Aesthetic Surgery, commonly known as cosmetic surgery, refers to plastic surgery that is performed in a patient with normal forms and functions to enhance the patient’s appearance based on their personal choice.
The following are an overview of the key points, surgical approaches and the broad spectrum of aesthetic surgeries offered by Mr. Fuan Chan MD FRCSI(Plast).
Please click here to learn more about Mr. Fuan Chan's professional profile in aesthetic, plastic and reconstructive surgery. Patients are strongly advised to do a certain amount of background reading, and seek more information about the respective aesthetic or cosmetic procedures and the credentials of the operating surgeon(s).
During the consultation, Mr. Fuan Chan will critically assess and examine various components involved in a particular aesthetic procedure and take you through the process.
Mr. Chan will also explain the risks and complications, including the alternative options to the proposed aesthetic surgery. You will have plenty of time to think things over and come back with further questions for subsequent consultations before committing to the surgery.
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Surgical Facial Rejuvenation encompasses many surgical procedures to enhance or rejuvenate the aging face, which is characterised by descent of the facial soft tissue and volume loss. Fat is part of the structural supports of our face. There are many different sizes and depths of fat compartments within the face. We lose facial fat in the different facial compartments as we age. Thus, purely lifting the facial skin or soft tissue is not adequate,. Currently, 'lifting and filling' is the latest trend of facial rejuvenation surgery. Facial harmony is the key to looking natural. Similarly, the face is also further divided into smaller areas, each known as the 'facial aesthetic units'. Respecting the facial aesthetic units during facial rejuvenation surgery leads to more natural looking results.
Facelift surgery is no longer a procedure that simply involves only tightening of the skin or trimming off excess skin from the face. In the modern world of plastic surgery, facelift surgery has evolved from simple facial skin tightening surgery to a more anatomically detailed surgery leading to more natural looking appearance with safe and more predictable outcome.
Shape and contour restoration are the goals of the facelift surgery. It is age-orientated to the patient so that it looks natural in that particular patient. It is worth indicating that we age differently in different part of our face. Thus, many surgical techniques are used in facelift surgery to accommodate the vast variation of patients’ biophysical profiles.
The first step to excellent outcomes is thorough pre-operative facial analysis and clinical assessment to ensure patients’ safety and suitability to undergo the surgery with minimum anaesthetic and surgical risks. It can not be emphasized more strongly that, often it is the little things or nuances that push the surgical outcomes from good results to great results. This is even more so in facelift surgery (Rhytidectomy).
Standard open facelift surgery involves dissection and re-draping of facial tissues. Safe facelift surgery involves a thorough understanding of the surgical anatomy to prevent nerve injury and minimize bleeding or haematoma formation. Again, every surgery has its potential risks and complications. You will be told about and have explained the risks and complications prior to the surgery. You are strongly advised only proceed to surgery with an informed consent.
Placement of skin incision is one of the most key components of facelift procedures because poorly placed skin incision can be the tell-tale sign of a “job” done on the face and also can distort the ear lobe causing a Pixie ear. This goes in parallel with meticulous skin closure without undue tension to achieve great outcome.
‘Brow lift’ or ‘forehead lift’ is surgery to reposition the descended or low brow to a more aesthetically pleasant position. It also can reduce the lines and wrinkles on the forehead and brow region, leading to a more youthful appearance.
The dynamic between the Frontalis muscle (the forehead muscle) at the forehead and the Orbicularis Oculi muscle (eye muscle) is antagonistic (opposing forces). It is like the tug of war; hence a good understanding of the anatomical dynamic between the forehead and brow muscles is the first step to successful forehead rejuvenation
Surgical planning for a low brow is different from a patient with a long forehead and receded hairline. Besides correcting the position of the brow, the critical point in Brow Lift surgery is to know pre-operatively where does the hairline is going to end-up and whether it is compatible with the patient’s facial features.
Another potential issue is the presence of eyelid ptosis (droopy eyelid) which needs to be appreciated and corrected in order to achieve good aesthetic outcome. Each of the relevant anatomical components are critically assessed and examined during the consultation.
Browlift surgery can be performed endoscopically (minimally invasive with 3 to 5 small incisions on the hair-bearing scalp area) or through open techniques via various incisions. In the right patient, ‘Brow lift’ is better to be performed together with the facelift surgery. The goal is to achieve facial aesthetic harmony yielding naturally looking results.
