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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Extensive liposuction surgery often pertains to large volume fat removal, i.e., more than 5 liters of fluids (fat, blood, and wetting solution) from the patient. It may also refer to treating multiple areas of the body under one surgical setting.


Dr. Tarick Smiley, a prominent Orange County plastic surgery expert, has recently posted a series of videos on Snapchat to demonstrate one case of extensive liposuction involving the anterior abdomen, flanks, lower back, “bra rolls,” upper arms, inner thigh, and “double chin.”


extensive liposuction surgery


One of the challenges of extensive liposuction is the increased risk of fluid imbalance, although Dr. Smiley says that certain steps can prevent or at least reduce the complication rate.


  • Meticulous patient selection


The ideal candidate should have no chronic medical condition that may increase the risk of complications. Hence, all Dr. Smiley’s patients are required to pass lab screening prior to surgery,


  • Accredited surgical facility


Accredited surgical facilities adhere to strict patient safety protocol and are staffed by licensed and well-trained medical professionals.


  • Well-trained anesthesiologist


A well-trained board-certified anesthesiologist accompanies Dr. Smiley in every surgery to further ensure patient safety. It should be noted that the anesthesiologist’s tasks not just include administering anesthesia; he also monitors vital signs such as blood pressure, oxygen level, and heart rate during surgery.


Furthermore, the “ideal” anesthesiologist is properly trained in the infusion and removal of large volume of fluids, allowing him to identify the risks and keep these well under control.


  • The use of Cell Saver


While this equipment is more commonly used in hospitals during prolonged surgeries, in large volume liposuction this can also be helpful in controlling blood loss. It works by filtering out the red blood cells, which are inadvertently collected during liposuction, and infusing it back to the patient.


By almost eliminating blood loss, Cell Saver is known to promote patient safety and lead to shorter downtime.


  • Tumescent liposuction technique


Despite the proliferation of new liposuction technologies (e.g., laser and ultrasound), the standard technique provides the most predictable results. This involves infiltrating the fatty area with tumescent solution, which is a concoction of saline (sterile saltwater), lidocaine (local anesthesia), and epinephrine.


Epinephrine constricts the blood vessels and thus reduces the amount of blood loss and surgical trauma.

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Arm liposuction surgery can provide impressive results when two key variables are present: strict patient selection and meticulous surgical execution.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate arm liposuction as part of a rather extensive body contouring surgery that also involved the patient’s anterior abdomen, flanks, lower back, bra rolls, and inner thigh.


arm liposuction surgery

Due to the natural distribution of fat, most of the upper arm circumference needs “contouring,” leading to smoother, more natural results.

Strict patient selection, which is primarily based on physical exam, is the first step to ensure impressive results from surgery. One of the objectives is to assess skin elasticity and its ability to snap back once the excess fat has been removed with the use of liposuction cannula.


During physical exam, the thickness of the hanging skin relative to the upper arm base is assessed, often with the “pinch” method in which the patient’s arm is extended horizontally while pinching the base of the upper arm skin right beneath the muscles. If the skin does not touch the evaluator’s palm, she is most likely a good candidate for a liposuction-alone surgery.


Meanwhile, patients with significant tissue laxity manifested by large or thick hanging skin are poor candidates for liposuction-alone surgery unless a concomitant arm lift is performed as well; this uses a long incision extending between the armpit and elbow, usually on the inside of the upper arm, to achieve a smoother, more athletic appearance.


To further guarantee satisfying results from arm liposuction surgery, Dr. Smiley highlights the importance of understanding what constitute a nice-looking feminine arm. After all, this is almost an exclusive procedure for women.


While most people appreciate a relatively slender arm, a slight convexity (fullness) along the posterior surface between the armpit and elbow contributes to a youthful and feminine appearance. It should be noted that this area is highly susceptible to heavy fat deposit and aging, leading to a varying degree of ptosis (sagging or even bat-wing “deformity”).


To preserve minimal convexity to the posterior surface of the upper arm, liposuction should not be done too aggressively that the contour becomes emaciated or too muscular. Furthermore, preserving a thin layer of fat beneath the skin will ensure a smooth surface.


The patient shown in the videos had about 450 cc of fat removed on each arm. While it may sound a lot, smooth and natural-looking results are to be expected because she has good skin shrinkage.


To further ensure smooth results, Dr. Smiley placed two liposuction incisions that were eminently small and thus expected to fade into imperceptible scars. The first one was placed on the outward-facing surface of the arm (near the armpit) and the other one was positioned right next to the elbow.


The celebrity plastic surgeon said it is important to use incision for each treatment area to achieve smooth results and to preserve the natural contours and valleys of the feminine arm.

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Liposuction of bra bulge deals with fibrous fats with deep compartments, making the surgery extra challenging unless the “right” approach is used. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the tumescent liposuction combined with microcannula remains the most ideal technique to create a smoother back.


Tumescent liposuction has been the gold standard in fat removal surgery. It injects fluids into the fatty tissue that causes the fat cells to expand, leading to smoother results and less bleeding and surgical trauma as the “mixture” also includes epinephrine, a drug that constricts blood vessels.


liposuction of bra bulge

Liposuction of bra bulge is followed by fat transfer or BBL.


To further promote “precision” during liposuction, Dr. Smiley says he uses microcannula, which is a hollowed probe with an outside diameter less than 2.2 mm—this is narrower compared with the standard cannula (4-6 mm). With this instrument, the risk of over-correction manifested by skin surface irregularities can be minimized, if not completely eliminated.


