Mr Juling Ong recently spoke to Top Doctors about craniosynostosis and answers a common FAQ: how do I know if my baby has craniosynostosis?

Children born with craniosynostosis can experience problems with brain growth, head shape and facial function. Depending on the individual case, surgery could be needed. Paediatric plastic surgeon Mr Juling Ong provides a comprehensive overview of the condition, including what exactly is craniosynostosis and at what age is craniosynostosis surgery done.

 

A new mother’s life was recently transformed when she had a ‘pulsating’ lump on her head operated on during scenes filmed for The Bad Skin Clinic on Quest Red.

Lauren Brook had lived with a blueberry-sized lump on her forehead for the last couple of years and had failed to get a correct diagnosis. Since the birth of her son the previous year, the lump had got larger and often ‘pulsated’, leaving Lauren feeling incredibly self-conscious. In fact, she often refused to take photos of herself with her baby due to insecurity.

Vascular malformation surgery

“It just puts so much strain on my day-to-day life. I just don’t feel confident anymore,” Lauren says. “Over the last year since I’ve had my baby, it’s just been growing bigger and bigger.”

Lauren visited Dermatological Surgeon Dr Emma Craythorne at her clinic in central London. Emma immediately realised that the lump was not a lipoma or cyst, but actually a type of vascular malformation called an arteriovenous malformation.

“This is entirely related to the little veins and arteries that we have in our body. This is something called a vascular malformation,” Emma explained to Lauren.

Dr Craythorne consulted with her colleague Mr Juling Ong and the decision was made to operate.

“I’m just marking the incision in a nice curvature just behind the hairline, so that eventually it’s hidden well in the hair,” Mr Ong explained to the camera, before he made his first incision, cutting into the skin and tissue behind Lauren’s hairline. “Although it’s a very big incision, once it’s healed, you’ll hardly see it.”

During the procedure, Mr Ong and his team cauterised the veins and the tumour of blood vessels was gently dissected free from the inside of Lauren’s scalp.

Just a few weeks after the operation, Lauren revisited Dr Emma’s clinic and was delighted with the results as her forehead is now completely smooth. “Literally just amazing,’ Lauren reported in the TV programme. “I just feel happy, all the time.”

What is a vascular malformation?

Mr Juling Ong treats vascular malformations in children and adults. These are abnormalities of the veins, arteries, capillaries or lymphatics.

Capillary malformations are commonly known as port wine stains and are caused by the smallest blood vessels or capillaries failing to constrict. Lymphatic malformations involve abnormalities of the lymph system and are often known as lymphangiomas. They can present as a small swelling or a much larger swollen or raised area and can result in skin changes, repeated infections or bleeding.

Venous malformations can be visible through the skin and can present as swelling or bruising after there has been increased blood flow to the affected area, for example, after exercise, when crying or becoming upset.

Vascular malformations often grow a bit faster when there are hormonal changes such as during puberty or pregnancy, as they did in Lauren’s case.

Arteriovenous malformations usually pulsate with a lot of blood flowing through the vessels. They can be painful and bleed and there is a high risk of them regrowing if not treated very carefully.

For more advice on vascular malformations and their treatment, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

The rhinoplasty remains one of our most requested cosmetic surgery procedures as the nose is the central feature of the face, so has a pivotal role in determining facial balance and overall appearance.

One of the most frequently asked questions about the rhinoplasty procedure is how long it takes to heal. The first consideration is which surgical approaches Mr Juling Ong uses. During a closed rhinoplasty approach, two incisions are made inside the nose, through which all alterations are performed. In an open rhinoplasty, the same two internal incisions are made, coupled with an additional incision across the columella between the two nostrils. This allows Mr Ong to unveil the nasal skin and see any asymmetry within the anatomy of the nose and make precise changes to the bone and cartilage.

In terms of healing, there may be slightly more swelling after an open rhinoplasty and there will be an external scar. However, in most cases, this scar will be virtually invisible once healed.

