It is not surprising that most patients are concerned about neck liposuction incision, which inevitably leads to scar. Nonetheless, not all scars are bad, particularly when they are made remarkably small and are placed in discreet areas, allowing them to blend well into the background.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has explained the two neck liposuction incision placements and how the patient’s underlying anatomy and fat location determine the ideal approach.
- Single incision under the chin
A small round incision is specifically placed within the skin fold for optimal scar concealment. This incision technique is only suitable for patients with minimal to moderate amount of fat that is mainly limited to the center of the neck.
- Two additional incisions behind the ears, ideally in the earlobe crease
Apart from the incision beneath the chin, patients who need more correction—i.e., they have a full neck fat that extends beyond the center—will need additional incisions behind the ears. This technique allows the surgeon to “attack” the excess fats from different directions, a technique that is tied to smoother and more natural results.
In fact, best results are usually obtained with the additonal incisions behind the ears.
Aside from the incision placement, another critical issue is how much fat remains afterwards. Contrary to popular belief, great resutls are achieved when enough fat is preserved during surgery, as it serves as a “carpeting” that will prevent the platysma muscle from becoming visible neck bands.
The ideal amount of fat that is removed during surgery also depends on the patient’s skin elasticity. Therefore, someone who is relatively young and possesses good skin shrinkage generally tolerates a more aggressive approach than someone with reduced skin elasticity.
For instance, Dr. Smiley has recently performed neck liposuction in which around 300 cc of fat was removed. While it may sound an excessive amount, for this particular patient it was the right volume due to the extent of her full neck and her good skin shrinkage, which could be attributed to her young age.
However, the same amount of volume might be considered “too much” when the surgery involves older patients who generally have reduced skin elasticity, unless a concurrent neck lift (or skin excision-based surgery) is performed as well to prevent sagging appearance.
Downtime for tummy tuck may differ from person to person, although the general rule of thumb is to take things slow for at least 2-3 weeks. Ideally, patients should take a time off from work during this time so they can focus on rest and avoid stressors, which have been known to delay healing.
As expected, the first few days are the most challenging period; patients need help getting up from a reclined position, and when going to the bathroom as well. Despite decreased mobility, it is highly advisable to walk as frequent as possible to prevent blood clot formation (deep vein thrombosis), to keep swelling to a minimum, and to ultimately promote recovery.
Due to the pulling sensation and discomfort around the midsection, it is not uncommon to walk slightly bent at the waist for about a week postop. But after this period most patients can resume their normal posture.
After 2-3 weeks, patients can gradually increase their physical activities, although anything that involves straining the abdominal muscles and doing rigorous exercise are best avoided for one to three months. People heal differently and so each patient may receive a slightly different postop instructions from his/her surgeon.
Pain and Discomfort
The pain mostly stems from muscle repair in which the pair of abdominal muscles is stitched together to achieve a flatter appearance. However, the amount of tightness and discomfort greatly diminishes by one week.
Because pain is one of the most common concerns of patients, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has started using a new way to control pain: Exparel injection. This drug is injected directly into the muscle during surgery and is expected to provide numbing effects for up to four days.
Exparel has eliminated the need for pain pump, a somewhat cumbersome device that is worn underneath the clothes. It is similar to a balloon with tubes where local anesthetics slowly drip into the surgical site.
Going Back to Work
The ideal time depends on factors such as the patient’s type of work (office vs. physically demanding job), pain threshold, and individual healing. In general, a two-week off will suffice, whereas a three-week vacation is considered as a nice luxury.
At three weeks postop, most patients are back on their feet although it is not uncommon to tire easily or to feel like going to bed earlier than their usual routine. This is expected as their body is still in the process of healing.
The vast majority of thigh lift procedures are performed on massive weight loss patients who for the most part are willing to accept the appearance of scar in exchange for some remarkable benefits. After all, the scars, while they are a permanent tradeoff, are generally placed in discreet areas such as the groin and thus easily covered by most underwear.
