Liposuction surgery removes the excess superficial fat beneath the skin, resulting in a slender physique. However, anecdotal reports show that about 20 percent of patients will have surface irregularities that generally disappear after 1-2 months.
Post-op surface irregularities are often caused by edema or fluid accumulation in the tissue where the fat has been removed, or by scar fibrosis with adhesions. While they often dissipate on their own as the patients move forward to their recovery, the use of VelaShape after liposuction is known to speed up healing.
In a recent Snapchat video, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has shown a female patient having a post-liposuction VelaShape, a non-surgical treatment designed to improve contour deformities and cellulites by using a combination of suction, massage, infrared light, and radio frequency.
This FDA-approved treatment is commonly performed after liposuction of the abdomen, thighs, hips, and buttocks, areas that are susceptible to postop surface irregularities and persistent swelling.
Dr. Smiley says that VelaShape uses a hand piece applied directly to the skin surface; it has rollers to smooth out surface irregularities, and a radio frequency device to melt and break up the fat cells, which are gradually flushed out of the body within a few weeks.
After 4-6 weekly treatments, most patients can expect a smooth skin after liposuction.
Patients often describe the procedure as like having a deep, warm tissue massage, with no or very little discomfort.
Meanwhile, Dr. Smiley says that a well-executed liposuction rarely results in permanent lumps and other types of surface irregularities; however, any contour deformity that persists after 4-6 months may require touch-ups usually in the form of another liposuction or fat grafting.
To prevent permanent contour deformities, the celebrity plastic surgeon highlights the importance of avoiding aggressive liposuction—i.e., there should remain some fat cells after surgery to serve as a “carpet” or cushion beneath the skin.
Too “superficial” fat removal should also be avoided to ensure a smooth skin after liposuction, says Dr. Smiley.
Breast implant profile refers to how much it projects off the chest wall. In the past, the only available design was the moderate profile implant, which is now considered the normal or standard projection.
But nowadays, patients have other options that include low, moderate Plus, high, and extra high profile implants.
High profile implants stick out more, giving an illusion of a bigger breast. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that women with a narrow chest are often a good candidate for such design because it occupies just the right amount of space.
Dr. Smiley has recently posted high profile breast implants before and after photos on his Snapchat account to demonstrate its effects on a patient who specifically asked for additional fullness in her upper breast pole.
Prior to surgery, Dr. Smiley performed breast and chest exam to determine the ideal implant profile, size, and shape based on the patient’s underlying anatomies. Of course, the surgeon also interviewed her to identify the aesthetic goals and to explain to her the surgical approach and implant design that could help meet her objectives.
During physical exam, Dr. Smiley used a pair of calipers to measure the breast width and identify any pre-existing asymmetry between the two breasts.
The celebrity plastic surgeon noted the patient’s highly symmetric breasts that had nice overall projections and ample soft tissue coverage, making it easier to achieve natural and balanced results from breast augmentation surgery.
“It is quite unusual to have highly symmetric breasts. For the vast majority of patients, one of the pre-existing breasts is bigger or wider than the other side,” he said in a Snapchat video.
Based on physical exam and consultation, Dr. Smiley decided to use 375 cc silicone high profile implants; these were the perfect choice as the relatively thin patient was more concerned about the upper pole fullness than the actual augmentation.
It should be noted that 375 cc implants would provide just a moderate amount of augmentation, leading to a more proportionate, natural result.
During surgery, Dr. Smiley positioned the silicone implants beneath the pec muscle, which provided additional soft tissue coverage, resulting in a softer feel and a more natural breast contour. This implant placement also reduced the risk of traction rippling and palpability.
Local anesthesia for upper eyelid surgery is a good option for patients who consider themselves “stoic” and have a relatively high pain threshold. In this technique, only numbing medications are used to provide comfort and so they are awake during the entire procedure.
Without general anesthesia that puts patients to a state similar to sleep, they avoid its common side effects such as nausea and lethargy, which in turn promote quicker recovery.
The patient receives local anesthesia alone during her upper eyelid surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated a surgery via Snapchat performed completely under local anesthesia. The patient requested for this procedure so she could drive herself home after surgery.
The patient was awake during the entire surgery, which involved removing some loose skin (and muscle) to eliminate the upper lid hooding that was aging her eyes and interfering with her vision.
