Posts by Dr. Tarick Smiley

Liposuction remains the most commonly performed body contouring surgery for men and women. Despite the introduction of some newer techniques and technologies, the basic principle of this procedure remains unchanged: Remove the unwanted fat that sits next to the skin to achieve a slender, more athletic physique.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares some of the surprising liposuction facts that you may not know about.

surprising liposuction facts

  • It is only suitable for patients with a relatively good physique.


As with any body contouring surgery, liposuction requires that you are at least within 25-30 percent of your ideal weight. Bear in mind that the lipo cannula (a stainless steel probe) can only remove the superficial fat, which has not responded to diet and exercise.


The “stubborn” superficial fat is more likely due to genes than lifestyle. The deeper visceral fat, meanwhile, is linked to obesity and will only respond to weight loss, which of course is only possible through lifestyle changes, as opposed to fad diets, pills, and body contouring surgeries.


  • You may gain more body fat afterwards, particularly the visceral fat linked to obesity-related problems. But only if you’re not careful.


Some researchers have suggested that the body makes every effort to protect its “natural” fat distribution and composition. Hence, after liposuction patients who remained sedentary were found to have their visceral fat increased by around 10 percent (from its pre-surgery level), predisposing them to increased risk of heart problems, insulin resistance (diabetes), and inflammation.


However, you can “re-train” your body, preserve the results of your liposuction, and ultimately maintain a healthy physique. According to the same researchers, doing moderate exercise (i.e., one hour of cardio combined with strength straining three times a week) has prevented patients from the “exercise group” to regain fat.


Furthermore, these patients were found to have improved their health just after six months of moderate exercise.


  • It’s more about what’s left behind, and not about removing the optimal amount of fat.


In fact, removing all fats from the treated area can lead to disaster—e.g., surface irregularities, unnatural contour, and sagging/gaunt appearance. To avoid any sign of botched result, a good surgeon preserves some fats especially beneath the skin.


  • Any doctor can perform liposuction, even if he has no standardized training.


Liposuction is best performed by a board-certified plastic surgeon—i.e., a member of the American Board of Plastic Surgery. Medical literature has suggested that they have the lowest complication rate due to their specialized training, in addition to the fact that they are required to pass rigorous oral and written exams, which they need to take every 10 years.

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The plastic surgeon’s Brazilian butt lift transformation pictures can shed light on his eye for detail and core competencies. It should be noted that the surgery is not just about augmenting the buttocks, but more importantly, improving the patient’s body proportions.


Liposuction is an integral component of any successful Brazilian buttock lift. Aside from harvesting the fats from two or more sites, this surgery also allows the surgeon to sculpt the adjacent areas of the buttocks and hips—such as the flanks and lower back—so the patient’s derriere is further enhanced.


Celebrated Beverly Hills plastic surgeon Dr. Tarick Smiley shares some Brazilian butt lift transformation pictures of his actual patients.


Patient 1


The above “before” photo shows that the patient’s hips and buttocks’ convexity was near absent, while her legs were relatively thin prior to surgery. Hence, some people may assume that the ideal results must lean on the conservative side to achieve natural-looking appearance.


But instead of going the conservative route, Dr. Smiley injected large volumes of fat, which he collected from the flanks, lower back, and bra rolls.


He says the patient’s “new” fuller buttocks and wider hips would compensate her broad shoulder, resulting in a more feminine physique from Brazilian butt lift.


Patient 2


The second before-and-after photos show a patient whose “starting anatomy” included boxy, flat buttocks that were lacking of any lateral “bulge.” Hence, Dr. Smiley allocated about one-third of the fat grafts into the hips to give her a more feminine curve; the rest of the volume then went to the buttock’s profile or forward projection.


This patient has specifically asked for the “bubble” effect in which the entire butt cheek has a relatively pronounced roundedness.


Patient 3


The third before-and-after photos, meanwhile, depict a patient who asked for subtler improvements, meaning her primary goal was to enhance the shape of her hips and buttocks, without the “obviously augmented look.”


Just like the rest of Dr. Smiley’s patients, she also received liposuction of the flanks and lower back so her “backside” would appear curvier and fuller.


Dr. Smiley says listening and respecting the patient’s input—instead of assuming that everyone wants the augmented or “bubble butt effect,”—is one of the most critical components of high patient satisfaction.

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Chin implant is primarily used to improve the appearance of “weak” chin, which is generally defined as having inadequate projection to the point that it “disappears” from the neck.


Nonetheless, some patients with pre-jowl sulcus (a “dip” on each side of the chin) and skin creases along their chin may benefit from a carefully selected chin implant size and design, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


chin implant size

Dr. Smiley performs rigorous physical exam to identify the most ideal chin implant size and design based on the patient’s starting anatomy and cosmetic goals.

The “ideal” chin—or at least according to popular definition of proper aesthetic harmony—has a projection that is 1-3 mm behind the vermilion border’s (of the lower lip) when an imaginary vertical line is dropped from this point.


Hence, if there is a greater disparity between the chin and the vermillion border’s projection the chin is perceived to appear recessed or weak.


Most chin implants have a central thickness between 4 mm to 12 mm. Some people may assume that simply using a dimension that will compensate for the deficiency (measured in millimeter) is the “end all and be all” of chin implant size selection. On the contrary, relying on this factor alone may not deliver the desired results and may even create an unnaturally deep lip-chin sulcus (depression).


