Chi Kung: The Medicine of Energy, Mind and Form

By Dr Khoo Lee Seng

In modern medicine, we are trained to observe structure, measure pathology, and intervene with precision. As a registered Western medical practitioner who completed Plastic & Reconstructive Surgery residency and also a practitioner of medical acupuncture, I have spent decades studying anatomy, physiology, and the science of healing. Yet, there exists another dimension of medicine—older, quieter, and deeply experiential—that complements what we see under the microscope.

This is the art of Chi Kung (Qi Gong).

Chi Kung is an ancient system within Traditional Chinese Medicine (TCM) that integrates movement, breath, and mind regulation to cultivate and harmonise the body’s vital energy—Qi . While Western science may describe its effects in terms of nervous system regulation, circulation, and musculoskeletal conditioning, Chi Kung approaches the human being as an integrated energetic system.

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Qi, Aging, and the Silent Decline of Vitality

Aging, in Western medicine, is often described as cellular senescence, oxidative stress, and progressive degeneration. In Chi Kung, aging is understood more simply—and perhaps more truthfully—as the gradual depletion and stagnation of Qi.

When Qi flows freely:

• tissues are nourished
• sinews remain supple
• the mind is clear
• the spirit is anchored

When Qi stagnates:

• toxins accumulate
• fascia and sinews tighten
• circulation is impaired
• disease begins to manifest

If you look at the electrical circuit in the illustration, you will see that:

1. The Qì channels are like the wires that carry electric current.

2. The internal organs are like the electrical components such as resistors and solenoids.

3. The Qì vessels are like capacitors, which regulate the current in the circuit.

4. The dāntián is like a battery, which stores the charge and provides the EMF in the circuit.

Modern research does show that practices like Chi Kung can improve circulation, flexibility, balance, and even aspects of cardiovascular health . From a surgeon’s perspective, this translates into improved tissue quality, better healing potential, and resilience against degeneration.

But Chi Kung goes further—it addresses the root.

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Sinews, Fascia and the Hidden Network of Health

In surgery, we see the fascia and connective tissues directly. These are not inert structures. They are living, dynamic, responsive. You may read more about the concept of fascia in the link below.

https://drkhooleesengplasticsurgery.blogspot.com/2025/07/fasciadiseaseandacupuncture.html

Figure A- Healthy Fascia which are neatly organized that allow easy gliding and smooth movements

Figure B- Aging and entangled fascia result in chronic pain, loss of flexibility and onset of degeneration.

Chi Kung traditions have long described the importance of “sinews” (tendons and fascia) as the physical expression of internal vitality. Practices such as Yi Jin Jing (Muscle/Tendon Changing Classic) specifically aim to transform these tissues—making them elastic, resilient, and energetically alive.

From a biomedical standpoint, this correlates with:

• improved fascial glide
• enhanced proprioception
• reduced chronic tension patterns

                                                      Tight entangled fascia causes lymph stagnation

From an energetic standpoint, it allows Qi to flow unimpeded through the meridians which are flow within the fascial connections.

Where there is stiffness, there is stagnation.
Where there is stagnation, there is disease.

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Toxins: Beyond the Physical

We often speak of toxins in biochemical terms—metabolic waste, environmental pollutants, inflammatory mediators.

But in Chi Kung, toxins also include:

• unresolved emotional states - anger, hatred, apathy, jealousy, evil thoughts.
• chronic stress patterns - worry, anxiety, greed.
• habitual negative thinking - the refusal of accepting facts and truths.

Dr Khoo Lee Seng's Plastic Surgery Blog: EMOTIONS THAT CAN MAKE YOU SICK & EVEN IMPEDE HEALING POST SURGERY by Dr Khoo Lee Seng

These are not abstract ideas. They manifest physically.

Persistent anger tightens the chest and jaw.
Fear weakens the kidneys and posture.
Worry knots the abdomen.

Over time, these patterns obstruct Qi flow and alter physiology.

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The Mind as the Primary Physician

One of the most overlooked truths in both Eastern and Western medicine is this:

The mind directs the body.

In Chi Kung, improper thoughts—particularly:

• anger
• resentment
• blame towards others
• internalised negativity

—are seen as major disruptors of Qi.

When a person constantly assigns blame externally, they lose internal agency. The mind becomes scattered, the breath becomes shallow, and Qi becomes chaotic. This disrupted chi is shown on the face and facial micro-expressions. A cruel person or someone who mentally unsound or even an instigator of evil can be "felt" and "seen" by their aura ("chi") and their facial appearance.

Dr Khoo Lee Seng's Plastic Surgery Blog: Leaking Qi & Depleted Jing- The Cause of All Medical Maladies & Premature Aging by Dr Lee Seng Khoo

This is not philosophy alone. It is observable.

Modern studies show that Chi Kung integrates mental focus, breathing, and movement to regulate both psychological and physiological states .

A disturbed mind leads to disturbed Qi. Disturbed Qi leads to disease.

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Facial Feng Shui: The Face as a Map of the Mind

As a plastic surgeon, I have a unique vantage point.

The face is not merely anatomy—it is history.

Over time, emotional patterns sculpt facial structure:

• chronic anger hardens the jaw and deepens lines
• worry hollows the midface
• resentment tightens the eyes
• fear alters posture and expression

Evil or cruelty can be seen on face due to manifestation of internal states.

