Thursday, November 27, 2014

Doc, Can You Balance My Double Eyelids?

This patient had had double eyelid surgery done somewhere but was unhappy with the left double eyelid which appeared to be too high. Examination showed this was caused by too much fat being removed and hence the high double eyelid with sunken look. 

Uneven double eyelids treated with hyaluronic acid.

I injected 0.3 ml of hyaluronic acid Juverdem into the preaponeurotic space (arrowed) to replace the missing volume and straight away the double eyelids appeared equal.

Friday, November 14, 2014

Doctor, I have swollen eyebrow!

This 65 year-old woman presented with a rapidly expanding lesion of the right medial eyebrow and swelling of the lymph nodes over the right jaw. The swelling first started 6 months ago. She was otherwise in good health. Examination revealed a non-reducible, non-tender and fixed mass. A CT scan shows no extension into the brain or the orbit. To avoid creating obvious scar, I perform the incision along the eyebrow with some medial extension. 

Right medial eyebrow sweling of 6-month duration.

Incision made along the eyebrow and the lesion removed completely.

Patient returned one week later for suture removal.

The lesion was sent in totality and sent for histopathology. I was expecting the lesion to show evidence of lymphoma but instead the report read chronic inflammtory changes consistent with a condition termed "Kimura's disease". As the patient was asymptomatic except for some swollen lymph nodes which are small in sizes, no treatment was needed but the patient was asked to return for regular review. 

Sunday, November 2, 2014

Beware of Bogus Korean Plastic Surgeons

Beware of bogus Korean plastic doctors from the Star newspaper.

Trouble brewing in South Korea's plastic surgery paradise

Kim Bok-soon cries during an interview with Reuters at her home in Seoul, Oct 14, 2014. - REUTERS
Kim Bok-soon cries during an interview with Reuters at her home in Seoul, Oct 14, 2014. - REUTERS
SEOUL: Kim Bok-soon disliked her nose and fantasized about getting it fixed after learning of the Korean superstition that an upturned nose makes it harder to hold on to riches. 
While waiting in a hair salon, she saw a magazine advertisement for a plastic surgery clinic and decided to go for it, despite her family's objections. 
In South Korea, where physical perfection is seen as a way to improve the quality of life, including job and marriage prospects, plastic surgery procedures can seem as commonplace as haircuts. 
Kim's doctor said he could turn her into a celebrity lookalike, and Kim decided to take the plunge, taking loans and spending 30 million won (US$28,000) for 15 surgeries on her face over the course of a day. 
When the bandages came off and she looked in the mirror, she knew something had gone horribly wrong. 
Only later did Kim find out her doctor was not a plastic surgery specialist. 

Kim Bok-soon cries during an interview with Reuters at her home in Seoul, Oct 14, 2014. - REUTERS 
Five years later, Kim struggles with an array of medical problems, and is unable to close her eyes or stop her nose from running. The 49-year-old divorcee said she was unemployed and suffers from depression. 
"It is so horrible that people can't look at my face," Kim, crying, said in her tiny one-room Seoul flat filled with photographs from before and after the surgeries. "This is not a human face. It is more revolting than monsters or aliens." 
A record from the Seoul central district court shows that Kim's doctor faces a pending criminal case on charges of violating medical law. 
The case began in 2009 after several patients including Kim reported him to the authorities. The doctor's lawyer turned down Reuters' request for an interview. 
The boom in South Korea's $5 billion plastic surgery industry - that's a quarter of the global market according to the country's antitrust watchdog - is facing a backlash, with formal complaints about botched procedures and dodgy doctors doubling in 2013 from a year earlier. 
Some plastic surgeons say safety fears could stifle the country's nascent but fast-growing market for medical tourism, especially from China. 
Complaints range from unqualified doctors to overly aggressive marketing to "ghost doctors", who stand in for more qualified doctors and perform surgeries on unwitting, anaesthetized patients. 
Cha Sang-myun, chairman of the Korean Association of Plastic Surgeons, which represents 1,500 plastic surgeons, is worried about their reputation. Cha and some lawmakers are among those calling for tighter supervision and stricter advertising rules.
"We've got to clean ourselves up," Cha said at his clinic in Seoul's high-end Gangnam district, which is filled with plastic surgery clinics. 
"Now, patients from China are coming in the name of plastic surgery tourism but if things go on like this, I don't think they will come in the next few years," he said. 
In a notorious case last December, a high school student ended up in a coma after surgeries to fix her nose and get a "double-eyelid", a procedure that makes the eyes look bigger. 
Cha's group looked into the incident and found the hospital that performed the surgery hired such ghost doctors, and referred the case to prosecutors.
It is still under investigation by prosecutors and nobody has been indicted, an official at the association said. 
Critics blame lax regulation, excessive advertising and society's obsession with appearance for fuelling an industry run amok. 
South Korea is home to more than 4,000 plastic surgery clinics and has the world's highest rate of cosmetic procedures - 13 for every 1,000 people in a population of 49 million - according to government data. 
The boom is gaining steam, fuelled by tourism, with the number of visiting Chinese patients tripling between 2011 and 2013, government data shows.
"Advertising too much has made people think surgeries are a commodity. People now think plastic surgeries are like buying stuff somewhere," said Cha, who has performed plastic surgeries for more than two decades. 
"But plastic surgery is a surgery too, which can risk your life," he said. 
A Miss Korea contestant in the 1980s underwent breast augmentation in 2008 in the hope that it would boost her chances of finding a husband. 
Park, 50, who is divorced and gave only her surname, ended up going to the same doctor as Kim. Due to a series of post-surgical infections, her right breast ended up half the size of the left.
"I regret it so much that I tried to kill myself twice," she said. "Plastic surgeries are like an addiction. If you do the eyes, you want to do the nose. And doctors don't say 'you are beautiful enough', but get people to do more." – Reuters