How to get a pretty nose  - asian rhinoplasty Korea

I am sure that there are many ladies who want to make their nose look pretty.
I would like to discuss about the “Mona Lisa line (Dorsal aesthetic line)” of the nose.

How to get a pretty nose job - asian rhinoplasty Korea

There are few questions that a lot of the patients ask.
How big silicone do I need?
Do you use septum, ear, or costal, here?

It is difficult to plan out the nose surgery while answering the questions above. Our nose is 3D therefore, it is difficult to answer one dimensional questions such as how high should the nose be or if it is Barbie doll(Curved line) nose job?
One must look at the nose in 3 dimension and design accordingly. Silicone and cartilage are used, and one must consider the side line and other dimensions as well.

Before and after nose job - asian rhinoplasty Korea

People look at the nose from 45 degree angle, from the front and from other various angles. Barbie doll(Curved line) nose job does not give full explanation in 3 dimensional aspect.

As I have stated below, I refer to the Mona Lisa line (Dorsal aesthetic line) at first. The core purpose of the nose surgery is to make the nose contour or line very clear and smooth.

Ideal dorsal aesthetic lines run smoothly from the brow to the tip of the nose

If you want a pretty looking nose, then you need the Mona Lisa line. All pretty people have this Mona Lisa line (Dorsal aesthetic line) on the noses.




But there is one thing that you need to remember. The nose starts from the eyebrows and downwards. Also, the nose tip needs to be aligned with the lips

If I have low forehead, then I cannot make the bridge thick.
If I have protruded lip then I need to have my nose higher than it is.

Therefore, I personally think that the nose surgery needs to “balance all the dimension of the face.” Many think that the nose job surgery is something artistic like sculpture or something similar, but I see it as something similar to architecture instead.

There must be a balance, harmony with the surrounding environment, and it cannot lose its structure. These all seem more like architecture.

Thank you for reading.

Breast augmentation Korea KIES-U



I recently saw news on “Increase in number of breast surgery side effects: Damaged breast implants”. I would like to share on this topic of damaged implants.

Let’s look at an example of a tire.



A reporter took a Bridgestone tire, randomly, and used a rolling mill on it.  He rolled 5 tons on the tire. There is no puncture.
If this reporter reports that the Bridgestone tire does not puncture after this experiment, and also add that the tire only punctures by the fault of the driver, how would a typical driver feel about this report?

The news showed an implant bursting because someone put much weight on it. When a 700kg object was placed on the implant, it burst. If the news reported that the implant does not have any problem on itself and that follow-up management is the problem.
As you can imply from the example on the tire, this too is not logical.

However good the tires are, if you use the tires for 5 to 10 years and go on-road or off-road, one of the tires can be punctured. This is not because the Bridgestone tire is bad or because the driver is a bad driver.
The conclusion should be something as the following. The tires have usage life as well. You need to manage it properly but if there is a problem with the tire, you need to get it repaired or even change the tire. This is what we all know, and what we do.



Breast implants are made by men too. God did not make it. Some company has made it. Artificial heart, pace maker, artificial bones / arteries are some of man-made things that we use today but these things do not last forever. They tend to break down at some point in time. Although many pre-launch experiments had been perfect, one cannot say that the product will not break down. No one would say that you do not need to worry about this product until you die. This would be a wrong thing to say.

There was a Korean drama last year in which the main actor lived with an artificial heart.




But this character has a problem with the artificial heart so he goes to the hospital to replace the heart. The operation is successful and the character lives happily ever after.

Just like the artificial heart getting damaged, artificial breast implants can be damaged as well. The extent of damage differs according to the makers of the artificial breasts.

The products are being upgraded and are made better than ever before. However, even God given original heart or breasts get ‘damaged’ as well, and so does these products. Not all man-made products can maintain its original form after decades. This is impossible.

You must know that these artificial implants can be damaged or leak substances within. The patients must hear such facts before any surgery and know that this is a possibility.

It is wrong to say that the silicone gel withstood 700kg of weight so it would not burst or be damaged therefore I can use the implant for my breast. This is absolutely false.

There are data on the damaged implants according to different types such as saline-bag, cohesive gel bag, smooth type, textured type and even by different companies. This data can be found in US FDA.
Also the data shows that the damage differs according to the body size of the patients. The life expectancy of the implants differ from a person who uses an appropriate size to those who used much larger implant compared to what is appropriate for the body.


Tear-drop type does not change shape but maintains the shape securely. If the implant changes shape easily or is too smooth, the damage rate can be increased.

All implants have life expectancy. Some can last longer than the patient’s life. I still have not seen any of my patients with damaged implant but in theory, it is possible that the implant can be damaged within a short period of time.

