Can I smoke after Plastic surgery?

Yes. “can I smoke after plastic surgery?” This is the question that a lot of people ask, and this is the topic that I would like to discuss today. First, I would like to provide you with a common sense answer.

One must take care of her own body. Everyone knows that smoking is bad for your health. Even a child knows that one must not smoke after a surgery. However, I would like to analyze this problem and share if this is medically not good for your health.

This is a happening that took place a few years ago.

I was going to take a look at a patient who just had nose correction surgery but the door was locked. 
I knocked the door and it opened after a long time.
The room was filled with smoke. 
The patient and her friend had smoked in the room. 
As a doctor, do you think that I was angry or not? 
I was really angry that a small smile appeared on my face.
I gave a ridiculous look and the patient apologized and told me that she wanted to smoke because she was feeling some pain. If she was hurting, she should have asked for a pain killer but instead she smoked.
She apologized again and she told me that she would throw away the bud. 
This made me laugh.

1. Smoking after a plastic surgery

Actually smoking is bad for the health if you smoke a regularly for a long period of time. It is not as harmful for the body if you smoke at the short time span of the recovery.

Cigarette has nicotine in it. Nicotine causes contraction of the blood vessels therefore it could have a bad effect on the scar. This is the reason why we did not allow the patients to smoke.

Nicotine has a wide, complex influence on the body. We cannot simply say that is delays the scar that is being healed. I tell my patients to not smoke for about two weeks after the surgery

However, there are no findings or reports that those patients who smoke after a surgery suffer side effects such as infection, scar not disappearing, pain, and those who do not smoke do not suffer such side effects.

I do not think that one should tell another not to smoke just because it is bad for health. Scientifically, there is no result that shows smoking causes delay in the scar being healed.

So I tell my patients this;
Just quit smoking. Then you would not have to worry about what could happen in the future. But, if you smoke again after a week or two, everything would be nullified. Smoking leads to bad health if you do it for a long period of time. It does not cause bad health all of a sudden.

Of course smoking is not good for the health after the surgery, but it does not cause a bad effect all of a sudden.

However, smoking is bad if you do it for a long term,
therefore, it is recommended that you quit smoking if you are concerned about your health.

2. Drinking after the plastic surgery

A lot of patients who have surgery close to the end of the year ask me this question a lot.
I need to meet my friends during the weekend, so can I drink?
I have year-end party and so it is difficult for me not to drink. Will it be OK to drink?
I am sure that these patients enjoy drinking. I am quite surprise that a lot of female patients rely on drinking as well. When I was in the 20’s, the ladies drank very little. So it was an insult to some if you said that a lady was a good drinker.

Anyway, I would recommend you to not drink after a surgery. 
Alcohol enlarges the blood vessels. Alcohol has an effect on the body right away compared to smoking that takes some time. The enlargement of the blood vessels leads to reddening of the face and the body. It also caused the heart to beat quicker. Alcohol also has a diuretic effect causing thirst.

After a surgery, we try to contract the blood vessels near the scar with ice in order to stop the bleeding however this would be no good if the patient drinks causing the enlargement of the blood vessels.

This might cause infection on the scar and other problems which we may not be able to find out properly. Therefore, it would be good for the patient not to drink any alcohol after a surgery.

There was a patient who had fat transplantation on the face. 
She drank right after the surgery and after a week, there was much inflammation on the face.
She took antibiotics for a few days however the transplantation had no effect on the face.

We cannot say for sure that the drinking was the cause of the inflammation however, if you are concerned about something similar happening to you, then you might want to avoid any activity that may be the cause.

Appropriate amount of drinking is good for the health in the long term compared to smoking which is not.

In summary,
First, smoking does not cause big problem in the first 1 or 2 weeks of the surgery however, smoking is not good for you in the long term. (Especially for those corrections that need good blood circulation such as nose and wrinkle correction, fat transplantation)

Second, it is a principle that you avoid drinking after the surgery. However, in the long term, an appropriate amount of drinking is good for you.

If you had a plastic surgery / correction recently, why don’t you quit smoking? Smoking is not good for the skin and also shortens your life.
Have a good day.
Thank you.

Nose Hump reduction surgery Korea

A nose is composed of a fibula, upper part, and the cartilage in the lower part.
Therefore, nose correction requires working not only on the cartilage but on the bone as well.

In what type of nose do we need to correct the bone?

We do not need to touch the bone in all type of situations. There are many times where we can have good results although the bone is not touched at all.

But in cases such as severe hump, tilted nose, damaged nose, or very wide nose, correcting the bone may be necessary

How do we correct the nose hump? 

Nasal hump is not only formed by the bone but also by the cartilage. So if you are to correct the hump, the surgeon would need to correct not only the bone but the cartilage also.

The correction does not stop with the removal of the hump part. The correction requires closing of the open roof on the nose. The details can be seen in the image below.







As in the top image, once the hooked part of the nose is removed, an open roof (in the lower image) is formed. If nothing is done on the open roof, the nose becomes wide and does not look pretty physically. Therefore, we fracture few parts of the bone to move the location.




