Dy Ayham Al-Ayoubi comments of Leann Rimes' facial surgery rumours and explains how Leann could improve her the appearance of her stretch marks

The Daily Mail have recently reported that Leann Rimes has recently undergone ‘painful minor surgery’ to her face, we could almost feel sorry for Leann if it wasn’t for the fact that she is able to recover on the beautiful beaches of Malibu, where she has been snapped relaxing with friends and showing off that flawless bikini body.

Many publications were quick to assume that Leann underwent plastic surgery; however Leann quickly quashed those rumours on the social networking site Twitter writing ‘That made it sound like I got work done. You are gonna start some rumours’.

Dr Ayham Al-Ayoubi of the London Medical and Aesthetic Clinic at 1 Harley Street was asked to comment on the rumours that Leann has ‘had work done’. Dr Ayham Al-Ayoubi says ‘because Leann has been photographed wearing dark glasses there have been rumours that she may have undergone a blepharoplasty procedure, however it seems more likely that Leann is sensibly wearing the glasses to protect her eyes from the sun whilst she is at the beach. There are also several photographs of Leann without the glasses and her eyes look perfectly normal and certainly not like she has had

eye surgery’. There has also been speculation that the ‘surgery’ that Leann tweeted about could have been botox or dermal fillers however, Dr Ayham Al-Ayoubi says that this is ‘unlikely’. Dr Ayham Al-Ayoubi goes on to explain that ‘whilst patients who undergo treatment with botox or dermal fillers may experience some swelling or bruising, they certainly would not be experiencing the degree of pain that Leann seems to be in. We treat many patients with dermal fillers and botox at the London Medical and Aesthetic Clinic and many of these patients return straight to work after treatment, they certainly do not need to take a holiday in order to recuperate!’ It has now emerged that Leann is suffering pain in her mouth and jaw, making it seem likely that the ‘surgery’ she has undergone was related to dental issues and was not facial plastic surgery.

Leann Rimes is often featured in the press for her impossibly slender and toned bikini body, though recently people have been commenting on the stretch marks Leann has on her back. Dr Ayham Al-Ayoubi of the London Medical and Aesthetic Clinic says that ‘almost all women suffer from stretch marks, particularly women who have lost or gained significant amounts of weight and women who have had children.

If women feel particularly self – conscious of their stretch marks there are ways of getting rid of them.’ Dr Ayham Al-Ayoubi goes onto explain that ‘we are able to treat stretch marks using lasers such as the smartxide CO2 laser which uses sophisticated laser dot technology to target stretch marks. We perform many of these treatments at the London Medical and Aesthetic Clinic for women like Leann and the treatments are almost painless and extremely successful leaving many women feeling far more confident with their bikini bodies’

Dr Ayham Al-Ayoubi explains how women can achieve a bikini body like Kelly Osbourne's

It seems that Kelly Osborne has finally won her well-publicised battle with her weight after proudly posting a photograph on Twitter of her enviably flat stomach.

Kelly has been steadily losing weight since 2009 and credits her appearance on the hit American tv show ‘Dancing with Stars’ with her new healthy approach to her diet. Kelly’s dance partner, Louis Van Amstel, taught her how to eat to optimise her performance on the show and Kelly began tucking into low carb and high protein meals including lots of fresh vegetables and fish. Unsurprisingly, Kelly’s new approach to her diet, coupled with her rigorous training regime for the show saw her drop twenty pounds during her stint on ‘Dancing with Stars’.



When her time on the show ended Kelly continued to exercise and is a well- known fan of Pilates and yoga, although she also builds some cardiovascular exercises into her routine to ensure that her metabolism continues to burn fat effectively. Kelly has continued to eat healthily and since the show has lost another 30lbs, bringing her total weight loss to an incredible 50lbs. Kelly says that she is absolutely thrilled with her new body and sticks to her diet ninety per cent of the time, but indulges in the occasional treat such as pizza or ice cream.



Dr Ayham Al-Ayoubi of the London Medical and Aesthetic Clinic at number one Harley Street has been asked to comment on Kelly’s incredible new shape. Dr Ayham Al-Ayoubi explains that ‘Kelly’s dedication to exercise has clearly paid off; because she has lost her weight slowly and sensibly she has no loose skin and appears to have no stretch marks. The amount of exercise she has been doing has also given her a very pleasing silhouette. It is not surprising that so many women want to emulate Kelly’s flawless bikini body’.



