Tummy tuck final shape: Can every patient enjoy a more hourglass figure?
It depends, says leading Orange County plastic surgeon Dr. Tarick Smiley who has about 7,000 tummy tuck surgeries under his belt.
Recently, Dr. Smiley performed tummy tuck on a female patient with loose skin and lots of stretch marks that extended above her navel due to previous pregnancies. However, she had very little fat thanks to her commitment to healthy and active lifestyle.
(Note: Her surgery was recently shown on Dr. Smiley’s Snapchat.)
The celebrity plastic surgeon was able to remove up to 90 percent of stretch marks with meticulous skin incision in which the resulting hip-to-hip scar was hidden beneath the patient’s underwear.
Meanwhile, some Snapchat followers wrote to the surgeon asking why he was not able to deliver “curvier results” as compared to his previous patients with remarkably defined waist line following their surgery.
“While I make every effort to reshape the midsection and adhere to the classic hourglass figure, we cannot simply go past the muscle and bone,” he said.
“We have to put in fillers on the side to give her a more S shape curve,” he further explained.
Fillers, which can be in the form of fat grafts or Sculptra (a type of dermal filler), can help reshape the hips to achieve a more hourglass figure, which is traditionally believed to be the hallmark of female fecundity and beauty.
In general, Dr. Smiley prefers fat graft or fat injection because of the additional contouring effects provided by liposuction, which is the method to collect fats from multiple donor sites.
Despite some limitations in term of the tummy tuck final shape, the surgery nonetheless created significant improvement over the patient’s previous appearance. Aside from removing the loose skin and eliminating about 90 percent of the stretch marks, Dr. Smiley also repaired the enlarged navel.
Navel repair was done by making an incision around its inner rim to conceal the scar. Afterwards, the surgeon reduced its size and made its shape slightly vertically oriented, leading to a more athletic appearance of the abdomen.
Breast implants for thin skin and little soft tissue coverage can pose challenges since there is a perceived higher risk of implant palpability, rippling, and unnatural breast shape. Nonetheless, Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated some surgical techniques and “core principles” that help him reduce such risks.
In Dr. Smiley’s recent Snapchat video post, he performed breast augmentation on a thin, small-breasted patient.
Dr. Smiley generally prefers the peri-areolar incision technique (i.e., a small scar blends into the dark-light skin junction); however, the patient has small areolas, which could make it difficult to conceal the scar, and thus he recommended the submammary fold instead in which the incision was concealed within the natural skin fold.
The celebrity plastic surgeon said the submammary fold incision measured only 3 cm thanks to the use of Keller Funnel technique; this involved a cone-shaped device that was lubricated profusely so the implant could be propelled inside the pocket in just one squeeze.
Because of the patient’s little soft tissue coverage, Dr. Smiley positioned the breast pocket beneath the chest muscle, which provided additional padding to reduce implant rippling and palpability.
Aside from implant placement (relative to the soft tissue layers), Dr. Smiley said natural results are further guaranteed when the implant’s size and dimension reflect the patient’s underlying anatomy, particularly relating to her chest and breast measurement.
Because the patient has a narrow chest wall, Dr. Smiley used high profile implants—i.e., they have narrower base but offer more vertical height—to ensure natural and proportionate results, which were the specific aesthetic goals of patients.
The high profile implants also suit the patient because she wanted additional projection. Furthermore, it complemented her thin frame.
Dr. Smiley warned that implants with lower profile (they have a wider base and project less) may not suit thin patients, particularly if these come with a base dimension that occupies too much space on the chest wall. Aside from higher risk of rippling along the edges of the breast, they could also result in excessive lateral bulge that looks anything but natural.
After ensuring that both breasts look symmetric, Dr. Smiley closed the incisions; the tissue beneath the skin was closed with absorbable sutures to ensure the best scar possible. The skin, meanwhile, was not picked up and instead “sealed” with a surgical tape to make certain that it would receive no or very little tension.
Hip augmentation fat transfer aims to improve the waist-to-hip ratio; this is particularly true if the donor or liposuction sites include the waistline (e.g., abdomen, flanks, and lower back).
Studies have found a strong preference for a WHR near 0.70, which interestingly does not rely on dress size. For instance, full-bodied celebrities like Beyoncé and Marilyn Monroe and lithesome beauties such as Keira Knightly and Jessica Alba all conform to this beauty hallmark that almost always transcends culture and milieu.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has recently performed hip augmentation fat transfer on a female patient with narrow hips although her buttock profile was relatively good.
