Posts by Dr. Tarick Smiley


Revision tummy tuck is generally more complex than the initial surgery due to the presence of old incision lines and scar tissue. Oftentimes, the patients also have some type of navel deformity, contour asymmetry, and residual excess skin, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

Dr. Smiley has recently posted a series of Snapchat videos to demonstrate revision tummy tuck performed on a male patient.

 

revision tummy tuck

 

A few years ago the patient underwent tummy tuck performed by a different surgeon. But instead of achieving a more masculine physique, the surgery left him with unnatural-looking navel (too big and round), visible asymmetry along his flanks, and high-riding and indented scars.

 

Aside from revision tummy tuck, the patient also asked for a simultaneous breast reduction to make his chest area congruent with the abdomen.

 

To conceal the high-riding tummy tuck scar beneath the patient’s underwear, Dr. Smiley created a new incision line (hip to hip) that was positioned very low that it settled within the groin and pubic hairline.

 

Through the new incision placement, he was also able to eliminate the appearance of indented scar by removing the residual loose skin. Furthermore, he removed more skin along the right flank to eliminate the contour irregularity.

 

Meanwhile, the celebrity plastic surgeon also performed navel repair, particularly with the intent to reduce its size and change its shape. He said that a natural-looking belly button has a more vertically oriented contour, as opposed to having a perfectly circular shape.

 

During navel repair, he placed the incision inside the belly button’s rim so the scar will remain imperceptible.

 

Afterwards, all the incisions were closed by multiple rows of stitches to promote the best scar possible. The skin, meanwhile, was not picked up by any suture and instead a surgical tape held its edges together to reduce superficial tension.

 

“The key to faded and favorable scar is to eliminate most of the tension on the skin,” says Dr. Smiley.

 

Dr. Smiley also injected Exparel directly into the abdominal muscle; this is a long-acting numbing medication that works for up to four days, thus allowing the patient to avoid or at least limit his use of narcotic pain relief.

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Male chest reduction surgery is not just about removing the excess tissue and fat that are causing the appearance of “man boobs.” Other equally important goals include creating high level of symmetry between the two sides, ensuring smooth and natural contour, and avoiding surgical stigmata such as surface irregularities and visible scars.

 

Prominent Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted male chest reduction before and after photos on Snapchat to demonstrate what the surgery can [realistically] accomplish.

 

male breast reduction before and after photos

 

Dr. Smiley combined liposuction and direct excision technique to achieve a more masculine physique. This “combo” surgery has allowed him to extract up to 2 liters of fat and copious amounts of glandular [breast] tissue.

 

He first performed liposuction to remove the excess fat through a small cannula (hollowed tube) that could fit into a puncture hole placed right at the lower border of the areola for optimal scar concealment.

 

When doing liposuction, Dr. Smiley said he preferred the tumescent technique in which large volume of fluids that contain saline, lidocaine (local anesthesia), and epinephrine (to constrict the blood vessels and thus limit the amount of bleeding) are injected into the treatment site.

 

With liposuction, he was able to remove around 1 liter of unwanted fat on each side.

 

Next, Dr. Smiley created an incision still right at the lower border of the areola so the scar would remain hidden. The idea, he said, was to remove the excess glandular tissue.

 

gynecomastia surgery

“The white glandular tissue is extremely fibrous and so it will not come out with liposuction alone. Most patients really need an excision-based technique to achieve a nicer and flatter chest,” Dr. Smiley said on Snapchat.

 

Before closing the incisions, the surgeon examined both sides to ensure that high level of symmetry has been achieved and possibly to address any contour irregularities while the patient was still on the operating table.

 

He then closed the incisions with multiple rows of tiny sutures without picking up the skin whose edges were instead held together by surgical tape. With this suturing technique, the skin received no or very little tension, which is the key to favorable scar.

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Fibrosis from liposuction happens because the body invariably creates scars in the areas where the cannula (or suction tube that removes fats) has passed through. This creates adhesion that results in surface irregularities and firmness, which tend to improve with time.

 

In a nutshell, most patients can expect smooth results as the scars remodel and soften with time, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

fibrosis from liposuction

Dr. Smiley uses gentle liposuction techniques to minimize injury and internal scarring, which is tied to surface irregularities.

However, a small number of patients can have fibrosis that can last for many years (or even permanent) and thus they necessitate some type of revision. The flanks and upper abdomen are areas believed to be susceptible to this problem.

 

If excessive scars form internally under the skin surface and do not improve with time, subcision can help minimize skin puckering or firmness. This is a rather straightforward procedure in which a special needle is inserted adjacent to the scar and is moved back and forth in a fan-like motion to release the fibrous bands.

 

Nonetheless, there are ways to prevent aggressive formation of fibrosis, which is tied to contour irregularities and other surgical stigmata. For instance, Dr. Smiley highlights the importance of correct motion when using the liposuction cannula.

