also to help her look as good as possible.
kristie.f asks: Dr. Jawad, was the skin so damaged it was down to the bone underneath on Katie's face? Did you have to reconstruct the muscles as well as the skin?
Dr Mohammad Jawad: No the damage was down to the fat and into the muscle, but bone structure was intact. We only had to reconstruct the skin, not the muscle. We have published this case in the medical journal and it should be available online in a month or so. This will give all the details of this rather challenging case.
Thomas asks: What do you recommend for scars? Can they be dulled down years after occurring?
Dr Mohammad Jawad: Scars go through a phase of maturation so only an aggressive massage and moisturising creme and silicone gel have shown to be beneficial, along with the pressure therapy. there are some simple creams good enough for most which helps to exert pressure when massaged. If the scars are not maturing the way we expect them to, we can do some other treatment. When we treat the scars every couple of months and see if they are responding to the treatment or not.
kristie.f asks: Dr. Jawad, have you dealt with skin damage from sulphuric acid prior to this case?
Dr Mohammad Jawad: I have. In different parts of the body including the face but not only there. I am also reconstructing deep sulphuric facial burns on a woman in Pakistan. So yes, I have dealt with cases before and ongoing cases. It sends a strong message to the criminal they will not get away with it.
lauren asks: Hi! As a student Enrolled nurse, currently studying wound care. How where you able to prevent infections, and I understand the 1st, 2nd, 3rd degree burns, but what are 4th degree burns?
Dr Mohammad Jawad: All the laws of skill are involved down to the soft tissue and the muscle. 4th degree is when other tissues are involved, such as fat muscle and bone. We can prevent infection with good nursing care, caring and ensuring the wound has a good healthy environment to recover.
yeeman asks: Would the injuries mean she has lost sensation to her face due to her Trigeminal nerve being damaged?
Dr Mohammad Jawad: There is no deep damage to the Trigeminal nerve but the overlying skin is becoming sensitive very slightly but gradually.
jane asks: Is there a point at which scars are matured fully and treatment has no benefits?
Dr Mohammad Jawad: Yes. The point of treatment the scars mature sometimes and you have to encourage people to live with them. They do stabilise where they don't get any worse or any better and after that no treatment really helps.
kristie.f asks: Do you treat chemical burns in a different way to heat burns?
Dr Mohammad Jawad: Yes slightly, you have to be more aggressive with chemical burns, especially on the face. You use a chemical evaluation to help come to a correct diagnosis.
Nick asks: Hi Dr Jawad: I recall hearing the mention that (it is hoped?) Ms Piper will eventually regain around ~90-95% of her appearance over time. Can I ask, what 'level' would currently be attributed to her reconstruction progress thus far (or at time segment filming)?
Dr Mohammad Jawad: Very good question. Filming was done 2 weeks ago so they would be the latest results. She is about 18 months down the line and very stable. This would be about 80% so far. After the fat transfer I will assume that after about 6 months she will about 80 to 90% of her original appearance.
blackmercslk asks: Dr Jawad I was wandering who actually pays for her treatment? Did it have to be done privately or under the public health system?
Dr Mohammad Jawad: Public health system - PM Gordon Brown when he was Chancellor of the Exchequor they funded a lot of money and have increased it so it was all at the expense of the health system. All her clinical and psychological have been funded including her trip to the south of France so everything was funded by the public system.
kristie.f asks: Dr Jawad, why did you choose Katie’s back as the location to gather the skin for the grafts? Was it the size of the skin available, so her entire face could be covered?
Dr Mohammad Jawad: The amount of skin we needed was not available apart from that area and Katie decided that she did not want her obvious parts of her body to also be scarred. The back has some thick skin that also has a good regenerative capacity. After 18 months you can hardly see where we took the skin from. So choosing the back was availability for a large donor, Katie's insistence and it was also my choice and decision.
jane asks: They said she lost sight in one of her eyes, is there is possibility of sight restoration?
Dr Mohammad Jawad: She is due for a corneal transplant in the left eye and we hope she will get some sight back from that.
Bonded asks: Was there something specific that made you want to do this type of surgery?
Dr Mohammad Jawad: I guess every stage of your life there are challenges and to strive to the bigger challenge makes your speciality more positive. Why did I do this, because I wanted to and because I get paid to deliver. All my training that was available was a great testimony to what I have achieved. I have wonderful team members in the hospital. It's a collective effort.
Interviewer: I am sorry we are out of time, do you have anything else you would like to share before we finish tonight?
Dr Mohammad Jawad: It's a great testimony of human endeavour, scientific marvels and of course surgical techniques to achieve what we have achieved and it gives us hope to go forward with more difficult challenges. I must say my first trainer in plastic surgery was an Australian registrar Timothy Cooper and he actually gave me the insight of tissue handling. So I have a great respect for what he showed me. What I learned when training with him helped me achieve what I have today. Thank you very much for having me tonight it's been very interesting for me to answer your questions.
Interviewer: Once again thank you and goodnight.
Interviewer: This concludes our chat with Dr Mohammad Jawad, Sunday November 15, 2009.
