Buccal fat extraction aims to slim a markedly rotund face by reducing the cheek fat pad. However, the buccal fat in the cheek region should not be entirely removed because years down the road an overly aggressive approach can lead to a very gaunt countenance.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate this procedure performed in a female patient with a markedly plump face due to her chubby cheeks and “heavy” neck.” Hence, she was also deemed as a good candidate for neck liposuction.
Prior to surgery, Dr. Smiley examines the facial anatomy of the patient whose face is markedly full due to her chubby cheeks and heavy neck.
Dr. Smiley first performed neck liposuction with a creation of a small round incision beneath the chin, specifically within the skin fold for optimal scar concealment.
The surgeon performed neck liposuction with microcannula, a hollowed steel probe used to remove the fat. However, he made sure to leave behind a layer of fat to conceal the platysma muscle; going the conservative route also made sense to anticipate the progression of age-induced facial volume loss.
After suctioning the excess fat in the neck area, Dr. Smiley proceeded to buccal fat extraction with the creation of a small intra-oral incision on each side of the cheek. No external incision was used and so the risk of visible scar was eliminated completely.
Dr. Smiley said the intra-oral incisions should avoid the submandibular duct and the salivary glands to prevent excessive swelling and other complications.
The patient receives buccal fat extraction and neck liposuction for a more balanced result.
During the creation of incisions, the celebrity plastic surgeon used a cautery device, which also sealed off the blood vessels and tissues, resulting in minimal bleeding and ultimately shorter recovery.
Instead of removing the entire buccal fat pad, he just reduced its size in order to slim the face without making it look too gaunt and unhealthy. As stated earlier, conservative removal has always remained safe and “predictable.”
While the results of buccal fat extraction with neck liposuction are often immediate, the final outcome takes 1-3 months as the residual swelling takes a while to subside.
With more than one-third of the US adult population considered obese, over the recent years there has been an upsurge on the number of bariatric or weight loss surgery. While this a life-saving procedure, some patients remain dissatisfied with their appearance due to their large redundant skin and hanging fats that no longer respond to further diet and exercise.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says thigh lift is one of the most common requests of massive weight loss (MWL) patients, citing a survey showing that about 4,800 patients underwent the procedure last year alone.
This is an incision pattern used in outer thigh lift surgery.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 55,200 MWL patients had some type of body contouring surgery.
Dr. Smiley says that post-MWL thigh lift is often just a component of a series of body contouring surgery due to the natural distribution of redundant skin that also affects the abdomen, buttocks, breasts, and upper arms. Oftentimes, the patients also develop a varying degree of sagging neck and jowl, he adds.
Meanwhile, he explains some surprising thigh lift facts:
- All efforts are made to hide the scar within the natural skin fold—e.g., groin and gluteal fold.
While a good surgeon will make every effort to create incision patterns in which the resulting scar runs within the natural skin fold, the scar length will still depend on the extent and location of loose skin. Hence, inner thigh lift for MWL patients entails a vertical scar on the inside of their leg that may even reach their knee.
- Outer thigh lift is often a component of lower body lift.
As a stand-alone procedure, outer thigh lift uses an oblique incision between the top of the leg and hip, resulting in a V-shaped scar pattern. But due to the natural diffusion of excess skin, occasionally the incision is extended across the circumference of the torso, leading to a belt-like scar.
With a lower body lift, the outer thigh, hips, anterior abdomen, and buttocks are simultaneously lifted and their contours improved.
- Most patients described their recovery after medial thigh lift “tough.”
Due to gravity and persistent swelling, the medial thigh lift incisions are susceptible to wound breakdown. In fact, it is not uncommon to have small separations in the incision, which mostly do not require a surgical closure although they can result in additional healing time.
In general, it takes three weeks for most patients to be able to return to work and another 3-4 weeks before they can gradually start doing more rigorous activities.
- Medial thigh lift is best performed separately from tummy tuck.
Tummy tuck often elevates the sagging mons pubis, while the inner thigh lift pulls down the skin to improve the contour of the leg. Due to the opposing tension, it is often ideal to perform them separately.
The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.
Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.
Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.
Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.
In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.
The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.
“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.
Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.
Body contouring plastic surgery is a broad term used to describe any techniques employed by surgeons to improve areas of the body that have redundant skin and sagging appearance, which commonly occur after massive weight loss and pregnancy. Meanwhile, the aging process can also contribute to tissue laxity.
Body contouring after massive weight loss almost always entails skin removal. Good examples include arm lift, tummy tuck, lower body lift, and thigh lift. The vast majority of MWL female patients also warrant some type of breast enhancement—e.g., breast reduction and/or breast lift.
Tummy tuck is arguably the most powerful tool in body contouring for MWL patients, according to the Inland Empire Plastic Surgery Institute. It removes the excess skin and fat between the navel and the pubic “hairline,” before redraping the skin in the upper abdomen to close the hip-to-hip incision.
All efforts are made to place the hip-to-hip scar very low so it remains concealed by the patient’s underwear. But for massive weight loss patients, the scar might be extended to their flanks or even around their entire torso, a technique referred to as lower body lift or circumferential lift.