Dr Ayham Al-Ayoubi says that many women would like to look like Kelly in a bikini, however many women may feel self-conscious about loose or sagging skin, particularly if they have had children. However, Dr Ayham Al-Ayoubi says that these women should not despair ‘luckily, there are a number of treatments for women who want a body like Kelly’s but feel that it is an unattainable goal. For women with loose or sagging skin we can offer the bodytite procedure which tightens the skin and also melts away and removes excess fat, leaving the patient with a smoother silhouette. This procedure is particularly popular at this time of year when women are beginning to think about their Summer holidays, and one of the best things about it is that it is virtually painless and results in very little downtime for the patient.’



For women who want a washboard stomach like the one Kelly was proud to flaunt in her Twitter photo, Dr Ayham Al-Ayoubi recommends the smartlipo procedure, available at the London Medical and Aesthetic Clinic at one Harley Street in London. He says that ‘Smartlipo is a cutting edge fat reduction treatment which uses laser assisted liposuction technology combined with gentle suction to liquefy and remove areas of excess fat, the treatment is particularly effective on the abdominal area and really could help women to get a stomach like Kelly’s. We would often recommend that patients also undergo velashape treatment to smooth the silhouette and help to eradicate cellulite, ensuring that women really can achieve the perfect bikini body they have always dreamed of.

Dr Ayham Al-Ayoubi introducing the revolutionary long lasting dermal filler Ellanse Into Japan

It was a great honour and privilege for Dr Ayham Al-Ayoubi to be invited and participate at Tokyo clinic for the official launch of the revolutionary dermal filler Ellanse to Japan.













Dr Ayham Al-Ayoubi had performed a master class in Ellanse which was attended by plastic surgeons and cosmetic Doctors from all around Japan and neighbouring countries to be taught how to use Ellanse from a basics format up to Dr Ayham Al-Ayoubi’s advanced technique as a non-surgical full face lifting.
The clinical programme was planned with special lecture, luncheon seminar and an open panel discussion session on the theme “The latest developments of Art and clinical Science in non surgical Facial Aesthetic treatments ”. The diverse program content, which was all based on this theme, will promote knowledge and skills in both the aesthetic and reconstructive fields.

Dr Ayham Al-Ayoubi with professor Dr Yoshiaki Hosaka, Professor Emeritus of Showa University. Director, Plastic & Aesthetic Surgery Centre, Tokyo General Hospital & Tokyo clinic.













Dr Ayham Al-Ayoubi was the key speaker where he lectured about his expertise in Ellanse –the latest dermal filler which was introduced into Japan at the conference.

The Tokyo Clinic is one of the World's Leading Centres for Advanced Diagnostics and Treatment. The Tokyo Clinic is Japan's leading centre for cutting-edge medicine. Featuring an "All-Star" list of Japan's leading doctors and specialists, the Tokyo Clinic provides a single destination for the early detection of cancer and other complex illness and it's subsequent treatment. Top physicians and surgeons such as Dr. Fukushima, world renowned neurosurgeon at Duke University, use state-of-the-art medical equipment such as PET, MRI and CT to diagnose patients and establish effective treatment plans.

Dr Ayham Al-Ayoubi with Mr Johnny You, CEO of CnM continental, Mr Henk Super and Alex Lankhorst from AQTIS Medical.

The Tokyo Clinic is widely known for its "Human Dock" or Total Health Evaluation Program consisting of PET, CT, MRI, Echography, simulated stomach endoscopy and a variety of blood and urine tests. The Tokyo Clinic is also widely known for its innovative cancer therapy including Proton, Immunotherapy, and Hyperthermia treatment. In 2008, the Tokyo Clinic's affiliate hospital has opened the first privately owned Proton treatment centre to remove cancer without surgical intervention."Our mission is to provide the best patient experience medicine can offer". Dr. Miyazaki, President of the Tokyo Clinic

Ellanse which was developed by AQTIS Medical is the first dermal filler which offers a safe unique Tunable Longevity specifically designed for the field of aesthetic medicine and surgery with the result lasting from 3-5 years.












