Logo Roy Kim, MD
San Francisco Plastic Surgery

call us at 415.362.1846

220 Montgomery Street, suite 348
San Francisco CA - 94104

Why Pre-Surgical Clearance is So Important


I saw a patient several years, and he required pre-surgical clearance before his facelift. I remembered his case because he’s happy with the results, and wanted something else done recently. Looking through his old chart, I saw his medical clearance for surgery, and I just had to comment on it.

Getting pre-surgical clearance before any type of surgical procedure is vital for your health. Many times, the surgery in and of itself does not have significant complications. Many times, even if a complication occurs, it’s correctable. A known risk of having surgery is the ANESTHESIA- the medicine and the overall process of going to sleep for your procedure, and waking up from your procedure.

Anesthesia medications may slow down your heart rate, have an effect on your blood pressure, and may slow down your lung capacity and breathing. Often, these risks can be minimized by making your overall health is in good shape. I may ask for pre-surgical clearance from your family doctor. This ensures that someone who has known you for some time has clear documentation from a consultation, physical exam, blood tests, and other tests, that your overall health can tolerate the anesthesia needed for your surgery.

This is a copy of the original pre-surgical clearance I received from the family doctor. After reading it, I asked for more documentation, and the doctor did a much more complete job. However, to me, this document implies a slightly more lax standard than I would expect from a typical doctor.

Some patients don’t understand why a pre-surgical clearance is so important. I hope that you realize that your health is very important, and that anesthesia is not something to be taken lightly. Actually reading the medical notes for my patients has helped me to become a better doctor and to ensure that my patients have a safe journey for their pre-, intra-, and post- surgery procedures. I trust you’ll find a great family doctor that is able to help you attain a more vibrant, healthier life.

This particular note says-

“He Is in good health and diabetes Is in good control- see attached labs.

He is cleared fror (sic) surgery (no period at end of this sentence)”

View Comments

Saturday Shout Out- the Pittsburgh Steelers


I'm  from Pittsburgh, PA, and I grew up a Steelers fan.  I will always be a fan until I die, even though I live in San Francisco. 



View Comments

What Kind of Facelift Leaves the Smallest Scar?


Technically, the smallest facelift scar would be limited incision scar in front of the ear. However, I would not concentrate on the smallest scar, but rather figure out what procedures you want and need to get the best long-term result.

The smallest scar for a facelift depends on what you need and what procedures you eventually decide to have.  A scar can be just in front of the ears, or just around the earlobe.  If you need a neck lift, or have more loose skin, then you may need an incision that goes into your hairline above your ear, and an incision that goes behind your ear.

During your consultation, you should be able to get an idea of where your facial scars will be and how long they will be before surgery.  Depending on what you want done, you may need to have your forehead rejuvenated, or your eyebrows pulled to a higher position, which may necessitate scars hidden in your hairline.

Your facelift scars should be hard to see, since they are hidden in natural folds of your skin.  If your scar is where hair grows, then some hair should naturally cover the scar as well.  Micro hair grafts can be placed in strategic areas to help reduce the amount of scar that is visible in your sideburn areas.  Facial fillers, such as fat or Juvederm, can also be used to strategically rejuvenate your face and camouflage any incisions you may have.

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 (415)362-1846.


View Comments

Non Surgical and Surgical Options for Your Sagging Neck


A sagging neck is a visible sign of aging, and the neck is one of the first areas of the body to exhibit what time and gravity can do to your skin elasticity.   If you have lost a substantial amount of weight, you may also find unwanted band lines, excess skin, or excess fat in the neck area. There are several non-surgical and surgical options to restore the suppleness in the neck and rejuvenate your skin.

People who prefer a less drastic option to surgery can undergo laser therapy, chemical peel (usually glycolic acid, TCA, or phenol), or a specialized skin care regimen to help tighten the skin around the jaw lines and neck.  They work well for minimal skin sag or to address the early signs of loose neck skin. However, none of these non-surgical approaches work too well to achieve a desirable long-term result if you have moderate or significant signs of neck aging.

