A circumferential body lift, also known as lower body lift, removes the redundant skin and fat around the frontal abdomen, hips, and back, resulting in a belt-shaped scar that is generally concealed by the patient’s underwear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Circumferential body lift is almost always performed after massive weight loss and basically combines three major surgeries, namely, tummy tuck, outer thigh lift, and buttock lift. For this reason, it is only reserved for healthy patients with no healing problems.
While most patients having some type of body lift already know the basic preparations—e.g., 8-10 hour fasting prior to the operation, eating healthy, reaching the ideal weight, avoiding tobacco products and drugs with blood thinning properties (aspirin and ibuprofen)—they may not be aware of some seemingly trivial details explained below.
Due to the invasive nature of circumferential body lift, the amount of bleeding might be an issue. For this reason, some patients may need blood transfusion during surgery; however, in the ideal scenario they can donate blood at least four weeks ahead of time and have it stored in case they need it.
- Some natural remedies can affect healing
Some natural remedies and herbal supplements not just affect healing or increase bleeding, but may also may interact with anesthesia and painkillers. Furthermore, their effects are still widely unknown and so a good rule of thumb is to avoid them altogether at least 2-3 weeks before surgery and about a week afterward.
- Caregivers are life-savers
In the first few weeks postop, the patient should only focus on her recovery. Everything else—e.g., childcare, house chores, and office work—are put on the sidelines.
A good rule of thumb is to line up two or more caregivers, who can help the patient get around during recovery.
Loose soft clothes (button down shirt and loose-fitting pants) that are easy to put on and take off are important during recovery especially when the patient is made to wear compression garments and surgical drains.
- Ask for the surgeon’s shopping list
Most surgeons will provide a shopping list that typically includes painkillers, compression garments, scar creams, and even healthy snacks and drinks to help their patients plan their recovery well ahead of their surgery.
Eyelid surgery after care may differ from surgeon to surgeon, thus a prudent patient will only stick to her doctor’s specific advice. The main idea of postop care is to keep swelling and bruising to a minimum, ultimately resulting in shorter social downtime.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains his eyelid surgery after care tips.
* Pain Control. Most patients will only experience minimal discomfort that can be easily managed through acetaminophen such as Tylenol for a few days. Others do not even require medications.
* Head elevation for a few days. The goal is to keep swelling to a minimum and thus promote shorter social recovery, which typically occurs after 1-2 weeks.
* Cold therapy. In the first 48 hours cold therapy can control the amount of swelling; however, it should not be applied for more than 15-20 minutes at a time to avoid cold burns and blisters.
* Avoid or at least limit the consumption of alcohol and salty foods during the initial healing stage (2-3 weeks). They can cause fluid retention and thus aggravate the amount of swelling.
* Never rush one’s recovery. A good rule of thumb is to avoid rigorous activities that can result in increased heart rate and blood pressure for a minimum of three weeks. Nonetheless, bed rest is not good because it can lead to lethargy and may even aggravate swelling.
* Avoid activities that can dry the eyes. In the first week postop, activities that may dry up the eyes—e.g., using computer, watching TV, reading, and wearing contacts—must be avoided.
* Wear large dark sunglasses. The idea is to protect the sensitive eyes from harsh elements such as the wind, sun, and small particles.
* Expect 1-2 weeks of social downtime. Some patients may return work a week after their surgery, although they will most likely need a camouflage make-up to hide the outward signs of their surgery. At 2-3 weeks of their recovery, meanwhile, they can go outside without wearing eye make-up.
* Avoid drugs and supplements with blood thinning properties. These are best avoided 2-3 weeks before surgery and about a week afterward to prevent bleeding and persistent swelling and bruising.
One of the most common concerns of patients seeking plastic surgery to remove the redundant skin in their abdomen is that pregnancy after tummy tuck may be risky or might completely reverse its results.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs over hundreds of tummy tucks every year, says the surgery does not affect conception or safety of mothers, nor automatically reverse the contouring effects of the procedure.
In his recent Snapchat video post, Dr. Smiley is seen suturing the pair of loose abdominal muscle along the midline between the breastbone and the pubic region to achieve a flatter, more feminine waistline. He says that permanent sutures can limit the effects of “unexpected” pregnancy or even mild to moderate weight gain in the future.
While pregnancy after tummy tuck is safe, Dr. Smiley says it remains best to postpone the surgery until the patient is done having children to ensure near permanent results, or at least does not plan getting pregnant in the near future.
Dr. Smiley says that muscle repair, which he almost always incorporates with tummy tuck, will still allow the body to stretch to accommodate the growing body.
(Note: Some women think that pregnancy after tummy tuck can increase the risk of prematurity. However, one patient who had twins about two years after her surgery says she went full term and had less loose skin afterward as compared to her “pre-tummy tuck” pregnancy.)
Should the patients become pregnant years after their tummy tuck, Dr. Smiley recommends avoiding unnecessary weight gain, which can have more detrimental effects on the surgery’s result than the pregnancy itself.
Because the celebrity plastic surgeon uses permanent sutures during muscle repair, he says the vast majority of his patients who became “unexpectedly pregnant” did not require any type of touch-up and remain happy with their results.
In most cases the amount of liposuction pain is fairly minimal thanks to the introduction of tumescent technique, which is now the gold standard. This involves injecting a special type of fluids into the fatty area before removing the localized fat deposits with a cannula (flexible hollowed tube).
