Dr. Tarick Smiley Plastic Surgery Articles and News

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Liposuction consultation involves a lengthy, honest discussion between the surgeon and his patient. The first meeting is also a good time to assess the qualifications of a certain doctor, particularly pertaining to his board certifications, experience, and quality of work.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares his tips on how to make liposuction consultation a worthwhile experience.

liposuction consultation

  • Be honest about your goals.

 

Know your exact reasons for considering liposuction. If you have made all the efforts to keep a normal weight through healthy lifestyle but your fat rolls do not seem to budge, you might be a good candidate for the surgery.

 

But if your goal is to lose weight or to significantly drop your dress size, your unrealistic expectations could lead to more frustrations after surgery. Bear in mind that liposuction, as with any body contouring surgery, is only reserved for healthy, normal weight individuals with achievable goals.

 

  • Know what makes a good liposuction surgeon.

 

Some states allow any licensed doctors to perform cosmetic surgeries despite their lack of specific and relevant training in the field. For this reason, you must know the difference between a qualified liposuction surgeon and a mediocre one.

 

Before your first meeting with a certain doctor, you may want to visit online database of reputable board-certifying bodies (e.g., the American Board of Plastic Surgery and the American Society of Plastic Surgeons) to determine if he has passed rigorous requirements that make him qualified to perform the sought procedure.

 

  • Know the right questions.

 

Once you have confirmed that a certain surgeon is indeed board certified to perform liposuction and other types of plastic surgery, you may call his office to schedule for a face-to-face meeting so you can ask him questions that concern you.

 

However, you may want to focus on questions that will shed light on your doctor’s experience (how frequent and how long he has been performing liposuction), training, and “personal style.”

 

  • Scrutinize your surgeon’s before-after-after photos.

 

You can gauge the quality of work and personal style of your surgeon by looking at his photo gallery. Ideally, he should be able to show you hundreds if not thousands of before-and-after pictures of his previous patients, which can serve as a proof that he frequently performs liposuction.

 

  • Get all the financial details.

 

While the cost should not be the “end all be all” when selecting a surgeon, it remains an integral part of your decision. To avoid confusion, ask your doctor to list down all the details such as the facility fee, anesthesia fee, medications, compression garments, etc.

 

Take note that some facilities (or even doctors) have a number of hidden fees that could appear at the last minute of the surgery or after it. Nonetheless, this remains a poor practice.

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An immediate revision neck lift is quite rare after a properly executed surgery.   The goal is to remove just the right amount of excess skin and possibly some fat, and tighten the deeper muscle to achieve a stable result that can last for many years.

 

Nonetheless, aging continues after surgery although how long the sagging returns will depend on several key variables such as the inherent skin elasticity, sun exposure, diet, and patient’s weight. But one way to postpone the need for a revision neck lift is to take care of one’s skin.

 

revision neck lift

 

Avoiding drastic weight fluctuations, sun’s UV rays, and smoking can prevent or at least slow down the aging of skin, as suggested by several studies conducted by Los Angeles plastic surgery experts.

 

In the event that an immediate revision neck lift is warranted, oftentimes the culprit is the incorrect execution. Sometimes, poor healing could also get in the way of achieving optimal results from the surgery.

 

It may be safe to surmise that under-corrected surgery is much easier to address than over-corrected operation. Once the skin, tissue, or fat is depleted, the revision becomes complicated that the surgeon will employ techniques more commonly used in reconstructive plastic surgery—e.g., skin grafts, fat transfer, etc.

 

In revision involving under-corrected neck lift, doctors use additional incision or possibly extend the existing scar to remove additional skin. Inexperienced surgeons may commit the mistake of using liposuction-alone approach to address jowling and turkey neck appearance without realizing that the problem is caused by the excess skin and not just by the extra fat.

 

The only way to remove the excess skin that contributes to the jowling and saggy neck appearance is by making incisions behind the ear, particularly within the ear-face junction for optimal scar concealment.

 

Revision dealing with under-corrected surgery may also involve additional scar beneath the chin, which is the only way to access the separated neck muscle responsible for the unsightly vertical bands. Evading this additional step results in less than optimal “angle” of the chin and neck.

 

Over-corrected, meanwhile, is typically more difficult to improve. Sometimes, the only way to address the problem is to do nothing—i.e. wait for the skin to relax and settle.