A local anesthesia-alone surgery also precludes the need for fasting; this is not the case with general anesthesia in which the patients are required to avoid foods and drinks for 8-12 hours prior to the operation.
While local anesthesia for upper eyelid surgery is a reasonably safe option—some doctors would even compare this to a dentist visit involving cavity fillers treatments—Dr. Smiley says that not everyone is a good candidate for this approach, particularly those requiring other concurrent procedures like facelift, fat transfer, and brow lift.
Also, patients who are anxious are poor candidates for “pure” local anesthesia as they might experience increase in blood pressure, which can result in more bleeding and thus the surgery becomes more difficult. For these individuals, the use of local anesthesia with sedation or general anesthesia remains the most ideal approach.
For patients who want to avoid general anesthesia but may be too nervous to be awake during surgery, a good alternative is to combine local anesthesia with sedation, which means that they will have no memory of the surgical experience.
Furthermore, sedation does not involve placing a tube in the throat, which the general anesthesia entails.
Panniculectomy with liposuction can produce dramatic contouring effects by removing the apron of skin and tissue that hangs from the abdomen, and suctioning the excess fat. This “combo” approach is often reserved for massive weight loss patients with large redundant skin and “stubborn” fat rolls, which do not lend themselves to diet and exercise.
(Note: Tummy tuck and panniculectomy are almost the same, except that the latter entails a larger skin removal, which MWL patients require to achieve near normal appearance.)
Before and After Photos
In a recent Snapchat video post, leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated panniculectomy with liposuction performed in a female patient with large rolls of skin in her anterior abdomen and fat rolls along her flanks and lower back.
Dr. Smiley first performed liposuction in which the fatty areas were injected with tumescent fluids, which caused the fat cells to expand and thus easier to be removed with a cannula (hollowed stainless steel tube attached to a vacuum pump).
Afterwards, Dr. Smiley created a curved flank-to-flank incision pattern to remove the hanging apron of skin and fat. He positioned the scar lower than the standard approach (i.e., a few centimeters below the pubic hairline) because the patient also needed a pubis lift.
Dr. Smiley said that following massive weight loss, the mons pubis tends to sag and/or appear noticeably full, which could prevent MWL patients to wear tight leggings out of embarrassment.
After removing the apron-like skin, which was about 2 ½ inches thick, Dr. Smiley slightly lifted the mons pubis so it would not detract from the flatter, smoother abdomen.
Afterwards, the celebrity plastic surgeon closed the incisions in a way that the resulting curved scar was positioned underneath the patient’s underwear. With meticulous suturing technique (no tension on the skin) and proper postop care, the scar is expected to fade into a thin white line after about a year.
The short scar arm lift procedure is reserved for patients whose excess skin is limited to the one-third of their upper arm (adjacent to the armpit). This technique results in a scar that runs parallel to the natural skin fold of the underarm and thus even with a short-sleeved top no surgical stigmata are seen.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the technique on his Snapchat account. The surgery involved a female patient who developed excess skin after moderate weight loss.
A wedge-shaped excess skin and fat is removed during a short scar arm lift procedure. The resulting scar is a short one that is perfectly concealed by the underarm.
Dr. Smiley said the patient was a good candidate for the short scar arm lift procedure because her excess skin did not reach her elbow.
“If we can do away with the long scar, which the standard arm lift entails, we do it,” he said on Snapchat.
Dr. Smiley said the standard arm lift uses a more extensive incision pattern that the scar extends from the armpit to the elbow. Nonetheless, it remains in a discreet position—i.e., on the inner aspect of the upper arm—so no surgical stigmata are seen unless the patient raises her arms, he further explained.
During surgery, the celebrity plastic surgeon created incisions to remove a wedge-shaped tissue (skin and fat) that was causing the sagging appearance. Afterwards, he tightened the fascia with deep sutures to further improve the contour.
Dr. Smiley reshaped the patient’s arm in accordance with the well-established aesthetic guidelines that suggest that a feminine arm has a relatively lean appearance, although it has a little convexity to the posterior and anterior surface.
before and after photos
After making sure that a high level of symmetry has been achieved, Dr. Smiley then closed the incisions with layers of sutures without picking up the skin (it was only held together by surgical tape). This suturing technique eliminated most of the tension on skin, allowing the wound to heal quicker and the scar to fade better into the background.
Dr. Smiley said that short scar arm lift procedure is occasionally complemented by minimal liposuction to further improve the arm’s contour.