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Wednesday, May 19, 2021




Ever wondered what constitutes an attractive pair of breasts?

Is bigger always better?

Plastic surgeons have been studying these questions for centuries and approached this in a scientific manner.

Patrick Malucci, a British plastic surgeon published his study in 2011 after studying 100s of pairs of breasts and in essence there are 4 points that constitutes the perfect breast.

 Point 1 - the proportion of the upper to the lower pole is a 45:55 ratio.

Point 1 Breast proportion is best at 55% lower pole and 45% in the upper pole.


Study done in 2014 studying the preferences of multiple population groups and published Plastic Reconstructive Surgery Journal. It does seem multiple population groups of all races and ethnicity and sex concur on what characteristics constitutes an attractive pair of jugs.

(The ideal breast characteristics are universally accepted and applicable)

Point 2 Nipples point upwards in a 20-degree angle.

Point 3 The upper pole slope is linear or slightly concave


Point 4 The lower pole is convex (bulging out)


Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: Analysis of the ideal breast. JPRAS 2012;65:8-16


To achieve the best breast aesthetics, the surgeon must first slightly overfill the upper pole to allow a natural drop with time to achieve the 45:55 ratio. Placing the breasts immediately “perfect” on the operating table during the surgery may result in the breast sitting too low later on.

This is a rookie mistake and is important that your surgeon is able to predict the implant and breast-nipple position not just immediately but in the long-term to provide the best results.


Does Size Come Into Play? Is Bigger Better?

Well, not really!



Test silhouettes used by Swami & Tovée (2013) with a histogram showing preferences for five breast size categories. In general, medium breast sizes are preferred.

Choosing between five different breast size categories, one third of men rated medium as most attractive. Only a quarter preferred large breasts and just one in 10 preferred very large breasts.


Histograms showing breast size preferences shown by men in each test population. Note that there is a predominant tendency towards a preference for medium-sized breasts, although Cameroon is an exception.


So there you have it - characteristics of the ideal pair of bosoms. However, I would like to note that every person’s built is different and one can be beautiful in a harmonious manner.

You will need to speak to an experienced surgeon to determine your ideal breast size and shape and to achieve the results you dream of.

And remember, bigger is not always better!

#breastaugmentation #breastimplants #motivaimplants #bliteimplants #skincheckmalaysia88 #gemclinic #drleesengkhoo #augmentationmamaplasty #aumentodemama


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Sincerely yours,

Dr Khoo Lee Seng

Thursday, May 13, 2021


Salah satu kemahiran yang diperlukan oleh doktor bedah kosmetik adalah kemampuan untuk menyesuaikan prosedur pembedahan payudara untuk pesakit golongan Asia. Ukuran badan golongan pesakit Asia dan tekstur kulit mereka berbeza dengan pesakit Eropah dan merupakan faktor yang kritikal ketika membuat keputusan mengenai implan payudara.

Kebanyakan wanita Asia memiliki ketinggian yang lebih rendah, bentuk badan yang lebih mungil dan juga saiz payudara yang lebih kecil berbanding dengan wanita Eropah. Implikasinya adalah doktor bedah mesti menggunakan implan yang lebih kecil daripada yang akan digunakan untuk wanita Barat. Contohnya, implan untuk membesarkan payudara wanita Asia menjadi Cawan (Cup) A atau B sudah cukup untuk menjadikan mereka lebih feminin, dengan penampilan yang dianggap ‘natural’ atau semula jadi. Peningkatan ukuran cawan C atau D mungkin terlampau besar untuk tubuh segolongan wanita Asia dan akan memberikan penampilan yang kurang natural.

Golongan pesakit Asia juga memiliki kecenderungan bekas luka yang timbul dan berpigmen. Kulit orang Asia lebih halus dan itu merupakan salah satu sebabnya wanita Asia sering kelihatan anggun walaupun dalam fasa penuaan 40an dan 50an. Walaupun ini boleh dianggap sebagai satu kelebihan, tetapi dalam pembedahan payudara, doktor bedah harus berhati-hati untuk mengelakkan parut yang prominen. Wanita Asia juga suka merahsiakan prosedur kosmetik. Justeru itu, bekas luka yang terserlah boleh mengakibatkan ketidakpuasan pesakit.

