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Operations


Mr Liew offers a wide range of cosmetic procedures, both invasive and non invasive. During consultations, your aspirations will be discussed. By taking into consideration of your existing appearance, and past medical history, an appropriate procedure will be tailored to your needs. Here is a list of some of the procedures that he performs:


Non invasive procedures ie fillers, botulinum toxins
Abdominoplasty (tummy tuck)
Blepharoplasty (eyelid reduction)
Breast augmentation
Breast reduction
Breast lift
Rhinoplasty (nose reshaping)
Pinnaplasty (ear reshaping)
Corrrection of gynaecomastia (male breast)
Liposuction
Laser resurfacing

For information on specific surgery, please click on it, or go to www.baaps.org.uk

 
Operation Details
Abdominoplasty
(tummy tuck)
Improvement in abdominal contour can be achieved in several ways. If your skin is firm and elastic, liposuction alone is sufficient. However, if the skin is loose and flabby, and the problem is both above and below the navel, then a full abdominoplasty is needed. If most of the problem is below the navel, a mini abdominoplasty is more appropriate. Patients who have a large amount of excess skin extending over the hip and waist may benefit from circumferential skin removal. It should be stressed that abdominoplasty does not remove all stretch marks, especially those above the navel.

The length of incision for an abdominoplasty depends on the amount of skin to be removed. It normally involves one that follows the crease of the groin up towards the hip bones. The navel is resited to a new position in full abdominoplasty. The skin is usually tightened downwards and this does not tighten the waist.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with abdominoplasty. Any major operation with a general anaesthetic carries a small risk of chest infection particularly in those who smoke, and there is also a small risk of thrombosis in the veins of the leg, particularly for those who are taking contraceptives. This should be stopped 6 weeks before surgery. Occasionally, heavy bleeding can occur after the operation, which may need a further operation and a blood transfusion. Infection may occur, which can be treated with antibiotics, but will delay the healing process, resulting in inferior scar formation.

Usually the scars settle well to end up as white lines but they will always be noticeable. However, some people have inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time. Sometimes, poor wound healing occurs, when the skin becomes sloughy and forms a scab, which gradually separates to leave a broad scar. Those who smoke and overweight are at greater risk. You should therefore stop smoking 6 weeks before the surgery.

Sometimes there could be a slight asymmetry of the abdomen after surgery. The appearance of the navel may not be satisfactory, and in rare circumstances, when the blood supply to the skin is poor, you may lose the navel. A fatty bulge may remain above the scar.

If the incision is too short, there will be extra skin at the ends of the incision that will form a skin flap, a ‘dog ear', that can be excised later.

There maybe some accumulation of tissue fluid in the abdomen after surgery. Normally it settles within a few months. If this volume is too great, it may have to be drawn out by inserting a needle into it.
Eyelid reduction
(blepharoplasty)
Eyelid reduction (blepharoplasty) is a procedure to remove excess skin and muscle, usually with fat, from the upper and lower eyelids. As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing ‘bags' above and below. These features make you look older and more tired than you feel, and may even interfere with your vision. However, blepharoplasty will not remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. It can be done alone, or in conjunction with other facial surgery procedures such as facelift or browlift. Fine wrinkles around the eye can be abolished by laser resurfacing, while crow's feet can be abolished by botox injection.

A few medical conditions make blepharoplasty more risky. These include thyroid problems such as hypothyroidisma and Grave's disease, dry eye, high blood pressure, cardiovascular disease, bleeding tendencies, diabetes, detached retina and glaucoma. Before the surgery, you should alert your surgeon on any previous eye trauma, eyelid surgery, eye or eyelid inflammation and allergies. You should also provide any relevant information from your ophthalmologist or the record of your most recent eye examination. Aspirin should be discontinued for 2 weeks prior to surgery.

