Author: drngsw

Breast Augmentation: Breast Fillers & Implants Surgery in Singapore

Breast - Anatomy Breast – Anatomy
  • Breast augmentation using implants has been an established procedure with a long historical record of safety.
  • It is the most assured and quickest way to achieve the desired breast volume.
  • The use of implants is one of the best breast enhancement surgery options available in Singapore.

SUITABLE CANDIDATES FOR BREAST ENHANCEMENT SURGERY

Suitable patients for breast implants include individuals with:

  • Mammary hypoplasia or Micromastia (small breast)
  • Significant breast asymmetry
  • Slight breast ptosis
    • After breastfeeding some patients experience significant upper pole breast volume loss. Suitably sized breast implant can provide some lifting effect and restoration of the upper pole volume loss.
  • Post mastectomy reconstruction

PROCEDURES DONE TOGETHER WITH BREAST AUGMENTATION

  • Nipple reduction
    • Enlarged, drooping nipples are commonly encountered especially after breastfeeding. However, many patients often neglect the importance of a matching nipple size when considering breast augmentation.
    • Nipple reduction is essential to achieve a harmonious result.
  • Mommy make-over – abdominoplasty combined with breast augmentation
    • It is common for women after childbirth to experience both deflation in breast volume and lax abdominal skin with stretch marks. Mommy makeover which is a combination of breast enlargement surgery (lift and implant) with abdominoplasty (tummy tuck) is a common request. This combination treatment provides significant rejuvenation effects to the entire torso.
  • Mastopexy
    • This is a surgery for patients with significant drooping of breast tissue. Breast implants can be inserted to provide additional volume and lifting effects.

WHAT DO I NEED TO CONSIDER WHEN UNDERGOING BREAST AUGMENTATION SURGERY?

  • Here are some of the most important factors to be considered:
    1. Size of the Breast Implant
    2. Type of Breast Implant: Saline vs Silicone
    3. Shape of the Breast Implant
    4. Surface of the Breast Implant
    5. Surgical Incision
    6. Placement of the Breast Implant
  • Based on Dr. Ng’s experience with Asian patients, the most common request is for teardrop shaped silicone breast implants, sized between 200-300ml placed via inframammary incision into the sub-pectoral pocket.
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1. SIZE OF THE BREAST IMPLANT

  • The size of the breast implant should be in proportional to body stature, height and chest circumference.
  • It is also determined by the width of the breast base, the amount of breast tissue and skin elasticity.
  • Placing excessively large implants will result in an unnatural appearance if there is insufficient tissue coverage.
  • During the consultation, you can try a variety of implant sizes to simulate the final outcome.

2. TYPE OF BREAST IMPLANT: SALINE VS SILICONE IMPLANTS

Silicone Breast Implant - Cohesive Gel Silicone Breast Implant – Cohesive Gel
SalineSilicone
Popularity
  • Less popular
  • More popular
Texture
  • Less natural feel
  • More natural feel
Shell Wrinkling
  • Common
  • Rare
Implant Volume
  • Adjustable
  • Fixed
Adjustment to body temperature
  • Adjust quickly
  • Adjust slowly (e.g. the implant remains cold for a longer duration after a swim)
Contracture Rate
  • Low
  • Higher
Leakage
  • Leakage causes complete deflation but safely absorbable
  • Leakage may cause local inflammation and granulomas, but much safer for modern cohesive gel implants

3. SHAPE OF THE BREAST IMPLANT

Round/ CircularAnatomical/ Teardrop
Profile
  • Dome shaped – less natural appearance
  • Tear drop shape – more natural appearance
  • Large variety of shapes based on different height and projections
Implant Orientation
  • Less crucial
  • Very crucial
Incision
  • More options for incision
  • Usually inframammary incision

4. BREAST IMPLANT – SURGICAL INCISIONS

Breast implant : Choice of Incisions Breast implant : Choice of Incisions
InframammaryPeriareolarAxillaryTrans-umbilical
Scar
  • Scar well-hidden within breast fold
  • Scar at areolar margin – may result in hypertrophic scars
  • Hidden in the armpit crease but visible when wearing sleeveless
  • Well hidden in the umbilicus
Accuracy of implant placement
  • Direct visualization of orientation of implant
  • Best accuracy for all implant placement
  • Reasonably accuracy of implant placement
  • More difficult to ascertain the orientation of implant
  • Least accurate placement of implant
Limitations on implants
  • No limitations
  • Limit choice of implant size if areolar diameter is < 3.5- 4 cm
  • Difficulty with teardrop shape implant
  • Suitable only for saline implant not for silicone implants
Breastfeeding
  • Not affected
  • Can be affected
  • Not affected
  • Not affected
Remarks
  • Most popular approach for tear drop shape silicone implant
  • May cut through breast tissue to allow implant placement
  • Risk of nipple numbness
  • Risk of skin numbness around armpits and upper arm
  • Difficult to lower inframammary fold if needed
  • Difficult and blind dissection
  • High or asymmetrical implant placement

5. SURFACE OF THE BREAST IMPLANT

TexturedSmooth
Contracture Rates
  • Lower
  • Higher
Implant Migration
  • Infrequent
  • Common
Shell Thickness
  • Thicker – maybe palpable
  • Thinner – less palpable

Polyurethane (PU) -covered implant – had a very low contracture rate, but has been withdrawn because of a carcinogenic compound from PU breaking down (although at very low levels).

