Dr. Tarick Smiley Blog

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Some people consider having a chin implant in order to elongate or slim their face. However, it should be noted that the prosthesis is primarily designed to improve the profile or forward projection thereby correcting the appearance of a recessed chin, according to the California Surgical Institute website.


Nonetheless, customized chin implant can give a few millimeters of added height to the chin and thus may give an illusion of a more elongated face, although the effect is very subtle.


chin augmentation for round face

Chin implant is primarily used to correct the weak or recessed chin.


Simply put, chin augmentation for round face provides no or very little improvement.


When the patient’s primary goal is to slim a markedly round face, her surgery should take into account several factors that may include a weak or recessed chin, wide jawline, chubby cheeks, or a combination of them. Some people require more than one procedure to achieve proportionate results and more slimming effects.


Chubby cheeks are often caused by excess fat, which can be removed with a procedure called buccal lipectomy. This involves a small incision created inside the mouth in order to remove a walnut-sized fat and thus improve the facial contour.


Most surgeons prefer calling the procedure buccal fat reduction, instead of removal, because removing the fats entirely can result in a gaunt appearance, which might become apparent right after surgery or years down the road due to age-induced facial volume loss.


Hence, the vast majority of doctors offering buccal fat reduction take the conservative route—i.e., they remove only small amount of fat—to prevent premature aging of the face.


Occasionally, a markedly round face is caused by wide jawlines. In the past, most surgeons would perform a surgery in which the masseter muscle, the one responsible for chewing, was shaved down. But nowadays, Botox injection can serve as a great alternative without the prolonged downtime and other risks associated with surgery.


Botox weakens the masseter muscle and thus causes it to shrink. However, the effects can only last 4-6 months and thus it entails regular touchups.

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Achieving a pleasing breast shape after breast reduction surgery is possible with deep tissue work and the creation of “appropriate” cup size, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


In the past, breast reduction surgeries were primarily concerned with the removal of excess tissue and redraping the skin over the smaller breast. However, the approach has a fundamental weakness: The skin stretches over time and so the initial perkiness is lost invariably.


breast shape after breast reduction surgery

To prevent breast sag, or at least prolong the perky appearance of the breast, Dr. Smiley says he performs deep tissue work alongside his breast reduction surgery.


His deep tissue work is the same with the breast lift technique in which internal sutures and breast tissue “elevation” are used to create a pleasing shape—i.e., some fullness in the upper breast pole.


With the suturing techniques, the breast shape is not dependent on the overlying skin, which is known for its inherent weakness, but rather on the deeper structures. This approach promotes longer lasting perkiness and more favorable scarring and healing since the skin receives no or very little tension.


When there is little tension on the skin, the scar tends to fade and heal much better, says Dr. Smiley.


“Sufficient reduction” is another critical element to promote a pleasing breast shape that can last for many years. It should be noted that one of the most common causes for “bottomed-out” breasts after surgery is that they are not made small enough.


Patients with overlarge breasts who want a conservative size reduction should realize that they remain susceptible to bottoming out or sagging due to the excessive weight that is causing the skin below the nipple area to stretch out.


It should be noted that the surgery does not change the quality of skin, although making the breast smaller and lighter can diminish the effects of gravity.


The breasts appear perky in the first few weeks postop until they gradually settle (i.e., lose some of the fullness in the upper breast pole) within 6-12 months.

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Rhinoplasty for thick skin poses some challenges. Nonetheless, achieving an aesthetically pleasing nose remains possible with meticulous reshaping of the bony and cartilaginous framework, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.


During rhinoplasty, or nose job in layman’s term, the cartilage and bone are reshaped and a small piece is removed to eliminate the hump, correct the over-projection, or raise the drooping tip.   Meanwhile, the skin must redrape well to the new framework to achieve a smooth and natural contour.


rhinoplasty for thick skin

Ethnic patients often have thick nasal skin. Nonetheless, meticulous rhinoplasty can still provide impressive results.


