Q: I wish to undergo plastic surgery on my deep wrinkles around my eyes and smiling lines. What procedure is best suited for me?
A: Current advances in the field of plastic surgery contribute to the increasing options of rejuvenating periocular beauty area. Popular procedures are, for example, neurotoxin injection (botox) and hyaluronic acid filler injection. Other options include the use of PRP (plasma fluid taken from your body) to reduce wrinkles around your eyes. A method currently studied by plastic surgeons around the world is fat graft (transferring fat tissue from another site of your body), which has attained a place as the “definitive therapy” and requires no additional interventions. Crow’s feet (wrinkles on the side of your eyes) removal can be done by eyelid surgery. Deep wrinkles in smiling lines can also be managed by fat graft and hyaluronic acid injection.
The benefits and disadvantages of each procedure can be discussed during in-depth consultation with your plastic surgeon. To decide on what’s best for you, a plastic surgeon will need to consider other information including your age and facial appearance as well as its dynamic aspects when you make a facial expression.

Q: Areas around my breasts look unfirm and flabby. Is there an instant and painless way to solve this problem? How long will it take to recover after the procedure?
A: If the “areas around your breasts” don’t refer to your breasts, it is hard to ascertain your problem. Additional data on your age and other complaints may help in further understanding your condition. For complaints on your breasts, you can refer to many sources on how to fix them, with further confirmation from your plastic surgeon.

Q: Is there a specific therapy for body shaping, particulary on areas such as thigh and waist? I feel uncomfortable with the fat around that area.
A: Your direct question indicates that you know the ins and outs of aesthetic plastic surgery quite well. Your discomfort can be managed by liposuction procedure. However, you should remember that this procedure is aimed to refine body shape in areas of fat deposit not caused by obesity, not suitable to reduce body weight.

Q: I recently read an article which discussed “slim liposuction”, and I am interested in trying the procedure. What is the difference between “slim liposuction“ and “smart liposuction”? Is this particular procedure more effective than other liposuction procedures?
A: It is interesting how a vast array of information, especially in the field of aesthetic surgery, floods the society. Furthermore, the information is often advertorial in nature. It is no different with what you inquired. “Slim liposuction” and “smart liposuction” are actually the brands of equipment used to help a plastic surgeon in accomplishing liposuction procedure. Both are liposuction equipment which work with the help of laser energy. There are several technical differences, but basically the success rate on a liposuction procedure depends heavily on the surgeon’s skill. It would be best for you to inquire your surgeon directly when you discover that he/she uses this equipment.

Q: My bra size is 32 cup A. I wish to have a bigger breasts. What size is suitable for me and won’t cause back pain? Is it too excessive for me to increase to size D?
A: The ideal size of breasts depends on each woman’s body size, as well as her perception of beauty. Breast enlargement through augmentation procedure usually doesn’t enhance more than 2 cup size. Thus it is would be reasonable to enhance your breasts to size C.

Q: I’ve heard that keloid can’t be avoided. I am among those who have a predilection toward keloid. Two years ago I underwent an appendectomy and the scar became keloid. I want to get a breast augmentation procedure but I’m in doubt since I don’t want to have any more keloid. Any suggestions?
A: I understand your concern. However, based on my clinical experience, people often mistook an unattractive scar for keloid. Keloid is actually an extreme condition. For example, a piercing wound on your earlobe which turns into a scar the size of a meatball or even a tennis ball. Therefore, it is best for you to see your plastic surgeon to evaluate whether your scar is actually a keloid. There is a lot of factors which influence the forming of keloid, genetics being only one of them. A lot of people who have keloid on their body can still undergo surgery without suffering additional keloid on their surgery scar.