6. PLACEMENT OF THE BREAST IMPLANT

Sub-glandularSub-pectoral
Diagram
Breast implant - Sub-mammary placement Breast implant – Sub-mammary placement
Breast implant - Sub-pectoral placement Breast implant – Sub-pectoral placement
PlacementImplant underneath breast tissue, above pectoris major muscle – is more anatomicalImplant underneath pectoralis muscles – is less anatomical
Suitable CandidatesFor patient with sufficient original breast tissue – result can be very naturalFor patient with very little breast tissue –pectoralis major muscle provides additional coverage to camouflage edge of implant.
Natural AppearanceMore natural appearance  if there is sufficient breast parenchymalBetter appearance for those patients with very little breast parenchymal
Capsular ContractureHigher riskLower risk
Nipple SensationMaybe affectedNot affected
Implant Size LimitationAllow larger implantImplant size limited by size of subpectoral pocket
Limitation of activityNot likelyChest muscles contraction may cause implant to shift laterally (“dancing breast”)
RecoverySlightly less painSlightly more pain
  • It is advisable to consult an experienced breast enlargement surgeon before proceeding with the surgery.

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DESCRIPTION OF BREAST ENLARGEMENT SURGERY PROCEDURE

  • Pre-operative sizing during the consultation :
    • Patient to try multiple implant sizes to simulate the final outcome.
  • Pre-operative screening includes a blood test and breast imaging (ultrasound, mammogram)
  • In a typical surgery via inframammary incision :
    • Pre-operative marking includes planning of the new inframammary fold and incision.
    • Incision at the new inframammary fold
    • Dissection to create space either a sub-glandular or sub-pectoral pocket for implant placement.
    • Insertion of the implant.
    • Meticulous wound closure in multiple layers.
  • Support bra are worn immediately post-operatively.

KEY POINTS IN BREAST FILLERS SURGERY

  • Accurate assessment of suitable implant size. The size of the implant has to be proportional to a patient’s body stature, height and chest circumference. It is also determined by the width of the breast base, the amount of breast tissue and skin elasticity.
  • Accurate placement of the new inframammary fold.
    • Most patients undergoing breast fillers surgery have insufficient breast tissue and tight skin envelope. The inframammary fold needs to be lowered to accommodate the implant to avoid a high riding appearance.
    • It is crucial to determine how much the inframammary fold is to be recited according to the implant size and elasticity of the native skin envelope.
  • Accurate dissection of implant pocket :
    • The size of the implant pocket determines the final appearance of the implant. An inadequately dissected pocket can cause rippling of the implant surface. Over dissection can result in implant displacement and synmastia (bilateral breast pockets communicating together with loss of cleavage).

ANAESTHESIA

  • Dr Ng prefers general anaesthesia for greater patient comfort and safety.
  • In order to create a sub-pectoral pocket for insertion of the implant, the chest muscles need to be relaxed. This may compromise the patient’s breathing capability if done under deep sedation. General anaesthesia is safer because continuous oxygen delivery to the patient is ensured throughout the surgery.

WHAT TO EXPECT POST OPERATIVELY

  • Home on the same day
  • Medication includes antibiotics, pain relief and medication to reduce swelling and bruising.
  • Support bra to prevent the implant from displacing laterally or riding high. The patient wears this bra for at least a month depending on the clinical outcome.
  • Back to work (non-strenuous) within 2-3 days.
  • Stitches (if any) are removed in about 2 weeks.
  • Breast massage:
    • Initiated from 2-3 weeks onwards to further improve the final appearance.
    • Usually the direction of massage is downwards and inwards. This may differ depending on clinical status.
  • Scar management:
    • Scar massage to soften the scar
    • Scar gel application to prevent scar thickening and reduce redness.
    • Photo Therapy to further reduce pigmentation.
  • Exercise:
    • Light exercise can be restarted after 1 month.
    • Avoid exercise that involved heavy usage of the pectoralis muscles for at least 2 -3 months.
  • Appearance of breast:
    • It is normal to expect swelling and tightness over the breast for the first 1-2 weeks. During this period of time the implant may feel more stiff and firm. The breast tissue covering the implants stretches over the next 2-3 months, the implants will feel softer and more natural.
    • Final appearance is usually achieved from 3 months after the breast enlargement surgery. 

RISK AND COMPLICATION OF BREAST SURGERY

  • Bleeding and infection are uncommon.
  • Infection is kept to a minimum by the use of antibiotics, good surgical techniques and having the surgery done in a sterile operation room.
  • Synmastia
    • Is a condition where both breast tissues were merged across the sternum due to over dissection during breast augmentation.
  • Low risk of implant rupture due to modern day implants.
  • Implant displacement
  • Seroma
  • Capsular contracture

COST OF BREAST AUGMENTATION

  • Breast reconstruction using implant post mastectomy due to breast cancer may be considered as a non-cosmetic procedure.

FREQUENTLY ASKED QUESTIONS

Are silicone breast implants safe?

  • Silicone breast implants have been used for several decades for cosmetic as well as reconstructive purpose. They have a good safety record despite being temporarily banned for cosmetic usage in the United States for possible association with connective tissue disease. This was found to be untrue and the ban was lifted.

What is the biggest implant for me?

  • The size of the implant has to be proportional to the patient’s body stature, height and chest circumference. It is also determined by the width of the breast base, the amount of breast tissue and skin elasticity. The placing of excessively large implants will result in an unnatural appearance if there is insufficient tissue coverage.

What is the length of the scar?

  • In most cases, the scar ranges from 3.5 to 4.5 cm depending on the size of the implant chosen. It would be unwise to place a very large implant through the narrowest incision – implant rupture during surgery rarely occurs. During the consultation Dr Ng shall illustrate this point.
  • Through a very small incision, the dissection of the implant pocket and the control of bleeding (haemostasis) is much more difficult.

Can I achieve a natural cleavage after breast augmentation?

  • During dissection of the implant pocket, it is conventional to keep about a 3 cm wide spacing of central chest tissue intact. This is to prevent over dissection which can result in the breast pockets from both sides communicating with each other (synmastia). This is a very difficult complication to rectify.

Do I need to replace the implants after many years?

  • The silicone implant theoretically can last indefinitely i.e. the silicone in the implant does not harden over time. As long as there is no significant capsular contracture there is no need to replace the implant.

