Posts by Dr. Tarick Smiley


Brazilian buttocks lift is a colloquial term for buttock augmentation via fat injection. This combines liposuction, which is the method to harvest the donor fats, and structural fat grafting wherein the patient’s own fat is injected to reshape and augment her “derriere.”

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos demonstrating a female patient with markedly flat buttocks and narrow hips, leading to poor waist-to-hip ratio.

brazilian buttocks lift

The before photo shows flat buttocks and narrow hips, leading to poor waist to hip ratio.

Studies have suggested that the ideal WHR ratio is 0.7, or at least near this proportion. This means that the waist, which is the narrowest part of the midsection, accounts for 70 percent of the hips circumference, which is measured around the apex or most prominent aspect of the buttocks.

 

Across different cultures, generations, and socio-economic backgrounds, the preference for 0.7 WHR remains constant, as suggested by several studies.

 

Further aggravating the patient’s poor WHR was her thick waist. Hence, Dr. Smiley performed 360-degree liposuction, meaning the flanks, lower back, and anterior abdomen were all addressed.

 

To further achieve a smooth transition between the torso and buttocks, Dr. Smiley also performed liposuction in the upper back to eliminate the “bra rolls” that tend to become more recognizable in tight clothing.

The after photo shows fuller and curvier buttocks juxtaposing the slender flanks and lower back.

Performing liposuction on a larger surface area is the key to harvest sufficient donor fats to reshape and augment the buttocks. Nonetheless, the tightness and elasticity of butt skin would still determine the ideal fat volume.

 

A skin that is too tight may not allow large volume injection because it will resist expansion. On the other end of the spectrum, a skin that is too loose may lead to sagging buttocks and surface irregularities such as dents and cellulites after surgery. Hence, Dr. Smiley said “respecting and recognizing the quality of skin” is one of the keys to achieve great results.

 

Fortunately, the patient’s skin has the right amount of tightness and elasticity, allowing him to inject a relatively large fat volume. In general, women reuire more than 800 cc on each side to achieve noticeable improvements in the shape and projection of their buttocks.

 

Because the patient also had narrow hips, which are basically the lateral aspect of the buttocks, Dr. Smiley allocated about one-third of the fat volume into the area before injecting the remaining amount into the butt profile or “forward projection.”

 

To further promote a good WHR, Dr. Smiley focused on reshaping the upper half of the buttocks, which should carry most of the prominence if the goal is to deliver more natural-looking results. Furthermore, this “allocation” prevents or at least minimizes risk of sagging because no excessive weight is placed in the lower half cheek of the butt, which serves as a “foundation.”

 

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Male chest reduction surgery corrects the woman-like breasts generally caused by excess fibrous tissue and fats of varying amounts. All efforts are made to conceal the scars by placing them at the edge of areola, allowing them to blend into the background once fully healed.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat showing a patient with overdeveloped breasts that looked incongruous with his athletic physique.

 

chest reduction surgery

Notice that the “after” photo of the breast profile looks more masculine and flatter.

Dr. Smiley started the procedure with tumescent liposuction in which a flexible hollowed tube was used to remove the excess fat. But prior to fat extraction, he injected the breasts with tumescent fluids so the fatty cells would swell thus paving way for quicker and gentler removal.

 

The tumescent liposuction technique is also known to promote smoother results.

 

A thin liposuction cannula was inserted into a tiny wound puncture that was positioned at the lower border of the areola to hide the scar. After removing the excess fat, Dr. Smiley extended the incision to perform the excision-based aspect of the surgery.

 

In the video, Dr. Smiley said the patient required the excision-based surgery because a liposuction-alone approach cannot remove the fibrous [breast] tissue.

 

Thin liposuction cannula is used to remove fats in smaller, more accurate bits.

In addition to liposuction, the patient also requires excision to remove the fibrous breast tissue.

“The fibrous tissue will not come out with liposuction or even exercise,” he said in the video.

 

After removing the excess fat and breast tissue, Dr. Smiley closed the wound in deep rows without “picking up the skin.”

 

“The trick between a perfect wound closure and an okay one is the use of deep sutures. The idea is to suture the dermis, which is the deeper layer of the skin, without including the actual skin surface whose edges are simply allowed to kiss each other. We should always respect the skin,” he further explained.

 

With very minimal tension on the skin, Dr. Smiley said the incision tends to heal quicker and the scar fades better into the background.

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Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.

 

Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.

 

fat transfer buttock augmentation

 

The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.

 

Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.

 

After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.

 

In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.

 

Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.

 

“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.

 

When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.

 

Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.

 

The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.

 

But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.

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The surgeon’s eyelid surgery before and after photos can shed light on his artistic skills, which play a critical role in any facial plastic surgery. Hence, a prudent patient should insist to view this material before scheduling her surgery.

 

The before and after photos should have no classic surgical stigmata such as skeletonized eye socket, abrupt lower lid and cheek transition, unnatural height of the upper lid, retracted skin lid, and visible scar.