(You may watch my webinar on Facial Feng Shui and Cosmetic Surgery here)

https://youtu.be/-SiQubvjpcI

This is what traditional practitioners refer to as facial feng shui—the outward manifestation of internal imbalance. You may read more about Facial Feng Shui and how plastic surgery and emotion management can alter the facial structures and appearance.

https://healthcaretoday.com.my/facial-feng-shui-bridging-aesthetics-with-cultural-harmony.html

No injection or surgical technique can fully reverse what is continuously reinforced by the mind.

Chi Kung, however, works from the inside outward.

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The Systems of Practice I Teach

My training in Chi Kung emphasizes both structure and spontaneity. The systems I practice and teach my students include:

Ba Duan Jin (Eight Brocades)- Wuji modification

A foundational system of dynamic movements that:

• improves circulation
• stretches the sinews
• regulates organ systems

Microcosmic Orbit- Wuji Modification

A meditative practice circulating Qi through the Ren and Du meridians:

• enhances internal energy flow
• stabilizes emotional states
• builds internal awareness

Yi Jin Jing - Wuji Modification

Focused on transforming muscles and tendons:

• increases strength and elasticity
• improves posture and structural integrity

Xi Sui Jing (Marrow Cleansing)

A deeper internal practice aimed at:

• revitalising internal systems
• strengthening core vitality

Standing Meditation (Zhan Zhuang)

Often underestimated, this is one of the most powerful practices:

• develops a one-pointed mind
• builds internal force
• aligns structure with energy

I also practice moving meditation using Gung Fu forms that realigns the muscles and fascia to promote qi flow and cat-like reflexes.

Spontaneous Chi Flow

At higher levels, the body begins to move naturally:

• releasing deep blockages
• restoring natural rhythms
• allowing the body to “self-correct”

At this stage the body will sway and move on its own accord and practitioners may jump, roll, cry or simply enjoy the movements that allows chi to flow and unblock "blocked" meridians and channels in the human body.

Example of the hand Jue Yin pericadium meridian.

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Death, Stillness, and the Return to Simplicity

Ultimately, Chi Kung is not merely about health or longevity.

It is about alignment—with oneself.

Death, in this framework, is not an enemy but a transition. A life lived with chaotic Qi, emotional turbulence, and internal conflict leads to suffering—both in life and at its end.

A life cultivated through:

• calm mind
• balanced emotions
• smooth Qi flow

—leads to clarity, acceptance, and peace.

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Bridging Two Worlds

As a Western-trained doctor & surgeon, I do not reject science. On the contrary, I rely on it daily.

But science, at its current stage, measures what is tangible. Chi Kung operates in a domain that is experiential, functional, and deeply personal.

The two are not in conflict.

They are complementary.

Where surgery corrects structure, Chi Kung restores function.

Where medicine treats disease, Chi Kung cultivates health.

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Conclusion

Chi Kung is ultimately a practice of responsibility.

Not blaming others. Not inciting hatred. Not harboring evil thoughts or intentions. Not externalizing suffering. Not waiting for cure.

But cultivating:

• clarity of mind
• harmony of emotion
• smoothness of Qi

Health is not given. It is cultivated.

Meanwhile, keep smiling from your heart! Keep pleasant thoughts if not for others, at least for your own health!

Dr Khoo Lee Seng

When Complications Happen: Why Even the Best Surgeons Can Face Risks—and Why Patients Must Look Beyond Registration

When Complications Happen: Why Even the Best Surgeons Can Face Risks—and Why Patients Must Look Beyond Registration

Surgery is often described as high-stakes, high-skill work, and for good reason. Even the most experienced, highly trained surgeons can encounter complications. That’s a reality that is uncomfortable but unavoidable. Every patient’s anatomy is unique. Healing varies. Some procedures are inherently complex. Even in the hands of a world-class surgeon, outcomes are not 100% predictable.

Yet, in today’s medical ecosystem, complications are too often misrepresented. Patients frustrated by outcomes may “doctor hop,” seeking someone else to blame. Worse, some colleagues use these moments to throw surgeons under the bus—sometimes subtly, sometimes overtly—claiming the complication is proof of incompetence. In the worst cases, surgeons are actively vilified because of professional registration technicalities rather than clinical skill.

This is particularly apparent in Australia, where highly trained surgeons like Dr. Darryl Hodgkinson who completed Plastic Surgery residency at the famed Mayo Clinic in the United States have been unfairly targeted by his Australian colleagues because they are not registered as plastic surgeons in the country, despite decades of international experience and clinical competence.

Appendix 15 - Letter from Dr Darryl Hodgkinson and attachments.pdf

 Why Complications Happen—Even with the Best Surgeons

Surgery is not a machine; it is an interaction between a trained surgeon and a living, breathing, uniquely complex human body. Complications can occur due to:

(1) Case complexity – Patients who have undergone previous surgeries or have challenging anatomy due to threads/fillers and various energy devices present a “redo surgical terrain” that can increase the likelihood of complications.

(2)Healing variability – Age, nutrition (use of GLP injectables) or low calorie intake including low carb diets and Intermittent fasting (IF), smoking/vaping, chronic illnesses, and genetics all influence how the body recovers.

(3)Unexpected intraoperative events – Even the most meticulous planning cannot account for every variable. 

Importantly, a complication does not automatically indicate medical negligence. Medical negligence occurs only when a surgeon’s care falls below the accepted standard of practice, as judged by peers in the field. 

In contrast, many complications arise despite careful planning, skill, and adherence to professional standards. Mislabeling every complication as malpractice is misleading, harmful, and unfair to surgeons.

The celebrated neurosurgeon Henry Marsh and Surgeon General Atul Gawande emphasize that complications are an inevitable part of medical practice. What separates excellent surgeons from average ones is how they manage complications, communicate with patients, and learn from every outcome.

