A considerable amount of fat in our cheeks can help us look younger and the general idea is that volume in the face = a younger look. However, there is also such a thing as chubby cheeks that border on looking chipmunk-esque.
You may also feel self-conscious as chubbier cheeks may signify weight gain. Although most individuals lose their chubby cheeks as they age, some are genetically predisposed to having chubbier cheeks that are harder to get rid of. In this article, we’ve lined up some methods to help reduce your chubby cheeks:
Although you can’t spot-reduce, exercising regularly can help us lose weight even in our cheeks. You could also try facial exercises to improve muscle strength and tone facial muscles, creating a slimmer appearance.
Cardio exercises are physical activities that increase your heart rate and are one of the most effective methods for weight loss. Several studies have shown that regular cardio helps increase fat loss over time - aim to get about 150 minutes a week in.
Your drinking habits are crucial for your health and can be particularly important if you’re looking to lose facial fat. Studies have shown that regular water consumption can keep you full and enhance weight loss.
Aside from being an appetite suppressant, water is needed to metabolise fat or carbohydrates in a process called lipolysis. During a process called hydrolysis, water molecules interact with fats to create glycerol and fatty acids.
You are what you eat
As the saying goes: “whatever you eat in secret, shows up in public”, face included. Try steering clear of cookies, crackers and pasta because empty carbohydrates are common culprits to weight gain and fat storage. They have little to no nutrients and fibre, and are often heavily processed.
You should also consider reducing your sodium intake by avoiding salty foods as it can lead to fluid retention, ergo swelling and puffiness. Instead, you should increase your fibre intake (yes, vegetables!) as it can help keep you full longer and is good for your gut.
Sleep deprivation can lead to an increase in cortisol, which is a stress hormone. It can indirectly lead to an increased appetite, altered metabolism, and hence, increased fat storage. Adopting a regular sleep cycle can help you shed extra pounds, and lead to successful weight loss maintenance.
Buccal Fat Removal
If you’ve exhausted all options and still struggle with chubby cheeks, you can consider buccal fat removal, also known as cheek reduction surgery.
What is it?
Buccal fat removal is a permanent procedure that involves surgically removing the buccal fat pad, a naturally-occurring pad of fat around the cheek hollow. This is done through an incision inside the mouth, between the gums and cheeks, so there won’t be any scarring on the face. This creates a slimmer and more contoured V-shaped face.
What to expect
The procedure takes about 30 - 60 minutes and you’ll be put under light IV sedation. Although it may take several weeks to a month to see the full results, you’ll be able to return to work after 2 to 3 days! Remember to follow all post-procedure instructions given to you by your doctor, such as taking your antibiotics and anti-inflammatory medication.
Should you undergo cheek reduction surgery?
While the idea of a slimmer face is attractive to many, not everyone is a great candidate for buccal fat removal. Sometimes, a proper diet and frequent exercise may suffice!
However, chubby cheeks may be caused by genetic predisposition. If you find that you've exhausted all options even with a low body fat percentage, cheek reduction surgery may be for you.
There is also a lot of aftercare required, so it’s important to be able to keep to a routine to prevent post-surgical complications.
Buccal fat removal is considered a permanent procedure as the buccal fat does not grow back even with weight gain; what you put on is subcutaneous fat, which is the more superficial fat under the skin.
If you’re considering buccal fat removal, do come in for a consultation and Dr Samuel Ho would be able to advise you on whether this surgery is right for you, or suitable alternatives to consider.
Ptosis Surgery in Singapore: Dr Samuel Ho’s Guide for 2022
Ptosis surgery in Singapore is a procedure meant to correct droopy eyelids by lifting the eyelid and removing the excess skin affecting the patient’s vision. Sometimes, people undergo ptosis surgery for aesthetic reasons, such as to fix asymmetry in the eyelids or to look more awake.
Ptosis is often caused by the effects of ageing such as increased skin laxity and the weakening of the levator palpebrae superioris muscle tendon, which is responsible for lifting the eyelid. However, younger people may have it too! In fact, more than a third of Dr Samuel Ho’s ptosis patients are patients in their early 20’s to 40’s. In these cases, the droopy eyelids may have been caused by trauma, disease or the continuous stretching of the eyelids. Ptosis may also be a result of anatomical defects at birth (congenital ptosis).
What can ptosis correction surgery treat?
As mentioned earlier, ptosis correction surgery can treat the drooping of the eyelid(s) caused by excessive eyelid skin, weakened eye muscles or disease. In severe cases, ptosis compromises vision, significantly affecting your ability to see. Ptosis correction surgery treats droopy eyelids, hence, improving vision and overall quality of life.
What is droopy eyelid surgery in Singapore like?
What to expect for your droopy eyelid surgery will be dependent on its severity and causes.
It always starts with a comprehensive consultation with your surgeon in order to accurately map out and discern what surgical techniques to employ based on the severity of your condition, its causes and your facial features. Dr Samuel Ho will measure your Marginal Reflex Distance (MRD), which is the distance of your pupil’s centre to the upper eyelid to determine whether ptosis correction would be necessary.
There are a huge variety of surgical methods to treat droopy eyelids. Cases of mild ptosis (where the eyelid only covers a small portion of the iris) may only require a scarless suture technique, whereas more severe cases (where more than 2mm of the iris is covered by the eyelid) may require incisional surgery.
One of the most common methods would be the manipulation of the levator aponeurosis — the fascial tissue that connects the levator muscle to the connective tissue in the upper eyelid. Excess eyelid skin and fat can also be removed.
You will be put under local anaesthesia and IV sedation to keep you comfortable throughout the procedure which lasts for about 30 - 60 minutes per eyelid. After which, you will be allowed to go home to rest and recover.
Downtime is dependent on what type of blepharoplasty technique was done. You may experience some bruising, which will subside in about 7 - 10 days. Swelling may take 2 weeks to a few months to resolve. Your surgeon may also prescribe certain medications to help reduce these side effects.
Is ptosis correction surgery the same as double eyelid surgery?
No, they are not the same. Ptosis correction involves the repair of the levator muscle and/or removal of the excess eyelid skin to lift the eyelid, whereas double eyelid surgery is the creation of an eyelid crease to create a larger, almond-shaped eye.
However, these procedures are similar and it is possible to achieve a double eyelid during ptosis correction surgery by making an incision and removing the excess eyelid while creating a double eyelid fold or crease.
Who is suitable for droopy eyelid surgery in Singapore?
Droopy eyelid surgery is recommended for patients where one or more of their eyelids droops significantly, affecting their ability to keep their eyes open. This drooping often obstructs vision, causing eye strain and fatigue. The correction surgery is also suitable for less severe, more aesthetic-related cases.
A child may be anatomically predisposed to having droopy eyelids and should undergo ptosis correction surgery if it interferes with your child’s visual development. However, if it does not affect their vision, Dr Samuel Ho suggests that you wait until the child is at least 12 years old before undergoing ptosis correction when your child is mature enough to cooperate with your surgeon to make more accurate intra-operative measurements.
How much does ptosis surgery cost in Singapore?
In Singapore, ptosis surgery can cost anywhere between $7,000 to $18,000. This is dependent on the surgeon’s expertise, anaesthetic fees, facility fees and the medication prescribed.
At Allure Plastic Surgery, surgeon fees cost about $6,900 onwards. The cost of the operating theatre, anaesthesia and medical consumables apply. Please contact us for a quotation.
Is ptosis surgery claimable by Medisave or insurance?
Yes, if severity meets the benchmark. Moderate to severe ptosis is considered a medical condition, which may make the surgery eligible for Medisave or insurance claims.
In order to get Medisave or insurance coverage for your ptosis surgery, you will require an official visual assessment by an opthalmologist according to guidelines stipulated by the Ministry of Health (MOH) Singapore.
Are there any risks to ptosis surgery?
Although rare, some risks related to ptosis surgery are:
Post-surgical swelling or bruising
Asymmetry in eyelid height
Overcorrection or under-correction
Some of these are rare cases and can be avoided with a skilled surgeon and by properly following post-surgical care instructions. Swelling and bruising subside after 7 - 10 days. You may find it difficult to completely close your eyes right after surgery, but lubricant eye drops or ointment can be prescribed to help. The eyes should close completely once the swelling subsides.
What happens if I do not fix my droopy eyelids?
If left untreated, most cases of droopy eyelids worsen over time. This can greatly impair the patient’s vision. Additionally, the forehead is often used to compensate for the drooping and used to lift the eyelid margin, which, in turn, causes forehead wrinkles. Other symptoms include feelings of heaviness and fatigue, headaches and eye irritation.
In children, severe ptosis may affect vision development and cause amblyopia, more commonly known as lazy eye.
How do I choose a clinic for ptosis surgery in Singapore?
When it comes to choosing the right clinic for your ptosis surgery, there are a few things to take note of:
Board certification can be likened to a mark of distinction. Getting a board-certified surgeon ensures that the doctor has trained extensively in their area of expertise, have mastered great technical skill for complex cases, are at the top of their profession and will be able to deliver high-quality care. In Singapore, ptosis surgery can be performed by plastic surgeons, oculoplastic and facial plastic surgeons.
Surgeon’s expertise and skills
Similar to the above, it is important to find a surgeon with expertise in ptosis surgery and has the skills needed to treat your condition safely and successfully. Eyelid surgery is one of Dr Samuel Ho’s specialities. To date, he has performed over 600 ptosis correction surgeries of varying complexities.
He has worked alongside top plastic surgeons at plastic surgery centres around Korea. His passion had led him to discover new surgical techniques, such as the use of the “under through” levator aponeurosis plication technique for ptosis surgery. This technique, compared to the conventional levator plication method, increases the surgery’s success rate and significantly reduces the chances of ptosis relapse.
Clinic’s facilities and technology
Clinic facilities and technology play a huge role in ensuring a comfortable surgical experience and also lowering your risk of complications from infections. The latest technology also improves patient safety and reduces the chances of medical errors.
Allure has its own day surgery centre, fully equipped with the technology and amenities needed for your procedure. This means less hassle and enhanced patient comfort. Furthermore, Dr Ho will be at the surgery centre to make sure all goes well, even when you wake up after the procedure.
Proper assessment and follow up
A good healthcare experience not only involves a smooth operation but also a proper assessment and follow up. Your surgeon should carry out a comprehensive pre-op assessment, as well as a follow up to make sure you are recovering well and without complications. Having your surgical expectations managed and having the right post-surgery care is as important as the surgery.
Allure Plastic Surgery provides a health concierge service for both international and Singapore-based patients to ensure a smooth and comfortable experience. For international patients, arrangements can be made for Dr Ho to liaise with your overseas physician to ensure that you get the necessary care and attention.
Why choose Allure Plastic Surgery?
Allure Plastic Surgery is led by Consultant Plastic Surgeon, Dr Samuel Ho, who specialises in mummy makeovers and eyelid surgery, among others. Thus far, he has performed over 600 ptosis correction surgeries of varying complexities.
If you’re still in doubt, please reach out to any of our friendly staff. You are encouraged to address any concerns or queries so that you can make a confident decision about undergoing ptosis surgery.
All About Cheek Dimples: How they're formed
In the Russian Roulette of facial deformities, cheek dimples are often something many of us wish we had landed on. Technically known as fovea buccalis, cheek dimples are caused by the irregular growth of a certain facial muscle during embryonic development. This muscle is shortened, causing our skin to stretch and pulling our lips behind into corners when we smile.
As cheek dimples can accentuate smiles, they can make someone look more youthful, approachable and societally attractive. In fact, in some cultures, dimples are associated with beauty and good luck.
While it is rather common to see individuals with cheek dimples, not everyone has them. Approximately 20-30% of the world’s population has dimples, making them less common than desired. For us undimpled lot — how are they formed and can we get them? Read on to find out more.
In individuals with no dimples, the muscle usually begins at the bone in your cheek called the zygomatic bone. It runs downwards, connecting to the corner of your mouth.
On the other hand, the muscle may divide into two separate bundles of muscle on its way to the mouth for individuals with dimples. One bundle connects at the corner of the mouth, and the other connects below the corner of the mouth. This split in muscle can be referred to as a double major muscle. The movement of the skin over this major muscle causes the dimple to form when you smile. As it results from muscular variation that occurs during the development of the foetus, it can be thought of as a “birth defect”.
Can cheek dimples go away?
For some people, dimples may appear in their early years and fade away as they age. Additionally, cheek dimples can also become less noticeable when one ages and loses skin laxity, or loses weight drastically. That said, in most cases, this genetically inherited trait does not disappear completely.
Conversely, weight gain may make your cheek dimples appear more prominent because of the excess fat in your cheeks and face.
Can you get cheek dimples without surgery in Singapore?
Although you may temporarily create indents in your cheeks, it is impossible to get permanent dimples with methods such as facial exercise.
Some people try to get dimples by piercing their cheeks instead, and often the results are unsatisfactory and not everyone is comfortable with having a dimple piercing.
Is there surgery for cheek dimples in Singapore?
Fortunately, those of us who did not inherit the trait can get them through surgical means — this is called dimple creation surgery or dimpleplasty. This is also a viable option for those who would want to make their one-sided dimple symmetrical.
A dimpleplasty is an outpatient procedure performed using a suture technique with an intra-oral incision. It is relatively simple, has few complications and can be performed under local anaesthesia or IV sedation. A study of 20 patients, only had 2 reported adverse outcomes. 
30 - 45 minutes
3 - 5 days
What to expect during a Dimpleplasty procedure in Singapore
The procedure begins with a consultation with Dr Samuel Ho, where he understands both your needs and concerns. If all checks out, your new dimple location will be marked out on your face based on your requested position and Dr Ho’s recommendation.
An absorbable suture is then passed through the inside of the cheek, followed by a small incision made on the interior of the mouth. This suture then catches the undersurface of the dermis and is looped back to the first incision site, creating an indentation.
This suture is safely tied down to the buccinator muscle to create a dimple in the overlying skin. Dr Ho careful adjusts the tension of this suture to determine the depth of the dimple — a key step in ensuring a natural-looking cheek dimple.
This procedure takes about 30 to 45 minutes.
What to expect during recovery from a Dimpleplasty in Singapore
There is no need to worry, as the surgery will not leave a scar on the outside of the face and there is minimal downtime involved. You may return to work on the same day with a mask and you should avoid hard, chewy or spicy food for a week.
To minimise the risk of infection, a mouth gargle will be prescribed. As your cheek heals, avoid moving your mouth excessively and strenuous blowing actions to avoid complications.
You can also expect the dimple to look very deep within the first month, but this will gradually recede and appear shallower and natural-looking in the following months as the suture tension decreases. The sutures are then gradually absorbed by the body, resulting in a permanent dimple.
