Logo Roy Kim, MD
San Francisco Plastic Surgery

call us at 415.362.1846

220 Montgomery Street, suite 348
San Francisco CA - 94104

How Do You Know What Size Breast Implants to Get Before Surgery?

15
Oct

There are several ways to size yourself and your breast implants before you have the actual breast augmentation procedure. From my other blog posts, you should know that breast implants come in different volumes and profiles. There are also different filler materials, specifically saline solution and silicone gel.

You can ask for recommendations from friends who have had breast augmentation. They may have specific or general hints regarding size. I have found that many patients are unaware of profile, and may only be able to give you general guidelines. Even if you have a similar body type to your friends, you should not rely on them to be able to give you an exact recommendation on the volume and profile of breast implant that is best for you.

There is software available that helps with sizing your body and breast augmentation surgery. I have found that such software is helpful, but not the most accurate, in depicting what is the best size for you. Also, most software programs must be done in the office, because multiple photos needs to be taken at the office. It’s generally not possible at this time for you to take photos from multiple angles at your house and then be able to email them or upload them to a software program that can give you a rough estimate of what you would look like after surgery.

Some people advocate filling plastic bags with a carefully measured amount of rice or water, and then trying them on with an unpadded bra. Although you should be able to get an exact volume, it may be difficult to get an exact profile, or the diameter and height of a breast implant, exactly correct.

Breast implant manufacturers offer sizers to plastic surgeons. These are sample breast implants, with the exact volume and profile, so that you can try them on with an unpadded bra and clothing. These sizers are very precise, and should be able to give you the breast representation possible to figure out the optimal breast implant for you. In my opinion, this is the best way to figure out the best breast implant for your body.

 

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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When to Get Liposuction Versus Diet and Exercise

14
Oct

beauty portrait of young adult female in a black tank top as she holds up an apple

As you probably already know, liposuction is a surgical procedure that permanently removes fat. However, you may not know when to get liposuction versus trying diet and exercise first.

In general, you should always try diet and exercise first. There are many diets and exercise programs to follow, and in a future post, I will give my advice to achieve weight loss. In general, natural, consistent, and progressive weight loss over several months is probably the best way to reduce your weight and achieve your overall body goals.

If you have stubborn, isolated areas of fat, and your weight loss has stabilized, then liposuction may be an option for you. The ideal candidate is someone who has had stable weight, external fat,a reasonable BMI/ body mass index, and isolated areas of fat.

A stable weight is self-explanatory, and you should not be gaining or losing excessive amounts of weight. If you area, then you should consider postponing liposuction until your body weight has stabilized.

External fat can be removed by liposuction, as opposed to visceral fat. External fat can be pinched from the outside, whereas visceral fat is external, and is wrapped around the intestines and other organs of the abdominal cavity. Any visceral fat you may have can only be reduced through overall weight loss, not liposuction.

BMI, or body mass index, is a rough measurement of fat. If you are a bigger and more muscular person, you will naturally have a higher BMI. It’s not a perfect measurement, but if you have a BMI of 30 or higher, then you may be considered overweight, and you may need to be examined by your plastic surgeon to see if you are a candidate for liposuction or overall weight loss. A handy BMI calculator can be found here- http://www.nhlbisupport.com/bmi

If you have isolated areas of fat, then you may be a good liposuction candidate. Liposuction will permanently remove the fat in an isolated area, as long as you maintain your diet and exercise program. If you do gain some weight in the future, then unfortunately, you will gain fat in the same areas as before.

 

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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How to Improve Your Facelift Scars

13
Oct

Iconic funny woman, and plastic surgery advocate, Joan Rivers, takes part in a Q&A after a screening of her film Piece of Work in New York City, New York, USA on July 1, 2010. Joan admitted that childhood poverty caused her to be the driven person that she is today. She also divulged that she would be making an appearance on The Late Show With David Letterman after many years away from late night television that stemmed from a long running conflict with the late Johnny Carson. Fame Pictures, Inc

A facelift is a surgical rejuvenating procedure that can tighten your facial skin and the underlying structures. The surgical incisions are on your face- but they can be hidden and improved to achieve the best result possible.