The aging neck is characterized by the lost of the normal neck contour with fullness beneath the lower jaw and loss of jawline definition. The majority of surgical rejuvenation surgery of the neck is performed together with facelift surgery so as to achieve a complete facial rejuvenation leading to more natural looking results.
Successful neck rejuvenation must address three main structures in the neck region:
There are two fatty compartments or layers which contributed to the fullness underneath the lower jaw and the neck; one is located above the platysma muscle, and the second layer is situated beneath the platysma muscle. The fatty layer can be contoured with liposuction using specific flat liposuction cannula or by direct resection of the fatty tissue (lipotectomy). The plastyma muscle layer is addressed by various surgical techniques according to the prominence of the platysma banding. Meanwhile, the skin laxity is addressed by re-draping along the correct vector with excision of excess skin if necessary. The end result is a well-contoured neck with smooth jaw-line definition and minimum skin laxity.
Peri-orbital aging is very complex. It is multifactorial with the main factors including photo-aging, loss of skin elasticity, weakening of the surrounding structures and volume shifting around the eyes. The anatomical structures of the eyes, the eyelids and its surrounding structures are very intricate and complex. Thus, precision and careful execution of peri-orbital surgery is mandatory, as there is little margin for error.
To simplify the explanation and understanding of the common aesthetic surgery performed around the peri-orbital region; the surgical procedures performed have been simply narrowed down to the upper eyelid and the lower eyelid surgery (blepharoplasty), which are the two most commonly performed aesthetic surgeries around the eye region. Eyelid surgery aims to improve the gradual loss of youthful appearance or to rejuvenate the aging features around the peri-orbital regions, such as the presence of redundant upper eyelid skin or hollowing around the upper eyelid, lower eyelid laxity and formation of wrinkles, lower eyelid bags and deepening of the groove between the lower eyelid and the side of the nose. As a one step treatment, surgical rejuvenation of the eyelid is still the best way to achieve a good, if not a great outcome, in peri-orbital aesthetics.
Upper blepharoplasty aims to preserve the volume and optimizing the upper eyelid folds and its definition leading to an aesthetically pleasing and youthful appearance.
There are 3 main areas that are being addressed surgically during blepharoplasty: a) the excess skin (laxity), b) the orbicularis oculi muscle and c) the fat compartment beneath. The decision to excise or remove either one of the three components or all of the three components is determined by the severity and appearance of the peri-orbital area.
Often, it is not what you remove but actually what you leave behind that counts. Additionally, the presence of ptosis and brow position will also influence the priority and timing to perform blepharoplasty. Of note, the final outcome is tailored to fit the patient’s facial profile so as to blend well with the patient’s facial proportion to achieve facial harmony.
Lower eyelid blepharoplasty is a much more challenging procedure compared to upper eyelid blepharoplasty. Specifically, excision of skin and Orbicularis Oculi muscle tissue is conservative. Excessive removal of the three fat compartments during lower eyelid blepharoplasty can lead to hollowness and further revealing the aging peri-orbital area. Fat injection and the appropriate use of a small amount of filler can be beneficial to treat the lower eyelid hollowness but over-use and excessive amount will create severe and unwanted complications such as contour irregularity, changing the eye shape, asymmetry and severe prolonged swelling or oedema which can be very difficult to treat.
The small area of transition from the lower eyelid to the cheek, which is known as the ‘lid-cheek junction’ which is best appreciated in profile view. It is smooth with a good contour in youth but becomes attenuated or loss with the aging process.
Besides addressing the above 3 components (skin, muscle, fat) as in upper eyelid surgery, the restoration of smooth lid-cheek junction is of paramount importance in order to achieve great outcomes with facial harmony. In lower eyelid surgery, the surgical incision can be placed at the eyelashes margin or through the conjunctival (transconjunctival approach).
For comprehensive rejuvenation of the lower eyelid, the followings are the key components of the surgery:
In certain patients, application of filler (mainly hyaluronic acid) or small amount of fat injection can suffice to enhance the appearance of the lower eyelid but it is not a substitute for a comprehensive lower eyelid surgery.
