davidlohsurgery

Qualms no more about Cosmetic Surgery

If aesthetic treatments and cosmetic surgery are still taboo, it is because of the stereotypes still perpetuating in popular media. These stereotypes tend to portray aesthetic treatment or cosmetic surgery patients as being vain or narcissistic, or that they cannot reconcile with their bodies (a condition called body dysmorphia syndrome). And that cannot be further than the truth!

The vast majority of patients who come forward for aesthetic treatments and cosmetic surgery are actually highly motivated and very driven individuals. Their underlying motivation is about taking control over their appearance and hence their destiny. Whether it is to find a life partner or to look sharp for job and business prospects, aesthetic treatments and cosmetic surgeries give them a sense of empowerment over their own destiny. It is this sense of empowerment that defines the modern day patient for aesthetic treatments.

Modern day aesthetic treatments with little or no downtime fits fits right into this whole frame of mind. Where the individual takes control over his or her destiny, appearance and competitiveness.

And very often, they are so empowered they will travel the world to seek out the best treatments and best practitioners.

And these individuals usually have no qualms about admitting to having work done. So there you have it, the modern day aesthetic and cosmetic surgery patient.

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Storing your Fat’s Stem Cells

Let us get the facts straight.

  1. At the time of writing this blog, there are no approved uses for Mesenchymal Stem Cell (MSC). MOH in Singapore only allows the use of stem cells in approved clinical trials. And for the treatment of medical conditions only. Their use in aesthetics is particularly frowned upon because it is expected that greedy and unethical doctors (or worse beauticians) would exploit the situation.
  1. The technologies to harvest and store stem cells over long periods have existed for decades.
  1. To avoid coercion or conflict of interest, the liposuction doctor who harvests the fat, the facility that stores the MSC, and the doctor or institution that initiates the clinical trials for the stem cell therapies should be separate unrelated people.

What are Stem Cells?

There are several types and sources of stems cells. Embryonic stem cells are derived from aborted embryos, which as you can imagine are outlawed in many countries due to ethical concerns. Adult stem cells can be derived from placenta, umbilical cord, adipose, bone marrow and even teeth.

Stem cells from the bone marrow are well-established therapies for various blood diseases. Some initial success has also been reported for cord blood.

Stem cells extracted from your own fat deposits are a newcomer. A mini-liposuction procedure is needed to get the fat out of the body to yield the stem cells. Adipose tissue derived stem cells are called Mesenchymal Stem Cells (MSC).

The technology to cryo-preserve stems cell has been around for decades. Just make sure the stem cell bank is properly accredited.

The cryo-preserved MSC can in the future be used in regenerative therapy. This refers to the use of regenerated MSC to replace damaged cells in organ failures. One such area of research is in pancreatic beta-cells for the treatment of diabetes. The future for many other diseases may well be in MSC and regenerative therapy.

However in order that you have the best MSC when you most need it in the future, you can do 2 things.

  1. Ensure that the mini-liposuction is done in a reputable and experienced centre.
  2. Choose the best stem cell bank that will store your stem cells for decades to come.

If you happen to be thinking about liposuction anyway, it might be a good idea to have some of the excess fat (which will be discarded) processed for MSC storage. Perhaps one day the MSC can grow a much-needed organ for you.

Watch a video about Fat Dervied Stem Cells from the Plastic Reconstructive Journal dated Sept 2021

What is Liposuction?

Liposuction is a treatment that is useful to sculpt areas of the body or the face that are disproportionate. Pockets of fat are extracted using a thin cannula to reveal a better body contour. The saddlebags, the love handles or a belly that is not in sync with the rest of the body shape are common areas for liposuction.

Liposuctions are minor surgical procedures. They are performed in a day-surgery OT with an anesthetist to administer sedation. The surgery takes about 1-2 hours in general to complete. The recovery time depends on the extent of the liposuction, but generally most patients will be able to go out of the house and run errands to very next day.