Hopefully, this article has helped answer any queries you may have about dimple creation surgery. Although it is a relatively simple surgery, it will still require a lot of thoughtful consideration before making a final decision. Always remember to communicate both your needs and concerns with your plastic surgeon so that they can work with you in getting a comfortable experience with results that best suit you.
Chen, A., Gerry, D., & Zimmerman, Z. (2019). The dimpleplasty: a new streamlined approach to surgical creation of dynamic facial dimples, our experience, and results. The American Journal of Cosmetic Surgery, 36(3), 138-142.
Things To Know About Tummy Tuck Surgery
Getting rid of fat in the abdomen is often the hardest when it comes to losing weight as that is where stubborn fat tends to settle, especially for women. From physical changes as we age, weight fluctuations, and childbirth, excess fat and skin can accumulate around our stomach. Excess fat, skin or drastic weight loss is why people tend to consider a tummy tuck surgery or abdominoplasty.
Many new mothers also consider a tummy tuck, as it helps get rid of post-pregnancy woes such as excess skin, the tummy pouch and C-section scars.
Understandably, getting a tummy tuck is a big decision and it’s always important to do ample research before deciding on the surgery. Hopefully, this guide will help you in your decision-making process.
Can tummy tucks help me lose weight?
While some individuals may lose a few pounds from this procedure, a tummy tuck should be seen as a way to sculpt and shape the body.
Ideally, you should only consider a tummy tuck when you are close to your desired weight from a minimum of six to twelve months from your goal weight or are already at your ideal weight. This is a crucial step as gaining or losing too much additional weight can undo the contoured shape you have achieved from the tummy tuck; the main worry is too much excess skin laxity after a huge amount of weight loss after the procedure. Your weight fluctuations can also stretch the abdominal tissues that may require a revision procedure to restore the initial results.
If you’re looking to get rid of stubborn fat, perhaps liposuction would be a better option. You may even undergo a combination of liposuction and abdominoplasty for the best results.
What abdominoplasty scar can I expect post-surgery?
Depending on the type of tummy tuck done, you might have a different scar from another individual depending on the location and size of the abdominoplasty. For example, a traditional tummy tuck will have a scar from hip-to-hip that is hidden under the bikini line. If you only need a small amount of skin removed, a mini tummy tuck will have a smaller scar. The scar will also be permanent and will be visible for about 12 weeks before fading off nicely.
C-section scar after pregnancy
If you’ve just undergone a C-section, your plastic surgeon can work with you in performing a tummy tuck that tightens your abdominal muscles, removes the excess skin and creates a new, cleaner scar.
You’ll require help at home
A tummy tuck is an outpatient day surgery, which means you’ll get to go home right after the tummy tuck is done. However, you will need some time for recovery. As your wound is situated in an area that might limit movement, you will need help for about a week to prepare food and keep the house clean.
Some patients will need some assistance to sit up or grab anything far for the first couple of days for the full tummy tuck, although many of the patients will feel it is an easier recovery as compared to the C-section. Mini-tummy tuck patients are usually very mobile even the next day after the surgery. Heavy lifting should also be avoided for the first month or so, so mothers with young children should consider this as well; carrying your young child after the first 5 days is usually not an issue.
Is it normal for my stomach to feel tight after a tummy tuck?
As a result of your stomach muscles being tightened, excess skin removed and skin pulled tautly, you’ll be bent over for a few days. It is more psychological than an actual physical need to, and I usually advise patients to keep their back as straight as possible after the 3rd day post surgery, to avoid backaches.
You might have difficulty reaching for things and it will impact the way you rest. Plan on sleeping in a recliner, with a wedge pillow or with a bunch of pillows that allow you to prop up your legs until you are able to lie flat comfortably.
How long after a tummy tuck will I see results?
A tummy tuck wound takes 12 days to heal on the superficial surface, but the deeper tissue will take 4 to 6 weeks to heal. You may feel fatigued, swollen, sore and some pain during the first few days. It is crucial to focus on rest and healing for up to six weeks. As the swelling can linger over four to six months, it can take up to a year to see the full results of your surgery. Results will be most obvious when the swelling has subsided.
It is also important to remember to wear the compression garment provided to you religiously for the first 4 to 6 weeks, as this will help greatly in facilitating the healing process.
What is the best type of tummy tuck?
There are various types of abdominoplasty, such as:
The full abdominoplasty
Belt lipectomy and lower body/buttock lift
Based on your needs and concerns, your plastic surgeon will recommend a type of abdominoplasty suited to you.
For example, for post-pregnancy mothers with not a lot of skin excess/laxity or a very large bulge, a mini-abdominoplasty or mini tummy tuck is often recommended. This is because it creates a much shorter scar and provides good results. The scar formed from this type of tummy tuck would be well hidden where a caesarean scar might be. It also helps eliminate the problem of sagging skin, simple umbilical defects and splaying of the abdominal rectus muscles. 
To find out more about abdominoplasty, click here.
Choosing the right plastic surgeon is important
A tummy tuck procedure is not cheap, so doing your research on a certified surgeon is important as it may affect your results. In Singapore, only plastic surgeons are allowed to perform this procedure. They must be accredited by the Ministry of Health Singapore (MOH) and have at least 6 years of experience specialising in general surgery — this ensures that they are capable of handling complications during and after surgery. If possible, during your consultation, request pictures from other tummy tuck procedures done by the surgeon to have a better idea of his skills.
The right surgeon would also be able to advise you on whether you’re suitable for abdominoplasty based on the characteristics of your body and your needs. For example, those planning to conceive or have unstable weight are advised against this procedure. If so, they would also be able to provide you with alternative options that would be safer for you.
At Allure, Dr Samuel Ho performs the tummy tuck as a day surgery, without needing to stay in the hospital for a few days. Patients are required to wear a compression garment for optimal results and follow Dr Ho’s advice post-surgery that entails the alteration of abdominal muscles for the best results.
If you’re looking at considering a tummy tuck, it would be good to check in with a doctor on your suitability. When discussing your options, it is important to inform your doctor of your lifestyle and any kind of medical history you have for an accurate evaluation.
Friedman, J. D., Gordon, S., Kaufman, M., & Menn, Z. K. (2015). Expanded role and usefulness of the mini-abdominoplasty. Plastic and Reconstructive Surgery, 136(4S), 98-99.
Get beach body ready with a tummy tuck in 2021
Getting beach body ready in Singapore isn’t very time-specific to the summertime as this little island is generally sunny all year round. However, with restrictions in place, it would be an especially good time to hit the beach for some rest and relaxation. But before that, consider getting a tummy tuck so that you can look your best.
Perhaps you’re planning a nice evening out, dipping your feet in the sand, and posing with your best friends in your new bikini for the gram. Here are some tips to get your body feeling and looking beach body ready for the summer.
Work your core
A strong core isn’t just about perfect abs or a toned stomach! Often referred to as the centre or bridge of the body, the core is important for balance and posture. Core strength helps you move better and avoid injuries. Well-defined abs are just a bonus!
Many exercises work for core training, such as crunches, sit-ups and planks. Apart from your core, planks help strengthen your glutes (a.k.a. your butt) and hamstrings.  If you are doing your exercises correctly, 8-15 repetitions are all that you need to target your abs and get results. Importantly, keep your back straight and butt level with the rest of your body during the plank to get the most out of it.
Don’t forget the booty
A good buttock is important not just for how it looks — but also the fact that strong glute muscles can protect your lower back during squats and weightlifting exercises.
Some of our favourite butt exercises include lunges, squats and step-ups. If you’re up for a bigger challenge, throw a resistance band into the mix!
Go snack-less... or try to snack less
If you’re hoping to lose some weight, there’s no escaping the no-snack rule. Or, really, the less-snack rule, because dieticians say some snacking can be a part of a healthy diet.
A healthy diet and a good fitness regime are really the two non-secrets to achieving our ideal, strong bodies. If you already have those nailed like a champ, but still find yourself short of your desired beach-ready body, you may want to give body contouring procedures a shot.
Different from weight loss, body contouring entails fat (and excess skin) removal. Tummy tuck surgery, in particular, target the removal of lax skin and fat around your abdomen, improving your tummy contour, building your core muscle strength, and correcting any herniation.
But how does it work? A tummy tuck (formally called an abdominoplasty) is a surgical procedure that requires general anaesthesia. The surgeon separates the patient’s skin and fat from the muscles before the splayed muscles are pulled and stitched together for a more defined and controlled contour.
There are different types of tummy tucks, and the type of procedure you undergo depends on your specific needs and concerns, mainly:
For example, post-pregnancy mothers usually benefit most from the mini-abdominoplasty or a mini tummy tuck. Your plastic surgeon will recommend what would be best for you.
What you can expect from your tummy tuck procedure is a smoother, firmer and more sculpted stomach. Potentially, it could also fix marks that your past weight fluctuations could’ve left on that area, such as stretch marks.
Strong mind for a strong body
Ultimately, more than just looking good, you should be feeling strong, proud, and happy with your body. No matter if your goal is a perfectly flat tummy or just clocking in thirty squats a day, it is always a good time to refresh and recharge.
Just remember that even as you work on your 2021 beach body, don’t forget to give yourself a break (and a whole lot of love) amidst the crazy COVID19-filled year we’ve been having!
Lee, J., Jeong, K. H., Lee, H., Shin, J. Y., Choi, J. L., Kang, S. B., & Lee, B. H. (2016). Comparison of three different surface plank exercises on core muscle activity. Physical Therapy Rehabilitation Science, 5(1), 29-33.
Hervik, A. K., & Svihus, B. (2019). The Role of Fiber in Energy Balance. Journal of nutrition and metabolism, 2019, 4983657. https://doi.org/10.1155/2019/4983657
The Complete Guide to Fat Grafting (2021)
At some point in our life, we’ve had stubborn pockets of fat that we wished would’ve grown somewhere else — it could have benefitted us more in the booty than our mid-waist. Fortunately, plastic surgery has made this possible and it is called fat grafting or fat transfer.
Fat grafting is the process of surgically transferring fat from one area of the body to another. This helps to replace lost volume, and improve or augment where the fat is injected.
As the material transferred is natural and from your own body, there is no risk of rejection and a lower risk of infection. The risk of wound infection is relatively low at a rate of about 1-5% only. 
What can I expect when I go for fat grafting?
Your first consultation will involve a comprehensive review with your plastic surgeon. During this time, it is important for you to address both your needs and concerns, so that they may best tailor the treatment to you. Your plastic surgeon will also explain what to expect during the procedure and will recommend the ideal area from which to harvest the fat.
For example, if you intend to do a facial fat graft, Dr Samuel Ho from Allure will evaluate your face and bone structure to discuss the changes you desire, such as where to strategically inject the fat to accentuate parts of your face.
Initially, modified minimally-invasive liposuction is carried out, which is the harvesting of fat from the tummy or thighs through pinhole incisions. This is then carefully processed using a strict protocol for grafting to areas of the face such as the cheeks, lips, forehead or temporal areas.
For fat grafting around the eyes or periorbital fat grafting, a micro fat grafting technique is used. Micro-needle incisions are used to meticulously inject the processed fat around the eyes  to correct a sunken appearance, wrinkles, prominent tear trough or lid-cheek lines or dark eye circles. This can be done as a standalone procedure or in combination with a blepharoplasty to achieve a youthful appearance.
Patients are given moderate sedation and will be asleep throughout the procedure.
Breast fat grafting
Fat grafting can be used to augment the size and symmetry of your breasts. Similar to facial fat grafting, the fat used is first harvested from the patient’s tummy, thighs or buttocks.
The fat is processed under strict protocols and injected into the breasts.  Staged procedures may be required to achieve the desired outcome. This is usually performed 3 months apart.
What is recovery like?
After the procedure, you will be allowed to go home to rest. There are no visible scars and full recovery is expected in 1 to 2 months.
Major swelling and bruising should subside between the first and second week and will continue to improve within the next two months.
Is a fat grafting procedure permanent?
The fat transfer results are permanent. However, not all the fat that has been transferred will survive. The fat that survives the transfer will remain permanently and behave just like the other fat in your body.
Would I be suitable for a fat grafting procedure?
To be suitable for a fat grafting procedure, certain prerequisites have to be met. One of these is that there should be an ample amount of fat in the harvest site for a successful procedure. This would also be dependent on where you want to transplant the fat to.
Transferring fat is definitely an option to consider if you want a more permanent form of correction than what is provided by temporary fillers. It can contour the body, fill bodily depressions and rejuvenate your appearance. Always remember to consult your plastic surgeon for a proper assessment and to communicate both your needs and concerns.
Kim, S. K., Choi, J. A., Kim, M. H., Kim, M. S., & Lee, K. C. (2015). Treatment of the Mycobacterium chelonae Infection after Fat Injection. Archives of plastic surgery, 42(1), 68–72. https://doi.org/10.5999/aps.2015.42.1.68
Sezgin, B., & Özmen, S. (2018). Fat grafting to the face with adjunctive microneedling: a simple technique with high patient satisfaction. Turkish journal of medical sciences, 48(3), 592–601. https://doi.org/10.3906/sag-1711-42
Zielins, E. R., Brett, E. A., Longaker, M. T., & Wan, D. C. (2016). Autologous fat grafting: the science behind the surgery. Aesthetic surgery journal, 36(4), 488-496.
How Prominent Ear Correction Is Done
What are prominent ears?
Prominent ears or otapostasis, are ears that protrude from one’s head more than they usually would. This usually occurs from childhood and although protruding ears do not affect one’s hearing, this condition can take a toll on one’s self-esteem and cause psychological distress. Thankfully, this can be resolved with prominent ear correction, also known as otoplasty surgery.
They may appear unilateral or bilateral, where the concha is large with a poorly developed antihelix and scapha. Stemming from the malformation of cartilage during primitive ear development, this stage in intrauterine life may result in ears that appear much bigger and even considered unsightly in some cultures
Surgical options for prominent ear correction
Prominent ear correction, also known as otoplasty, is a surgical procedure that changes the shape and position of the ears to create a more balanced appearance. A combination of surgical techniques is done and is ultimately dependent on the characteristics of the prominent ear, such as removal of certain parts of ear cartilage, scoring, otobrasion of other parts of the ear cartilage, as well as the placement of mattress sutures to correct the angulation and the prominence. 
Congenital ear deformities in newborns, often a result of external forces on normal ears like malposition while sleeping or pressure from the birth canal, occur with an incidence between 6 and 58%. 
For young infants with prominent ears, moulding can produce a good result as the structure in their ear cartilage is still elastic and susceptible to pressure changes — making it easier to correct prominent ears without any invasive treatment. For adults and adolescents, however, the calcification or hardening of the ear cartilage might mean that surgery would be needed for protruding ear correction. In fact, in some older individuals, the degree of calcification might mean that otoplasty may not yield good results or have a high failure rate, where the ear returns to its previous prominent position.
