Lateral Canthoplasty that avoids the skin sticking back together

Asian people have eyes that are narrow, lower, and the eyelids are thicker compared to the Westerners. Such differences with the Asians lead to them wanting double eyelid surgery or blepharoplasty.

If the width of the eyes are short, and if epicanthoplasty is not enough, then, at times, we go with lateral canthoplasty as well.
There are many patients who worry that the separation from the lateral canthoplasty does not last making the skin come together again, and ask questions regarding the procedures that do not result on the re-surgery or the skin sticking back together again

So today, the post will have contents regarding the lateral canthoplasty that does not result in the skin coming together after the surgery.

[Lateral canthoplasty that avoids the skin sticking back] 

Many patients consider having lateral canthoplasty if they have narrow eyes or have sharp out corner eyes. These patients have concerns about the detached outer part of the eye sticking back after the surgery.

In Kies-U, we consider re-locating the (*)lateral canthus for conducting lateral canthoplasty.
(*) lateral canthus: Point where the upper and lower eyelids meet

Before and after Lateral Canthoplasty

Relocating the lateral canthus is a little radical method compared to the lateral canthoplasty. However, this is a very good method regarding the fact that there are many patients who are not completely satisfied with the result of the lateral canthoplasty. Also it is used as a part of the re-surgery.

[Differences from the standard lateral canthoplasty]

Originally, the first lateral canthoplasty introduced was targeted on the Western patients.




Westerners tend to have thin skin layer, and the eyelids do not cover much of the eye ball therefore we do a lot of geometric type design on the eyes and cut off then reattach the skin.

However, this technique is not applicable to the Asians who have thick eyelids as such technique would result in many scars and outer part sticking back together after some time.

Lateral canthoplasty that does not result in outer part sticking back together again involves not the removal of the skin but relocating near the periost to avoid scars and greatly reduce the possibility of the outer skin sticking back.

Procedure of lateral canthoplasty

[Who needs the lateral canthoplasty?]

There are many who ask "Can I get lateral canthoplasty?”.
Anyone and everyone can get lateral canthoplasty but the result of the surgery differs from person to person according to the sharpness of the eyes and the tightness of the skin around the eyes.

If the skin around the eyes are tight, then it becomes difficult to pull and fix the skin around the lateral canthus.
Also, we do not recommend lateral canthoplasty to those who have Western looking eyes.
The surgery is effective to those who have Asian looking eyes.

Lateral canthoplasty, lowering the outer part of the eye

[Problems with lateral canthoplasty]

The biggest problem with the lateral canthoplasty with the outer part that does not stick back is the conjunctiva edema.

Originally, the surgery exposed the conjunctiva so that it becomes a part of the eye making the eye look a little swollen and different from how the eye had looked before.

Also the eyelashes are removed as much as the incision so the eye may look unnatural, however, this can be avoided if the incision is done at an appropriate length.

Most important aspect of the overall approach is to interview with the surgeon and then make a final decision.

Today, we shared about the lateral canthoplasty. I hope the contents help you understand better about this topic.

Thank you very much.

Breast augmentation Surgery To Know List 2. 

Is the silicon implant safe to use?

Today’s post is on the safety of the silicone gel implant. There are many of those who are highly interested in this topic therefore; I will go over the details briefly.
 

1. Is there any relationship between the silicone gel breast implant and breast cancer? 

Since 1992, many plastic surgeons, and other scientists studied and gathered data on the safety and effectiveness of the breast implants.

The 7 years of work was put into a book, "Safety of Silicone Breast Implants", published in 1999;. (Washington DC, National Academy Press)

This book was complete through much effort not only from the plastic surgeons but with the efforts from other scientists as well. The book has a reputation for being one of the most scientific and reliable book of its kind. It also meant that silicone breast implant is safe.





Another acknowledged medical journal, New England Journal of Medicine, in its 1995 332nd edition, announced a finding by Dr. Guerrero, who studied the relationship between silicone breast implants and Autoimmune Diseases on 87,000 patients. The result showed a proof that the silicone breast implant does not cause any body illness.

Such reliable scientific findings were published continuously, and since then, many people in Europe and South America used silicone implants. The implants were restricted only in US and Korea.