In some cases, the extracted fat can be transplanted to augment other areas, which have shrunk in the process of aging. This is referred to commonly as Fat Transfer. The face and the breasts are examples of such areas for Fat Transfer.

And of course during liposuction, a portion of the fat cells can be sent to the laboratory for extraction of mesenchymal stem cells (MSC), which are then stored for future use.

Storage of Mesenchymal Stem Cells (MSC)

The extracted MSC should be stored in a reputable cell banking facility, and preferably in a country like Singapore, which has very stringent laws regarding cell banking and storage standards. Cell banking facilities in Singapore have more than 20-year experience for successfully storing cord blood and stem cells of other sources.

Check that MSC may be withdrawn at the patient’s request for therapeutic purposes.

For ethical reasons, and to avoid and conflict of interest, the therapeutic applications should be administered by a doctor or institution other that the liposuction doctor or the stem cell banking facility.

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davidlohsurgery

Ultherapy V-Lift

[vc_row][vc_column][vc_column_text]The Ultherapy V-Lift is a non-invasive, non-surgical method to reduce the width of the lower and face. It sculpts the face while giving it a mild facelift-type effect.

Ultherapy is FDA approved since 2009 to lift a sagging face. It does this by tightening not only the skin, but the layers under the skin which we call the SMAS. This is a tough layer comprising muscles and the fibrous tissue. This is a strong supporting layer for the face.

Sound waves are focused by Ultherapy to leave tiny shockwaves under the skin and into the SMAS. Each point of these shockwaves triggers a cascade of collagen regeneration that translates into firmer and tighter skin. The results progressively improve over a period of several months.

What most patients experience is a mild facelift type effect that gets better as the months go by. All just after one treatment of Ultherapy.

It’s safety profile is unparalleled. In over a thousand cases done at David Loh Surgery since 2009, no one has suffered any form of injury from Ultherapy. Which sometimes happens with most other RF, IPL or laser treatments. The worst that can happen with Ultherapy is a mild mosquito-bite looking type of reaction in the skin, we call wheals. These will typically settle within a few days.

Ultherapy works particularly well in the lower face and under the chin. If fired deliberately into the fat fads in the jowl areas and under the chin, it can reduce these fat pads ever so slightly. Which is great because we can achieve a gentle sculpting of the face. These effects on the lower face we have term as The Ultherapy V-Lift.

The Ultherapy V-Lift is available at David Loh Surgery at both Novena Medical Centre and Wheelock Place. Our clinic is one of the first to start using Ulthera in 2009.

[/vc_column_text][vc_single_image image=”4424″ img_size=”full” add_caption=”yes”][vc_column_text]Read more:

Ultherapy, Facial Sculpting using Ulthera, Ultherapy page in Chinese, Ultherapy in Russian, Thread Lifts vs Ulthera[/vc_column_text][/vc_column][/vc_row]

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Aesthetic Doctor
davidlohsurgery

Dr David Loh teaching in various Asian countries

[nz_dropcap type=”empty full” color=””]I[/nz_dropcap]f he is not busy treating patients an his Wheelock Place clinic along Orchard Road, Dr David Loh travels to teach doctors throughout the region. In fact, Dr David Loh has trained a generation of doctors on the art of administering B*tox and facial fillers since 2006. Some of his trainees are now experts in the field themselves.

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Back in 2006, he was appointed as one of the original trainers for the Restylane range of HA fillers. This was when Q-Med still owned the Restylane brand. And there was only Restylane and Perlane. Q-Med was the only serious filler manufacturer at that time. Of course in the years since, Q-Med was acquired by several parties and it is now owned by Galderma. And Allergan has since risen to also be a global player in the aesthetic field. It too was a target of mergers and acquisitions. Despite all the upheavals in the industry, Dr David Loh remained steadfast in honing his skills and techniques with some of the best in the industry from Australia, Brazil to France (You know who you are!).

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Dr David Loh has worked closely with Allergan since 2009, and is now a faculty member of the Allergan Academy. The Allergan Academy formalises B*tox and facial fillers training for doctors progressing from basic to advanced levels.