 

  • The cannula is moved back and forth in a criss-cross fashion to remove fats uniformly.
  • Avoid being too close to the skin. Meanwhile, the cannula must be moved at varying levels to achieve smooth results and to avoid dermal damage, which is tied to excessive scarring or fibrosis.
  • Use microcannula, as opposed to large cannula, because it removes smaller bits of fats and causes less amount of trauma.
  • Prolonged aspiration in one spot should be always avoided.

 

Aside from meticulous surgical techniques, the celebrity plastic surgeon says other modalities can further promote smooth results and prevent fibrosis from liposuction. These include the use of good-fitting compression garment for at least two weeks, massage to control swelling, VelaShape, or a combination of them.

 

VelaShape, which is an FDA approved non-surgical treatment, is particularly ideal after liposuction. This uses a handheld device that improves contour deformities through massage, suction, infrared light, and radio frequency.

 

Most patients will need 4-6 weekly VelaShape treatments to achieve smoother skin surface following liposuction surgery.

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BBL surgery, also called Brazilian butt lift or buttock augmentation via fat grafting, is a two-step procedure: liposuction to collect fats from multiple donor sites followed by fat injection into the buttocks and hips to achieve a more feminine curve.

 

While fat or volume distribution is the key to achieve a more feminine silhouette—i.e., narrow waist juxtaposing the curvy hips and buttocks—symmetry also plays a critical role in patient satisfaction following BBL.

 

bbl surgery

Photo credit: kidshealth.org

One way to ensure a good level of symmetry (“perfect” mirror image between the left and right side is simply impossible) is to identify any existing asymmetry prior to surgery. This is particularly true for patients with scoliosis, a disorder in which the spine curves sideways.

 

(Note: The spine should appear straight when looking from the front.)

 

Orange County plastic surgery expert Dr. Tarick Smiley has previously performed BBL on a female patient with scoliosis.

 

The patient’s spine curved to the right and thus it appeared to have more volume compared to the left side. Hence, during liposuction Dr. Smiley removed a bit more fat to the “bulging side” to achieve a more symmetric appearance.

 

A meticulous performed liposuction of the flanks and lower back also allowed Dr. Smiley to reduce the appearance of skin fold caused by the sideway curve of the spine.

 

It should be noted that scoliosis also affects the appearance of hips, making one side appear more prominent. This asymmetry must be taken into account during fat injection so as to allow the surgeon to make some adjustment in volume distribution.

 

During fat injection, Dr. Smiley says that microdroplet technique is critical in creating infinitesimal compartments of fat, which allow for blood vessel ingrowth that is the key to achieve near permanent results.

 

Without blood vessel ingrowth, Dr. Smiley has warned that fat would simply die and become resorbed by the surrounding tissue.

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Closed rhinoplasty dorsal hump reduction involves meticulous techniques in order to create natural-looking results—i.e., the patient’s new nose looks as if he or she was born with it.

 

Recently, Inland Empire plastic surgery expert Dr. Tarick Smiley has shown images on Snapchat depicting this surgical technique performed on a female patient with nasal aesthetic issues that included prominent dorsal bump, droopy tip, and “nostrils that were showing too much.”

 

 

The patient’s rhinoplasty, or colloquially referred to as nose job, was performed via closed technique in which all the incisions were made inside the nostrils, precisely along their inner lining. Not only it resulted in well-concealed scars, she also mentioned a “relatively easy recovery due to minimal pain, swelling, and bruising.”

 

Dr. Smiley was able to create a “nicer and flatter” dorsal (nasal bridge) by removing the excess bone and cartilage. (Note: The upper one-third of the nose is composed of bone, while the remainder is comprised of cartilaginous framework, which makes it malleable but nonetheless firm.)

 

A piece of cartilage was then cut/reshaped so it could provide a strong tip support, ensuring that the results are stable (can resist or postpone aging and other changes). The same technique has also corrected the drooping tip appearance.

 

In general, a drooping tip, which also elongates the nose, detracts from the feminine face. According to several studies, attractive female noses have an angle of tip rotation that is between 95 and 110 degrees, giving it a slightly upturned appearance.

 

On the other hand, men can tolerate a slightly droopy tip without affecting their facial balance and level of attractiveness.

 

Elevating the patient’s droopy and bulbous tip has also made it appear more refined and narrower, and the nostrils have invariably improved as well.

 

Dr. Smiley says the ideal nose is not strictly defined by specific looks or rigid beauty tenets. The goal is to reshape the nose in a way that it complements the patient’s facial features, gender, ethnicity, age, and even height/body frame.

 

However, certain mathematical ratios that determine the ideal facial proportions do exist that can help plastic surgeons create natural results from rhinoplasty. For instance, for most people the ideal breadth of the nose is equal to the distance between the eyes.

 

Also, the length of the nose is ideally similar to the vertical height of the chin.

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