What is capsular contracture?

  • The body naturally produces a thin membrane (capsule) around any implanted foreign object, this membrane normally remains thin and pliable. In some patients, significant scarring occurs in the membrane in this capsule, causing the whole construct to appear stiff and hardened (capsular contracture).
  • The severity of capsular contracture has been classified by Baker (1980)
    BAKER CLASSIFICATION SYSTEM OF CAPSULAR CONTRACTURE
    Grade INo palpable capsuleThe augmented breast feels as soft as an unoperated one.
    Grade IIMinimal firmnessThe breast is less soft and the implant can be palpated, but is not visible.
    Grade IIIModerate firmnessThe breast is harder, the implant can be palpated easily, and or implant outline (or distortion from it) is visible.
    Grade IVSevere contractureThe breast is hard, tender, painful, and cold. Distortion is often marked.
    Usually implant replacement is done for grade III to IV capsular contracture.

Can I breastfeed after breast augmentation?

  • Breast enhancement surgery should not interfere with breastfeeding as long as milk ducts are not cut. Other than peri-areoalar incision there is a very low chance of affecting breastfeeding.

Can I still do breast screening examinations?

  • After breast augmentation, cancer screening can still be performed using ultrasound, mammography, and MRI scan. There are special mammographic views (Eklund Displacement) available for better visualization after breast augmentation.
BOOK AN APPOINTMENT

If you are looking to undergo breast enhancement surgery in Singapore, SWENG Plastic Aesthetic and Reconstructive Surgery is the place for you. During your consultation, Dr Ng will explain the common breast enhancement options. He will recommend the most suitable breast enhancement surgery methods used by some of the top breast enlargement surgeons, including those in Korea.

Abdominoplasty (Tummy Tuck Surgery)

INTRODUCTION

  • Weight gain and post-child often result in excessive abdominal skin, fats and skin striae. Liposuction is useful in removing excessive fats in young patients with good skin elasticity. However for older patients with poor skin elasticity, liposuction may result in excessive unsightly loose skin.
  • Abdominoplasty (Tummy Tuck) is a definitive way to remove excessive skin and fat from the abdomen. It is particularly helpful in removing post childbirth abdominal skin excess with stretch marks (striae).
  • The rectus abdominis muscle (the 6 pack muscle) can be overstretched during pregnancy leaving a gap between them (divarication of recti). This gives the abdomen a very full appearance even if there is little excess fat.
  • During this procedure, any abdominal muscle separation (divarication of recti) will also be tightened (plication of divarication of recti), resulting in a flatter abdomen and more of an hour glass waistline.
  • To further improve the result liposuction of the abdomen can be done during the same surgery.
  • Occasionally abdominoplasty can also be combined with abdominal hernia repair. Abdominal hernia is a result of bulging of abdominal contents through the weakness of the abdominal wall.
  • Abdominoplasty is a procedure that can radically contour the abdomen at the expense of having a reasonably well hidden scar. There are many patients who cannot accept having an abdominal scar and who are willing to live with a less than ideal abdominal contour.

TYPES OF ABDOMINOPLASTY:

Conventional AbdominoplastyMini AbdominoplastyFleur De LisBelt Abdominoplasty
Diagram
Abdominoplasty - Conventional Tummy TuckAbdominoplasty – Conventional Tummy Tuck
Abdominoplasty - Mini Tummy TuckAbdominoplasty – Mini Tummy Tuck
Abdominoplasty - Fleur De Lis Tummy Tuck Abdominoplasty – Fleur de Lis
Abdominoplasty - Belt Tummy Tuck Abdominoplasty – Belt
PurposeRemoval of massive abdominal skin and fat; and plication of divarication of recti.Removal of minimal to moderate abdominal skin and fat just below the umbilicus.Removal of the massive upper and lateral abdominal skin and fat. ie. removal of vertical and horizontal abdominal excessRemoval of massive abdominal, hip and back excessive skin and fat.
IncisionAbove pubic hairline, slightly extended to the hip bones.Short incision above pubic hairline.Above pubic hairline, slightly extended to the hip bones and vertical extension upwards.Circumferential incision from front to back.
Umbilical RepositioningUmbilicus repositioned as the abdominal skin pulled downwards. Small scar around the umbilicus.Umbilicus left intact as abdominal skin pulled down. It may be separated from underlying attachment.Similar to Conventional AbdominoplastySimilar to Conventional Abdominoplasty
Associated ProcedureLiposuction of the love handles and upper abdomen for further enhancement of the abdominal shape.Similar to Conventional AbdominoplastySimilar to Conventional AbdominoplastyLiposuction and buttock lift

 

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CONCURRENT PROCEDURES

Abdominoplasty can be combined with the following :

  • Liposuction and fat grafting to breasts and face
    • Fat can be harvested using a syringe from the abdomen before abdominoplasty. The harvested fat can then be injected into the breast for volume enhancement and into the face for rejuvenation.
  • Mommy make-over – abdominoplasty combined with breast augmentation
    • It is common for women after childbirth to experience both deflation in breast volume and lax abdominal skin with stretch marks. Mommy makeover which is a combination of breast augmentation (lift and implant) with abdominoplasty (tummy tuck) is a common request. This combination treatment provides significant rejuvenation effects to the entire torso.
  • Abdominal Hernia Repair
  • Buttock Lift
    • Can be done with Belt Abdominoplasty
  • Thigh Lift
    • Can be done with Belt Abdominoplasty

SUITABLE CANDIDATES

Patients who have :

  • Excessive abdominal fat and poor skin elasticity.
  • Excessive abdominal skin striae (usually post childbirth).
  • Abdominal muscle laxity (divarification of recti) usually post childbirth.
  • Concomitant abdominal herniation
  • Completed family planning. Female patients who intent to become pregnant in future may decide to defer this procedure.

