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.

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.

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.

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, ACCSM, and reputable articles to verify information which is non-biased.

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.skim-milk.com/facial-plastic-surgeons-vs-plastic-surgeons/

* [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!

The Psychological Aspects of Medical Acupuncture - Treating the Patient Beyond Surface Pathology

As both a medical professional - surgeon and martial artist I meditate a lot. In meditation, we often confront the impulse to judge our thoughts and feelings for example of shock, sadness, anger or guilt. That judgment hardens into rejection; rejection resists the flow; and resistance becomes stagnation. Where there is stagnation, the qi cannot move — and where qi cannot move, suffering takes root and disease sets in.

An example of moving meditation that I do is using the Siu Nim Tao 小念頭 form to guide my mind to only focus on the movements thereby achieving a one-pointed-mind instead of no-mind.https://vimeo.com/1074016019?share=copy&fl=sv&fe=ci

Yet emotions are not enemies. They are not to be feared, condemned, or exiled. Nor are they to be indulged without restraint. They are simply energy in motion — echoes of the spirit stirring within the blood. The instruction I received was simple, yet profound: do not cling to the story; feel the energy beneath. Sit with it. Let it rise, and let it fall away like a wave returning to the sea. Breath in and breath out the emotions. Be the observer of the emotions not the bearer of the emotions.

https://www.youtube.com/watch?v=y7KSMYTsZKM

In the classical view of Chinese Medicine, all emotions are natural — they become harmful only when they linger, becoming trapped in the body. The Huang Di Nei Jing  黄帝内经(Yellow Emperor Classic Cannon of Medicine) teaches us that the Shen 神 (spirit) rides the blood; and when the blood stagnates, so too does the Shen. What we call “emotion” is not merely psychological — it is movement, vibration, a rhythm of energy coursing through the meridian rivers.

There are three layers to this emotional current:

1. Moods – Wei Level

Moods are like weather passing across the surface of the body. These arise without story or known cause — a sudden melancholy, an unexplained irritation often in women but also in men. They dwell in the Wei Qi, the protective energy that circulates through the muscles, skin, and sensory gates. When Wei becomes obstructed, we may find ourselves burdened by emotion that feels foreign or rootless. Clearing the surface — through breath (meditation), movement (chi kung), or needle (medical acupuncture) — restores clarity, allowing the cloudy moods to part.

2. Repression – Ying Level

Repressed emotion sinks deeper — hiding within the blood and sinew, waiting. I once seen and treated a woman who presented with red, scaly patches at her toes, first diagnosed by various dermatologists as athlete’s foot. But the location — Gallbladder 43, "Valiant Ravine" — revealed the truth: heat rising from unresolved anger, trapped and seeking release. 

Medical Acupuncture treatment to restore flow to the Gallbladder meridian and also to treat psychosomatic Shu points on the back eliminated the skin disorder without any prolonged use of topical antifungals.

Repressed emotions is a quiet fire. It may not appear as feeling, but as symptom — pain, inflammation, rigidity in the joints such as arthritis or knee pain. 

The Gallbladder stores our unexpressed courage or anger and frustration.

The Bladder becomes the holding place of unspoken fear and unresolved will.  When these organs bear more than they can transform, the body whispers through pain and manifests as illnesses or diseases. If the person is very nervous or scared, he may urinate out of fear or have frequent urination.

3. Suppression – Shen Level

Suppressed emotions are known to us — we feel them, we know their stories — yet we do not let them go. We keep the motions however painful or uncomfortable within ourselves and not reveal them.

They will the dwell in the chest, in the palace of the Heart and the Lungs. Pain in love connections or in relationships is felt directly at the Heart. The Heart houses the Shen, the sovereign spirit. The Lungs command the Po 魄, the corporeal soul, the part of us that grieves, releases, and returns to Earth. When the chest is open, the Lungs allow us to exhale emotional tension like a bird shaking off rain. The Heart speaks through the tongue — not just in words, but in the vibrational truth of our expression.

But when the chest is closed, when the grief is not cried, when the words are not spoken, the digestive organs must step in — Earth transforming what Heaven could not. 

The Stomach and Intestines begin to digest our emotions, sorting the pure from the impure. We begin to lose appetite, lose weight and cannot digest what we consume.

And if even Earth cannot bear it, the unresolved energy descends into the depth — into the joints, the low back, the bones — hiding within the Bladder and Gallbladder meridians like seeds of latency. 

There, the fire continues to burn, low and unseen, weakening the immune gates and fraying the vitality of the blood giving rise to high blood pressure, blood cancers/dyscrasias and various circulatory disorders of the body.