Regarding your operation, your plastic surgeon should be able to hide your incisions within the natural curves of your ear. The old school method of facelift surgery is to make an incision that does not follow your natural ear lines, but more recent techniques can hide your incisions better, so that even with a short hair cut or ponytail, your facelift incision should be difficult to see.

Right after your facelift, you should care for your incision. Typically, you will want to let them heal, and your plastic surgeon may recommend antibiotic ointment. During this immediate healing period, you may also be given antibiotics by mouth to prevent infection as well.

Exercise may slow down your healing, especially if you increase your heart rate or blood pressure significantly. Your incisions are technically a fresh wound, and any increase in blood flow or blood pressure may cause more bleeding at your facelift incision sites. If you’re on any blood thinning medicine such as aspirin or Coumadin, then you should coordinate with your family doctor and your plastic surgeon when to resume taking those medications after surgery.

After you incisions have healed with new skin, you should be prepared to care for your incisions for up to 12 months after your facelift. Scars take 6-12 months to fully mature, so during this wound healing phase, you will want to do simple steps such as protect your incisions from the sun, use special anti-scar creams or bandages to help your scars, and possible cortisone injections to make the scars less thick and red.

If you notice that you slowly develop thicker, wider, or darker scars, then you may be developing hypertrophic or keloid scars. The treatment for this is to use special anti-scar creams, bandages, or cortisone injections.

If your facelift surgery was greater than 6-12 months ago, then your only option may be surgical scar revision, where the edges of your scar are incised and the thick scar tissue underneath is removed. Non-surgical treatment may not work at this time, because the scar tissue underneath the skin has quit changing and may not respond to any normal non-surgical treatment.

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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What To Do When Your Plastic Surgeon Fires You

12
Oct

Breaking up is hard to do, and sometimes, your plastic surgeon may be the one to do it. What should you do?

In general, doctors are pretty reluctant to terminate the doctor-patient relationship. Usually, the patient doesn’t follow instructions, doesn’t show up for appointments, and can be antagonistic to the doctor and the office staff. If this happens, then the doctor has the right to end the relationship, just like the patient has the right to end the relationship.

If this happens to you, you may have to confront some unpleasant truths. You probably understand that it’s your responsibility to show up for appointments, be reliable and responsible about after care instructions, take your medications as directed, and keep open lines of communication with your plastic surgeon and his staff.

It’s important to obtain your medical records, and your original plastic surgeon should be able to give them to you or your next plastic surgeon. You may want to retain a copy of those medical records as well.

The problem may be- you. Specifically, you may not realize how disruptive your behavior may be, or how unrealistic your demands and expectations are. If you can find another plastic surgeon quickly, then perhaps it was the relationship with your original plastic surgeon that was at fault. However, if you find it difficult to schedule any consultation with any plastic surgeon and get treatment, then you may have to realize the unpleasant truth that you may be a “difficult” patient.

Even though there aren’t a lot of plastic surgeons, I’m not a huge believer that there are conspiracies within a community to not see a certain patient. Especially in larger cities, not every plastic surgeon will know every other plastic surgeon. Besides, gossiping and exchanging information about patients may violate HIPPA laws and guidelines. In a nutshell, it’s doubtful that all of your neighboring plastic surgeons are talking about you behind your back.

Rather, your particular case, your attitude, your energy, your vibe- however you want to term it- may be of concern to any potential plastic surgeon that may want to see you. Sometimes what you want is possible, but your plastic surgeon may not want to operate on you, due to an inability to connect with you.

I’m sure you connect with your parents, kids, neighbors, co-workers, friends, and others on differing levels of depth and understanding. This holds true for the doctor-patient relationship. You need to find a good match with your plastic surgeon. Sometimes it’s not you, or your plastic surgeon- you just need a better match with a different plastic surgeon.

