With more than one-third of the US adult population considered obese, over the recent years there has been an upsurge on the number of bariatric or weight loss surgery. While this a life-saving procedure, some patients remain dissatisfied with their appearance due to their large redundant skin and hanging fats that no longer respond to further diet and exercise.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says thigh lift is one of the most common requests of massive weight loss (MWL) patients, citing a survey showing that about 4,800 patients underwent the procedure last year alone.
This is an incision pattern used in outer thigh lift surgery.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 55,200 MWL patients had some type of body contouring surgery.
Dr. Smiley says that post-MWL thigh lift is often just a component of a series of body contouring surgery due to the natural distribution of redundant skin that also affects the abdomen, buttocks, breasts, and upper arms. Oftentimes, the patients also develop a varying degree of sagging neck and jowl, he adds.
Meanwhile, he explains some surprising thigh lift facts:
- All efforts are made to hide the scar within the natural skin fold—e.g., groin and gluteal fold.
While a good surgeon will make every effort to create incision patterns in which the resulting scar runs within the natural skin fold, the scar length will still depend on the extent and location of loose skin. Hence, inner thigh lift for MWL patients entails a vertical scar on the inside of their leg that may even reach their knee.
- Outer thigh lift is often a component of lower body lift.
As a stand-alone procedure, outer thigh lift uses an oblique incision between the top of the leg and hip, resulting in a V-shaped scar pattern. But due to the natural diffusion of excess skin, occasionally the incision is extended across the circumference of the torso, leading to a belt-like scar.
With a lower body lift, the outer thigh, hips, anterior abdomen, and buttocks are simultaneously lifted and their contours improved.
- Most patients described their recovery after medial thigh lift “tough.”
Due to gravity and persistent swelling, the medial thigh lift incisions are susceptible to wound breakdown. In fact, it is not uncommon to have small separations in the incision, which mostly do not require a surgical closure although they can result in additional healing time.
In general, it takes three weeks for most patients to be able to return to work and another 3-4 weeks before they can gradually start doing more rigorous activities.
- Medial thigh lift is best performed separately from tummy tuck.
Tummy tuck often elevates the sagging mons pubis, while the inner thigh lift pulls down the skin to improve the contour of the leg. Due to the opposing tension, it is often ideal to perform them separately.
Local anesthesia during breast augmentation offers some benefits such as quicker recovery, no post-op effects of general anesthesia (vomiting and nausea), and no need for overnight fasting prior to surgery. Nonetheless, renowned Beverly Hills plastic surgeon Dr. Tarick Smiley says not everyone is a good candidate for such approach.
For the vast majority of breast augmentation patients, the use of general anesthesia remains the most ideal and convenient approach, he says in a recent Snapchat video.
Exparel can numb the surgical site for up to four days.
However, one of Dr. Smiley’s recent patients requested for “purely” local anesthesia during breast augmentation, which was documented on Snapchat. Although the breasts were completely numb, during the entire surgery she was awake and would even ask the surgical team to show the results while she was still on the operating table.
Dr. Smiley said not everyone should “jump into the bandwagon of local anesthesia-alone breast augmentation or any type of surgery,” adding that he would only reserve it for a few highly selected patients who have a high pain threshold and are not “squeamish.”
Furthermore, he said the local anesthesia-alone breast augmentation is only reserved for someone who does not require extensive correction or prolonged surgery (such as the case of combo procedures). For instance, patients who require a concomitant breast lift should stick to general anesthesia.
Aside from breast augmentation, Dr. Smiley said that the local anesthesia-alone approach may also be used in nose surgery, eyelid surgery, facelift, and liposuction, provided that the surgery is not an extensive one, and the patient has a high pain threshold.
However, the celebrity plastic surgeon said that tummy tuck, which is one of the most commonly sought body contouring surgeries to date, should always be done under general anesthesia due to the extent of skin excision and the concomitant surgical techniques such as muscle and navel repair and liposuction of the flanks.
Another possible alternative to perform surgery is local anesthesia combined with deep sedation. But no matter option one has chosen, all plastic surgeries should be done in a certified operating room staffed by licensed and well-trained staff, which must always include board-certified plastic surgeons and anesthesiologists.
Pocket revision breast augmentation corrects implant malposition that causes deformity such as bottoming out, “double bubble” (the breast appears to have two folds), and excessive lateral bulge. The idea is to allow the implants to settle into the most natural position, which is approximately at the center of the “breast mound.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated pocket revision breast augmentation in his Snapchat account. It involved a patient who has had surgery done by a different doctor last year.