Bagi mengelakkan bekas lupa yang prominen, doctor bedah mesti membuat sayatan yang tepat dan sesuai untuk tubuh pesakit. Terdapat pelbagai pilihan untuk penempatan sayatan contohnya yang paling popular adalah di bawah lipatan payudara kerana sayatan tersebut tersembunyi dalam lipatan semulajadi payudara. Ada juga doktor bedah yang membuat sayatan lingkaran sekitar puting atau di lipatan ketiak. Terdapat kelebihan dan kekurangan bagi setiap sayatan pembedahan yang terbabit.

Pilihan implan yang digunakan untuk pembesaran payudara wanita Asia mengikuti prinsip perancangan dan pengukuran tisu yang disyorkan untuk membantu pilihan implan yang sesuai. Bagi wanita Asia yang mahukan penampilan susu labung yang lebih penuh dan terserlah, doktor bedah akan mengesyorkan implan silikon bulat yang berprofil tinggi. Bagi golongan yang mahukan penampilan yang lebih semulajadi; implan Ergonomix atau implan yang berbentuk air mata (teardrop) boleh digunakan. Cantuman lemak atau “fat grafting” boleh digabungkan dengan pembedahan payudara (dipanggil Hybrid Breast Augmentation) untuk penampilan yang paling natural.​augmentation-in-Malaysia.htm

Sekiranya anda mempertimbangkan pembesaran payudara tetapi mempunyai keraguan atau kebimbangan, sila hubungi kita untuk berbincang mengenai pilihan implan dan kaedah pembedahan yang paling sesuai. Hubungi Skin Check Malaysia untuk menempah konsultasi peribadi hari ini.

Ikuti kami di laman media sosial untuk informasi koleksi terbaharu dan aktiviti kami sepanjang tahun.

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Friday, April 16, 2021

Should I Get Breast Implants or Fat Grafting? – That Is the Question


Should I Get Breast Implants or Fat Grafting? – That Is the Question

When considering breast augmentation or enlargement surgery, implants are no longer the only options. There is also the possibility of using the fat transfer techniques for natural or organic breast augmentation. With the option to choose between the two, anyone who is considering a breast augmentation procedure needs to think about which option might be better suited to the results that they want. Fat transfer isn’t always the right choice, and implants could be the better option for some people. Both implants and fat transfer have pros and cons, which should be explored before deciding which procedure might be best for your breast augmentation.


What Is Fat Transfer?

Fat transfer is an “organic” method augmenting the breasts by harvesting fat from another part of your body for example your thighs and tummy. The procedure starts with liposuction techniques to harvest donor fat from an area of the body with excess fat. The fat cells are then washed, centrifuged and purified before being reinjected into your breasts (or another part of the body that you want to augment – fat grafting is also an alternative for facial volumization with fillers). This means that you can both remove excess fat from an area which you would like to reduce and augment your breasts or another body part (such as your butt in the Brazilian Butt Lift) at the same time.

The Advantages of Implants

Using implants offers a number of advantages for augmentation. Breast implants offer excellent shape and projection which is unmatched with fat grafting alone. It could be the best choice for those who want to enlarge or lift their breasts.

Size and Shape

Choosing implants means that you can select a size and shape that suits you. You are only limited by the implant sizes & dimensions that are available, whereas if you choose fat transfer, the amount of fat that you have makes a difference (Disadvantage in slim or thin women as they have less fat for harvest).


When it comes to the safety of implants, breast augmentation surgery is something that has been carried out and tested for many decades. Although there have been safety concerns related to certain types of older implants, this has mostly been related to poor quality implants or incorrect insertion & technique or sterility. They are generally regarded as being very safe, especially with newer type of microtextured implants to choose from such as Polytech, Lifesil & Motiva.

Implant guarantee | POLYTECH Health & Aesthetics (


Another advantage of breast augmentation with implants is how long they last. The lifespan of breast implants should be between around 15 to 20 years before they need to be replaced. Unless you experience any complications, they need not be replaced any earlier than this.


