The ideal neck liposuction techniques primarily depend on the patient’s skin quality, amount of excess fat, and cosmetic goals. Despite varying methods, the aesthetic goal remains the same: create a firmer and more refined neck and chin angle.
Recently, celebrity Los Angeles plastic surgeon Dr. Tarick Smiley has posted a Snapchat video demonstrating a surgery performed on a female patient who complained about her double chin appearance and “heavy” jawline.
Since the patient is young, which often translates to having a good skin shrinkage or elasticity, she has been deemed as a good candidate for a liposuction-alone approach.
A liposuction-alone approach does not require skin excision and thus longer scars are avoided.
Dr. Smiley started the procedure by creating three small incisions (about 1.5 mm); the first one was placed under the chin precisely at the natural skin fold, while the two were placed behind the earlobes for optimal scar concealment.
Occasionally, the use of only one incision behind the chin will suffice. But since the patient had excess fat that extended to a large surface area, a pair of incisions was also necessary to access the fats from different directions, which further promoted smoother results.
Meticulous incision placement was particularly critical because the patient is of ethnic background. Studies have suggested that darker complexion is more susceptible to hyperpigmentation (scar turning significantly darker than the surrounding skin) and keloids.
Aside from meticulous incision placement, the diminutive size of the incision (thanks to the use of liposuction microcannula) has further ensured “invisible” scars.
The use of microcannula is critical in small areas such as the neck and jawline because it removes smaller bits of fat compared to the standard cannula; this of course results in smoother skin surface.
After surgery, the patient was asked to wear a supportive chin strap for at least a week in order to keep swelling to a minimum and help the skin heal closer to the tissue, further improving the angle between the chin and neck.
The success of liposuction for men’s belly boils down to proper patient selection. It should be noted that normal weight patients with subcutaneous fat, which is a type of genetically predetermined fat that is resistant to exercise and diet, is the right candidate for the procedure.
While liposuction removes the excess fat, prominent Inland Empire plastic surgeon Dr. Tarick Smiley says it is not a weight loss solution because it only removes the superficial fat that lies beneath the skin.
This male patient had belly liposuction in which about 5.7 liters of fat was removed.
Meanwhile the deeper visceral fat, which is closely linked to obesity and its concomitant health risks, is unaffected during liposuction. This type of fat, which is tied to poor lifestyle, only responds to regular exercise and healthy diet.
“Liposuction or any body contouring surgery is not a quick fix solution. A good physique always entails commitment to healthy lifestyle,” says Dr. Smiley in his previous Snapchat post.
Liposuction for men’s belly is typically performed with a tumescent technique in which the fatty area is injected with large amounts of sterile saltwater (saline) infused with epinephrine to control bleeding and lidocaine, a local anesthesia known for its antibacterial effects.
Once the tumescent fluids take effect, several small incisions are created so the surgeon can insert a straw-like tube called cannula.
The liposuction cannula is moved back and forth in rapid motions to dislodge fat and suction it out. The entire surgery can take between 45 minutes and two hours and is often performed as an outpatient procedure.
Oftentimes, male patients who ask for abdominal liposuction also require their flanks to be treated at the same time. The goal is to create a smoother and more natural contour of the midsection.
Occasionally, liposuction for men’s belly can unveil the stomach muscles, resulting in a six-pack appearance. This is particularly true for patients with great physique prior to surgery due to regular exercise and healthy diet.
Meanwhile, some doctors attempt to create a six-pack ab by performing aggressive liposuction to create deep grooves in which the skin almost sticks to the muscle. Not everyone agrees that the results look natural and thereby some surgeons only perform small etching right above the navel.
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.