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.
Facial proportions refer to the relationship in size and placement between features, while symmetry pertains to how similar the left and right side of the face appear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Just like artists who need to an in-depth knowledge of facial proportions to create their masterpiece, facial plastic surgeons must also possess such critical but nonetheless hard-to-grasp concept of beauty and balance.
But what constitute a face that is deemed attractive? And what are the features that distinguish it from plain and not-so-pleasant ones? Or does the axiom “beauty is in the eye of the beholder” have merit despite claims made by scientists and researchers suggesting that there are indeed mathematical ratios that can quantify objectively the level of attractiveness or lack thereof?
On top of these conundrums surrounding physical attractiveness, some research studies have pointed out that the perception of beauty is affected by variables that include culture, media, and socio-economic background.
Nonetheless, Dr. Smiley believes that beauty does possess certain hallmarks that transcend culture and milieu; these hallmarks, he suggests, can help plastic surgeons deliver natural and pleasant results from rhinoplasty (nose reshaping), facial implants, fat injection, chin reduction, etc.
Chin and Jawline
When the face is divided into three horizontal segments—from the forehead hairline to the outside corner of the eyes, from the eyes to the base of the nose, and from the base of the nose to the chin margin—and their distances are all equal, the face is considered more attractive.
The aforementioned ratio can help guide surgeons during chin reduction/augmentation and jawline enhancement.
Rhinoplasty, aka nose job
A nose deemed attractive has a breadth that is similar to the distance between the eyes; however, it does not strictly apply to ethnic noses, which can even tolerate a slight nostril flare that may even contribute to facial attractiveness.
Furthermore, the length of the nose is ideally equal to the chin’s vertical height in order to increase the attractiveness of the face. It should be noted that the chin and the nose play a critical role in facial proportion and harmony and thus it is not uncommon to combine rhinoplasty and chin augmentation.
Typically, the length of attractive faces is roughly one-and-a-half times longer than their width. This hallmark of beauty and youth may guide plastic surgeons during cheek augmentation (via implants or fat injection) and buccal fat reduction.
Furthermore, the lower two-thirds of a youthful face has an inverted triangle shape thanks to fullness of the upper cheek (or prominent cheekbone), which gently tapers toward the lower cheek and jaw.
Forehead and hairline
The ancient Greeks believed that the Golden Ratio, now more commonly referred as the Divine Proportion or phi (1.618), was the key to beauty and was seen in nature. When applied to facial proportions plastic surgery, it states that the ideal distance between the forehead hairline and the upper eyelid is 1.6 times the distance between the top of the upper eyebrow and the lower lid.
Hence, the concept of phi might be applied during brow and forehead lift surgeries.