When Colleagues Exploit Complications

Unfortunately, some surgeons face more than just medical challenges—they face "professional politics". Complications can be weaponized by colleagues who have ulterior motives: turf wars, financial competition, or a desire to maintain control over a specialty. 

Patients can be subtly brainwashed into believing they have been wronged if the operating surgeon is not formally registered as a specialist.

Take the case of Dr. Darryl Hodgkinson Despite being fully trained in the specialty of Plastic Surgery at the Mayo Clinic and internationally experienced, and highly competent, some colleagues encouraged patients to sue him simply because he was not registered as a plastic surgeon in Australia. The following sources provide insight into his professional challenges:

* Dr. Hodgkinson’s own letter and supporting documents

https://cosmeticmedicalpracticesubmission.info/appendices/Appendix%2015%20-%20%20Letter%20from%20Dr%20Darryl%20Hodgkinson%20and%20attachments.pdf

* [Sydney Morning Herald report on alleged cartel behavior among Australian surgeons]

https://www.smh.com.au/healthcare/australian-surgeons-accused-of-cartel-behaviour-to-control-fees-20160922-grm5rh.html)

The SMH article highlights systemic pressures where groups of surgeons allegedly attempted to control fees and restrict competition—a backdrop that makes it easier for colleagues to vilify competent surgeons who are “outsiders” to the system and are trained abroad or in another system.

Registration vs Competence: Why Titles Aren’t the Whole Story

Many patients assume registration as a plastic surgeon guarantees the best outcomes. While registration is legally significant, it does not necessarily indicate experience or skill in every cosmetic procedure. Conversely, many surgeons who are not registered as plastic surgeons in their country Australia for example - Dr Patrick Tansley (British trained plastic surgeon & former Hunterian professor) and Dr Darryl Hodgkinson (American trained plastic surgeon and founder of an International Cleft Mission Society - Operation Restore Hope) have extensive training, including accredited aesthetic surgery programs, and are perfectly capable of delivering excellent outcomes.

Dr Patrick Tansley FRCS Plast was denied entry to the Australian Specialist Register

[ACCSM Guidance on Qualifications and Competence in Cosmetic Surgery (PDF) emphasizes that specific training, experience, and professional development can matter more than formal registration especially in aesthetic plastic surgery.

https://www.accsm.org.au/download/?id=media&doc=189 

[PMFA Newsdiscusses how registration and specialist status are distinct from actual procedural expertise.

IN RESPONSE TO: Plastic surgery and aesthetic medicine - specialties and specialists | The PMFA Journal

Liposuction | The PMFA Journal

https://www.thepmfajournal.com/features/post/plastic-surgery-and-aesthetic-medicine-specialties-and-specialists

 Professor Dr Andrew Burd and Dr Lee Seng Khoo on Training and Competence

Dr. Andrew Burd and Dr. Lee Seng Khoo, in their PMFA journal articles, underscore a critical principle: competence in aesthetic surgery comes from specific, structured training, case experience, and continuous professional development—not solely from registration as a plastic surgeon. Key points from their paper include:

1. Procedure-specific training matters most – A surgeon may be registered in plastic surgery but have limited experience in a specific cosmetic procedure for example a complex procedure such as RibXcar https://nypost.com/2025/03/31/lifestyle/women-are-spending-20k-to-shrink-their-waists-in-viral-craze-experts-call-ribxcar/ or orthognathic two jaw surgery https://www.mahoganyoralsurgery.com/double-jaw-surgery/#:~:text=Double%20jaw%20surgery%2C%20also%20known%20as%20bimaxillary,bite%2C%20or%20crossbite%20*%20Obstructive%20sleep%20apnea. 

Competence comes from dedicated practice in that procedure.

2. Mentorship and ongoing education are essential – Continual learning and peer-reviewed assessment improve outcomes and patient safety.

3. Outcome-based evaluation – Surgeons should be assessed by their results and complication management, not just by certificates or titles.

In short, PMFA guidance emphasizes that training, skill, and professionalism are far better predictors of safe outcomes than registration alone.

International Examples: Lessons for Patients

Joe Niamtu a friend and surgical mentor of mine faced disputes with the American Board of Plastic Surgery but went on to become a world-leading facelift surgeon.

Joe Niamtu on LoveThatFace https://www.lovethatface.com/2008/09/14/only-use-a-board-certified-plastic-surgeon/ discusses how patients should focus on surgeon experience, outcomes, and procedural expertise.

https://www.styleweekly.com/a-battle-between-competing-surgical-fields-spills-into-the-courts-and-patients-are-caught-in-the-middle/

Niamtu had to fight for his right to be allowed to perform Facial Plastic Surgery including facelifts and eyelid surgeries in a court battle way back in the 1980. He won and as they say the rest is "history"!

Patrick Tansley FRCS Plast, a British trained plastic surgeon, faced systemic barriers and was refused entry to the Plastic Surgery specialist register in Australia despite being highly qualified.

Banned surgeon considers legal action | The Advertiser

Cosmetic Surgery Regulation in Australia: Who Is to Be Protected—Surgeons or Patients? - Patrick Tansley, Daniel Fleming, Tim Brown, 2022

Mr Patrick Tansley Supreme Court Libel Action Melbourne -

In the United States, the Skim Milk article highlights conflicts between facial plastic surgeons and traditional plastic surgeons, demonstrating how professional politics can distort public perception.