The lip-chin sulcus may become exaggerated when an implant with a significant central thickness (more than 10 mm) is used in a markedly recessed chin. This of course does not look natural and so a good surgeon will also take into account the postop convexity of the chin.


Contrary to popular belief, chin implant not just improve the profile of the chin but also its convexity. Furthermore, it has no or very little effect on the vertical height of the chin.


Simply put, identifying the ideal chin implant size based on its central thickness starts with meticulous evaluation of the chin’s convexity and its shape in profile view.


In most cases, the central thickness of the chin implant has the most effect on the final result (and of course, the patient’s underlying anatomy). Nonetheless, the horizontal length of the implant might be used in some cases of noticeably narrow chin.


It is not uncommon to customize chin implant due to the rather limited sizing and shape of “regular” or “standard” designs created by manufacturers. Custom-made implants are particularly ideal for patients with markedly narrow chins and obvious asymmetry between the left and right side of their face.

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Follow up care after plastic surgery differs from patient to patient. Nonetheless, most surgeons prefer to see their patients the morning after their surgery and a week afterward for monitoring the healing process.


The succeeding follow up visits become less frequent or will have longer intervals (e.g., one month, three months, and six months) provided that the patient heals nicely and does not encounter worrying symptoms such as persistent swelling and bruising, increasing pain, excessive bleeding, and fever.


follow up care after plastic surgery

Dr. Smiley requires regular follow up visits to ensure that his patients are healing nicely.

Should any of the aforementioned symptoms arise during recovery, patients should see their plastic surgeon ahead of the scheduled follow up to prevent more serious complications. Take note that fever is usually a sign of infection, while increasing pain and bleeding signal that the body is not coping well.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who regularly performs body contouring surgeries like liposuction and Brazilian buttock lift, may require follow up visits at six months to one year, although it will depend on patient’s availability.


There are specific protocols used by each surgeon during a follow up consultation. Oftentimes, he simply checks if the wound is healing well and asks the patients for symptoms that are bothering or worrying them. In some cases, he removes the sutures and/or dressing, or assess if the patient’s compression garment (commonly used after liposuction and body lift) fits snugly but is not causing skin changes or interfering with circulation.


Furthermore, during a follow up consultation doctors ask their patients about the progress of their healing and their level of pain. If needed, he may adjust the medications to help them cope with any discomfort.


Meanwhile, long-term follow up visits tend to be more important after a facial plastic surgery—e.g., facelift, neck lift, cheek lift, and fat transfer. This is particularly true for patients who want to maintain their more rejuvenated appearance for as long as possible. For instance, people who have had facelift may need minor tweaks in the form of dermal fillers or mini facelift to preserve their youthful look.


Nonetheless, the details of follow up care after plastic surgery depend on many variables such as the patient’s age, type of surgery she had, her expectations and level of commitment, and lifestyle.

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Breast reduction consultation will play a critical role in patient satisfaction. This gives the patient the opportunity to describe her goals in precise detail, express her concerns, and assess the qualifications of her doctor.


On the other hand, breast reduction consultation allows the surgeon to explain the benefits, limitations, and potential risks of the surgery. Nonetheless, he must be able to allay the concerns of his patients by describing the preparation guidelines, surgical techniques, medications, and postop care that will reduce if not eliminate risk of complications.


breast reduction consultation

A good surgeon will make every effort to create a relaxed atmosphere, making it easier for his patients to express their goals, concerns, and medical history.

Oftentimes, the initial breast reduction consultation lasts 45 minutes to an hour, allowing the surgeon to listen to his patient’s input, goals, expectations, and medical information, particularly relating to current medications, family history, previous surgery, and medical condition, if there is any.


Afterwards, the surgeon may proceed with breast examination to determine its dimension, shape, nipple position, and skin quality, which will all determine the “best” incision pattern. To some extent these anatomical details will also dictate the final results and so the right patient should have realistic goals and expectations.


Then, the surgeon or his staff will take photographs of the breasts. This is particularly important when the patient is seeking insurance coverage. (Note: Many insurance issuers in Los Angeles plastic surgery require at least 500 gram of breast tissue removed from each side of the breast before they pay the surgery’s cost.)


It is not uncommon for patients to feel uncomfortable during breast exam. However, a good plastic surgeon will make every effort to create a more relaxed atmosphere.


The breast exam will allow the surgeon to determine the most helpful incision pattern. In general, patients with overlarge, pendulous breasts will need the standard anchor technique in which the scar goes around the areola, down to the midline, and across the base.


The anchor breast reduction is aptly called this way due to the resulting shape of its scar—i.e., like a nautical anchor. Over time, the scar is expected to fade into the background that most patients are not bothered by its appearance after 1-2 years.


Most surgeons will show the before-and-after photos of their actual patients to would-be patients to help the latter set realistic goals and to further improve the discussion.


At the end of consultation, surgeons typically provide a written material about breast reduction and possibly all the costs involved in the surgery.


Should the patient decide to go ahead with the surgery, a second consultation is scheduled so her doctor can tell her what medications to avoid and the lifestyle changes she needs to adopt to avoid or at least minimize risk of complications. Lab screening is also required to ensure that she is physically fit for the surgery.

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