What to expect for a prominent ear correction procedure
Depending on the individual characteristics of the prominent ears, the surgical correction may involve the removal of certain parts of the ear cartilage or scoring and otobrasion of the cartilage. Typically the ears are assessed in thirds, with the top ⅓ being the prominent helix, the middle ⅓ being the prominent concha, and the lower ⅓ being the prominent earlobe, which is rarely in need of correction. During the surgical procedure, mattress sutures will be placed in the treatment area to correct the angulation of the ears and their prominence.
During your consultation, the plastic surgeon will discern what combination of surgical techniques will be needed to achieve the best aesthetic outcome possible. At Allure Plastic Surgery, protruding ears can be corrected using Dr Samuel Ho’s hybrid technique of suture and cartilage abrasion and excision with the surgical incision well hidden in the fold of the ear.
For your comfort, you will be put under local anaesthesia with some intravenous sedation. At the patient’s request, general anaesthesia is also available. The procedure usually lasts about 1 to 2 hours, depending on the complexity of the surgery, severity of the prominent ears and how much correction is desired.
Post-operative aftercare usually involves having compression bandages over your ears for a few days after surgery. This is then replaced by a headband during your first follow-up with your surgeon.
Patients will be able to return to work a week after surgery and should avoid strenuous activity which is high in intensity. Patients should also avoid touching or sleeping on the treatment areas.
Not all ears are built the same. In some rare cases, patients may have ear deformities such as Stahl’s ears, lop ear or cryptotia, which is part of the top ear which is hidden under the scalp skin. These rare conditions require careful assessment in order to achieve a good correction.
After careful consideration with the surgeon, ear correction should only be performed after a detailed consultation with the patient’s surgeon. Although there are no perfect pair of ears, it ultimately boils down to what the patient is happy and comfortable with and what would best frame their face. Therefore, it is important to communicate both your needs and wants with your surgeon so that they may work with you in finding the best surgical outcome for you.
Nazarian, R., & Eshraghi, A. A. (2011). Otoplasty for the protruded ear. Seminars in plastic surgery, 25(4), 288–294. https://doi.org/10.1055/s-0031-1288921
Hallac, R. R., Jackson, S. A., Grant, J., Fisher, K., Scheiwe, S., Wetz, E., ... & Kane, A. A. (2021). Assessing outcomes of ear molding therapy by health care providers and convolutional neural network. Scientific reports, 11(1), 1-8.
5 Things To Know About A Nose Job (Rhinoplasty)
In recent times, Singaporeans have become more open to the idea of undergoing cosmetic surgery. At Allure, one of the most common procedures they opt for is a rhinoplasty or a nose job. People often think getting a nose job is a straightforward procedure — however, it does have a revision rate of 5 to 15% , with about 14% of these patients being teenagers. It is a big decision to make, especially since your nose sets the tone for the appearance of the face. Don’t worry, we’ve got you! Read on for 5 important things to consider before getting a rhinoplasty.
What is a Nose Job (Rhinoplasty)?
A rhinoplasty is a surgical procedure that entails changing the shape of your nose. Often, the motivation behind it is to change the nose’s appearance, improve breathing or both. The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three.
Understanding the difference between a Septoplasty and Rhinoplasty
A “nose job” is often used to refer to a procedure conducted on someone’s nose. However, a nose job may actually refer to two separate procedures: septoplasty and rhinoplasty.
Individuals with deviated septums may choose to undergo a septoplasty to fix it. During the septoplasty procedure, the doctor straightens the septum to relieve any breathing issues which stem from the blockage of the nasal passage. A rhinoplasty is generally for aesthetic purposes as the nose shape is changed.
If you have a deviated septum, you may require both procedures in order to correct any bumps or crookedness caused by their deviated septum.
The technique used usually varies depending on your desired results. Generally, a rhinoplasty can be performed to address the following:
Increasing or decreasing the nasal bridge
Increasing or decreasing the length of the nose
Reducing the size or width of the nose
Changing the size of nostril flares
Reshaping the nose tip
Enhancing the angle between the nose and upper lip
Getting rid of nose bumps
Straightening a crooked nose
Understanding what you truly want is a crucial part of the decision-making process. It is also important to communicate this effectively with your plastic surgeon.
Finding a plastic surgeon for your nose job
Not every nose job has the same end result. While plastic surgeons are medically certified to perform these surgical procedures, you could try looking for a plastic surgeon who specialises in or has a specific interest in rhinoplasty.
It is also important to look for a plastic surgeon who understands your needs and concerns, and who can help you get the desired results you envision. During your consultation, ask all the questions you need that you know would help you make a sound decision. You may also request to view before and after pictures to see the previous work the doctor has done.
Find a plastic surgeon you can trust who is board-certified and up-to-date with changing trends within the realm of rhinoplasty and aesthetic surgery.
Understanding your recovery process
As it is a surgical procedure, you may want to take note of the recovery process in order to plan your schedule around the surgery and give yourself enough time to heal.
Generally, a nose job is a safe and straightforward procedure and can be carried out on an outpatient basis, which means there is no need to stay overnight. You will be put under either a moderate/deep sedation or general anaesthesia (GA) during the procedure.
It would take around 3-4 weeks to have most of the swelling reduced, but you can expect minimal bruising, which will subside within a week. For the final result, it can take anywhere from a month to 12 months depending on what is done and if there was previous surgery to the nose. Therefore, remember to plan ahead so that you can give yourself enough time to rest and avoid physically strenuous activities post-surgery. Blunt force may also cause serious trauma and damage as the nose is still sensitive and flexible.
Managing your expectations
You may experience significant swelling right after the procedure, so do not expect the results to be immediate as you’d have to wait for the swelling to subside. Eventually, your new nose will heal and may appear significantly different from your nose before the procedure.
There could be instances where you aren’t happy with the outcome of your procedure and will have to undergo a revision rhinoplasty. Don’t hesitate to raise your concerns with your plastic surgeon so that they can work with you in achieving your desired appearance.
Minimally invasive alternatives to a nose job
Understandably, it is a permanent decision and the thought of going under the knife may seem daunting to some. You could also consider minimally invasive alternatives such as a nose threadlift or nose fillers.
The nose threadlift procedure has become commonly known as a lunchtime procedure because of its minimal downtime and non-invasive nature.
This procedure helps enhance the shape of the nose and improves its contours without having to undergo plastic surgery. Using biocompatible threads, doctors are able to make the nose bridge and nose tips higher by strategically raising, straightening and defining the nose.
A nose threadlift utilises threads made of absorbable material such as Polypolydioxanone (PDO). They are completely absorbed into the body over time. As these threads dissolve over time, the ultra-fine threads create new tissue fibroblasts and collagen, additionally creating a tightening effect and further enhancing the effects of the nose contour. 
The effects of a nose threadlift last for about 6 months to a year, with the threads naturally dissolving within the skin. Downtime is generally minimal and the side effects are generally rare and mild such as:
Mild bruising and swelling around the thread insertion areas
Nose fillers are another alternative to getting a rhinoplasty. Dr Samuel Ho regards nose fillers as a prelude to a surgical rhinoplasty, as this allows you to experience your desired “new nose” first before deciding to have surgery done.
Similarly, there is no immediate downtime period to this procedure. Patients expect to return to their regular daily activities after an hour’s rest. Patients have reported feeling minor discomfort after the treatment. In some cases, patients have experienced post-operative bruising and swelling, and this usually subsides within 24 hours.
Prior to the treatment, a topical numbing cream will be applied to the areas undergoing treatment to minimise pain and discomfort.
Fillers are then injected into specific areas of the nose to alter its shape. This creates a more appealing look by only working on areas that require the alteration the most. The procedure takes approximately 15 to 20 minutes to complete.
While there are minimal risks and side effects of the procedure, this varies from patient to patient. Side effects experienced by each patient are often impacted and/or influenced by external factors which may include and are not limited to their daily habits, diet, intensity and frequency of exercise as well as stress levels.
There is no right treatment, but rather one that would be best for you. Undergoing a rhinoplasty can sound overwhelming, so take your time with your decision. Alternatives such as nose threadlifts and nose fillers can be useful as these procedures are not permanent and allow you to see if you’ll be happy with your ideal nose before undergoing rhinoplasty.
That being said, always remember to communicate both your concerns and desires with your plastic surgeon so that they may work on a treatment plan that best suits you.
Neaman, K. C., Boettcher, A. K., Do, V. H., Mulder, C., Baca, M., Renucci, J. D., & VanderWoude, D. L. (2013). Cosmetic rhinoplasty: revision rates revisited. Aesthetic surgery journal, 33(1), 31-37.
Halepas, S., Chen, X. J., & Ferneini, E. M. (2020). Thread-lift sutures: anatomy, technique, and review of current literature. Journal of Oral and Maxillofacial Surgery, 78(5), 813-820.
Man Boobs and How to Get Rid of Them
Contrary to popular belief, man boobs aren’t always a result of weight gain. You may find yourself working out every day and still finding it hard to get rid of man boobs — that’s because it may also be more of a hormonal issue.
Men have breasts too, although they do not enlarge the way breasts do in women. Due to certain factors, men sometimes end up with enlarged breast tissue or gynaecomastia, commonly known as man boobs. This has both medical implications, such as a small lifetime risk of male breast cancer or may be indicative of health issues in other organ systems (such as the liver or the testes), as well as emotional implications such as taking a toll on one’s self-esteem and may be a source of embarrassment.
Read on to find out about what causes man boobs and how to get rid of them.
Testosterone in men is what keeps the breast tissues from developing and enlarging. Fluctuations in testosterone levels, as well as an increase in oestrogen levels, can lead to the enlargement of breast tissues, also known as man boobs. 
This typically occurs in teenagers undergoing puberty, as well as men over the age of 50. Changes in hormone levels could also be caused by underlying medical conditions such as hyperthyroidism and kidney failure.
Diet and exercise
Poor diet and the lack of exercise can also lead to man boobs. This occurs when excess fats are stored in the breast tissues, resulting in an increase in chest size.
What can I do to get rid of man boobs?
If you find yourself with a hefty set of man boobs, don’t fret! There are ways to get rid of these and help you achieve your desired physique:
See a doctor
You can start by seeing a doctor to rule out any underlying medical conditions that may be causing your enlarged breast tissues, such as hyperthyroidism or liver disease.
If your man boobs are indeed caused by medical conditions or certain drugs, your doctor will be able to help rectify the issue by prescribing medications or finding alternative medications from those that had been prescribed to you.
Exercise and a healthy diet
If your gynaecomastia is caused mainly by fat tissue, then yes, you can lose weight to reduce the size of your male breasts!
Cardio exercises such as walking, running and swimming can also help to burn excess fats and reduce the size of your man boobs. Additionally, you could try eating healthier. Cut down on foods with low nutritional values such as soda and candies, replacing these with healthier options like whole grains, oats and lean meats.
Breast reduction surgery
Some men may turn to male breast reduction surgery or gynaecomastia correction to help combat their man boobs. This is the most effective way to get rid of man boobs. Male breast reduction surgery removes excess fat and glandular tissues, resulting in a flatter and slimmer chest.
Dr Ho will examine whether your gynaecomastia is caused by fat or a hormonal issue by examining the breast disk under the areola during consultation. He’ll also let you know what can be done and what to expect for the surgery.
What’s gynaecomastia correction like?
Gynaecomastia correction is a day surgery procedure performed by your plastic surgeon. Here at Allure, Dr Samuel Ho will examine your condition and assess the best way for natural-looking breast reduction work based on your physical anatomy and the changes you desire.
You will be put under general anaesthesia (GA) and the procedure performed using a minimally-invasive technique. Oral painkillers will be provided to be taken for a few days after the operation as you heal from the surgery. You can resume normal activities within a few days and there are usually no visible scars after a month.
It would also be good to note that your gynaecomastia could be a medical condition and, may be MediSave and/or insurance claimable if so.
Understandably, although the majority of man boobs may not pose any health risk, it can still adversely affect one’s confidence. Fortunately, the appearance of man boobs can be reduced by losing weight or through surgical means. Always remember to communicate both your needs and concerns with your plastic surgeon so that they can work with you in getting your ideal physique.
Swerdloff, R. S., & Ng, C. M. (2019). Gynecomastia: etiology, diagnosis, and treatment. Endotext [Internet].
Johnson, R. E., & Murad, M. H. (2009). Gynecomastia: pathophysiology, evaluation, and management. Mayo Clinic proceedings, 84(11), 1010–1015. https://doi.org/10.1016/S0025-6196(11)60671-X
What To Know Before Visiting a Plastic Surgeon
Undergoing plastic surgery is a big decision. Lots of factors come into play before ultimately deciding to go under the knife, and deciding to have the surgery is the first step. Afterwards, it would be having to work with your plastic surgeon in making decisions that would best suit you, your needs and your concerns.
Fret not, we’re here to give you the lowdown of the different aspects before you deep dive into a procedure.
Firstly, do your research beforehand. The results you get are only as good as the clinic, technology used, and the surgeon’s experience and skill. You could look into:
Experience — your plastic surgeon’s experience is a key factor when it comes to making your decision. What training did they undergo? What are their practices? What do they specialise in?
Reviews — although many of these reviews should be taken with a pinch of salt, you could consider looking into reviews on the clinic and the surgeon to see if they’re a good fit for you and what you expect.
Due to Ministry of Health (MOH) guidelines in Singapore, clinics in Singapore are not allowed to show reviews or patient testimonials. They're usually shown during the consultation. You could ask friends or family who have undergone surgery for recommendations as well.
Location — if you are considering travelling to another country for your surgery, it is important to look into whether you save money on the operation at the expense of travel charges and accommodation.
That being said, it is still best to verify your surgeon firsthand. Make that appointment for a consultation and proper analysis, and see what your plastic surgeon has to say.
Check your calendar and set a date to see your plastic surgeon
Before heading down to the clinic, make an appointment on your preferred date to avoid the disappointment you might experience if you choose to do a walk-in. Over the phone, inform the staff of a rough idea of what you intend to do and make a confirmation of the day of your visit.
What to expect for your first consultation with your plastic surgeon
Your first visit to the clinic can be both exciting and scary, and it’s normal to feel nervous and uncertain at the same time. During your first consultation, you’ll be required to fill up the necessary forms prior to the actual consultation with your surgeon.