If you’d like some more counseling, I’m probably the wrong person to talk to. However, Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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Is There a Difference Between Female and Male Liposuction?

10
Oct

Couple on the beach

In terms of surgical technique, there is no difference between doing liposuction on a woman versus a man. However, there is a difference in the quality of fat, where it’s deposited, and the desired overall aesthetic result. These factors may result a difference between liposuction done in women or men.

Localized fat in women tends to be a little easier to remove. Men’s fat, at least subjectively, can be slightly more fibrous, especially in areas around the love handle or back areas. This may result in less swelling and bruising in women than men for a given area.

Women tend to deposit fat in different areas than men. Women tend to have fat deposits in the outer thigh, inner thigh, and love handle areas, as well as the axilla and the upper arms. Men tend to deposit fat in the anterior abdomen, love handles, and breast areas. This is natural, and the common areas of liposuction tend to differ between the genders.

Overall, women tend to want to retain their feminine curves, and not necessarily have every remaining fat cell removed. Men tend to want as much fat removed as possible, to reveal as much musculature as possible. Everyone has a different opinion and body shape, but liposuction techniques need to be tailored to your body, and not just a template.

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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7 Ways to Reduce Your Pain After Your Facelift

9
Oct

Woman rubbing temples

Facelift procedures are not the most painful procedures in plastic surgery , and knowing what to expect may help reduce your anxiety. Some hints and tweaks will help to reduce your pain, especially in the immediate recovery period.

As a matter of routine, I inject long-term numbing medicine into the areas of facelift surgery at the end of the procedure, while in the operating room. The numbing medicine lasts 6-8 hours. This allows my patients to wake up comfortably right after surgery, and they can take wake up and take pain medicine 6-8 hours afterwards to keep ahead of any pain that may develop. You should ask your plastic surgeon if he or she can give you these injections while you’re still under generate anesthesia.

Ice and cold compresses to the areas of your face will reduce swelling and pain. It’s important not to leave the ice on your face for too long- you don’t want a frost bite injury on top of your facelift!

Elevating your head above heart level will help to reduce pain and swelling right after your facelift procedure. You may need to sleep on 2-3 pillows to achieve this effect.

Applying numbing cream after surgery, on your facelift incisions or near them, may help with pain control. I don’t feel that this is as effective as taking pain pills by mouth, but it may help a little. Most effective numbing creams are prescription only, so you may have to ask for a prescription for your doctor.

Take your pain pills by mouth when you feel a little pain, and don’t try to catch up to your pain levels. It’s probably better to take only 1 pill when you feel some to moderate pain, versus 2 pills to try to catch up to severe pain.

Drink plenty of fluids, since surgery may make you feel dehydrated. Rehydration and maintaining circulation may help reduce your pain levels, and may help your body flush out anti-oxidants.

Walking around, or what we doctors like to call ambulating, may also help with pain. Sitting still and not moving doesn’t help with your circulation, and walking may help with reduce overall body stiffness and increase blood flow to your body, helping to flush out anti-oxidants and reducing pain.

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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Should You Fire Your Plastic Surgeon?

8
Oct

Just like many relationships, your relationship with your plastic surgeon should be based on trust, open and honest communication, proximity, and respect. If any of these are not optimal, then it may be time to fire your plastic surgeon.

Of course, this is probably not a common topic in a blog actually written about by a plastic surgeon, but there are ways to end this relationship that are respectful and helpful.

First, do you really want to end the relationship and start over? The grass is not always greener elsewhere, and if your relationship can be salvaged, especially with someone who has operated on you, then it may be worthwhile to save the doctor-patient relationship. With some thought, you may realize that an office staff member, and not the plastic surgeon, may be the source of your consternation. Work with your doctor and the office staff to re-establish a good relationship.

