Idea behind structural nose surgery:

Nose surgery does not only mean that you can make the nose higher or longer.
One must know the structure and anatomical situation of the nose and change accordingly in order to result in long maintenance of the new nose without any side effects.

This is the most important point of the structural nose surgery.




The most concerning part about the nose surgery is that many are worried about the nose looking ‘fake’. Also many are worried that things may go wrong somehow.

If you want to avoid the feeling that your nose is fake, or want to avoid any future problems such as inflammation or contraction (nose becoming smaller), then there is one very reliable method.

Do not damage your original nose structure. Just use the skin for the surgery.


About silicone:  
It is true that the silicone most instantly and quickly makes the nose shape into what the patient wants. The price is relatively cheap and it is easy to make into the shape necessary. If you design it properly with clear lines and shape, there would be good results after the surgery.

But the problems rise few years after the surgery.
However, this does not happen to all the patients.
Many patients suffer change, contraction, inflammation, etc after a few years.
Reconstruction is even worse.

Silicone does not mix with the body therefore thick walls are formed around the implant.
We call this capsule. If the capsule does not cause any problem, then it is fine. However, this is not always the case.
If there is a severe case of capsule on one side only, then the implant would change its location. The implant moves to the weaker side and with time, the nose changes shape as well.


If there is a capsular contracture, the tissue at the tip of the nose gets pulled in and the nose becomes shorter.
If there are some substances around the silicone, these substances do not dissolve and stay around leading to inflammation and infection.
These are some problems of using silicone implant.

If the implant stays in the body for a long time, the cover tissue or skin that surrounds the implant suffers resistance from the implant and becomes thinner.



The skin tends to age and the skin tissue suffers difficulty in blood circulation becoming thinner. In the long run, you will be able to see the two end margin of the silicone that is shaped as “11” (margin visibility).



Therefore, it is more effective to use your own skin tissue for the reconstruction in the nose surgery.
The goal of nose surgery that everyone wants:
No fake looking nose,
Avoiding horrendous side effects
Can be achieved when taking your skin tissue and improving the body through anatomical and structural approach. This is what we call structural nose surgery.


Some methods of structural nose surgery: 

If you divide the nose at large, there would be a case where the bone is low (root of the nose ~ nasal ridge) and where the cartilage is low (nasal ridge ~ nose tip). Most Koreans have both these problems as they want the nose surgery.

 I would like to share an example of a good method on how the surgery can be conducted.

The shape and the height of the nose tip is controlled by using ear cartilage or the nasal septum cartilage.

Artificial skin, artificial bone, and donated cartilage all have their limitations and there are concerns of inflammation, the all these can be sucked in and stuck out.
There are many different methods but the simplest one is to use the ear cartilage and put it on top of the nose wing cartilage.

If you are a patient with thick skin and need to put the nose up high, then we use the nasal septum cartilage and place it on top of the nose wing cartilage making the nose tip stronger.

Nose surgery requires using own cartilage to come up with the best possible result.
Second method is to use anything to place it on top of the nose root ~ nose ridge area. The doctors are often tempted to use silicone or gore-tex implant.

However, this is not a structural surgery but a structure destroying surgery. I think that it is best to limit the usage of implants when possible (unless it is definitely necessary).
If you put silicone or Gore-Tex, it would push down the structure making it difficult for you to breath and might end up with some unexpected results in the long term.

It could be a good idea to use polyamide and liquid formed aqua filling filler or hydroxyapatite for the first nose surgery. The surgery time would be extremely short and if you do not like the result, we can correct it or even melt the substance.
This would be mostly impossible to do for the reconstruction.

One can use the fat between the buttocks and thigh to make the nose root ~ nose ridge part higher.
The nose skin that has become thin due to the silicone and the lower part of the nose bone after the removal of the silicone would not look good for the nose shape.

But using the silicone again to fill up this space will make the nose thinner and hollowed out.
If you use your own thick skin, you can supplement on the skin loss and also reduce the concern of the bone hollowing.
If the nose is severely changed in share, costal cartilage is used for the reconstruction surgery.

Structural nose surgery is not hurting the face structure or the nose organization but positively improving the looks. This approach would lead to best long term results and also reduce the possibility of reconstruction surgery.

Let’s summarize the structural nose surgery algorithm.





Thank you very much.


KIES-U Korea website : www.kiesu.com
Kakaotalk consultation : http://kiesu.com/sub_5/?p=2

Q. How is the breast cosmetic surgery for those in 50’s ~ 60’s different?

A. It is difficult to say that those in 50’s~60’s are old these days. Our society is becoming elderly and there are many who are in the 90’s.

Today, I would like to share about the breast cosmetic surgery for those in 50’s ~ 60’s that many are interested about. There aren’t much information in this area even on the internet.