Every surgical procedure carries a certain amount of risk, and it is important that you understand the risks involved with blepharoplasty. Complications after blepharoplasty are infrequent and usually minor. Common complications include swelling, bruising slight dryness of eye and conjunctivitis. Less common complications include bleeding, infection, wound break down, excessive scarring, excessive tearing, increased pigmentation of lower eyelid, residual bags, asymmetry, hollow lower eyelid and retracted lower eyelid. Very rare but serious complication is blindness.

If only the upper eyelid is operated on, local anaesthesia could be used. If both the upper and lower eyelids are operated on, general anaesthesia is generally advisable. In a typical procedure, the surgeon makes an incision following the natural lines of your eyelids: in the creases of your upper eyelids, and just below the lashes in the lower eyelids. The incisions may extend into the crow's feet or laughter lines at the outer corners of your eyes. If you have a pocket of fat beneath your lower eyelids but do not need to have any skin removed, a transconjunctival blepharoplasty can be performed. In this procedure the incision is made inside your lower eyelid, leaving no visible external scar.
Breast augmentation
Breast implants can bring psychological benefits for women who feel that their breast size is inadequate. It is important to have realistic expectations of the surgery, as the outcome of surgery depends on your existing breasts, the position of your nipples, your age, skin texture, healing properties and your general health.

All implants are surrounded by a firm silicone shell, with two types of implant fillers: silicone gel, both semi-liquid and cohesive, and saline. Implants are available in round or anatomical shape. Silicone implants are soft and feel more natural. There is no eveidence that silicone implants is associated with any serious health hazard.

It is important to know about some of the short-term effects of breast implant surgery and the long-term potential risks:

Some short term effects:

You will have swelling and discomfort, with possible changes in breast sensation. Sometimes the change in breast sensation can be permanent. It will take several months for breasts to look more natural. Infection and bleeding after surgery can occur.

Potential risks:

Capsular contracture occurs in about 10% of patients. It presents as hardening of the breast as the body forms a wall of scar tissue around the implant. The implant may then have to be removed and exchanged.

Some implants may rupture, but the rupture rate amongst the newer, tougher implants is unknown. Rupture does not necessarily create a medical problem as the silicone gel will remain within the capsule that the body forms. The life expectancy of the newer implants is unknown.

The scars resulting from the surgery is usually satisfactory. However, in a small number of patients, it may be thick, and can take several months to settle.

The position of the breast may be unsatisfactory and the shape may be unpredictable. Augmentation may magnify breast asymmetry. The final cup size cannot be gauranteed after surgery. In women with very little breast tissue, creasing and rippling of the implants may be a problem.

Implants do not interfere with the ability to breast feed. There is also no evidence of increased breast cancer. However, you have to inform the radiographer during breast screening that you have implants so that the screening techniques could be modified.

Remember that breast implants do not come with a life time guarantee. They are likely to need replacing with consequent further surgery and expense. More detailed information on breast implants can be obtained from: www.doh.gov.uk/bimplants
Breast reduction
(reduction mammaplasty)
Women with very large breasts may experience back pain, neck pain, grooves in the shoulders from bra straps, rashes under the breasts and feeling of self-consciousness. It is also difficult to wear fashionable clothes and play sports, especially in the summer months. Breast reduction involves removing fat, glandular tissue and skin from the breasts, making them smaller, lighter and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. Breast reduction is also used to correct asymmetry of the breast, where one breast is very much larger than the other. The outcome of surgery depends on several variables, such as your age, size and shape of your breasts, and the condition of your skin.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with breast reduction. Any major operation with a general anaesthetic carries a small risk of chest infection particularly in those who smoke, and there is also a small risk of thrombosis in the veins of the leg, particularly for those who are taking contraceptives. Occasionally, heavy bleeding can occur after the operation, which may need a further operation and a blood transfusion. Infection may occur, which can be treated with antibiotics, but will delay the healing process, resulting in inferior scar formation.

Breast reduction involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural crease beneath the breast. Usually the scars settle well to end up as white lines but they will always be noticeable. However, some people have inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time. Sometimes, poor wound healing occurs, when the skin forms a scab rather than healing in a nice neat line, which gradually separates to leave a broad scar. Those who smoke are at greater risk. You should therefore stop smoking 6 weeks before the surgery.