Q: I feel bothered by my smile line. Although it is not easily noticeable when I look into the mirror, I feel that it makes my face looks gloomy. Can botox injection solve my dilemma? The problem is, I am only 26 years old. Am I still too young to undergo the procedure? I’ve heard that botox injection is only meant for obvious wrinkles.
A: Botox injection is indicated not only for those who are middle-aged or older, but also younger people who have a particular problem that can be solved by botox. This injection can be given to manage children with rigid extremities due to central nervous system disturbance (such as cerebral palsy). For problem with smiling lines, botox can help on selective cases. Considering your complaint about a gloomy appearance, it is possible that the problem is caused by your mouth muscles’ function. A younger age is not generally accompanied by deep smile lines, therefore botox won’t be of much help. To decide on the best management for you, a plastic surgeon will need to evaluate your facial expression in both a static and dynamic state.

Q: I’ve heard that laser is the best procedure for vaginoplasty and labiaplasty. Is it true?
A: In my opinion, it is not true. Vaginoplasty and labioplasty can be done properly without laser. Laser is actually a decent device for surgery, especially in creating an incision, and generally cause less bleeding. Even so, the technique of minimizing bleeding is a daily work of a plastic surgeon, who regularly work on facial area, a region of our body rich with blood vessels. Hence, laser is not a replacement of conventional surgery, but rather an alternative. Of course, the consequence of laser use is the increase in budget. Moreover, the outcome of surgery heavily depends on the assessment and skill of the surgeon, apart from the methods and equipment used.

Q: Am I allowed to undergo a blepharoplasty procedure after a LASIK procedure?
A: Yes, a blepharoplasty can be done after a LASIK procedure. Nevertheless, it would be good not to hurry to undergo a surgery procedure. It would be best if the post-LASIK healing process have reached the optimum duration, generally after 2-3 months.

Q: When is the best time to have breast reconstruction surgery? Can breast malignancy recur after breast reconstruction?
A: This is an excellent question since this issue is rarely discussed among layman people. Reconstruction procedure after breast tissue removal due to malignancy can increase the quality of life of the patient. Doctors and patients have usually agreed to perform immediate reconstruction (reconstruction done at the same time of breast removal). From the perspective of medicine and patients’ preference, immediate reconstruction is more preferable, making it a trend for the last 10 years. Another option is to perform delayed reconstruction, in which reconstruction is done at a later time.
About recurrence, there is no significant difference between immediate and delayed reconstruction, or between patients who undergo reconstruction surgery or not. As long as the treatment plan goes well without considerable complication and the patient complies dutifully to the treatment, the treatment outcome is generally fine. To read more on breast reconstruction after breast removal surgery, you can read the article here.

Q: Is there an alternative if I want to remove smile line wrinkles without surgery?
A: Of course there is, as long as it is feasible according to your plastic surgeon’s judgment. Fat transfer or hyaluronic acid filler can help for certain indications; the same goes to Botox injection. Fat transfer is a fine option, but unfortunately for this procedure you would have to undergo surgery, although it may only need local anesthesia. Filler and Botox are nonsurgery options.
For more information on hyaluronic acid or dermal filler, you can visit this article.

Q: Please explain to me about liquid silicone injection. Is it banned in Indonesia? If so, why are many people still using this procedure? What is the negative effect it may cause on the breasts? Can it cause cancer in the future? Is there any risk for the baby if the woman is currently breastfeeding?
A: There was never any legal regulation prohibiting the use of liquid silicone injection in Indonesia. However, this procedure is not justified in the medical world. Although there is no report regarding its association with cancer so far, liquid silicone injection is responsible for many negative effects on the patients’ breasts, for example the presence of lumps of tissue mixed with silicone, breast gland and skin damage, and infection. The effect on breastfeeding babies is still unknown. Basically, if the woman can still produce breast milk, it means that there are breast glands and ducts which are not damaged. Theoretically, breast glands that have been damaged by silicone injection can’t produce breast milk.
Public’s knowledge on medical service is still limited. Liquid silicone injection is not performed in medicine. Usually layman people who don’t even have the authority to use a needle perform the procedure. Sometimes, they state a different name for the injected material; one which does not indicate liquid silicone (They often refer it to collagen injection, which is even worse when one does not have any prior knowledge on collagen and starts injecting it to others!). Unfortunately, victims of silicone injection often do not report such practice because they are usually ashamed and they fear that they may be exposed to the media. A continuous public education practice is required regarding this issue.

