Health Sense: Plastic surgery

and expectations for your

nip/tuck
Yeap Choong Lieng, MD, Contributor, Singapore | Body and Soul | Wed, November 20 2013,
1:09 PM

When a doctor claims that he has had no complications ever in his experience, it may be wise
to reconsider.
Plastic surgical procedures are very fine and precise. Expectations of patients are often very
high. The chances of things going wrong and the resulting unhappiness are more common.
Patients come for enhancements and improvements that they want to attain with satisfaction.
When a procedure goes wrong, it can result in unhappiness for both patients and plastic
surgeons.
The causes are often many the incorrect selection of a procedure, the surgery itself,
accidental trauma or infections. It can also be due to inadequate explanations to the patient
regarding the importance of postoperative care and their expectations.
When such problems occur, the most important thing is to rectify them. Both the patient and
plastic surgeon must patience and cooperation.
First, to minimize problems, the initial consultation is very vital.
A detailed and careful consultation is important so that the plastic surgeon can explain
possible problems and complications. This will allow the patients to give their final informed
consent after weighing the risks. If the surgeon or patient is not comfortable, it is wise to
reconsider the treatment or seek a second opinion. Patients should be patient.
Some want immediate results and may wear a plastic surgeon down with their persistence,
despite accepting that, for example, post-operative swelling will take at least three to six or
even more months to subside, depending on age and anatomical areas.
In these cases, a plastic surgeon must also be patient, reassuring the patients and convincing
them to be patient as well and wait for the final results.
Diplomacy may not work all the time. Sometimes, it might be good for a surgeon to arrange
for an unbiased colleague to re-affirm the patients.

For very anxious patients who keep coming to see the plastic surgeon over small matters like
change of appearance of scars and character of the wounds, reassurance is important.
After a while, when they start to see their desired results, they will leave the surgeon alone.
With certain procedures like Botox injections and fillers, if there are complications, the
damage is not permanent. Therefore, with patience, they can recover.
It can be annoying but the patients have to be reassured that the unwanted results would only
last for a few months.
Similarly, excessive bruising and swelling tend to be transient and will improve with time.
When it comes to surgical procedures, there can be real complications like accidental damage
to blood vessels, muscles or nerves. These can be serious and will require rectification.
Nerve injuries can be permanent like loss of muscle power leading to loss of functions or
deformities. Patients must be made aware of this. They must understand that extra procedures
may be required. The incidence of surgical complications would be lesser with a well-trained,
experienced and careful surgeon.
Therefore, it is important for the patients to select the accredited plastic surgeons rather than
untrained doctors without proper qualifications. Unfortunate incidences involving fatality or
morbidity can occur, but these are rare.
Perforations of the peritoneal cavity with intestinal organ injuries during liposuction, fatal fat
embolisms and anaesthetic complications can also occur. These are very damaging to the
patients and their families. Accidental burn injuries to the skin leading to extensive skin
necrosis or dead skin may scar or maim the patient.
These could all lead to medical-legal proceedings. It must be stressed that neither the doctor
nor patient would ever want any problems during a procedure, but unfortunately these may
happen at times.
In such situations, it is important for the doctor to be patient, honest and advise the patient
accordingly.
Clear explanations concerning the corrective procedures must be communicated to the
patients. Sometimes, it is important to seek help from other specialists.
It would also be wise for the disappointed patient to cooperate with the doctors and carefully
consider the corrective process. It is natural for the outburst of anger and threats but this
would not be beneficial to either party.
Complications can happen at any time with varying degrees of severity to any doctor or
patient. It is natural that properly accredited plastic surgeons, with their years of arduous
training and examinations, would have a lesser number of complications than those untrained
non-surgeons who aspire to do plastic surgical procedures.

Accredited plastic surgeons have to maintain their standards and strive to uphold them. It is
also important that patients must be comfortable with their surgeons and trust their
judgements and abilities.
The writer, previously deputy head of the Department of Plastic Surgery at Singapore General
Hospital, currently practices at the Mount Elizabeth Medical Center. For more information,
visit dryeapplasticsurgery.sg.