Many women wish for a very radical reduction but in order to achieve this the shape and aesthetic quality of the breasts may be compromised. It is also possible that there may be a degree of asymmetry. It is difficult to predict the exact size and shape of the breasts prior to surgery. When reducing large breasts, it may be necessary to adjust the folds of skin at the end of the scar, both between the breasts and at the sides. This can simply be carried out under local anaesthesia a few months later.

Sometimes fat necrosis can occur, when the blood supply of the fat cells in the breast is disturbed. This may present as discharge from the breast or lumpiness in the breast. The nipples are likely to be less sensitive, which could be temporary or permanent. If the blood supply of the nipple is disturbed in rare circunstances, you may loose the nipple.

Some women find it difficult to breast feed after breast reduction as the nipples are separated from the underlying milk ducts. However, breast reduction can be performed before pregnancy.
Breast lift
(mastopexy)
Over the years, factors such as pregnancy and the force of garvity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to raise the sagging breasts. It can also reduce the size of the araola, the darker skin surrounding the nipple. If your breasts are small or have lost volume after pregnancy, breast implant inserted in conjunction with mastopexy can increase both their firmness and size.

If you are planning to have more children, it may be a good idea to postpone your breast lift. While there is no special risks that affect pregnancy (for example, breast lift does not interfere with breast feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Breast lift is performed under general anaesthesia. Depending on the amount of lifting necessary, the scars can either be just around the nipples, or extend as an anchor shape following the contour of breast.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with breast lift. The complication rate is related to the amount of tissue removed during the procedure. If the breasts are merely lifted, with just the excess skin removed, then the complication rate is very low, compared with the procedure when excess breasts tissue need to be removed as well. The possible complications are bleeding, infection, poor wound healing, and rarely, reduced sensitivity to the nipples. Usually the scars settle well to end up as white lines but they will always be noticeable. However, some people have an inborn tendency for scars to stretch and sometimes they can stay thick, red and irritable for a long time. Sometimes, poor wound healing occurs, when the skin forms a scab rather than healing in a nice neat line, which gradually separates to leave a broad scar. Those who smoke are at greater risk. You should therefore stop smoking 6 weeks before the surgery.

The breasts may be slightly asymmmetrical after the operation. Most women have slightly asymmetrical breasts before their surgery, and a small deviation in size or appearance must be regarded as normal.
Rhinoplasty
(cosmetic nose surgery)
An attractive nose is one that achieves a harmonious balance with your other facial features. The characteristics of the nose are inherited. The objective of the operation is to make your nose look right for your eyes so that you lose your self-consciousness. It is, therefore, most important that you are clear in your mind what it is that you dislike about your nose, and that you are able to explain this to your surgeon. It is usually recommended that young people wait until facial growth is completed, at around 16 years old, before considering rhinoplasty.

Sometimes the size of the nose as a feature of the face is influenced by the proportions of the other facial features, such as the chin and cheek bones, and to ‘normalise' the appearance of the face, it may be advisable to alter these features as well, either at the same time as the rhinoplasty, or during a separate procedure.

Rhinoplasty is performed under general anaesthesia. It can be performed from within the nose, with incisions made inside the nostril (closed rhinoplasty), or by making incision across the vertical strip of tissue separating the nostril (columella), as well as within the nose (open rhinoplasty). The type of technique depends very much on the nasal work required. The sacrs resulting from the surgery is usually satisfactory. However, in a small number of patients, it may be thick, and can take several months to settle.

