Why a surgeon and anaesthetist performs your Endolift
What that training actually changes, in practical terms
Every clinic says its practitioners are highly trained. That phrase means nothing, so here is the specific version. Endolift puts a laser fibre under the skin of your face and neck, under local anaesthetic. Two very particular kinds of training bear directly on that, and this page explains exactly what each one changes about the treatment you receive.
I am uncomfortable writing about my own credentials, which is probably why this page took two years to exist. What changed my mind was the number of people arriving here having had something done elsewhere that a better understanding of anatomy would have prevented, and having had no idea at the time that there was a question worth asking.
Endolift is a procedure performed under the skin, under local anaesthetic, in the head and neck. Surgical training is where three-dimensional anatomical knowledge comes from, which governs where a fibre can safely go. Anaesthetic training is where local anaesthetic technique and the management of an unwell patient come from. I hold both, as Fellowships of two Royal Colleges, and practised for fourteen years as a Consultant Anaesthetist in the NHS. Neither qualification is a marketing badge. Each maps onto a specific part of what happens in the room.
What the procedure actually asks of the operator
Strip the marketing away and Endolift is this. A small entry point is made. An optical fibre finer than a needle is advanced through it into the plane immediately beneath the skin. Laser energy is released along its path as it is drawn back. The operator cannot see the fibre. They know where it is by anatomical knowledge, by feel, and by having a clear mental model of the layers of the region they are working in.
That is the whole job. Everything else, the device, the settings, the protocols, is downstream of one question. Does the person holding it know what is underneath.
You cannot see the fibre. You know where it is by knowing the anatomy. That is the entire safety argument for this treatment, and it is why the operator matters more here than with almost anything else in aesthetics.
What surgical training gives you
Anatomy can be learned from a book, and every practitioner will have learned some. What surgical training gives you is different in kind. It is the experience of having opened that region repeatedly, seen the layers separate, seen where a structure actually sits in a real person rather than in a diagram, and seen how much that varies from one person to the next.
Three things follow from it directly.
The planes. The face and neck are built in layers, and a fibre in the correct plane produces tightening while a fibre a couple of millimetres out produces either nothing or a problem. Recognising the plane you are in by feel is a surgical skill, and it is trained by doing rather than read.
The danger zones. There are regions of the face and neck where the margin for error narrows sharply, because a nerve or a vessel runs close to the surface. Around the jawline the nerve supplying the lower lip is the one that concentrates the mind. Knowing where those zones are, and how their position shifts with age and with individual anatomy, is what determines the route the fibre takes.
Knowing when not to. The most useful thing surgical training gave me is a well-calibrated sense of when a plan is a bad one. Turning treatment down is a skill, and it is trained by having seen the consequences of not turning it down.
What anaesthetic training gives you
This is the half that surprises people, because anaesthesia sounds like something that belongs to general anaesthetic and operating theatres. Endolift is performed under local anaesthetic, and local anaesthetic is an anaesthetist’s core business rather than an afterthought.
The block itself. How comfortable this treatment is depends almost entirely on how well the local anaesthetic is placed. Which nerve to target, how to reach it, how long it will last, how to achieve good coverage without flooding the tissue with volume that then distorts the very anatomy you are about to work in. Done well it is a non-event. Done poorly it is the part people remember.
Dose and safety. Local anaesthetics are drugs with a ceiling, and exceeding it causes systemic toxicity. Calculating a safe total dose for a specific patient, with their specific weight and medical history, and recognising the early signs if something is wrong, is trained daily in anaesthetic practice and is not trained at all on a weekend device course.
When someone becomes unwell. People faint. People react to things. Occasionally someone has a genuine emergency that has nothing to do with the treatment they came in for. Fourteen years as a Consultant Anaesthetist is fourteen years of being the person in the building who manages exactly that, and it is the single most reassuring thing I can tell you about this clinic even though it is the thing least likely to ever be needed.