When diet is not enough

Elyzabeth Winda, The Jakarta Post, Jakarta | Body and Soul | Wed, November 14 2012, 11:53
AM
When was the last time you exercised? Have you checked your weight and also your body
mass index (BMI) lately? If you havent, probably it is time for you to get on the weight
scales and pay attention to your own bodys needs.
On Friday, a seminar titled Hope and Help for Obesity was held to raise public awareness
about obesity.
Obesity is a severe disease. Everybody is in danger of obesity, especially young people. It is
because of drive-through restaurants. We have cars, we have no time to cook at home. Our
lifestyles are changing. It is projected that for the first time in the history of mankind, our
children will live shorter lives than we will. And this is the dark result from obesity or
overweight-related diseases, affirmed Aaryan N. Koura, a surgeon and senior consultant at
Tan Tock Seng Hospital in Singapore.
Obesity was once ranked second as a cause of disease, after smoking. A study published by
the American Journal of Preventive Medicine in 2010, however, showed that the quality of
life and years lost to obesity are now equal to or greater than those lost due to smoking.
A person with a BMI of 25 to 29.9 is considered overweight. If the index is higher than 30,
one better start to seek the best treatment possible, because thats the BMI for people with
obesity problems.
Approximately 1 billion people worldwide are overweight. If we dont act now, the number
will exceed 1.5 billion people by 2015.
In Indonesia, based on the results of National Basic Health Research in 2010, the number of
overweight people is twice that of those who have malnutrition. The result says that 12.6
percent of Indonesians are classified as skinny. Meanwhile, 21.7 percent are classified as
overweight or obese.
Obesity has become a global epidemic which can cause death, yet the disease is preventable.
When one is trying to lose some weight, the first thing that they usually complain about is
that its really hard to get rid of the weight, said Grace Judio-Kahl, a physician and weight
consultant for the lightHOUSE Clinic Jakarta.
In some severe cases of obesity, intervention by doctors or experts is needed, Grace added.
She also explained that there were some other methods to help the overweight slim down.
We are often told to manage our diet, take some pills, workout, or to do some adjunct
therapy such as acupuncture, mesotherapy, electrotherapeutics, etc. But, still, it is hard to
get permanent and significant results. This is called the conventional approach, she said.

Most weight loss programs advertised are cosmetic. Meanwhile those who are overweight
need more than cosmetic solutions. Cognitive behavior therapy [CBT] is considered effective
to help people with obesity problems. It focuses on the behavior that is related to their
psychological condition. A weight problem is not merely about nutrition and diet. It also
needs holistic treatment, she went on.
Despite the fact that CBT initially involves medication, educating the patient not to be
dependent on treatment or medication is what the therapy is aiming for. The CBT is also
applicable for people with eating disorders such as bulimia, anorexia, night-eating syndrome,
compulsive overeating, and binge-eating disorder.
A good weight loss program is not supposed to create [new] eating disorders, Grace
emphasized.
When obesity substantially affects ones health or a person is classified as morbidly obese
and all of the methods already mentioned have been done in vain, one can consider invasive
treatment: bariatric surgery. Vertical-sleeve gastrectomies and Roux-en-Y gastric bypasses are
two commonly performed procedures in the United States.
In a vertical-sleeve gastrectomy, the surgeon will permanently reduce by 60 to 80 percent
the size of the stomach. This reduces hunger by eliminating production of ghrelin [a hormone
that appears to be an appetite stimulant], he explained after the showing an animated video
of the surgery.
Meanwhile, Roux-en-Y bypass surgery is also about sharply limiting the amount of food one
can consume by sectioning off the stomach into a thumb-sized sac that is connected to a
portion of the small intestine. The audience held their breath while the animated video of the
Roux-en-Y-bypass considered the gold standard, according to Koura was demonstrated.
After surgery, one still has to maintain a healthy lifestyle (or the weight will be regained) and
there will likely be some side effects due to the rearrangement of a persons internal organs.
The surgeries mentioned above, however, still have some pros and cons. According to Grace,
in Indonesia, the surgery has led to one patient death and sent several others to the ICU.
We dont have doctors in Indonesia who specialize in bariatric surgery yet. It is a matter of
life and death were talking about. Thats why we refer our [morbidly obese] patients to
foreign doctors abroad. Theres still a very long way to go. Hopefully this issue will move
doctors to learn more about the surgery. Also the government should be more attentive to
obesity cases in the country, said Grace.
The formula for surgical success, as Koura explained, was 25 percent surgical procedure, 25
percent program/dietitian and group support, and 50 percent you.
But the most important thing is, Its not to late to go out and exercise and live a healthy
live, as Koura said at the beginning of the seminar.