Battle Over Beauty : In Changing Face of a Turf War, Cosmetic Surgeons Gain Ground - Los Angeles Times

The Georgia Society of Plastic Surgery published an article called “Things Are Never What They Seem, Skim Milk Masquerades as Cream.” This article called plastic surgeons “cream” and facial plastic surgeons and cosmetic surgeons “skim milk.” A lawsuit for slander and libel was filed by the Facial Academy and the Cosmetic Association. E. Gaylon McCullough, MD, past president of the American Academy of Cosmetic Surgery and secretary of the Facial Academy of Plastic Surgery, testified at the trial. The jury returned a guilty verdict against the plastic surgeons and awarded the largest judgment in history against medical organizations. The plastic surgeons were told to pay $1.5 million in punitive damages.

[Skim Milk article]

https://www.lovethatface.com/files/2013/04/Should-Cosmetic-Surgery-be-Limited-to-Certain-Specialties1.pdf

How Evil Narratives Can Mislead Patients

Unscrupulous colleagues can manipulate patient perception in subtle ways:

* Suggest that complications automatically indicate malpractice 

* Emphasize registration over competence to cast doubt on the surgeon (cases of Darryl Hodgkinson & Dr Patrick Tansley)

* Encourage unnecessary litigation to protect personal or financial interests 

Patients must recognize: that not every complication is negligence, and specialty registration status alone does not define competence. Hitler managed to convince many a folk by brainwashing in his Neo-Nazi heyday, and yet no one stopped to think for themselves.

Excerpt from Article "Don't make Your patient a Victim - When Doctors Criticize Other Doctors"

When Doctors Criticize Other Doctors

“Doctors will throw each other under the bus,” said Susan H. McDaniel, M.D., lead author of the study from the University of Rochester Medical Center. “I don’t think they even realize the extent to which they do that or how it can affect patients.” 

Provider jousting comes in many forms. When one physician criticizes another, both may be at increased risk for litigation. When a patient hears criticism, they may feel the care they received was inappropriate. The words they hear may lead them to seek legal counsel regarding litigation. A glance away, a look of incredulity or an offhand comment may also be enough to trigger the feeling that care was inadequate even if it wasn't.

How Good Surgeons Handle Complications

The hallmark of excellence in surgery is how complications are handled:

Transparency – Discuss risks and realistic outcomes openly.

Reflection– Analyze what occurred and refine techniques.

Empathy – Treat patients with understanding & respect, not blame.

Henry Marsh’s philosophy reminds us: complications are inevitable, but they are opportunities for improvement, learning, and better patient care.

Even when every accepted precaution is taken, the human body can heal unpredictably, which is why surgery always includes careful follow-up and candid discussion of possible outcomes.

Only 2 types of doctors never have surgical complications: those who don’t operate and those who aren’t truthful.

When considering cosmetic or reconstructive surgery:

1. Research qualifications and training carefully – Look beyond titles.

2. Evaluate procedural experience – Ask how many of the specific procedure the surgeon has performed.

3. Ask about complication management – Good surgeons will discuss risks openly.

4. Be aware of professional politics – Recognize when criticism may reflect turf wars rather than incompetence. And a medical professional who speaks ill of another not only violates the Hippocratic Oath but such behavior reflects on their own unprofessionalism and personal integrity in the "noble profession". 

Henry Kawamoto MD world renowned Plastic & Craniofacial Surgeon, stated in his lecture at the Kawamoto workshop in Egypt that he will never respect any colleague who speaks ill of another colleague & as he says as professionals and decent human beings - first deal with the problem, refrain from bad-mouthing any colleague & realize that we were not there during the procedure and hence not in a position to judge. If we do judge, be a professional and judge quietly, heal adequately and be a good doctor. 

5. Consult multiple sources – Use PMFA, Australian College of Cosmetic Surgery, and reputable articles to verify information which is non-biased.

EPILOGUE

A scar may widen unexpectedly. Swelling may persist longer than anticipated. A wound may heal unevenly. A small area of tissue may not settle exactly as planned. Occasionally, revision surgery becomes necessary—not because the original operation was careless, but because biology does not always follow textbook expectations.

This is true across all fields of surgery, including plastic and aesthetic surgery. Even in internationally respected centres, surgeons with extensive experience and excellent outcomes still encounter complications. What matters most is not whether a complication ever occurs, but **how it is anticipated, explained, recognised early, and managed responsibly.**

For this reason, responsible surgeons discuss risks before surgery, not after problems appear. Every operation carries known possibilities such as bleeding, infection, asymmetry, delayed healing, scar variation, or the need for further refinement. These are not hidden possibilities; they are part of the reality of operating on living tissue.

Patients often ask whether perfect results can be guaranteed. The honest answer is no surgeon can ethically promise perfection. Surgery improves, reshapes, reconstructs, and refines—but it always takes place within the limits of human anatomy, tissue response, circulation, scarring tendency, and healing biology.

This does not reduce the importance of skill. On the contrary, training and judgment matter enormously. Surgical experience helps reduce avoidable risk, improve decision-making, and guide safe responses when healing does not proceed exactly as expected. But even the most experienced surgeon cannot fully control every biological variable after an operation is complete.

The true measure of surgical professionalism is therefore not the unrealistic absence of all complications, but careful patient selection, thoughtful planning, technical discipline, close follow-up, and honest communication throughout recovery.