Open communication is key to any great relationship, and you should feel free to talk openly and honestly about what’s wrong in your relationship. Maybe the plastic surgeon is technically gifted but not the warmest or most articulate person in the world. Or maybe you’re not explaining yourself well enough to your doctor and the office staff. Either way, it may be worth spending the extra effort to get your point across, or listening more closely to what your plastic surgeon is telling you.

Just like your Mom told you- never burn bridges. Especially in smaller communities or with more difficult procedures, word does get around. Angry soliloquies might work in movies, but in real life, it’s better to part ways in a respectful fashion. You never know when you need more medical records, more hints, or even medical care from your original plastic surgeon.

If you truly feel that your relationship with your plastic surgeon is suboptimal, then getting your medical records and maintaining a professional attitude during the entire break-up is helpful.  Although plastic surgery is very personal, there is a fair amount of science and medicine involved, and sometimes your body will not heal as well you would like, despite the best surgical care and your personal attention after your procedure.

Due to Federal privacy laws, it is imperative that you sign consent forms allowing your medical records to be sent to you, another doctor, another hospital, or another medical entity. Just calling and making a verbal request is generally not considered as secure. Also, the Feds have discussed with doctors the need to check ID and to avoid identity theft. Don’t be peeved if you’re asked repeatedly to confirm your identity for your medical records- it’s for your overall benefit!

Please realize that many plastic surgeons are wary of seeing a patient who has had surgery elsewhere, and may be interested in revision surgery or a second opinion.  Any patient who is not happy with their previous plastic surgeon tends to raise our antennae, and the consultation can be long and very detail oriented. Every case is different, of course, but don’t be surprised if it takes several attempts to find a plastic surgeon in your town who is willing to see you.

Previous medical records are key to getting a good 2nd opinion. Although you may be very intelligent, you may not know exactly what technique or suture was used for your particular procedure. Any medical information about your surgery is helpful with a consultation with another plastic surgeon.

Please feel free to leave any comments below.

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How Do You Get Rid of Dark Circles Under the Eyes?

7
Oct

Dark circles under your eyes may be due to a tendency to have darker skin, excess fat deposits under the lower eyelid, or several other factors. There are some non-surgical as well as surgical ways to remove these circles.

Getting more sleep should help with your dark circles under your eyes. You may need to catch up for several nights before the dark circles improve.

Excellent hydration also helps with eliminating or helping dark circles under the eyes. Some people think that dehydration in general causes dark circles, and other think that abnormal fat deposits may cause dark circles under the eyes. Regardless of the cause, well hydrated lower eyelid skin may help with your lower eyelid skin tone.

Tightening the skin naturally, such as with cucumbers or other health spa products, may also help with your overall skin tone, helping to eliminate your dark circles.

Excellent skin care, including vitamin C products, medical grade eye creams, and Retin-A may help tighten your skin more than just over-the-counter products. One of my favorite medical grade products is Elastiderm, made by Obagi. All of these products will improve your lower eyelid skin color and tone, and help to reduce dark circles under the eyes.

An injection of a dermal filler, such as Juvederm XC, may plump up and fill the soft tissue around the dark circle, helping to make it less noticeable. You will probably need only 1 syringe for both eyes, and you may even have some left over for other areas of your face. However, a dermal filler injection will not necessarily completely eliminate a dark circle.

The most complete and lasting option to eliminate a dark circle under the eye is surgery, or a lower eyelid lift. This allows your eyelid fat to be removed and repositioned. If you need a filler agent, then your own fat or other agent can be placed. Your eyelid skin can be lift, tightened, and repositioned. However, the downside is that this is a true surgical procedure, with the associated surgical risks and recovery needed after wards.

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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How To Get Rid of Tattoos

6
Oct

THE LASER IS USED TO REMOVE THE SKIN LAYER BY LAYER; IN BETWEEN LAYERS THE BURNT SKIN IS RUBBED OFF. HERE THE LASER IS BEING USED TO REMOVE ANOTHER LAYER OF SKIN AFTER SEVERAL LAYERS HAVE ALREADY BEEN REMOVED. TATTOO REMOVAL,CLOSEUP USE OF LASER

Tattoos are increasingly popular, but some of my patients have wanted me to remove them. A new job, a bad reminder from the past, or simply a change in taste-  but there are ways to remove your tattoo.