 

Scar revision is another reasons for touch-up following a neck lift surgery. While most patients have no visible scars after surgery, some individuals may experience poor healing or their surgeons have failed to remove the tension on the skin during the initial surgery, leading to scar migration or aggressive scarring.

 

Ideally, revision neck lift is performed 6-12 months after the initial surgery to ensure that all the swelling has dissipated and the skin has settled to its final shape.

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The reasons for tummy tuck and hernia repair share some common conditions. Due to pregnancy, C-section, massive weight loss, and other factors known to put too much pressure on skin, the abdominal walls become separated and weakened.

 

The separated abdominal muscle along the midline (starting from the pubic bone up to the area slightly below the sternum) occasionally leads to hernia in which the internal organ, usually the intestine, escapes the abdominal wall and fascia, leading to the appearance of “pocket” or sack.”

 

tummy tuck and hernia repair

For this reason, the intestine that pushes through the “break” can lead to serious problems such as blockage, dysfunction of the organ, pain, and infection, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

Simultaneously performing tummy tuck and hernia repair typically requires a horizontal incision across the lower abdomen or pubic bone. While the resulting scar is long, it is positioned in a way that it is concealed by the patient’s underwear.

 

Through the horizontal incision, doctors are able to remove the hanging skin and excess fat, and tighten the separated abdominal muscle along the midline with the use of internal sutures. In one of Dr. Smiley’s Snapchat video, he says that he prefers the use of permanent stitches, as opposed to absorbable types, due to their additional support.

 

While internal sutures are enough to tighten the weakened abdominal wall, Dr. Smiley says that hernia requires additional reinforcement in the form of mesh to prevent any organ from slipping out of its original position or breaking through its cavity of tissue in the future.

 

Mesh products use in hernia repair are typically made of plastic-like material that allows the patient’s own tissue to grow and incorporate around its structure. This “scaffolding” is either placed under or over the “defective” part of the abdominal wall, says Dr. Smiley.

 

The results from tummy tuck and hernia repair are mostly permanent provided that the patient maintains a healthy weight and avoids pregnancy in the future. As a result, women of childbearing age may have to postpone the cosmetic aspect of the surgery (tummy tuck).

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Bruising after rhinoplasty or nose-reshaping surgery is often more evident along the lower eyelid where the skin is notably thin and “sensitive,” according to the California Surgical Institute website.

 

Bruising after rhinoplasty is caused by leakage of blood from ruptured blood vessels, which has become visible beneath the skin. While this postop symptom is normal, a good surgeon will try to minimize it by using the gentlest surgical techniques and avoiding unnecessary injury around the soft tissue.

 

bruising after rhinoplasty

Reducing the amount of bleeding at the time of surgery can minimize postop bruising as well.

 

Aside from the use of gentle surgical techniques, the amount of bruising is also partly determined by the patient’s anatomy and healing. Some individuals bruise more easily than others; this is particularly true for those with hypertension and other medical conditions. For this reason, the best candidates for rhinoplasty or any other form of elective plastic surgery are those who are in their optimal health.

 

The preoperative instructions will also affect the amount of bruising. Aside from achieving one’s optimal health prior to surgery, it is also important to avoid aspirin-based medications (and other drugs and supplements known as blood thinners), tobacco products, and excessive alcohol weeks prior to surgery.

 

Some surgeons recommend Arnica montana, bromelain, or other similar homeopathic remedies taken a few days before and/or after surgery as a way to limit bruising and possibly promote healing. However, their purported benefits are still up for debate so a prudent patient will only stick to his doctor’s specific instructions.

 

Furthermore, strict adherence to postoperative instructions can minimize bruising. The consensus is to avoid rigorous activities and heavy lifting for 4-6 weeks because these can trigger leakage of blood from the ruptured capillaries, leading to persistent bruises and swelling and ultimately longer recovery.

 

Elevating one’s head is also known to minimize bruising after rhinoplasty or any other surgery on the face. Meanwhile, bending over must be avoided for a few days or even weeks because of its detrimental effects on healing.

 

In the first two days after surgery, icing is believed to be one of the best ways to control swelling and bruising. But to prevent cold burns and blisters, the ice packs should be wrapped in thin cloth or towel and should not be used for more than 20 minutes at a time.