ANAESTHESIA

  • General anaesthesia

DESCRIPTION OF PROCEDURE

  • Pre-operative marking to determine incision and amount of skin to be removed with agreement of patient.
  • Liposuction of the love handles and upper abdomen for further enhancement of the abdominal shape (if necessary).
  • Excision of the excess skin and fat according to markings.
  • Plication of the divarication of recti (tightening of the abdominal muscles by suturing) if necessary.
  • Insertion of wound drains (plastic tubings) near the pubic hairline for evacuation of residual blood to prevent blood clot accumulation.
  • Closure of the abdominal fat and skin in layers and skin dressing. The patient is at rest in a Jack-Knife position (abdomen is flexed)
  • Surgical duration : 4-5 hours

 

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POST OPERATIVE CARE

  • After the procedure the patient may opt to stay in the hospital ward or hotel room with a private nurse for recuperation.
    • The patient usually goes home by the 3rd or 4th day after surgery.
  • In the 1st and 2nd day after surgery the patient rests in a jackknife position to relieve abdominal wound tension.
  • The patient may be able to ambulate with support from 2nd to 3rd day onwards.
  • Removal of drains usually by second or third day when the drainage decreases to an acceptable level.
  • Abdominal binder : Wear round the clock for about 3 months to provide support and to reshape the abdomen.
  • Medication: Analgesics (pain killers), Antibiotics and medications to reduce swelling and bruising.
  • Suture removal : 1-2 weeks
  • Bruising and swelling : May last for about 2 weeks.
  • Return to exercise : Light exercise permitted at about 4 weeks: heavy exercise at about 3 months.

 

FINANCIAL COUNSELLING

  • Abdominoplasty for cosmetic purposes is not insurance claimable.
  • There are very few insurance claimable procedures that can be done together with abdominoplasty.

 

RISK AND CAUTION

  • Infection
  • Bleeding
  • Bruising – usually resolved by 2 weeks
  • Swelling – usually resolved by 2 – 4 weeks
  • Wound dehiscence – may occur in patients who have a tendency of poor wound healing eg. Diabetes, Smokers, Patients on chronic consumption of corticosteroids, and patients with vascular disease.
  • Numbness – over the abdomen within expectation and can last for 6 – 12 months
  • Undesirable scar can be address by injection or simple scar revision.

 

BOOK AN APPOINTMENT

During the consultation, our plastic surgeon would guide you to choose the best tummy tuck surgery method used most commonly by some of the leading plastic surgeons in Singapore and Korea. Apart from abdominoplasty, Dr Ng would discuss associated procedures like liposuction, fat grafting and mommy makeover.

多样化疗程，让你恢复亮丽神采

爱美是人的天性，也正如此，无论是古时或今日，男男女女不断采用各种手法或护理，努力让自己拥有美丽的肌肤和漂亮的容颜。

一些临床问题包括：色素、表层结构缺陷、皱纹（动态或静态）、深褶、畸形轮廓和松弛皮肤。

面部年轻化（facial rejuvenation）疗程可分为非手术疗程（非侵入性）和手术疗程（侵入性）。这些疗程都有个共同点，即对不同皮肤层进行控制性破坏，刺激修复和重生功能。

非手术疗程（非侵入性）

最普遍的光线疗法是IPL或BBL（broadband light）。它们能够同时改善多个肌肤问题，如斑点、皱纹、疤痕等等，让肌肤达到更加紧致、饱满、明亮及年轻化。

若想让皮肤表层取得更大的效果，激光换肤是理想选择。Erbium Yag 激光或二氧化碳激光是用来消除表皮层的一般做法。Erbium Yag 激光的其波长接近水的吸收能力，热能量更低，对周围邻近组织的热损伤也更小，尤其适合亚洲皮肤。处理后的皮肤需涂抹抗生素。微激光焕肤的康复期是3-5天，之后病人就可上妆。

为进一步紧缩外胚层，改善静态皱纹，顾客可选择不同的疗程模式。Profractionl Erbium Yag（或二氧化碳）激光、射频（radiofrequency ） 、聚焦超声（focused ultrasound）和红外（infrared wave）波可在控制的情况下，对真皮胶原和弹性蛋白造成热伤，从而刺激新胶原再生，达到紧肤效果。

传统激光换肤烧蚀整个处理范围。Profractional激光仅烧蚀皮肤窄道，这让上皮可以更快地再生。Profractional激光一般用来治疗萎缩性痘疤（atrophic acne scars）。

肉毒杆菌（botulinum toxin）具有瘦脸淡化皱纹的功效，主要用来出来抬头纹、眉间纹及鱼尾纹等，效果一般可维持3-4个月。

填充物（fillers）适合处理静态面部皱纹如泪沟（tear trough）和鼻唇沟（nasolabial fold），以及轮廓缺陷如太阳穴凹陷（sunken temporal areas）。它也能用来让两颊看起来更加丰润，肤质更紧实细致。肉毒杆菌和填充物有辅助作用，一些病人必须两者兼具，才能取得最佳效果。

手术疗程（浸入性）

移植脂肪整容术（fat transfer）近年来深受欢迎，它是指将人体自身脂肪较丰富的部位如腹部或者大腿等处的皮下脂肪细胞，用负压吸脂方法吸出，经过特殊处理后，通过注射的方式在移植到需要进行脂肪填充的部位。由于脂肪是自体移植，还含有一小部分具年轻化功能的干细胞（stem cells），因此是理想的填充物选择。这项疗程也对化疗后的慢性伤口有疗效。