This article is not intended to invoke fear, but rather a reminder to let some emotions go and walk lighter in life. Do not dwell on emotions such as greed, anger, jealousy, apathy or having a vengeful spite because ultimately this will only injure yourself. 

Focus on emotions of joy or being engrossed in the moment. Become a child again for once and everything is a wonder again. A child does not need much to be amused or to smile. Even after crying, all is forgotten as the child is now giddy with joy again.

Conclusions

Emotions are not separate from qi, nor from blood. They are the spirit’s response to life. To heal is to clear the meridians, restore the free flow, and allow the Shen to reside peacefully in the Heart. Acupuncture, like meditation, opens the gates, revives circulation, and allows the spirit to move freely again.

When the chest opens, when the breath deepens, and the blood warms with flow — we remember what it feels like to be light. To feel. And to let go. And to be a child again.

Unapologetically Yours

Dr Khoo Lee Seng

EMOTIONS THAT CAN MAKE YOU SICK & EVEN IMPEDE HEALING POST SURGERY by Dr Khoo Lee Seng

You eat right, you do regular exercise, you take the correct supplements, heck you don't even smoke or drink but yet you became severely ill! Why? You did everything right but your emotions ran wild....

“The seven emotions give rise to chaos, which leads to the formation of mucus.”

 “Shock, fear, worry, and pensiveness are the roots that produce mucus.”

The Yellow Emperor's Classic of Medicine 黃帝內經

These observations are grounded in the ancient wisdom that recognizes the subtle interplay between emotions and the body’s internal balance. Emotions—particularly those that are intense and unresolved—are the source of qi stagnation. 

This stagnation manifests in the body’s most vital systems, especially the lungs and liver, disrupting their natural functions. 

The lungs, which are responsible for the downward movement of qi, and the liver, which governs the upward flow of energy, become obstructed. 

The result is a cascading imbalance that impedes the spleen’s ability to regulate water, giving rise to dampness, which accumulates as mucus in the lungs. This dampness blocks the body’s ability to metabolize water properly, further exacerbating heat and contributing to a cycle of anxiety.

“Strange and difficult diseases come from mucus,” Huang Di Nei Jing (Yellow Emperor's Classic of Medicine).

Allow me to translate this understanding into the language of Western medicine. 

YOUR EMOTIONS CAN MAKE YOU ILL 

Strong emotions—such as anger, fear, grief, and stress—create a dysregulation in the body's delicate balance. 

For example when the liver is overworked for example processing too much alcohol or toxins such as nicotine or drugs - the person manifests this as easily angered. 

Overthinking and overworking taxes the spleen and disrupts the digestive system leading to constipation or diarrhea. In traditional Chinese medicine, a weak spleen may lead to blood leaving its vessels, which can manifest as easy bruising, and it can also be associated with a low iron count (anemia).

Specifically, they interfere with the production and function of gasotransmitters (such as nitric oxide and hydrogen sulfide) and elevate cortisol levels. 

QI (CHI) STAGNATION

This is the manifestation of qi stagnation. This disturbance leads to an imbalance in the gut and respiratory microbiomes—what the West refers to as dysbiosis—which further impedes the body’s natural water metabolism.

As the body attempts to deal with the dysregulated water, it accumulates in inappropriate areas, creating what we call dampness. 

This dampness becomes a fertile ground for pathogens—molds, vaginal yeasts, bacteria (bacterial vaginosis), and viruses (HPV, Hepatitis, Herpes Simplex 1 & 2)—which trigger a low-grade systemic inflammation and create biofilms to shield themselves from the immune system. 

This is the mucus, the thickened, protective barrier that obstructs the flow of energy, impeding circulation and contributing to further stagnation. This results in tender and blocked meridians that need to be treated with medical Acupuncture and emotional regulation.

A vicious cycle emerges, a loop that strengthens itself over time, leading to the slow decline of health, vitality, and a gradual process of aging.

Sadness & Lung Health

When a person is sorrowful, their lungs often become weak. In Chinese medicine, sorrow is linked to the lungs, both of which belong to the metal element. So, how does one treat a patient with weak lungs caused by sorrow?

A mediocre physician might prescribe herbs to strengthen the lungs directly. A more knowledgeable physician might strengthen the stomach to improve digestion and nourish the lungs, following the inter-creativity principle (earth creates metal). While this is a more thoughtful approach, it still addresses only the symptom.