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filler expert
Allergan Academy Training

 

Beyond the Allergan Academy, Dr David Loh also works closely with Galderma in China to impart his facial fillers injection techniques and artistry. He has lectured at the 1st People’s’ Army General Hospital’s plastic surgery conference in May 2014, and at a major national plastic surgery (3rd MIAPSD) conference in Shanghai in September 2014.

He works closely with hospitals in Changsha, Guangzhou, Shenzhen and Dongguan to elevate their standards of practice, at least where filler injections are concerned.

Registered to practice Medicine in The People’s Republic of China, Dr David Loh held regular visiting-expert sessions at a hospital in Shenzhen in 2013-2104. “Full face makeover with just Fillers” was his area of special interest, often drawing large crowds.

Besides China, Dr David Loh has also trained doctors in Jakarta and Bali in Indonesia on B*tox and Fillers. Dr David Loh lectured on micro-focused ultrasound at the SWAM conference in Jakarta in 2015.

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Visiting Fillers Expert to Hospital in China
Expert Meeting in Shenzhen China
Facial Fillers Teaching at Hospital in Changsha China
Teaching at Hospital in Changsha China
Facial Fillers Lecture and Workshop at the 1st Army General Hospital in GuangZhou, China
Lecture and Workshop at the 1st Army General Hospital in Guangzhou, China
Lecture at 3rd MIAPSD in Shanghai
Lecture at 3rd MIAPSD in Shanghai
MIAPSD
3rd MIAPSD in Shanghai, China
Facial Fillers Workshop at BIMC Bali
Workshop at BIMC Bali
Facial Fillers Workshop at Rejuvie Clinic in Bali
Workshop at Rejuvie Clinic in Bali
Facial Fillers Workshop at ARC Bali
Workshop at ARC Bali
Workshop in Dongguan China
Facial Fillers Workshop in Dongguan China
Facial Fillers Workshop in Guangzhou, China
Workshop in Guangzhou, China
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Liposuction
davidlohsurgery

3 Misconceptions about Liposuction

First Misconception: Is liposuction a method of weight reduction?

The answer is no. Liposuction will not reduce weight and if any, it’s only marginal.

While it is an established fact that Liposuction can effectively sculpt areas that are out of proportion or are not in harmony with the rest of the body, a common misconception about liposuction is that it can also help the patient to lose weight.

According to Dr David Loh, “The only way to lose weight is with determination and with help from a dietitian, a gym-trainer and occasionally, if the obesity is severe, a bariatric surgeon.” A bariatric surgeon specialises in surgery to treat pathological obesity.

“Liposuction is best used to sculpt areas that are out of proportion with the rest of the body.” Dr David Loh stresses.

doc-david-loh-2

Liposuction is a procedure where fat deposits directly under the skin are extracted through a small incision in the skin. Fats wrapped around organs, which are called visceral fats, are not dealt with during liposuction.

The arms, chest, breasts, waist, thighs, calves, ankles and the area under the chin can be sculpted. These areas can be difficult to tone with just just exercise and diet, and liposuction offers a helpful option.

Dr Loh stressed that patient selection and education are important for the long-term success of the procedure.

 

Second Misconception: Can we do a full body liposuction?

“We cannot do ‘whole body liposuction’ for the obese. It will not succeed. Nope, liposuction is not for weight reduction.” he said.

Patients need to understand that they must continue to exercise and diet in order to maintain good long-term results. Areas that have been treated will not accumulate fat again. If the patient puts on weight after liposuction, other areas will take over the task of storing fat. This can cause a distortion of the overall figure. Visceral fat can also  accumulate faster around the organs during periods of drastic weight gain. This is unhealthy.

So, it is of utmost importance that patients understand that must not to allow any weight gain after liposuction. “If you maintain your weight within a plus-minus 1-2 kg band, you will be fine.”

Third Misconception: Vaser is the best form of Liposuction.