Q: What is a breast lift? Are there any requirements to undergo breast lift procedure? Are there any negative effects of breast lift? Is the procedure safe?
A: Regarding breast lift, you can refer to my article on the particular procedure here.

Q: I am 54 years old and just recently underwent facelift to tighten my face. It is quite satisfactory, since I feel my facial skin is firmer, with decreased wrinkles and laxity. Yet I feel that the effect doesn’t include my neck, since it is still loose and flabby. How do I manage this problem?
A: It is not easy for me to evaluate your condition without seeing it myself. Moreover, to evaluate the outcome of surgery, we should compare it with preoperative condition. Actually, the best answer would be one from your surgeon, since he/she is already familiar with 2 important aspects: the preoperative condition and the surgery method he/she has performed it to you. Hence, I suggest that you consult your surgeon again.
If I may assume from your complaints, you might need a non-invasive procedure that can be done 6 months after surgery, for example a Botulinum toxin type A injection, to manage your flabby neck muscles (if such problem does exist). Other alternatives are liposuction to remove excess fat (if any), or neck skin lift by radiofrequency or laser irradiation with a limited result. The last option would be a second surgery to address your neck, which is mainly a neck lift surgical procedure. For more details, I suggest you consult your plastic surgeon.

Q: My 13-year-old daughter has an abnormal ear shape. They are long and wide. Currently it is not a problem for her, but I fear that she will be ashamed with her condition when she grows up later. Is it possible for an ear repair procedure at her current age?
A: You should not let your concern drag on, since it may disturb your daughter’s psychological growth. You may discuss her condition with her and get her understanding to consult a doctor. Your daughter’s condition can be repaired at her current age, because the ears have reached their full size. The surgery consists of ear shape reconstruction to achieve a near-normal shape. The result is permanent. There are always risks in every surgery procedures. One example of them is infection, which may affect the outcome of surgery. You should see your doctor to get a detailed explanation.

Q: I am a 45 years old, and I’m starting to notice wrinkles on my forehead, the corners of my eyes, and upper lip. This bothers me very much, but I do not plan on undergoing a surgery procedure. What method can be taken to remove those wrinkles?
A: It is good to know what you need yourself! Facial wrinkles do not always need to be managed by surgery. The best method is Botulinum toxin type A injection. Wrinkles are the result of contraction of facial expression muscles, which has been going on for years. The injection works by obstructing contraction of these muscles. Wrinkles will be removed approximately 1 week after the injection.
You also need to know that the effect of this injection only lasts for 4-6 months, after which you may repeat the procedure. Practically, the injection is perfect, provided that a competent plastic surgeon or dermatologist performs it. Botox is also acceptable for long term use.

Q: Is it allowed for a woman to get pregnant again after undergoing tummy tuck or abdominoplasty procedure? Is the skin not at risk of getting damaged if it is stretched, particularly during the later stage of pregnancy, since some of the skin has been removed?
A: Of course she can, as long as the wound caused by the procedure has gone through enough healing time (at least 1 year after the surgery). Enough healing time means that the wound has “matured”. In that particular condition, it is hoped that the skin and fat tissue under the skin can be induced to expand slowly along with the growth of the fetus. There is no danger of the skin getting damaged, since the expansion process proceeds slowly. No special care is needed during pregnancy. To read more on wound healing, click here.
A woman may repeat tummy tuck procedure after giving birth if the skin becomes flabby again, generally 3-6 months or longer after delivery. It is not recommended to follow a false concept to undergo the procedure on the same day directly after giving birth. However, the skin may occasionally adjust itself to an acceptable firm appearance after delivery. Individual factor holds a great role in this.
Personally, I suggest that a woman think it through before deciding to undergo a tummy tuck. The best condition is if the woman does not wish to get pregnant anymore. But, should she and her husband decide to have another child, I suggest that she wait for 2 years before getting pregnant again, so that she can have enough time to enjoy the result of surgery she has gone through. Imagine if she had to get pregnant after only recently getting a tummy tuck procedure!

Still have unanswered questions about plastic surgery? You can send an email to teddyohp@yahoo.com or leave a comment below this page.

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