A lower body lift basically combines tummy tuck, outer thigh lift, and buttock lift.
Meanwhile, body contouring plastic surgery also encompasses procedures to reverse the effects of pregnancy. Common examples include tummy tuck, breast augmentation, breast lift, and abdominal liposuction, which can help patients regain their pre-pregnancy body.
Whether liposuction is performed in MWL patients or individuals who have always managed a healthy weight but nonetheless have “stubborn” fat, skin elasticity—how much shrinkage it can allow—will determine the ideal amount of removed fat. Furthermore, it is important to preserve a thin layer of fat beneath the skin to avoid surface irregularities.
Implants are also used in body contouring plastic surgery. Their main objective is to increase volume of the “target” area, which could be the female breast, male chest, calf, and bicep.
Male patients who seek body implant surgery typically want to emphasize bulk; hence, a good number of them are body-builders. (Note: Some men do not have the muscle type that allows them to develop their calf, chest, or bicep muscle with weight lifting and other rigorous exercise routine, making them good candidates for implants.)
Women, meanwhile, generally seek body implants to improve their proportions. As a result they typically seek breast and buttock implants—two synthetic prostheses that can deliver a more feminine silhouette.
Upper body lift is typically a combination of two or more procedures such as breast lift or male breast reduction, upper arm lift, back lift, and liposuction. The vast majority of patients who request for this “combo operation” have redundant skin and tissue laxity caused by massive weight loss.
Due to the extensive nature of the redundant skin and “stubborn” fat rolls following massive weight loss, total body lift is typically performed as a two- or multiple-staged procedure. According to California Surgical Institute website, keeping an elective surgery under six hours can minimize risk of complications related to bleeding and surgical trauma.
As with any body contouring surgery, the patient should meet certain requirements before an upper body lift is attempted.
- Near the ideal weight, which has stabilized for at least six months
- No healing problem and other serious medical conditions
- Has realistic goals and expectations
- Has excess skin and fat and widespread tissue laxity
One of the most common variations of upper body lift uses a circumferential incision along the breast crease that extends into the back. This allows the surgeons to tighten the upper abdominal area, reshape the breasts (provided that an additional lollipop-shaped scar is utilized), and eliminate the unsightly back rolls.
While the scars are permanent, they typically fade to a significant degree after 6-12 months. Also, all efforts are used to ensure that they remain within the breast crease and concealed by the “bra line.”
Instead of the horizontal scar, some patients who need a back lift can achieve better results with a bilateral vertical incision between their armpit area and the hips. This technique not only removes the appearance of back rolls but can also improve the flanks.
Aside from the improved body silhouette, which allows the clothes to fit better, some patients can also enjoy immediate relief from rashes and chafing caused by excess skin. For some MWL patients, the redundant skin could be so severe that it even traps sweat and moisture, leading to foul odor.
Body contouring procedures for female MWL (massive weight loss) patients involve unique challenges due to the sizable redundant skin that leads not just to poor body proportions but also to skin breakdown, non-healing irritation, and limited mobility.
The redundant skin which develops after significant weight loss—i.e., 100 lbs. or more—generally affects the waistline, upper arms, thighs, buttocks, and breasts. For this reason, MWL patients may have to accept longer, more visible scars just to achieve a near normal body proportion.
The list below shows the most common body contouring procedures for female MWL patients, as explained by experts at the renowned California Surgical Institute.
* Extensive tummy tuck. Instead of the usual hip-to-hip incision, MWL patients will need a longer scar that extends to their lower back to address both the frontal abdomen and flanks.
Almost all MWL patients will also require some type of muscle repair; this is accomplished by suturing the pair of abdominal muscles into the midline. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says in his Snapchat video that he prefers permanent sutures to absorbable stitches due to their additional support, which counteracts the effects of inadvertent [mild to moderate] weight gain and even pregnancy.
* Lower body lift. In essence, it combines three surgeries—e.g., tummy tuck, outer thigh lift, and buttock lift—in one operation with its incision that covers the entire circumference of the lower torso. Due to its high invasiveness, not every MWL patient is a good candidate and may have to stage each procedure to minimize bleeding and surgical trauma.
* Some type of breast surgery. Women who lost a significant amount of weight typically end up with flaccid breasts whose upper pole lacks volume, further contributing to the unflattering shape. For this reason, they typically require breast lift, which may be combined with breast reduction should they want to “downsize,” or implants in the event that they want additional volume especially in the upper cleavage.
* Back lift. The skin in the back is susceptible to sagging in the event of significant weight loss. Basically, there are two ways to address this problem: a horizontal incision where the “bra band” lies across, or a bilateral scar below the armpit that travels down toward the flanks.
* Arm lift. MWL patients will typically need an armpit-to-elbow incision that is placed in a more posterior manner, as opposed to the “inside” of the arm. While the posterior scar is more visible, it allows the surgeons to remove more redundant skin and minimize the tension on the wound, leading to more favorable scarring.