Your rhinoplasty recovery timeline

Day of surgery: a rhinoplasty operation can take between two and five hours and, depending on the complexity of the procedure, you’ll either return home the same day or have a one night stay in hospital

One week: your cast is typically removed a week after your operation 

Two weeks: the majority of the facial swelling should have eased and most patients feel comfortable returning to work and social engagements 

Six weeks: the bones should have healed to the point that you can resume vigorous exercise

Between three and six months: often you can experience loss of sensation in the nasal skin after surgery, but any numbness should be resolved by this point

One year: you should expect the majority of the healing process to be complete at this point with almost all of the swelling gone however, changes can continue in the nose for many years following nasal surgery.

Is it possible to speed up my rhinoplasty recovery?

  1. Follow your surgeon’s instructions: this is essential to ensure a smooth rhinoplasty recovery. Mr Juling Ong will provide comprehensive advice on managing your rhinoplasty downtime and is on hand if you have any queries.
  2. Keep your head elevated: in the day and weeks after your procedure, it’s advisable to sleep in an elevated position as it will help to reduce any bruising and swelling. Sleeping on your back will also be uncomfortable as the nasal passages will be swollen immediately afterwards.
  3. Get plenty of rest: congested nasal passages may make sleeping more challenging initially, but the body needs plenty of rest to repair itself.
  4. Maintain a healthy diet: the body requires a balanced diet during the recovery period. Protein-rich food will help the body repair damaged tissue, while vitamin-enriched food sources can aid you in fighting off infection, reducing inflammation and regenerating collagen.
  5. Keep cool: hot showers or relaxing saunas may feel good, but they increase swelling of the tissues. Mr Juling Ong also advises you to avoid vigorous exercise in the first six weeks after surgery, as it can increase nasal swelling.
  6. Avoid sun exposure: it’s advisable to wear sun cream all year round to protect the skin from harmful UV rays, but it is vital immediately after surgery when too much sun can affect pigmentation in the healing skin.
  7. Don’t smoke: this is one of the most important things you can do and Mr Juling Ong will not operate on patients that aren’t willing to stop smoking before and after their procedure. Nicotine restricts blood flow, making it more challenging for the body to heal itself and can cause tissue necrosis in rare cases.

For more advice on rhinoplasty surgery, please call us on 020 7927 6528 to book an appointment with Mr Ong.

At birth, babies are screened for several congenital abnormalities during a routine physical assessment that is carried out within 72 hours of birth and then later at six to eight weeks of age, as some conditions may take a while to develop.

Conditions they are assessed for include congenital hip dysplasia, heart murmurs, cataracts and cleft palates. Tongue tie or ankyloglossia is not routinely checked for, yet can cause significant difficulties for new mothers who are attempting to breastfeed. A recent BBC article demanded that NHS midwives and health visitors receive specialist training to help spot the condition.

Signs of tongue tie

It’s estimated that 10% of babies are affected by tongue tie, a condition where the tongue is tethered to the bottom of the mouth by a strip of tissue known as the lingual frenulum.

Often the first sign of tongue tie is difficulties establishing and maintaining breastfeeding. One study estimated that 60% to 80% of women experience problems breastfeeding, and 42% of all women who attempt breastfeeding quit within six weeks. A speedy diagnosis and treatment of tongue tie could support more women at this time.

Issues with tongue tie and breastfeeding:

  • For the mother, breast feeding can often be painful
  • Can cause mastitis and blocked ducts
  • For the baby it can cause limited tongue movement including inability to poke out their tongue
  • Unable to open mouth wide when breastfeeding
  • Fussy behaviour when feeding
  • Coughing during feeds
  • Frequent or extended feeds
  • Poor weight gain
  • Colic

The women interviewed in the BBC article were both second-time mums and their previous experience of breastfeeding meant they suspected tongue tie. However, they both had to fight hard to get a diagnosis and treatment, which is typically tongue tie surgery.

About half of babies with ankyloglossia will require a surgical procedure to release the tongue. Paediatric plastic surgeon Mr Juling Ong performs both frenotomy, where the tongue is released with surgical scissors, and frenuloplasty, in which plastic surgical techniques are used to release the lingual frenulum prior to reconstruction. Dissolvable sutures are used.

For more advice on tongue tie surgery, please call us on 020 7927 6528 to book an appointment with Mr Ong.

