Posts by Dr. Tarick Smiley


Mommy makeover procedures are body contouring techniques that reverse the effects of pregnancy—e.g., sagging breasts and apron-like skin that hangs from the abdomen. Tummy tuck, breast lift, and breast augmentation best exemplify these surgeries.

 

Oftentimes, plastic surgeons who use the term mommy makeover refer to a combination of two or more surgeries.

 

mommy makeover procedures

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted on Snapchat before-and-after photos of one patient who has had extensive mommy makeover procedures: breast implant, breast lift, flank liposuction, and tummy tuck.

 

Multiple procedures surgery is a reasonable approach provided that its estimated blood loss and the time under general anesthesia are within the standard safety limit.

 

Most surgeons agree that a surgery performed within 4-5 hours is reasonably safe, while going beyond this duration may lead to increased risk of certain complications. Consequently, some patients may need a team of plastic surgeons who can work simultaneously on them to shorten the operation time.

 

Blood loss is another issue with mommy makeover procedures and other multiple surgeries. Specifically, the main concern is the drastic fluid shift, which can lead to longer and tougher recovery, and higher risk of healing problems.

 

To keep blood loss to a minimum, Dr. Smiley says that prior to making incisions he injects epinephrine into the tissue; this is a drug that constricts blood vessels and thus it is particularly ideal in tummy tuck, which typically removes huge redundant skin hanging from the abdomen.

 

The use of epinephrine is also ideal in large volume liposuction.

 

Another auspicious benefit of epinephrine: It prolongs the numbing effects of local anesthesia, which in turn allows the patient to avoid or take less oral painkillers within the first few days of their recovery.

 

Aside from a well-thought planning and a meticulous surgical execution, Dr. Smiley says the safety of mommy makeover procedures also boils down to identifying the right candidates.

 

Instead of going by the BMI, which Dr. Smiley says is not always an accurate criterion, the surgeon puts more importance on the patient’s physical fitness and willingness to follow a healthy lifestyle. Therefore, he recommends all his patients to pass a lab screening.

 

Furthermore, Dr. Smiley says multiple plastic surgeries or combo procedures entail more emphasis on patient safety due to the perceived challenges. For this reason, he only works with board-certified anesthesiologists and qualified medical staff during surgery.

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Many people already know that brow lift surgery can elevate the sagging brow, leading to a more youthful appearance. However, not everyone knows that it can inadvertently alleviate migraine, improve perceived personality traits, and reduce the hooded appearance of the upper lid.

 

Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained the lesser-known brow lift benefits.

 

brow lift benefits

before and after photos depicting great results from brow lift surgery

 

  • Alleviate or even eliminate migraines

 

Surgeons say that some patients who have had brow lift, also referred to as forehead lift, reported less frequent migraine attacks or even complete remission. Experts have concluded that elevating the sagging tissue may release the pressure that is “pinching” or “irritating” the nerves responsible for chronic headache and its secondary symptoms such as light and nose sensitivity, blurry vision, and nausea.

 

  • Increase trustworthiness

 

Researchers at the New York University have conducted a survey showing that people with high eyebrow, which is medically referred to as high oblique frame or wide brow-lid complex, were perceived to be more honest and trustworthy by others.

 

Whereas people with furrowed brow, either caused by aging or as an inherited feature, scored lower in the perceived trustworthiness reviews.

 

Aging causes the brow particularly the lateral or tail end to sag, which can lead to an angry or sad appearance, depending on the degree or angle of droop.

 

Most patients will only need their brow’s tail end elevated, with no or very little advancement of the inner or medial aspect, to achieve a more refreshed appearance.

 

  • Increase femininity

 

A youthful female brow lies slightly above the bony orbital rim of the eye socket, and also comes with a soft lateral arch.   But with aging, the soft tissue sags causing the tail end to lose its height, leading to a more horizontally oriented shape of the brow.

 

Therefore, most brow lifts just require conservative elevation of the tail end to restore the lost arch.