It would be good to come in with a general idea of what kind of procedure you would like to have and your expectations. You could also prepare for your consultation beforehand by coming up with a list of questions such as:
The surgical options you have
The risks and possible complications
What you can expect from the procedure
The type of anaesthesia used
Recovery time for the surgery
Any before or after photos of other surgeries your doctor has performed
Your plastic surgeon will work with you in managing your concerns and expectations. Some of these would be on:
What results you can expect from the procedure
How the surgery will be performed
Whether you are healthy enough to undergo the procedure
What kind of anaesthesia would be used
How you can prepare for the procedure
What you can expect during recovery
Operating room costs and surgeon’s fees
Whether the procedure is MediSave claimable
Other alternative procedures
Follow up appointments
While you can choose to confirm your surgery on the same day as your consultation, you should not feel obligated to make a decision immediately! Understandably, it may all be overwhelming and you should take it at a pace you’re comfortable with.
On some occasions, one consultation may not be enough for you to give the green light and new questions may arise. If so, that is perfectly normal. You can always call for a second consultation, and make sure to take note of the questions that need to be addressed before you can comfortably make a decision.
Is it safe to undergo plastic surgery in Singapore?
You can rest easy knowing that plastic surgery in Singapore is safe because of strict guidelines put in place by the Ministry of Health. Accredited plastic surgeons are put through years of rigorous training and examinations before they’re qualified. Additionally, all trained medical practitioners will be registered with the Singapore Medical Council that will also ensure that guidelines for surgery are adhered to.
Many plastic surgeons even undergo additional specialised training programmes locally and overseas to ensure that they are equipped with the appropriate skills needed to deliver the best possible results.
What if I need to do revisions for my procedure?
In most cases, it is unlikely that a revision is required. Although infrequent, complications after the surgery can occur. Sometimes, results that are expected after the surgery are not fulfilled and a revision may be necessary. A few reasons for a poor outcome may be:
Lifestyle choices like exposure to the sun
Lack of compliance with post-operative instructions
Weight gain after surgical procedure
Some complications can also occur even if the doctor is extremely careful as it is largely dependent on how your body recovers. To ensure you enter the surgery worry-free, check in with your surgeon’s revision policy, such as fee waivers and validity duration. Lastly, patients should have realistic expectations of the outcome of their procedure and select the plastic surgeon carefully to achieve the closest results to their goals.
In recent years there has been a growing demand for plastic surgery in Singapore, and, in turn, an increasing number of plastic surgeons. Understandably, this may make your decision harder. Always remember to communicate both your desires and concerns with your plastic surgeon, so that they may work with you in getting results that best suit you.
How to Spot Skin Cancer and What to Do About It
Our skin is the largest organ in our body, consisting of about 16% of the body's total weight. Unfortunately, it is susceptible to a variety of diseases, too — from harmless skin splotches to dangerous skin cancers. Sometimes we experience strange changes in the skin and the occasional suspicious mole now and then. How do we know if it’s a precursor to skin cancer and what should we do about it?
What is skin cancer?
Skin cancer, which is the abnormal growth of skin cells, can develop in all areas of your body from your head to your toes. Oftentimes, these are areas frequently exposed to the sun and its ultraviolet rays. That being said, other areas that rarely see the light of day, like under your toenails and genital areas, can be affected too.
What are the types of skin cancer?
There are three major types of skin cancer with cancerous lesions that can appear suddenly or develop slowly. But don’t panic! The good news is most of the time, these cases are curable if detected early and treated on time. The types of skin cancers are:
The most common form of skin cancer; is the easiest to treat and the least likely to spread to other areas of the body. This cancer arises in the basal cells, which are found at the bottom of the epidermis, or your outer skin layer. It occurs most frequently in exposed areas of the body and is caused by chronic exposure to the sun. 
What it looks like:
Usually appears as a pearly or waxy bump on your face, ears or neck. Alternatively, it can also appear on your chest or back as a flat, flesh-coloured or brown scar-like lesion.
The second most common form; is a tumour that occurs on the outer layer of the skin or epithelium. Individuals with frequent exposure to the sun are more susceptible to this disease. It can be easily treated if detected early but is more likely to spread. Unlike basal cell carcinoma, it can metastasise and spread to other areas if it is not treated. When detected early, it can be easily nipped in the bud. 
What it looks like:
It often appears as a firm red nodule on your face, lip, ears, hands or arms. This form of cancer also often arises from small, sandpaper-like growth called actinic keratoses, and the nodules have a red, scaly, crusted surface.
The most serious form of skin cancer; this tumour is the cause of most skin cancer deaths globally. It can develop anywhere on your body in existing moles that turn malignant, or otherwise normal skin. 
What skin cancer looks like:
For men, it usually appears on the trunk, head or neck. In women, it often develops on the arms or legs. Some of the warning signs that you can look out for are:
A large brownish spot with darker speckles located on your body
A simple mole that has changed in colour, size, feel. It may also bleed.
A small growth with irregular borders or red, white, blue or blue-black spots on your trunk or limbs.
Shiny, firm, dome-shaped bumps
Dark patches on your palms, soles, fingertips, toes or mucous membranes of your mouth, nose and genital areas
Weight loss, fatigue, headaches and weakness of the arms and legs
In recent years, all three types of skin cancer are on the rise. To prevent late detection of skin cancers, it is crucial to check your body for any suspicious growth. If you have pre-existing moles, or even new ones, you should observe it from time to time as early detection of cancerous change can reduce cancer mortality massively.
What do I do about skin cancer?
One good tip would be to take photographs of your suspicious moles and splotches, especially if they seem to change. It would be useful to show your doctor during your consultation.
Your doctor may take a small sample during your consultation to have it checked, and measure the tumour based on its thickness. This helps your doctor determine the treatment plan.
If it is diagnosed as benign, you have the option to remove it completely if you feel it’s not aesthetically pleasing. In this case, it can be done with minimal scarring through careful placement of small incisions or suture techniques. On some occasions, if it is small enough, laser ablation can be done to avoid a surgical procedure if it is small enough In other cases, an excision biopsy will have to be performed to remove these.
Just like warts and cysts, these can be removed. Allure provides treatment to help remove these skin cancers with minimal scarring. Even though benign, you could still opt to have them removed if they are symptomatic and you may be getting recurrent infections, or simply because they are aesthetically displeasing. If the mole or wart is small enough, laser ablation can be performed instead of a surgical procedure.
Basal cell carcinomas and squamous cell carcinomas are generally removed via surgical incisions. A small margin of normal tissue is also removed to prevent cancer recurrence. In cases where larger tumours are involved, reconstruction may be required in the form of a skin graft or local flap. Dr Samuel Ho will advise you on the best course of action in order to minimise cancer recurrence and to achieve the best cosmetic outcome.
It will also be good to note that as these are considered medical procedures, they are Medisave and insurance claimable.
Why is it important to spot potential skin cancer early?
Unlike other forms of cancer, skin cancer is visible and - if spotted early - can be cured. In its earliest stages, it is localised and the tumour’s malignant cells have not multiplied to the point that they extend beyond your skin. For example, the earliest melanomas do not extend past the top layer of the skin and are considered non-invasive.
Once the tumour penetrates deeper into the dermis, the chances of curing it drop sharply as it begins to spread beyond the original tumour site. This is when it metastasises, drastically lowering the survival rate of the patient. Moreover, it is almost impossible to predict how fast it can metastasise and action should be taken immediately.
Although it is one of the most common forms of cancer, it also has one of the highest chances of being cured. This is why it is important to take note of any suspicious moles or changes in your skin. If so, check in with your doctor and be sure to communicate both your concerns and needs so that your doctor can recommend a treatment plan that best suits you.
Lanoue, J., & Goldenberg, G. (2016). Basal cell carcinoma: a comprehensive review of existing and emerging nonsurgical therapies. The Journal of clinical and aesthetic dermatology, 9(5), 26.
Combalia, A., & Carrera, C. (2020). Squamous cell carcinoma: an update on diagnosis and treatment. Dermatology Practical & Conceptual, 10(3).
Davis, L. E., Shalin, S. C., & Tackett, A. J. (2019). Current state of melanoma diagnosis and treatment. Cancer biology & therapy, 20(11), 1366-1379.
Can Hair Loss Be Reversed?
Our hair greatly influences our personal and professional lives, and hair loss can take a huge toll on our self-esteem. Our hair health and how well our hair grows is dependent on how well we take care of our scalp and sometimes, genetic disposition. Is hair loss really irreversible or do we have more control over how our hair grows?
This is a genetic condition that can affect both genders — more commonly known as male pattern baldness and female pattern baldness respectively. This condition affects up to 50% of males and females. Men can experience this as early as in their teens or early 20’s and it’s often characterised by a receding hairline and a gradual disappearance of hair from the crown and frontal scalp. Women, on the other hand, generally experience thinning hair beyond their 40’s throughout the entire scalp, with the most extensive hair loss at the crown. Depending on severity, this form of hair loss is usually reversible. 
This type of hair loss is an autoimmune disorder where the body attacks the hair follicles. It is usually identified by a few patches of baldness and can occur at any age, though most common in people younger than 20. Unfortunately, there is no known cure for alopecia areata.
Also known as scarring alopecia, this form of hair loss is fairly rare but is a potentially permanent and irreversible destruction of hair follicles. Sometimes, the bald patches appear smooth and clean or one could experience redness, scaling, changes in pigmentation or raised blisters with pus.
Any tips to prevent hair loss?
Ensure a healthy diet
A poor diet can cause a nutrient imbalance, which may affect your hair follicle structure. According to a 2017 study published in the Archives of Dermatological Research, following a Mediterranean diet rich in vitamins and minerals can help decrease the risk of androgenetic alopecia.
Our hair is essentially made up of protein, so incorporating this nutrient into our diet could help such as green leafy vegetables and fish rich in vitamin D and omega-3 fatty acids. Avoiding processed foods could also help promote healthy hair growth.
Limit the use of damaging treatments and excessive styling
Excessive bleaching, perming of hair or chemical straightening can lead to damaged hair and breakage. Using flat irons, curling irons and tightly pulling your hair back could also cause damage when done too often.
Use hair growth treatment products You could try over-the-counter haircare products or tonics specially formulated to help slow hair loss.
Depending on the type of hair loss, your doctor may prescribe medication that could help slow hair loss and may encourage new hair growth.
Ultimately, whether hair loss is reversible is dependent on what kind of hair loss you suffer from and the reasons for your hair loss. If you’ve maxed out all options in frustration and just want your luscious locks back, you could consider getting proper treatment — from minimally invasive treatments to surgical options, like hair transplantation.
Contrary to popular belief, there are effective ways to regain lost hair by addressing the medical condition on a cellular level.
This begins with a detailed consultation with your doctor for a proper diagnosis of your condition. This will help the doctor discern the best course of treatment that would benefit you the most.
Although it is necessary, it is also the most significant cause of hair loss. You can be prescribed an anti hair-loss shampoo and serum that can reduce DHT production by inhibiting the 5-alpha-reductase enzyme.
The FUE technique is a hair transplantation method that is safe and minimally invasive. When healthy areas with DHT resistant characteristics are transplanted onto bald areas, they will continue to grow naturally. This is a highly effective and permanent solution. 
Dr Samuel Ho utilises the FUE technique for hair transplantation as it allows for more precise and natural placement of the hair grafts as micrografts of only 1-3 shafts are implanted each time. This minimises the transaction rate of the hair shafts cutting through the roots, resulting in the hair not surviving.
Although this procedure - as opposed to other hair implant techniques - is more laborious and time-consuming, it is more aesthetically pleasing, and Dr Ho tends to perform this method with a big team of professionals to speed up the entire process. Fret not, because you will be under mild sedation and kept as comfortable as possible.
If drugstore creams and hair tonics don’t seem to work, there are a variety of minimally invasive ways to promote hair growth, from serums to hair transplants. Assessing your eligibility for certain treatments and procedures is necessary, which is why it’s best to consult your doctor for a proper evaluation. Additionally, it helps to communicate both your desires and concerns with your doctor so that they can recommend a treatment plan that would best suit your needs.
Ho, C. H., Sood, T., & Zito, P. M. (2021). Androgenetic alopecia. StatPearls [Internet].
Dua, A., & Dua, K. (2010). Follicular unit extraction hair transplant. Journal of cutaneous and aesthetic surgery, 3(2), 76.
Rhinoplasty Vs Nose Fillers: What Should I Go for?
What is Rhinoplasty?
Rhinoplasty, colloquially known as a nose job, is a surgery that changes the shape of the nose. It is often carried out to enhance the nose’s shape and even improve breathing function. During surgery, your doctor will sculpt the bone, skin, and cartilage of your nose in order to achieve the desired shape.
A rhinoplasty can achieve the following:
Increase or decrease the nasal bridge
Reduce the size or width of the entire nose
Reduce the size of the nostrils
Reshape the nasal tip
Enhance the angle between the nose and upper lip
Smoothening humped or crooked appearances
Rhinoplasty can either be open or closed, depending on the desired outcome of the operation. For minor changes, a closed technique that keeps all incisions inside the nostril can be used. However, more significant rhinoplasty will require an open technique, which will leave a 5mm scar across the columella, or the tissue that links the nasal tip and nasal base. In most cases, this scar will fully heal without leaving any visible marks.
What are Nose Fillers?
Nose fillers can help to:
Nose fillers, also known as liquid rhinoplasty, are a minimally invasive procedure that alters the shape of the nose for aesthetic purposes. With a needle and syringe, hyaluronic acid is inserted at various points on the nose to adjust the shape of the nose as desired. This is a quick procedure that only takes 15 to 20 minutes.
Create a higher nose bridge
Reshape the nasal tip and nostrils
Permanence of Rhinoplasty
Rhinoplasty is a permanent procedure, although a revision rhinoplasty may sometimes be necessary if complications arise or if further adjustments are needed. Postoperative deformities are considered as one of the main risks of rhinoplasty, leading to the need for revision surgery in 5% to 15% of the cases. 
In contrast, the effects of nose fillers are much more temporary.  As hyaluronic acid dissolves over time, the changes to your nose will only last as long as the hyaluronic acid remains in the nasal tissue. This can be anywhere from 6 to 12 months. As a result, your doctor will likely ask you to come in for touch-ups every few months to maintain the new shape of your nose.
Side Effects of Rhinoplasty
Possible side effects of rhinoplasty include:
Although rare, rhinoplasty may result in infections, permanent numbness, scarring, and breathing complications.
On the other hand, possible side effects for nose fillers include:
Downtime and Post-Surgery Expectations
Regardless of whether a closed or open rhinoplasty is performed, the recovery period for the nostril wounds lasts one to two weeks. For the first few days, you will experience the worst of the bruising, swelling, and pain. You will also be fitted with a splint, which can be removed after 5 to 7 days. The swelling can take anywhere between a month to several months to resolve.
In contrast, nose fillers are a generally painless procedure with no recovery period needed. Any post-operative discomfort or swelling is expected to subside after 24 hours. However, since nose fillers are temporary, you will need to return for touch-ups every few months to maintain the changes to your nose shape.