Because thick skin has less flexibility, it does not shrink-wrap as well or as tight as a thin skin. On the upside, it is good at hiding tiny contour irregularities, which could easily show through a markedly thin skin.


Dr. Smiley explains some possible maneuvers used in rhinoplasty involving patients with thick nasal skin.


  • Go easy on reduction and narrowing.


The skin’s elasticity, which is closely linked to its thickness, will determine how much the nose can be reduced or narrowed without looking amorphous especially at the tip. Hence, the surgeon’s training, experience, and ability to predict the amount of skin shrinkage following surgery will play a critical role in the final result.


  • Use meticulous dissection to limit scar.


Thick skin is susceptible to scars, which could conceal the details of the surgery or cause polly beak deformity in which the nose resembles a parrot’s beak.


Polly beak deformity happens when the supratip of the nose (right above the tip) pushes the tip downward.


Aside from meticulous dissection, another way to prevent or at least limit the risk of unnatural nose contour and other complications is to use closed rhinoplasty technique in which all the incisions are made inside the nostrils, while the wall of tissue between the nostrils remains intact during the entire surgery.


  • Consider thinning of the subdermal fat.


When surgeons mention thinning of the skin, they actually mean thinning of the subdermal fat, a surgical maneuver that only suits a small number of patients. It should be done precisely lest the patient ends up with surface irregularities.


Thinning of skin may also translate to reducing the pre-existing scar tissue caused by a previous rhinoplasty. In this scenario, doctors should be extra careful and proactive (e.g., possible use of steroid injections postop) to prevent further scarring.


  • Steroid injection to treat patients with persistent swelling or a strong history of aggressive scarring.


Steroid injections might be a good option in patients with persistent swelling (lasting more than three months) or a strong history of keloids. Occasionally, this is also used after a revision rhinoplasty.

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In 2017 about 1.8 million cosmetic plastic surgeries were performed in the US, totaling more than $16 billion when combined with minimally invasive procedures, according to data released by the American Society of Plastic Surgeons.


Despite the prevalence and growing acceptance of plastic surgery, there are some things that may come as a shock to many people. For instance, some doctors use medical-grade leeches to treat gangrene in which the tissue dies due to insufficient blood flow after surgery.


weird facts about plastic surgery

Photo credit: photostock at FreeDigitalPhotos.net

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley shares some weird facts about plastic surgery:


* Medical grade leeches are sometimes used to treat postop complications.


Smoking causes poor healing by constricting the blood vessels that are supposed to bring the much-needed oxygen, leading to gangrene and other complications. This is where leeches come to the rescue.


Leech therapy has been around for 2,500 years. Its concept is fairly simple: Blood-sucking worms drain the old blood and thus improve circulation. Oftentimes, the unhealthy purplish tissue turns into healthy pink just after a few days of treatment.


  • Today’s men are placing more attention on their appearance.


Last year more than 1.6 million cosmetic plastic surgeries were performed on US men, accounting for 13 percent of all the procedures. In addition, they had about 14 million minimally invasive treatments, with Botox and dermal fillers being the most common.


Meanwhile, South Korean men kick it up a notch. Not only they undergo plastic surgery to have a softer, more feminine face (juxtaposing it with their macho physique), they also consume 20 percent of the world’s cosmetics for men.


  • Cosmetic surgery may motivate people to live healthier lives.


A recent study published by journal Plastic and Reconstructive Surgery has suggested that patients quit smoking or at least smoke less after their surgery. (Note: The vast majority of plastic surgeons require complete smoking cessation two weeks before and two weeks after the operation.)


In addition, several studies have suggested that tummy tuck patients who were previously obese were more successful in keeping a healthy weight compared to patients who skipped body contouring following massive weight loss. Some researchers concluded that the improved physique could serve as their motivation, while others attributed it to the reduction of belly fat, which is linked to the feeling of hunger.