微针拉皮（thread lift）利用可与人体相融并被自然分解的幼细材料穿入皮下组织内，将松弛下垂的皮肤上提拉紧，适用于眉毛和双颊皮肤的提升。

面部年轻化（facial rejuvenation）的常见手术包括眼皮整形（blepharoplasty）、提拉眉术（browlift）、太阳穴提拉术（temporal lift）、面部拉皮（facelift）和提拉颈术（neck lift）。这些手术可单一进行或配合多项手术进行，情况视顾客实际状况而定。老化的下垂眼皮（aged droopy eyelids）可能结合眼皮整形、提拉眉术或者太阳穴提拉术等。

眼皮整型手术（blepharoplasty）是修饰眼睛周围下垂和松弛的组织的外科手术。若要消除眼袋（eye bag removal），可能必须把多余的皮肤赘肉和脂肪除掉或者重新分配（fat redistribution）。这项手术可结合迷你拉皮（mini facelift），取得更和谐的整体美。

下垂下巴（sagging chin）和颌（jow）可能需要结合脸部拉皮和提拉颈术，通过去除颈阔肌让松弛颈项（turkey neck）达到紧实效果。

Breast enlargement: Various modalities

Who would potentially require breast enlargement?

Patients with a natural breast volume deficiency, that could affect their level of self-esteem and choice of clothes.

“Some patients need enhancement due to breast volume deflation after pregnancy and breast feeding. A smaller group seeks correction for severe volume discrepancy which may be in-born or post surgery,” said Dr Ng.

What are the various methods of breast enhancement?

There are surgical, non-surgical methods and combination of both. Patients who are not keen in foreign material may consider the Brava (negative suction device) or a combination of Brava with fat transfer to the breast.
Artificial filler injection has been controversial and associated with undesirable complications.

Is fat transfer to the breasts effective?

Each session of fat transfer to the breast can increase the volume by half to one cup size. This can result in soft and natural breast consistency.

Fat is harvested from the abdomen and thighs in a non-traumatic fashion. It is then processed after centrifugation.

Injection is given carefully in the subcutaneous layer of the skin to ensure optimal survival of the fat cells. Non-surviving fat cells do not turn cancerous but leave behind calcification that may cause confusion during mammography.

Several sessions may be necessary to achieve the desired outcome.

What are the various types of breast implants and are they safe?

Breast implants can be filled with saline or silicone. They are either circular or tear drop (natural profile) in shape.

To most common implant used nowadays contains cohesive silicone gel in tear drop shape. This type of implant simulates the natural appearance of the breast and its content resists extensive leakage even when the implant is ruptured.

Silicone breast implant has good safety record.

What are the considerations when choosing breast implants?

The main points of discussion with your surgeon would include size, type of implant, location of the cut and placement of the implant.

The most common incision is at the breast fold. This incision affords easy access and allows more accurate orientation of tear drop shaped implant.

Incision in the armpit used to be popular with round implant.

Incision around the areolar can affect nipple sensation and limit the size of implant if the areolar is small.

“For most Asian patient with smaller breast volume, the implant is usually placed behind the chest muscle (subpectoral). This placement provides more soft tissue coverage and reduces the incidence of capsular contracture (scarring) around the implant,” said Dr Ng.

What is the recovery process after breast implant surgery?

Breast enhancement is a day surgery procedure.

Most patients return to work within a few days and the swelling and bruising would resolve in about two weeks. Self-massage would be taught to hasten the recovery.

Rhinoplasty: The entire spectrum

Q: What aspects of the nose do most patients want correction?

A: A Rhinoplasty or commonly referred to as a “nose job” can be done for cosmetic or corrective purpose. Common problems include a low nasal bridge, bony hump, crooked, broad and drooping nasal tip, widened alar base and retracted columella.

Q: How does a nose job change the face ?

A: A good nose job can make the face appear slimmer, sharper and more three-dimensional. From the side profile, the angle between the columella and the lip would be improved. For patient with a receded upper lip (which makes them appear older than their age), this can make them look younger.

Q: What are the various methods to augment the nose?

A: These are minimally invasive and surgical procedures. Minimally invasive procedures are unable to produce all the features of an ideal nose.

Examples include hyaluronic acid filler injection and thread insertion. The latter technique is still fairly new and the long term risk of scar formation and thread extrusion is unknown.

Surgical techniques include closed and open rhinoplasty which is more versatile.

Q: Can filler injection alone do the job ? Is it safe?

A: Filler injection can improve the height of the nose bridge. It is not able to narrow a broad nose tip or wide alar base. It provides immediate result which lasts for about six months. Infrequent complications include alar skin tissue loss and blindness.

Dr Ng Siew Weng, a consultant plastic and reconstructive surgeon of Sweng Plastic Aesthetic and Reconstructive Surgery, said “I have encountered several patients who had received repeated filler injections by their previous doctors, resulting in a broad and undefined nose bridge due to migration of filler. Filler in this region may take longer to resolve compared to injection elsewhere in the face.”

Q: Tell us more about rhinoplasty using a L-shaped implant.

A: This short procedure can improve the dorsal height and tip projection. It has limited ability to augment a contracted columella or narrow the nose tip and alar base.

“In Korea where I had my advanced training, the L-shaped implant is infrequently used by rhinoplasty surgeons due to frequent implant extrusion and deviation,” said Dr Ng.

Q: What are the different types of rhinoplasty ? What is involved ?

A: Rhinoplasty can be divided into open or closed procedure. Closed rhinoplasty involves only a small cut inside the nose. Its efficacy is limited compared to open rhinoplasty which visualises all the structures in the nose for definitive correction.

The typical Korean-style open rhinoplasty for an Asian nose involves a small cut across the columella, placement of silicone implant, cartilage from the nose septum and ear cartilage to achieve a natural-looking and refined nose profile. Some patients do not have sufficient cartilage of their own and rib cartilage may be used.

Q: Recovery process after rhinoplasty ?

A: After surgery the nostrils are sponge dressed to prevent bleeding for 24 to 48 hours. Patient wears a supportive splint over the nose for one to two weeks. Sutures are removed after one week.