Implants can be the less expensive option when compared to fat grafting. This is because fat transfer requires two procedures to first harvest the donor cells and then inject them, whereas implants require only one procedure. Furthermore, some breast envelope pockets are tight necessitating a second fat grafting procedure after the initial expansion. Some grafted fat is also lost (about 20-30% of fat is lost by resorption) after surgery. We use Stromal Vascular Fractionate (SVF) and Platelet Rich Plasma (PRP) to enhance the fat graft survival in our surgeries leaving our fat grafting ‘take’ to be between 70- 80%.

The Disadvantages of Implants

Implants can also have a few drawbacks that should be considered when one decides between implants or fat grafting for breast augmentation.

Today, implants can be made to look very natural, especially when you choose the right type of implants and technique used by the surgeon (I prefer using a dual plane placement of implants and sometimes perform hybrid breast augmentation combining breast implants and fat grafting in the same surgery). However, some women with very little soft tissue coverage over their breasts who undergo breast augmentation with implants alone may have some rippling and slightly unnatural appearance such as less cleavage.


A hybrid breast augmentation – implant combined with simultaneous fat grafting will be indicated in such situations but can pose a problem for patients with budget constraints.

You may read more about Hybrid Breast Augmentation here.

There is also a very small risk of implant capsular contracture. Your body builds a “capsule” around each breast implant. The capsule is made from interwoven collagen fibers, or scar tissue. In some cases, the capsule tightens over time. This is called capsular contracture. When this happens, the collagen “fabric” around the implant shrinks due to a buildup in fibers. This tightening can squeeze the implant, making it feel hard and painful to touch. The incidence of capsular contracture is very low if correct technique which is surgeon dependent.

To prevent capsular contracture, I do not use breast sizers during the surgery as this can increase trauma & contamination leading to higher rates of capsular contracture. I published this study with world famous plastic surgeon Ivo Pitanguy who was also my Program Director during my plastic surgery training in Brazil.

You may read more about the Founding Father of Plastic & Reconstructive Surgery, Ivo Pitanguy here.

I also use the Keller’s Funnel to decrease contamination and trauma during implant insertion ultimately leading to lower rates of capsular contracture.


The Advantages of Fat Transfer

Fat transfer also has some excellent advantages that might tempt you to choose it over the traditional augmentation method of implants.

For many people, the appeal of fat transfer is that it is more natural. Not only does it mean you won’t have any foreign material in your body, but it can create a softer more natural-looking augmentation too. However, it is still a major procedure, even if it is sometimes called natural breast augmentation.

Another benefit of fat transfer is it can address two concerns at once. If you want to augment one area but also reduce fat in another area, this procedure can help. You can remove fat where it’s unwanted and inject it into your breasts or another area where you want to increase the size, volume or shape.

Fat transfer is still a major procedure, but it is less invasive compared to implants. It does not require the incisions that are required for inserting implants.

In circumstances when implants may not be required, fat transfer can be a good choice. It is ideal for evening up uneven breasts or restoring the shape of a breast after a lumpectomy or in breast reconstruction.


The Disadvantages of Fat Transfer

Fat transfer has its share of drawbacks, which are important to understand before going ahead with the procedure.

Fat transfer can work out if you are looking for modest results. However, if you’re thinking about enhancing your breasts more than half a cup size or so, implants are likely to be better. You are also limited by how much fat you have available to use from other parts of your body.

While implants can last for many years, the results of a fat transfer might not last as long. The fat cells that are transplanted could be absorbed into the body if you diet or lose weight.


Overall, a fat transfer will cost you more than implants. It involves both liposuction techniques and injecting the harvested fat cells into the desired area. While these things can be done with local anesthetic and as an outpatient procedure, it can still be more expensive than implants. You may also require 2 to 3 sessions of fat grafting to expand the breast envelope to allow you to achieve the cup size that you desire.

The fat transfer method might not always be suitable in very thin or slim women. It works best for anyone who has some extra fat that they can use in another area of their body. If you are particularly slim or thin, you will probably find that you don’t have the necessary fat cells to harvest. It’s also not suitable for anyone who wants to go up by more than around a cup size.


Fat transfer might be referred to as natural augmentation, but it’s still a serious procedure with risks. It’s a newer procedure compared to implants, so the safety issues aren’t as well explored. It is a safe procedure, but it’s still a surgery that comes with some risks.