Exemplary patient care is the foundation of our practice so Mr Juling Ong was delighted to be certified as excellent by the patient at Top Doctors, a leading independent healthcare review site in the UK.

Call us on 020 7927 6528 to arrange a consultation to see more patient reviews or see before and afters of previous cosmetic surgery patients.

Whether you’ve always been dissatisfied with a facial feature, bothered by lack of symmetry, or started to notice ageing changes, there are several approaches to augmenting, reconstructing or rejuvenating the face.

Facial fillers

Dermal fillers are one of the most popular procedures worldwide for addressing ageing changes in the face, particularly for filling lines or addressing loss of facial volume. The gold standard hyaluronic acid dermal filler brands are available in different consistencies, so can be used to fill the very fine lines around the mouth and enhance the lips, as well as adding more volume to the chin, cheeks or temples or fill a skin defect.

Dermal filler products can also stimulate collagen and elastin production so there is a gradual improvement in skin quality as well as immediate volumisation.

Longevity of results depends on the product used, where it is placed and the individual patient’s response, but you can expect hyaluronic acid dermal fillers to last between six and 12 months.

Facial fat grafting

Restoring or adding fullness to the face with your own fat has several advantages over facial fillers. If significant volume is needed at the temples, cheeks, jawline or chin, facial fat grafting is usually a better choice. Fat that is successfully grafted to the new area will last much longer than dermal fillers in terms of maintaining fullness.

During the facial fat transfer procedure, Mr Juling Ong will remove small amounts of fat, typically from the abdomen, flanks, or thighs. The fat is then purified, before it is injected into the area of the face that requires filling. Small droplets of the fat are injected to produce a smoother appearance and ensure that the fat is successfully grafted.

Another advantage of facial fat grafting over implants or fillers is that there is no chance of an allergic reaction or rejection.

Facial implants

Facial implants are a permanent solution to loss of volume. Results are immediate and can be subtle or dramatic depending on the shape, size and projection used.

The advantage of facial implants over dermal fillers is that results are long-lasting, whereas temporary dermal fillers may need top-up treatments once or even twice a year. There is a small risk of infection immediately after the procedure, but this can be managed with antibiotics. Once in situ, the implant is usually well-tolerated by the body and result will be long-lasting.

Unlike fillers and fat transfer, facial implants enhance the bony structure of the face rather than replacing or augmentation the soft tissues. If the concern is asymmetry, an ill-defined facial feature or deformity due to trauma or congenital conditions, then facial implants may be a more appropriate solution.

During your consultation, Mr Juling Ong will be able to advise you on which treatment option is the most appropriate for you and explain all potential risks as well as the benefits.

Please call us on 020 7927 6528 or email us at info@julingong.com to arrange an appointment.

If you have made the decision to undergo surgery to reshape your nose, it’s not surprising you may have several concerns alongside anticipation for the increased confidence you’ll feel once your facial features are brought into greater harmony and balance. A common question that patients ask is whether rhinoplasty is painful and what they should expect in the days, weeks, and months following their operation.

Understanding the rhinoplasty procedure

The first factor to bear in mind is the extent of the procedure as every patient may require slightly different techniques depending on what they are hoping to achieve.

Whether you’ve always been unhappy with the appearance of your nose or it has been injured at some point, there are several concerns that can be improved with a rhinoplasty. These include:

  • Your nose is not the right size or proportion for your face
  • There is a bump on the bridge
  • The angle of the nose is not in harmony with your other facial features
  • The nose and/or nostrils appear too wide
  • The tip of the nose is bulbous, protruding, drooping or oversized
  • The nostrils can appear too pinched
  • The nose is crooked or noticeably asymmetrical
  • You may have breathing issues as a result of the internal structures of the nose

A closed rhinoplasty involves making two incisions inside the nose, through which Mr Juling Ong will be able to make the necessary changes to the cartilage and bone. An open rhinoplasty. also involves making a small incision between the nostrils, known as a trans-columellar incision. Juling is then able to unveil the nose and adjust the substructures before the skin is redraped over.