Dr ayham Al-Ayoubi explained : Ellanse is made of Poly-caprolactone (PCl), is a well-known totally bioresorbable soft medical polymer. PCl is used in numerous CE-marked and Food and Drug Administration (FDA) approved commercial bloresorbable product applications for several decades world-wide and has demonstrated an excellent safety profile.

ELLANSE offers the maximum potential for modelling due to the combination of optimum viscosity, unique elasticity and uniform homogeneity. Hence, the ELLANSE Family can be used in a variety of beautifying indications:
• Correcting wrinkles and folds
• Volumizing
• Contouring
• Sculpting









Dr Ayham Al-Ayoubi explains:The ELLANSE is an injectable implant, indicated for deep dermal and sub dermal implantation. The nasolabial folds used in the clinical study are representative for deep and sub-dermal soft tissue augmentation of the facial area.

Ellanse is officially approved by MHRA in the UK and the FDA in the USA and for restoration and/or correction of the signs of facial fat loss (lipoatrophy) and is used for treating facial lines and wrinkles.













Dr Ayahm Al-Ayoubi explained that Ellanse is suitable for both woman and men of different ages. It can help with deep folds around the mouth and nose, sunken cheeks, facial scars, deep acne scars and loose skin. Our surgeon will be able to assess your suitability for the Ellanse treatment.
In the 20s: Collagen production slows down and then becomes dormant. This is an ideal time to start Ellanse to keep the collagen reserves active and for skin tightening.

In the 30s and 40s: Ellanse is ideal for long lasting lines and wrinkles correction and enhances cheek volume and stimulates collagen in a natural way.

In the 50s and onward: Ellanse is ideal to restore facial contours and volume and correct facial laxity and improve the jaw line and other areas and patients can achieve full face lifting without the need for aggressive surgery with the result lasting up to 3-4 years.












Dr Ayham Al-Ayoubi said: Patients will travel from all over Japan to have Ellanse treatment at the Tokyo Clinic, which is one of the leading training centres for Ellanse treatment in Japan.

Ellanse is officially approved by MHRA in the UK for restoration and/or correction of the signs of facial fat loss (lipoatrophy) and is used for treating facial lines and wrinkles

Doctor Ayham Al-Ayoubi explains the science behind dermal fillers

Dr Ayham Al-Ayoubi performs many procedures using dermal fillers at the London Medical and Aesthetic Clinic at 1 Harley Street and says that his clients are very enthusiastic about the anti-aging and plumping effects of the treatment and love their fresher appearance. However, Dr Ayham Al-Ayoubi notes that when his clients come for a consultation, they are often confused by the sheer number of fillers on the market and the way in which they work, saying ‘I always explain the science behind the treatment very thoroughly to my patients, and ensure that they are aware of the different options available to them, as here at the London Medical and Aesthetic Clinic we think that it is essential that patients thoroughly understand their treatment.’


Dr Ayham Al-Ayoubi explains that the physical properties of each of the 100 fillers on the market is different, saying that one of the key differences is the concentration of HA (hyaluronic acid, a protein which is found naturally in the body, important for the hydration and elastic strength of cartilage, which depletes as we age). Another difference between different fillers on the market is the degree of cross linking in the product, as this will produce different characteristics, resulting in a softer or harder gel. Dr Ayham Al-Ayoubi tells us that ‘in terms of HA concentration 18 – 24 mg/ml is generally the best, to give an example, Restylane and Juvederm, which are two of the most popular fillers on the market have concentrations of 20 mg/ml and 24 mg/ml, although some companies choose to go slightly below, which results in different characteristics. An uncrossed-linked product will be tolerated by the skin and no reaction will be caused, however, it will give no lifting capacity, so there needs to be a balance to give the filler the physical properties that we need.’

Dr Ayham Al-Ayoubi continues ‘The more cross-linking there is in a product, the more inflammation it will cause, this is why it is so important for manufacturers to balance the concentration and cross-linking for the optimum effect. We must cross link HAs, because otherwise they will give no lift, the two groups most commonly used are carboxylic acid and hydroxyl with alcohol, these cross-links will try to improve the bio-chemical properties, whilst ensuring that it is still compatible with the body.’ Dr Ayham Al-Ayoubi notes that ‘only cross-linked HAs will resist degradation in the body. The more cross linked a product is the closer it is to a solid, therefore the gel is harder, which in turn, makes it more difficult to manipulate, however, it will be more resistant to higher forces. Harder gels are ideal for injecting into deeper places or naso-labial folds when a lot of movement is desired. If the product is less cross- linked it is closer to a liquid and will dissolve more in the tissue and spread more easily, these gels are used for more static and superficial wrinkles, or for enhancing the lips.’