A master physician, however, understands the deeper issue: the real problem is emotional. Strengthening the lungs directly with herbs will only aggravate the imbalance. If the lungs are weak (yin deficiency), increasing their function (yang) will create a disharmony—too much yang will overwhelm the already frail yin. Strengthening the stomach is a better choice, but it still doesn’t address the root cause: sorrow itself.

USING EMOTIONS TO "TREAT" EMOTIONS

To treat sorrow, the physician must work on the emotion. The Chinese saying “emotional illness is best overcome by using emotions” holds the key. Sorrow corresponds to metal, and metal can be countered by fire—joy. By cultivating joy in the patient, the sorrow is diminished, and the weakness in the lungs gradually resolves.

This is the inter-destructivity principle: joy (fire) destroys sorrow (metal). But the real skill lies in the physician’s ability to bring joy into the patient’s life. The practitioner must invoke the emotion of joy to restore balance, not just focus on physical symptoms.

GOING BEYOND TREATING JUST THE SYMPTOMS

In true healing, the master physician treats the cause, not the symptoms. By addressing the root emotional imbalance, the body’s natural harmony is restored.

Here is a STORY that illustrates how a deep understanding of emotional theory in Chinese medicine can lead to powerful healing—though not in the way most would expect.

An emperor fell ill. Despite the best efforts of his imperial physicians and the finest delicacies prepared by palace chefs, he could not recover his appetite. No treatments worked. (In hindsight, one might wonder whether the physicians could not cure him—or dared not.)

One day, a renowned physician who had long declined palace service in favor of helping the common people offered to treat the emperor.

“I’m glad you’ve finally come to serve the court,” the emperor said.

“This will be my final act of loyalty,” the physician replied. “But I ask only one thing: allow me to roam freely within the palace grounds.”

“Of course,” said the emperor. “Wander as you please.”

Days later, the emperor entered his beloved concubine’s chambers and, to his shock and fury, found the physician appearing to assault her.

“Seize him! Behead him immediately!” the emperor roared in outrage.

And not long after—the emperor was cured. His appetite returned.

Why did this work?

In Chinese medicine, worry corresponds to the earth element. Excessive worry weakens digestion and appetite. To counteract worry, one must engage the wood element—its controlling counterpart. And the emotion of wood is anger.

By provoking intense anger, the physician used the emotional force of wood to destroy the stagnating influence of earth, thereby restoring the emperor’s appetite and internal balance. This was not madness or disrespect—it was a calculated act, rooted in deep medical theory and an understanding of how emotions govern the organs.

This is the power of treating the root cause, not just the symptom. True healing often lies in the unseen, in the emotional landscape that shapes the flow of qi.

An ingenious doctor may invoke certain emotions to cure certain disorders!

Dr Khoo Lee Seng

Leaking Qi & Depleted Jing- The Cause of All Medical Maladies & Premature Aging by Dr Lee Seng Khoo

 

“This leak happens little by little, silently. It doesn’t cause a major illness all at once. But gradually, you grow older, get sick, fall behind — without even realizing it.”

And that’s what’s truly frightening.

It’s not a sharp pain.

It’s not a sudden diagnosis.

It’s like a tiny crack in the pipes hidden behind your walls — dripping bit by bit, day after day, silently wearing you down.

Until one day, you suddenly realize: your energy is gone, your mind scattered, your thoughts cloudy and you are emotional and easily agitated or overreact to everything. It’s like someone has quietly stolen the vitality from your life.

These “leaks” come in three forms:

Qi Leak: Your vital energy drains away. You feel exhausted and sluggish all the time, like a deflated tire that can’t hold air no matter how much you pump it.

Essence (Jing) Leak: Your muscles and bones deteriorate prematurely. You have back pain, stiff joints, and feel like an elderly person despite your age — your body no longer feels like your own.

Spirit (Shen) Leak: Your memory fades, attention scatters, and your mind becomes foggy and slow. It’s harder and harder to focus. Your thoughts drift like you’re walking through a mist. This is the most common and most overlooked leak in modern life.

You may not even realize these symptoms are caused by leaking. Sometimes you may still look pretty good exteriorly from the naked eye but damage to the engine is taking place often irreversibly.

For example, leakage of Qi as it relates to the Middle Jiao, or middle burner, involves how the Spleen is managing blood. In Chinese Medicine, the Spleen’s Qi is responsible for containing the blood in the vessels. A person who bruises or hemorrhages easily likely has a weakness of the Spleen Qi. 

You just assume it’s “stress from work,” “lack of sleep,” or “weather changes”…

You Think You’re Just Tired — But It’s Your Spirit Leaking

In the modern world, spirit (shen) is the most vulnerable to leakage.