REFERENCES

* [Sydney Morning Herald – Australian surgeons accused of cartel behavior] 

https://www.smh.com.au/healthcare/australian-surgeons-accused-of-cartel-behaviour-to-control-fees-20160922-grm5rh.html

* [ACCSM PDF – Qualifications in Cosmetic Surgery]https://www.accsm.org.au/download/?id=media&doc=189

* [Skim Milk – Facial plastic surgeons vs plastic surgeons] https://www.lovethatface.com/files/2013/04/Should-Cosmetic-Surgery-be-Limited-to-Certain-Specialties1.pdf

* [PMFA News – Specialist registration vs competence] https://www.thepmfajournal.com/features/post/plastic-surgery-and-aesthetic-medicine-specialties-and-specialists

IN RESPONSE TO: Plastic surgery and aesthetic medicine - specialties and specialists | The PMFA Journal

* [Style Weekly – Surgical turf wars in court https://www.styleweekly.com/a-battle-between-competing-surgical-fields-spills-into-the-courts-and-patients-are-caught-in-the-middle/

* [LoveThatFace – Board certification vs experience] https://www.lovethatface.com/2008/09/14/only-use-a-board-certified-plastic-surgeon/

* [Joe Niamtu – world leader in facelift surgery]https://www.lovethatface.com/

* [Darryl Hodgkinson – Letter and attachments PDF

Appendix 15 - Letter from Dr Darryl Hodgkinson and attachments.pdf

“Capsular Contracture: An Overlooked Cause in Breast Implant Surgery (Electrostatic Contamination)”

 🧠 The Invisible Risk in Breast Implant Surgery — And Why It Matters More Than You Think

In surgery, we are trained to focus on what we can see.

Sterility.

Technique.

Precision.

But what if one of the most important risks… is completely invisible?

⚡ A Detail Most Surgeons Never Think About

How Surgeons Can Reduce Infection Risk??

When a breast implant is opened, it doesn’t just sit there passively.

It can carry electrostatic charge.

In simple terms, this means the implant can behave like a magnet—attracting microscopic airborne particles in the operating room.

Not because the environment is unclean.

Not because of poor technique.

But because of physics.

🌫️ “But the Operating Room Is Sterile…”

Yes—modern operating rooms are highly controlled.

But “sterile” doesn’t mean the complete absence of airborne particles. It means they are minimised.

And that distinction matters.

Because even a small number of particles—if attracted to an implant surface—can become clinically relevant over time.

🦠 Why This Small Detail Can Become a Big Problem - Can Breast Implants Attract Bacteria?

These microscopic particles are not just dust.

They may carry bacteria.

And once bacteria adhere to an implant surface, they can form biofilm—a protective layer that is extremely difficult to eradicate.

Over time, this may contribute to:

Infection

Chronic inflammation

Capsular contracture

One of the most frustrating complications in breast surgery.

What causes capsular contracture?

Capsular contracture may be caused by bacterial contamination, biofilm formation, and inflammatory responses. Emerging evidence suggests electrostatic charge on breast implants may attract airborne particles that contribute to this process.

🔍 The Turning Point: Asking a Different Question

“How Electrostatic Charge Affects Implant Contamination”

While working with Jeroen Stevens MD  in Holland, we asked something deceptively simple:

👉 Are we overlooking a source of contamination we cannot see?

This question led us to explore how electrostatic charge interacts with implant handling during surgery.

💡 The Insight: Prevention Can Be Simple

What we found was not the need for complex technology.

Instead, it pointed toward something more fundamental:

👉 A simple intraoperative adjustment can reduce electrostatic attraction.

No expensive equipment.

No radical change in workflow.

Just a better understanding of how basic science applies in the operating room.

🧪 Rethinking “Innovation” in Surgery

When people think of innovation, they often imagine:

Robotics

New devices

Advanced materials

But in reality, some of the most meaningful improvements come from:

Recognising overlooked risks

Understanding fundamental principles

Refining technique at critical moments

And ...this is one of those cases.

👨‍⚕️ What This Means for Surgeons

This isn’t about adding complexity.

It’s about awareness.

Because once you understand that electrostatic charge exists, you begin to see implant handling differently:

Timing becomes more intentional

Exposure becomes more controlled

Small steps gain significance

🤍 What This Means for Patients

For patients, this isn’t something to worry about.

It’s something to reassure you.

Because it highlights how much attention goes into the smallest details of your surgery—many of which you will never see.

Better outcomes are not the result of one big decision.

They are the result of hundreds of small, thoughtful ones.

📌 Final Thought

In surgery, precision is not just about what we see.

It’s about what we understand.

And sometimes, improving outcomes begins with something as invisible… as static electricity.

“The most important risks in surgery are often the ones you cannot see.”

Our paper on implant contamination and electrostatic charge was published in the Aesthetic Surgery Journal (ASJ)

Link to me and Jeroen Stevens' paper :

Preventing Electrostatic Contamination of Breast... : Aesthetic Surgery Journal (ASJ)

#PlasticSurgery #BreastImplants #CapsularContracture #InfectionPrevention #PatientSafety #MedicalInnovation #AestheticSurgery #SurgicalTechnique #EvidenceBasedMedicine #HealthcareInnovation

Note -Dr Lee Seng Khoo is a fully registered Medical Practitioner in Malaysia who completed his Plastic & Reconstructive Surgery residency training at the 38th Infirmary Santa Casa Misericordia Hospital under Professor Ivo Pitanguy. His interests are medical research, medical education and teaching surgical anatomy as applied for reconstructive surgery and revisional (redo) surgery.

Vaping & Smoking (Oral Fixation Habits) is Hurting Your Surgical Results & Health

If you’re planning to undergo reconstructive surgery—or really any kind of surgery—one of the first things your doctor will tell you is this: you must stop smoking (yes even weed!) and vaping. And here’s the key point many people miss—it’s not just the smoke or the vapor. It’s the nicotine.