Depending on what kind of changes you'd like to make to your nose shape, nose fillers can be a good alternative to rhinoplasty if you are willing to make repeated trips to your doctor to maintain your desired nose shape.
It can also be a way for you to test out changes to your nose shape before you commit to traditional rhinoplasty. However, as there are limitations to what nose fillers can do, it is best to discuss your options thoroughly with your plastic surgeon who will also be able to advise you on what nose shape will best suit the rest of your face.
Rettinger G. (2007). Risks and complications in rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery, 6, Doc08.
Rohrich, R. J., Agrawal, N., Avashia, Y., & Savetsky, I. L. (2020). Safety in the Use of Fillers in Nasal Augmentation—the Liquid Rhinoplasty. Plastic and Reconstructive Surgery Global Open, 8(8).
Why Are Mesolipo Injections Banned in Singapore?
What are Mesolipo Injections?
According to the WHO World Health Statistics Report 2012, 1 out of every 6 adults is obese globally.  People have come up with mesolipo injections to deal with having too much fat; but why has it been banned?
Mesolipo injections, also known as fat dissolving injections, are a non-invasive procedure that involves injecting fat-dissolving substances to specific areas of the face or body to get rid of fat cells. However, Mesolipo Injections, although sounding like a cure-all for our stubborn fat, come with their own set of risks and complications.
They are banned from countries like Brazil and even Singapore. Some Mesolipo injections have been recorded to cause side effects from nausea to skin infections and even arrhythmias (abnormal heartbeat).
As the mixture varies, some of these Mesolipo injections may include:
Prescription medicines such as antibiotics
What could happen after Mesolipo Injections?
Some of the possible side effects are:
Blood vessel damage
Irregular skin contours
Arguably, although there is evidence that these injections can work, they are not without significant concerns that could do more damage than good. Because of this uncertainty and lack of regulation on standard formulas, they’ve been banned in Singapore.
Are there any alternatives to Mesolipo Injections?
Fortunately, we are at the advent where there are safer alternatives to getting rid of fat.
Buccal Fat Removal (Cheek Reduction Surgery)
If you’re looking to get a v-shaped face and rid yourself of chubby cheeks, a buccal fat removal could be ideal. Dr Samuel Ho performs this day surgery procedure in 30-60 minutes, under local anaesthesia and sedation.
Buccal fat removal is a permanent fat removal procedure, where a small incision is made at the area between the gums and the cheeks and the buccal fat pad is removed.  The oral wound heals in a week, but the swelling will take a few weeks to a month to fully resolve from the surgery.
The harvested fat can also be purified and grafted into other areas to enhance the contours of the body. Dr Samuel Ho uses a S.A.F.E liposuction technique — a low-risk liposuction technique that makes it safer and can even be performed in repeat cases.
We hope this article helped provide better insight into Mesolipo injections in Singapore and approved alternative methods for fat removal. However, these procedures have their own side effects, considerations and downtimes. If in doubt, book a consultation with your plastic surgeon so that they may tailor a treatment best suited to your needs and concerns.
Thomas, M. K., D'Silva, J. A., & Borole, A. J. (2018). Injection Lipolysis: A Systematic Review of Literature and Our Experience with a Combination of Phosphatidylcholine and Deoxycholate over a Period of 14 Years in 1269 Patients of Indian and South East Asian Origin. Journal of cutaneous and aesthetic surgery, 11(4), 222–228. https://doi.org/10.4103/JCAS.JCAS_117_18
Moura, L. B., Spin, J. R., Spin-Neto, R., & Pereira-Filho, V. A. (2018). Buccal fat pad removal to improve facial aesthetics: an established technique?. Medicina oral, patologia oral y cirugia bucal, 23(4), e478–e484. https://doi.org/10.4317/medoral.22449
The Ultimate Mummy Makeover
What is a Mummy Makeover?
Having children is an exciting and fulfilling experience for women. However, pregnancy can sometimes leave certain undesirable after-effects that no amount of nutrition plans or personal trainers can fix. These most often manifest themselves as sagging breasts and a loose tummy. Well, a Mummy Makeover can solve all that.
The Mummy Makeover was designed as a set of postpartum strategies that help women with their post-pregnancy body issues — reversing some of the undesirable effects of pregnancy, childbirth and breastfeeding through surgical means.
In this article, we’ll walk you through what to expect for a Mummy Makeover and hopefully help you in your decision-making process.
Am I suitable for a Mummy Makeover?
Generally, you are suitable for a Mummy Makeover surgery if you are in good health, have realistic expectations and are at your ideal body weight. There are, however, some other important points to consider before undergoing a Mummy Makeover:
Do you plan to have more children?
Ideally, it is recommended that you undergo a Mummy Makeover when you no longer plan to have more children. Most procedures do not affect future pregnancies. However, you risk undoing the results of your surgeries if you do have a subsequent pregnancy as it will stretch the skin on your abdomen and breasts again.
How long has it been?
Giving birth can put a lot of strain on your body, so it is important that you give it a chance to heal first before undergoing any surgical procedures. The plastic surgeon would recommend that you wait at least three to six months before undergoing your Mummy Makeover, so as to allow the body shape to recover before undergoing any corrective procedure.
Have you finished breastfeeding?
As breastfeeding alters the shape of your breasts, it would be best to undergo surgery only after you have stopped breastfeeding and your breasts have settled into a more permanent shape and size.
What can I expect during my first consultation?
During your first consultation, it would be good to prepare a list of questions you may have for your doctor and ideas on what procedures or areas of concern you would like to focus on.
In particular, which are the areas of greatest concern, for eg. breasts, tummy, thighs etc. For each area, you should also highlight what are the undesirable aspects bothering you most, such as skin laxity, excess fat, drooping and so on.
Your doctor will then inquire about your medical history and carry out assessments to ensure that you are fit for surgery. A physical examination then follows to discuss the procedures that you would like to have based on your areas of concern and the outcomes that you can expect.
Your doctor will give you a detailed explanation on what to expect post-operation, such as what you should prepare for during your recovery, how long it will take for the scars to heal, and when you can expect to see results. The consultation should also be clear on the surgical goals and what can be achieved and what can not.
A Breast Augmentation is a viable option if you would like to have fuller-looking breasts. This can be done by surgically implanting silicone (cohesive-gel) or saline implants. There are also various sizes and shapes to choose from, so it’s best to have a detailed discussion with your surgeon to help you in your decision.
Another option would be to undergo a breast lift or mastopexy. This procedure can be done with an augmentation with an implant if required. The plastic surgeon raises and reshapes your breasts, repositions the nipple-areolar complex and removes the excess skin around the breast.
It’s a normal occurrence for us to develop new deposits of stubborn fat because of pregnancy hormones. This may lead to the unwanted post-pregnancy “muffin tops” and “love handles”. Liposuction is a procedure where these fat deposits are surgically removed through small puncture holes in the areas of concern. This allows us to remove fat quickly and safely and create pleasing contours for your body shape.
Women tend to develop extra fat on hips and thighs during pregnancy as well, which can also be removed with liposuction.
Often, a liposuction is done before a Tummy Tuck. Although liposuction can remove fat, it cannot firm a tummy or repair stretched muscles. A Tummy Tuck, also known as an abdominoplasty, is the only way to address the issue of damaged abdominal muscles.
To accommodate the growing baby, our stomach expands and this causes our skin to stretch and possibly, our abdominal muscles to move far apart from the midline. The surgeon will remove excess fat, stretched skin and correct the splayed abdominal muscles by stitching the torn tissue between the sections of the abdominal muscles for it to heal properly.
Abdominal laxity correction
Similar to the aforementioned procedure, an abdominal laxity correction procedure helps correct the bulge around our lower abdomen. The procedure for correction involves suturing of the splayed rectus abdominis muscles (diastasis recti) or the placement of permanent barbed sutures to plicate the abdominal muscles together. 
Childbirth could also lead to stretched labia skin, causing it to be large or asymmetrical. It may be unsightly but also cause great discomfort due to chafing. A labiaplasty can correct this issue by removing the excess skin from the labia minora.
An alternative would be the use of fat grafting to the labia majora, where the patient’s fat is removed, purified and injected into the labia to replenish its lost volume.
A minimally invasive labiaplasty can be done with hyaluronic acid (HA) fillers injected into the labia. However, it is important to note that it is not a permanent solution and will have to be repeated every year or so.
Summary of Mummy Makeover
Getting your pre-pregnancy body - and confidence - back is definitely possible, but will take careful consideration and time. It is important to understand that results are not instantaneous and that you plan your surgery when you can commit to maintaining a healthy lifestyle.
Getting a Mummy Makeover is definitely a tough decision, especially when you have to get into the details of what exactly you would like to have done. Fortunately, you don’t have to make this decision alone. Consult a trusted plastic surgeon for a proper examination and advice on a treatment plan tailored to your desires and concerns.
Motosko, C. C., Bieber, A. K., Pomeranz, M. K., Stein, J. A., & Martires, K. J. (2017). Physiologic changes of pregnancy: A review of the literature. International journal of women's dermatology, 3(4), 219-224.
Rinker, B., Veneracion, M., & Walsh, C. P. (2010). Breast ptosis: causes and cure. Annals of plastic surgery, 64(5), 579-584.
Nahabedian M. Y. (2018). Management Strategies for Diastasis Recti. Seminars in plastic surgery, 32(3), 147–154. https://doi.org/10.1055/s-0038-1661380.
Ptosis Correction For Children
What is Congenital Ptosis?
Ptosis (blepharoptosis), more commonly known as droopy eyelids, is a condition where one or both upper eyelids droop lower than they should, possibly causing obstruction of sight. Ptosis that occurs at birth or within your child’s first year is called congenital ptosis. Congenital ptosis may be treated with ptosis correction surgery.
Usually, ptosis occurs with old age because of weakened muscles and sagging skin. In infants and children, childhood or congenital ptosis is often due to neurological issues that affect the nerves or levator muscles of the eye. These include:
It may also be caused by an eyelid mass or accidental stretching or tearing of the levator muscle. If ptosis occurs suddenly, it may be indicative of a more urgent medical issue and immediate medical attention may be necessary.
What are the complications of untreated ptosis in children?
If the ptosis is not severe, the only complication would be that your child’s eyelid creases do not line up evenly with each other and it may not look aesthetically pleasing. However, for more serious cases, your child’s droopy eyelid may cause severe vision issues and give rise to other complications such as :
Amblyopia (lazy eye)
They may develop amblyopia or developmental delay because their eyelids limit their vision.
They can also have astigmatism, where their vision is blurred.
The most obvious sign of ptosis is drooping eyelids or when your child’s eyelid creases do not line up evenly with each other.
You may notice your child tipping their head back, lifting their chin up or raising their eyebrows to try to see better.
Your child may often experience headaches and tiredness.
Your child may feel heaviness of the eyelids. 
When can my child have ptosis correction surgery?
If time permits, we suggest that you wait until your child is older before undergoing ptosis correction surgery. This ensures better patient compliance and allows the surgeon to make more accurate pre-operative measurements, as your child’s facial features would have grown and matured. Moreover, post-operative recovery may be too distressing for young children to experience.
Personally, we would recommend that your child be at least twelve years old before undergoing ptosis correction. An exception would be if it interferes with normal visual development, in which case the blepharoptosis should be corrected early.
How is ptosis treated in children?
Ultimately, the treatment of your child’s ptosis is dependent on its cause. If your child has ptosis due to other underlying medical issues, your doctor will treat the issue first. For example, if a tumour is causing your child’s ptosis, the doctor may remove it.
For temporary ptosis, a special intervention, known as Ptosis Crutches, can be prescribed to hold the eyelids up and are attached to the frame of your child’s glasses.
In moderate to severe cases, ptosis correction surgery is advised.
What happens during my child’s ptosis correction surgery?
The doctor will first conduct a detailed examination of your eyes and facial anatomy before deciding on what changes will be made and addressing any concerns you may have. The doctor will take note of the marginal reflex distance - which is the distance from your pupil’s centre to the upper eyelid - to determine whether ptosis correction is needed.
Local anaesthesia will be administered to ensure that your child is comfortable. After which, the treatment entails tightening or shortening the tendon of the eyelid opening muscle. It is an outpatient procedure and lasts about 30-60 minutes.
The upper eyelid anatomy is delicate and complex, therefore it is paramount to consult a specialist surgeon to ensure an optimal outcome.
How long will recovery take after ptosis correction?
Generally, your child will experience minor swelling and bruising around the eyes which will disappear within a few days. If proper post-surgery care procedures are followed, there should be no visible scarring.
Summary of ptosis correction surgery
Ptosis correction surgery is definitely a procedure to consider for your child when they are older and if they suffer from moderate to severe ptosis. After surgery, It is important for your child to practice proper post-surgery care to prevent complications and to ensure optimal results. Moreover, Ptosis correction may help to improve your child’s self-confidence later in life. Always remember to communicate both your desires and concerns with a trusted plastic surgeon so that they may assist you in your decision.
Griepentrog, G. J., Diehl, N. N., & Mohney, B. G. (2011). Incidence and demographics of childhood ptosis. Ophthalmology, 118(6), 1180-1183.
Pavone, P., Cho, S. Y., Praticò, A. D., Falsaperla, R., Ruggieri, M., & Jin, D. K. (2018). Ptosis in childhood: A clinical sign of several disorders: Case series reports and literature review. Medicine, 97(36), e12124. https://doi.org/10.1097/MD.0000000000012124
Shukla, U. V., & Patel, B. C. (2021). Congenital Ptosis. StatPearls [Internet].
How to Minimise Scars When Creams Don’t Work
Permanent scars from a burn or a previous surgery can often cause emotional distress, especially when put on display on our face or often exposed parts of our body for everyone to see. What can you do when chemical peels and over-the-counter creams don’t seem to work, and you’ve tried almost every possible home remedy to minimise scars recommended on the internet?
Scarring is part of our body’s natural response to tissue damage. When we get wounded, collagen builds up in the area to help strengthen the wound. This formation may form a scar over time -- and sometimes scars eventually fade and smoothen out, but other times they don’t. Each year in the developed world 100 million patients get scars, some of which cause considerable problems. 
Fret not, because there are a variety of treatments available to help improve your scar’s appearance and help make it less visible.
Types of scars
There are different types of scars and oftentimes, a combination of treatments are used to produce the best outcome.
Although mature scars usually aren’t itchy or painful anymore, they could still be unsightly or hinder your movement. Surgical revision of these scars usually help make them less visible. Sometimes, this can be accompanied by a postoperative dermabrasion treatment.
