Plastic Surgeon

Drastic breast reduction surgery is performed not solely for aesthetic reasons, but to improve the patient’s quality of life, said leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Dr. Smiley has recently demonstrated drastic breast reduction surgery on his Snapchat account. The female patient shown in the video complained about the chronic back pain, postural problem, and shoulder discomfort due to the extra weight of her large, pendulous breasts.


drastic breast reduction

The left photo shows the result of drastic breast reduction surgery.

In the video, Dr. Smiley has explained the challenges of drastic breast reduction, particularly relating to increased bleeding and loss of nipple sensation. However, the risks can be avoided or at least minimized with meticulous dissection and deep understanding of the breast anatomy, he added.


Dr. Smiley said that large, pendulous breasts have longer blood supply originating from the muscle and therefore there is an increased risk of excessive bleeding and nipple areola loss.


“Nipple areola loss occurs when its skin literally dies,” he said, adding that one way to avoid this complication is to perform free nipple graft in which it is removed entirely from its stalk (main blood supply) and later grafted back into its place after eliminating some of the breast tissue and skin to reduce the “cup size.”

drastic breast reduction

The right breast looks significantly smaller and perkier versus the “untreated” left side.


But even the free nipple graft has its own caveat, Dr. Smiley has warned.


“We try to avoid the free nipple graft because it typically causes loss of sensation in the areola. Hence, we only decide if this is warranted during the operation and I will try to avoid it as much as possible,” he said.


During the operation, Dr. Smiley decided not to perform the free nipple graft; hence the areolar complex has remained attached to its stalk or main blood supply. Nonetheless, he was able to lift the drooping nipple by 20 cm from its previous location.


He also reduced the areola so it will look proportionate to the new, smaller breast size.


Meanwhile, Dr. Smiley has ensured that the scar goes precisely around the areola’s border and parallel to the breast fold for optimal scar concealment.


And while the vertical scar between the nipple area and the breast fold is in a more obvious location, Dr. Smiley said it is expected to fade into the background after 6-12 months.

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Brazilian booty lift, also referred to as buttock augmentation via fat transfer, is one of the most commonly sought after procedures in Beverly Hills plastic surgery.


Instead of implants, patients can achieve fuller, shapelier backside with the use of their own fat, which is derived from two or more areas.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video explaining how Brazilian booty lift can achieve the “Kylie effect.”


brazilian booty lift

Posterior View of the Patient.  The left photo shows the results of Brazilian booty lift with a “Kylie effect” in mind.


Over the past several months, Dr. Smiley’s patients have been citing reality TV star Kylie Jenner’s voluptuous body to describe their cosmetic goal.


“Basically, the Kylie effect is achieved by creating a narrow and high waist and the fullness of the hips,” he explained in the Snapchat video.


One female patient had requested for this “effect,” although she is naturally thin (weighing just 115 lbs. at the time of surgery) and so Dr. Smiley used multiple donor fats/liposuction sites to collect enough fats to be injected into her buttocks.


Dr. Smiley used the inner thigh, flanks, lower back, and arms as donor sites. He performed liposuction via microcannula, a suction probe with a very narrow body to dislodge and suction the fats in the most accurate and gentlest manner.


The use of microcannula, Dr. Smiley said, is particularly critical when treating the inner thigh because the area is susceptible to surface irregularities and so he avoids the use of large cannulas, which remove fats in bigger chunks and thus with less precision.


Moreover, Dr. Smiley had focused on reshaping the lower back and flanks through meticulous liposuction in order to replicate the reality TV star’s sultry silhouette.


Afterwards, the collected fats were processed with the centrifuge to separate and discard impurities such as the oil and blood cells.


Dr. Smiley injected more fats into the hips to make them appear fuller and curvier.


The celebrity plastic surgeon said that achieving high level of symmetry on both sides is one of the challenges of Brazilian booty lift; hence, he always uses laser light to guide him during the actual injection of fat.

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The appearance of brachioplasty scar is perceived to be a major concern of patients with sagging skin in their upper arm caused by significant weight loss. Nonetheless, most feel that the “tradeoff” of having scars is worth it, particularly when the main goal is to have more slender arms that look proportionate to the body.


Leading Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate the appearance of brachioplasty scar resulting from the “standard” technique.


brachioplasty scar

The female patient shown in the video has “flabby” upper arms due to large amounts of redundant skin that extended down to her elbow. For this reason, she required an incision pattern technique that extended from the armpit down to her elbow.


Dr. Smiley was able to remove a large wedge-shaped excess skin along the inner arm between the biceps and triceps.  The brachioplasty scar from this technique is hidden as people usually hold their arms by their sides.


While placing the brachioplasty scar on the inner aspect of the arms is perceived to be the most ideal technique, sometimes having it more posteriorly (i.e., back of the arm and thus more visible) may provide a better contour. Nonetheless, the patient may have to ponder on the ramifications of each scar technique/placement.


A scar placed more posteriorly is also perceived to heal and fade better because of the reduced tension. The inner aspect placement, meanwhile, is believed to be slightly more susceptible to wound separations due to the natural tension in the area.


However, Dr. Smiley remains partial to the inner aspect scar placement because there are many ways to reduce tension on the wound and thus ultimately promote “better” scars. For this reason, he encourages his patients to take a proactive approach in scar treatments that typically include the use of compression garments, silicone gel and/or sheets, and sunscreen.


Dr. Smiley advocates the use of scar gels and other treatments containing silicone, which hydrates the skin and helps the scar fade better and remain thin and flat. (Note: Wound is known to heal better in a moist environment; hence, the mucosal skin of the mouth has almost zero risk of scarring. The same “line of thought” can be applied to keeping plastic surgery scars unobtrusive with the use of silicone gel and sheets.)

