All efforts are made to hide the neck liposuction incisions to promote high patient satisfaction. After all, people do not want telltale signs of plastic surgery such as visible scars, skin irregularities, and unnatural contour, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently performed neck liposuction in a female patient and posted her surgery on Snapchat.
Dr. Smiley uses one small incision precisely placed within the natural skin fold for optimal scar concealment.
The patient said she was bothered by her “heavy” neck and “double chin” appearance caused by the excess fat. Meanwhile, she had a decent skin shrinkage and so she was deemed as a good candidate for a neck liposuction-alone approach.
(Note: Patients with poor skin elasticity may need a concomitant excision-based surgery—e.g., facelift and neck lift—as a liposuction-alone approach may aggravate the appearance of sagging neck or jowl.)
To create a more slender neck, Dr. Smiley performed liposuction, which also included the patient’s chin to achieve a smooth, natural transition between these areas. He also removed some fats along the jawline to deliver a more chiseled appearance. This was all done with the use of a small round incision (about 1 cm) beneath the chin, specifically within the natural skin crease to further hide the scar.
Occasionally, the under the chin incision is complemented by a pair of incisions below the earlobes. This approach is particularly ideal for patients whose neck fat extends significantly beyond the center.
Dr. Smiley says that neck liposuction requires a “highly meticulous approach” to prevent surface irregularities.
To achieve smooth results, Dr. Smiley highlights the importance of “cross feathering” technique in which the liposuction cannula (stainless steel tube to remove the fat) is moved back and forth quickly and at varying angles.
The idea of cross feathering, Dr. Smiley explains, is to promote uniform removal of the excess fats, and to ensure that some fats remain after surgery to preserve a smooth skin surface.
Contrary to popular belief, the celebrity plastic surgeon says that neck liposuction is not about removing the entire fat. In fact, doing so could lead to visible bands caused by the lack of “carpeting” to the point that the platysma muscles show through the thin skin, he warns.
To preserve smooth surface and natural neck contours, he highlights the importance of leaving behind enough fat beneath the skin.
Inner thigh liposuction poses some challenges such as increased risk of surface irregularities and unnatural contour. However, renowned Orange County plastic surgeon Dr. Tarick Smiley says that with meticulous techniques these surgical stigmata can be avoided or at least minimized.
In liposuction, the most important issue is the smoothness, not the volume of fat removed. Anecdotal reports show that the most common cause of patient dissatisfaction is surface irregularity, which require a revision surgery.
These are the basic guidelines to avoid unfavorable outcomes in inner thigh liposuction, according to Dr. Smiley.
Liposuction microcannula is a stainless steel probe with an outside diameter measuring 1-3 mm. It removes fats in smaller bits, making it especially ideal in treating the inner thigh that is known to be susceptible to surface irregularities particularly when large cannulas are used.
Microcannula should be moved back and forth using a fanlike motion radiating out from each incision site. Furthermore, fat removal should be done in an overlapping and intersecting manner to promote smooth and uniform results.
“Uniform” fat removal is also achieved when small decrements over the treated area are gradually suctioned out; the process is repeated several times until the desired result is accomplished.
- Maintaining sufficient fat reserves
As previously stated, the success of inner thigh liposuction or any liposuction site boils down to the preservation of smooth skin surface and natural contour. Hence, it is a sacrosanct rule to maintain sufficient “carpet of fat” beneath the skin.
When too much fat is removed, bumps and dents appear. Furthermore, the contours and curves of the inner thigh are obliterated.
The general rule of thumb is to preserve sufficient amount of fat based on the patient’s skin shrinkage and other underlying anatomies. And due to the susceptibility of the inner thigh to surface irregularities, skilled surgeons typically choose a conservative route.
Liposuction for male breast reduction is often inadequate because the vast majority of patients have chest enlargement caused by excess glandular tissue and not just fat, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
“The breast or glandular tissue is too fibrous that it will not come out with liposuction alone,” says Dr. Smiley in his recent Snapchat post.
Before removing the excess breast tissue, Dr. Smiley performs liposuction first to eliminate the fat.
Dr. Smiley says that liposuction uses a hollowed steel tube to suction the fat out of the treated area; however, it cannot draw out the “extremely fibrous and dense” glandular tissue, which can only be removed with a longer incision.
To allay the concern of patients regarding the appearance of scar, Dr. Smiley says the incision is “precisely made at the lower border of the areola” to hide the scar.
“The light and dark skin junction perfectly conceals the scar. After all, men like to take off their shirt without having to worry about surgical stigmata. They are simply more secretive when it comes to plastic surgery,” Dr. Smiley says.
Recently, the renowned plastic surgeon performed a combination of excision and liposuction in a male patient who has good physique due to regular exercise and superb diet. But despite his commitment to healthy lifestyle, his chest remained unusually large for a man, a condition medically referred to as gynecomastia.
A small U-shaped incision is placed at the lower border of the areola to remove the excess tissue with a cautery device.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 27,760 men with gynecomastia had male breast reduction surgery, which is traditionally performed with an excision-based technique.
However, Dr. Smiley says that a good number of men can benefit from a simultaneous liposuction, which he performed in the said patient.
Dr. Smiley started the procedure with the injection of tumescent fluids into the chest before performing liposuction to remove the excess fat. The idea, he says, is to keep bleeding to a minimum and to numb the area.
The liposuction incision was a small “puncture hole” placed at the border of the lower areola.
Afterwards, he created a curved incision also placed right at the lower border of the areola so he could remove the excess glandular tissue that was causing the “appearance of woman-like breast.” Nonetheless, he maintained the patient’s good muscle definition so his new chest would not detract from his athletic physique.
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.
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.
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.