As shown in the image above, if the nose is fractured then the nose has the movability. Movability makes it possible for us to have the nose is the shape that we want. If the nose is too wide after the nose hump correction, then it is possible to have reduction by closing the open roof to give good final results.




If the nose is dented to one side (It is common to find dented nose with hump), we can push the bones to the opposite side to make the nose straight.

Is it dangerous to touch the bone while correcting the nose?

Touching the nose bone means that you are exposed to the risk of touching other parts during the procedure. If you touch the lacrimal drift by mistake, this may lead to teary eye symptoms. Also, as you can see in the image below, there are thick arteries on the sides of the nose. If the arteries are touched then there is high possibility of this causing swelling of the nose.

Does it hurt?
 

There are no receptors on the nose that feels the pain. The receptors are on the periost. During the nose correction, there are times when the bone needs to be fractured but this does not cause any pain.

There are no nerves on the on the bone, so it would be wrong to say that there is pain on the nose. However, the nose bones are formed closely together with the bone around the nose and the forehead therefore, making the bone fracture can be scary for the patient causing stress also.

So, there are at times when we have to do general anesthesia. There are some patients who are brave enough to do just the local anesthesia.

Breast Surgery To Know List 4.
Deciding on the Breast implant size

There are many posts on how we can decide on the size of the breast implants. Today, I would like to summarize the core contents with this post.




Before the doctor would see the patient and say “You would need xxx cc.” This was about 7 to 8 years ago.
But today, this process is different. There are several stages on how we go about in choosing the right breast implant size.

We usually use the below 3 stages.
 
1. Upper body measurement
2. Implant fitting (T-shirt test)
3. Sizing while conducting surgery

I will go in detail for each one of them.

1. Need to get upper body measurements in the first consultation with the surgeon

You need to take different measurements but the most important one is the width of the original breast.
The average width size of those patients (those in 20’s ~ 40’s) who come to have breast augmentation surgery is about 11 cm. If the upper frame is big then this width size is big. If the upper frame is small then the width is small also.
The greater then growth amount in the breast, the wider the width is. So if the original breast is small then the width is small as well.




The width of the implant depends on the width of the breast. So if the width of your breast is about 11 cm, we would choose an implant with width of 11 cm or less.





But there is another part of the body that is as important as the width of the breast. It is the extensibility of the breast tissue
There are those who have elastic skin, tissue, muscle, fat that surround the implant, and there are those with less elastic parts of the body.

The younger the patient is, before giving birth, the skin on the breast does not stretch out as the skin is less elastic.
As you get older, and give births, the skin becomes easily stretches therefore, losing the skin elasticity.

If the skin is tight and does not stretch easily, then it is difficult to use wide implant.

In opposite, if the skin stretches easily, then a larger width implant can be used.





Therefore, we decide on the size of the implant by measuring the upper body, i.e. the width of the breast and the skin elasticity.

This is preliminary, and is not the final decision.

2. Implant fitting (T-shirt test)

 
How big should the implant be in order to make my breast bigger? A question as such can be answered easily by fitting the implant just as you try different clothes when you want to buy one.

The size of the breast is very subjective and also the satisfaction survey of breast surgery is very subjective as well. So, it is important to check the breast size after the surgery although she knows how much cc implant has been used. If the patient is not satisfied, then this is not a meaningful event for the patient.
Let’s imagine that you are buying a dress.
There are those who think that size 44 is too big.
There are those who think that size 66 is too tight and small.






This is the same with the size of the breast implants. There are those who think that 200cc is too big and those who think that 400cc is too small.

The subjective feeling in choosing the size of the breast implant depends on the size of the upper body, not the absolute number in the size of the implant (cc).

It is not always the case that the size of breast implant chosen at the first stage of upper body measurement would be the same as the size that the patient wants.

So the surgeon prepares the implant that is recommended size and another with the size that the patient wants. There are many variables during the breast augmentation surgery and the size might look differently while having the surgery.

3. Sizing while conducting the breast augmentation surgery

Final decision making is done during the breast augmentation surgery. The measurement size and the patient wanted size are just references sizes for the implant.
During the breast augmentation surgery, we make look for the implant and fit in the implant imitation to measure again which size is the most appropriate one. We call this, sizing.

If the diameter of the breast is about 10.5 cm, and the patient wanted 270cc implant however the recommended size was 290cc, we would prepare all implants from 250cc to 300cc before the start of the surgery.

During the surgery while we test different sizes and decide that 290cc is appropriate, we fit in the 290cc implant into the breast.

In opposite, if there is enough room for the implant but the skin does not stretch so that the 270cc implant cannot fit it, then we used 250cc~260cc implant for the surgery.





There are some patients who visit various clinics but decide on the one that will use the implant with the size that the patient wants.

But, this could lead to trouble in the future. The young patients are too focused in wanting larger breast compared to what the body can take therefore, demand more volume rather than what is appropriate for the body.