Liposuctionliposuction_and_fat_transfer can be done with the help of assisting devices. Dr David Loh uses Vaser Liposelection. But regardless of which assisted form of liposuction, it is essentially the experience and the skill of the liposuction surgeon which will determine results and the outcome of the surgery, not the tools. Dr David Loh also performs High Definition Vaser (Vaser HD).

Dr Loh also performs autologous fat-transfer to the face and breasts. This is where a person’s own fat is transplanted to the face for greater support of the skin or to the breasts for a slight enhancement. For the face, Nanofats can be grafted to do the work of fillers.

If cellulite is is caused by some degree of lipoedema, then Liposuction can be one of a range of tools to correct it.

Liposuction is performed in a Day Surgery OT and Dr David Loh works with anaesthetists to provide greater comfort and safety to his patients.

Here’s a piece written by Dr David Loh explaining what is Liposuction.

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Thermage CPT
davidlohsurgery

All you need to know about Thermage treatment.

Thermage is the pioneer of non-invasive skin tightening. It’s unique technology of monopolar capacitively coupled radiofrequency (RF) enables volumetric heating much deeper than lasers. It can penetrate the dermis and into subcutaneous tissues to firm up existing collagen and stimulate new growth. In addition to tightening, this deep penetration helps to slim down the silhouette, especially flab-prone areas like double chin, cheeks, tummy and arms. The top-down heating profile also addresses superficial skin problems like wrinkles and pores, improving skin texture. Unlike lasers, the superior heating technology of Thermage makes it a one-time procedure, lasting an amazing 2-3 years!

These days, there are so many skin tightening devices in the industry. I have tried many variants of bipolar radiofrequency, cavitation, infrared light… but none safely delivers the levels of energy as Thermage can. Clinical studies show up to 4 times more therapeutic heating by Thermage, compared to current technologies! In other words, Thermage still produces the most dramatic and lasting results.

The Thermage Journey

Since its launch in 1995, Thermage has withstood the test of time. Technology so often burns brightly, transiently, and then gets replaced by the next new upstart. (Just look at how I have to change a new iphone almost every year!) So what makes Thermage different?

Thermage is backed by strong research and development, continuously improving its safety and effectiveness. To be perfectly honest, I was never a huge fan of Thermage until the latest generation Thermage CPT (Comfort Pulse Technology) came along. This new platform incorporates vibration with cryogen bursts and pulses of RF, making it so much more comfortable. The tip design and software has also been upgraded to deliver more uniform heating. The new larger body tip contours almost anywhere in the body faster. All this translates into much better results, more uniform tightening, with virtually painless treatments.

Which Is Better? Thermage CPT Or Ulthera?

I get asked this very often. While both are giants in the industry, they work in different ways. Thermage treats the skin from top down using radiofrequency waves; while Ulthera rejuvenates the skin from inside out with focused ultrasound energy. Thermage CPT treats all the problems in the skin – texture, wrinkles, firmness; while Ulthera tightens even deeper layers like the SMAS to give a lift against gravity. As a matter of fact, the 2 treatments work synergistically. So do both (budget-allowing), for a 3-dimensional non-invasive facelift. At different times of course.

Thermage CPT is safe to perform alongside other energy-based devices like IPL and lasers, once the skin has settled. B*tox and Fillers are especially useful to further smoothen wrinkles and re-volumize hollowed areas, thus creating a more enhanced facelift.

When Should I Do This?

I often tell my patients not to wait until your skin has gone south before you start treatments. Anti-ageing procedures are best done preemptively, before skin loses all its collagen. That way, your youthfulness will be maintained. Once the skin sags and loses elasticity, it will be much more challenging to restore it to its former glory.

For more information on skin tightening and face lifting, contact Dr Phoon – phoonys@davidloh.sg or call us at +65 67339114

Dr Phoon and The Thermage CPT
Thermage CPT

Nuyou Jan 2014

 

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liposuction
davidlohsurgery

Liposuction is about a Sense of Proportion

Dr David Loh on Liposuction

This is a transcript of an interview with Dr David Loh on Liposuction.

