Plastic Surgeon

News of botched cosmetic surgeries have recently circulated the Internet, most of which demonstrate stories of permanent deformities, life-threatening complications such as septic shock, and even death.


The vast majority of botched results were performed by doctors with no or very little training in plastic surgery. For instance, one OB-GYNE was able to operate a “beauty clinic” in Manhattan and performed liposuction and Brazilian buttock lift, which mostly resulted in serious complications and deformities, because of the legal loophole.


cosmetic surgeries

Dr. Smiley advocates patient safety, which he believes can be bolstered by stringent state laws and patient awareness campaign.

In New York state law, any doctor may wish to offer cosmetic surgeries even without an anesthesiologist or nurse.


Further complicating things is the proliferation of board-certifying bodies and professional organizations claiming to possess superior training compared to other competing groups. Nonetheless, there is one ultimate parameter patients can rely on: Physicians certified by the American Board of Plastic Surgery, which is a member board of the prestigious American Board of Medical Specialties, are deemed to be the crème de la crème.


Aside from passing a rigorous oral and written exam that they must retake every 10 years, ABPS members must have also completed their education from an accredited medical school; they should have at least two years of supervised residency in plastic surgery; they must have completed a minimum of three years of general surgery; and they must have two years of professional practice under their belt.


Meanwhile, other cosmetic surgery organizations, despite their professional sounding names, have been criticized for their very lax standard. For instance, they might accept doctors from non-surgical specialties as long as they have liposuction machines and several days of training offered by the manufacturer.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that other doctors from other specialists encroached the cosmetic surgery field due to its lucrative nature, making it more critical for anyone to do their “homework and conduct extensive background check on their surgeons.”


Dr. Smiley says that prudent patients should also take into account the “staple practice of their plastic surgeon’s.” For instance, someone doing hundreds of breast augmentation every year is markedly more adept than someone only doing it as a “side business.”


“In plastic surgery, we should do it right the first time. Hence, plastic surgeon selection should not be taken lightly,” he says.

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Breast augmentation through fat transfer offers unique benefits: Lack of any risks associated with artificial implants, more natural shape and feel, and more control over the final cleavage appearance (i.e., upper breast pole and mid cleavage).


And because the procedure entails liposuction, which is the process of harvesting fats from “troublesome” areas of the body, patients can also expect a more holistic improvement compared to the standard breast augmentation.


breast augmentation fat

The deflated breast has its implant removed. The “perky” side, meanwhile, has already received fat transfer giving it ample volume and projection with the use of the most natural material possible–the patient’s own fat.

Renowned Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a female patient who has had breast implant removal immediately followed by fat transfer.


During surgery, Dr. Smiley removed the implant through an incision made precisely at the upper border of the areola (this was the same incision created during her previous breast augmentation).


Removing the implant could lead to deflated-looking breasts, particularly in the upper pole; hence, Dr. Smiley performed a simultaneous fat transfer.


To harvest sufficient fat volume, Dr. Smiley performed liposuction on different body areas including the abdomen, flanks, and lower back. The collected amount is then washed and sorted to remove dead cells and other “non-fat” biomaterials such as blood to ensure high survival rate.


The purified fat volume was then injected into the breast, specifically above the implant pocket. Dr. Smiley said microdroplet (less than 0.1 cc) of fat has been inoculated into the tissue and muscle to promote vascularization or blood supply ingrowth, which allows the fat cells to persist long term.


About 70-80 percent of the injected fat volume is expected to survive long term, while the remaining is resorbed within a few weeks of injection. Hence, it is a common practice to slightly overfill the breast to anticipate this “consequence.”

breast augmentation through fat transfer

Final result from the surgery

Another issue with breast augmentation through fat transfer is the varying permissible amount of fat injection. It is important to note that overzealous augmentation may lead to low survival rate because of the excessive pressure experienced by the fatty cells; this is particularly true for patients with markedly tight skin.


In general, 200-300 cc of purified fat can be injected into each breast without worrying about low survival rate and other complications caused by excessive pressure.


In the video, Dr. Smiley said the main advantage of breast augmentation through fat is that it “provides more control over the final width of the breast,” making it easier to improve the mid cleavage and upper breast pole compared to implants.

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It is important to note that plastic surgeon experience directly correlates to the cosmetic results following liposuction or any other forms of body contouring surgery.