The qualifications, and what each one is
Set out plainly, because credential strings are designed to impress rather than inform.
| Qualification | What it is |
|---|---|
| BDS | Bachelor of Dental Surgery. The first degree, and the origin of a detailed working knowledge of the head and neck |
| FDSRCS | Fellow in Dental Surgery of the Royal College of Surgeons |
| MBChB | The medical degree, taken after the dental one. This is what makes him a doctor |
| FRCS | Fellow of the Royal College of Surgeons. The surgical Fellowship |
| FRCA | Fellow of the Royal College of Anaesthetists. The anaesthetic Fellowship, and the basis of fourteen years as an NHS Consultant Anaesthetist |
| PgDip | Postgraduate Diploma |
| MSc (Cos Med) | Master of Science in Cosmetic Medicine. The formal qualification in the field itself |
| GMC 4229209 | General Medical Council registration number, which anyone can check on the public register |
Two Royal College Fellowships, in Surgery and in Anaesthesia, is an unusual combination. It is unusual because most people do one or the other, and for a procedure that involves placing something under the skin of the head and neck while the patient is awake, it happens to be the two that matter.
What I will not claim is a specialty I do not hold. I am not a dermatologist and I am not on a dermatology register. Where a concern is dermatological rather than aesthetic, the right answer is a dermatologist, and I have written about how to tell the difference because getting that wrong wastes people’s time and occasionally something more important.
What to ask any clinic, including this one
You are not being difficult by asking these. A good clinic will answer them without hesitating, and a clinic that bristles has told you everything you need.
- Who will actually perform my treatment? Not who owns the clinic, not whose face is on the website. Who is holding the fibre.
- What is their registration, and what is the number? GMC, NMC or GDC numbers are all publicly checkable in about a minute.
- Who administers the local anaesthetic, and what is their training in it? This one is almost never asked and it is a good question.
- How many of these have they performed? The honest answer to this varies enormously and the question is rarely put directly.
- What happens if there is a problem at eleven at night, and will the same person see me? Continuity after the treatment matters more than anything said before it.
I would rather you asked all five somewhere else and came back than took my word for any of it. The register is public. Look me up.
Training is not a guarantee of a good result and I am not going to pretend it is. Plenty of excellent practitioners hold different qualifications from mine, and holding a Fellowship does not make anyone immune to a bad day. What training changes is the distribution of outcomes. It makes serious complications less likely, it makes recognising a problem early more likely, and it makes turning down the wrong case more likely.
For a treatment where the fibre goes somewhere you cannot see, in a region where nerves run close to the surface, that distribution is the whole thing. If you want to talk it through, the consultation here is free, carries no obligation, and is conducted by the person who would perform the treatment.
Dr James
Common questions, answered
Endolift involves placing a laser fibre beneath the skin and is performed under local anaesthetic, so it should be carried out by a registered medical professional with detailed anatomical knowledge of the head and neck. Rather than relying on job titles, ask who will perform your treatment, what their registration is, and check that number on the public register.
Because the treatment is done under local anaesthetic, and local anaesthetic is core anaesthetic practice. It governs how comfortable the procedure is, how the block is placed without distorting the anatomy being treated, how a safe total dose is calculated for your weight and history, and who manages it if you become unwell for any reason during the appointment.
Ask for their registration number and search the relevant public register, which is the General Medical Council for doctors, the Nursing and Midwifery Council for nurses and the General Dental Council for dentists. It takes about a minute and it is free. A practitioner who is reluctant to give you a number has answered the question.
No. He is a GMC-registered doctor holding Fellowships of the Royal College of Surgeons and the Royal College of Anaesthetists, and a Master of Science in Cosmetic Medicine, and he practised for fourteen years as an NHS Consultant Anaesthetist. He does not hold a dermatology registration, and where a concern is dermatological rather than aesthetic he will refer you appropriately.
No, and anyone who says otherwise is overselling. Training changes the odds rather than removing them. It makes serious complications less likely, makes a problem more likely to be recognised early, and makes an unsuitable case more likely to be declined before it starts. For a procedure performed where you cannot see, that shift matters a great deal.
The person you meet is the person who treats you
No treatment coordinators, no handing you on. Book a consultation with Dr James and he will assess you, answer the awkward questions, and tell you honestly if the answer is no.
This article is general information about treatments we offer, not personal medical advice. Individual results vary, and suitability can only be established at a face-to-face consultation with Dr Corcoran. Every treatment carries risks and limitations, which we discuss in full before you consent.