Working through these incisions, the nose's framework of bone and cartilage is sculpted to the desired shape. Your surgeon may reshape or reposition the bones in your nose, or build up certain areas, using either nasal cartilage or bones and cartilage from other body site, or other materials. The skin and soft tissue are then redraped over the reshaped framework. If the lower part of the nose is being narrowed or the nostrils are being reduced, small wedges of skin at the base of the nostrils may be removed through incisions that are hidden in the nose's natural creases.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks before embarking on any surgical procedures. It is quite common to experience some difficulty in breathing through the nose during the first week after rhinoplasty, which disappears as the swelling settles. Occasionally though, the difficulty persists and can be permanent. Occasionally the operation is complicated by heavy nose bleed, or infection. In about 10% of patients, surgical revision may be necessary 6-12 months after nasal surgery when all the swelling has settled. Secondary surgery like this will involve additional expenses.

There are certain limitations to the surgery , such as: If the skin on the tip of your nose is thick and oily, it may not be possible to reduce its bulk as much as you like. There may be limitation to the amount of reduction that can be achieved to the size of your nose. If your nose is bent from previous injury, it may not be possible to make it completely straight. Large nostrils can be difficult to reduce without leaving noticeable scars.
Correction of prominent ears
Approximately 1-2% of the UK population have prominent ears. People with prominent ears are sometimes teased, particularly during their school years, and this can lead to loss of self confidence. It is recommended the operation be performed after 5 years old, when the underlying cartilage is more amenable to resculpturing. It is also better to wait until the child recognises the problem and wants the ear corrected. Children are more cooperative and happy with the outcome when they understand why the surgery is taking place. Correction of prominent ears can also be carried out in adults.

Pinnaplasty or Otoplasty is an operation that adjusts the shape of the cartilage within the ear to create the missing folds and to allow the ear to lie closer to the side of the head. Because the operation is carried out from behind the ears, a small scar is left close to the groove between the ear and the side of the head. The procedure can be carried out under local or general anaesthesia, depending on the age of the patient.

Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include ‘lop ear', where the top of the ear is folded down; ‘cupped ear', which is usually very small ear. Where the lobe of the ear is especially large, a small procedure to reduce its size may also be required.

It is important to know about the possible complications from the surgery. In about 3% of patients, the scar may become thick and red. Infection is not common, but should this occur, it would require treatment with antibiotics and regular dressing changes. Post-operative bleeding can occur, and if significant, blood clots may need to be evacuated from the ear. Sometimes the bandage can chafe the ear to produce a break in the skin which can take a long time to heal. There is a small risk that further adjustment surgery may be necessary. The ears are often a little numb after surgery, and ususally takes several weeks to settle.
Correction of gynaecomastia
(male breasts)
Gynaecomastia is a term that describes large breast in men. Although certain drugs and medical problems can cause gynaecomastia, there is no known cause in the vast majority of cases. For men who feel self-conscious about their appearance, breast reduction surgery can help. The procedure removes fat and/ or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, frimer and better contoured.

The best candidates for surgery have firm, elastic skin that will reshape to the body's new contour. Surgery is discouraged for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, excessive alcohol, marijuana and anabolic steroids may cause breast development, and hence patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is offered.

If the amount of breast tissue is minimal, liposuction alone is effective in removing it. However, more commonly, an incision needs to be made at the edge of the nipple to remove the excessive underlying glandular tissue. In cases when large reduction is necessary, larger incision may be needed that will result in more conspicuos scars.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with breast reduction. The greatest risk is that there may be some unevenness in the areola-some depressions or some remaining bulge. The procedure may also result in noticeble scars, permanent pigment changes in the breasts area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue. Other possible complications include infection, skin injury, excessive bleeding, adverse reaction to anaesthesia, and excessive fluid loss or accumulation. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.
Liposuction
Liposuction is a surgical technique to remove unwanted deposits of fat from specific areas of the body, include the face and neck, upper arms, trunk, abdomen, buttocks, hips and thighs, knees, calves and ankles. Liposuction can enhance your appearance and self-confidence, but it may not change your looks to match your idealized concept or cause people to react to you differently. This is not a substitute for weight reduction, but a method for removing localised deposits of fatty tissue that do not respond to diet or exercise.

