All efforts are made to hide the neck liposuction incisions to promote high patient satisfaction. After all, people do not want telltale signs of plastic surgery such as visible scars, skin irregularities, and unnatural contour, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently performed neck liposuction in a female patient and posted her surgery on Snapchat.
Dr. Smiley uses one small incision precisely placed within the natural skin fold for optimal scar concealment.
The patient said she was bothered by her “heavy” neck and “double chin” appearance caused by the excess fat. Meanwhile, she had a decent skin shrinkage and so she was deemed as a good candidate for a neck liposuction-alone approach.
(Note: Patients with poor skin elasticity may need a concomitant excision-based surgery—e.g., facelift and neck lift—as a liposuction-alone approach may aggravate the appearance of sagging neck or jowl.)
To create a more slender neck, Dr. Smiley performed liposuction, which also included the patient’s chin to achieve a smooth, natural transition between these areas. He also removed some fats along the jawline to deliver a more chiseled appearance. This was all done with the use of a small round incision (about 1 cm) beneath the chin, specifically within the natural skin crease to further hide the scar.
Occasionally, the under the chin incision is complemented by a pair of incisions below the earlobes. This approach is particularly ideal for patients whose neck fat extends significantly beyond the center.
Dr. Smiley says that neck liposuction requires a “highly meticulous approach” to prevent surface irregularities.
To achieve smooth results, Dr. Smiley highlights the importance of “cross feathering” technique in which the liposuction cannula (stainless steel tube to remove the fat) is moved back and forth quickly and at varying angles.
The idea of cross feathering, Dr. Smiley explains, is to promote uniform removal of the excess fats, and to ensure that some fats remain after surgery to preserve a smooth skin surface.
Contrary to popular belief, the celebrity plastic surgeon says that neck liposuction is not about removing the entire fat. In fact, doing so could lead to visible bands caused by the lack of “carpeting” to the point that the platysma muscles show through the thin skin, he warns.
To preserve smooth surface and natural neck contours, he highlights the importance of leaving behind enough fat beneath the skin.
Inner thigh liposuction poses some challenges such as increased risk of surface irregularities and unnatural contour. However, renowned Orange County plastic surgeon Dr. Tarick Smiley says that with meticulous techniques these surgical stigmata can be avoided or at least minimized.
In liposuction, the most important issue is the smoothness, not the volume of fat removed. Anecdotal reports show that the most common cause of patient dissatisfaction is surface irregularity, which require a revision surgery.
These are the basic guidelines to avoid unfavorable outcomes in inner thigh liposuction, according to Dr. Smiley.
Liposuction microcannula is a stainless steel probe with an outside diameter measuring 1-3 mm. It removes fats in smaller bits, making it especially ideal in treating the inner thigh that is known to be susceptible to surface irregularities particularly when large cannulas are used.
Microcannula should be moved back and forth using a fanlike motion radiating out from each incision site. Furthermore, fat removal should be done in an overlapping and intersecting manner to promote smooth and uniform results.
“Uniform” fat removal is also achieved when small decrements over the treated area are gradually suctioned out; the process is repeated several times until the desired result is accomplished.
- Maintaining sufficient fat reserves
As previously stated, the success of inner thigh liposuction or any liposuction site boils down to the preservation of smooth skin surface and natural contour. Hence, it is a sacrosanct rule to maintain sufficient “carpet of fat” beneath the skin.
When too much fat is removed, bumps and dents appear. Furthermore, the contours and curves of the inner thigh are obliterated.
The general rule of thumb is to preserve sufficient amount of fat based on the patient’s skin shrinkage and other underlying anatomies. And due to the susceptibility of the inner thigh to surface irregularities, skilled surgeons typically choose a conservative route.
Liposuction for male breast reduction is often inadequate because the vast majority of patients have chest enlargement caused by excess glandular tissue and not just fat, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
“The breast or glandular tissue is too fibrous that it will not come out with liposuction alone,” says Dr. Smiley in his recent Snapchat post.
Before removing the excess breast tissue, Dr. Smiley performs liposuction first to eliminate the fat.
Dr. Smiley says that liposuction uses a hollowed steel tube to suction the fat out of the treated area; however, it cannot draw out the “extremely fibrous and dense” glandular tissue, which can only be removed with a longer incision.
To allay the concern of patients regarding the appearance of scar, Dr. Smiley says the incision is “precisely made at the lower border of the areola” to hide the scar.
“The light and dark skin junction perfectly conceals the scar. After all, men like to take off their shirt without having to worry about surgical stigmata. They are simply more secretive when it comes to plastic surgery,” Dr. Smiley says.
Recently, the renowned plastic surgeon performed a combination of excision and liposuction in a male patient who has good physique due to regular exercise and superb diet. But despite his commitment to healthy lifestyle, his chest remained unusually large for a man, a condition medically referred to as gynecomastia.
A small U-shaped incision is placed at the lower border of the areola to remove the excess tissue with a cautery device.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 27,760 men with gynecomastia had male breast reduction surgery, which is traditionally performed with an excision-based technique.
However, Dr. Smiley says that a good number of men can benefit from a simultaneous liposuction, which he performed in the said patient.
Dr. Smiley started the procedure with the injection of tumescent fluids into the chest before performing liposuction to remove the excess fat. The idea, he says, is to keep bleeding to a minimum and to numb the area.
The liposuction incision was a small “puncture hole” placed at the border of the lower areola.