Nicotine, no matter how it’s delivered, is the real culprit. That means e-cigarettes, vaping devices, nicotine patches, gum, lozenges—all of it is off-limits for at least six weeks before and six weeks after surgery. Why? Because nicotine directly interferes with your body’s ability to heal.

How Nicotine Sabotages Healing

Nicotine is a powerful blood-vessel constrictor. When your blood vessels narrow, circulation slows, and less oxygen reaches your tissues. Oxygen is the fuel your body needs to repair itself.

Imagine a healthy blood vessel as wide as an extension cord—plenty of room for oxygen-rich blood to flow. Now imagine nicotine squeezing that vessel down to the width of a phone-charging cable. That dramatic reduction means tissues are starved of oxygen right when they need it most.

From e-cigarettes to snuff, all nicotine products impair your body’s natural healing mechanisms—and they can seriously compromise your surgical results.

Why Surgeons Insist on Nicotine Abstinence

During surgery, skin and tissue are carefully lifted, repositioned, and temporarily separated from their blood supply. Surgeons are meticulous about preserving enough circulation to allow proper healing. But when nicotine enters the picture, that already-delicate blood flow is further reduced.

The result? Healing may be delayed—or fail altogether.

The Real Risks of Nicotine After Surgery

Patients who continue to smoke or use nicotine during recovery face significantly higher risks, including:

• Delayed wound healing

• Skin loss

• Thicker or wider scars especially in armpit or below breasts or in tummy tucks & facelifts

• Infections

• Fat necrosis (death of fat cells that form hard lumps)

• Increased pain

• Life-threatening complications such as blood clots, stroke, heart attack, or pneumonia

This isn’t theoretical. Smoking after a facelift can cause tissue loss in the cheeks. After a breast lift or reduction, it can lead to nipple tissue death. After a tummy tuck, it can result in skin loss along the abdomen. These complications are so serious that many practices—including mine now—routinely test patients for nicotine before cosmetic procedures.

Tummy tuck necrosis example

Many patients who love vaping and smoking also have thalassemia which carries now a double jeopardy going into surgery as their red blood cells don't carry enough oxygen to begin with!

Oxidative Stress & Inflammation: Vape aerosols contain reactive oxygen species (ROS) (like free radicals) and toxic chemicals (aldehydes, heavy metals) that create oxidative stress and inflammation, damaging cells and tissues, which is detrimental to someone with a pre-existing blood disorder such as thalassemia.

Bone Marrow Suppression: Studies show chronic e-cigarette exposure can decrease hematopoietic stem and progenitor cells (HSPCs) in the bone marrow, hindering the production of new blood cells, a critical function for thalassemia patients.

Quit at Least 6 Weeks Before Surgery—Earlier Is Better

A history of smoking does increase surgical risk, but quitting at least six weeks before surgery dramatically lowers the chance of complications. The sooner you stop, the better your body can prepare itself to heal.

Vaping Is Not a Safe Alternative

Let’s be very clear: vaping is not harmless. Nicotine is the primary addictive ingredient in vaping cartridges, and research shows that even nicotine-containing aerosols damage cells and cause inflammation.

A landmark study from the University of Pennsylvania School of Medicine demonstrated that even a single vaping session can impair blood vessel function and damage hemoglobin, the molecule that carries oxygen in your blood. These findings were published in Radiology in 2019—and they should concern anyone considering surgery. Even cosmetic laser procedures are not spared!

How Vaping Undermines Laser Treatment Results

Vaping may seem harmless, but when it comes to laser and energy-based treatments, it can quietly sabotage your results.

Impaired Healing and Blood Flow

Nicotine constricts blood vessels, limiting the delivery of oxygen and nutrients to your skin. This slows regeneration, delays wound healing, and increases the risk of infection after laser treatments.

Dry, Dehydrated Skin

Vapor exposure dehydrates the skin and underlying tissues. Since procedures like Hydrafacials and laser peels rely on well-hydrated skin to heal and renew properly, dryness can blunt their effectiveness.

Weakened Immune Response

Vaping can suppress immune function, making it harder for your body to repair itself. This is especially important for treatments like tattoo removal, which depend on your immune system to clear ink particles.

Reduced Collagen and Elastin Production

Smoking and vaping decrease collagen and elastin—the building blocks of youthful skin. With less elasticity and firmness, the visible benefits of anti-aging laser treatments are significantly diminished.

Bottom line: if you’re investing in laser treatments, quitting vaping helps ensure your skin can heal, regenerate, and deliver the results you’re paying for.

The Psychology Behind Vaping: Oral Fixation

Many younger adults believe vaping is “cool” or safer than smoking. But beyond the chemicals, there’s another layer: oral fixation—the habitual need to keep the mouth busy, often as a response to stress or anxiety.

Sigmund Freud suggested that unresolved psychological stages can lead to fixations later in life. Modern psychology shows that oral fixation often emerges during times of chronic stress—and let’s face it, stress levels today are sky-high.

Millennials, in particular, are experiencing record levels of anxiety and are more likely to engage in “occasional” smoking or vaping. The hand-to-mouth motion, the inhalation, the flavors—these behaviors become deeply ingrained habits.

Why Oral Fixation Matters When Quitting Nicotine

Many former vapers will tell you this: nicotine withdrawal isn’t the hardest part—it’s missing the habit. That repetitive hand-to-mouth motion becomes a powerful trigger.

