Terence Goh, MBBS, MRCS(Ed), FAMS (Plast Surg)

Dear jymjym,

Thanks for your question on the possibility of non-incision ptosis surgery.

Depending on the severity of the ptosis there are options for either non-incision ptosis surgery or incisions on the underside of the eyelid. However, having said this, it would usually be most effective and most precise to correct the ptosis with an incision on the external eyelid skin. Techniques that utilise sutures to alter the eye opening can improve the ptotic eyelid and can also change the eyelid crease but there is a limitation on how much it can do. If there is much asymmetry then an open incision would usually be better. Similarly for procedures done on the underside of the eyelid, the crease cannot be altered so these are only to correct symmetrical problems or in situation when the asymmetry is small.

The eyelid scar for ptosis surgery is placed in an ideal eyelid crease and it usually heals well and it is not usually noticeable except when u close your eyes. After a few months,that scar also usually becomes very faint and appears like a natural crease.

Hope this helps to answer your question.

All the best!

Dear Rational7375,

Thank you so much for your questions and sharing your photos.

There is puffiness of the upper chest and also a mild droop of the nipple. This could be pseudo-gynaecomastia or gynaecomastia. Pseudo-gynecomastia and gynecomastia can both cause an enlargement of the male breast area, but they have different causes. The nipples can also be asymmetrical and this is also rather common and normal.

Pseudo-gynecomastia, also known as lipomastia, is caused by an accumulation of fat in the breast area. This is more commonly found in overweight or obese men, but it can also occur in men who have lost a significant amount of weight and have excess skin and fat in the chest area.

Gynecomastia, on the other hand is caused by an increase in glandular breast tissue, resulting in the enlargement of the male breast area. Gynecomastia can occur in males of any age, from infancy to adulthood, and it can be caused by a variety of factors, including hormonal imbalances, medication use, and underlying medical conditions.

While both conditions can cause emotional distress and self-consciousness for those affected, the treatment options may differ. Treatment for pseudo-gynecomastia may involve weight loss and exercise, liposuction, or other surgical options to remove excess fat. Treatment for gynecomastia will require surgery specifically to remove excess glandular tissue e.g. the MELT technique which we have described in our publication in 2018 . Please click on the link below for more details.

Hope this answers your questions!

All the best!

The Motiva Ergonomix Full 400cc and the Motiva Ergonomix 2 (Joy) Full 400cc are both breast implants manufactured by Establishment Labs, and they have similar volume and shape characteristics. However, the Motiva Ergonomix 2 (Joy) Full 400cc implant has a slightly different design compared to the Motiva Ergonomix Full 400cc implant.

The Motiva Ergonomix 2 (Joy) implant has a more tapered and curved shape compared to the Ergonomix Full implant, which has a more oval shape. As an example, the Ergonomix 2 (Joy) 400 cc implant has a narrower base width of 11.75 cm versus the Ergonomix 400 cc implant which has a base width of 12 cm. What this means is that Ergonomix 2 may be more suitable for women with a smaller frame or narrower chest.

However, the overall size of the implants is the same, with both the Motiva Ergonomix Full 400cc and the Motiva Ergonomix 2 (Joy) Full 400cc containing the same volume of silicone gel.

I hope this answers your question.

The survival rate for fat grafting to breasts can vary depending on a variety of factors, including the technique used, the expertise of the surgeon, the amount of fat transferred, and the individual patient's biology. In my experience, here are some factors that can help in improving the fat graft survival:

1. Harvesting technique: The technique used to harvest the fat can play a role in the success of the graft. Gentle liposuction with low negative pressure and the use of a closed-system can help minimize trauma to the fat cells, which can increase their viability. In my practice, we do this using a Microaire system to harvest the fat, coupled with a Puregraft system to process the fat harvested.

2. Processing of the fat: The way in which the fat is processed prior to transfer can also impact graft survival. We use the pure graft system which has been shown to reliably reduce surgery time and increase fat graft yield.

3. Injection technique: The technique used to inject the fat into the recipient site is also critical. A slow, controlled injection technique, with small amounts of fat deposited in multiple layers, can help ensure a uniform distribution of the fat and minimize trauma to the surrounding tissue. We also use specialised cannulas made by Tulip to inject the fat grafts.

4. Patient factors: Certain patient factors, such as smoking, diabetes, and obesity, can negatively impact fat graft survival. Patients who are in good overall health, have good blood flow to the recipient site, and have adequate tissue volume are more likely to have a successful outcome.

5. Post-operative care: Proper post-operative care, including avoiding pressure on the graft site, maintaining good hydration, and avoiding smoking and other activities that can impair healing, can also help improve fat graft yield. I also advise patients not to lose weight over the next 4 months to ensure maximal take of the fat grafts.

Depending on your fat distribution it may be possible to harvest about 800cc-1.2L of fat from the abdomen and thighs and have about 200 cc to be injected into each breast. This can give an increase of 100-120 cc per side. which is about 1/2 to 1 cup size increase. I routinely inform patients that there may be a need for repeat grafting to achieve their goals if they want to have an increase of more than 1 cup size.

Hope this helps.

All the best!

Dear momocat24,

Thank you for your questions and your photos. I hope you are keeping well during this COVID-19 circuit-breaker period .

From the photos, it would seem that you want a higher and more defined nasal dorsum , as well as a more defined a full nasal tip. These are the common requests for most male rhinoplasty patients. These can be achieved with the silicone implant for the nasal bridge and the ear cartilage for the tip. This is a good hybrid technique so that we do not use silicone implants to create the tip - that would give more complications in the long-run. This is something that I would do as well. 

If the afore-mentioned procedure is performed by a skilled and experienced surgeon, in a properly equipped facility, I would say that it is very safe to perform your surgery under deep sedation in the presence of a trained anaesthetist. 

As for the final question, do you need an alarplasty?. From the limited photos, it would seem that you do. However, the analysis must be done with a complete photo including your eyes and the rest of your face. Although the procedure is on the nose, it is important to consider how we sculpt and change the nose such that it fits most harmoniously with the rest of your facial features. The width of the nose, should be about the width of your eye. In my practice, I rely a lot on  3D imaging software, so that patients can see before-after photos, to see for themselves if the different steps recommended is what they truly want. 

Hope this helps in your journey. All the best!