Dare to Transform

April 14, 2017

Most of us are mindful of our appearance and concerned about what others think. Some of us who aspire to make changes fear being negatively judged by friends and peers. Others may need approval or blessings from their close relatives before making any decisions. In the process, we often forget what we ourselves want, and what will make us happy.

Having undergone one year of Advance Training in Plastic Surgery in South Korea. Siew Weng perceives that the Koreans feel less restrained in this aspect.

With them, he says, there are fewer considerations when it comes to improving their appearance. They are fairly ready to seek surgical treatment to correct imperfections and thereafter willing to share their experience.

“In South Korea, front office staff in many organizations including clinics have undergone plastic surgery — they are endorsements of what can be achieved.”

So it comes as no surprise that the country is one of the leading capitals of plastic surgery in the world.

Looks matter

We are brought up in a meritocratic society. Intellectual capability and certain skill sets are prerequisites for success. Appearance is deemed not to be an important factor.

“But the truth is that looks do matter, though many people do not wish to openly endorse this Studies have shown that babies tend to look at nicer images for a longer time. Our judgements are very often subconsciously influenced by appearance. For example, at the supermarket buying apples, we would choose those with more appealing colour and without any blemishes. At the bookshop, most customers prefer to purchase books without dog-eared covers. This is “judging a book by the cover”. We are wired to appreciate beauty.

As a society becomes more advanced with high literacy, competition for employment has escalated to a new level. It would be common to find many job applicants having fairly similar paper qualifications.

“How do you choose between two graduates, all things being equal ? Looks provide an edge, helping you pass the two-second test”.

Physical attributes become important, apart from charisma in a short interview process. That is why we consciously dress our best for an interview.

“Many Korean parents are aware of this and are ready to give their children the competitive edge and improvement in self-esteem. It is fairly common for students to undergo cosmetic surgery, before entering college in Korea.”

Early perspectives

As a medical student. Siew Weng discovered a love for shaping and moulding.

“Of all the medical disciplines, plastic surgery is the only one that offers that opportunity. You can restore a deficiency in a patient because of birth defect, trauma or disease, using the entire armamentarium of reconstructive techniques giving both function and form.”

Along the way. he gained insights from patients who were testimonies to the importance of body parts that are missing or taken away and never restored, and a realisation that this should never be taken for granted or trivialised.

“I had two patients who had their breasts removed decades ago. Both asked for breast reconstruction surgery, and I wondered why, after such a long time. One wanted it because of an embarrassing situation that happened in public and had left her feeling humiliated, and the other was because of a family wedding at which she wanted to look and feel her best. They were so grateful, it was like a new lease of life, a gift after years of living without.”

Reconstructive surgery

He was particularly fascinated by reconstructive microsurgery. He remarked “Some patients with head and neck tumours lose part of their jaw to the disease. Reconstruction would require a challenging microsurgical operation lasting more than 10 hours. A bony segment is taken from the leg with resident blood vessels. This is used to reconstruct the jaw. The blood vessels are connected using microsurgical techniques.”

Siew Weng is pushing the boundaries of microsurgery to a higher level – super-microsurgery. “Post-cancer treatment, some patents develop prolonged swelling of the upper or lower limbs (Chronic lymphedema). In the past there was no good treatment except for bandaging and compression garments. Now it is possible to improve the condition with super-microsurgery by joining congested lymphatics to small veins (lymphaticovenous anastomosis). Another method involves microsurgical transfer of living lymph nodes from the neck to the affected areas to relieve lymphedema.

“I find breast reconstruction the most rewarding. It is a balance of reconstructive and aesthetic surgery to restore physical form and the patient’s self-esteem”

Aesthetic surgery

Cosmetic plastic surgery can, in some instances, positively re-shape lives – it’s not a passing or trivial vanity.

“Some patients have certain physical attributes which have attracted unkind remarks from their peers since they were young. These insensitive comments can cause untold misery for some patients. I have encountered young patients who resent the appearance of their nose or lips. Their parents may not fully comprehend the magnitude of the issue. After surgery, some patients and their parents have noted an improvement in self-esteem, relationships and ability to study. Of course, this should not serve as an excuse for young patients wanting surgery for only cosmetic improvement.”

Siew Weng points out that plastic surgery is sometimes called psychiatry with a knife “To some extent, that’s true because of the far-reacting effects on the patient’s psyche.” he explains.

Among the various aesthetic surgeries, he likes doing rhinoplasties best. “The nose is the central feature on the face. Most plastic surgeons tend to agree that rhinoplasty is one of the most difficult surgeries to master because the nose is a three dimensional structure. A properly done nose job can provide a quantum change to the whole face.”

Korean experience

Siew Weng was the first plastic surgeon from the Singapore General Hospital to receive a one-year intensive fellowship programme training under world-renowned surgeons in South Korea.

He was pleasantly surprised that this very advanced country is steeped in Confucian teachings. He found the Koreans very hospitable and enjoyed his stay in Seoul. He found his Korean contemporaries extremely disciplined and hardworking. Siew Weng remains very thankful to his professor mentor who arranged for him to learn from some of the top plastic surgeons in Korea.

“Very often I get asked what is the difference between a Korean and a local patient. I feel that the Koreans are more receptive and open about having plastic surgery done. They have also been influenced by their local celebrities who openly discuss surgical procedures.

Our local patients prefer to keep physical enhancement a private matter. They are afraid of comments and social pressure, and this holds them back. So they opt for very subtle changes which will not be obvious or will not invite questions. Our Korean contemporaries tend to look for quantum changes.”

But the Singaporean reticence is changing. Younger people are, like their Korean counterparts, more open to plastic surgery, thanks to blogs, celebrities “coming clean” about the procedures they undergo, and of course, apps that allow them to digitally alter selfies so that they look exactly the way they want to. Making that ideal image a reality is just consultation away.

Personal philosophies

Siew Weng understands that most patients only want correction to a particular feature which they are most dissatisfied with. However, any minor change to a particular feature will affect the appearance of the nearby features.

He explains, “It is most important to achieve harmony of facial features. A nose job (rhinoplasty) which improves nose shape, height and length may accentuate the appearance of a pre-existing small chin. In this situation, I would suggest, in advance, a procedure to improve chin projection to match the nose for a pleasing outcome.

“Some patients with eyebag problems only wish to remove the eyebags to look younger. The result may not be satisfactory if they also have ageing upper eyelids. I would advise both upper and lower eyelid surgery at the same time for a more harmonious appearance.”

The ageing process affects all the facial features. To achieve a synchronised and harmonious result, many “touch-up procedures” may be needed.

“It is important to respect the wishes of the patient. Most patients want incremental change. They still want to look like themselves. In these instances, I strive to improve on what they already have rather than to change their identity, unless this is their intention.”

Life kept simple

Away from the rigours of running his own practice where he offers surgical and non-invasive procedures as well as reconstructive surgery, Siew Weng leads a simple life with his wife and two children. He confesses to love for computers, photography, motoring and exercise.

He has also devoted time over the years to humanitarian work overseas in Laos, China. India and Uzbekistan, performing free surgery for cleft lip/palates as well as post-traumatic and burn deformities.

He was an Adjunct Assistant Professor at Duke-NUS Graduate Medical School and is a Visiting Consultant at Singapore General Hospital. He enjoys sharing his experience teaching doctors and residents. His personal philosophy is reflected in his message to his students.

“In the practice of medicine, be prepared to spend time with your patients – your time is no longer your own. Remember to manage the patient in the same way you would want your close ones to be treated.”