Abdominal revision liposuction poses some unique challenges. First and foremost, plastic surgeons often have to deal with skin irregularities caused by over-removal of fat, and the internal scar tissue from the previous surgery.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video showing a female patient who had botched liposuction that resulted in large dents below her navel, contour irregularity on the left flank, and less than optimal waistline.

abdominal revision liposuction


The large dents and surface irregularities, according to Dr. Smiley, were primarily caused by over-liposuction or removing too much fat.


In the video, the celebrity plastic surgeon said a thin layer of fat must remain after surgery to ensure a smooth skin surface and to avoid a wide range of surgical stigmata.


To correct the ill effects of over-liposuction, Dr. Smiley performed fat transfer, which in essence is a reverse liposuction. After removing some fats along the flanks and waistline, instead of discarding them he injected them to smooth out the indentations.


To further achieve a smooth skin surface, Dr. Smiley released the scar tissue that was causing the skin to adhere to the muscle, which in turn also improved the contour of the left flank.


Moreover, he removed additional fat along the flanks to create a more hourglass silhouette (narrow waistline and wide hips).


Since revision abdominal liposuction is more complex than the initial surgery, Dr. Smiley always uses the tumescent technique combined with microcannula, or flexible hollowed tube with an outside diameter of less than 2-3 mm.


Tumescent liposuction involves injecting large amounts of tumescent fluids into the fatty area before the actual removal fat is performed. The idea is to make the fat cells swell up to pave way for a more precise, gentler extraction.


Furthermore, the tumescent fluids contain epinephrine that constricts the blood vessels and thus the amount of bleeding is reduced by up to 90 percent as compared to the “dry” or “no wetting solution” technique.


Precision is further improved with the use of microcannula during the actual extraction of fat, allowing the surgeon to remove excess fats in smaller bits, as opposed to larger chunks. For this reason, he avoids using large cannulas especially when doing some type of revision liposuction.


The female patient has presented Dr. Smiley her “wish pic” (Kylie Jenner’s voluptuous body). For this reason, he not just sculpted the four quadrants of the frontal abdomen and the flanks, but also the inner thigh and hips.


Overall, Dr. Smiley used 12 tiny liposuction incisions to meet the cosmetic goals of this particular patient; these are expected to fade into the background after 6-12 months.

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The axillary lift is a type of body lift commonly performed in massive weight loss patients. This procedure deals with the redundant skin and fat along the armpit, which not only causes unsightly bulges but also poor odor, skin rashes, and non-healing irritation.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the axillary lift on his Snapcat account. He performed the surgery in a female patient who had lost a lot of weight and so she was left with redundant skin.


axillary lift

The celebrity surgeon created a wedge-shaped incision covering the armpit and the lateral chest, thus allowing him to remove a large amount of skin and fat. The wound was then closed in a way that the resulting scar would lie parallel to the transverse armpit fold.


Dr. Smiley says it is of critical importance to remove just the right amount of redundant skin to allow for proper wound closure and to prevent limited activities of the arm.


“We should strike the perfect balance between creating a tighter, smoother armpit area and avoiding too much tension, which happens after an over-aggressive skin resection,” says Dr. Smiley.


Hence, he highlights the importance of the surgeon’s experience and “eye for details” when performing any type of body contouring surgery after weight loss.


The resulting scar from the axillary lift could migrate or appear conspicuous if there is too much tension on skin. For this reason, Dr. Smiley always closes the wound in several rows so the tension on the superficial layer is mitigated, which also allows for good healing.


To further promote favorable scars, he recommends silicone sheets and gels as they hydrate the skin. Wound that heals in a moist environment is known to fade better.


Occasionally, the axillary lift is combined with other body contouring surgeries such as brachioplasty (arm lift), arm liposuction, and even breast surgery, says Dr. Smiley.

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Liposuction preparation aims to prevent complications and achieve optimal results from the surgery. While most patients already know about the importance of achieving their prime health and weight through superb diet and regular exercise, not everyone knows the importance of prepping up the skin.


It is important to note that skin quality, along with the surgeon’s skills and experience, will play a crucial role in the final results. First and foremost, the skin must shrink-wrap smoothly around the new contour to achieve a tight, natural-looking appearance.


liposuction preparation

Experts at the California Surgical Institute have provided a list of ways to prepare the skin before liposuction surgery.


  • Stop smoking


Apart from increasing the risk of poor healing and skin necrosis, smoking causes skin dryness and premature aging and thus may preclude the patient from achieving optimal results from liposuction.


While the general rule of thumb is to discontinue smoking for three weeks before surgery and about a week afterward to reduce the risk of healing problems, complete cessation remains the best route to prevent premature aging of the skin.


  • Avoid or at least cut back on alcohol


Alcohol causes dry skin (thus it appears ashy) and may aggravate postop bruises. A good rule of thumb is to avoid or cut back on alcohol three weeks before surgery.


  • Avoid Tanning


Tanning booths, sunbathing, and even self-tanning products must be avoided for a minimum of three weeks before surgery. The goal is to help the skin achieve its healthiest and least sensitive state.


  • Avoid skin irritants


Patients undergoing facial liposuction are generally instructed to avoid facials, skin peeling, steaming masks, and other similar treatments for at least three weeks before surgery.

  • Purchase “recovery” supplies weeks or days ahead of the surgery


Aside from dressing and compression garments, “recovery” supplies should also include sunscreen, protective clothing (with special fibers that offer SPF protection), and scar creams and silicone sheets.


  • Ensure that the skin is in its optimal health


A prudent patient should immediately notify her surgeon’s office if she develops any skin infection or pustules, or if she develops any type of illness within a week prior to her surgery.