Keloids or keloidal scars
These scars are difficult to treat and manage, and often grow much larger than the original injury that caused the scar. Keloids can be surgically removed. However, they often return even after surgical treatment, and so your doctor may suggest additional injections, surgical revision and possibly localised radiotherapy.
For hypertrophic scars, excess connective tissue accumulates in the area of the original wound.  Hypertrophic scars are generally milder than keloid scars and do not grow beyond the area of injury. Early hypertrophic scars should not be treated too soon and it is good to check in with your doctor before starting any treatment.
How do I know which treatments are best for my scar?
Scar revision surgery is a common surgical procedure that helps minimise the scar - making it less visible by allowing it to blend in with your skin’s natural tone and texture. In some cases, it could also help restore function and mobility to the scarred area. This procedure can be performed under local anaesthesia, IV sedation or general anaesthesia, depending on the severity of the scar and your level of comfort.
Many factors and techniques come into play when undergoing scar revision, such as the type of incision made, how the tissue is handled, layered wound repair, and how the bleeding is minimised. One common surgical technique for scar revision is a Z-plasty, where the scar is redirected into better alignment with the natural skin fold to make it less noticeable.
Other important factors to consider when undergoing a scar revision is how long you have had your scar, your level of health and your medical history.
It will also be good to note that if these scars were caused by trauma, burns or medical surgery, they can be categorised as medical procedures and therefore, could be partially covered by Medisave.
In addition to surgical interventions, corticosteroids, or steroid injections can be used to treat some keloid and hypertrophic scars. These are injected a number of times over a course of several weeks to months, depending on the severity of the scar, to reduce swelling and flatten it. It also helps these scars from recurring after surgical treatment.
Side effects and downtimes vary and are dependent on the types of treatments and severity of the scar. Therefore, it is important to communicate both your needs and concerns with your doctor. Visit your plastic surgeon for a thorough and detailed consultation so that they may tailor a scar revision treatment specific to your needs and the characteristics of your scar.
Bayat, A., McGrouther, D. A., & Ferguson, M. W. (2003). Skin scarring. BMJ (Clinical research ed.), 326(7380), 88–92. https://doi.org/10.1136/bmj.326.7380.88
Schmieder, S. J., & Ferrer-Bruker, S. J. (2017). Hypertrophic scarring.
Questions about Droopy Eyelid Surgery Answered
As we age, our skin’s laxity increases and everything starts to sag — our eyelids included. This effect is known as ptosis, blepharoptosis or droopy eyelids, which can be corrected by droopy eyelid surgery.
Contrary to popular belief, droopy eyelids may not only be caused by old age, but also by a variety of other factors such as genetic disposition (congenital ptosis) or acquired through contact lens wear, eyelid infections or continuously rubbing our eyes. Severe ptosis may also lead to vision impairment. That being said, in many cases, ptosis is idiopathic, which means a definite cause often cannot be found.
Whether it is for aesthetic purposes or to help with your field of vision, ptosis correction is a common outpatient procedure to consider. In this article, let plastic surgeon Dr Samuel Ho, walk you through and answer some frequently asked questions you may have about droopy eyelids and ptosis correction.
If you suspect you have ptosis, it is paramount that you consult your doctor for a proper diagnosis, as it may be indicative of an underlying medical condition. In this case, you may be able to treat the ptosis without undergoing an eyelid correction procedure.
Are there any non-surgical alternatives to droopy eyelid surgery correction?
Unfortunately not. The non-surgical alternatives often do not work or they only work for a very short period of time. Eyelid tape, glue, false eyelashes and coloured contact lenses all serve to mask the issue initially, however, eventually make the problem worse through a vicious cycle of exacerbating the skin laxity and eyelid muscle tendon damage.
Will people be able to tell that I've had droopy eyelid surgery?
Ptosis surgery aims to correct the eye droop and the resultant smaller eye size/aperture. It also seeks to reduce the symptoms that are listed above. As such, you will have larger sized eyes that look much less sleepy or asymmetrical in some cases.
The naturalness of the surgery is then dependent on the eyelid crease that is chosen; typically a lower height or thickness appears more natural as does a tapered shape crease as compared to a parallel shape.
Will I have asymmetrical eyes after a droopy eyelid surgery?
The risk of residual asymmetry is around 10-20%  and can be corrected with a simple touch up surgery, which is generally performed 1-2 months after the original surgery to allow for resolution of swelling, which is the chief cause of initial asymmetry.
Having said that, there is no perfect symmetry between both eyes as factors are affecting the size, such as the globe size, the bony orbit size and the muscles around the eye. In fact, most people are born with slight asymmetry between the left and right eyes.
How bad will I look after a droopy eyelid surgery?
Initially, you would expect some bruising and swelling. The bruising usually lasts between 7-10 days and will gradually fade from a patchy purplish colour to green, then golden yellow before disappearing. The swelling or puffiness takes longer and depends on the age group of the patient, with older patients generally taking longer to resolve. The average patient takes 1-3 weeks for the swelling to completely resolve.
The double eyelid crease will also not look natural at the start, being very deep and high, which is normal. As the swelling solves and the skin relaxes over the incision, the double eyelid crease will soften out and take on a more natural curve. It will also look less deep/ defined due to the relaxation of the internal scar tissue. This can take anywhere between 1-3 months to occur.
Is it possible to perform droopy eyelid surgery on only one eye?
Yes, I do that for around 25% of my patients. However, I have to ensure that the ptosis is truly one-sided; often it can be masked (Herring’s effect), where the more severe eye appears droopy but because of compensation on both eyelids, the less severely droopy eye appears normal.  A simple clinical examination can exclude this. If there is asymmetrical ptosis in both eyelids, then both eyelids should be corrected at the same time.
What happens when I'm not happy with the results?
There are usually two reasons for this -- either with regards to the double eyelid shape/height or with the symmetry of the eye size. If it is a problem with the eye size symmetry, a simple touch up procedure can be performed to tighten the smaller or more droopy eye. This takes about 20 minutes and can be performed under local anaesthesia.
On the other hand, if it is an issue with the double eyelid crease shape or height, then it would depend on what needs to be adjusted. If the height needs to be increased due to excess skin, then the procedure to remove that extra bit of lax skin is a simple one that can also be performed under local anaesthesia.
Will there be a scar after droopy eyelid surgery?
Initially, a pink-coloured scar, where the incision is made, can be seen when the eyes are closed. Over a period of 1-3 months, this scar will fade into a thin skin-coloured line along the double eyelid crease. Keloids generally do not occur in the upper eyelid. 
How long does it take to recover from a droopy eyelid surgical procedure?
The wound typically heals in 4-5 days, after which, the skin sutures are removed. After a week, light upper eye makeup is allowed, as is the use of contact lenses.
However, strenuous exercise, contact sports, swimming, eyelid extensions and false eyelashes have to be delayed till 1 month after the surgery. This is to allow for the internal wounds to heal and for the internal repair to be stable. Early return to any of these activities risks loosening the ptosis repair prematurely.
Will the recovery period be painful?
No, most patients will only feel an aching, swollen or tight sensation. There should not be any significant sharp pain after the procedure. Many of my patients do not take painkillers after the first day.
Are there any post-procedure tips after droopy eyelid surgery?
Yes, avoid strenuous activity and do the cold compress diligently. After the first week, I usually tell my patients to switch to a warm compress, which really helps with the bruising and swelling resolution.
Ptosis is treated with a form of double eyelid surgery; it falls under upper blepharoplasty. The double eyelid creases that form are a bonus of ptosis surgery, although there is an option to do without. The two, however, should be not treated as the same because ptosis surgery is a far more technically complex upper eyelid surgery that seeks to treat a medical condition.
Zoumalan, C. I., & Lisman, R. D. (2010). Evaluation and management of unilateral ptosis and avoiding contralateral ptosis. Aesthetic surgery journal, 30(3), 320-328.
Carraway, J. H. (2004). The impact of Herring's Law on blepharoplasty and ptosis surgery. Aesthetic surgery journal, 24(3), 275-276.
Ogawa, R. (2019). Keloids and hypertrophic scars can now be treated completely by multimodal therapy, including surgery, followed by radiation and corticosteroid tape/plaster. In Scars. IntechOpen.
Nose Job Surgery Vs Nose Threadlift
When looking at a person’s face, the nose is probably the second feature you notice, the eyes being first. With the advancement in aesthetic innovations, you can now explore different ways to enhance your look with a further defined, lifted nose. From choosing a surgical procedure such as a rhinoplasty, called nose job surgery, to a non-surgical nose threadlift, there are several aspects to consider on what fits best for you.
What is a Nose Job Surgery (Rhinoplasty)?
A rhinoplasty surgery is a nose job to enhance the shape of the nose so that it harmoniously balances with your facial features, if only aesthetic aspects are considered. In some cases, this procedure can also be functional and improve your breathing, by correcting bad curvature or collapsed nasal valves. Well executed rhinoplasties are aesthetically pleasing and will improve your appearance. Plastic surgeons perform highly-refined work involving the sculpting of cartilage, skin and bone to achieve the patient’s desired look. The technique used depends largely on your desired results.
A rhinoplasty can help to address some of the following concerns:
Reduction of the size or width of the nose
Slim or reduce nostril flares
Reshaping of the nose tip
Smoothening of nose humps
Straightening crooked appearance
Increasing or reducing the bridge height
What are the different approaches to Nose Job Surgery?
A closed technique keeps all incisions inside the nostril, with no external scars. This technique is suitable for patients who desire augmentation or reduction of the nose bridge, with minimal change to the length of the nose and moderate change to the appearance of the nasal tip.
Implant-based: The closed rhinoplasty is performed with a silicon I-shaped implant that is carefully carved to the patient’s specific requirements.
Autologous: The patient’s own tissue is used for augmentation of the nose bridge.
Hybrid: An implant and cartilage composite construct is used for augmentation of the bridge as well as the tip.
Open rhinoplasty is performed when the patient requires significant nasal tip surgery, where the rhinoplasty is a revision procedure or performed for functional reasons (for example, to alleviate nasal obstruction). This involves a small 5mm scar across the columella, with the other incisions hidden within the nostril.
Autologous: The open rhinoplasty is performed using only the patient’s own tissue, usually cartilage harvested from the ear or rarely, the ribs. A combination of umbrella cartilage grafts, spreader grafts, caudal septal grafts and/or derotation cartilage grafts is used.
Hybrid: The rhinoplasty is performed using a combination of a silicone implant for the nose bridge and the patient’s own cartilage for the nasal tip and mid-vault.
The choice between an autologous or a hybrid technique is dependent on the requirements of each individual patient.
Pros and Cons of Nose Job Surgery
With the choice of a closed or open approach, there are advantages for both procedures.
Advantages of Nose Job Surgery
No external scars
Shorter recovery time
Reduced operative time although in some cases, a closed approach may need a longer time than an open approach
More accurate diagnosis
More precise correction
Increased options with grafts
While there are advantages of both options, there are also disadvantages to consider when you choose to do this procedure. Deformities are a common complication of a nose job surgery. About 10% of the patients after primary rhinoplasty complain about residual or new breathing problems because of these deformities. 
Disadvantages of Rhinoplasty
Requires 2 to 6 weeks of recovery time
May have scarring
Longer recovery time of 2 to 3 months
What is Nose Job Surgery Generally Like?
The procedure for rhinoplasty will begin with a consultation with Dr Samuel Ho. During the consultation, you will discuss with him the choice of surgery and the kind of aesthetics you are looking at.
Thereafter, he will assess your nose and advise on the type of rhinoplasty surgery best suited for you. After the consultation, the reception will arrange the necessary should you wish to proceed with the surgery. This includes advising you on surgery costs, arranging instalment payments if needed, surgery date, as well as going through with you the do’s and don’ts pre- and post-surgery.
During the day of surgery, pre-surgical markings will be done on your nose and you will be sedated for the procedure. The choice of anaesthesia will be dependent on the extent of the rhinoplasty procedure and the accompanying risks. The choices of anaesthesia are general anaesthesia, moderate sedation or local anaesthesia - with the majority of rhinoplasties done under moderate sedation.
In moderate sedation, the patient is given intravenous medication (via the vein) for sedation and pain relief, before administering local anaesthesia to the nose. This would be generally performed as a day surgery procedure that usually takes between 2 to 4 hours, depending on the requirements for surgery.
These procedures may vary depending on your nose and the aesthetics you are looking at. As such, it is important to assess it with Dr Ho to understand the procedure further.
What is a Nose Threadlift?
Also known as a “lunchtime nose job”, a nose threadlift is another option you may consider to achieve your desired look. This is a non-surgical procedure that uses absorbable threads that are 100% bio-compatible with your body.
With 6 months to a year, the threads will naturally and gradually dissolve within the skin. However, the effects of a threadlift may last for 1-2 years, lasting even after all the threads have dissolved.
The nose threadlift is achieved by placing fine threads along the nasal bridge to lift the nose bridge. These threads also inspire a healing response from within the skin, causing the body to direct a large surge of collagen to the treated area. Collagen is important in combating ageing and giving your skin a youthful look. 
Pros and Cons of Nose Thread Lift
Despite nose thread lifts being increasingly popular, there are also certain aspects to assess prior to your decision.
Advantages of Nose Thread Lift
Lower cost compared to Rhinoplasty
Disadvantages of Nose Thread Lift
Creates internal scarring that makes future rhinoplasty surgery more difficult
What is a Nose Threadlift Procedure Generally like?
Prior to your procedure, a consultation with Dr Ho will be required to discuss the look that you would like to achieve. Thereafter, you can decide if you want to proceed with the procedure.
During the procedure, he will inject you with a local anaesthetic in order to numb the relevant parts of your face. This will take about 10-15 minutes. Under local anaesthesia, he will use a needle to insert the threads to create a lifting effect.
He will also assess the “weight” of the patient’s skin prior to the threadlift to ascertain if the lifting effect will be sustained.
The entire procedure can take anywhere between 15 to 45 minutes.
Which Procedure Is Best?
Depending on your personal goals and aesthetics, it is essential to explore and assess what would be the best fit for you. Do extensive research and we would also advise seeking a consultation with a specialist before making any final decisions.
Rettinger G. (2007). Risks and complications in rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery, 6, Doc08.
Wong, V. (2021). The Science of Absorbable Poly (L-Lactide-Co-ε-Caprolactone) Threads for Soft Tissue Repositioning of the Face: An Evidence-Based Evaluation of Their Physical Properties and Clinical Application. Clinical, Cosmetic and Investigational Dermatology, 14, 45.
Which Is Better: Tummy Tuck or Liposuction in Singapore?
Living with stubborn fats throughout your life or after pregnancy can affect your everyday life. When no amount of exercising, fat burning creams and other home remedies seem to help, perhaps a liposuction and a tummy tuck in Singapore are options that may solve your troubles.
What is a Tummy Tuck?