The patient’s right breast had its submammary fold positioned 2 cm lower than the other side. Dr. Smiley said the asymmetry was caused by incorrect pocket dissection—i.e., the previous surgeon made it too big—leading to implant drooping and thus causing “slight double bubble” due to the appearance of two breast creases.
The bottoming out of the implant not only caused unnatural placement of the right submammary fold, but also poor projection of the entire breast mound, excessive lateral bulge, and unnatural nipple position. Meanwhile, the left breast had no such problem because its pocket was done correctly.
Dr. Smiley measures the breast dimension from different angles, allowing him to determine the ideal implant size range and design and ultimately deliver natural-looking, proportionate results.
“When you lift the base of the right breast, you would see that everything shifts. This means that correcting the bottom of the pocket can improve the symmetry of the cleavage, projection, nipple position, and lateral bulge. After all, the breast has a three-dimensional geometry,” Dr. Smiley said in the video.
Prior to surgery, the celebrity plastic surgeon performed extensive breast exam with the use of multiple measuring devices such as laser and vernier caliper. The goal was to improve the symmetry of both breasts in terms of base width, submammary fold position, and volume distribution.
The surgery was performed under local anesthesia. The patient requested for it so she could immediately see the results and decide if these would meet her aesthetic goals, explained Dr. Smiley.
Aside from pocket repair, the patient also requested for slightly bigger implants (from 350 cc to 450 cc) filled with silicone gel, which is known to provide more natural feel and contour than saline-filled implants.
To avoid additional scar, Dr. Smiley used the previous incision site created at the border of the areola. To prevent puckering of the skin and promote the best scar possible, he released the previous scar tissue and closed the incision in several rows of absorbable sutures.
The skin, meanwhile, was not “picked up” by any suture to eliminate tension on its surface (it was held together by a surgical tape instead), which is the key to the best scar possible.
Breast implants with fat transfer can be a powerful tool in breast reconstruction, as recently demonstrated by leading Beverly Hills plastic surgeon Dr. Tarick Smiley on his Snapchat account.
The patient shown in the video had breast implant removal two years ago due to capsular contracture, a complication in which the thin scar capsule surrounding the prosthesis becomes copious and hard, leading to pain and deformity. Some studies have linked implant contamination at the time of surgery and low-grade infection during the initial recovery to this problem.
Dr. Smiley is able to deliver natural-looking results with meticulous and customized breast reconstruction surgery.
(Note: A thin scar capsule always forms around any implanted device. In fact, this is an auspicious natural process that prevents the breast implants from migrating or causing deformity. It only becomes problematic when the scar tissue becomes too thick and thus causes pain and unnatural contour.)
However, the patient’s previous corrective surgery (i.e., the capsular contracture was removed simultaneously with the implants) left her with marked asymmetry between her breasts, with the left side having its submammary fold riding higher and its tissue looking droopier than the other side.
To improve breast symmetry, shape, and projection, Dr. Smiley performed breast implants with fat transfer. The implants would provide additional volume and improve the overall contour, while fat transfer would give extra padding to make the left submammary fold match the other side.
During breast reconstruction surgery, Dr. Smiley created a small incision right at the border of the areola (pigmented part of skin) to propel the implants into their respective pocket. This incision technique generally leads to invisible scar provided that it heals well and lies precisely at the dark-light skin junction.
In the video, Dr. Smiley said the peri-areolar incision would suit the patient because it was also the incision site during her two previous surgeries (primary breast augmentation and breast implant removal due to capsular contracture). Hence, she has avoided additional scar.
After ensuring that both implants were positioned in their most natural, symmetric placement, Dr. Smiley released the lower pole of the left breast so it could take fat grafts. He then performed fat transfer with the use of blunt cannula that released “minute droplet of fat graft one at a time,” a technique known to result in high survival rate (70 percent is expected to last a lifetime).
With the concurrent fat transfer, Dr. Smiley said the once higher submammary fold of the left breast would match the other side.
He then closed the tissue in several rows with absorbable sutures, without “picking up the skin.” By eliminating most of the tension on skin, the incision is expected to heal well and its resulting scar can fade better into the background.
The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.
Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.
Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.
Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.
In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.
The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.
“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.
Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.