A lot of the patients are curious about the life expectancy of the implants that they used. But the reality is that we do not know this for sure. First reason is that the manufacturers do not provide data on this.



All the surgeons and patients was the implants to be new and maintain its original shape for a long period.


The 5th generation silicone gel implants that are sold today are much better in quality compared to the ones that were first sold in 2007. The possibility of damage, leak, capsular contracture have decreased but still, there is a possibility that the implant can be damaged.

Also, one must know that if the cost of the breast surgery is very cheap, then one must doubt if the surgeon is using bad quality product or not. A proper breast surgery cannot be done with low cost.

A patient from China needed a re-surgery on her breasts. The implants that she used previously did not have any brand mark on it. (I had to doubt what I saw but there was absolutely nothing on the implants)

A Korean patient went to Thailand and got cohesive gel implants but she too needed re-surgery. I asked her how much did it costs to get this done in Thailand. The price was lower than what one could even think of. I could not understand why she had gotten this procedure in Thailand. The implants could be in the body forever, so I could not understand why she was less careful about the whole procedure.

I think that the 5th generation silicone gel implants are safer than ever before. If a properly trained surgeon uses such products, I believe that 99% of the cases would avoid any problems.

This is all for today. Thank you.

Taking care after the breast augmentation surgery 

There are many patients who ask me what to do after the breast augmentation surgery and so I would like to answer this question today with this post.

A surgery must be done perfect so that the patient does not have to do much after-surgery management.

But the body is complex and different from one person to another and also some implants might have problems even before using. There are many variables so it would be good to know that you need to carefully take care of your body after the surgery.

1. Breast augmentation after care massage

Before, we used to think that massaging was a “must”.
Massaging was only for those body parts that used implants, especially the breasts. The main objective of massaging was to make the breast more soft.



Massaging in other words could be described as enlarging the non-surgical epithelium.
This would be to push the implant from the outside so that the epithelium opens up in order to make the implant move more easily.

But, epithelium is not something that is bad, and it is necessary for the implant to be secure at its original position and also it is something unavoidable.
Also, enlarging non-surgical epithelium is disregarded today.
If you look at the textbook of breast surgery, you would not find any details on massaging. This is not necessary any more.
I, too, do not provide massaging to my patients unless there is some special case.

2. Removing stiches, dressing 

Where ever the incision was, there is an entrance of the implant and this entrance needs to be closed properly and dressed properly as well.

It is good to close the incision from the outside, but the trend today, is to use the thread that dissolves inside the derma and use adhesive gel on the outside.
We cannot say which is the better method of the two because each has its own advantages.

I usually put sutures because I think that this is the most comfortable method for the patient.

Do not forget that there are no differences in the wound or scar with the two different methods. Scar is not an important factor in deciding which method to apply.
Putting sutures is to make the patient more comfortable. It would save the patient coming to the hospital and allow her to shower freely.
Sometime we apply taping so that the implant places itself properly and securely. This taping loses stickiness after 3 to 4 days so we remove the taping after so many days.

3. Compression garments breast augmentation

Corrector bras are used commonly in order to secure the position / location of the implant during the earlier stages after the breast surgery.
The important thing is that the implant does not move about to different location but maintains the appropriate position. You do not need to use the corrector bra.

But some special cases require you to use the corrector bra. If you have bird chest or have problem with the thorax, you might be required to use the corrector bra.

4. Managing scars 

The epithelium is formed 48 hours after the stitching leading to water tight closing. The recovery from the scar takes about 3 to 6 months.
If you look at the scar for a month, some might see red swelling.
If this is you, it would be better to leave it as it is.
This red look might change its color to brown after 3~6 months.




The tissue around the scar generates leading to scar remodeling. This takes about 2 to 3 years. There are many procedures that we can take during this period for better recovery.
I will add more details regarding this in the future posting.

5. Ultrasound 

There are many things that we check for when doing the ultrasound test on the breasts.
If there is blood between the implant and the skin?
If there is any other seroma?
How thick is the epithelium? Is it very thick and white? (Capsular contracture)
Is there any problem with the implant? (leak, damage)
Is the implant properly positioned? (Rotation, change of position)
The good thing about the ultrasound is that the patient feels no pain and she can do this test any time she wants.



Ultrasound test is subjective and it cannot accurately make out if there is a damage on the implant.
You need to do MRI to see if there is a damage on the implant but this is too expensive therefore, many patients take ultrasound tests.

 6. High frequency 

High frequency is used to send heat to the deeper layers below the epidermis. It is used to control the pain.
This is used in orthopedics for physical treatment. High frequency sends heat making the blood circulation better and makes the breast with implant feel better as well. If a patient feels pain after the surgery, we apply the high frequency as well.




There is no preparation necessary for high frequency therefore it is comfortable and frequently requested by the patients. If there is no problem with the recovery then you would not need this.