 

  • Reduction of wrinkled skin in the upper eyelid

 

Occasionally, the drooping brow causes skin wrinkles and “heaviness” along the brow-upper lid complex. Hence, lifting the tail end of the brow could make the eyes appear more alert and more youthful without resorting to a separate procedure in the form of upper eyelid (blepharoplasty).

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The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.

 

A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.

 

facial plastic surgery

To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.

 

The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.

 

Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.

 

Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.

 

Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.

 

Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.

 

Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.

 

Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.

 

However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”

 

“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.

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The standard brow lift technique uses an ear-to-ear incision across the top of the head, within the hair-bearing scalp. While it provides the most lifting effect, it comes with one major downside: Patients whose “starting” forehead is big may end up with a “five-head effect.”

 

People use the humorous term five-head to describe a forehead that is oddly large that five fingers can all fit on the space between the hairline and eyebrow, instead of just four fingers.

 

brow lift technique

Standard brow lift vs. endoscopic technique

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that most brow lift patients either want to maintain their forehead height or even slightly reduce it, making the standard technique inadvisable because it can elevate the hairline by up to 1 inch.

 

A hairline that is too high not just results in the five-head appearance, but it also has a masculinizing effect on the female face. Nonetheless, the standard brow lift remains ideal if the patient has a notably short forehead (which may sometimes lead to a primitive look) and desires to change this feature.

 

But for most patients, placing the incision precisely at the hairline, instead of inside the scalp, provides the most auspicious results—i.e., it maintains the hairline height or it can be even elevated if the patient wants to shorten her forehead.

 

The endoscopic technique is another type of brow lift that has no or very little effect on the hairline height; this often involves 4-5 tiny keyhole incisions placed behind the hairline. It favors patients with minimal forehead and brow sag.

 

With the right incision pattern based on the patient’s desired goals and starting anatomy, brow lift can provide natural looking effects. This is particularly true when the lateral brow or “tail end” is elevated, with no or very little change in the height of its medial or inner aspect.

 

To ensure that the scar remains hidden, all efforts are made to reduce the tension on the skin especially during the healing stage. Hence, most skilled surgeons use the horizontal and vertical mattress sutures so that the deeper structures carry most of the tension, instead of the skin.

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When doctors mention 3D facelift procedure, they typically refer to a more holistic facial rejuvenation method, meaning that loose skin and soft tissue laxity is not the only thing addressed, but also the fat or volume loss.

 

As a stand-alone procedure, facelift tightens the skin and elevates the deeper structures of the soft tissue, bringing them closer the skeleton. While this mechanism creates a tauter appearance, it does not address facial volume loss; in fact, it may even aggravate the gaunt visage.

 

3d facelift procedure

The patient has received facelift combined with structural fat grafting. Hence, at one year postop her appearance remains youthful and attractive.

 

To address the inherent problem of facelift, leading Beverly Hills plastic surgeon Dr. Tarick Smiley often combines it with structural fat grafting. It starts with collecting small amounts of fat from tummy or thigh (or any area that carries excess fat), filtering out any biomaterial aside from fat cells and stem cells, and then injecting them into the soft tissue.

 

By incorporating structural fat grafting, doctors are able to create a more youthful dimension—i.e., there is adequate plumpness commonly found in young faces—which is the main advantage of 3D facelift procedure over the standard approach.

 

3D facelift procedure also prevents the classic signs of facelift, which include abrupt lid-cheek transition and flatness of the cheeks. Moreover, this new approach can smooth out deep laugh lines and hide the pre-jowl sulcus, which is the dip on each side of the chin.

 

Furthermore, fat grafting has been tied to improvement in skin texture, one of the auspicious benefits of using fats that are naturally infused with stem cells, which are known for their rejuvenating effects; they have also been found to increase the survival rate of grafts.

 

Any amount that survives after 2-3 months is expected to be near permanent or at least 12-15 years, as suggested by Dr. Smiley.

 

In addition to structural fat grafting, facelift may also be combined with other procedures such as neck lift, brow/forehead lift, eyelid surgery, and chin implant. The idea is to create a more congruent result that is less susceptible to gravity and aging.

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