Most patients are able to return to work in one to two weeks. The swelling subsides after a month and the final result will be assessed in about three to six months.

Fat Transfer to Breasts

  • A permanent way of augmenting the breast shape and volume by transferring fat from another part of the body e.g. the abdomen or thighs.
  • The fat is processed and injected under the skin (in the subcutaneous plane) of the breasts, and not into the actual breast tissue.
  • The technique of injection is very crucial to the survival of fat. The fat is gently injected using multiple small 1 ml syringes depositing the fat in small aliquots (parcels). This ensures the largest surface area for maximal diffusion of nutrients from surrounding tissue and thus enhance survival of the fat cells.
  • At least about 60-70% of the fat injected survive. These cells will permanently live in the injected site.
  • The fat injected contain a small amount of patient’s own stem cells which helps to rejuvenate the skin.
  • The amount of fat injected in each session should not be excessive. Otherwise the resultant swelling would reduce blood flow to the fat cells and thus lower their survival rate. Therefore multiple sessions of fat transfer may be needed to achieve the desired volume.
  • Realistically each session of fat transfer can increase the breast volume by half to one cup size (75 – 150 ml)
  • The survival of fat injected into the breast can be further enhanced by wearing the Brava Device.
    • A device that uses a negative pressure to stretch the breast tissue
    • It is worn for more than 10 hours day for at least 2-4 weeks after the fat transfer procedure
    • This promotes better blood circulation within the breast tissue that helps fat survival
  • Fat transfer to the breast generally does not affect breast feeding.

CONCURRENT PROCEDURES

  • Patients undergoing liposuction of the abdomen and thighs may transfer the unwanted fat to the breasts
  • Mummy makeover which consists of tummy tuck and breast augmentation. Fat transfer to the breast can be considered instead of breast implants.
  • Fat transfers to face and breast concurrently.

SUITABLE CANDIDATES

  • Patients who do not want augmentation using a foreign body.
  • Sufficient fatty deposits in the abdomen or thighs.
  • Willing to undergo more than one session of this procedure.
  • Willing to accept less dramatic and instantaneous results.
  • Suitable for :
    • Tuberous breast..
    • Mild breast deflation after breast feeding
    • Widened cleavage post breast implant insertion.
    • Breast contour deformity post breast cancer surgery reconstruction.

 

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DESCRIPTION OF PROCEDURE

  • Injection of tumescent fluid (to control bleeding) into fat donor site (abdomen and/or thighs)
  • Fat is gently syringed out from the abdomen and/or thighs via well-hidden small cuts (less than 1 cm)
  • Fat is processed using Coleman’s technique : Harvested fat is then centrifuged and separated into 3 layers : upper layer of free oil, middle layer of usable fat, and lower layer of water, blood and tumescent fluid.
Fat Transfer Technique Fat Transfer Technique
  • The usable fat is gently injected into the breast under the skin, using multiple small 1 ml syringes depositing the fat in small aliquots (parcels).
  • The injection sites in the breast are well hidden in the areola.
  • Duration of procedure (depending on complexity) : 1.5 – 3 hrs

ANAESTHESIA

  • General anaesthesia
  • Combination of local anaesthesia with intravenous sedation

POST OPERATIVE COURSE

  • Home on the same day.
  • Support bra for 1-3 months.
  • Medication to reduce swelling and pain.
  • Swelling, bruising and tightness over the breast for about 2 weeks.
  • Sutures over the small injected sites are removed after 1 week.
  • Light exercise from 3-4 weeks after procedure.
  • Final results usually seen in approximately 3 months.

FINANCIAL COUNSELLING

  • Fat transfer for the management of tuberous breasts or post breast cancer reconstruction may be considered as non-cosmetic.

RISK AND CAUTION

  • The transferred fat that did not survive can result in a small amount of calcium deposits (macrocalcification) appearing in a mammography. This is different from microcalcification (which is indicative of breast cancer). Meticulous injection technique is important in preventing this.
  • Fat injection does not increase the chance of breast cancer. Patients are often confused about this point.

 

 

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After consultation, Dr Ng would guide you to decide on the best surgery for breast enhancement i.e. fat grafting (transfer) to breast or breast augmentation using implant. Structural fat grafting to the breast remains a top choice of some of the best plastic surgeons in Singapore and around the world.

Laser Vaginal Rejuvenation / Tightening

INTRODUCTION

  • With ageing, the facial skin tissue loses elasticity and sagging occurs. The same occurs to the genital area and vaginal lining. However, the most common cause of vaginal wall laxity is overstretching of the vaginal wall during childbirth, which worsens with the number of child deliveries.
  • Loss of tissue tensile strength can also result in an increase in the inner diameter of the vaginal wall. It can result in loss of friction and sexual satisfaction for both the woman and her partner.
  • Laser Vaginal Rejuvenation is a non-invasive procedure that can address these conditions. In addition it is also used to rejuvenate the outer part of the female genital (labia minora and labia majora). It can treat stress incontinence but not all types of urinary incontinence.
  • Urinary incontinence (leakage of urine) is also frequently noted in patients with vaginal laxity.
    There are different types of urinary incontinence :

    • Stress Incontinence – urine leakage caused by activities that increase intra-abdominal pressure, such as coughing, sneezing and laughing. This is due to weakness in the pelvic floor muscles.
    • Urge Incontinence – urine leakage caused by an overactive bladder resulting in involuntary loss of urine occurring when the patient suddenly feels the urge to urinate. This can be due to issues in the bladder nerves or muscles.
    • Overflow Incontinence – urine leakage due of inability to totally empty your bladder, which is usually caused by a weakened bladder and blockage within the ureters.
  • This procedure uses a laser probe inserted into the vagina canal that emits Er:YAG non-ablative laser for tightening the vaginal wall. It heats up the genital mucosa to initiate collagen remodelling and subsequent production of new collagen.
  • The final result of collagen neogenesis is the shrinking and tightening of vaginal mucosa tissue and collagen-rich endopelvic fascia and subsequently greater support to the bladder and the return of normal continence function.
  • This procedure has been reported to provide over 90% patient and partner satisfaction rate.
  • This treatment consists of 2 laser sessions done 6-8 weeks apart. Significant results are usually felt by 6 weeks.