The best candidates for liposuction are individuals of relatively normal weight who have excess fat in particular body areas. Having firm, elastic skin will result in better final contours after liposuction. Hanging skin will not reshape itself to the new contours and may require additional surgical techniques to remove and tighten excess skin such as facelift, abdominoplasty, or thigh-lift procedures. Body contour irregularities due to structures other than fat cannot be improved by liposuction. The ideal candidates for liposuction should also be physically healthy, psychologically stable, and realistic in their expectations. Liposuction is not recommended for individuals with heart or lung diseases, poor blood circulation, diabetes or those who have recently had surgery near the area to be suctioned.

Cellulite is a term used to describe a specific look of skin that reflects the architecture of the fat and skin overlying certain areas of body. As people age, almost all develop some areas of cellulite. At this time, there is no ‘cure' for cellulite. However, improvement can be achieved by proper diet and exercise in combination with liposuction.

Liposuction is performed using a hollow metal surgical instrument known as a cannula that is inserted through small skin incision (s) and is passed back and forth through the area of fatty deposit. The cannula is attached to a vacuum source, which provides the suction needed to remove the fatty tissue. Liposuction can be performed under local or general anaesthesia, depending on the areas to be suctioned.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with liposuction. The potential complications of liposuction are: Bleeding, infection, scarring either at the incision site or in deeper tissue, skin discolouration and swelling, change in skin sensation which is normally temporary, skin contour irregularities, perforation injury to the skin or organs, excessive accumulation of fluid that must be drained, adverse reactions to the anaesthetic used, excessive fluid loss that can lead to shock and blood clots in legs and lung. It may not be possible to achieve symmetric body appearance from liposuction. Factors such as skin tone, bony prominence, and muscle tone may contribute to normal asymmetry in body features. Subsequent alterations in body contour may occur as a result of aging, weight loss or gain, pregnancy, or other circumstances not related to liposuction.
Laser resurfacing
Laser resurfacing is helpful in reducing facial wrinkles, improving skin textures, skin colour, appearance of scars and certain skin lesions. It involves the removal of the top layer of skin and hence new skin formation, and encourages new collagen formation. Other treatment options for improving skin quality include dermabrasion and chemical peel. Before laser resurfacing, you should understand the treatment procedure, including any necessary pre-treatments and precautions, post-operative care, likely outcome of the procedure and the associated risks. You should also be familiar with other treatment options before you agree upon a particular treatment.

Every surgical procedure carries a certain amount of risk , and it is important that you understand the risks involved with laser resurfacing. Redness of the treated area is common after resurfacing, and normally lasts about 10 weeks. In some patients, especially those with fair skin and red hair, it can lasts longer.

Hyperpigmentation (darkening of skin colour) can occur in up to 30% of patients, but usually temporary and rarely lasts more than 2 months.

Hypopigmentation (lightening of skin colour) can occur in up to 30% of patients, and may not become apparent until 6-10 months after resurfacing. This is most noticeable in dark skinned or deeply tanned individuals, after resurfacing of just part of the face.

Infection is rare, and occurs in <1% of patients. Antibiotics and anti-viral therapy are given to prevent infection. If you are prone to cold sores, you have to be on a course of acyclovir 1 day before laser resurfacing, and for 5 days afterwards.

Scarring can occur. This can be due to over aggressive resurfacing, or post-operative infection of the resurfaced area. Patients who have recent roaccutane treatment for acne also have higher chance of post-operative scarring. Roaccutane should therefore be stopped at least 6 months prior to laser resurfacing. Some patients are more prone to scarring than the others.

Allergic dermatitis of skin can occur due to the use of topical ointments after resurfacing.

Acne breakouts can occur, especially in those who with history of adult acne.

It is important to remember that laser resurfacing does not remove all the scarring/ wrinkles of the face. Repeated treatments may be necessary to achieve optimum outcome. In acne scarring, the maximum improvement that can be expected after one treatment is 30-50%. If resurfacing is used to treat pigmentary changes or lesions, there is a chance of recurrence.