FDA restriction of the silicone breast implant was set only for the beauty surgery temporarily. So if the surgeon thought that it was necessary, then he/she could make a request to the FDA so that the patient can use the breast implant.

But in Korea, the importing of the implants was banned. Korea bench-marked the restriction from the FDA and made the implant banned from the country without any logical reasoning.





In 2006, FDA finally approved the use of silicone implants and Korea Food and Drug Administration did the same copying the exact standards from the FDA. The importing and the usage of the silicone breast implants were opened up since 2007. In 2012, there was an approval in the import, distribution, and usage of cohesive gel breast implant such as water drop type.

Silicone gel breast implant is safe. There is no proof that the silicone gel breast implant causes breast cancer or other Autoimmune Diseases such as lupus, and rheumatism. The public news and opinions without any justification caused moratorium that restricted medical development.

2. Why do we use the silicone? Is there no substitute? 

Silicone is chemically a safe substance. There is a long history of using silicone in the medical industry and there have been many successful cases in the usage.

Silicone can be made in many different forms, and can be easily put into the body. The cost is relatively low as well.

But this does not mean that there is only good in silicone. The biggest problem with the silicone is the structural look. If the silicone implant goes into the body, the body starts to become immune to it. This happens to every person except for those who have problem with immune system like AIDS. If this immune activity becomes rigorous, then the skin that surrounds the silicone becomes thick and hard causing bad structural look and touch.

There have been many studies related to such problem with the silicone. In Europe, there has been a history of using polyurethane instead of the silicone. This implant has near to 0% of causing structural problem.

However, polyurethane cannot be imported to Korea. There is a complex reason for it.

3. What happens if the silicone gel breast implant burst? 

There still are some contents on the blogs and homepages of some individuals that if the silicone gel breast implant bursts, the silicone gel leaks and goes into the blood or lymph circulation causing various types of sickness.

These contents do not have any logical ground. There are some people who think that if they eat snakes, their body becomes more flexible. However, science should not be based on likelihood. There must be a solid reasoning behind any explanation. Also, there are no proofs or facts that the silicone gel goes into the circulation and that the silicone causes any illness.

There is still some coherence in the leaked silicone gel so the gel stays together. Also, the gel remains in the epithelium so there is no possibility that it enters the circulation.





If the silicone gel gets damaged, then the shape of the implant changes slowly causing the shape of the breast to change over time. If this change is observed, then it is recommended to take MRI or ultrasound test to get a confirmation on the damage and them replacing the old implant with a new one. Silicone gel breast implant does not get damages as easily as the saline type.

Today’s post was answering if the silicone breast implant is safe or not. I hope the post helped you out. Thank you very much. Have a nice day.

When I meet patients for breast surgery, there are many frequently asked questions and there are some facts that the patients do not know well enough. I would like to post on these one by one.

Also, I would like to set facts straight, especially those wrong information on the internet.
If any of you have had thought about having a breast augmentation surgery even once, I am sure that you will be able to have more structured knowledge and have good interviews with the surgeons.

Breast Surgery To Know List 1. Knowing your body

The most important part of your body in breast augmentation surgery is the shape of your upper body.
When you interview with the doctor regarding the breast augmentation surgery, the whole process is a matching process that includes the implant and your upper body.
At times you may think that since “I am tall, I need a large implant.” However, the height of a person and the implant does not have any relationship.

First of all, we need to analyze the upper body then decide on the type and volume of the breast implant. Also, we need to go over some precautions before the surgery.




First thing that we check is the breast and the cortical organization – mainly how much of the subcutaneous fat and mammary glands you have.
In putting this in easier terms, we look at how thin you are, how much fat you have, and how big is your current breasts.

This is the most important factor in having a breast augmentation surgery. If the fat that surrounds your upper body is thick, then one will not be able to make out that you have an implant and there is less possibility of after-effects as well.

In opposite, if you have less fat then, one will be able to make out that you have had an implant. Also, there would be bad side-effects.

There is a paradoxical aspect here.
If you have thick upper body that means that you have a large breast. If you are a person with such body, then you might not need a breast surgery.
However, if your upper body is thin, then you would have small breasts, and may need a breast implant, but, this implant may not be good for you.




