Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.
It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.
Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.
The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.
Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.
After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.
The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.
Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.
While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.
Several studies have been conducted to evaluate long-term liposuction results. In this procedure, the unwanted fats—specifically the subcutaneous fat found beneath the skin—are suctioned out with the use of a flexible tube called cannula.
Some studies have suggested grim findings: After about a year all the benefits of liposuction were gone.
Nevertheless, several studies have also shown that good old-fashioned exercise can preserve liposuction results and prevent patients from regaining fats elsewhere in their body (i.e., areas not treated by the surgery). Of course, physical activities must always be complemented by superb diet, which is an equally critical aspect of long-term weight management.
To shed light on the long-term results of liposuction, a team of Brazilian researchers conducted a study in which 36 healthy but inactive women aged between 20 and 35 had undergone the surgery.
These non-obese participants had 2.5-3 lbs. of abdominal fat removed through liposuction. Afterwards, they were divided into two groups: half were asked to stick to their old habits, while the other half were required to follow a moderate exercise routine.
By six months after liposuction, the first group had regained all the fats previously removed by surgery. And not only that, they developed additional visceral fat—or fat deposition in organs such as the liver and intestines—and thus predisposed them to increased risk of insulin resistance (diabetes), inflammation, and a wide range of health problems.
The uptick in the percentage of visceral fat was notable—about 10 percent more compared to their pre-surgery level.
However, the participants who were asked to perform moderate exercise for four months did not regain fat and even achieve additional health benefits. (Note: The exercise regimen was “doable”—an hour of cardio and weight lifting three times a week.)
Furthermore, the women included in the “exercise group” have improved insulin sensitivity and physical fitness.
The researchers have concluded that exercise can prevent the body from [over] compensating for the abrupt change in the fat composition and distribution caused by liposuction. It is believed that the body has a strong predisposition to defend its fat stores, and a sedentary lifestyle can aggravate this propensity.
Meanwhile, separate studies have suggested that a sedentary/poor lifestyle after liposuction may cause the patients to regain fats in other parts of their body not treated by liposuction, which of course could lead to a disproportionate appearance.
The liposuctioned areas, meanwhile, were less likely to regain fat unless in the event of significant weight gain (i.e., more than 20 lbs.)
With these findings, Dr. Tarick Smiley, a board-certified plastic surgeon who has performed over 9,000 liposuctions, says the long-term success of surgery will always boil down to patient’s commitment to healthy lifestyle.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has provided a list of liposuction incision care. The goal is to help it fade into an invisible scar; therefore, all efforts are made to avoid infection and “irritants” that can interfere with healing.
(Note: This is not an extensive list of post-surgery tips as it only tackles issues involving liposuction incision care. However, Dr. Smiley has some previous blog entries involving the ideal postop diet, ways to control swelling and bruising, managing pain, etc.)
Most patients may shower 48 hours after surgery; however, they should never submerge their incisions in water for three weeks. The incision sites must be completely sealed before swimming in pools and using bathtubs to avoid infection.
Moreover, avoid touching the incision area and stay away from pets and dirty bed linen to minimize risk of infection and wound breakdown.
Body lotions, creams, scented soaps, perfumes, and other similar products may irritate the incision site or lead to suboptimal scar appearance. Should the patient experience itching or tingling sensation, which is not uncommon around the incision, anti-itch creams might be an option but only after the incision is completely sealed.
- Scar creams that contain silicone
Once the liposuction incisions are fully healed (around three weeks postop), patients may use scar creams and gels or any topical product containing silicone as its main ingredient. Studies have suggested that silicone hydrates the skin and allows the scar to heal and fade better.
Sun protection—i.e., using sunscreen and protective clothing or staying in the shade—can prevent hyperpigmentation in which the scars become permanently dark due to the over-production of melanin, which gives the skin its color.
The general rule of thumb is to avoid exposing the liposuction scars to the sun for at least six months.
While there is no specific liposuction method to get a “beach ready body,” leading Los Angeles plastic surgeon Dr. Tarick Smiley says there are core principles that help surgeons achieve impressive results from fat reduction surgery.
For instance, he always ensures that a thin fatty layer remains beneath the skin to achieve a smooth surface (instead of appearing like a cottage cheese) and to preserve the body’s natural curves and valleys.
To further ensure a smooth and natural result, he occasionally performs fat transfer or injection, which is particularly helpful in smoothing out pre-existing dents and cavities (e.g., lateral depression of the buttocks) or skin asymmetries caused by a previous botched liposuction.
Dr. Smiley, who regularly posts videos on his Snapchat and other social media accounts as part of his patient safety awareness campaign, says the ideal liposuction method will also depend on the target area. For instance, small areas such as the knee, calf, and ankle will require a high level of precision to avoid over-correction, which can lead to unnatural contour.
Areas that require a high level of precision warrant the use of microcannula or pen-like device with a hollowed narrow body use to suction the unwanted fat from the body. Large cannulas (outside diameter is 4-5 mm), meanwhile, remove large masses of fat and so there is a perceived higher risk of skin irregularities.
The celebrity plastic surgeon says he also uses vibrating microcannula, or more aptly referred to as power-assisted liposuction, when treating fibrous fat commonly found in the back (bra rolls), around the navel, and the male breasts. This special cannula releases tiny vibrations to dislodge the fat and so the “process” can significantly lessen operator’s fatigue.
(Note: Operator’s fatigue, which might be an issue when the surgery involves large volume of fat, could contribute to less than optimal results from liposuction.)