Potential specific complications but not limited to include the following: ectropion, lid retraction, lid malposition, scarring and lagophthalmos, conjunctival oedema(swelling) and change of vision.
The goal is improvement, never perfection, is the main message in aesthetic rhinoplasty. It is important to note that 90% of the success of aesthetic rhinoplasty surgery is in making sure that the operating surgeon and the patient agree on the operative goals.
Pre-op photographs and more importantly, the adoption of the most advanced and latest computer-generated 3D simulated images during consultation provide for better communication. They also serve to provide simulated results so that patient can appreciate where the changes will occur. Additionally, the 3D images will also be used intra-operatively as an additional guiding tool for the desired outcome. It is important to state that the 3D computer images are simulated results and a surgeon cannot promise the patient that the end result will be identical, but every effort is made to achieve the optimum outcome for the patient.
Patients’ presentations for 'nose job' surgery could range from a simple hump reduction to a very complex presentation with many aesthetic issues in different parts of the nose.
During the consultation, the nose and the face are critically assessed. The nose are further divided into smaller unit know as the nasal sub-units. More than 12 important landmarks and at least 4 aesthetics lines and 2 angles related to the nose and the facial structures are being examined. Any obvious deformity or nasal deviation are identified pre-operatively so that the patient is fully aware of the inherent deformities prior to surgery.
There are multitude of surgical techniques involved in aesthetic rhinoplasty surgery, such as
The detail of all the surgical techniques involved in aesthetic rhinoplasty can be overwhelming and therefore will not be cover specifically in this brief introduction to aesthetic rhinoplasty surgery. As mentioned earlier, during consultation, Mr. Fuan Chan will critically assess and examine the various components involved in the particular aesthetic procedure and take you through the process. Mr. Chan will also explain r the risks and complications, including the alternative options to the proposed aesthetic surgery. You will have plenty of time to think over and come back with your questions for the subsequent consultations before committing to the surgery.
Although the skin and soft tissues are the covering and final determinant in facial appearance, the underlying facial bones are the framework and predictor of facial beauty. A small or retruded chin can affect facial harmony and can result in lower face weakness. This group of patients seek chin augmentation to improve the aesthetic appearance of the lower face. Additionally, about 20% of patients undergoing facelift surgery may require chin augmentation.
Surgical manipulation of the chin requires an in-depth understanding of the bony architecture and an artistic eye to predict expected aesthetic outcome. Increasingly, patients are seeking quick and relatively simple solutions for aesthetic improvement of chin utilizing chin implants. A desirable additional effect often seen with chin augmentation alone or with advancement osseous genioplasty is the creation of a more aesthetic smile arc.
Chin augmentation with either implants genioplasty or osseous genioplasty (surgical manipulation of the bony chin) are well-established technique that are widely applied in aesthetic surgery. In the chin, alloplastic implants are chiefly indicated if the required aesthetic improvement is mainly for augmentation in the profile view. However, osseous genioplasty is generally required if movement of the chin is required in 3 dimensions.
The recognized risks with chin augmentation surgery include malposition, infection, thinning of the overlying soft tissues, and implant exposure. Occasionally, patients may require secondary procedures to adjust the position and change the size of the implants.
Body contouring surgery encompasses a number of surgical procedures that involve the removal of fatty tissue, with or without excision of skin. The two most common examples are liposuction and tummy tuck surgery (abdominoplasty). A combination of fat removal and skin excision surgery are often utilised, especially in those patients seeking body contouring surgery after severe weight loss. Body-contouring surgery aims to achieve the best possible contour outcome but the lengthy operating time and co-morbidities such as diabetes, high blood pressure and heart disease in this patient group result in a higher risk of serious complications. Specific examples include thomboembolism (formation of clots in the legs or the lungs), significant blood loss, seroma issues and wound healing problems. Thus, a careful pre-operative assessment and optimisation of patient medical conditions accompanied by a good and thorough surgical plan are important steps so as to prevent or minimise these potential risks and complications. In addition, many body-contouring procedures require change of positions to treat specific areas, thus proper patient positioning on the operating table is paramount.