When to Use Implants

When should you choose implants for breast augmentation, or to enhance other parts of your body? Implants are probably the best choice if you want to increase the size of your breasts by more than half to one cup size. This is more difficult to achieve with fat transfer. Implants are also the better option if you are looking for more long-term results. Implants will last for a long time, and you can wait for 15 to 20 years before you need to consider replacing them. Choosing implants could also save you money too, especially as they last for a long time.


When to Use Fat Transfer

Fat transfer could be a good option for people who want to both remove fat in one area and enhance another area. It is ideal for women who want a more natural or subtle change, as it’s used to make a smaller change. It might also be right for those who want to even out uneven breasts or want to smooth out changes after a lumpectomy. If implants seem too big of a change or you want to keep things subtle, fat transfer could be the right option.


Whether you choose implants or fat transfer, it’s essential to have the right surgeon with ample experience with breast augmentation and liposuction & fat grafting.

#breastaugmentation #organicsurgery #fatgraftingbreasts #lipografting #liposuction #breastimplants #hybridbreastaugmentation #polytechimplants #bliteimplants #motivaimplants #motivaimplantsmalaysia #lifesilimplants #aumentodemama #drleesengkhoo #skincheckmalaysia88 #gemclinic


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Sincerely yours,

Dr Lee Seng Khoo




Saturday, March 20, 2021




Masalah faraj longgar merupakan masalah bagi ramai wanita selepas melahirkan anak. Namun demikian, perkara itu kurang diberikan perhatian kerana ramai yang malu atau kurang pemahaman mengenainya.

Lebih kurang 50% wanita menyatakan kebimbangan terhadap masalah faraj longgar tetapi cuma 20% telah mendedahkan hal tersebut dengan pakar perubatan.

Biasanya, aduan pesakit ialah kurangnya “rasa” penetrasi semasa menjalankan hubungan kelamin.

Ada pihak yang mendakwa bahawa masalah ini berpunca daripada kerap melakukan hubungan seks. Tetpai adakah kenyataan ini berdasarkan fakta ataupun merupakan mitos semata-mata?

Faktor Usia Meningkat & Hormon Estrogen Menurun

Sebenarnya, faraj adalah struktur yang bersifat elastik dan fleksibel. Tetapi dengan peningkatan usia (40an ke atas), hormone estrogen dalam badan akan menurun sehingga masuk fasa menopaus. Akibatnya faraj akan menjadi lebih nipis dan kering, kurang elastik dan juga kurang anjal.

Kelahiran Anak (Bayi)

Sewaktu bersalin,otot faraj anda akan meregang secara maksimum supaya bayi boleh keluar melalui saluran kelahiran. Selepas bersalin, anda sudah pasti akan rasakan yang faraj anda lebih longgar berbanding sebelum ini. Hakikatnya, faraj anda juga akan menjadi semakin longgar selepas kelahiran anak-anak yang seterusnya.

Suami atau kekasih anda mungkin tidak suka atau bisa melakukan hubungan intim kerana merasakan faraj cik puan longgar dan tidak memberikan kenikmatan. Ini sudah pasti akan mencacatkan kehidupan seks dan hubungan intim suami isteri.

Jadi, Persoalannya -Bagaimanakah Cik Puan Boleh Mengetatkan Otot Faraj & Meremajakan Kerupaan Faraj?

Bagi wanita yang masih muda dan belum lagi bersedia untuk menjalankan prosedur pembedahan, rawatan terapi laser atau readiofrequency faraj boleh dipertimbangkan. Tenaga haba yang dihasilkan oleh laser merancakkan pengeluaran kolagen dan elastin yang dapat membantu menguatkan saluran faraj. Namun demikian, kaedah laser kurang berkesan bagi kes kelonggaran yang lebih serius.

Pembedahan merupakan cara yang paling efektif bagi mengetatkan faraj. Antara prosedur yang boleh dilakukan adalah vaginoplasty dan labiaplasty. Kedua-dua prosedur ini bertujuan dapat mengetatkan kembali dinding dan otot faraj selain meremajakan rupa luaran faraj yang mempunyai tisu yang berlebihan.