KIES-U Plastic surgery Korea

It is difficult to say that there are much difference for those in the 50’s~60’s and those in 2-‘s~30’s. But, as a doctor, I need to be aware of few things.

1. Thinning and loss of skin, breast elasticity 

As the skin gets older, it loses elasticity related components such as elastane. Also the skin becomes thinner leading to loss of volume in subcutaneous fat.

Therefore, the main focus of the breast cosmetic surgery is if one can regain the breast elasticity with the implant whether it is your first time getting a breast surgery at an old age, or you lost volume in the original implants due to old age.

It is same as saying that you want to wear a dress that is many decades old. But, this dress stretches down a lot. In order to make it more fixable, you take it to a tailor to make the dress fitting to you.

However, the first breast augmentation is not like tailoring the dress but adding more fat to your body to make the clothes more fitting.

For such reasons, the implant needs to provide enough elasticity and stickiness.
The implant need to provide anti-aging effect on the breast skin.

2. Sagging breast and change in the location of the nipples

The skin tissue becomes thinner as you age. This can be easily noticed on the breasts.
 
Cohesive gel implants are half-solid, therefore has a lot of liquidity. So, if you stand up the implant, the gel centers at the bottom making the upper part wrinkly.

The less wrinkly the upper part is, it fills up the volume better on the upper breast. We call such product to be stabled in shaped, therefore, form-stable implant. If you use an implant that is not form-stable, then the upper part of the breast would lose volume and the implant sagging down. You will not be able to fix the shape of your breasts.

The 1 and 2 contents above are to summarize that the implant used in the breast augmentation is to fill up the volume in the upper part of the breasts and to strengthen the breast elasticity.


3. Weakening of cardio pulmonary function and other various organs

As you get old, you might have weakened heart or any other organs due to the general anesthesia that is required for the breast augmentation.
 
If you have a severe respiratory problem, you might not be able to get the breast augmentation due to breathing problem.

If you have liver problems, then you will not be able to take anti-biotics, and other anesthesia medication because your body have not be able to respond normally.
So it you have decided to get the breast augmentation, then you need to get examination to determine that you can resist the anesthesia and other medication and have a healthy body.

If you have diabetes and are controlling your blood sugar level properly, there would be no problem with getting the breast augmentation.

Those with asthma would need to be at a good form so that they do not get asthma attack in order to get the breast augmentation.

If you have a high blood pressure but your body is healthy and the blood pressure is controllable, you can get the breast augmentation.


4. Complications

There is no evidence that aged patients are more likely to suffer capsular contracture or inflammation.

In theory, there are few side effects or complications that aged patients suffer more than the younger ones; able to feel the implant, able to see the border lines of the implant, and thinning of the breast skin, etc

Most of those patients in their 50’s ask me if they can get the breast augmentation at an old age that their husbands might criticize them, and they are shy that they have come to see the doctor for the breast augmentation.

However, I think that the age is not a problem when it comes to a woman wanting to look more beautiful. It is wrong to think that those in 20’s can use cosmetics and get beauty surgeries but those in 70’s cannot.

Today, we looked at the problems and concerns of those patients in 50’s~60’s wanting to get breast augmentation.
Thank you for reading.

Sagging breasts: Inevitable after breast-feeding?

"My breasts.. were a little sagging.. but they became worse after breast feeding my second child. My breasts became wrinkled. My friends were amazed at what they saw and they wanted to touch my breasts. They say that they will never breast feed their children. I didn’t know that this would happen because I didn’t breast feed my first child but after breast feeding my second child, my breasts have become like that of an old woman. "

This is a content written by a housewife in an internet community. This was something that I could not neglect. It is sad to know that one needs to give up beauty for pregnancy and breast feeding.

But there is something unscientific here. It’s not just the content but there are many who think similarly. As a cosmetic surgeon, I would like to point this out. Sagging breasts are closely related to pregnancy but it is not related to breast feeding.
Of course, I have medical reasoning behind.



In conclusion, breast feeding does not lead to sagging breasts therefore, you can relax and carry on with breast feeding

I would like to refer to a research conducted by Dr. Brian Rinker from Kentucky University, USA.

The research was conducted on 134 patients with sagging breasts. The research covered various factors such as age, weight change, high BMI (body mass index), bra size, number of times begin pregnant, smoking, breast feeding, weight increase while pregnant, regular exercise, etc.

The factors that lead to sagging breasts are
1) Age
2) Smoking
3) Sudden loss of weight (20 kg or more)
4) Obesity
5) Large sized original breasts
6) Number of pregnancy

Factors that do not influence sagging breasts are

1) Breast feeding
2) Increase in weight during pregnancy
3) Not exercising upper body

The surprising fact here is that the breast feeding is not a factor that leads to sagging breasts. Also, a common happening of increase weight during pregnancy does not make your breasts look bad.

Upper body exercise that a lot of fitness trainers recommend, also does not help out prevent the sagging breasts.