To quit successfully, you must address both the chemical addiction and the behavioral habit. Understanding oral fixation causes and childhood or early adulthood trauma understanding allow us to step back, blame no one and take concrete actions to help ourselves.

Healthy Replacements That Actually Work

• Chewing gum (sugar-free) to satisfy oral fixation

• Nicotine gum, used correctly with the “chew and park” method, for short-term support

• Fidget tools and stress balls to break hand-to-mouth muscle memory

• Drinking straws or flavored toothpicks to mimic the physical habit

• Exercise, which reduces cravings, lowers stress, improves sleep, and boosts healing

• Digital tools and apps that provide accountability and reward progress

• Healthy, crunchy snacks like raw vegetables, fruit, nuts, and popcorn to satisfy oral cravings

Replacing vaping with multiple healthy alternatives—not just one—dramatically increases your chances of success.

The Bottom Line

Quitting vaping and nicotine isn’t easy—but it is achievable. People who combine physical replacements with psychological strategies are far more successful than those who rely on willpower alone.

When you eliminate nicotine, you don’t just improve your surgical outcome—you improve your circulation, your healing capacity, your mental clarity, and your long-term health.

Freedom from vaping is possible. Thousands of former users prove it every day. With the right tools, the right support, and the right mindset, you can protect your body, enhance your recovery, and give yourself the best possible outcome—especially if you’re preparing for cosmetic or reconstructive surgery.

Your body wants to heal. Give it the chance to do what it does best.

Watch Dr Khoo Kick the Habit!

Let's Kick The Habit! ( I was a former smoker from 1995 to 1999. If I can do it, you can do it too!)

Like most surgeons, I strongly recommend stopping all smoking and vaping at least four weeks before any elective cosmetic surgery. Study after study shows that quitting before surgery dramatically reduces post-operative complications and allows your body to heal the way it was designed to.

There’s an added bonus: when you quit smoking, you’re not just improving your surgical outcome—you’re breaking a habit that accelerates aging at the cellular level. That’s one of the reasons many patients who stop before surgery choose to stay smoke-free long after they’ve healed.

Make no mistake, quitting isn’t easy. But it is one of the most powerful steps you can take for your health, your appearance, and your long-term well-being—and it’s absolutely worth the effort.

Unapologetically Yours

Dr Khoo Lee Seng

What God forgot to tell surgeons: the science of acupuncture - My practice of Medical Acupuncture as a Surgeon

 I am primarily a surgeon by training having completed a Plastic & Reconstructive Surgery residency (38th Infirmary Santa Casa de Misericordia- Ivo Pitanguy Institute) with international fellowships in both Craniofacial Surgery (Chang Gung Memorial Hospital) and Reconstructive Microsurgery (Universitat Autonoma de Barcelona). www.linkedin.com/in/drkhooleeseng

As of the past year, I have an integrated practice dedicated to acupuncture within my surgical practice.

https://www.instagram.com/reel/DGmrGilPw_Y/?igsh=d2U3dHRtcXUydnp0   (Neck pain treated with medical acupuncture & Botox)

https://www.instagram.com/reel/DA3nbmes8lq/?igsh=c3l3MmpocG02bG55    (Weight Loss acupuncture)

As a surgeon, I bring a unique perspective to acupuncture, with a deep understanding of the body’s anatomy, particularly in areas where acupuncture needles are often used. https://drkhooleesengplasticsurgery.blogspot.com/2025/07/fasciadiseaseandacupuncture.html

Having performed surgeries in many of these regions, I’m able to apply my surgical dexterity to acupuncture maneuvers. In addition to acupuncture, I also use acupressure when appropriate, either as an alternative or in combination with acupuncture needles, depending on the situation.

My background in surgery allows me to address post-operative discomforts, like pain, nausea & vomiting, and issues such as slowed gastrointestinal tract movement in my patients. I believe that acupuncture can be considered a specialty of surgery, not because it deals directly with anatomy, but because it influences the body’s energy flow via meridians, which can have a profound effect on healing.

I was born in Malaysia and eventually made my way to read medicine at the Royal College of Surgeons in Ireland. After completing basic General Surgery training, I obtained the Intercollegiate Membership of The Royal College of Surgeons in Edinburgh (MRCS Edin). My background in Surgical Sciences & General Surgery gives me a solid scientific foundation that complements my acupuncture practice.

After General Surgery training, I pursued Plastic Surgery training at the 38th Infirmary Santa Casa de Misericordia Hospital under auspices of  the renowned Father of Modern Plastic Surgery, Ivo Pitanguy.https://www.wmagazine.com/story/ivo-pitanguy  

https://www.irishexaminer.com/lifestyle/fashionandbeauty/arid-20271869.html

During my residency, I was honored to receive a research award for best Scientific Research paper (Jane Brentano Prize award) among all Plastic Surgery residents in Brazil. Dr Khoo Lee Seng's Plastic Surgery Blog: Ivo Pitanguy

My interest in Medical Acupuncture was ignited as my mentor in Plastic Surgery, Dr Vasco Senna-Fernandes was also a hand surgeon and a medical acupuncturist. He taught me the concept and technique of using acupuncture points in Plastic Surgery. https://pmc.ncbi.nlm.nih.gov/articles/PMC2740529/

                      Picture of myself (middle), Ivo Pitanguy (left) & Vasco Senna-Fernandes (right)

Dr Vasco Senna-Fernandes also exposed me to the concepts of using Acupuncture pre-surgery to reduce anxiety and also post-surgery to alleviate pain and discomfort or abdominal bloating. We wrote several papers in Plastic Surgery together one of which was enjoyed immensely was the following (click link)https://www.scirp.org/pdf/MPS_2014033114215017.pdf