You might have already heard about tummy tuck procedures but you might not yet know what the details of this procedure are. A tummy tuck, also known as an abdominoplasty, is both a functional as well as a cosmetic surgical procedure to remove excess skin and fats at the abdomen. Through this procedure, the abdominal muscles are tightened and any hernias, such as an umbilical hernia, are corrected, the fat in the tummy is removed and the skin in the abdomen is tightened and repositioned to give you a more toned look.
If you have excess fat or skin around the area of your belly button or have a weak lower abdominal wall, a tummy tuck might be more suitable for you as compared to liposuction.
Reasons to Undergo a Tummy Tuck in Singapore
There are several reasons why a tummy tuck is something to go for or has been recommended to you. Be it genetics, stubborn fat or any variety of aesthetic reasons, they could be hindering your health and daily routine.
Some reasons you might have extra skin around your abdomen:
Tummy tucks can help to remove loose and excess skin and fat as well as tighten weak fascia (bands of connective tissue). The procedure can also help to remove stretch marks and excess skin in the lower abdomen but it will not be able to remove any stretch marks outside the lower abdomen area.  C-section scar removal can also be incorporated into tummy tuck surgery.
It is important to consult with a plastic surgeon regarding your eligibility to go for liposuction. Allure’s plastic surgeon, Dr Samuel Ho would be able to confirm your eligibility once you have gone through a consultation with him.
Why Go For Tummy Tuck and Liposuction Together?
Tummy tucks are often coupled with liposuction and it’s not surprising why. When large amounts of fat are removed through liposuction, excess skin is left behind and this can be a little unsightly.
Tummy tucks and liposuction are two different procedures. A tummy tuck is more invasive and involves many aspects of correction, while liposuction is basically a contouring procedure ; both are performed under general anaesthesia.
Opting to do these two procedures together will help you to achieve significant results that address both the problems of stubborn fat and excess skin. It will also help to achieve better body contouring results and can be difficult to achieve if done separately for some patients. Also, in some cases, excess fat and loose skin can occur together making this surgical combination even more appealing.
Preparations for a Tummy Tuck
Before your procedure, you will first have a consultation with Dr Ho where he will review your medical history, do a physical examination and discuss your expectations. This is where you can have an honest conversation with him about what you would like to achieve as well as confirm if you are a candidate for the surgery.
Before having a tummy tuck procedure in Singapore, you might also need to:
Stop smoking: Smoking decreases the blood flow in the skin and can slow the healing process. Smoking can also be a factor in tissue damage. You might be recommended to stop smoking before surgery and during the recovery period.
Avoid some medications: Some medications like aspirin, anti-inflammatory drugs and herbal supplements can increase bleeding.
Maintain a steady weight: It is ideal to maintain a stable weight for around 6 to 12 months before going through a tummy tuck. If you’re severely overweight, you might be recommended to lose weight before the procedure as significant weight loss after the surgery can change the results of the procedure.
Take medication before to prevent complications: Before you go through a tummy tuck, you may need to take some medications that reduce the incidence of bruising.
Arrange for help during recovery: When leaving the hospital and recovering at home, it is best to have someone with you to drive you home after the surgery as well as to stay with you.
Preparations for Liposuction in Singapore
Preparation for liposuction looks a little different from a tummy tuck as it’s a less invasive surgery.
Some things you might need to prepare:
Food and medication: Your plastic surgeon will help you to review what medications you are currently taking as well as the medical conditions you might have that requires you to take them. Some medications such as blood thinners of NSAIDs are some that you will be recommended to stop taking as these might complicate the surgery.
Arrange for help during recovery: Depending on how much fat needs to be removed, you might have to stay overnight at the hospital but if it’s a small amount, it might be done in an office setting. Either way, it is recommended to make arrangements with someone to drive you home and to stay with you for the first night after the procedure if you are staying at the hospital.
Post-Care for Tummy Tuck and Liposuction
As a tummy tuck is more invasive than liposuction, it is to be expected that you would need a longer recovery period for the former than the latter.
You will usually have a drain to promote fluid drainage
For the first six weeks, you will also have to be extra careful when moving around to avoid straining your incision line
You will also need to schedule regular follow-up visits to check on your healing progress
How post-care for liposuction will look like:
Some pain, swelling and bruising is to be expected after the procedure – some medication may be prescribed to help with this
You might be attached to drains to promote fluid drainage
You will be required to wear tight compression garments to help reduce swelling
You may need to wait for a few weeks before resuming activities such as exercise
It is recommended for you to seek the advice of a professional plastic surgeon before deciding on a tummy tuck in Singapore or a combination of these two procedures. These procedures are not to be decided on lightly and it is important to think about some of the long-term goals you might have – these can be communicated with Dr Ho to discuss how he may fit in a tummy tuck and/or a liposuction procedure for you.
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British journal of sports medicine, 50(17), 1092–1096. https://doi.org/10.1136/bjsports-2016-096065
Branford, O. (2018). Abdominoplasty procedure. Journal of Aesthetic Nursing, 7(10), 542-545.
Wu, S., Coombs, D. M., & Gurunian, R. (2020). Liposuction: Concepts, safety, and techniques in body-contouring surgery. Cleveland Clinic Journal of Medicine, 87(6), 367-375.
Scar Removal – We Have the Solutions
If you think of scars, you might probably be able to identify a few scar types be it scars from falling, acne or burns. But there are other scars that you might have that you might not think are scars. There are three different types of scars that are the hardest to remove without going through treatment or surgery. They are the mature widened scars, bad depressed scars and keloid scars. However, we have the solutions for all your scar removal needs.
Types of scars that can be treated with scar removal surgery
Mature scars will not cause you any itchiness or pain but like all surface scars, they will affect the appearance of your skin and sometimes the function of that area. The appearance of these scars are typically widened beyond the original injury or trauma and have a pale silvery or translucent appearance due to the abundance of scar tissue rather than the normal constituents of the skin, which can cause the skin to appear unattractive.
Depressed scars are scars that appear sunken beneath the contour of the surrounding skin. This may be due to the original injury, or a result of repeated high dose steroid injections administered to treat the thickened scar initially.
Depressed scars that are shallow may be amenable to simpler techniques such as filler or fat grafting that serve to elevate the scar to match the level of the surrounding skin. Badly depressed scars or those that have thick internal scar that tethers it down to the deeper tissue will require surgical correction.
An estimated 10% of people experience keloid scarring. Men and women are equally likely to get keloid scars. People usually confuse all thick scars to be keloid scars. There are 2 forms of thickened scars - hypertrophic scars and keloid scars.
Hypertrophic scars are thick, wide and raised above the skin. They develop where the skin is injured and occurs during the wound healing process. However, hypertrophic scars are an uncommon and abnormal response to trauma or injury that you might have experienced. 
This type of scar occurs when body cells called myofibroblasts produce too much collagen during healing. This might also occur because of someone’s skin type and body healing tendencies but most often, the scars are produced when the wound becomes infected or inflamed due to a great deal of tension or motion. This can occur when wounds are left to heal without stitches.
Hypertrophic scars are the most common by-products of burn injuries but can also be due to acne, cuts or piercings. They do not extend beyond the original area of injury. Once formed, they are not dangerous or life-threatening but can be itchy and painful.
Keloidal scars on the other hand are much larger than the original wound. They can most commonly be found on the shoulders, earlobes, cheeks and chest but keloids can be formed on any part of the body, even without penetrating trauma to the skin. 
They are formed when scar tissue is formed over the wound to repair and protect the injury with an excess of scar tissue growing beyond the area of injury to form smooth and hard growths. They may develop months or years after the original injury has healed, distinguishing them from hypertrophic scars.
How to identify a keloid scar:
A flesh-coloured, pink or red scar that is irregular in contour
A lumpy or ridged area that is raised
An area of scar that continues to grow larger
Pain and itch
Keloid scars are not harmful to your health or life-threatening but they are often itchy or painful and clothing or friction against your skin might cause discomfort or itchiness.
Non-Surgical Methods for Scar Removal
There is a variety of non-surgical methods that can lessen the appearance of these types of scars but they may not entirely get rid of them. There is no research at the moment that guarantees the complete removal of scars from the skin if these home remedies are used.
A non-invasive treatment, silicone sheets can be applied right after the skin heals from an injury. Silicone treatments are also available through a variety of products such as sheets, sprays, gels and foams – many of which are available in pharmacies. A silicone sheet must be worn over the scar for around 12 to 24 hours a day for 2 to 3 months and a gel has to be applied multiple times a day to work.
Onion Extract Creams
Onion extract creams might sound strange but it is just a topical gel made from onion extract. They are usually marketed as Mederma in pharmacies and is easily available. However, their effectiveness on scars have limited research in reducing their appearance.
Pressure and Massage
Massaging the area(s) affected or applying pressure to the scars is one of the most affordable ways to treat these scars. Another way to do this is through bandages or tape to put pressure on the scar if you do not have time to constantly be massaging the area. This method helps to weaken the scar tissue and thus, improve the appearance of the scar you might have.
Bio-oil is probably the method you might already know about. It’s a product that is known to treat all types of scars and can be purchased from most stores. Test trials using this product have shown positive results but because sample sizes were small, bio-oil may not be so effective for scar removal.
What is Scar Revision Surgery?
If you’ve already tried every home treatment there is and are frustrated with the results and want to get rid of your scar(s) for good, you might want to consider a scar revision surgery. Scar Revision Surgery helps to considerably reduce the appearance of the scars as compared to home remedies.
The surgery is suitable for both children and adults. If you’re unsure if you can qualify for this surgery, a qualified plastic surgeon will be able to tell you.
There are a few techniques that the doctor may use for this surgery such as:
Fusiform elliptical excision
Geometric broken-line closure
V-Y and Y-V enhancement
Flaps and grafts
During consultations with a plastic surgeon, they will conduct an assessment to assess the scar(s) you have on the skin. These assessments are usually non-invasive and are only used to map the surgical plan before surgery.
What to Expect During Scar Removal Surgery:
Anaesthesia – the choice of this will vary by surgery but the main types you can expect are local anaesthesia, regional anaesthesia and general anaesthesia
Incision direction – where 90-degree incisions are made to the skin to keep edges clean and in the direction of the skin’s hair follicles
Tissue handling – Using fine-tooth forceps and skin hooks, the skin will be gently handled to reduce tissue trauma
Skin hydration – Using a moist sponge, the skin will be kept hydrated regularly to ensure that the tissues can adhere smoothly
Layered skin repair – Repairing the lower layers of the skin first, the surgeon will then move gradually to the upper layers
Wound edges – This refers to how the edges of the wound are cut and fit so that they can be sewn back together
After Scar Removal Surgery
After the surgery, you may experience mild pain, swelling and wound discolouration for about 1 to 2 weeks. This is normal and is important to follow wound care instructions given to you by your doctor to avoid infection. The wound should be clean and dressed regularly to prevent moisture build-up.
Your body will start producing collagen and this phase will be when the skin tissues will start to rebuild themselves. To aid recovery, you will be advised to take vitamin supplements to aid in recovery as well as a well-balanced diet. Smoking should be avoided during this time and hydrogel dressings may be prescribed to you by your doctor to keep the recovering area hydrated.
Any surgery should be considered carefully and at Allure, we recommend you make your final decisions only after seeing an experienced plastic surgeon.
Schmieder, S. J., & Ferrer-Bruker, S. J. (2017). Hypertrophic scarring.
Betarbet, U., & Blalock, T. W. (2020). Keloids: A Review of Etiology, Prevention, and Treatment. The Journal of clinical and aesthetic dermatology, 13(2), 33–43.
Rhinoplasty Surgery: Open Vs Closed
Rhinoplasty, also known as a nose job, is a surgery that alters the shape of the nose. Patients typically undergo rhinoplasty surgery for reconstructive, aesthetic or functional reasons. This is due to the fact that undergoing rhinoplasty could improve breathing, the aesthetic appearance of the nose or both.
What is the process before a rhinoplasty?
The process usually begins with an initial consultation with Dr Samuel Ho. During this process, your surgeon will begin the navigation to understand your motivation for undergoing a rhinoplasty, to identify and understand what are the aesthetic and functional goals for the surgery.
Additionally, Dr Ho may need to delve deeper into your medical history. Typically, this includes a short discussion to consult your history of nasal obstruction, fillers, thread lifts, past surgeries, blood disorders and medications included in your diet.
A physical examination, including laboratory tests, will be conducted to help determine what changes need to be made to the nose. The patient’s physical features such as the thickness of skin and strength of their cartilage may affect the outcome of the rhinoplasty.
Going through the consultation process with your surgeon is pivotal. Though there is no ideal nose for everyone, surgeons will thoroughly refine their list of selected patients for rhinoplasty. Finding the right nose also depends heavily on the facial and nasal anatomies of the patient.
What are the common reasons for getting a rhinoplasty?
The most common requests for corrections for nasal aesthetic issues include:
A low or flat radix and dorsum
A short nose or excessive nasal length (long nose)
Inadequate tip projection
Broad or boxy alar rims (nose rims)
Other reasons for undergoing a rhinoplasty include:
Bulbous or short, upturned nasal tip
Hanging columella (bridge of tissues that separates the nostrils at the nasal base)
A nose that is too wide or narrow
Flaring or wide nostrils
Dorsal hump (hump on nose)
A nasal bridge that is too high or low
A crooked, droopy, long or upturned nose
Asymmetrical or under-projected nose
What are the types of rhinoplasty surgery procedures?
There are two different types of rhinoplasty procedures: Open and Closed Rhinoplasty. Depending on the nasal corrections needed to be made, some surgeons will determine the type of rhinoplasty needed by examining the advantages and risks of both procedures.
Open Rhinoplasty Surgery
Open rhinoplasty is a superior procedure in terms of best visualising the nasal structure for aesthetic or functional purposes. In an open rhinoplasty, an incision will be made beneath the tip of the nose where the columella is. The purpose of an open rhinoplasty is to achieve facial harmony through the reconstruction of the shape, size and angle of the nose. 
The nose is then retracted backwards. The nose cartilage will be dissected without causing incisions to the medial crura, where the cartilage separates the nostrils. The flap is then raised off of the nose for maximum exposure.
At this point, the nasal tip cartilages, upper lateral cartilages, bridge, or septum will undergo reshaping, reduction or augmentation (typically with external cartilage from the ears or rib). Once completed, the flap will be draped again over the bone and cartilage framework. Re-contouring and re-shaping will be repeated at this point till the target nose shape is achieved. The incision will be closed with sutures and an external splint or cast will be placed over the nose.
Advantages of an open rhinoplasty include:
Better binocular vision
More accurate diagnosis
More precise correction of deformities
Increased options with grafts
Disadvantages of an open rhinoplasty include:
Increased operative time
Oedema (fluid retention) or swelling of the nasal tip may persist for several months.
