Some patients with “fat flabs” on their knees can benefit from knee liposuction, which is essentially a minor surgery. It is important to note that the superficial fat (it lies beneath the skin) is often genetically predetermined and so it may not always respond to exercise and diet.
The deeper visceral fat, meanwhile, will only respond to weight loss—i.e., superb diet combined with regular exercise. For this reason, liposuction or any form of body contouring surgery is only reserved for patients of normal weight, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
In his recent Snapchat video post, Dr. Smiley has showcase a female patient undergoing knee liposuction. Her inner thigh was also included in the surgery to achieve a more attractive contour. The idea is to create a smooth transition between the knee and its adjacent areas, which is seen in “supermodels,” he explained.
The celebrity plastic surgeon positioned small round incisions on the inner side of the knees; these are expected to fade into scars that are almost invisible. This has become possible thanks to microcannula, a stainless steel tool with an outside diameter of less than 2-3 mm.
Dr. Smiley said he prefers the use of microcannulas to large cannulas because they remove fats in smaller, more “precise” bits and so the risk of over-correction is significantly reduced, if not almost eliminated.
To further improve “precision” during fat extraction, Dr. Smiley injected the knee and its adjacent areas with tumescent fluids, which contained local anesthesia for numbing effects, and epinephrine to reduce the amount of bleeding.
Dr. Smiley also performed liposuction along the inner thigh to achieve proportionate results. He has warned that the area is highly susceptible to surface irregularities (dents and cellulites) and thus a layer of fat must remain afterwards.
“In liposuction, regardless of the treated area, the most important thing is to leave a layer of fat beneath the skin in order to deliver a smooth result,” he said.
Furthermore, the volume of fat removed during liposuction should always take into account the skin shrinkage; it is important for the skin to “snap back” to achieve a tight and smooth appearance, he further explained.
After removing the “unwanted fat,” Dr. Smiley wrapped the liposuction sites with bandages and compression garment to control swelling and to speed up healing.
Extensive tummy tuck does not only rely on skin removal. It is important to note that after pregnancy or massive weight loss, the apron-like abdominal skin is not the only “factor” that contributes to the sagging or barrel-shaped appearance of the waistline.
The splayed or separated abdominal muscle, excess fats, and hernia (weak spot in the muscle or connective tissue that causes the intestine to squeeze through) also contribute to the unattractive appearance of the waistline.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted educational videos on his Snapchat account to demonstrate surgeries involving extensive tummy tuck. It is important to note that each surgery is highly customized due to varying anatomies of the patients.
One female patient has received extensive tummy tuck that involved muscle repair, navel repair, liposuction of the flanks and lower back, and mons pubis lift.
Liposuction was first conducted to remove the excess fat along the flanks and lower back before the actual components of the tummy tuck were performed.
The patient then received a hip-to-hip incision made very low so that her underwear can easily cover the resulting scar. Over time, the scar is expected to fade into the background.
The hip-to-hip incision has allowed Dr. Smiley to lift the skin off and expose the pair of vertical muscle between the breastbone and the pubic region. Using the permanent “individual” suturing technique, he was able to tighten the muscle in the midline, leading to a flatter abdomen in frontal view.
After muscle repair, he injected Exparel into the muscle; this is a long-acting numbing medication that can significantly reduce the amount of pain for about four days.
Then, he removed a wedge-shaped excess skin before closing and tightening (centrally) the remaining skin in order to achieve an hourglass figure effect.
Of course, the enlarged navel has also been repaired so it will not detract from the narrower, more feminine waistline.
Because the female patient had lost a lot of weight, she also had sagging of the mons pubis, which has been lifted and re-anchored to achieve a smooth transition between the pubic region and the lower abdomen.
Hourglass body contouring surgery is a highly customized procedure, although it usually combines liposuction and buttock augmentation through fat transfer, as suggested by renowned Los Angeles plastic surgeon Dr. Tarick Smiley who regularly posts Snapchat videos involving this combo technique.
Dr. Smiley says most patients seeking body contouring surgeries want natural results (i.e., what nature intends) and so they must combine art and science to deliver the most desired results.
The celebrity plastic surgeon says the “core principles” that help him deliver natural results from hourglass body contouring are backed by science. He cites the studies that suggested women with an hourglass-shaped figure are the most appealing to men.
Some researchers have even suggested that having an hourglass figure is more important for most men than their facial features.
The consensus is that the waist-to-hip-ratio of 0.7, or a waist measurement accounting for 70 percent of the hip circumference, is the ideal feminine physique.
To achieve this ratio, Dr. Smiley highlights the importance of contouring, or to be more specific, narrowing the waistline, which can be achieved by 360-degree liposuction.