 

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vaginal tightening Vaginal Tightening
Courtesy of: Fotona
Laser source: Fractional Er:YAG
Stress Urinary Incontinence Treatment Stress Urinary Incontinence Treatment
Courtesy of: Fotona
Laser source: Fractional Er:YAG

SUITABLE CANDIDATES

  • Vaginal muscle and lining laxity resulting in dissatisfaction in both partners.
  • Urinary incontinence (involuntary passage of urine while laughing, coughing and sneezing)

DESCRIPTION OF PROCEDURE

  • Two laser sessions – 6 to 8 weeks apart
  • Pap Smear done prior to the procedure.
  • Sedation can be given according to patient’s preference.
  • Application of topical anaesthesia (numbing cream) to the genital area
  • Insertion of laser probe for vaginal tightening.
  • Laser treatment to the labia for further tightening and rejuvenation.
  • Application of antibiotic cream to the outer genital area
  • Duration of procedure : 30-45 minutes
  • Patient can go home on the same day.

ANAESTHESIA

  • Topical anaesthesia + IV Sedation – Sedation can be given according to patient’s preference.

POST OPERATIVE CARE

  • Medication : Oral and topical antibiotics, analgesics (pain relief).
  • Avoid activities that will exert pressure to the groin for 2-3 days.
  • May resume sexual activity after 1 week.
  • 2nd laser session in 6-8 weeks

RISK AND CAUTION

  • Patient may experience transient vaginal dryness for up to 1 week.

REFERENCE

  • Novel Minimally Invasive VSP Er:YAG Laser Treatments in Gynecology
    Vizintin Z, Rivera M, Fistonić I, Saraçoglu F, Guimares P, Gaviria J, Garcia V, Lukac M, Perhavec T, Marini L.
    Journal of the Laser and Health Academy, Vol. 2012, No. 1, P. 46-58.
  • Minimally invasive laser procedure for early stages of stress urinary incontinence (SUI)
    Fistonić I, Findri-Guštek Š, Fistonić N.
    Journal of the Laser and Health Academy, Vol. 2012, No. 1, P. 67-74.
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Liposuction Surgery in Singapore – Body Contouring

WHAT IS LIPOSUCTION?

Liposuction is a body contouring and sculpturing surgery.  It is not meant for patients who just want to lose weight. The best liposuction surgery results can be achieved in conjunction with exercise and diet planning.

HOW IS THE LIPOSUCTION SURGERY PERFORMED?

This procedure can be done under sedation or general anaesthesia. Small volume liposuction can be done as a day surgery procedure. Large volume of liposuction may require hospitalization as required by the Ministry of Health.

Liposuction can also be combined with abdominoplasty (tummy tuck). Post liposuction, there could be skin laxity. Non-surgical radio frequency or infra-red based skin tightening procedures can be used to improve this.

Power-assisted liposuction has been a proven technique and is most popular in Singapore.

Vaser liposuction was once thought to be the best for skin tightening. But it has been associated with complications like skin burn and organ perforation.

COST OF LIPOSUCTION SURGERY

The cost of liposuction surgery in Singapore typically includes the surgeon’s fees, anaesthesia fees, facility charges, and pre and post-operative care. It is important to note that choosing the cheapest option may not always be the best decision, as the quality of the surgeon and the facility should be a priority to ensure safety and optimal results.

To obtain an accurate and up-to-date cost estimate for liposuction in Singapore, it is best to consult with our plastic surgeon who can assess your individual needs and provide you with a personalised quote. The expertise and experience of the surgeon should be a priority over cost when it comes to any surgical procedure.

 

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CONSULTATION FOR LIPOSUCTION SURGERY

During your consultation, Dr. Ng will advise you on the best option for sculpting and slimming the body — either by liposuction or coolsculpting. The top priority for our surgeon is to plan the location for fat removal to ensure the optimal outcome. Liposuction is best combined with a slimming regime, including mindful eating habits and exercise.

Breast Enhancement

What are the various methods of breast enhancement ?

There are surgical and non-surgical methods and combination of both. Breast augmentation using implant is still the most common option. Patients who are not keen on foreign material may consider the Brava (negative suction device) or a combination of Brava with fat grafting to the breast. Artificial filler injection has been controversial and associated with undesirable complications.

Is fat grafting to the breast effective ?

Each session of fat grafting to the breast can increase the breast volume by half to one cup size. This can result in soft and natural breast consistency. Fat is harvested from the abdomen and thighs in a non-traumatic fashion. It is then processed after centrifugation. Injection is done very carefully in the subcutaneous layer of the skin to ensure optimal survival of the fat cells. Non-surviving fat cells does not turn cancerous but leave behind calcification that may cause confusion during mammography. Several sessions may be necessary to achieve the desired outcome.

What are the various types of breast implants and are they safe ?

Breast implants can be filled with saline or silicone. They are either circular or tear drop (natural profile) in shape. The most common implant used nowadays contains cohesive silicone gel in tear drop shape. This type of implant simulate the natural appearance of the breast and its content resists extensive leakage even when the implant is ruptured. Silicone breast implant has good safety record.

What are the considerations when choosing breast implants ?