Pregnancy can lead to sagging breasts, so if you get pregnant number of times, this might worsen the sagging breasts. However the breast feeding does not. Breast feeding does not have any influence on how your breasts shape.
 
This research needs more work in the future, but it is defining that the result shows that breast feeding does not have any relations with sagging breasts.
There is no scientific fact that sagging breasts and breast feeding are related to one another. We call this superstition. It’s like saying that there is a goblin on that mountain that moves around the hills whenever it rains.

Another problem is that fashion or fitness related websites or magazine advertisements show contents that have absolutely no relationship with the cause, prevention, and treatment of sagging breasts. There are contents such as some healthy food, exercise, or a certain type of clothing help improve on sagging breasts.
This is kind of funny.

Breast tissue are close to Cooper’s ligament. It is not closely stuck to the pectoral muscle. Exercising in a fitness center does not help improve the breast tissue. Also fitness training contracts the muscles often therefore making the fibrous tissue larger. The training does no pull up the muscles. It is same as saying that if a person uses his face muscles a lot such as smiling a lot, then he should not have any wrinkles.
There is no scientific fact that sagging breasts can be improved with exercises. I do not want my patients to believe something like this as a doctor.

It is not good to gain and lose weight frequently. If you lose weight all of a sudden, you will lose much energy and your breasts will fall down as well. Sudden change is weight is not good for you.

There must be some genetic reasons as well for the sagging breasts. Age or the large size of the original breasts are some factors that you cannot control
But there are factors such as smoking, sudden weight change, obesity and others that you can control.

In 2003, 32.8% of women breast feeded their babies in US. There is not much difference in Korea.

There was a survey for the high school girls in Italy and 30% of these students though the breast feeding leads to sagging breasts.

There were survey result in Dominican Republic in which the mothers stopped breast feeding quickly because they thought that their breasts looked weird or abnormal because of it.

Breast feeding is a great source of health for the babies. There needs to be more women who breast feed their children. There is no scientific proof that breast leading badly influence the shape of your breasts.

Sagging breasts after pregnancy and giving birth can be solved with simple cosmetic surgery.

Breast augmentation Before & After

You need to quit smoking, not lose weight suddenly, and control so that you do not become obese. These are things that you can control. But you do not need to control breast feeding. As of what we know today, breast feeding does not have any effect on sagging breasts.

All mothers are beautiful. Breast feeding mothers are more beautiful.

This is all for today. Thank you very much.

Q. What underwear(bra) can I wear after breast augmentation? 

A. Underwear such as bra have a lot of functions.
Normally, bra is used so that a woman feels comfortable in doing breast related activities. In our country, all women need to wear it and it has become one beauty fashion product.




It is difficult to say that the bra is a mandatory clothing for the breasts. Also there are some people who think that the bra limits the blood circulation in the breasts there is having a bad influence.
I would like to share few things that you need to be careful about after breast augmentation.


First, you will be wearing bandage or pressurized bra after the surgery. Such clothing is a functional one and is used to stop the bleeding.
After you loose the bandage, you need to be careful so that the breasts do not get any harm and you need to know that you need about 6 months for your breasts ‘to get in shape”.




As the swelling gets better, the implant needs to press on the skin tissue making a good looking shape and also preventing itself from moving into another location or position. This can be helped with the use of correction bra.

However in my case, I have felt that the correction bra has a lot of inconveniences and there are some patients who can never get used to it, therefore I do not always recommend the correction bra to my patients.

Breast augmentation through axillary crease can make the implant move to upper location therefore one uses a band on the upper part so the implant cannot be moved.
The implant tends to move downwards in case of inframammary fold incision, therefore you need to wear sports bra so that the bra can withstand the weight of the implant.



Therefore, in the first month after the surgery, you need to use a bandage of Surgi-bra. In 2 ~ 3 months of the surgery, you can use upper band if necessary, and wear various type of other bras if necessary.

Younger patients have tight skin therefore the skin itself are pressurizing the implant. So it is recommended that these young patients do not wear bra that are too closely pressed on.

Older patients have loose skin with less elasticity therefore the implants are not pressurized. Therefore, it is recommend that they wear bra that will help the implants be stationed at the required location quickly.

Most patients can wear wired or wireless sports bras within the 6 months of the surgery.
If you get breast augmentation through fat transplantation, it is recommended that you use correction bras that are fitting with the inframammary fold as the fat used is half liquid therefore it gets absorbed or extinct as the liquid slips downwards.



Wearing what type of underwear depends on case by case. You should check with your doctor frequently on what kind you clothing to wear. The bra that you wear in the first 6 months of the surgery are strictly for functional purposes therefore it is not wise to wear tight bra to cosmetic reasons.

Today we looked at what bra to wear after the breast augmentation.
Thank you for reading. Have a great day.