At the London Medical and Aesthetic Clinic at 1 Harley Street, we always want to ensure that our patients experience the least discomfort possible, and Dr Ayham Al –Ayoubi explains that this is why the particle sizing in the gel is extremely important. ‘Particles must be small enough to flow through very small needles, the particle sizes also need to be even, otherwise we will not have a continuous flow through the needle, which can be painful for the patient.’

Dr Ayham Al-Ayoubi gives some interesting facts about the history of dermal fillers:
As early as the 1890s fat was extracted from patients’ bodies and injected into their faces to plump up the skin and create a more youthful look. In the early 1900s physicians began to use paraffin instead of the patient’s own fat, however a high incidence of foreign body granuloma was discovered. In the 1940s a highly refined injectable silicone was used as a dermal implant with excellent cosmetic results. However, this injectable silicone had problematic side effects from contaminated composites and it has now been banned. Bovine collagen was then approved by the FDA in 1981, known as Zyderm I, Zyderm II and Zyplast, Further into the 1980s a reconstituted human serum which worked by forming clots was introduced.

However, in the wake of the AIDs epidemic and a concern for blood borne diseases, it was quickly taken off the market. It was replaced with autologous collagen processed from harvested fat and Aquamid, an injectable water based polyacrylamide gel was launched. In 1996, Hylaform, an FDA approved hyaluronic acid obtained from Rooster combs and then purified by a filtering process was launched. Despite being animal derived, it does not require a skin test and lasts 4 – 5 months before being naturally re-absorbed by the body. In 1998, Restylane came onto the market, Restylane is still very popular today, and many procedures are performed in our London Medical and Aesthetic Clinic at 1 Harley Street. 1999 was a very exciting year for dermal fillers, as it was the year that Sculptra was introduced to the market. Sculptra is still considered to be an extremely advanced product, and skilled Sculptra surgeons are able to achieve a non-surgical facelift using this Sculptra.

Between 2001 and 2009, many new products were launched, including Aquamid in 2001, Isologen, which uses the body’s own cells to repair trauma and aging in 2002, Cosmoderm in 2003, Radiesse in 2004 and Novabel (no longer available)in 2009.

Dr Ayham Al-Ayoubi condemns the decision of private clinics not to replace PIP implants free of charge

As the scandal surrounding substandard PIP implants continues to unfold, it has recently come to light that some of Britain’s largest cosmetic surgery clinics, have taken the decision not to replace PIP implants free of charge. Even more damningly, many stand accused of trying to ‘fob off’ women by discouraging them from coming in for checks on the substandard implants and saying that women may need to wait for up to a month before they will learn whether or not they have PIP implants. Dr Ayham Al-Ayoubi of The London Medical and Aesthetic Clinic at 1 Harley Street points out that ‘It is hugely unethical that some of the country’s largest clinics will not remove these implants; I am also surprised that such large organisations seem to be unsure of what products were used for which patients’.

It also seems that some private clinics have been misrepresenting advice given by MHRA. The Times reported this weekend that one clinic’s ‘PIP enquiry script’ advises call handlers to tell women that ‘The MHRA’s current advice is that if you are not experiencing any changes in your breasts then not to worry and only patients that think that their implants have ruptured ought to seek advice from their surgeon. What this means is that there is no need for a scan or for you to remove your implants unless you are showing clear signs of rupture.’ The enquiry script goes on to say: ‘Please do not advise all PIP enquiry patients to have a scan; this is not necessary and is not the guidance which has been given by either the Department of Health or the MHRA’.

Doctor Ayham Al-Ayoubi says that the above recommendations one clinic is currently issuing to patients are ‘simply wrong’. Dr Ayham Al-Ayoubi goes on to say ‘it is shocking that this clinic is misrepresenting the Government’s advice in this way, the way in which they have selectively quoted the MHRA is extremely misleading for patients. Currently, it seems that this clinic is not acting in its patient’s best interests’. Dr Ayham Al-Ayoubi goes on to say that ‘It is essential that any woman who is concerned about PIP implants attends a consultation with her surgeon to determine whether or not she needs a scan. If it is decided that a scan is needed the woman should then be offered one. This is the way in which the NHS is handling its own patients who have had PIP implants and private clinics should certainly be offering the same service to their own patients.’

