Dr. Tarick Smiley Blog

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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.

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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.

 

facelift and neck lift

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.

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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.

 

multiple plastic surgeries

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).
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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.

 

mommy makeover procedures

 

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.

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Many people already know that brow lift surgery can elevate the sagging brow, leading to a more youthful appearance. However, not everyone knows that it can inadvertently alleviate migraine, improve perceived personality traits, and reduce the hooded appearance of the upper lid.

 

Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained the lesser-known brow lift benefits.

 

brow lift benefits

before and after photos depicting great results from brow lift surgery

 

  • Alleviate or even eliminate migraines

 

Surgeons say that some patients who had have brow lift, also referred to as forehead lift, reported less frequent migraine attacks or even complete remission. Experts have concluded that elevating the sagging tissue may release the pressure that is “pinching” or “irritating” the nerves responsible for chronic headache and its secondary symptoms such as light and nose sensitivity, blurry vision, and nausea.

 

  • Increase trustworthiness

 

Researchers at the New York University have conducted a survey showing that people with high eyebrow, which is medically referred to as high oblique frame or wide brow-lid complex, were perceived to be more honest and trustworthy by others.

 

Whereas people with furrowed brow, either caused by aging or as an inherited feature, scored lower in the perceived trustworthiness reviews.

 

Aging causes the brow particularly the lateral or tail end to sag, which can lead to an angry or sad appearance, depending on the degree or angle of droop.

 

Most patients will only need their brow’s tail end elevated, with no or very little advancement of the inner or medial aspect, to achieve a more refreshed appearance.

 

  • Increase femininity

 

A youthful female brow lies slightly above the bony orbital rim of the eye socket, and also comes with a soft lateral arch.   But with aging, the soft tissue sags causing the tail end to lose its height, leading to a more horizontally oriented shape of the brow.

 

Therefore, most brow lifts just require conservative elevation of the tail end to restore the lost arch.

 

  • Reduction of wrinkled skin in the upper eyelid

 

Occasionally, the drooping brow causes skin wrinkles and “heaviness” along the brow-upper lid complex. Hence, lifting the tail end of the brow could make the eyes appear more alert and more youthful without resorting to a separate procedure in the form of upper eyelid (blepharoplasty).

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The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.

 

A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.

 

facial plastic surgery

To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.

 

The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.

 

Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.

 

Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.

 

Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.

 

Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.

 

Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.

 

Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.

 

However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”

 

“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.

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