Several options exist for tattoo removal, including

- Laser removal

- Physical removal, usually dermabrasion

- Surgical removal, and closure of the wound or skin graft coverage

A professionally applied tattoo is done by a machine, and the tattoo ink is embedded in the skin at a consistent level. If you have an inconsistent tattoo artist, an inconsistent machine, or an amateur tattoo, then the tattoo ink is not being placed at the same level, and you may not be a good candidate for laser tattoo removal.

 

Laser tattoo removal is very popular. You will need a laser of a different wavelength for different colors of tattoo ink. Basically, the laser zaps the tattoo ink within your skin, and the ink is obliterated and absorbed by your body.

You will also probably require several different treatment sessions, since all of the ink can’t be removed in 1 session. A drawback of laser is that not everyone can achieve an excellent result. There will always be a better appearance, but sometimes the tattoo will only appear to be faded, and not completely gone.

Physical removal is removing the skin, usually by dermabrasion, and allowing new skin to grow underneath. This can be done as a procedure in the office or in an operating room setting, depending on your pain tolerance and how large the tattoo is.  Dermabrasion, for lack of a better analogy, is like applying sand paper to your tattoo, removing the tattoo and skin, and causing new skin to grow underneath.   This is usually more consistently successful in removing any trace of the tattoo, but may result in different skin texture and color in the area of your original tattoo.

Tattoo excision with wound closure or skin grafting is also an option. The tattoo is completely removed, and the skin is discarded. If you have a small tattoo, and if the skin around it is relatively loose, then the open wound can usually be closed. If the tattoo is large, and if the skin around it is tight, then you may need a skin graft to completely cover the open wound to achieve healing. Skin grafts will almost always leave a slightly color and texture discrepancy compared to surrounding skin.

 

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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Do You Leak After Liposuction?

5
Oct

Dripping faucet

Liposuction is a surgical procedure to remove external fat. There are several technologies that are used, and they include mechanical removal, use of laser, use of ultrasound, and other technologies.

The common factor that all of these liposuction technologies have is that tumescent fluid is usually injected before the surgical procedure starts. Tumescent fluid is fluid, usually saline solution, that is mixed with other medicine that slows down bleeding and gives some numbing medicine relief. It is injected into the areas of liposuction right at the beginning of the surgical case. This tumescent fluid is then allowed to sit for about 10-20 minutes.

After allowing this fluid to work, liposuction then starts. The material removed by liposuction is called aspirate. With the tumescent fluid action of vasoconstriction, or lowering blood loss, the aspirate is typically white or yellow, implying that mainly fat and soft tissue is being removed. If no tumescent fluid is used, or it has not been allowed to settle for a longer period of time, the aspirate can be reddish, or blood tinged.

After your liposuction procedure is done, there is probably still some tumescent fluid left behind. This fluid is absorbed, but some of it may leak out through your tiny liposuction incisions. This is what causes some leaking after surgery.

This fluid may be pink or red, but usually, there is not much blood in it. Remember, blood is dark red and will form a clot. Liposuction fluid is pink or red, and usually not as dark red. Also, usually, it will not clot, and will need to be absorbed by gauze or other dressings right after surgery. Some leaking after your liposuction surgery is to be expected, but an excessive amount may indicate that you will want to talk to your plastic surgeon or go to the emergency room.

Typically any leaking or excess fluid will occur within the first 24 hours. It is unusual to continue after this time period.

A hint if you run out of gauze dressings- you can always use sanitary napkins over your incisions to absorb any extra fluid.

 

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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  • American Board of Plastic Surgery
  • American Aesthetic Society of Plastic Surgery
  • American Society of Plastic Surgeons
  • Real Self