While education and formal training are the foundations of good plastic surgeons, experience allows them to further hone their eyes for detail. It is important to note that body contouring surgery is a combination of art and science.


plastic surgery experience

Although beauty is not confined by strict definition or mathematical equation, most scientists, visual artists, plastic surgeons, and even “ordinary observers” know it when they see it. Hence, experts have come up with standards in an attempt to define attractiveness.


Dr. Tarick Smiley, who is the medical director of California Surgical Institute, explains how plastic surgeon experience affects the results of liposuction, a body contouring surgery in which the unwanted fat is removed with a slender steel probe called cannula.


  • “Feeling” the surgical site


Contrary to popular belief, great liposuction surgeons do not rely mainly on their eyes during surgery, but more on “feeling” the treated site, as explained by Dr. Smiley on his recent Snapchat video post.


“While I move the cannula back and forth with my right hand, my left hand feels the skin, allowing me to decide if I need to stop or continue what I’m doing. It is critical to leave behind a layer of fat afterwards, as opposed to removing it entirely, to ensure a smooth skin surface,” he said.


  • Numbers matter a lot


Dr. Smiley, who has performed more than 9,000 liposuctions, said that board certified plastic surgeons with extensive experience have a notably low complication rate.


Inexperienced and unqualified surgeons, meanwhile, may commit a serious mistake of removing too much fat and causing excessive injury on the skin. Aside from surface irregularities, being too aggressive results in tissue necrosis (death of tissue) and poor scarring (liposuction is supposed to result in nearly invisible scar).


The consensus is to choose a board certified plastic surgeon who performs liposuction almost every week, or someone who conducts over a hundred surgeries every year.


  • Revision rate


Major revisions after liposuction (due to surface irregularities) can be serious that sometimes that it is better to leave the area alone than risk having a more severe problem. Hence, Dr. Smiley believes that the surgery must be performed correctly the first time.


Despite best effort, minor revisions may be sometimes necessary to further improve the initial results after liposuction. Nonetheless, a major “overhaul” is not to be expected if the surgery is performed by a qualified, reputable plastic surgeon, Dr. Smiley has explained.

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Plastic surgery safety should be the utmost priority of any plastic surgeon, says Dr. Tarick Smiley who is the medical director of the California Surgical Institute.


Dr. Smiley has recently posted a series of Snapchat videos in an attempt to explain the importance of having one’s surgery at an accredited surgical facility, which is also referred to as ambulatory facility or same day surgery center.


“Plastic surgery is not just about doing the operation. Because we prioritize patient safety one of our most critical tasks is overseeing the facility centers. Currently, we have four accredited surgical facilities; they have been accredited for over 10 years. This means that they meet the strictest safety standard required by health regulators,” he said in the Snapchat video.


“Even the air ventilation system is designed to reduce risk of contamination and infection,” he added.


The list below explains the specific benefits of having one’s surgery at an accredited surgical facility:


  • It is fully equipped with medical apparatus and medications should a complication arise.
  • The staff members are certified in Advanced Cardiac Life Support.
  • Should the patient require an overnight stay, she will receive round-the-clock care by licensed medical staff.
  • The staff receives regular training to ensure patient safety.
  • The staff knows the emergency plan that is implemented should any complication arise that requires transferring patients to a hospital.


Dr. Smiley prides himself for being fastidious in terms of patient safety and comfort that all the blankets, covers, and even the fluids used by patients are “warmed” in a special storage, which he has shown in his Snapchat posts.


To further promote plastic surgery safety, Dr. Smiley said he regularly uses sequential compression device, which resembles a pair of leggings worn during surgery. It works by “massaging” the lower limb to promote good blood circulation, which in turn reduces the risk of deep vein thrombosis or blood clots.


Dr. Smiley’s accredited surgical facilities also contain state-of-the-art equipment to promote patient safety. For instance, Cell Saver processes the bodily fluids collected during liposuction and then filters out the red blood cells, which are re-infused into the patient.


With the use of Cell Saver, no or very little blood loss occurs after liposuction. Hence, patients can expect a shorter and more convenient recovery—i.e., no significant lethargy and nausea, which usually follows after large volume liposuction.

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Renowned facelift surgeon Dr. Tarick Smiley said the surgery should not solely rely on pulling tight the tissue and removing the excess skin lest it results in a “done” or “fake” look.