There are some people who say that “the rich get richer” and “the poor get even more poor” about plastic surgery. In some aspects, this applies to breast augmentation surgery as well. If you have a large breast then it is advantageous to have a larger implant. If you have small breasts, it is less advantageous for you to have large implants.
Those with asymmetric breasts need to be aware of this.

If your left breast is larger than the right, then a larger implant will go on the right and a smaller on the left.
However, in reality, a larger implant can be put into the larger breast (left) but the smaller breast (right) will not be able to take in a large sized implant.
An implant goes into a very closed and tight space therefore, the implant can be folded, or look unnatural.




A lot of the patients set a larger breast as a standard and think that “I might have to put this big implant.” In such case, a much larger implant needs to be used for the smaller breast.

If you want to lessen the possibility of side-effects then, you must consider the smaller breast as the standard one. First, you need to decide on the implant size of the smaller breast, then decide on the larger breast so that the two breasts look more natural and to minimize the side-effects.

Next, we need to consider the bones of the upper body.


Bones on the upper body are important because it becomes the framework of how your fat/skin is laid out. Therefore, it is important to see how the overall frame is shaped.
If the both ribs are shaped inwards, so that the breastbone sticks out, we call this a bird chest. The problem with the bird chest is that if we out in the implants, there is a high pressure in the center of the body therefore, the implants can be forced outwards looking far apart.

The number 2 ~ 4 ribs stick out so the upper body may look very thick.




If the breastbone is too low, we call this funnel chest.
The implants in a funnel chest act differently than the ones in the bird chest. The implants mover towards the center and make your breasts too large causing a problem.

As you can see, the cause of the asymmetric breasts is the shape and size of the ribs.

The surgery procedure will differ according to the shape of the upper body bones therefore it is important to check on the upper frame.


Third, we need to check on the location and the location and the placement (proportion) of the nipples.

This is one of the most common factors that I check when I analyze the breasts or upper body shape.
The core objective is to look at the upper body proportion.

All beauty surgeries are successful if the upper body proportion is good. The surgery becomes more difficult if the upper body proportion is bad.

Let’s call the middle inward part of the two collarbones, #1, and call the nipples on both your breasts #2 and #3. When you link the three points, you will be able to see a triangle.




If this shape is close to an equilateral triangle, then we can say that you have a good proportion.
If the triangle looks like an isosceles with tall height, then you might be having sagging breasts.
In such case, we need to select appropriate implant and plan the surgery accordingly.

If the triangle is wide, then the breasts are far apart, so we need to have surgery that will place the nipples closer or recommend short type implant such as water drop implant.

Fourth, we need to consider the skin elasticity of that which surrounds the breasts.

The size of the implants depends on the skin elasticity. If the skin is elastic then we can use a larger sized implant. In opposite, if the skin is less elastic then it becomes difficult to use a large sized implant.

Usually, as you age, or after you give birth, you skin becomes more elastic. Those in 20’s and 20’s would have tighter skin.


Today’s post was the first one for “Breast Augmentation Surgery – To know list”. If you have any questions, please feel free to ask me.

Thank you for reading. Have a great day.

Pectus Carinatum Breast augmentation Surgery 

I have personally analyzed statistically that there are about 12~16% of those with Pigeon chest. This is rather a common form of chest cage.



Pigeon chest is when the chest cage is roundly shaped by ribs, and breastbones. We call pigeon chest medically pectus carinatum.

The shape is formed because costal cartilage and breastbone stick outwards. A bad case of pigeon chest comes with scoliosis but there is almost no case where pigeon chest leads to respiratory problems and therefore, this is not a type of illness.

I use the term pigeon chest on a situation where the middle part of the chest sticks outwards and does not look pretty or good physically. Of course, there are many with pigeon chest who receive a breast augmentation surgery.

In most cases of pigeon chests, there are situations where the breasts look far apart from one another. This is due to the location of the nipples that are far apart.
Also, if the upper body sticks out, there the breast augmentation surgery does not lead to a natural look but there might be a bad case of bad looking upper block.