The range of surgical techniques involved in body contouring (liposuction, abdominoplasty, brachioplasty, thigh lift, buttock lift) is extensive and therefore will not be covered in this brief introduction to body contouring surgery. During consultation, Mr. Fuan Chan will critically assess and examine the various components involved in the particular aesthetic procedure and take you through the process. Mr. Chan will also go over the risks and complications, including the alternative options to the proposed aesthetic surgery. You will have plenty of time to think over the decision and come back with any questions for subsequent consultations before committing to the surgery.
Early liposuction was associated with significant blood loss, which limited the amount of fat that could be removed in a single procedure. In 1987, Dr J. Klein introduced the tumescent technique in liposuction surgery. This tumescent technique involved the infiltration of solution which contained local anaesthetic agents(lidocaine or marcaine) and epinephrine to the site of fatty tissue prior to liposuction. This technique enables removal of larger volumes of fat without excessive blood loss which translates to better safety and patient care.
During the liposuction procedure, specially designed cannula(probes) of varying size are use, depending on the deposition, volume and characteristic of the fat at the target sites. Liposuction by itself is not a technically difficult procedure but the challenge lies in having the aesthetic sense to achieve a great contour and smooth transition that fit the aesthetic ideal for the patient.
With better surgical techniques and medical advances, liposuction has become one of the safest procedures in cosmetic surgery. In addition, liposuction has also become a common procedure being used in combination with other surgery such as tummy tuck (abdominoplasty), breast surgery and fat grafting surgery.
The success of surgery is in ensuring that the operating surgeon and the patient are agreed the same page operative goals and expectations. There are inherent risk and complications, these include, but are not limited to, bleeding, infection, bruising, seroma, contour irregularity and asymmetry.
The abdomen (tummy or belly) is one of the most commonly affected areas of our body displaying the unpleasant aesthetic and functional issues as a results of obesity, weight loss and pregnancy or a combination of these factors. The main components for success are establishing good patient and doctor relationship, careful patient selection and education, with measures to reduce surgical complications while achieving earlier recovery, better contouring of the shape with less post-operative wound healing issues.
The patients may present with either flaccid skin, excess fatty tissues or weak abdominal muscles (diastasis of the rectus muscles) or combination of the above. Preoperatively, patients' goals and expectaions are assessed, including fitness for surgery and history of smoking, diabetes and use of anticoagulants such as warfarin. Similarly, clinical examination also involves the identification of any bulges (hernia) at the abdomen or (belly button) umbilcus. Previous surgical scars on the abdomen can complicate the surgery, and in certain instances leading to the patient's unsuitability for tummy tuck surgery. Of note, patients are also informed of the scars and understood that any stretch marks(striae) on the abdomen will still remained after the surgery.
Pre-operatively, patient's medical conditions and general health status are assessed and optimized if indicated. Surgery is strongly against unless ceasation of smoking for at least 3 months and weight stabilised for at least 1 year especially in post severe weight loss patient.
Marking with the patient standing and lying down are done in the morning on the day of surgery or the night before surgery. The procedure is performed under general analgesia with adherence to specific protocol regarding safety, positioning of patients on the operating table and use of compression devise on the legs together with relevant measures such as keeping patients warm and well hydrated during the surgery in order to minimize complications.
Intraoperatively, the excess skin and fatty tissue are addressed surgically with re-inforcement (plication) of the weakened rectus (abdominal) muscles while ensuring good contour as the endpoint. Liposuction (removal of fatty tissue) is also performed during the surgery if indicated. Upon satisfactory outcome assessed intra-operatively, the wounds are closed by layers using specific plastic surgery techniques to minimise risk of wound breakdown and bleeding complications.
The post-operative management is important for a great outcome. Patient wake up from the theatre with an abdominal support garment (binder)and drains. Compression devices and compression support TED stockings with commencement of anticoagulants to thin the blood on the same day (Clexane or Innohep) minimise the risk of blood clotting in the legs and the lungs which could have serious consequences. The patient is positioned appropriately on the bed to minimize undue tension to the wounds. On discharged, usually within next two to five days, adequate support at home is crucial to facilitate the uneventful recovery. Risk and complications, but are not limited to, include clots in the leg and the potentially fatal clots in the lungs (Pulmonary embolism), bleeding, infection, bruising, seroma, hematoma, contour irregularity, asymmetry, wound healing problem, potential risk of loss of the belly-button (umbilicus) and scarring.