A closed rhinoplasty leaves no visible scarring and typically has a quicker recovery time, but an open rhinoplasty allows for more precise alterations to the internal structures of the nose if required.

Both a closed and open rhinoplasty are performed under a general anaesthetic so there is no pain experienced during your procedure, but what about afterwards?

Your rhinoplasty recovery

In the first few days after your rhinoplasty procedure, you’ll experience swelling, bruising and potentially some minor bleeding. Every patient’s pain threshold varies, but most patients report fairly mild discomfort after surgery.

Most patients find the sensation of being ‘bunged up’ more disorientating. The swelling can force you to breathe through your mouth and this may last a few days, leaving you with a dry throat and lips. You may also experience some pressure in your ears and head as a result of the congestion. For most patients, though, all this is easily managed with over-the-counter medications.

For more advice on the rhinoplasty procedure, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

Liposuction remains one of the most popular procedures in the UK, as a highly effective solution to unwanted fat deposits and it can be performed on the abdomen, hips, flanks, thighs, upper arms and even in the face, along the neck and under the chin.

The internet can be a valuable resource on anything cosmetic surgery-related but there are many misconceptions about this frequently performed body contouring procedure.

Misconception: liposuction can help you lose weight

Liposuction should not be seen as a weight loss procedure. It achieves the best results for those men and women who are near to their ideal body weight but wish to achieve a more defined shape or target isolated fat deposits.

Misconception: you can’t put weight back on after liposuction

The fat cells that are suctioned out during your liposuction procedure are permanently removed, but that doesn’t mean you can’t put weight on in the future. The remaining fat cells can still grow to compensate, so it is important to commit to a healthy lifestyle to maintain your results.

Misconception: liposuction can eradicate cellulite

Cellulite is a complex issue caused by subcutaneous fat pushing against the fibrous connective bands in the skin, which results in cellulite’s dimples and bumps. Liposuction removes soft fatty tissue and doesn’t loosen these bands so often the appearance of cellulite is not changed.

Misconception: liposuction delivered immediate results

You’ll experience post-surgical swelling for the first few weeks and months after your liposuction so your final outcome will not be evident for approximately six months. Mr Ong will advise you to wear a compression garments for at least 6 weeks after liposuction to help with the healing process.

Misconception: you’ll be left with loose skin

The skin is composed of a network of collagen and elastin which provides elasticity and support. If you have good skin elasticity prior to your liposuction procedure, your skin is more likely to contract to your new shape after surgery. However, if you have a significant degree of sagging skin after weight fluctuations, you may not be suitable for liposuction.

Misconception: liposuction is less invasive than other cosmetic surgery procedures

Liposuction is typically less invasive than a tummy tuck, for example, as it doesn’t entail a lengthy incision, but it is not an ‘easy’ option. As with other surgical procedures, it is typically performed under a general anaesthetia although some smaller areas can be performed safely and comfortably under local anaesthesia. There are potentially serious complications with all procedures, but these are rare with liposuction.

If you have more questions regarding liposuction, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

The recovery period is a crucial part of the cosmetic surgery journey and the correct advice can contribute significantly to the overall success of your procedure. Although there is much information available online on how best to prepare for your recovery, there are some aspects that you may not have taken into account. Mr Juling Ong will always provide comprehensive aftercare advice and is available throughout your recovery period to answer any queries.

Swelling after facial surgery:

 Swelling is the most common side effect of any surgical procedure and one of the first signs of the normal healing process. After a facelift or neck lift, you will typically experience the peak of swelling a few days after your operation and the face and neck can feel very tight. It may be difficult to open your mouth,  turn your head fully and smile fully. This can often be concerning, but it is normal.

It’s important to avoid any extreme movements of the face, neck or mouth in the immediate period after facial surgery. Keeping your head elevated at all times, particularly when you’re sleeping, is key as this will help optimise blood flow to your face, improve healing and will relieve some of the pressure.

Posture after a tummy tuck:

Most tummy tuck patients are aware that there should be no heavy lifting after an abdominoplasty, but they may not expect to have a slightly hunched over posture in the days following their operation. This is a normal and protective response of your body to abdominal surgery. It is important you do not force yourself to stand up straight as that can strain the incisions and any muscle repair that has been performed.