What do you see when you look in a full-length mirror? Almost all of us have it: that one despised fatty area that inexorably draws your eye and annoys the perfectionist in you. Most often the belly, the buttocks or the thighs, it could also be hamster cheeks, a double chin, a fatty chest, flabby underarms – anywhere, really, all the way down to the ankles.

Liposuction is one of the most popular aesthetic surgical procedures for a very good reason, says Dr David Loh. It allows both men and women to achieve, through a minor surgical procedure, a more svelte, proportional and beautiful figure and also, in the process, regain their confidence.

“Liposuction is not a treatment for obesity,” he warns. “Only with diet and exercise can one lose weight. If someone eats more calories than they expend after liposuction, over time the body will store those fat cells, albeit in a different location than where the liposuction was done.”

Liposuction is excellent for addressing areas of disproportion, he says. That does not mean the patient has to be thin; it only means that there needs to be an area that is disproportionate, such as a bulge that does not flow harmoniously with the surrounding areas.

Though Dr Loh also performs various non-surgical methods of body contouring, he feels that liposuction remains a gold standard for permanent fat removal. And for areas where non-surgical sculpting methods are awkward, it’s the only way.

 

Dr David Loh is one of the pioneers of office based liposuction in Singapore since 2007. MOH accredited to perform liposuction in the clinic and in Day Surgery OT, Dr David Loh is the first Chairman of the Liposuction Peer Review Committee of The Society of Aesthetic Medicine in Singapore. His Wheelock Place clinic is one of a few aesthetic clinics in Singapore that is accredited for small area office based liposuction. He also performs fat transfers to the face, buttocks and breasts. 

 

Read more about Why Liposuction is not a means to Weight Reduction and also about Vaser Liposelection

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Facial Sculptor
davidlohsurgery

Sculptor without Scalpel – Dr David Loh using Facial Fillers

facial fillers singapore
The article was written circa June 2013. And reported in Herworld.
Since then, Dr David Loh has gained multiple international awards for his work on safety and innovative techniques. 

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Doctors welding syringes of facial fillers instead of scalpels have changed the entire landscape of aesthetic treatments. Firstly, they are not just wrinkle chasers anymore. With highly evolved perspectives of what constitutes beauty, they are injecting fillers into areas hitherto unimaginable and sculpting and contouring faces in ways previously unheard of. And secondly, using only facial fillers, they are transforming faces into spectacular works of art! These are the sculptors without scalpels.

If you thought during your visit to the aesthetic doctor, he will simply inject some fillers into your nasolabial folds (the folds beside your nose), then you are quite mistaken. That’s almost an extinct method. Facial fillers are now used to prop up skin in surrounding areas to stretch out the naso-labial folds – all without ever injecting into the fold itself.

With facial fillers, you can expect to come out of the doctor’s office not only looking younger and fresher, but a more beautiful and more stunning version of yourself.  There’s nowhere that fillers cannot be injected. The forehead, around the eyes, the nose, the cheeks, the chin and even lips can be made to look more prominent or de-emphasized, as may be needed – all just with fillers.

“Evolved into art form, facial filler techniques are used to sculpt and contour faces to enhance beauty in already beautiful faces. Beyond just chasing wrinkles, facial fillers more importantly restore proportions, balance and symmetry.”

Faces that are flat can be made to appear shapelier; faces that are broad appear slimmer; or faces that are angular to appear softer. Small chins can be made more prominent; and flat noses more projected. And the list goes on.

And where fillers were once a dull and boring cousin of B*tox, it now takes center-stage as the most impressive and the most instantly gratifying aspect of any encounter with aesthetic doctors.  Not surprisingly, it has had a major revival in popularity in the last 5 years.

Previously taboo subjects about cosmetic surgeries suddenly became cool, hip, and something to talk about over dinners and at parties. While “no-recovery time” is de rigueur, facial sculpting and contouring with fillers is now the cutting-edged frontier.

