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.


smooth skin after liposuction

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.

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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.)


panniculectomy with liposuction

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.

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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.


buccal fat extraction

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.

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The success of Brazilian buttock lift surgery largely depends on how meticulous the surgeon is during physical exam and consultation. The goal is to identify the patient’s pre-existing anatomy and ascertain her aesthetic needs, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


In Dr. Smiley’s recent Snapchat video post, he demonstrated a patient with noticeable asymmetry between her left and right hips, poorly projecting buttocks, and excess fat along her flanks and lower back that further “concealed” her derriere.


brazilian buttock lift surgery

Prior to surgery the left hip appears flatter compared with the right hip. Furthermore, the patient has pre-existing surface irregularities, which must be addressed at the same time as the surgery.


Dr. Smiley says it is critical to identify any pre-existing asymmetry prior to surgery to customize the procedure and achieve the most balanced results possible. For instance, the patient’s left hip was significantly flatter in comparison to the right side. Furthermore, her oblique and profile view showed that the buttocks were almost at the same level as the lower back.


before bbl

Prior to surgery, the patient’s buttocks are flat that they are about the same level as the lower back.

During physical exam, Dr. Smiley also assessed the patient’s skin quality, particularly its elasticity and shrinkage, an anatomical aspect that would help him determine how much fat volume the buttocks could carry without resulting in sagging appearance or other surgical stigmata.


The pre-existing skin elasticity would also determine how much fat volume that could be harvested from the donor sites without predisposing the patient from surface irregularities and other telltale signs of liposuction.


“The skin of the liposuction or donor sites should be able to retract or shrink nicely. This is possible when the surgeon is able to assess the patient’s skin shrinkage,” says Dr. Smiley.


For the vast majority of patients, Dr. Smiley says the lower back and flanks “carry a large amount of excess fat, which makes them a great donor site,” adding that contouring them creates a more feminine “S” curve and a smoother transition between the back and upper buttocks.


Aside from the lower back and flanks, the celebrity plastic surgeon also collected fat from the patient’s “bra rolls” and tummy, areas that often carry excess fatty tissue as well.


Dr. Smiley allocated about one-third of the fat volume into the outer-lateral side of the buttocks, since the patient requested for curvier hips, while the rest was injected to improve the buttock’s profile.

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During a secondary liposuction surgery of the same area, plastic surgeons deal with more challenges due to the scar tissue created by the previous surgery.


Scar tissue forms within the fatty layer that has been previously suctioned through a liposuction cannula, a slender steel probe attached to a vacuum pump. Hence, during a revision surgery the area is very “tough,” making it more difficult to move the instrument back and forth.


secondary liposuction surgery

A secondary liposuction surgery is performed to correct the unsightly rolls and contour irregularities caused by a previous liposuction. Afterwards, the patient receives BBL surgery.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a female patient who underwent secondary liposuction surgery that was shortly followed by Brazilian butt lift or BBL.


In standard liposuction the fats are discarded, but in BBL they are “re-used” in order to improve the volume and contour of the buttocks and hips, thus obviating the need for synthetic implants.


Dr. Smiley said the patient previously had botched liposuction of the back done by another surgeon, leading to the appearance of rolls and contour irregularities.


The celebrity plastic surgeon corrected the botched results by using liposuction microcannula, which has a narrower diameter compared to the standard design. With this technique, he was able to remove small bits of fat, as opposed to large chunks, leading to smoother results.


The use of microcannula also favored the patient because of the internal scar tissue in her back.


To further ensure smooth and natural results, Dr. Smiley preserved a thin layer of fat beneath the skin.


“Liposuction is not about removing all fats. What is more important is to preserve a smooth skin surface, which is only possible when you leave a carpet of fat beneath the skin,” he said in a previous Snapchat video.


Because the patient also requested for BBL and thus required large volume liposuction, Dr. Smiley also used the axilla (armpit area), bra rolls, anterior abdomen, thighs, and knees as donor sites.


The patient also requested for “wider and curvier hips,” Dr. Smiley said he allocated a large portion of the purified fat into the area.


It should be noted that most patients will need 600-900 cc of purified fat (after removing all the impurities such as the oil and blood inadvertently collected during liposuction) to see a noticeable difference. But for more impressive results, some may even need up to 1,200 cc.

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Cankle liposuction, which is an almost exclusive procedure for women, corrects the appearance of “chubby” ankles. The goal is to create a more tapered and slender appearance of the lower leg, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


The ankle is an eminently challenging liposuction area because it is replete with blood vessels and nerves. Hence, all efforts are made to minimize bleeding and risk of nerve damage with the use of gentle techniques and tumescent fluids.


cankle liposuction

Photo Credit: David Castillo Dominici at

Dr. Smiley says he injects tumescent fluids into the liposuction area to constrict the blood vessels and thus minimizes bleeding and nerve injury. This technique also promotes gentler fat removal because the solution also causes the fatty cells to expand, making them easier to remove with microcannula.


The use of microcannula, a liposuction hollowed tube attached to a vacuum pump, can further minimize surgical trauma as well as the amount of postop bruising and swelling. And since the ankle is considered a tough area and there is not a lot of fat, it becomes more important than ever to use this device.


Large cannulas (they have thicker outside diameter), meanwhile, are best avoided during cankle liposuction because they remove fats in bigger chunks and thus may result in higher risk of nerve injuries and over-correction.


To ensure smooth and proportionate results, some patients also require liposuction of their calves.


Because of gravity, the lower leg experiences longer and more pronounced swelling than any other parts of the body. Hence, a many surgeon recommends the use of compression hose for longer periods, sometimes for up to six months.


(Ordinarily, liposuction elsewhere entails 3-4 months of complete healing and skin retraction. But with ankle and/or calf, patients may have to wait a bit longer.)


To further control swelling and ultimately promote healing, rigorous activities are best avoided for six weeks. Leg elevation, good hydration, and superb diet (avoid salty and fatty foods known to aggravate swelling) are also known to control postop inflammation.

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