For moderate neck skin sag, there is the iGuide system. It is a minimally invasive technique used to define and sculpt soft tissues under the jaw line with special surgical needles and tools.  Under sedation anesthesia, a continuous thread is weaved in a trampoline-like suture in your neck muscles and neck skin, tightening both structures at the same time. The iGuide system eliminates the need for cutting; hence, swelling and bruising associated with neck lift surgery are considerably reduced. Recovery time is also substantially improved as well-  typically only 2-5 days off of work are needed.

People suffering from moderate to severe neck skin laxity can opt for a traditional neck lift procedure. A neck lift can be performed to remove excess skin, to remove excess fat deposits by means of a liposuction, or to alter neck muscles to reduce the banded appearance in the neck area. Typically, a successful neck lift leaves a patient looking thinner and younger, and with a more defined jaw line. With excess skin and fat removed, the neck area will appear to have fewer wrinkles, bands, and have a much more youthful appearance.

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 (415)362-1846.

View Comments

What Kind of Anesthesia Will You Get During Your Plastic Surgery?


You will get the anesthesia that best helps you be pain-free during the surgery, and will also help you to stay still during your procedure as well. This usually means general anesthesia, or sedation anesthesia. I tend not to use local anesthesia unless the procedure is smaller and more limited.

Certain areas of the body require more anesthesia than others. Also, certain procedures, especially procedures that require muscle stretching or skin rearrangement, will require more anesthesia as well. Generally, in my medical opinion, it is better to have a board certified MD anesthesiologist monitoring you and giving you anesthesia, and not a nurse, nor the plastic surgeon.

I recently read an article from www.msnbc.com which lists the many concerns about ineffective anesthesia and plastic surgery. (www.msnbc.msn.com/id/40950317/ns/health-womens_health/)

It seems that you can save some money with non-general anesthesia delivered by someone who is not a MD anesthesiologist, but the problem is that the patient may feel more pain during and after the procedure. To me, the most important thing is patient safety. It is better to be seen by your family physician, cleared by your family doctor for surgery, and undergo anesthesia by another doctor monitoring you through the entire surgical case. Although it may cost more, your health will be in better hands while you sleep.

Also, I don’t know if the cost is actually that much higher. Theoretically, I could anesthesia myself for some of my plastic surgery procedures, and eliminate the cost of an anesthesiologist. However, it will take me longer to do that particular surgical case, so any cost savings you get from no anesthesiologists fee may be eaten up by the increase operating room time.

Finally, as you are probably aware, even light sedation anesthesia may lower your heart, your blood pressure, and your breathing ability. In small amounts, this can be tolerated, but if you feel anxious or pain during your procedure, you may need even more sedation. If you have underlying heart of lunch disease, or some other problem, then more anesthesia may hurt your overall health. To me, the small added cost of getting a pre-surgical check-up with your family doctor, getting anesthesia from a board-certified MD anesthesiologist, and having your plastic surgery procedure in a fully accredited facility, is the safest way to go.

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 (415)362-1846Your safety during surgery can’t be underestimated.

Please feel free to ask me a question or leave a comment below.

"Nipped, tucked and wide awake?- Bargain plastic surgery procedure uses only local anesthesia but can be dangerous, experts warn"


View Comments

Saturday Shout Out- The White Loupe


Today's Saturday Shout Out Goes to White Loupe, a photography blog.

I've always loved big, interesting photos, especially from looking at Life magazine as a kid.  With the advent of video and the internet, it's always nice to slow down and take a look at interesting, beautiful images. As a Plastic Surgeon, we are required to take good before and after photos to document our work.  Although I'm probably not an expert at manual f-stops, I can appreciate the technical skill and expertise required to obtain awesome images.

The White Loupe Blog is a cool website that offers new and exciting images from well known photographers and newer ones.  You can sign up for daily updates, and maybe your mind will expand.





View Comments

Is It Possible to Get Silicone Breast Implants Through an Underarm Incision?


YES- it is possible to get a silicone gel breast implant augmentation through an underarm incision.

The underarm or axilla approach for breast augmentation surgery is a popular alternative to the breast fold or nipple/ areolar incision. Your surgeon makes an incision in your underarm, then creates a tunnel under the muscle. With special surgical instruments, a circular pocket is created for your breast implant. The breast implant is then placed into the tunnel, and then placed under the breast tissue. The end result should be a breast enhancement procedure without any incisions on your breasts.