Other links to my research papers in Plastic Surgery https://scholar.google.com/citations?user=00YRWlsAAAAJ&hl=en

I then later sought a year-long formal Medical Acpuncture training at the University of New England under Dr Jospeh Audette who was Former Course Director of the International Structural Acupuncture Course for Physicians at Harvard Medical School and currently the President of the American Academy of Medical Acupuncture (AAMA). It was a wonderful training program with a diverse faculty who mostly are medical doctors & healthcare professionals who practice medical acupuncture. The robust and well organized training program allowed me to cosolidate my acupuncture knowledge and skills into mainstream Western Medicine and deepened my understanding of Traditional Chinese Medicine (TCM) https://acumed.org/medical-acupuncture-course-approved-cme-training-program/

                           Myself (middle) with mentors Joseph Audette (right) and Yuan Chi-Lin (left)

        Medical Acupuncture Diploma "Integrated Structural Acupuncture Course for Physicians"

 

Acupuncture, a form of alternative and complementary medicine, is part of the wellness treatments I offer in my practice.

Medical Acupuncture is available at Skin Check Malaysia. I also perform Acupuncture pre and post surgery for enhanced recovery and reduced pain.

What is Acupuncture?

Some details on acupuncture

Is acupressure the same thing? 

Acupressure developed from acupuncture points. They’re related, but not the same. Acupressure is a type of massage, while acupuncture involves placing very tiny needles to achieve bigger results. Both can be used together for enhanced benefits.

Conditions I Treat With Acupuncture

I offer acupuncture care for:

-Acne (and other forms of skin-care–related acupuncture)

-Allergies (allergic rhinitis and skin allergies)

-Asthma

-Back pain

-Cosmetic acupuncture (sometimes called an acupuncture facelift) — this can soften wrinkles and lift areas such as the brows, cheeks, under-eye bags, and even help with a double chin. There is a separate cost for cosmetic acupuncture.

-Vaping/Smoking cessation (the biggest cause of slow wound healing and poor scarring in surgery)

- Carpal tunnel syndrome

- Constipation

-Depression

-Dermatitis and skin diseases ( I also hold a Diploma in Dermatology)

-Diverticular disease

-Endometriosis

-Fatigue

 -Fertility

-Fibromyalgia

-Headaches and migraines

-Hemorrhoids

-Hot flashes

-Infertility

-Menstrual cramps

-Myofascial pain / trigger points

-Pain management

-Sinusitis (often allergy-related)

-Tinnitus (ringing in the ears)

-TMJ / jaw pain

-Weight-loss acupuncture for obesity

-Auricular (ear-only) acupuncture or Battlefield Acupuncture

…and more. Feel free to Whatsapp +6014-200 6558 and ask about specific needs.

What to Wear to Your Acupuncture Sessions

Most acupuncture points are located on the extremities — below your elbows and knees. Wearing loose-fitting pants and shirts that can be rolled up works well, or you may wear shorts.
For hip-related back pain, I may need to use acupuncture points around the hip area; we have towels and drapes available for modesty.
If you’re coming straight from work in a uniform or tight clothing, we also have patient gowns. (Keep in mind we are also a surgical clinic.)

How Many Acupuncture Sessions Will I Need?

It depends on your goals and your condition. For most concerns, I usually recommend 4–12 sessions over about two months, followed by a maintenance program anywhere from once a month to once every six months.
Of course, you don’t need to be sick to benefit from acupuncture — so your schedule is ultimately your choice.

 Scared of Acupuncture Needles?

                    Patient recounts her experience undergoing Acupuncture under Dr Khoo

About 8 out of 10 of my patients tell me the needle insertions are completely painless and the session is relaxing.
The other 2 out of 10 say the needles feel like a tiny mosquito bite (they must have been bitten by large mosquitos!). Almost no one tells me the needles hurt “like crazy”—those patients either don’t come back or ran too fast for me to notice.

                                 Patient recounts her experience as an Acupuncture patient of Dr Khoo

I’ve done acupuncture on myself and yes, it hurt a bit — but that was during training when I didn’t realize the sample needles we were given were actually thicker needles reserved for special cases.

In my practice, I use much thinner needles, about 36-gauge, so thin that several acupuncture needles can fit into the hole of a standard needle used to draw blood.
All needles I use are single-use, disposable, and among the highest-quality needles available.

If you sign up for an acupuncture session, you’ll hear plenty more about needles — fun times!

Side note: If you're scared of needles, you’re in good company — I am too, especially the ones used for blood draws. I’m not afraid to use needles on patients, though! And I definitely understand how it feels to be anxious about them.

What to Expect at Your First Acupuncture Session With Me

I’ll start by sitting down with you to discuss your goals and what you hope acupuncture can help with. We’ll talk about your symptoms, and I’ll explain what acupuncture may be able to do for you. I’ll answer any questions you have.

I’ll likely take your pulse and perform a physical examination — both are part of Chinese medicine diagnosis — and then I might give you beautifully poetic phrases such as “damp spleen” or “overheated liver”.

We’ll go over some acupuncture point charts so you’ll know what to expect. Then I’ll perform the acupuncture treatment.

During the session, we’ll keep an open dialogue; many patients end up sharing great stories, which I enjoy immensely.

Unapologetically Yours

Dr Khoo Lee Seng

Me and my young patient who came for Acupuncture treatment for rhinosinusitis and allergies. All children are welcome for Medical Acupuncture treatments at my pratice!