Brain fog, forgetfulness, mood swings, lack of focus… these aren’t just issues for the elderly. They’re symptoms of sitting too long, overusing your brain, and having poor posture — all of which prevent qi from rising to your brain.

Many people overwork their mind closing business deals with more and more deadlines, making more connections while struggling to optimise the ones that matter most, seeking money to maintain their image or lifestyle while simultaneously draining their body of the most important lifeforce “qi” thereby draining their “jing”. With high stress levels and cortisol overload coupled with lack of sleep and late nights working or substance abuse to cope with stress; it is little wonder how some seemingly vibrant people suddenly age rapidly in their late 30s and early 40s. Diseases that was supposed to only surface at old age manifest prematurely. 

It’s like charging your phone every day, but only up to 80% — while constantly using energy-intensive apps. Over time, the battery wears out early. Yes, even doctors who chase money or work without rest meet the Grim Reaper early or get ill. "Superman" doctor loses battle with leukaemia in Malaysia: 'He was our pillar of support' | STOMP

Renowned liver transplant surgeon Dr Yoong Boon Koon passes away at 54 - News

It is most important to know where, how, when, and why our Jing leaks. Only then can we begin to prevent it.

To protect our Jing, we must first recognize that the main causes of its loss are not external, but internal. The way we live, the habits we cultivate, and the thoughts we entertain (overthinking) all contribute to the depletion of our essence. Therefore, the responsibility is on us to make the necessary changes.

The mind is one of the most powerful tools for preserving Jing. When the mind is scattered, it creates disturbances in our Qi and depletes our essence. Meditation (Neigong & Qigong) and solitude helps to calm the mind, replenish the spirit, and prevent the excessive use of Jing through overthinking and mental agitation.

Neigong (internal work) focuses on refining the body’s energy channels and improving the circulation of Qi, while Qigong (external work) helps to build strength, flexibility, and stamina. Both play vital roles in reinforcing the body’s ability to retain and store Jing. Such exercises include Hua Tuo's Five-Animal Play Wǔ Qín Xì(五禽戲), Eight Pieces of Brocade- Ba Duan Jin (八段錦), 18 Lohan Hands Shiba Luohan Shou (十八羅漢手) and ultimately the Small Universe - Xiao Zhou Tian (小周天), Muscle Tendon Change Classic -Yi Jin Jing (易筋經) and the Big Universe Da Zhou Tian (大周天) to end dualism by expanding into the cosmos.

In modern life, many people deplete their Jing through overwork, poor sleep, stress, and overindulgence (or severe calories restriction) in food, heavy alcohol intake and smoking or drugs. This creates a vicious cycle where the body and mind become weakened, and Jing leaks out faster than it can be restored. It is essential to adjust your lifestyle so that you can support your Jing. This may involve eliminating unnecessary stress, setting boundaries, and prioritizing rest and recovery.

Jing Loss and the Dangers of Stress: A Taoist Perspective

In the Lingshu section of the Yellow Emperor's Classic, it is written:

"Xue and Mai, Ying and Qi, Jing and Shen are stored by the Five Zang. If a situation becomes such that by a succession of overflowings (leaking) and invasion they leave the Zang, then Jing is lost, and Hun and Po are carried away in an uncontrollable agitation."

This ancient wisdom reveals the profound relationship between the Five Zang, the vital substances — Jing, Qi, Ying, Xue, and Shen — and the importance of maintaining their balance. When these vital substances overflow, leak, or are invaded, they leave their proper storage in the Zang organs, and Jing is especially vulnerable. Without Jing, the Hun (the ethereal soul) and Po (the corporeal soul) become unsettled, leading to chaos in both the body and mind.

Conclusion

Leaking Qi and depleted Jing is common and can negatively impact health, but it is typically resolved with proper diagnosis & treatment as well as lifestyle (mental) & dietary changes. Preventing Qi leakage and depletion of Jing  is crucial for maintaining energy levels and preserving Essence (Jing), which helps slow aging and promotes long-term health and longevity.

When Chi and Jing is restored, one becomes luckier in life and the Shen is seen in the eyes. In Traditional Chinese Medicine (TCM), "shen" (or "shen qi") is the spirit, consciousness, and vitality of a person that is said to manifest in the eyes. When a person's shen is bright and lively, it is seen in sparkling, clear eyes, indicating good mental, emotional, and spiritual health.

PS- Acupuncture is one of the methods used to unblocked blocked meridians to restore qi flow and to rebalance qi in the body. However, without adequate mental rest and without plugging the leaking qi and restoring the depleted jing- good health and vitality remains at large.