Pembedahan Vaginoplasty

Pembedahan Labiaplasty

Pembedahan Labiaplasty & Vaginoplasty oleh Dr Khoo

Terdapat juga prosedur lain yang boleh dilakukan untuk memperbaiki faraj seperti hymenoplasty atau revirgination. Artikel berikutnya ditulis oleh pengarang Dr Khoo Lee Seng sendiri.

Objektif hymenoplasty (dan revirgination) adalah untuk memperbaiki selaput dara dan mengembalikan bentuk asalnya. Dari segi pandangan budaya dan agama tradisional, selaput dara merupakan lambang perawanan bagi setiap perempuan. Selaput dara boleh terkoyak semasa melakukan hubungan seks, melakukan aktiviti lasak seperti sukan atau menggunakan tampon semasa kedatangan haid. 

Walaupun terdapat isu kontroversi, kaedah tersebut dilakukan untuk mengembalikan virginity atau kedaraan seorang gadis secara pembedahan.

Selain itu, wujud juga prosedur mendedahkan sktruktur klitoris wanita yang terlindung yang dipanggil “clitoral dehooding” bagi membolehkan wanita mencapai kepuasan maksimum semasa melakukan hubungan intim dengan suami atau kekasih. Salah satu lagi prosedur yang popular adalah G-shot di mana doctor akan menguatkan G-spot dengan Platelet Rich Plasma (PRP), lemak atau filler supaya wanita dapat sensasi yang lebih sempurna semasa menjalankan hubungan kelamin.

Pembedahan Clitoral Dehooding


G Shot (juga dikenali sebagai O Shot atau Orgasm Shot)

Selaras dengan proses penuaan, wanita akan kehilangan tisu lemak bukan sahaja dari muka dan susu labung tetapi juga dari bahagian kelamin.

Pemindahan lemak merupakan satu kaedah yang selamat bagi mengembalikan kemontokan dan kemudaan mons pubis dan labia luaran. Lemak yang diekstrak dari bahagian-bahagian badan yang lain seperti bahagian bawah abdomen, pinggul atau punggung boleh digunakan untuk mengisi mons pubis dan labia luaran bagi mengembalikan penampilan yang muda dan lembut.


#farajlonggar #mitos&fakta #farajbecak #vaginaltightening #vaginoplasty #labiaplasty #gshot #oshot #vaginalrejuvenation #clitoraldehooding #meremajakanfaraj #hubungansuamiisteri #skincheckmalaysia #drleesengkhoo

Ikuti kita di dan juga di Instagram #skincheckmalaysia88 #drleesengkhoo

Sila buat temu janji rawatan berkaitan prosedur mengetatkan faraj selepas bersalin (invasif dan non-invasif).

Hantarkan mesej Whatsapp +6014 2006558 atau telefon 03-5621 1909. Anda juga boleh menghantar email kepada:


Yang Benar,


Dr Lee Seng Khoo




Monday, March 8, 2021



I personally receive many enquiries requesting breast fillers daily. Touted as a risk-free alternative to breast augmentation with implants; they are actively promoted by many aesthetic clinics to patients as safe, reversible, having no downtime and cheaper to boot. Furthermore, filler breast injections require no hospitalization or surgery. Boobs can be discreetly enlarged in 30 minutes or less with instant gratification.

Hence, the big questions – why I do not perform filler injections for breast enhancement?

The use of fillers for breast augmentation has been performed since the dawn of time. Early attempts at augmentation involved injection of substances such as liquid paraffin or oil into the breast tissues. Other more bizarre materials such as ivory or glass balls and rubber have been tried. Then came the era of the injection of liquid silicone, polyacrylamide hydrogel and hyaluronic acid.

Virtually all of these injectable substances have been associated with high rates of unacceptable and often irreversible complications.

During the 1940s and 1950s, a half-century after the paraffin saga, history repeated itself again with silicone injections. Some of the complications were even worse, because industrial grade silicone was injected and contaminants were purposely added to the silicone injections, to cause sclerosis of the silicone, to hopefully restrict its migration.

During the past 20 years, a newer class of injectable material emerged: Polyacrylamide Hydrogel. This material was originally introduced under the name of Royamid in the late 1980s. It was subsequently marketed under the name of Interfall and Formacryl. In 1997, it was approved by the State Drug Administration in China (the Chinese equivalent of the FDA). Most preparations marketed today are manufactured by Contura International (Denmark), under the brand name Aquamid which was popular in Malaysia.