Difference between normal chest and pigeon chest

So, we mostly recommend water drop shaped implant for the pigeon chest breast augmentation. This is more effective for the upper block. Also, it is not good to use a large volume implant. There is a high pressure on the mid part of the chest, therefore, physically there would be more pressure on the chest if the implant is larger therefore, causing a push outwards, making the breasts look even more far apart.

Therefore, you need to be more conservative in selecting the implant size and to select water drop shaped implant.

Breast augmentation for Pigeon chest

There are cases where the chest from top to bottom comes out for where only the upper part sticks out in pigeon chests.

In the former case, the breasts look far apart, and most of the patients who come in for an consultation know that they have pigeon chests.

For the latter, the breasts do not look wide apart, and there are many of those who do not know that they have pigeon chests. If a surgeon is unaware of the bird chest and just conducts the breast augmentation surgery with normal sizing and implant, then there might be a bad upper block on the chest.







So there are at times when I have difficulties when consulting. The chest look different from a normal person but this is not something abnormal. This is just s characteristics of the chest. This is something similar to a nose surgery. Your nose might be a little closed or lifted. The surgeon must select the type of the implant according to the type of the chest and decide on the surgical procedure. However, if the patient does not accept the characteristics of her chest and accept it, then we might have difficulties in proceeding with the breast augmentation surgery.


I talked about percentage earlier on, but there are many of those who have costal cartilage and breast bone that stick out. This is not something abnormal. It is important to plan out the breast augmentation surgery according to the shape of the chest to have most effective results.




This is for today. I hope you understood the contents. Have a nice week.
Thank you very much.

Passion to protect the patient’s rights

KIES-U Realtime Surgery Monitoring System

Q. Today we will be interviewing with Kies-U’s Doctor Lee about a unique real-time monitoring system in the surgery room. Hello Doctor Lee.

A. Hello.

Q. There is an issue about people playing with implants, cutting cakes, and having a party inside a surgery room in one of the plastic surgery clinics in Kangnam. Does this happen quite a lot in the surgery room?

A. I have read that news as well. I think something this ridiculous happens for a reason. A surgery room is a much closed environment, therefore, people inside the room think that they think it is ok to be by themselves in the room and do anything. A surgery room needs to be closed for the safety and hygienic issues of the patients, but to think that anyone could do anything that they want inside this room is a very serious issue.

Q. You can do anything in a surgery room that is a closed environment… this is rather scary. What do you think about a “shadow surgeon” issue?

A. Shadow surgeon, by the words themselves, means that the doctor is just a shadow without a face. There is a doctor who does an interview with the patient and there is another doctor who does the surgery. However, the patient does not about this so it is unethical to have a shadow surgeon and another one who interviews the patients.

KIES-U Realtime surgery monitoring system

Q. After listening to you, it seems that there is a relation between the shadow surgeon and people have parties in the surgery room that these activities are happening in a closed environment. Is it alright for me to understand that you have made ‘real-time monitoring system for the surgery room’ in order to prevent such activities?

A. A surgery room needs to be a closed environment in respect to safety and hygienic status for the patients, not anything more. The trust between the patients and the surgeons, the hospital and the family members of the patients is at the bottom. I think that the related members of the patients need to know what is happening insider the surgery room in order to recover the trust between the doctor and the patient. The best method to do this, is making it possible for the relative members to see real-time activities in the surgery room through wifi connection. As a result, the relatives will feel secure. They will be able to see from the anesthetic stage until the patient comes out from the room. They will be able to check if the patient is being treated properly or not, and if the surgeon and the nurses are not doing anything inappropriate. Therefore, I think that the real-time monitoring system in necessary.

Q. Do you feel uncomfortable if you think that someone is watching what you are doing behind your back?

A. I have done many surgeries with other doctors on site who ask various questions and I provide answers and description of the surgery to them. The relatives of the patient have the right to check and see if the patient is being treated properly therefore, this is not something that is uncomfortable to me. 

Q. Thank you very much for the interview Doctor Lee.

A. Thanks a lot.

There are many of those who have difficulty on deciding where to do the incision for the breast surgery.

Today, we will look at how you can make such a decision according to different situations.

Breast Augmentation Incision Options,

How to decide the incision site on Breast augmentation

1. Breast size 

If the breast size is rather small and if you are young, it is difficult to know about the breast anatomically. This is where the areola is very small also. For those who are in such a situation, the choice is limited to arm pit or belly button.