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the tumescent fluids contain local anesthesia for numbness and epinephrine that constricts the blood vessels, which in turn prolongs and “spreads” the numbing effects up to 48 hours after surgery.
Hence, most tumescent liposuction patients will only need mild painkillers such as Tylenol, as opposed to narcotic pain medications. In fact, the postop discomfort is generally attributed to the soreness and tenderness almost similar to the muscle soreness experienced after a hardcore exercise routine.
Meanwhile, liposuction under general anesthesia without tumescent fluids involves significant amount of pain that most patients will need strong narcotic meds. And because of the significant bleeding it entails this has become a less popular technique, says Dr. Smiley.
The celebrity plastic surgeon says that liposuction pain is most intense in the first 2-4 days postop, which is expected to gradually resolve as the soreness and swelling also subside.
Most of the swelling will take at least a month to dissipate, although it is possible to return to work a few days or about week postop provided that the patient’s tasks do not involve heavy lifting and over-exertion. A good rule of thumb is to avoid strenuous activities for three weeks to prevent healing problems.
It is important to note that aside from oral painkillers, there are other ways to control pain, which is closely linked to swelling. For this reason, keeping the inflammation to a minimum is one of the keys to promote healing.
Superb diet (rich in micronutrients and lean meat and low in sodium and processed carbs), light exercise (walking), compression garments, good hydration, and lymphatic drainage massage can all promote healing and possibly reduce the amount of pain.
Lymphatic drainage massage is known to help the body flush out excess fluids (seromas) and toxins, and thus keep swelling to a minimum and the pain as well.
Furthermore, consistently using compression garments especially during the initial healing stage (2-4 weeks) can encourage quick drainage and thus prevent seromas and significant postop swelling and pain.
The appearance of brachioplasty scar is perceived to be a major concern of patients with sagging skin in their upper arm caused by significant weight loss. Nonetheless, most feel that the “tradeoff” of having scars is worth it, particularly when the main goal is to have more slender arms that look proportionate to the body.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate the appearance of brachioplasty scar resulting from the “standard” technique.
The female patient shown in the video has “flabby” upper arms due to large amounts of redundant skin that extended down to her elbow. For this reason, she required an incision pattern technique that extended from the armpit down to her elbow.
Dr. Smiley was able to remove a large wedge-shaped excess skin along the inner arm between the biceps and triceps. The brachioplasty scar from this technique is hidden as people usually hold their arms by their sides.
While placing the brachioplasty scar on the inner aspect of the arms is perceived to be the most ideal technique, sometimes having it more posteriorly (i.e., back of the arm and thus more visible) may provide a better contour. Nonetheless, the patient may have to ponder on the ramifications of each scar technique/placement.
A scar placed more posteriorly is also perceived to heal and fade better because of the reduced tension. The inner aspect placement, meanwhile, is believed to be slightly more susceptible to wound separations due to the natural tension in the area.
However, Dr. Smiley remains partial to the inner aspect scar placement because there are many ways to reduce tension on the wound and thus ultimately promote “better” scars. For this reason, he encourages his patients to take a proactive approach in scar treatments that typically include the use of compression garments, silicone gel and/or sheets, and sunscreen.
Dr. Smiley advocates the use of scar gels and other treatments containing silicone, which hydrates the skin and helps the scar fade better and remain thin and flat. (Note: Wound is known to heal better in a moist environment; hence, the mucosal skin of the mouth has almost zero risk of scarring. The same “line of thought” can be applied to keeping plastic surgery scars unobtrusive with the use of silicone gel and sheets.)
The Brazilian butt lift results can be more impressive when the hips, which in essence are the lateral aspect of the buttocks, are included as well. For this reason, leading Beverly Hills plastic surgeon Dr. Tarick Smiley almost always includes the area to create a nice curvature.
Improving the hips contour at the same time will also give an illusion of a rounder, fuller backside, says the celebrity surgeon. As a result, he allocates about a third of the donor fats collected through liposuction to the hip area, while the remaining is injected into the actual buttocks.
In his recent Snapchat video post, he has shown a female patient with noticeable side indentations and flat hips that further worsened the appearance of her flat buttocks.
The female patient required liposuction of the lower back and flanks not just to remove the appearance of “fat rolls” but also to “curve out a more feminine silhouette” in which the hips and buttock profile are further “emphasized.”
In the video, the celebrity plastic surgeon is seen filling out the lateral depressions along the hips to create a smoother transition between them and the buttocks. Also by improving the hip contour, the butt’s posterior view is further enhanced.
Aside from liposuction of the lower back and flanks, Dr. Smiley also collected donor fats from the “bra rolls” for a more holistic improvement of the feminine curvature.
To achieve high survival rate of fat grafts, Dr. Smiley uses centrifuge to separate and remove biomaterials (e.g., blood) and “broken” fat cells so that only the purest and healthiest fats are transferred to the buttocks.
Structural fat grafting injection further ensures high survival rate and smooth results. This technique involves “micro-injection” of fat (less than 0.1 cc) to gradually build up new soft tissue and ensure blood vessel ingrowth.
Without blood vessel ingrowth, the fats will simply die and become absorbed by the surrounding tissue.
Aside from meticulous handling of fat, Dr. Smiley says the survival rate will also depend on patient cooperation. A good rule of thumb is to avoid direct sitting (i.e., the patient should make every effort to sit on her posterior thigh with the use of boppy pillow or U-shaped cushion) for at least three weeks.
And during sleep, the patient must assume a fetal position in which she must lean more toward her stomach to prevent inadvertent shifting of fats along her hips.