Many plastic surgeons have a difficult time placing silicone breast implant through an underarm incision, but I have found that it is possible, with careful surgical technique, to place them through this incision for my patients.

The main disadvantages for the underarm incision are that it generates more swelling and takes longer to heal. The tunnel created under the muscle tends to generate more swelling than the breast fold or nipple incisions, and the pectoralis muscle commonly takes 2-4 months for the swelling to fully go away. Also, the breast implant may occasionally wish to go into the tunnel the surgeon has created, so you may have to do more breast implant massage for a longer period of time to ensure that your breast implants maintain an excellent position after your breast augmentation procedure.

The time in the surgery is about the same compared to other procedures, and the post-op pain control is also similar. You may experience a little more pain or soreness over the pectoralis muscle, since more surgery needs to be done to accommodate the surgical tunnel and swelling after your breast augmentation procedure. You should still be able to get a pain pump after surgery as well to help reduce your need for pain medications after your procedure.

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 (415)362-1846.

View Comments

What is the Best Age for an Eyelid Lift?


An eyelid lift or blepharoplasty is an aesthetic procedure performed to repair saggy or droopy eyelids. Advancing age primarily accounts for loose eyelid skin and eyelid bags, but some people are born with circles under their eyes. Some diseases may also cause eyelids to sag prematurely.

Assuming you are in good health, technically anyone can get an eyelid lift. However, for cosmetic reasons, I would recommend that any potential patient be at least 18 years old. In general, I would not recommend a teen ager undergo an eyelid lift.

An eyelid lift, or a blepharoplasty, is a surgical procedure that will rejuvenate lower eyelid excess skin and bags, and puffy, tired-looking eyelids. The results of a cosmetic eyelid surgery are usually long-term and very fulfilling with respect to your appearance and self-esteem, especially if you have realistic expectations of the outcome.

People who have loose skin, excess fat, bags under the eyes, or simply want to have rejuvenation, should discuss with a board-certified plastic surgeon about getting eyelid lift surgery. This is normally done as an outpatient procedure, and you can leave the recovery room shortly after the surgery. An eyelid lift is typically carried out with some anesthesia given through an IV to ensure drowsiness, and we make sure that you do not feel pain during the surgery.

Depending on what modifications you need, your plastic surgeon will tighten loose skin, remove excess fat, and tighten the loose structures around the eyelid . A few stitches will be required to close most of the small incisions. Initial discomfort and swelling can be alleviated with pain medication, ice and cold compresses, and head elevation.

Scars may be slightly visible after the surgery but should eventually fade to an almost invisible white line. A more youthful, fresher, and enhanced appearance awaits those who undergo this procedure. There is no need to wait until “a certain age” to rejuvenate your eyes.


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 (415)362-1846.

Did you find this article interesting? Please share via Twitter or Facebook below. Thank you for helping our articles inform your friends.

View Comments

How Long do Breast Implants Last?


Breast Implants, whether they are saline or silicone, are medical devices, and theoretically will not last forever. However, they should last for many years, and certainly beyond their current warranties.

In the US, Mentor and Allergan implants have similar warranties. Saline breast implants are warrantied for 5 years, and silicone breast implants are warrantied for 10 years. These warranties are through the manufacturer, and are not dependent on your plastic surgeon.

There is a misconception among some of my patients that if your implant is older than 5 or 10 years, then you need to change them. That is actually not true. As long as your breast implants are fine, you do not have to change them. There is no need to change them every 5-10 years. In fact, there is no specified mandatory change or replacement that you must make.

In general, many patients considering changing breast implants if they want to increase volume. Some patients eventually need a breast lift, and they may wish to change the volume of their breasts.

Assuming normal activities and exercise, your breast implants should last longer than the warranties, and may last for years or decades.

View Comments

Why Do Insurance Companies Not Pay for Cosmetic Plastic Surgery?


A great question asked on my Dr. Roy Kim Facebook Page: “Explain why insurance companies do not pay for elective cosmetic plastic surgery and what have you done to help your patients understand. Would your answer be different if obama-care paid for this procedure?”


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