Dr Ayham Al-Ayoubi says that ‘it is important to bear in mind that the clinics which are refusing to remove PIP implants are by no means representative of the ethics of the industry as a whole. At The London Medical and Aesthetic Clinic we would most certainly offer correct advice to concerned women, as well as removing the implants as quickly as possible and free of charge.’ Currently eight UK clinics have committed to removing and replacing PIP implants free of charge, while others have refused to do so. Dr Ayham Al-Ayoubi is also shocked that private clinics are putting further strain on the NHS, which will provide scans and remove implants if private clinics refuse to do so. Dr Ayham Al-Ayoubi says that ‘it is wholly unfair that the NHS must care for private sector patients because some clinics have abandoned their duty of care towards their patients. At the London Medical and Aesthetic Clinic at number one Harley Street we take our duty of care towards our patients extremely seriously and would certainly not allow the NHS to clear up this mess’.

Some clinics have attempted to justify their decisions by pointing out that that replacing all PIP implants would cost over £40 million and that these sorts of costs would bankrupt clinics. However, Dr Ayham Al-Ayoubi says that ‘this justification is simply not acceptable. The CEOs of these clinics are businessmen not Doctors; however they ought to appreciate that as Surgeons it is essential that we consider the welfare of our patients before profits. These clinics have profited significantly from the breast augmentations they have performed and PIP implants have improved their already wide profit margins due to the fact that they are cheaper than other implants on the market. Patients are now left waiting anxiously and confused by conflicting advice, which is simply unacceptable and certainly not what I would consider to be the correct way in which to practice medicine. At the London Medical and Aesthetic Clinic, if something were to go wrong we would take immediate responsibility and correct the problem no matter what the cost, because that is the ethical way in which we choose to operate our clinic.’

Dr Ayham Al-Ayoubi provides a few answers to the most frequently asked questions about PIP implants

Who are PIP?
PIP (Poly Implants Prostheses) was a company operating out
of France from 1996 which was licensed to make breast implants from medical
silicone.

What is wrong with their implants?
Problems were found with PIP implants as early as 2000 when
eleven deviations of ‘good manufacturing practices’ were discovered at their
factory. At this time PIP recalled all of its hydrogel implants which were withdrawn from the market. However the real problem began in 2001 when PIP began using industrial silicone in their implants and dispensed with the protective shell, which meant that the implants were far more likely to rupture.

What should I do if I think I have had PIP implants?
The French government are currently advising all women who have had PIP implants to have them removed and women in the UK are advised to contact that clinic or hospital who performed their breast augmentation procedure.

What side effects or symptoms am I likely to have?
If your implants have ruptured you are likely to experience hardening of the breast tissue and you are likely to feel lumps of silicone in the arm pit. Many women also experience pain in their breasts, usually a dull ache or burning pain in one or both
breasts. This pain is due to the irritant nature of the industrial grade silicone.

Can PIP implants cause cancer?
The Medicines and Healthcare products Regulatory Agency is
satisfied that PIP implants do not cause cancer, going as far as saying ‘there
is no evidence of an association’ (between cancer and PIP implants).

I have breastfed my child with PIP implants, is the likely to have caused my child any harm?
The Medicines and Healthcare products Regulatory Agency have
looked into this issue in depth and have concluded that PIP implants do not harm babies.

Did my surgeon know that these implants were substandard?
Absolutely not. The implants were quality marked for sale in Europe because PIP began manufacturing them using medical grade silicone, so you can rest assured that your surgeon used them in good faith.

How to stop snoring? Daily Mail interviewed Dr Ayham Al-Ayoubi

Every night millions of Britons are engaged — often obliviously — in a snoring chorus of rumbles, rasps and grunts while

their suffering partners lie awake beside them. A recent study found many of us lose the equivalent of three weeks sleep every year because of our other halves' snoring.

Dr Ayham Al-Ayoubi says: "It's a widely under-reported problem that can have a significant impact on people's well-being and relationships," A recent study found many of us lose the equivalent of three weeks' sleep every year because of our other halves' snoring "I have seen two people who said they would have to cancel their engagement if their partners' snoring

couldn't be fixed."