  • Selfies are driving plastic surgery’s boom.

Small surveys and anecdotal reports have pointed out a link between selfies and the growing popularity of facial plastic surgeries and non-surgical enhancements. Dermal fillers, Botox, chin augmentation, and rhinoplasty (nose job) are often mentioned by Selfie enthusiasts.

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Obesity and plastic surgery simply don’t mix. Several studies have already shown that obese patients—i.e., their body weight is at least 20 percent higher than it should be—face higher risk of wound infections, heart attacks, nerve injuries, and urinary tract infections after surgery.


Furthermore, morbidly obese patients, meaning their weight is more than 100 lbs. over their ideal weight, are twice more likely to die as a result of any non-cardiac surgery.


obesity and plastic surgery

Due to higher risk of postop complications, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that obese patients also tend to incur more hospital bills, citing a 2015 study suggesting that they paid additional $7,100-$7,400 after tummy tuck and breast reduction.


The study has also suggested that obesity was linked to higher risk of serious complications that required hospital admission within 30 days after plastic surgery: About 72 percent higher compared to non-obese patients.


Obese patients are also at an increased risk of poor scarring and healing problems because they typically suffer from some type of malnutrition and their skin has been damaged by the excess weight over the years, as suggested by experts.


While it might be easy to turn down obese patients seeking an elective body contouring surgery, this may not be the case with someone considering breast reduction to help improve her mobility, which could allow her to increase physical activities to promote weight loss. In this scenario, Dr. Smiley says the benefits should always outweigh the potential risks.


Furthermore, the celebrity plastic surgeon says obese patients should be made aware of the risk so they can make an informed decision.


“Letting them know of the increased risk in terms of wound breakdown and delayed healing also allows them to handle postop complications better should they happen,” says Dr. Smiley.


Should a plastic surgery is deemed necessary to improve the patient’s quality of life, experts recommend at least a 24-hour hospital stay for closer monitoring.

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BBL, which stands for Brazilian buttock lift, is one of the most commonly performed body contouring surgeries to date. This basically combines liposuction to collect donor fats from multiple areas; the fats are then immediately purified and injected into the backside to improve its shape and fullness.


While the vast majority of patients require fat injection into their buttocks and hips, which are the outer or lateral area of the butt region, some women only want hip enhancement.


bbl and hips

Photo Credit: Dr. Tarick Smiley


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says it is possible to enhance the hips alone or anywhere additional volume is needed.


“That is the beauty of fat grafting or fat injection. We can put them anywhere and thus we have more control over the final results. Butt implants, meanwhile, can be limiting because they are placed above the patient’s sitting area and so only the upper half of the buttock region is enhanced,” says Dr. Smiley in a previous Snapchat video.


Fat injection to hips alone is ideal for patients who have sufficient butt size but want to achieve a more hourglass physique, which is believed to be the most attractive feminine figure.


A hip alone “enhancement” may also favor women who want subtle results—i.e., they want better shape instead of additional volume or forward projection to the buttocks.


“It is important to identify each patient’s goals so we can deliver results that can make them happy,” says Dr. Smiley.


Dr. Smiley says the vast majority of his patients require both BBL and hips enhancement, which are possible with at least 800 cc of purified fats. However, people who want more augmentation may need more than 1,000 cc to achieve their desired result.


The celebrity plastic surgeon says the best donor fats come from the lower back and flanks because of two main reasons: First, because they are adjacent to the buttocks and hips they tend to have impressive survival rate, and second, sculpting the area further emphasizes the contour and projection of the backside.


Including the abdomen as a donor site further improves the patient’s physique.


“By removing the excess fats through liposuction, we can significantly improve the patient’s waist-to-hip ratio. Studies have suggested a strong preference for WHR of 0.7, meaning the waist circumference is 70 percent of hips measurement. This is seen across different cultures and demographics, says Dr. Smiley.

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