The patient had a previous liposuction performed by a different surgeon, which made it more challenging to collect sufficient donor fats. To compensate for this, Dr. Smiley treated more surface areas that included the flanks, bra rolls, lower back, and anterior abdomen.
He used power-assisted liposuction technique, meaning the cannula (steel tube) has a vibrating tip that made fat collection gentler, quicker, and more precise.
Afterwards, he purified the fats in order to remove the dead fat cells, red blood cells, anesthetic solution, oil, and other biomaterials and impurities. This was primarily done with a centrifuge, which separated materials based on weight.
With centrifugation, Dr. Smiley was able to collect the healthiest fat cells along with stem cells, which can increase the survival rate of fat grafts and improve skin texture and appearance thanks to their “healing properties.”
The celebrity plastic surgeon created a small puncture hole on each side of the outer-lateral buttock (i.e., hips) to make the area appear curvier. The vibrating cannula was again used to inject fat grafts through a microdroplet technique—i.e., they are compartmentalized, with minute spaces between them in order to promote blood vessel ingrowth.
To further promote high survival rate and near permanent results, Dr. Smiley inoculated the fat grafts into varying layers.
Meanwhile, the patient was instructed to avoid pressure on the fat grafts for at least three weeks to further promote high survival rate and to ensure highly symmetric results.
Tummy tuck is one of the most popular body contouring surgeries after massive weight loss. This involves removal of loose skin and fat that hangs from the abdomen; oftentimes, it also combines some type of muscle repair (tightening) to further contour and narrow the waistline.
The tummy tuck incision, which typically runs from hip to hip and is beneath the undergarment, generally takes 3-4 weeks to heal—i.e., all the scabs are gone and so there is no longer risk of wound irritation and infection. At this point, patients can start using scar treatments such as silicone sheets and gels.
TUMMY TUCK RECOVERY PHOTOS
While most of the swelling and bruising are already gone by 2-3 weeks, tummy tuck scars take longer time to “stabilize” or reach its maturity. Oftentimes, they look worst at 4-6 weeks postop due to the reddish color stemming from new blood vessels growing beneath their surface.
And after about six weeks following tummy tuck, the scar appearance starts to improve. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says most scars fade gradually over a period of 12-18 months until they leave a white or silver mark that is barely visible.
Meanwhile, a few patients end up with a less than optimal scar appearance (due to keloids or hyperpigmentation in which the scar is noticeably darker than the surrounding tissue). Laser treatments, medical-grade chemical peels, steroid injections, and scar revision are some of the options that can help improve its appearance.
Two months postop.
While certain risk factors of scar are beyond the surgeon and the patient’s control (e.g., genetic propensity to keloids), some methods remain useful in promoting faded scars; these include the use of scar treatments such as silicone patch or gel, sun protection, and scar massage.
In general, tummy tuck scar should never be exposed to the sun for a minimum of six months to prevent hyperpigmentation.
Scar barely detectable after two years.
Tummy tuck recovery with Exparel injection has completely revolutionized postop pain management.
Dr. Tarick Smiley, one of the most prominent Beverly Hills plastic surgeons, uses Exparel in most of his tummy tucks. This drug is injected directly into the abdominal muscle right after surgery while the patient is still on the operating table.
Exparel is a type of local anesthetic (bupivacaine) that is slowly released into the surrounding tissue; its effects can last up to four days. According to studies, patients who had this medication took less pain relievers and were less likely to use narcotics than non-Exparel patients; they also recovered quicker because they breathe better, experienced less stress, and moved more freely.
(Note: Some patients require additional [oral] painkillers, while others may avoid them altogether; it really depends on their pain threshold.)
In addition, Exparel is a non-opioid medication and thus it is not addictive. According to recent studies, patients who use opioid/narcotics for more than three days postop face an increased risk of addiction.
This injectable drug lasts 3-4 days, which is the worst period of the post-surgical discomfort. Afterwards, patients might take non-narcotic pain relief for a few more days until they are able to tolerate the [slight] discomfort.
In the past, narcotic medications were the only option to minimize discomfort following tummy tuck or other surgeries. Aside from risk of addiction, they also have unfavorable side effects that include drowsiness, constipation, abdominal cramps, nausea, and vomiting.
Then came pain pump, which is a small balloon-like device attached with a tube to slowly deliver numbing medications into the surgical site for three days. While it manages the pain quite well, due to its tubes and straps (worn by the patient that goes around the neck) it can restrict one’s movement.
To avoid any cumbersome device, Dr. Smiley now recommends Exparel injection to his patients.