We have looked into few measures that you can take after the breast surgery. A patient might require some treatment but the doctor needs to check on the status of the patient and decide what to do.
Thank you for reading.

Breast implant placement : Under and over the muscle or Dual Plane

If you are aware about the breast implant placement, then you know just about 90% of what the breast implant that we use for the breast surgery is.

When I talk to many patients, they ask,

“How large (cc) implant do you use?”
“Do you use the round type or the tear-shaped?”
“What is the incision location?”

But rarely do they ask about the placement of the breast implant.

If someone does ask about the plane, she would not ask about the differences in the plane and why such differences exist.

I have always been wondering how to communicate this to the patients easily and clearly.

So, I decided to draw an image.

Below is the explanation.



 


As you can see above, if the breast implant is located over the muscle, you are able to feel the implant. This can be easily felt with the thin patients relatively more so than those who are not thin.

Then why do we put the implant over the muscle? There are many advantages. The implant, itself, pushes up the fat so the breast looks bigger and prettier. Also there is no pressure from the pectoralis, so the implant would not be moved to another location.




We usually put the implant under the muscle for the thin patients. You would not be able to feel the implant in this way however, the muscle tends to push on the implant. As time passes, there are few cases where the implant moves up and changes the location.



Dual plane surgery takes on the advantage of the over muscle and under muscle surgeries. We cut off the muscular fiber and put the implant at the top of bottom of it.



In doing so, this would lead to the separation of the pectoralis. Some people worry that this causes no movement of the arm.
A body builder had the same surgery. She was able to lift weights after the surgery without any problmes. You do not have to worry about the muscle functioning.




Dual plane breast augmentation causes no pushover of the implant, and you cannot feel it either.

I hope this has helped you understand what the whole process it. Dual plane breast augmentation has least number of side-effects and is a very good method.

If you know about this, then you know almost everything about breast surgery. This is the most important part of the breast augmentation surgery.

Thank you for reading. Have a great day.

Textured silicone breast implant use in primary augmentation 

Academical findings do not stay fixed but the details are changed as new findings and results come out. So the doctors pay careful attention to the new findings.
The doctors who do not study would not provide outmost result to the patients.
Also, science is something that “you might think correct, but can be mistaken”.
Medicine is a part of science.

Below is an article, released on January 2015, on “Textured silicone breast implant use in primary augmentation core data update and review"





It is stated that in 2013, there were about 290,000 breast augmentations done in US. This figure comes from American Society of Plastic Surgeons, so maybe the actual number may be greater. One of the most popular plastic surgeries around the world is breast augmentation.

The most common side-effects of breast augmentation are
Contracture, moving location, refilling, seroma, etc

Why is a contracture?

There are various reasons but the most commonly stated one is that the strain around the skin and the breast tissue comes in contact with the implant and this contaminated implant causes infection within the pocket.

How does textured implant minimize the contracture?

In theory, the texture physically breaks down the epithelium tissue, leading to the breakdown of the collagen fibers and reducing the epithelium. This is what we currently understand. 
(But using textured does not mean that you are completely free from the contracture)

What can you do if there is a contracture? 

The most effective method would be to cut off the epithelium. The epithelium incision would reduce the muscle tension so the cell that makes the epithelium would not grow and therefore not survive. 

Does the appearance of the textured implants differ according to different products?

Yes, they are different. The most widely used on is Allergan’s textured salt loss technique which leads to deeper and more textured surface.
Mentor’s textured uses imprinting technique which makes the surface little thinner and smooth. 

Does the anatomical type lead to less contracture?

Yes. The 5th generation tear-drop type implants have strong exterior with strong agglutinability on the inside therefore, it causes tension with the breast tissue and sticks together more firmly leading to lower possibility of contracture.

There are many who thinks that the tear-drop implant feels better.

Tear-drop type implant feels better because the implant / breast / epithelium all move together naturally. 

But the smooth type implant is relatively more separated from the epithelium therefore when you touch it the implant seems to be separated from the skin. 

(This comment does not apply to all patients. This applies more to those patients who gave birth) 




Some say the refilling is more common with textured type

There is still not much reference for this. We are short of data on this. 
The type of the implant do not matter, but thinner patients have higher possibility of refilling than those who are not.
Also there are some who say that more texture implants lead to more refilling than the smoother ones.


Then which type shall I use? Textured or smooth?

It is said that textured minimizes contracture and also limits rotation and movement of the implant. However, there is a higher possibility of seroma and more texture it is, there is higher chance of refilling as well.

I tend to use the textured implant more.

As a surgeon, it is more relaxing for me to use an implant that does not move or rotate easily.

Today, we share a little about the textured implants.

Thank you for reading.