Afterwards, he created a curved incision also placed right at the lower border of the areola so he could remove the excess glandular tissue that was causing the “appearance of woman-like breast.” Nonetheless, he maintained the patient’s good muscle definition so his new chest would not detract from his athletic physique.
Brazilian buttock lift or BBL has revolutionized the way plastic surgeons perform buttock augmentation surgery. In fact, this technique has almost precluded the need for butt implants and other synthetic materials since most people have adequate fat reserves.
During BBL, excess fats are collected from multiple sites, which typically include the lower back, flanks, and anterior abdomen, using liposuction surgery. The fats are then sorted, washed, and transferred to several tubes to be later injected into the buttocks and hips.
While the term large volume BBL is not clearly or medically defined, most surgeons agree that it involves more than 1,000 cc of fat volume injected into each side, resulting in drastic improvements in the projection and shape of the buttocks.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley explains the factors that allow or warrant large volume BBL.
- Tall and broad-shouldered patients
Contrary to popular belief, the ideal butt and hip dimension created during BBL is largely influenced by the patient’s upper torso/shoulder dimension, not her legs. The idea is to achieve a more hourglass physique, which is the quintessential feminine shape.
Meanwhile, petite patients (e.g., 5’2 and 118 lbs.) are generally poor candidates for large volume BBL due to disproportionately huge results, which can be a clear sign that a plastic surgery has been performed.
Furthermore, petite/thin patients have not enough fat reserves to allow for large volume BBL. Nonetheless, aesthetic improvements particularly in the shape of their buttocks remain possible in the hands of a skilled surgeon. In fact, due to their small body frame they tend to have a more pronounced roundedness of their backside.
- Skin that is not too lose nor too tight.
A skin that has a good level of elasticity allows for large volume BBL, while a skin that is markedly tight, which is commonly found in patients with square buttocks, can only take a conservative fat volume.
Dr. Smiley says that tight skin causes too much pressure, which is the “enemy of fat grafts” and thus results in low survival rate; hence, only a conservative volume of fat is administered in patients with this anatomy.
BBL on small frame generally entails a conservative approach as patients typically have limited amount of fat reserves. Nonetheless, the results on petite women often show a more pronounced roundedness of the buttock particularly on the posterior view.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that average patients typically require at least 800 cc of purified fat on each side to see a noticeable result; however, markedly thin patients may have little excess fat, which could limit the amount of projection and augmentation created by BBL, which is an acronym for Brazilian buttock lift.
However, there are ways to compensate for the low fat reserves such as performing liposuction in small volumes over multiple areas, Dr. Smiley says on Snapchat.
“When dealing with petite patients, I will find all the unwanted fats to come up with sufficient amount that is later injected into the buttocks,” he says.
Dr. Smiley says that contrary to popular belief, the legs are not the main consideration when deciding for the “ideal” buttock projection and hips width during surgery.
A few months ago, a thin and tall woman asked for BBL to improve her flat buttocks and near absent hips. While her legs were relatively thin and slender, Dr. Smiley decided to inject more fat volume into the butt and hips to make them look proportionate to her broad shoulder/upper body.
Aside from taking into account the patient’s overall physique, Dr. Smiley says BBL on small frame should also focus on the shape, adding that some patients are more concerned about the contour improvement than the actual amount of augmentation.
Recently, Dr. Smiley had a patient who requested for a conservative BBL (this generally refers to 200-300 cc fat injection on each side) because she only wanted more hips. Meanwhile, the profile or forward projection of her buttocks required little fat injection because it was already adequate prior to surgery.
Dr. Smiley says that BBL on small frame can provide great improvements in the entire physique when 360 degree liposuction is performed, meaning the flanks, lower back, and anterior abdomen are treated as a donor site. By creating a smaller waist, the buttocks and hips are further highlighted.
Liposuction surgery removes the excess superficial fat beneath the skin, resulting in a slender physique. However, anecdotal reports show that about 20 percent of patients will have surface irregularities that generally disappear after 1-2 months.
Post-op surface irregularities are often caused by edema or fluid accumulation in the tissue where the fat has been removed, or by scar fibrosis with adhesions. While they often dissipate on their own as the patients move forward to their recovery, the use of VelaShape after liposuction is known to speed up healing.
In a recent Snapchat video, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has shown a female patient having a post-liposuction VelaShape, a non-surgical treatment designed to improve contour deformities and cellulites by using a combination of suction, massage, infrared light, and radio frequency.
This FDA-approved treatment is commonly performed after liposuction of the abdomen, thighs, hips, and buttocks, areas that are susceptible to postop surface irregularities and persistent swelling.
Dr. Smiley says that VelaShape uses a hand piece applied directly to the skin surface; it has rollers to smooth out surface irregularities, and a radio frequency device to melt and break up the fat cells, which are gradually flushed out of the body within a few weeks.
After 4-6 weekly treatments, most patients can expect a smooth skin after liposuction.
Patients often describe the procedure as like having a deep, warm tissue massage, with no or very little discomfort.
Meanwhile, Dr. Smiley says that a well-executed liposuction rarely results in permanent lumps and other types of surface irregularities; however, any contour deformity that persists after 4-6 months may require touch-ups usually in the form of another liposuction or fat grafting.
To prevent permanent contour deformities, the celebrity plastic surgeon highlights the importance of avoiding aggressive liposuction—i.e., there should remain some fat cells after surgery to serve as a “carpet” or cushion beneath the skin.
Too “superficial” fat removal should also be avoided to ensure a smooth skin after liposuction, says Dr. Smiley.