“The way for aesthetic doctors to stand out from the crowd is to have a good foundation in injection techniques and to hone one’s skills into an art form. Today, aesthetic doctors are sculpting faces and shaping skin in such a way that lines stretch out even without a single drop of filler material injected into the line itself. In the future” Dr David Loh, who is the trainer for B*tox and fillers, added, “we will probably be looking at how to predict the effects of aging and using fillers to prevent it altogether. Already, studies have shown that fillers alone can stimulate the production of collagen just by their stretching the skin.”

Dr David Loh is the Allergan appointed trainer for B*tox and Fillers since 2006. He has trained more than 150 doctors in the region and was recently in Jakarta and Bali to train the future trainers for Indonesia. He also trains and consult for doctors in Guangzhou, Shenzhen and Shanghai, China. In China, he works with the Restylane range of Facial Fillers.

He owns a chain of aesthetic clinics along Orchard Road in Singapore. And he is the President of The Society of Aesthetic Medicine in Singapore.

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Expert's opinion on Filler Techniques
davidlohsurgery

How Hyalase changed the practice of Filler Injections

Tear Trough Correction with Fillers
Tear Trough Filler Injections.

In the age before Hyalase (or more accurately Hyaluronidase) became easily available, over injection of fillers was a nightmare most aesthetic doctors had to deal with pretty regularly. Luckily the fillers of that age didn’t last so long and most doctors weren’t so adventurous, sticking mostly to the nasolabial folds.

In that era (circa 2002-2005), some of us had to resort to using lasers and IPLs to dissolve the fillers, which of course didn’t work. We now know better and have stopped advocating lasers to “dissolve” fillers”. But the lesson learnt allows us to confidently use skin tightening devices like Ulthera together with fillers without the fear of destroying the fillers.

Now with hyaluronidase available, however, we can infinitely adjust fillers as long as they are made of hyaluronic acid. Too much and we will dissolve some of it away. Too little, we can inject some more. This gives us us accuracy and precision to venture into more hallowed areas like the tear trough and the marionette lines.

The hyaluronidase instantly dissolves the fillers in situ. It breaks Hyaluronic acid down into simple sugars that can easily be absorbed into the bloodstream or the lymphatic system. After several days when the hyaluronidase has been reabsorbed and any swelling has subsided, we can do the corrective adjustments for the areas as some of the surrounding will also be inevitably be affected.

Hyalase gave us the ability to infinitely adjust any filler treatments, gave us rise to the art of facial sculpting with fillers which we have termed the Liquid Facelift.

 

Photo Credit: Galderma Restylane

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correcting fat transfers
davidlohsurgery

Smartlipo to the Rescue. Correcting Over-done Fat Transfers

DID YOU KNOW THAT OVERDONE FAT-TRANSFERS CAN BE CORRECTED?

While Fat Transfer (aka Fat Grafting or Lipofilling) on the face is a relatively easy task for doctors with the setup for office-based liposuction, getting it just right is not always a given. There are many variables like the quality of the fat after liposuction; the quality of the skin on the face which will determine the blood supply available to support the fat;  the age of the patient; whether a smoker or not …and so forth.

I have been doing fat transfers since 2007 and I have had more than a few requests in the past to treat the overfilled foreheads, chins, and overfilled cheeks. Some were my patients, but mostly were done overseas – mainly in the country that is now very popular for cosmetic surgery. Not that their doctors are bad, I guess it must be too inconvenient to fly there to do corrections, hence they land up for corrections with me. The pros and cons of medical tourism for invasive procedures is of course a topic for another blog altogether in itself.

Our Smartlipo system is just ideal for this purpose. The technology started me on the road to liposuction in 2006, and now although I have moved on to more efficient and effective systems to do liposuction, I still fall back on Smartlipo to do small and delicate areas. Smartlipo gives me accuracy and precision to treat small areas like overfilled foreheads, cheeks and chins.

The fibre-optic system delivers pulses of laser to melt away excess fat. In doing so, I can partially or fully remove the overfilled areas. It’s almost like the “Eraser” for Fat Fillers.

Dr David Loh

Read more about fat grafting (fat transfers) to the face

 

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