Numerous reports subsequently appeared, demonstrating that numerous complications can occur after these filler injections. These can develop from several months to three years after injection. They include the following: migration, breast lumps, pain, infection, granulomas and permanent disfigurement. Migration of Polyacrylamide fillers appears to be due, in part, to a leak of the viscous injected material from the pocket, through the injection tract.

The filler thus has been rebranded as Outline, Bioformacryl, Argiform, Amazing Gel, Ao Mei Ding and Bio-Alkamid and pushed to various guillable medical professionals around the world again leaving a trail of often uncorrectable complications.

Migration of filler material from breasts to abdomen (tummy).

Realizing that Polyacrlyamide Hydrogel has been banned in several countries, manufacturers decided to capitalize on the ‘apparent’ safety of cross-linked hyaluronic acid which has been used in smaller amounts on the face to translate to breast enhancement. Marketed by Q-Med as Macrolane since 2008, colloquially referred to as the "30-minute boob job”. A recent study showed that Macrolane complications may appear months after treatment, as local infections, product dislocation, and breast lump onset. Ultrasound and MRI help to diagnose the nature of the complication. Patients must be warned that it can be impossible to totally remove Macrolane, once implanted.

MRI showing accumulation of filler material that failed to resorb causing infection.

In Sweden there have been a number of cases of erection problems and pain associated with erection when Macrolane injections were used to increase penile size, prompting a mandatory investigation into the safety of the product. Macrolane has thus been discontinued.

But many knock-off versions appeared in the market legally (example Charmost hyaluronic acid Ultra D breast fillers and 100s of other brands) under various trade names all touting “safe” hyaluronic acid that is cross-linked and is non-permanent and offer instant breast enhancement. Many doctors like to perform these injections as the profit margins are high and the procedure is easy to learn and perform.

Aquafilling was developed in 2005 and its use for breast augmentation has gained speed in several countries claiming that it lasts from 5 to 8 years but costs a fraction of a formal breast augmentation surgery or breast fat grafting. Its declared composition is 98% water and 2% polyamide. Various studies and case reports revealed the extent of complications/adverse effects of Aquafilling but the product and various generic brands of hyaluronic acid fillers for breast enlargement are still available in the market and is widely popular in Malaysia.

Granulomas forming after filler substance injection. Easy to perform, hard to remove.

I have seen and treated many of these patients presenting even years after filler injection. Some cases even warranted mastectomies (complete removal of breast tissues) and reconstruction for treatment of the complication.

Infected fillers removed surgically.

Fillers injected in high volumes often do not fully disintegrate as claimed by manufacturers.

The only lesson history has taught us so far in the use of fillers for breast augmentation is this – we have not learnt anything from history and hence history has repeated itself and is repeating itself.

I urge all patients seeking breast augmentation to not take short-cuts and opt for breast fillers no matter how tempting it may appear from an economic point of view (these fillers are still not cheap and costs start from RM12,000 and up to RM45,000) and also in seeking to avoid undergoing surgery at any costs (which contrary to popular belief is safer than breast fillers).


#breastfillers #dontdoit #breastfillerscomplications #aquafilling #macrolane #nonsurgicalbreastenlargement #breastaugmentationfiller #fillergranulomas #fillerinfections #breastaugmentation #fatgrafting #breastfatgrafting #breastimplants #hybridbreastaugmentation #motivaimplants #motivaimplantsmalaysia #lifesilimplants #bliteimplants #aumentodemama #drleesengkhoo #skincheckmalaysia88 #gemclinic


Follow us on and on Instagram #skincheckmalaysia88 #drleesengkhoo

If you have had complications after breast fillers treatment or would like to learn about safe breast enhancement, please Whatsapp +6014 2006558 or call 03-5621 1909. Alternatively, you may email


Sincerely yours,


Dr Lee Seng Khoo





Wednesday, February 3, 2021

Doctor (Nose) Best – Not All Nose-Jobs Are Created Equal

Doctor (Nose) Best – Not All Nose-Jobs Are Created Equal


“This doctor ripped me off! I could have gotten one for $200!”