While liposuction removes the unsightly rolls caused by excess fats beneath the skin (they are genetically predetermined and so they may not always respond to exercise and diet), Dr. Smiley says it remains important to leave behind some fat to preserve a smooth skin surface.
Should the patient desire to improve the projection of her “backside” as well, Dr. Smiley almost always performs liposuction of the lower back and flanks.
For a more hourglass body contouring effect, instead of discarding the fats collected from liposuction they are purified and re-injected into the patient’s backside and hips, says Dr. Smiley.
In his Snapchat videos, Dr. Smiley is often seen allocating about one-third of the fat volume to “widen” the hips and the remaining is then used to improve the shape and projection of the actual buttocks.
When performed in the right patient (healthy, near normal weight), the surgeon says that hourglass body contouring surgery can provide near permanent results that look natural and proportionate.
The guidelines involving liposuction safety are primarily aimed to control the amount of bleeding and surgical trauma, as suggested by world-renowned plastic surgeon Dr. Tarick Smiley who oversees accredited surgical facilities in Los Angeles, Dubai, and Lebanon.
A good number of doctors avoid large volume liposuction whose definition greatly varies. For instance, some interpret it as removing more than 4 liters of fluids (fats, blood, and anesthetics or wetting solution injected into the fatty area); others use the patient’s body weight to “establish” the maximum safety limit.
One way to avoid large volume liposuction in patients who need “extensive correction” is to conduct two procedures performed months apart. The goal is to give the body sufficient time to recover from the surgical trauma caused by the initial surgery.
However, the aforementioned approach can lead to additional expenses—i.e., the patient has to pay for two anesthesia and surgical facility fees. Moreover, it entails two recovery periods, which can be a rather inconvenient for someone with a hectic schedule.
Despite the caveat of large volume liposuction, Dr. Smiley still offers the procedure provided that the patient is healthy enough to handle the surgery and the recovery it entails; hence, lab screening and blood work is a critical component of his strict patient selection process.
To further ensure large volume liposuction safety, the celebrity plastic surgeon uses a new technology called Cell Saver, which can process the fluids collected during surgery. It works by collecting the red blood cells, which are then re-infused into the patient as if no blood loss has occurred.
Dr. Smiley has recently demonstrated large volume liposuction on his Snapchat account. He was able to collect more than 4 liters of fluids in the patient’s frontal abdomen alone.
The female patient required 360 degree liposuction (i.e., the entire waistline) to achieve a more hourglass silhouette.
While the use of Cell Saver enables the renowned surgeon to perform large volume liposuction without resulting in significant bleeding, trauma, and fluid imbalance, he does not always perform this type of aggressive fat removal, particularly in patients whose skin lacks a good amount of elasticity.
It is important to note that the skin must shrink-wrap to the new contour to achieve smooth results.
Body contouring liposuction takes the “standard” fat removal technique to the next level. Instead of simply removing the excess superficial fat that causes the “love handles” and “muffin top” appearance, the surgeon’s primary goal is to achieve a result that looks attractive and natural, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley sees body contouring liposuction not just a procedure for removing fat; the main objective is to reshape the body, not to eliminate the superficial fats entirely.
“The superficial fat, unlike the deeper obesity-related visceral fat, is often genetically predetermined; hence, no matter how much exercise you do sometimes these fat rolls wouldn’t budge. In this situation, liposuction might be warranted,” he says.
Dr. Smiley says body contouring liposuction is more focused on how much fat is left after surgery, rather than removing all the superficial fat in the treated area. He warns that over-removal can lead to a gamut of surgical stigmata such as skin asymmetries, contour irregularities, and function-related problems (imagine removing all the fat pads in the mons pubis, which of course leads to painful intercourse).
To achieve smooth results, the celebrity plastic surgeon ensures that a thin layer of fat remains beneath the skin. For this reason, he uses microcannulas—slender hollowed tubes with an outside diameter of less than 3 mm—to avoid inadvertent over-correction.
To further reduce the risk of over-correction during body contouring liposuction, he occasionally uses vibrating cannula, a technique more commonly referred to as PAL, an acronym for power-assisted liposuction.
The PAL device releases tiny accurate vibrations to break up and remove the fats in a very precise and gentle manner. Dr. Smiley says this “mechanism” makes it particularly ideal for treating highly fibrous fat found in the back, male chest, and around the navel.
Because body contouring liposuction does not only focus on removing the fat, but more importantly improving the overall proportions, Dr. Smiley occasionally uses the “collected fats” to reshape the buttocks, to smooth out dents (e.g., lateral dent on the buttock cheek), and to improve results from a poorly done liposuction in the past.
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.
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.