Moreover, patients with large redundant skin often suffer from skin lesions and tissue breakdown. Consequently, thigh lift not just gives aesthetic benefits, but also improves body functions, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
inner thigh lift incision pattern
Basically, thigh lift procedures either improve the inner/medial thigh or lateral thigh. Depending on the location of excess skin, the incision pattern may appear like an oval or a wedge. Nonetheless, all efforts are made to ensure that the scar settles within the most inconspicuous areas possible (i.e., groin and bikini line).
The inner thigh lift uses an incision pattern that removes the loose skin along the medial aspect of the thigh. The resulting scar, meanwhile, may lie within the groin and so it is hidden beneath the underwear, or may extend down towards the top of the knee should there is a significant amount of excess skin.
On the other hand, lateral thigh lift tightens the front and outer-lateral region of the leg, typically with an incision that extends between the hips and lower portion of the groin; hence, on frontal view the resulting scar resembles a V shape.
outer thigh incision pattern
After the redundant skin is removed, the remaining skin is pulled up to tighten the contour of the leg and the incisions are then closed with multiple rows of sutures. The idea is to eliminate most of the tension on the skin surface, which is tied to better healing and scarring.
Compared with most body contouring surgeries, thigh lift may involve a tougher recovery due to the amount of swelling that stems from gravity and tension when walking (especially in medial thigh lift). Nonetheless, there are several ways to keep the postop inflammation to a minimum such as the use of compression garments, light exercise such as walking, low-sodium diet, and possible use of homeopathic remedies.
Facial aging happens differently from person to person. For instance, some people have sagging skin that is mostly concentrated around their eyes, while others have most of the bagginess along their jaw line and neck.
Nonetheless, facial aging often affects multiple areas almost to a similar degree and thus facelift and neck lift are commonly performed together. Combining them in one surgery also makes sense because the standard facelift incision is simply extended into the nape.
This is an incision pattern used in facelift and neck lift approach. Take note that all scars are hidden.
(Note: Standard facelift entails an incision that starts inside the hairline at the temple area, which then curves in front of the ear and behind it. And with a concurrent neck lift, the scar is slightly extended into the nape, specifically behind the hairline, to hide any surgical stigmata).
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated on Snapchat the rejuvenation effects of this combo approach, particularly when combined with a SMAS lift technique.
SMAS refers to a soft tissue layer found beneath the facial skin and fat. During facelift, Dr. Smiley not just removes the loose skin and elevates the remaining skin; he also tightens this underlying structure.
To further ensure a congruous result, he also tightens the platysma muscle of the neck by using internal sutures, which essentially act as a sling.
The compounded effects of these techniques are tauter jawline, restored volume of the cheek, more youthful chin-neck transition, and smoother neck appearance.
The direction of pull also plays a critical role in facelift and neck lift. The correct vector can create a tauter jawline and restore the youthful plumpness of the cheek, whereas an incorrect one can spell disaster—e.g., wind tunnel effect or overly tight mid face, lateral pleating of the neck skin, and skin bunching around the earlobe.
In a recent Snapchat video, Dr. Smiley says the correct direction of pull is 45 degrees angle, adding that in no way that the soft tissue should be pulled in a blunt horizontal or vertical manner to avoid any telltale sign of surgery.
Multiple plastic surgeries or combo procedures have become a common approach in facial rejuvenation. Typically, patients require facelift combined with structural fat grafting/injection, brow lift performed concurrently with forehead lift, and facelift with a simultaneous neck lift or neck liposuction.
In many cases, facial combo procedures, which generally involve closely related surgeries, make sense as they reduce the total time in surgery. Of course, the approach can also pare down the cost.
A huge chunk of plastic surgery expenditure comes from the anesthesia fee, surgical facility fee, and surgeon fee. Consequently, stacking multiple procedures means the additional cost related to anesthesia and surgical center is ruled out of the equation.