Increased risk of altering support or definition to the nasal tip
In a study according to the patient self-evaluations, 65% of patients were partially satisfied and 35% were satisfied with the aesthetic results. Some required additional procedures along with rhinoplasty for better results of surgery. 
Closed Rhinoplasty Surgery
A closed rhinoplasty is also known as an endonasal rhinoplasty. In an endonasal rhinoplasty, surgical incisions are made inside the patient’s nose. This procedure is generally recommended for patients who require nasal bridge modifications. Nasal bridge modifications are made for mild to moderate cases. Endonasal rhinoplasty can also be performed for small adjustments in the tip. An endonasal rhinoplasty usually results in a scarless appearance, with reduced swelling and a shorter recovery time. 
Curved incisions are made in the internal aspect of the nostril lining but none of the incisions can be seen externally. Hence, visible scars are avoided. However, because incisions made to the right and left nostrils are disconnected, repositioning of the nasal skin is difficult and the entire operation must be conducted through narrow surgical openings with limited visibility.
Due to the fact that access to the nasal framework requires intensive and vigorous stretching of the nasal skin, the nasal cartilage risks distortion. While visible scars are prevented, considerable challenges and technical limitations are associated with the lack of surgical access.
Advantages of an endonasal rhinoplasty include:
Minimal to no external scars
Limited dissection then reducing the risk of nasal shortening and contour deformity
Minimises post-surgical oedema (fluid retention)
Reduced operative time
Increased recovery time
Intact tip graft pocket for placement of small tip grafts
Despite an endonasal rhinoplasty having many beneficial outcomes, patients should do thorough research before entering surgery. While scarless results are much sought after, surgeons are unable to make major revisions to the size and shape of the nose. This is due to the surgical incisions being made on the inside of the nose. Inherently, this limits the extent of adjustments that can be made to the appearance of the patient’s nose.
While experienced surgeons who specialise in endonasal rhinoplasty usually yield very satisfactory results, this procedure is both intricate and fragile. In medical terms, it is considered a “blind” procedure.
The surgeon has minimal room through the narrow openings of the patient’s nostrils to perform the surgery. The procedure is completed mostly through “feel” and the sight of the nostrils’ outer appearance.
Furthermore, due to the extensive stretching of the nasal skin, access to the interior of the nose is reduced.
During The Rhinoplasty
Regardless of whichever procedure the patient and surgeon choose, the choice of anaesthesia depends on the extent of the rhinoplasty as well as the potential risks of bleeding/airway compromise. This also depends on other factors such as the length of the procedure, choice of patient and comfort level of the surgeon.
The majority of rhinoplasties are completed under moderate sedation, where the patient is given intravenous medication for pain relief and sedation. Local anaesthesia will be administered to the nose.
This method also allows patients to avoid general anaesthetic and removes the presence of an airway tube which could potentially distort the nasal shape and inadvertently affect the final outcome of the rhinoplasty.
This ensures that most patients remain asleep throughout the whole procedure. The entire rhinoplasty procedure can last up to 4 to 5 hours with an average time of around 2.5 hours.
Recovery Period: Open vs Closed Rhinoplasty
The downtime for both closed and open rhinoplasty is about 1-2 weeks. After which, the post-surgery bruising is minimal. However, swelling can vary greatly, from a month to resolve for most closed rhinoplasties to a year for some open rhinoplasties.
During the recovery period of an open rhinoplasty, facial swelling is normally present but bruising is typically minimal and an external tape/splint will be applied to the nose for a week to give support to the underlying nasal framework. For open rhinoplasties, it takes a minimum of 2 to 3 months for the swelling to be completely resolved.
For closed rhinoplasties, a nose splint is similarly applied. The recovery period is much shorter than that of an open rhinoplasty, ranging anywhere from 2 to 6 weeks.
However, for the final effect to take place, in particular nasal tip sharpness and shape, it could take anywhere between 12 to 18 months.
Raggio, B. S., & Asaria, J. (2019). Open Rhinoplasty.
Manhas, P., Angral, S., & Kotwal, S. (2020). Outcome and Pitfalls of Open Rhinoplasty. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 72(1), 17–23. https://doi.org/10.1007/s12070-019-01712-z
Scattolin, A., & D'ASCANIO, L. (2013). Grafts in" closed" rhinoplasty. Acta Otorhinolaryngologica Italica, 33(3), 169.
Why you need to get Ptosis Surgery in Singapore
With ageing comes a common condition - saggy skin. Saggy skin can affect your entire body including your eyelids and it is completely normal. Our skin is a living organ and its elasticity will not be retained as we grow older. One of the common areas we can see this happening is on our eyelids. This is when we will need ptosis surgery.
It is not just the saggy excess skin that makes up a drooping eyelid, although that is the most obvious thing to most patients. The eyelid opening muscle is often affected; most commonly, the aponeurosis (tendon) of the muscle is lax or damaged, resulting in a poor eyelid opening function, given the appearance of a droopy eye.
A drooping eyelid, otherwise known as ptosis or blepharoptosis, is a condition in which the upper eyelid falls to a lower than normal position. In severe cases, this results in the drooping eyelid covering all or part of the eyelid impairing someone’s vision.
This condition can affect both eyes or just one eye. However, drooping eyelids can happen not just when we’re old but at any stage of our lives across all genders. It can be a condition one is born with but it can also be developed over decades as one ages. Ptosis can vary in different people – some may experience impaired vision while others will experience droopy eyelids without any impaired vision. This should not be taken lightly however even if one’s vision isn’t impaired as this could be a sign that a more serious condition could be affecting the muscles, nerves, brain or eye socket.
Having ptosis could mean that you are also affected by other sorts of medical problems. Even if your vision isn’t impaired, that doesn’t mean that you might not have any other medical conditions. If you think you might have ptosis, we would recommend a visit to your doctor to assess the reasons for it and to check if you might have other underlying health concerns.
Depending on the cause of ptosis, correcting it could help improve your daily life. Besides the obvious effect of looking younger, other factors come with having ptosis such as excessive pressure on brain nerves which could lead to blacking out or fading sight as well as other nervous system problems in the body.
Some immediate results of ptosis corrective surgery are:
More youthful eyes
Less eye irritation or feeling of heaviness/fatigue
No more headaches from the constant lifting of forehead/eyebrows to see
Ptosis Surgery in Singapore
The ptosis correction procedure is usually a quick day surgery. It typically takes around 45 to 90 minutes, depending on if the surgery aims to correct just 1 eyelid or 2.
There will be 3 different types of ptosis surgery based on the severity of the ptosis and the impact it has on your vision:
Transcutaneous external ptosis surgery: the most common type of ptosis surgery in Singapore, and this is done on patients that have a normal levator muscle working. The surgery will help to remove any saggy skin and at. The key step of this procedure is the repair of the aponeurosis (tendon) of the eyelid opening muscle (levator palpable superioris), either by tightening it or by shortening it. 
Transconjunctival ptosis surgery: for mild forms of ptosis that do not require skin removal, this type of treatment is usually used. This is done via an internal incision and leaves no scar on the eyelid. 
Use of the forehead (Frontalis) or eye-closing muscle (Orbicularis Oculi) to augment the eye-opening. This is usually reserved for very severe forms of ptosis, especially if the eye-opening muscle function is poor. 
How to Prepare for Ptosis Corrective Surgery
If you’re looking into having ptosis surgery in Singapore, your surgeon will be able to let you know in detail exactly what you need to do to prepare for it and you must consult your surgeon if you have any questions as they will have the best professional answers for you that are suited for your case.
However, before any surgery, it is important to minimise the risks for complications during the surgery such as infection and bleeding. Some things you should avoid are blood-thinners like aspirin, vitamin E and Ginkgo Biloba. Before the surgery, make sure to have an honest conversation with your surgeon about what sort of supplements and vitamins you are currently taking so they will be able to advise you on which you can continue taking or should stop taking.
Since this is eyelid surgery, chronic eye problems like dry eye or allergic conjunctivitis should be communicated to your surgeon. These can be managed with eye drops or other medications prescribed by your doctor. It is very important to let your surgeon know about any and every eye condition you have.
After you’ve had your surgery, you might experience your eyelid(s) swollen and your vision blurred as a result. It is important post-surgery to know this is normal and that you should be lifting your head and using cold compresses as much as you can to reduce the swelling. If swelling is not kept under control, this could stretch sutures and cause eyelids to droop again.
Another thing to note would also be that your eyelid(s) post-surgery can also be stiffer so using lubricating ointment and drops to prevent dryness will help you with feeling more comfortable. These can be prescribed by your surgeon. How long you have to use these will depend on person to person.
If you already have dry eyes or eye disease, there is a higher chance of having a drying of the eyes post-surgery. If you are having an issue with protecting your eyes, especially in those who have poor movement of the eyes and weak facial muscles, please consult your surgeon and they will be able to suggest the best way to prevent this.
As with all surgeries, it is important to observe how your body is reacting post-surgery but also before the surgery to make sure the chance of the surgery being successful is high.
There is still a possibility of complications as well as risks that come with ptosis surgery. These risks include infection, asymmetric eyelid height, need for adjustment or additional surgery, unusual bruising or swelling after surgery, overcorrection or under correction, needing the eyelid to be lowered if the eyelid cannot be fully closed, etc. Your plastic surgeon will be able to communicate the risks involved for your body but like any surgery, we recommend you seriously contemplate it over before going through with it.
Waqar, S., McMurray, C., & Madge, S. N. (2010). Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis. The open ophthalmology journal, 4, 76–80. https://doi.org/10.2174/1874364101004010076
Ichinose, A., & Leibovitch, I. (2010). Transconjunctival Levator Aponeurosis Advancement without Resection of Müller's Muscle in Aponeurotic Ptosis Repair. The open ophthalmology journal, 4, 85–90. https://doi.org/10.2174/1874364101004010085
Takahashi, Y., Leibovitch, I., & Kakizaki, H. (2010). Frontalis suspension surgery in upper eyelid blepharoptosis. The open ophthalmology journal, 4, 91–97. https://doi.org/10.2174/1874364101004010091
Eye Bags – the Baggage You Don’t Need
Puffy, thick and discoloured – eye bags can be a real pain adding years to an otherwise youthful-looking appearance. There is a common misconception that eye bags are caused by a lack of sleep. Thus, one cannot blame the general population who dishes out often ineffective advice such as “Maybe you should sleep more!” or “Have you tried an eye mask?”. Though the lack of sleep may be a contributing factor to the worsening of eye bags, it is but a minor one.
First, a brief anatomy of the eyes. The eyeballs or globes are an extremely sensitive organ and hence are protected by orbital fat (fat pads). These protect the eyeballs from external trauma while allowing them to rotate around smoothly. The orbital septum (tissue around the eyes) keep the fat pads from bulging out. However, as we age, these tissues lose their elasticity and thus result in the protrusion of fat pads. As we age, we also undergo maxillary retrusion, losing some fat and bone around the mid cheek area, accentuating the contrast between the eye bag and the surrounding cheek. 
Genetics may also play a part as some people may be born with inherently weaker tissue/orbital septum around the eyes. This situation is made worse by the accumulation of fluids or venous congestion around the fat region making the bulge even more prominent. This fluid accumulation is associated with conditions such as allergies and sinuses. This is why eye bags and dark eye circles can occur in the young age population, contrary to the belief that eyebags are a direct result of ageing. 
Many people would also notice that the areas under the eyes can appear darker hence making the eye bags that much more noticeable. This can be caused by a variety of reasons such as stress, lack of sleep and alcohol consumption. The skin under the eyes is significantly thinner than the skin on other parts of the face. This makes the blood vessels underneath very obvious. Stress, the lack of sleep and alcohol consumption all release hormones that lead to the dilation of these vessels. This would then cause more blood to rush to the area thus give the blue-black appearance commonly associated with dark circles. As mentioned above, this is one mechanism where allergies or sinus issues result in dark eye circles or eyebags.
The failure of creams and home remedies
There are many cosmetic eye creams and home-based remedies that promise they would be able to rid one of their eye bag problems. While it is true that some of these products would be able to improve the texture and colouration of the skin surrounding the eyes thus reducing the effect of dark circles, typically through the use of caffeine compounds that temporarily shrink the blood vessels or mild bleaching agents that reduce pigmentation, they would not be able to reduce puffiness in the eye bags. This is primarily due to the inability of the creams to penetrate deep enough to reach the fat pads. Realistically, the best and most efficient way to remove eye bags is through surgery.
Scarless Eye Bags Removal
This procedure is essentially carrying out eye bag removal surgery from inside the eyelid. Also known as Transconjunctival Lower Blepharoplasty, Dr Samuel Ho would access the fat pads from a 1.5cm incision made inside the lower eyelid. This allows Dr Ho to do much more such as removing the fat pads entirely or repositioning the fat pads into sunken areas for a more homogenous result. As the procedure is done on the inner eyelid, there will be no observable scarring.
Incisional Technique for Eye Bags Removal
Another option offered by Dr Ho is the incisional technique. This is the more traditional method of eye bag removal as the incision is made just below the lash line. The fat pads and excess skin would be removed before the wound is stitched closed. As the procedure is performed on the exterior, there would be a visible scar that will run below the lash line. This is typically chosen if there is excess skin to be removed, to achieve a smooth lower eyelid appearance.
With the scarless technique, patients are typically able to return to work within a few days with mild swelling. If fat grafting is performed at the same time, then they may need to take a week off work. With the incisional technique, patients would usually be able to return to daily activities within a few days, and back to work after suture removal after 10 days. However, strenuous activities or sports should only resume after 3-4 weeks.
Preparing for Eye Bags Removal Surgery
After a detailed consultation with Dr Samuel Ho, he would advise you on the best procedure to meet your aesthetic goals. He would also give you some pointers to prepare for the surgery and it is important to follow them to prevent any complications during the procedure.
In the week leading up to your procedure, avoid painkillers, alcohol, smoking and products containing Vitamin E. Certain food such as ginseng, fish oils, Ginko Biloba supplements should also be stopped. This is to prevent excessive bleeding and blood clots.
The recovery period is almost as important as the procedure itself. It is important to keep the areas around the incision site clean. If there is leakage or minor bleeding, use gauze to gently dab at the site. Diligently use eye drops to lubricate your eyes and a cold compress to reduce swelling.
Protect your eyes from the sun as well. Wear sunglasses when going out to prevent putting a strain on your eyes. Refrain from watching an excessive amount of digital media as it will also strain the eyes. Try to get as much rest as you can so your body can heal faster and the recovery process can be expedited.
Refrain from smoking or using products with nicotine and tobacco contents. These compounds not only slow down recovery but increase the chances of infections.
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