 

eyelid surgery before and after

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video demonstrating a patient who has had upper and lower eyelid surgery to correct age-induced skin and soft tissue laxity. To achieve a more natural and more youthful result, he combined the procedure with fat transfer.

 

Lower Eyelid Surgery with Fat Transfer

 

The idea of fat transfer, also referred to as fat injection and structural fat grafting, is to create a smooth transition between the lower lid and cheek. Occasionally, a lower lid-alone approach can create or worsen the appearance of tear trough, a problem best avoided when fats are injected beneath the skin to serve as padding.

 

While the superficial fat beneath the lower lid skin tends to shrink with aging, the deeper fat behaves differently: It becomes more prominent and saggy, leading a crescent-shaped bulge. Hence, the right surgical maneuvers reverse these age-induced effects.

 

The deeper lower lid fat is often removed or reduced during surgery to correct lid herniation or “bagginess.” This is typically followed by fat injection beneath the skin to create a smooth lid-cheek transition.

 

To further create a smooth lower lid and eliminate the crepe-like appearance, during surgery Dr. Smiley removed a small amount of excess skin with the use of a thin incision placed very close to the lower lash margin. This is expected to heal into a thin scar that is invisible at a conversational distance.

 

Upper Eyelid Surgery

 

The patient also received upper eyelid surgery to eliminate the hooding and fullness of the lid-brow complex.

 

“I placed the incision inside the new skin fold to hide the scarring,” Dr. Smiley said in the video.

 

The incision allowed Dr. Smiley to remove the excess skin and fat that was causing the “heaviness” and drooping of the upper lid. However, he made sure that sufficient fat pad would remain after surgery to avoid the skeletonized appearance, which in any way does not look youthful.

 

The skin excision aspect was also done in a highly meticulous manner to preserve “normal blink” and to ensure that the “new” upper lid would have a height that is consistent with the patient’s facial feature, gender, and race. For instance, female Caucasians often have a lid crease height that is between 8 and 12 mm; this generalization does not apply to men and other ethnicities.

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Brazilian buttock lift is a well-established plastic surgery technique in which the patients’ hips and buttocks are reshaped and augmented with their very own fat. Oftentimes, large volume of fat collected through liposuction is needed to deliver noticeable improvements.

 

Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgery expert, says the patient’s “starting anatomy” affects the results to a varying degree, with certain physical traits making this procedure more challenging. Nonetheless, the use of right surgical maneuvers and tools can counteract these “anatomical roadblocks” and ultimately achieve the desired results.

 

Dr. Smiley has shared some Brazilian buttock lift before and after photos depicting patients with challenging anatomy. He also explained the corresponding techniques that allowed him to overcome such anatomical roadblocks.

 

brazilian buttock lift before and after

Before photo of patient no. 1. She has large lateral dent, which needs to be released so her hips can expand after fat injection.

Photo of patient no. 1 right after surgery. Notice the complete elimination of the lateral dent and smoother, fuller buttocks and hips.

Patient no. 1 had lateral depression along her buttocks caused by tethering of the fascia or connective tissue that was pulling the skin inward. Failure to release the skin would not allow the hips to expand after fat injection.

 

Dr. Smiley released the skin from the fascia or thread-like anatomy so he could expand and sculpt the hips, improving the feminine silhouette. This was done with the use of a surgical fork that resembled a thin two-pronged cylinder inserted into a tiny puncture wound.

He says “the use of surgical fork requires precision” because a slight error can lead to more skin asymmetries and herniation.


Patient no. 2 was thin, weighing only 115 lbs. during surgery and so it was a challenge to collect adequate amounts of fat. Hence, Dr. Smiley performed liposuction on a larger surface area to harvest enough volume to sculpt the hips and augment the buttocks.

 

Before and after photos of patient no. 2. She is thin and so she requires larger liposuction surface area to harvest sufficient fat volume.

 

To further create an illusion of fuller buttocks and curvier hips, Dr. Smiley used the flanks and lower back as donor or liposuction sites. By removing the excess fat in the area, even though the volume was relatively small, he was able to carve it out and allow the butt to “stick out more.”

 


 

Patient no. 3 had asymmetric fat distribution along her back, with more fats along the right flanks. Hence, she required “an extra meticulous” liposuction to achieve smoother, more symmetric appearance between the left and right side of her torso.

Before and after photos of patient no. 3. The surgery corrects the fat rolls along her armpit, bra line, and flanks. Furthermore, it improves the symmetry between the right and left side of the torso.

 

Further complicating her case was the extent and distribution of fat that her armpit area—along with her flanks, lower back, and “bra rolls”—was even included during liposuction. The idea is to create a smooth silhouette from the posterior view.

 

Moreover, her skin buttock prior to surgery had visible dents and so Dr. Smiley filled in these tiny depressions with the use of microdroplets technique (0.1 cc of fat inoculated one at a time). This method of injection not just deliver smooth results, but also high survival rate in which 70-75 percent of the fat volume is expected to be near permanent.

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