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The abdominal etching liposuction aims to create the appearance of washboard ab. But to achieve good results, prior to surgery the patient must have achieved his ideal weight through healthy lifestyle, which he must stick to afterward to preserve his improved physique. The same thing applies to all body contouring surgeries in which the results are largely determined by the patient’s anatomy.


Simply put, achieving optimal results from abdominal etching liposuction entails good or at least a decent physique. This is the reason why patients who lead an active lifestyle (e.g., body-builders and avid runners) generally achieve a better outcome compared to [slightly] overweight patients after some type of body contouring surgery.


abdominal etching liposuction

Photo Credit: adamr at

While abdominal etching liposuction also removes the excess fat through the same “core” technique as the standard approach, it requires more precision. Leading Los Angeles plastic surgeon Dr. Tarick Smiley says it involves strategic removal of fat beneath the skin in a way that the appearance (or illusion to be more precise) of muscular definition is achieved. For this reason, the method is also sometimes referred to as high-def abdominal liposuction.


Whether abdominal etching or “regular” liposuction is performed, the celebrity plastic surgeon prefers the tumescent technique due to its impressive precision, smoother and more natural results, and notable safety record.


Tumescent liposuction injects the fatty area with fluids that trigger the fat cells to swell up, making the removal more précised and gentler. Furthermore, the “wetting” solution contains epinephrine that constricts the blood vessels that can significantly reduce bleeding by up to 90 percent (compared to the “dry” method), says Dr. Smiley.


Abdominal etching typically entails a few round incisions as small as 1 mm where a suction hollowed tube called cannula is moved back and forth to remove some of the excess fats. They are expected to shrink and fade into color about a year postop.


Despite the growing popularity of abdominal etching liposuction, some doctors remain skeptical about its contouring effects, suggesting that it may look fake and “done” because the “purported muscle” does not move when flexed. For this reason, they feel that the most natural results are only achieved when patients are working out regularly (and of course they adhere to a superb diet) and so when their surgeons “unveil” their muscular definition (by removing the thin layer of fat beneath the skin) the results are almost always natural.

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Gynecomastia surgery and liposuction can be a powerful body contouring surgery in men with breast enlargement (colloquially called as man boobs or moobs) and unsightly fat rolls especially along their flanks, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Gynecomastia surgery (i.e., the standard technique) creates an incision below the areola’s border so the resulting scar blends well into the dark-light skin junction. This allows the surgeon to remove the excess breast tissue that is causing the herniated-looking or “puffy” nipple area.


gynecomastia surgery and liposuction

Liposuction, meanwhile, uses a few round incisions (usually less than ¾ cm) to remove the excess fat causing the appearance of “love handles” and other unsightly bulges. Despite being a powerful tool in body contouring surgery, Dr. Smiley warns that it is only reserved for healthy, normal weight patients who are committed to maintain a stable weight through superb diet and regular exercise.


“The caveat of liposuction is that we only remove the excess superficial fat right beneath the skin and not the deeper visceral fat linked to obesity. This stubborn fat rolls are mostly determined by genetics and so despite impeccable lifestyle that involves rigorous exercise some men simply can’t show good muscle definition. Hence, for these individuals liposuction could be a good option,” he says.


While gynecomastia surgery can be performed as a stand-alone procedure, a simultaneous liposuction could deliver smoother, more proportionate results.


“The goal is to create a more masculine torso by removing the appearance of love handles. We don’t want the waist line to deviate from the athletic-looking chest contour,” explains the celebrity plastic surgeon.


Gynecomastia surgery and liposuction generally entails a two-week off to allow most of the swelling and bruising to subside, although some patients may return to work/school within a week provided that they avoid heavy lifting, strenuous exercise, or anything that can raise their blood pressure and heart rate.


A good rule of thumb is to avoid over-exertion for at least three weeks and then after this period the patients may gradually resume their exercise provided their doctors give them permission.

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In most cases the amount of liposuction pain is fairly minimal thanks to the introduction of tumescent technique, which is now the gold standard. This involves injecting a special type of fluids into the fatty area before removing the localized fat deposits with a cannula (flexible hollowed tube).


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the tumescent fluids contain local anesthesia for numbness and epinephrine that constricts the blood vessels, which in turn prolongs and “spreads” the numbing effects up to 48 hours after surgery.


liposuction pain


Hence, most tumescent liposuction patients will only need mild painkillers such as Tylenol, as opposed to narcotic pain medications. In fact, the postop discomfort is generally attributed to the soreness and tenderness almost similar to the muscle soreness experienced after a hardcore exercise routine.


Meanwhile, liposuction under general anesthesia without tumescent fluids involves significant amount of pain that most patients will need strong narcotic meds. And because of the significant bleeding it entails this has become a less popular technique, says Dr. Smiley.


The celebrity plastic surgeon says that liposuction pain is most intense in the first 2-4 days postop, which is expected to gradually resolve as the soreness and swelling also subside.


Most of the swelling will take at least a month to dissipate, although it is possible to return to work a few days or about week postop provided that the patient’s tasks do not involve heavy lifting and over-exertion. A good rule of thumb is to avoid strenuous activities for three weeks to prevent healing problems.


It is important to note that aside from oral painkillers, there are other ways to control pain, which is closely linked to swelling. For this reason, keeping the inflammation to a minimum is one of the keys to promote healing.


Superb diet (rich in micronutrients and lean meat and low in sodium and processed carbs), light exercise (walking), compression garments, good hydration, and lymphatic drainage massage can all promote healing and possibly reduce the amount of pain.


Lymphatic drainage massage is known to help the body flush out excess fluids (seromas) and toxins, and thus keep swelling to a minimum and the pain as well.


Furthermore, consistently using compression garments especially during the initial healing stage (2-4 weeks) can encourage quick drainage and thus prevent seromas and significant postop swelling and pain.

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