Many patients are always puzzled in the difference of pricing between surgeons who perform rhinoplasty.

Some doctors may perform a rhinoplasty (nose job) for as little as USD $200.00 and yet some surgeons who may charge as high as USD $10,000 to $20,000.

Why is there such a huge discrepancy in pricing?

After all, a nose job is nose job is a nose job! How different can it be?


Not All Nose-Jobs or Surgeons are Created Equal?!

Just like a car – 4 doors, 1 steering ,1 gear box and 4 wheels.

A Yugo or a Perodua is not a BMW, Jaguar or a Bentley. And we all know that! Yes, the Yugo gets you from A to B and so does the BMW – here is where all similarities end.

So, yes not all surgeons are of the same ability or pedigree (not that a better pedigree equates to a better result) as there are various factors at play including the surgeon’s experience with rhinoplasties and the technical and intellectual ability of planning the rhinoplasty AND the material used to perform the rhinoplasty.


Asian Rhinoplasty – Enter the Silicone Nose Implant

In Asia, the most popular form of rhinoplasty is with the use of the closed method rhinoplasty.

The doctor makes a small incision (cut) at the nose margin, dissects and inserts an L -shaped silicone implant and voila – a nose job done in 30 minutes or so!

Patients are more often extremely happy with the results and the surgeon is commended for being fast with an economical price to boot.

Downtime is minimal, there is no harvest of rib, nasal septum or intricate procedures that result in prolonged swelling and a higher price to boot.

Indeed, for many doctors this is what they only know how to do or for some, only choose to do.

Many patients may be limited by budget and also some unprepared to use autologous material such as rib (costal cartilage) or nasal septum and additional ear cartilage grafts; and swayed by online marketing ads often come to my practice requesting a pure silicone L shaped rhinoplasty. Although not my first choice, a safe reasonable result is often achievable with silicone nose implants. I do perform silicone rhinoplasties for certain patients with limited budget who understand its limitations.

Today other options include filler injections and PDO threads (again, not my preference although I have performed these procedures extensively at one point). I will touch more on that in future.


Wait! Isn’t A Silicone Nose Job Cheap & Good Enough?

For many decades, silicone nose job was the preferred choice of material for nose jobs. It was cheap (and still is!), the surgical procedure was quick and patients were thrilled (especially immediately post-surgery).

The patient also avoids additional general anesthetic and recovery room charges.

Ideally, the augmentation rhinoplasty should be achieved with autologous materials (from own body such as buttock dermal fat, rib and septal cartilage). These procedures are uncomfortable and unpleasant for the patient if not performed under general anesthesia.

However, there were specific complications associated with the use of silicone implants in rhinoplasties. The complications typically don’t occur until 12 months and sometimes a few years after nose implant surgery.

Silicone nose implant extrusions are one of the known complications as the nose tip skin is thin.


Examples of impending extrusion and extrusions due to excessive pressure of silicone implant on nose tip skin (a shorter implant should have been used)

And yes, if you are asking, the results of a shorter implant would be less aesthetic. Here, there is compromise between safety and enhanced appearance.

As silicone nose implants are foreign bodies and the implant has no external shell (unlike breast implants), they carry a higher risk of infection compared with cartilage grafts and dermo-fat grafts.


When infection (pus/abcess) and impending extrusion occur – the only solution is removal of the implant and replacement with a more biocompatible implant material such as Megaderm or autologous (own) rib graft or dermo-fat graft (more on that later).

Silicone being a foreign body elicits capsular contracture with calcification and can occur causing a distorted upturned nose even years or a decade after implantation.



Examples of silicone nose contractures


Up close of view of Calcium deposits on the silicone nose implant causing contractures.

This is not a knock against surgeons who continue to use Silicone nasal implants (even I do too!) but it is important to understand why cheap surgery is not always cheap in the long term.

Our nose has two joints, one connecting the cartilage with the bone and the other one connecting the alar cartilage with the upper cartilage.

These joints allow free movement of the nose from left to right, upwards and downwards.

If we place a hard silastic silicone implant above these structures, the joints will be fixed and any medium velocity force to the nasal area can lead to resulting trauma, much like placing a nail over the nose. Thankfully, we have much better silicone implants today such as the hybrid soft-hard silicone implants that I now use in my practice.