While the techniques and equipment play an important role in the success of liposuction, Dr. Smiley says that the surgeon’s skillset (which always includes having an eye for detail) remains the most important factor.
Having an eye for detail allows the surgeon to decide how much fat he needs to remove without causing surgical stigmata (e.g., skin asymmetries), and the “extent of the area” he needs to treat to achieve a congruous result. For instance, some patients with “saddle bags” may also need their hips addressed at the same time so the latter will not detract from the more slender outer thigh.
There is a growing mommy makeover trend: Today’s patients are more well versed in plastic surgery that they are demanding for more natural and more proportionate results.
Mommy makeover surgery, which is basically a marketing term, refers to multiple surgery procedures that restore or at least improve the post-pregnancy bodies of patients. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the most common “combination surgery” involves tummy tuck and some type of breast enhancement.
Dr. Smiley, who regularly posts Snapchat videos to spread patient awareness and to share his knowledge with medical students and colleagues, has provided a list of mommy makeover trend that generally favors “subtle” and “realistic” results.
- Curvier and slender waist with tummy tuck
In the past, most patients simply wanted the removal of their apron-like skin that hangs from their abdomen. But nowadays, women are more fastidious in terms of cosmetic results—they want the “corset effect” on their waistline.
To achieve a curvier and more defined waistline, Dr. Smiley highlights the importance of suturing the pair of splayed abdominal muscle, which prior to pregnancy is lined up closely side-by-side.
But during pregnancy that causes the abdominal wall to expand, the fascia (connective tissue) holding it together becomes weak, leading to a gap that could even become palpable. This gap is also causing the barrel-shaped waist that used to have an hourglass figure.
For additional contouring effect, Dr. Smiley pulls and tightens the abdominal skin “centrally.” And if needed, he also performs liposuction of the flanks to achieve a more hourglass figure.
- Breast augmentation beyond size increase
Modern breast augmentation is focused not just on size increase, but also on the final shape and projection. The goal is to achieve the most natural results possible, which all boils down to implants settling in their most ideal position.
Due to the growing demand for natural and “realistic” breast augmentation results, it is now commonly performed together with breast lift. The idea is to achieve optimal breast shape so the “fullness” will look natural.
Dr. Smiley warns that failure to address pre-existing sagging or asymmetry can lead to surgical stigmata like “Snoopy deformity,” excessive lateral bulge, and bottomed-out appearance.
Aside from breast lift, other common ancillary procedures of implants include areola reduction and fat transfer.
- Fat transfer for a more feminine figure
Fat transfer has revolutionized the way surgeons perform body contouring surgery, particularly buttock augmentation.
The growing popularity of fat transfer is attributed to the refinements in the purification techniques, allowing surgeons to increase the survival rate to more than 70 percent. It is important to note that any amount that remains about three months after injection is expected to persist long term.
Fat transfer as a way to augment the buttock is also a powerful body contouring procedure. Because it involves liposuction (in order to harvest the “unwanted” fats), it can contour the waistline at the same time, which in turn results in a more hourglass figure.
New liposuction trends have made this body contouring procedure safer and more effective. Nonetheless, no fancy equipment and media-hyped surgical techniques can serve as a substitute for the excellent skills of plastic surgeons. Simply put, patient satisfaction and success rate will all boil down to the operator, not his machine.
Furthermore, newer techniques do not always lead to better results. In fact, some have been found to provide little or no improvement in terms of contouring effects. For this reason, leading Beverly Hills plastic surgeon Dr. Tarick Smiley sticks to the safest and most studied liposuction procedure: the tumescent technique.
The tumescent liposuction involves infiltrating the fatty area with tumescent fluids—which contain local anesthesia, epinephrine that reduces blood loss by 80-90 percent, and saline—helping him to remove the unwanted fats with more efficiency and greater accuracy.
To further improve the safety and effectiveness of tumescent liposuction, Dr. Smiley may combine it with other liposuction trends, which he has explained below.
Instead of discarding the fats collected during liposuction, a growing number of patients are opting for fat transfer to the buttocks, or in layman’s term, Brazilian butt lift.
The fats are being readied for injection in an attempt to reshape the patient’s buttocks and hips.
According to a 2016 survey published by the American Board of Plastic Surgery, Brazilian buttock lift increased by 26 percent from the previous year. This can be interpreted that more surgeons are favoring the use of “natural material” over silicone implants and other artificial prosthetics.
This piece of medical equipment has long been used in hospitals to control bleeding, which is a risk following a prolonged operation. It prevents excessive blood loss by processing the fluids and collecting the red blood cells, which are then re-infused into the patient.
While significant blood loss is quite rare with “standard” liposuction, this might be an issue in patients having large volume liposuction and those with borderline anemia (or other medical conditions that may increase bleeding).
Dr. Smiley has previously posted a series of Snapchat videos to demonstrate how Cell Saver is used in large volume liposuction.
- Non-invasive way to remove the unwanted fat
One cool example is CoolSculpting, which freezes and kills the fat beneath the skin with the use of a paddle-like device. Within a span of several weeks, the body gradually flushes out the fatty cells and so the results are not that immediate.
Another non-surgical way to remove the fat is to inject Kybella, which has been approved by the FDA since 2015 for the correction of double chin appearance.
It is important to note that a good number of non-surgical fat removal techniques/devices have mixed reviews (some are effective to varying degrees, while others are downright waste of money) or can only provide minor improvements. Meanwhile, the tumescent liposuction provides the most predictable results.