In his recent Snapchat video post, he has explained how he delivers natural results from facelift, which he almost always combines with ancillary procedures (e.g., fat transfer, neck lift, eyelid surgery, etc.) to achieve a more natural, proportionate result.


In the video, the celebrity plastic surgeon has enumerated the “age-related problems” of a certain patient.


facelift surgeon

Before-and-After Photos of the Patient


  • Loose neck skin
  • Fullness of the neck due to the excess fat
  • Jowling
  • Fullness of the upper eyelid
  • Sagging of the mid face


Dr. Smiley started off the surgery with neck liposuction in which the excess fat has been removed. He placed a tiny round incision behind each ear where a slender probe called microcannula was moved back and forth to remove a small amount of fat.


Next, he proceeded to performing SMAS facelift in which all the incisions were hidden—i.e., inside the hairline and then curved behind the tragus (the small bump in front of the ear) before reaching the back of the ear or nape area.


The incision in front of the ear was positioned at the natural skin crease and so the resulting scar is expected to be invisible once healed.


Dr. Smiley said one of the most important elements is the vector of pull. After removing the excess skin, the tissue must be pulled at a 45 degrees angle before closing the wound.


“The right vector of pull results in natural fullness of the cheek and the best neck position,” he explained.


He has warned that the tissue should not be pulled straight up due to risk of skin pleating of the lateral face, nor horizontally because of the ensuing flat cheeks and poor neck appearance.


To further achieve proportionate results, Dr. Smiley also tightened the neck platysma muscle in the midline and removed the fat underneath. The goal is to create a smoother and tighter “angle” between the neck and chin, he said.


Then, he proceeded to upper eyelid surgery in which he removed a strip of excess skin with the use of incisions made precisely at the natural skin fold for optimal scar concealment. He also tightened the deeper muscle to further eliminate the appearance of fullness and thus achieve a more youthful eye.


He also injected fat to create a smooth transition between the lower lid and cheek, further contributing to the more youthful appearance.

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Blepharoplasty surgery, or more commonly referred to as eyelid lift, is believed to be a rather straightforward procedure—just removing the loose skin and excess fat is enough to address the aging upper or lower eyelid. However, this is far from the truth, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


The list below shows the most common blepharoplasty surgery tips and traps, as explained by Dr. Smiley.


blepharoplasty surgery tips

Before-and-After Photos of a Patient with Impressive Results from Blepharoplasty


* Placement of the scar in upper eyelid. In an attempt to raise the corner of the eyelid, some inexperienced surgeons commit a grave mistake of carrying the incision too high and lateral, which of course results in visible scar.


Dr. Smiley believes that the upper eyelid scar should follow the natural curve of the lid fold and then stop there. If the scar lies precisely at the natural skin crease, patient satisfaction tends to be high.


* Conservative fat removal. In the past, the fat pads were removed entirely in an attempt to eliminate the under eye bags or “heavy” upper lid. However, this aggressive maneuver almost always results in disaster—the eyes look skeletonized. To avoid this problem, Dr. Smiley will always leave a little fat; sometimes, he even perform fat injection particularly if the patient has deep tear trough or abrupt transition between the lower lid and cheek.


* Conservative muscle resection. When done judiciously during an upper eyelid surgery, this technique can contribute to a more youthful, natural appearance.


However, some doctors have tried to replace muscle resection with “multiple pinpoint” cauterization technique (“burning off” the tissue) in an attempt to create a lifting effect. But this method has a serious caveat—it may create a thick band of scar tissue in the muscle that can pull the edge of the eyelid, leading to unnatural contour. For this reason, muscle resection remains the most predictable and safest approach.


* Meticulous physical exam. Dr. Smiley says that great surgeons put a high value on precise anatomical evaluation in which the “rebound” of the lower/upper lid skin, the length of the lid’s border, and the amount of loose skin and fat are scrutinized.


Dr. Smiley says that blepharoplasty is a highly meticulous procedure that it is often referred to as surgery by millimeters.


Some patients may even require vision tests (and other similar modalities performed by ophthalmologists). This is particularly true when health insurance requires proof that upper blepharoplasty is going to be used to improve a person’s peripheral view affected by loose skin or eyelid ptosis (drooping).

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