Ok Doc- You Sound Like Your Surgery Costs a Bomb! What are the Alternatives?

Rhinoplasty Is way more than putting in an implant!

Surgical work on the tip to manipulate the size and shape is as important as increasing bridge height.

But anyway, let’s talk briefly on alternative implants (they cost more but are safer and more biocompatible)

Acellular dermal matrix (example Megaderm) is derived in the lab from human skin components that have been washed off immunological and bacterial debris leaving only the viable matrix. They have no risk of extrusion and have a lower risk of infection compared to Gore-Tex and silicone nose implants. Megacartilage are obtained from cadaveric ribs and are immunologically cleaned and hence inert and safe.


Megaderm & Megacartilage nasal implants

Dermofat (skin and fat graft) can be used to augment the nasal bridge safely.

Dermofat graft harvested from the buttock in an inconspicuous manner hidden incision. This is less invasive than a rib graft harvest.

All the aforementioned above are more costly than a simple silicone rhinoplasty and hence will cost more. It is not easy on the wallet short term but are safer and more stable for the nose structure.

Rhinoplasty is more than just placing in an implant!!!

Sometimes internal cartilages are crooked and impair breathing or cause the nose to be deviated.


They have to be removed, straightened and placed back into the space inside the nose.

And no, the implant alone will not solve this problem!

Sometimes in a fat nose tip, the size has to be reduced by removing some cartilage as follows.

The green area of the upper lateral nose cartilage is removed.

Once removed the upper lateral cartilages are smaller and a finer nose tip is possible.

But that’s not all!

Tip sutures further refine the nose.


Notice how the suture makes the tip finer and less wide.


Dome spanning sutures further increase the height of the nose.



Example of a tip work with cephalic trim and domal sutures, patient also had Septal Extension grafts and various techniques of tip grafting

An example of a shield tip graft (obtained from rib or ear cartilage) to increase projection in the nose.


Sometimes the nose buckles when a shield tip graft is placed hence a collumelar strut is needed to add strength so the nose maintains its shape over decades.



Various types of Septal Extension Grafts/Collumelar Struts are used to change tip inclincation, shape and direction.



Again, these are minute intricate surgery requiring the septal surgery and modification. We have not yet touched on osteotomies (breaking the nasal bone to reduce a wide nose) and other intricate procedures such as spreader grafts, correcting alar flaring and alar overhang and various other types of grafts, This is not achievable with a simple 30 -minute “cheap and good” silicone rhinoplasty.


Example of an osteotomy design (in blue) to break the nasal bones to allow repositioning to be less wide.

Osteotomies may require spreader grafts to prevent breathing difficulties in future.

Parting Thoughts

Rhinoplasty is an intricate surgery requiring specialized skills and training for satisfactory long-term results. Silicone rhinoplasty although less favourable is still the main choice in the Asian market due to competitive pricing, low downtime and high number of surgeons able to perform pure silicone rhinoplasty.

However, there are better implants in the current market such as Megaderm, Mega Cartilage and Silicone-PTFE Hybrid implants. The best option is autologous material from dermo-fat, ear cartilage or rib grafts. Patients may not agree to have dermo-fat or rib cartilage harvested. Many patients also have limited understanding on various grafting techniques to improve the appearance, inclination and angle of nose. Nose tip refinement techniques do cost more time and require good skill and experience of the rhinoplasty surgeon. Not all surgeons are created equal AND not all nose-jobs are created equal.

Sometimes we get exactly what we pay for! Remember you do your rhinoplasty once but should last you a lifetime. A good surgeon will find a middle path between technique/approach, budget and expectations while not breaking the bank! Don't let your nose job become a botch job.




#nosejob #rhinoplasty #siliconenosejob #asianrhinoplasty #budgetnosejob #cosmeticrhinoplasty #functionalrhinoplasty #botchednose #cheapandgood #plasticsurgery #skincheckmalaysia88 #gemclinic #drleesengkhoo


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To make an appointment to see the rhinoplasty works (before and after) of Dr Khoo, please Whatsapp +6014 2006558 or call 03-5621 1909. Alternatively, you may email


Sincerely Yours,


Dr Lee Seng Khoo

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