Dr Ayham Al-Ayoubi says: "In the majority of cases, simple lifestyle changes can have a big impact," Sometimes, however, the problem may require surgery.There are potential risks to the snorer's health, too, as certain types of snoring make you prone to high blood pressure, diabetes and even stroke. An estimated three million Britons snore regularly. The causes range from allergies to a late-night tipple and being overweight. Pinpointing the root of the problem is key to finding the right treatment. So how can you — or your long-suffering partner — work out what's behind your snoring?

Dr Ayham Al-Ayoubi reveals the different types of snoring, and how to tackle them...

NASAL SNORER

Dr Ayham Al-Ayoubi says: The classic 'snore' — a low-frequency fluttering or rumbling noise. "It sounds like someone doing an impersonation of someone snoring, or Darth Vader,"

THE CAUSE: If your nasal passages are partially blocked, more air is forced through the mouth while you sleep. This extra pressure causes the soft and dangling tissue of the throat to collapse. When it's collapsed, the soft tissue vibrates as air rushes past it, emitting the characteristic snoring sound. A common cause is an allergy or sinus infection which causes inflammation and swelling of the lining tissues.

Deformities of the nose such as a deviated septum (where the wall of cartilage that separates one nostril from the other is crooked) or nasal polyps (fleshy, non-cancerous growths) can also cause obstruction and sleep problems.

TAKE THE TEST: Stand in front of a mirror, holding one nostril closed and breathe in. If the open nostril tends to collapse, try propping it open by holding the outer rim with the clean end of a matchstick. Now, with your mouth closed, try breathing in through your nose — if breathing is easier with the nostril propped open, you could be a nasal snorer.

Allergies can be seasonal, such as hay-fever. However, if your nose is blocked all year round, this suggests a structural problem with the nose rather than an allergy. Other symptoms to look for include a dry mouth, bad breath or headaches caused by dehydration.

Dr Ayham Al-Ayoubi explains : The saliva dries in the open mouth as the air rushes to the back of the throat. Without saliva, the bacteria that cause bad breath can flourish. "If you snore and you need to constantly sip a glass of water by your bedside through the night, some form of nasal obstruction could be to blame."

WHAT YOU CAN DO: Breathe Right nasal dilator strips— special plasters you put on the outside of the nose which stretch the nostrils open — can provide extra external support to improve airflow, explains Dr Ayham Al-Ayoubi. "In extreme cases we can perform surgery to insert small rods, or silver rings, which keep the airways open," he says. If you have a deviated septum, an operation to straighten it, known as a septoplasty, is also possible.

Dr Ayahm Al-Ayoubi Adds:Polyps can be surgically removed with total resolution of the snoring. If you think allergies may be to blame, ask your GP for testing. "Using a mattress cover and man-made fibres for duvets and pillows can eliminate dust and house mites, a common cause of nasal congestion, and using nasal steroid sprays for a minimum of two months can help,".

TONGUE SNORER

Drinking alcohol just before bed can exacerbate the problem of tongue snoring by relaxing the muscles that support the tongue

SOUNDS LIKE: A high-pitched snore that comes in fits and starts, and stops when you roll on your side.

"The sound made by a tongue-based snorer is often higher pitched as it's more focused on the denser tongue muscle rather than the flappy palate," says Dr Ayham Al-Ayoubi. “It also tends to be in shorter bursts rather than the continuous flapping vibration of the soft tissue in the throat."

THE CAUSE: Roughly 30-50 per cent of snorers are tongue-based snorers,' says Dr Ayham Al-Ayoubi."Here, the tongue is in the wrong position, blocking the air flow through to the throat — perhaps as a result of a small lower jaw; or else the supporting muscles are too relaxed, allowing the tongue to fall back when you lie down, or you could simply have an overly-large tongue."

Drinking alcohol just before bed, sleeping pills and other medication such as antihistamines can exacerbate the problem by relaxing the muscles that support the tongue. Men in particular suffer from tongue-based snoring because they tend to put on weight around the neck, explains Dr Ayham Al-Ayoubi, and this can cause “a build-up of fatty tissue around the base of the tongue, constricting the airways".