Some plastic surgeons even package certain procedures at a discounted rate, which further makes multiple plastic surgeries a cost-effective approach.
Nonetheless, patient safety should remain the utmost priority and so combo procedures come with stricter safety guidelines. For instance, being under general anesthesia for more than 5-7 hours is known to increase the risk of complication (cardiovascular issues and prolonged recovery) and so all efforts are made to complete any elective surgery within this time frame.
To further promote patient safety, leading Orange County plastic surgery expert Dr. Tarick Smiley says any combo surgery, or any type of elective plastic surgery, should only be done in an accredited surgical facility or hospital setting.
Accredited surgical facilities and hospitals are staffed by qualified medical practitioners and are fully equipped with medical apparatus should complications arise.
Due to the perceived challenges that come with multiple plastic surgeries, Dr. Smiley emphasizes the importance of lab screening and honest discussion between the surgeon and his patient. The goal is to rule out chronic medical conditions, or if they have been detected during physical exam, address them well in advance of the surgery through medications and lifestyle changes.
During pre-op consultation, Dr. Smiley says a prudent patient should disclose her medical background, previous test results, and medications, including those seemingly innocuous herbal supplements and vitamins, some of which have been found to interfere with healing.
To recap, multiple plastic surgeries on face are generally deemed as a cost-effective and safe approach provided these elements are present:
- The total time under general anesthesia does not exceed the standard safety limit.
- The surgery is performed by a board-certified plastic surgeon.
- The combo surgery is performed in an accredited surgical facility/hospital, which is staffed by qualified medical practitioners, including a licensed anesthesiologist.
- The patient is physically fit based on lab screening and is “honest” during pre-op consultation (in no way should a patient hide or omit medical information to avoid complications).
Mommy makeover procedures are body contouring techniques that reverse the effects of pregnancy—e.g., sagging breasts and apron-like skin that hangs from the abdomen. Tummy tuck, breast lift, and breast augmentation best exemplify these surgeries.
Oftentimes, plastic surgeons who use the term mommy makeover refer to a combination of two or more surgeries.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted on Snapchat before-and-after photos of one patient who has had extensive mommy makeover procedures: breast implant, breast lift, flank liposuction, and tummy tuck.
Multiple procedures surgery is a reasonable approach provided that its estimated blood loss and the time under general anesthesia are within the standard safety limit.
Most surgeons agree that a surgery performed within 4-5 hours is reasonably safe, while going beyond this duration may lead to increased risk of certain complications. Consequently, some patients may need a team of plastic surgeons who can work simultaneously on them to shorten the operation time.
Blood loss is another issue with mommy makeover procedures and other multiple surgeries. Specifically, the main concern is the drastic fluid shift, which can lead to longer and tougher recovery, and higher risk of healing problems.
To keep blood loss to a minimum, Dr. Smiley says that prior to making incisions he injects epinephrine into the tissue; this is a drug that constricts blood vessels and thus it is particularly ideal in tummy tuck, which typically removes huge redundant skin hanging from the abdomen.
The use of epinephrine is also ideal in large volume liposuction.
Another auspicious benefit of epinephrine: It prolongs the numbing effects of local anesthesia, which in turn allows the patient to avoid or take less oral painkillers within the first few days of their recovery.
Aside from a well-thought planning and a meticulous surgical execution, Dr. Smiley says the safety of mommy makeover procedures also boils down to identifying the right candidates.
Instead of going by the BMI, which Dr. Smiley says is not always an accurate criterion, the surgeon puts more importance on the patient’s physical fitness and willingness to follow a healthy lifestyle. Therefore, he recommends all his patients to pass a lab screening.
Furthermore, Dr. Smiley says multiple plastic surgeries or combo procedures entail more emphasis on patient safety due to the perceived challenges. For this reason, he only works with board-certified anesthesiologists and qualified medical staff during surgery.