As the swelling subsides and the muscles and skin start to stretch out, you’ll be able to stand normally. In fact, many patients adopt an improved posture once they are fully recovered as the core muscles have been strengthened and stabilised as well as being more confident in the shape of their abdomen.

Sensation after breast surgery:

Many women worry that they will lose feeling in their breasts or nipples following a breast augmentation, reduction or lift. Numbness is a common side effect of any surgical procedure as delicate nerve connections are disrupted by incisions or manipulation of the tissue.

For most patients this is temporary – one study found that only 2% of women reported permanent loss of sensation after a breast augmentation. However, one side effect of breast surgery that women often don’t expect is hypersensitivity. And, as the body heals and nerve connections are re-established, you can also experience itching, burning and even sharp twinges and this can take a few months to fully subside.

Post-surgery blues:

One aspect of the cosmetic surgery recovery process that you may not have planned for is the emotional toll. It is very common for patients recovering from surgery to experience changes to their mood including lethargy, brain fog, emotional lows, and irritability. Causes can include the effect of a general anaesthetic and post-operative pain medication and your altered sleep and digestive patterns. The enforced rest period after surgery can also be a time for reflection.

Cosmetic surgery also differs from other surgical procedures as your appearance may be significantly altered. Even though these changes are planned and welcome, this can take some time to accept. The good news is that any post-surgery blues should be temporary and resolve itself in the weeks after your procedure.

For more advice on the recovery process, call 020 7927 6528 to arrange a consultation with Mr Juling Ong.

Pregnancy and childbirth can be a wonderful, life-changing experience, but it can also result in a whole array of body changes that may be less welcome. As your body transforms to accommodate the growing baby, the rectus abdominis muscles separate and, for many women, it results in a weakening of the abdominal wall.

Diastasis recti is defined as a separate of the rectus abdominis muscles in the midline, also known as the linea alba, and it’s thought that over 60% of women experience this in the final stage of pregnancy.

However, for some women this issue does not resolve itself in the postpartum period. As well as an aesthetic impact – a stomach bulge that is resistant to diet and exercise – it can also result in the significant health concerns such as lower back pain, incontinence and even digestive problems.

Also known as Rectus diastasis and Rectus divarication, the gap along the midline of the belly can be small or extend along the whole length of the abdomen. As well as removing excess skin, an abdominoplasty or tummy tuck can also restore the integrity of the rectus abdominis.

Problems caused by Diastasis recti

  • Stomach protrusion: this is the most common symptom of Diastasis recti. The linea alba, the fibrous structure down the midline of the abdomen, which maintains the position of the abdominal muscles can becomes stretched and thin and some women can have a pronounced stomach bulge.
  • Thickened waist: the abdominal muscles act as an internal corset and, as they weaken and separate, a wider waistline can result.
  • Hernia: as the linea alba stretches, it becomes thinner and an epigastric hernia can form. They are usually small and typically only preperitoneal fat will protrude but any hernia should be investigated by a specialist.
  • Lower back pain and impaired posture: the rectus abdominis muscle is an essential component in the core muscles that maintain balance and posture. As they weaken, more stress is put on your back muscles which must contract disproportionately, and women can often suffer from chronic lower back pain.
  • Incontinence: stretched abdominal muscles combined with a weak pelvic floor post-pregnancy can result in urinary incontinence. According to a 2018 study published in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons (ASPS), diastasis recti repair performed as part of a tummy tuck can significantly reduce incontinence.

What is Diastasis recti surgery?

Unfortunately, however many crunches and planks you do, stretched abdominal muscles usually remain resistant to exercise. The most effective and permanent solutions to diastasis recti is surgery to close the defect and tighten up the two sides of the rectus abdominis muscle.

As well as strengthening the abdominal wall, Mr Juling Ong will also remove any excess skin and fat. The belly button is also repositioned if required. Timing is essential for the best outcome, so it is advisable to wait until a year since your last pregnancy and plan surgery for when you’re not planning on conceiving again.

Call 020 7927 6528 to arrange a consultation with Mr Juling Ong to discuss your options.