The main points of discussion with your surgeon would include size, type of implant, location of the cut (incision), and placement of the implant. During the consultation, your plastic surgeon would let you try a variety of implant sizes to simulate the outcome.
The commonest incision is at the breast fold which is well-hidden. This incision affords easy access and allows more accurate orientation of tear drop shape implant. Incision in the arm pit used to be popular with round implant. Incision around the areolar can affect nipple sensation and limit the size of implant if the areolar is small.
In most Asian patient with smaller breast volume, the implant is usually placed behind the chest muscle (subpectoral). This placement provides more soft tissue coverage and reduces the incidence of capsular contracture (scarring) around the implant.

What is the recovery process after breast implant surgery?

Breast enhancement can be done as a day surgery procedure. Most patients return to work within a few days and the post- operative swelling and bruising would resolve in about two weeks. Self-massage would be taught to hasten the recovery.

Facelift Surgery in Singapore

Facelift surgery is a cosmetic surgical procedure designed to reduce visible signs of ageing in the face, it is the most effective and radical management for facial skin laxity. This process involves removing excess skin, tightening underlying tissues, and re-draping the skin to create a more youthful, rejuvenated appearance. For maximum skin tightening, it is best combined with laser skin resurfacing and fat grafting.

TYPES OF FACELIFTS

There are many ways to classify facelift. It can be simply divided into full-facelift (long scar) or mini-facelift (short scar). When the facelift is extended upwards, it can include a temporal lift. When extended downwards, it incorporates a necklift. The scar is sited in just front of the ears and may extend backwards behind the ears to provide lifting to the neck.

Endotine facelift is done via small incisions in the hairline. Endotine fixation devices are inserted. They are absorbable strips which bear small claws to lift up the cheek, jowl and neck. They are absorbed in about 3-6 months. Endotine lifting is suited for patients who do not have significant skin excess.

The facelift procedure can be done under sedation or general anaesthesia.

Facelift TypeDescriptionSuitable PatientsRecovery Time
Full Facelift
  • Addresses multiple areas of the face, provides dramatic results
  • Invasive procedure with longer recovery time
Patients with significant sagging or laxity in the face and neck, who are willing to undergo a more extensive procedure.2-3 weeks of downtime
Mini Facelift
  • Less invasive procedure with shorter recovery time, can address early signs of ageing in specific areas
  • Results may not be as dramatic as a full facelift
Patients with mild to moderate sagging or laxity in specific areas of the face, who are looking for a less invasive option with quicker recovery time.1-2 weeks of downtime
Endotine Facelift
  • Less invasive than traditional facelifts, shorter recovery time, results can be more long-lasting than a mini facelift
  • May not provide as dramatic results as a full facelift
Patients with moderate sagging or laxity in the midface or lower face, who are looking for a minimally invasive option with shorter recovery time and longer-lasting results.1-2 weeks of downtime

It is important to note that the suitability of each facelift surgery type varies depending on individual factors, such as skin elasticity, facial bone structure, and personal goals. A consultation with our surgeon can help determine the best facelift approach for each patient.

PROCEDURES DONE TOGETHER WITH FACELIFT:

Facelift surgery can be combined with other cosmetic procedures such as “double eyelid surgery (incisional blepharoplasty)“, “Fat grafting to the face”, and “laser skin resurfacing” for skin rejuvenation and skin tightening. 

Fat transfer to the face is commonly done during a facelift. Fat is harvested from the abdomen or thigh, processed and injected into the cheeks for volume augmentation and other areas of the face to reduce marionette lines, nasolabial fold, and nasojugal fold.

Erbium Yag Profractional laser skin resurfacing is another commonly combined procedure. This tightens the skin and improves the texture of the aged skin left behind after the face and neck lift.

FACELIFT SURGERY RECOVERY

Post surgical bruising may last for up to 2 weeks. Sutures are removed after a week.
The scar and recovery period for a mini-facelift is slightly shorter due to less dissection involved.

FREQUENTLY ASKED QUESTIONS

How long do the results of facelift surgery last?

The results of facelift surgery can last for several years, but they are not permanent as the ageing process will continue to affect the face over time. Maintaining a healthy lifestyle and following your facelift surgeon’s aftercare instructions can help prolong the results of the procedure.

Are there non-surgical alternatives to facelift surgery?

There are non-surgical alternatives to facelift surgery, such as botox injections, derma fillers, laser treatments, and thread lifts. Similar to facelift surgery, these treatments can help improve the appearance of wrinkles and sagging skin. However, non-surgical methods typically provide subtle and short-lived face lifting results, and they may not be able to address more significant sagging or excess skin. Additionally, non-surgical treatments require regular maintenance appointments to maintain the results.

Facelift surgery, on the other hand, can provide more dramatic and longer-lasting results by addressing underlying muscle and tissue laxity and removing excess skin. While it is a more invasive procedure that requires more downtime, it may be the best option for those who want to achieve more significant facial rejuvenation. 

Ultimately, the decision between surgical and non-surgical face lifting options depends on an individual’s concerns and goals, you may contact our facelift surgeon to provide guidance on the most appropriate treatment plan.

Is facelift surgery painful?

Facelift surgery is performed under sedation or anaesthesia, so the patient will not feel any pain during the procedure. After the surgery, there will be some discomfort, swelling, and bruising, but this can be managed with pain medication prescribed by our facelift surgeon.

What age is appropriate for a facelift?

There is no fixed appropriate age to undergo facelift surgery as each person ages differently. Generally, the common candidates for facelift surgery are in their 40s to 60s, this is when signs of ageing are more pronounced. However, age is not the only factor to consider, the decision to undergo a facelift should also be based on a person’s overall health, skin quality, and aesthetic goals. An experienced facelift surgeon can evaluate an individual’s candidacy for facelift surgery during a consultation.

 

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During the consultation, our facelift surgeon, Dr Ng, will advise the best method of facelift most suited for you. This may include a mini or full facelift, the use of Endotine devices, fat grafting, and laser resurfacing for further rejuvenation. A combination of techniques are often used by the top plastic surgeons in Singapore and around the world.