Liposuction of bra bulge typically involves the area between the armpit and “bra line.” In tight clothing or incorrect bra size, the “trouble spot” is further accentuated.


The success of surgery, particularly how “smooth” the results can be, depends on the patient’s skin shrinkage or elasticity. Hence, it is more commonly performed in women between 30s and 40s than those who belong in the older age bracket.


Past the age of 50, the skin does not snap back as easily as the young skin. And with this in mind, seniors and massive weight loss patients who generally have large redundant loose skin should expect no or little improvement from liposuction of bra bulge unless a concomitant skin excision surgery is performed.


Some patients want to avoid surgery and resort to non-invasive methods such as CoolSculpting that freezes and kills the target fat cells, which the body excretes gradually within a few weeks. The improvements are not drastic, reducing the fullness of bra rolls by only 20 percent and thus it only suits patients who require minimal correction in the first place.


Furthermore, CoolSculpting and other non-invasive alternatives require more than one session to appreciate the results.


Kybella injection is another possible alternative to reduce the unsightly bra bulge. While the US FDA has approved this drug to correct the double chin appearance caused by excess fat, using it outside of the submental area is considered an off-label practice.

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Bra rolls liposuction surgery eliminates the unsightly bulges that tend to become more prominent in tight clothes. But as with any body contouring procedure, its success boils down to strict patient selection and meticulous surgical execution.


Patients who can benefit from bra rolls liposuction have excess superficial fat (beneath the skin) caused by hereditary distribution and thus no matter how skinny they get, the “bra bulge” remains there.


bra rolls liposuction

The patient receives bra rolls liposuction immediately followed by fat injection into the buttocks, a procedure more commonly referred to as Brazilian buttock lift.

Meanwhile, no body contouring surgery suits significantly overweight and obese individuals whose main problem is the excess [deeper] visceral fat linked to obesity. This type of fat only responds to dieting and exercise, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


These are the bra rolls liposuction guidelines that help the celebrity plastic surgeon deliver natural and smooth results from the surgery.


  • Use of holistic approach


Due to the natural distribution of superficial fat, most patients who think they need bra rolls liposuction can achieve smoother results if their surgery also includes the upper-outer back near the armpit, posterior waist fat, and/or flanks (above the waist and below the shoulder).


Simply put, women seeking bra rolls liposuction may actually need their entire back, or at least a large surface of this region, re-sculpted to achieve smooth and natural results.


  • Use of microcannula and tumescent fluids


Tumescent fluids are injected into the fatty area, triggering the fat cells to swell up before they are suctioned out with the use of microcannula, a hollowed probe with an outside diameter less than 2.2 mm.


Microcannulae remove fats in smaller bits, making them ideal for highly fibrous fat, meaning it is tightly intertwined with the connective tissue. Furthermore, they tend to provide smoother results than the standard cannula, which suction out fats in bigger chunks.


  • Skin evaluation


The success of bra rolls liposuction primarily depends on the patient’s anatomy. For instance, anyone with excess skin, which can be verified when the rolls remain even after the arms are elevated, will require skin excision rather than just liposuction.


  • Ligament attachments


Sometimes, the bra rolls are also caused by how the ligaments are arranged and thus require to be “released” to achieve smoother results from surgery. To further ensure smooth appearance, it is ideal to treat the “bra bulge” individually during liposuction.

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Male breast reduction photos can shed light on the artistic and technical skills of a surgeon. Nonetheless, you should also take into account the “before” pictures, which show the patients’ starting anatomies that will always have an effect on the final results. Hence, overweight patients do not achieve the same results as men with good physique.


Sample photos depicting great results from male breast reduction.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat demonstrating a patient with gynecomastia, a condition in which his overdeveloped male breasts were caused by excess fat and glandular tissue.


Unlike fat that can be taken out with liposuction cannula, which is a hollowed steel probe attached to a vacuum pump, the glandular or breast tissue is noted for its highly fibrous nature. Thus, the patient required a concomitant excision procedure.


male breast reduction photo

Microcannula is used to remove the breast fat. The tiny round incision is placed precisely at the border of the areola for optimal scar concealment.

Dr. Smiley started the surgery with liposuction that involved a small puncture wound placed at the lower border of the areola. Since the breast fat is highly fibrous, meaning it has more connective tissue and thus harder to suction out, he used a microcannula instead of a large or standard cannula.


Microcannulae have a narrower steel body (2.2 mm or less) compared to the standard cannulae and so they remove smaller bits of fat. While this could mean slightly longer surgery, it promotes more precise fat removal, leading to smoother results.


The glandular tissue is very tough that liposuction cannula cannot suction it out. Hence, excision is warranted.

However, even a microcannula could not remove the patient’s extra glandular tissue that was mainly located behind the nipple area. Hence, Dr. Smiley created a curved incision right at the border of the lower areola in order to excise a huge chunk of tissue.


To prevent nipple collapse, surface irregularities, and other telltale signs of bad plastic surgery, Dr. Smiley ensured that enough soft tissue remained after surgery.


Meanwhile, he also performed liposuction along the patient’s axilla (armpit), particularly the lateral aspect of the torso so it would not detract from the flatter, more athletic male chest.


Because all the incisions were small and were placed in inconspicuous areas—i.e., border of the areola and armpit—the patient can expect invisible scar after 6-18 months.

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