We cannot decide on the size of the implant with just the first interview with the surgeon.
As we have stated earlier, there are many stages that are involved in deciding the size of the implant and the final decision is made in the surgery room.

A patient’s opinion is a consideration factor, and the surgeon cannot do everything that the patient requests or demands........
Doing what the patient demands may lead to future problems such as refilling, being able to feel the implant, damage to the implant, unnatural look, etc.




Today we shared the fourth post on the ‘To know list of the breast surgery’ that covered details on how the size of the implant is decided.
Thank you for reading.

Have a great day.

Breast Augmentation Surgery To Know List 3.
What types of breast implant are there?

I would like to present a simple description of the different types of implant for the breast augmentation surgery. There are many of those who are curious about this but it is not easy to distinguish the different types because there are too many.

First, we can divide into two types of saline solution type and cohesive gel.
This can be further divided into smooth type and textured type.
There is a smooth / textured in saline solution type, and smooth /textured in cohesive gel type. Also, we divide the cohesive type to round type and water drop type.

Types of Saline-filled Breast Implants

Types of Cohesive gel Breast Implants

The water drop type cohesive gel breast implants does not have smooth type, it consists only of the textured type. (Saline solution has water drop type as well but we do not import that in Korea)

Saline-filled breast implants is used primarily for re-surgery therefore it is not used in the usual 1st breast augmentation surgery that has the objective of beauty. So we will discuss about the cohesive breast implant today.

Cohesive gel Breast Implants

Therefore, we will talk about 3 types; Round smooth type, Round textured type, and finally Water drop type implant.

1. Round smooth type breast implant

Cohesive gel breast implant is made by filling the gel into the smooth surfaced layer. This type of implant is soft and is bendable.
Many say that the smooth type implant feels better than the textured implant but this is because the smooth type has a thin layer. Also, if the implant goes into the body, it is difficult to feel the difference between the smooth type and the textured type.

Round smooth type Breast Implant

The smooth type feels very thin and weak so many think that the implant might tear when put into the body. The biggest problem with the smooth type breast implant is that there is not friction between the layer and the body so we do not know where the implant would locate itself.
The layer is rather slippery so if the implant is not exactly placed in the room provided for it, the implant may shift to another location.

2. Round textured type Breast implant

Smooth type lead to different forms after the surgery, and so in order to prevent this, textured type implant was developed. The skin would grow into the textured implant therefore limiting the thickness in the epithelium however this was a failure. Different forms were made with the textured implant as well. Also, there was no difference in possibility of having different forms for both smooth and textured type if the implant was placed under the muscle.

Round Textured type Breast Implant

Then why do we use the textured type? It is used to stop the misplacement or the shifting of the implant to another location. Smooth type has smooth layers making it easy to move about to another location and also leading to deformation of the implant.
However, the textured type has rougher surface so it does not move about easily. I usually recommend the textured breast implant. There is no assurance that the implant will stay at the location that I intended.

3. Water drop type Breast implant

All water drop type breast implant have textured surface / layer.
Water drop type was made so that it would look natural on the body.
There are many of those who do not know about this properly but the water drop shaped cohesive gel breast implant was produced and sold at the same time as the round type cohesive gel breast implant. It is false that the water drop type is an improvement over the round type.

Water drop type Breast implant

The origin of water drop type breast implant is Natrelle Style 410. It was first sold in 1993 and was the first product of its kind.
This is the strongest of its kind as a cohesive implant, meaning that it is very safe. This is both the advantage and disadvantage of Style 410. It is very strong so it does not lose its form. Also it can fill up the volume properly.

On the other hand, since this is the strongest of its kind, it is very difficult to place it into the body. Also, the final feeling is not as good on a thin person. Recently there have been side effects of seroma and double capsule in the Natrelle product reported by the doctors.





So Natrelle develops a lower model Soft Touch in Style 410 lineup.
There is higher level of cohesiveness, and so it became easier to put in the implant. However, the safety level decreased as much as well.

The tight gel leads to longer formation of the breast and also improves on the sagging breast by uplifting it properly. But those who are young may feel dissatisfied with using this type as it feels less smooth.

There is no right answer in how you choose the implant. There are pros and cons according to different situations.





If you want satisfaction right now, you might want a soft breast implant, however, if you are looking long term, you might want to have a stronger breast implant.

However, there are many doctors and patients who say that Style 410 is too strong.
So other companies such as Mentor, Silimed, Nagor, Arion, Polytech, Sebine decide to make a softer implant than Style 410 and a tighter one compared to other round cohesive gel products.




If we compare the tightness and the softness of the imported implants, we could rank them as, Polytech being the softness, Silimed, Sebin, and Mentor at a similar level, and style 410 being the strongest.


I will prepare another post on the differences between the brands. Today, we differentiated various types of implants into three types and talked about the basics.

There is no absolute correct answer on how to choose the appropriate breast implant. This depends on the body, preference, age, financial status, and the doctor as well. One cannot say which implant is better than another.

Thank you for reading.

Have a great day.