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The two basic reasons for revision gynecomastia surgery are under- and over-correction. It is important to note that tissue regrowth that warrants a repeat procedure is quite rare after a well-performed male breast reduction surgery.

 

Renowned Inland Empire plastic surgery expert Dr. Tarick Smiley explains the basics of revision gynecomastia surgery dealing with the after effects of under- and over-correction.

 

revision gynecomastia surgery

Under-Corrected Surgery

 

Gynecomastia surgery removes the excess glandular tissue and possibly some skin and fat to correct the appearance of woman-like breasts. Under-correction or under-resection occurs when the patient feels he still has fullness in his chest area.

 

It is important to note that postop swelling may conceal the results of gynecomastia surgery for a few months and could even give some fullness that will take time to dissipate. Also, the internal scar tissue might contribute to the less than optimal results.

 

Should the patient contemplate another surgery, it is highly ideal to wait at least six months to ensure that all the residual swelling has dissipated to accurately assess the condition and appearance of the chest. Earlier intervention, meanwhile, could mean less predictable results.

 

Some inexperienced surgeons attempt gynecomastia surgery through a liposuction-alone approach (it only removes the excess fat through a few round 2-3 mm incisions) without realizing that the fullness is mainly caused by the excess glandular tissue instead which can only be resected with the use of longer incisions.

 

Revision for under-corrected surgery typically involves a U-shaped incision within the lower border of the areola. But for significant correction, the surgeon may elect to use longer scars within the submammary fold and/or vertical scars between the nipple area and the crease.

 

Over-Corrected Surgery

 

Over-corrected surgery is more difficult to treat than under-corrected procedure. Once too much skin, tissue, and/or fat has been removed, the patient will require soft tissue replacement to address contour irregularities such as skin dents, hollowness that commonly affects the lateral aspect of the breast, and sunken areola deformity.

 

Fat grafting is one option to smooth out contour irregularities. The procedure collects donor fats usually from the tummy area, which are later used and injected into the chest.

 

Fat flap is another possible technique, although it requires the patient to have sufficient fat from an adjacent area of the chest. This involves rotating the donor fat (without completely removing it from the donor site) to correct the dented or hollowed area.

Sometimes, silicone implants could improve the effects of over-correction, although they come with some potential risks.

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Rhinoplasty plus chin implant aims to improve facial proportions. Studies have suggested that the relationship between the nose and the lower third of the face has a large impact on the level of attractiveness.

 

The reasons for rhinoplasty, or nose-reshaping surgery, vary significantly from patient to patient. Nonetheless, its common goals include refining the tip, augmenting or reducing the nasal profile, removing hump or some form of deformity along the bridge, and/or correcting the excessive nostril flare.

 

rhinoplasty plus chin implant

But with a more refined nose after surgery, the weak chin which almost disappears from the neck is further emphasized. Thus the improvement from rhinoplasty may not really shine through because of the imbalance between the middle and the lower third of the face, as suggested by experts at the California Surgical Institute.

 

Hence, rhinoplasty plus chin implant has become a common combo procedure. The price range for this simultaneous procedure is typically between $10,000 and $15,000, although some patients may have to pay more particularly if their surgeon’s clinic is located in a posh area, and/or their doctor’s cater to high-profile patients.

 

The ideal chin projection is determined by several variables, although the most important ones include the patient’s gender (in men it should be more prominent compared to women), and the position and projection of the upper and lower lips.

 

The ideal chin projection from the lip-chin fold is about 6 mm in men and around 4 mm in women. The consensus is that chin augmentation via implant is highly recommended for individuals with more than 5 mm deficit.

 

Contrary to popular belief, “standard” chin implants do not increase the vertical height of the lower face. They are primarily designed to improve the profile of the chin; however, most surgeons today agree that they should slightly extend laterally (along the angle of the mouth) to avoid the illusion of a pointy chin.

 

Some patients will even need their actual jaw to be reshaped at the same time. Nowadays, there are chin implants that can enhance the front line of the jaw and chin projection at the same time.

 

While a good surgeon will not force his patient to get additional surgery, he should be able to explain and demonstrate clearly how incorporating chin implant can further improve the results of rhinoplasty. In this situation, the use of 3D simulating technology becomes particularly helpful.

 

3D simulating technology allows the patients to preview the likely results of their rhinoplasty plus chin implant.

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