TAKE THE TEST: Stick your tongue out as far as it will go and grip it between your teeth, says Dr Ayham Al-Ayoubi. Now try to make a snoring noise. If the snoring noise is reduced with your tongue in this forward position, then you are probably what is known as a "tongue-base snorer".

WHAT YOU CAN DO: If your tongue is falling too far back, a bespoke mandibular advancement device (MAD) has been shown to be effective in the majority of users, says Dr Ayham Al-Ayoubi.

This is in effect a plastic mouth guard that pulls the lower jaw and in turn, the tongue forward to open the airways. A low-tech solution to prevent the tongue falling into the back of the throat is sewing a tennis ball into the back of your pyjamas. “This simply prevents you sleeping on your back," he says.

Losing weight and avoiding night-caps and smoking (which irritates the throat and nasal linings) are also important.

MOUTH SNORER

Mouth snorer: Low-frequency rumbling, similar to nasal snoring

SOUNDS LIKE: Low-frequency rumbling, similar to nasal snoring. You snore whether on your side or back.

THE CAUSE: One of the most common causes of snoring is breathing through the mouth. This causes the soft tissues of the palate or the uvula (the dangling tissue in the back of the mouth) to bump against each other and vibrate, triggering the snore. This is known as “palatal" snoring.

TAKE THE TEST: Open your mouth and make a snoring noise, says Dr Ayham Al-Ayoubi. Now close your mouth and try to make the same noise. If you can only snore with your mouth open then you are a “mouth breather". You could also look at the soft tissue towards the back and top of the mouth. "There should be an open passageway for air to travel through — if the tonsils are clearly visible, or if the palate hangs down, this could well point towards mouth snoring — it's like a sheet flapping in the wind."

WHAT YOU CAN DO: Maintaining a healthy body mass index, limiting alcohol intake and stopping smoking can all help prevent palatal snoring by tightening the neck muscles and pulling up any soft tissue responsible for the noisy vibrations.

Dr Ayham Al-Ayoubi says :"The surgical solution I advocate in this situation is pillar implants that support the palate," These plastic rods are inserted into the soft, floppy part of the palate in a 15-minute procedure.

A NICE study three years ago found 67 per cent of cases had a reduction of at least 50 per cent in their snoring compared with none in the placebo patients. Other surgical options include trimming the uvula using laser or electrical forceps, or radiowaves to scar and so stiffen the tissue in the palate.

SLEEP APNOEA

SOUNDS LIKE: A crescendo of loud snoring followed by silence lasting from a few seconds up to 20, and then coughing, gasping or spluttering (your partner will describe it as if you are choking or gasping for air).

THE CAUSE: Obstructive sleep apnoea, which occurs as a result of narrowing of the airways. An estimated 4 per cent of men and 2 per cent of women are affected. During sleep, airway muscles relax too much and, as a result, tissue blocks the passage of air.

Partial blockage results in snoring, but in a total blockage — apnoea — the patient can stop breathing for up to 20 seconds at a time. When air is completely cut off, the brain sends an emergency signal, causing the airway muscles to contract. This reopens the airway, allowing the sufferer to take in a big gulp of air. The whole process is repeated, sometimes hundreds of times a night."In most cases, the sufferer has no recollection of the events, but will wake up feeling exhausted," says Ayham Al-Ayoubi, Ear, Nose and Throat surgeon at Barnet and Chase Farm Hospitals NHS Trust and North Middlesex University Hospital.Left untreated, sleep apnoea can increase the risk of high blood pressure, stroke and diabetes.

TAKE THE TEST: This is the same test as for mouth snoring, says Dr Ayham Al-Ayoubi, but the determining symptom of sleep apnoea is daytime exhaustion."Sufferers regularly find it impossible to stay awake while seated, especially driving, wake up feeling exhausted and often put on weight as they eat sugary snacks to temporarily boost concentration and energy levels," says Mr Al-Ayoubi.

WHAT YOU CAN DO: "One of the most effective therapies is continuous positive airway pressure (CPAP), a mask worn at night where air is pumped continuously to keep the airways open,"

Dr Ayham Al-Ayoubi.Says: "However, a large number of sufferers find a CPAP intrusive or invasive and many don't continue with it." Surgery to remove the excess floppy tissue can help, but less drastic measures include losing weight and eliminating other lifestyle factors such as drinking or smoking.