In opposite, if the breast size is rather large, then it is easy to know about the breast anatomically. The areola is clear to see. In such case, you do not have to worry about the scar wherever the incision is done.

If you want the incision on the areola but you have a narrow one, then we need to conduct the surgery from the arm pit or the bottom line of the breast.

If you want the incision on the bottom line of the breast however, if the line is not clear enough, then we need to conduct the surgery from the arm pit of the areola.





2. Revision

If we need to do a revision, then we need to fix the problem cause in the first surgery. If there is inflammation, problems with structure, rotation, position, etc and need second or third revision, the surgeon must have a good view of the overall surgery so that there aren’t any further problems caused and also for the surgeon to see and check if the problem has been fixed.





The location for the best possible view of the surgery is the bottom line incision. I recommend bottom line incision for the revision. If bottom line incision cannot be done, then I would recommend the areola.

If it is a simple revision, for example, if you just want to change the size of the implant, we can use endoscope on the arm pit. But most of the revision is required because 90% of them are due to severe problem.



3. Sagging breast

The difference between the sagging breast and other breast surgery is that we need to put the implant from the upper part of the breast and set initial prevention so that there is no wrinkle or double bubble line formed.

We need to conduct bilayer surgery in order to solve such as problem, and also use secure water drop shape type.



Also, such bilayer, water drop shape implant is most effective for the bottom line incision.

Bilayer level is differentiated according to how much the breast lags as well. In order to align the symmetry, and side effects, the surgeon must have 100% visibility. This visibility can be found from bottom line incision, and the procedure can be accurate and delicate as well.


4. Location of the scar

If you do not want to see the scar while you are lying down, then the incision at the bottom line should be avoided. If you do not want to see any scar around the areola, then the incision on the areola should be avoided as well. Also, if you are a model who takes a lot of photos, or are a fitting model who needs to wear sleeveless clothes, then you might not want the incision on the arm pit as well.




5. Large water drop shaped implant vs Small sized implant

Water drop shaped implant is very secure meaning that it is agglutinable and strong. If you have a small body but use a large volume implant, the implant would tear much of your skin when the surgeon puts it in. Such trauma causes a lot of bleeding and can be a cause that changes the structure or the location of the implant in the long term. If you want to avoid such a problem, then the best place for the incision would be the bottom line.

However, if the size of the implant is small, then none of these would be a problem. We can do the incision on the areola or arm pit or any other place that you want.



6. Size of the areola

If the Cohesive gel implant is to be successful, the diameter of the areola has to be about 2.5 cm. For saline bag implant, the size does not matter.

But if you want to use securely shaped water drop type implant, the process of putting in the implant is difficult, therefore, the areola’s width has to be bigger. If you have a naturally small areola, then it is advised that you do not do the incision on the areola for the water drop type implant.



7. Recovery period

If you want to get back to your normal life quickly after the surgery, then bottom line incision is recommended. The periosteum does not get damaged during the peeling stage so there is less pain and the surgery duration is very short so we do not need to use much of anesthesia. You can also recover mentally quickly as well and you do not feel awkward or bad after you wake up from the anesthesia. Athletes who perceive the recovery period to be important prefer the bottom line incision the most.

Before & After breast augmentation surgery [KIES-U Korea]

We looked at the various considering factors of each of the incision locations. On the internet, we can only refer to the advantages and disadvantages of the locations and the context seem like a reading from a textbook.

So this post looked at different situation and the appropriate incision locations. I hope such details would be able to help you out more.

Have a great day, thank you for reading.

This is a second post on the new trends in plastic surgery for correcting those who are aged between 20~30’s and look older compared to others to look younger.


There are many cases where we do V-line correction for those who are young with double chin.

For example, if you see Son Dam-bi’s (South Korean singer and actress) chin line, the angles are very clear and there is a sharp looking line between the chin and the neck. In order to have such a sharp line, the border between the chin and the neck must be very clear. The angle needs to be clear and the lower face needs to be definite to look pretty.

As you age, this part of the face becomes less clear. This is due to the drooping skin.

Double chin