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The Brazilian butt lift results can be more impressive when the hips, which in essence are the lateral aspect of the buttocks, are included as well. For this reason, leading Beverly Hills plastic surgeon Dr. Tarick Smiley almost always includes the area to create a nice curvature.


Improving the hips contour at the same time will also give an illusion of a rounder, fuller backside, says the celebrity surgeon. As a result, he allocates about a third of the donor fats collected through liposuction to the hip area, while the remaining is injected into the actual buttocks.


brazilian butt lift results


In his recent Snapchat video post, he has shown a female patient with noticeable side indentations and flat hips that further worsened the appearance of her flat buttocks.


The female patient required liposuction of the lower back and flanks not just to remove the appearance of “fat rolls” but also to “curve out a more feminine silhouette” in which the hips and buttock profile are further “emphasized.”


In the video, the celebrity plastic surgeon is seen filling out the lateral depressions along the hips to create a smoother transition between them and the buttocks. Also by improving the hip contour, the butt’s posterior view is further enhanced.


Aside from liposuction of the lower back and flanks, Dr. Smiley also collected donor fats from the “bra rolls” for a more holistic improvement of the feminine curvature.


To achieve high survival rate of fat grafts, Dr. Smiley uses centrifuge to separate and remove biomaterials (e.g., blood) and “broken” fat cells so that only the purest and healthiest fats are transferred to the buttocks.


Structural fat grafting injection further ensures high survival rate and smooth results. This technique involves “micro-injection” of fat (less than 0.1 cc) to gradually build up new soft tissue and ensure blood vessel ingrowth.


Without blood vessel ingrowth, the fats will simply die and become absorbed by the surrounding tissue.


Aside from meticulous handling of fat, Dr. Smiley says the survival rate will also depend on patient cooperation. A good rule of thumb is to avoid direct sitting (i.e., the patient should make every effort to sit on her posterior thigh with the use of boppy pillow or U-shaped cushion) for at least three weeks.


And during sleep, the patient must assume a fetal position in which she must lean more toward her stomach to prevent inadvertent shifting of fats along her hips.

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Liposuction tips for smoother, more natural results as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smiley (as seen on his Snapchat videos).


  • Use of microcannula


Instead of using large cannulas or hollowed flexible tubes when removing the “unwanted” fat, Dr. Smiley prefers microcannulas whose outside diameter is significantly smaller (2.5 mm or even less).


liposuction tips


While the use of microcannulas makes the process of fat extraction longer, they make up for the high degree of precision. For this reason, they can significant minimize the risk of dents and other untoward side effects of over liposuction.


Dr. Smiley highlights the importance of leaving enough fats beneath the skin to deliver smooth and natural results from liposuction.


  • Moving the microcannula at correct speed


After posting several videos demonstrating how he delivers smooth results from liposuction, many viewers asked the celebrity plastic surgeon why he “moves his cannula in a rather quick manner.”


In his recent Snapchat video post, he explained the importance of moving the cannula from one area to another in a fairly swift method to avoid removing too much fat.


“When the cannula stays too long in one area, it may remove way too much fat that the skin would collapse much like a Swiss cheese,” he said.


  • Liposuction may actually entail simultaneous fat transfer


Dr. Smiley had corrected indentations from a previous botched liposuction performed by another surgeon. The female patient had visible dents in the abdomen caused by removing too much fat to the point that her skin “collapsed.”


He corrected these skin irregularities with microcannula, which he moved back and forth parallel to the skin and in a rather quick manner. And instead of throwing away all the collected fats, he re-injected some of them into the indentations to smooth them out.


  • The success all boils down to correct patient selection


One of the most critical liposuction tips, he said, is to choose the “ideal” candidates—i.e., they are of normal, stable weight; they understand the importance of healthy lifestyle as a long-term approach to maintain the cosmetic results; they have no serious medical condition; and their skin has a good level of elasticity or “shrinkage.”

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How much skin removed during tummy tuck? Arguably, this is one of the most common concerns of patients with apron-like abdominal skin resulting from previous pregnancy or massive weight loss.


The truth is, the real issue is not how much skin removed during tummy tuck, but how much tissue is left behind that will allow for a safe wound closure.


how much skin removed during tummy tuck

Leaving sufficient tissue after surgery also preserves the natural contours and valleys of the abdomen and promotes favorable scarring—i.e., it appears thin and faded.


Most tummy tucks result in a hip-to-hip scar that is positioned immediately above the pubic hairline and thus easily covered by the patient’s underwear or bathing suit. Despite the media hype purporting the benefits of modified techniques (i.e., a much shorter horizontal scar), their contouring effects are rather limited.


Simply put, mini tummy tucks are only reserved for a very small subset of patients because the redundant skin following massive weight loss or pregnancy generally affects the entire abdomen, sometimes even the flanks.


It is important to note that mini tummy tucks can only remove a very small amount of loose skin in the lower abdomen, thus any “bulging” in the upper and lateral aspect remains after surgery, warns leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


After removing all the loose skin, the remaining tissue is then pulled down and sutured to the pubic hairline. Dr. Smiley says that precision during skin removal surgery is the key to preserve a smooth transition between the lower abdomen and the mons.


Over-resection of the tissue, he warns, can lead to surgical stigmata such as abrupt transition between the lower abdomen and the pubic hairline, scar migration (riding higher that the underwear no longer hides it), and unnatural contour.


To further achieve a smoother contour, some patients will need a simultaneous liposuction (fat removal), but only if they require minimal “correction.” This ancillary procedure is only reserved for patients with excess fat in their upper abdomen and flanks.


It is important to note that the standard tummy tuck automatically removes the excess fat in the lower abdomen as it trims away the loose skin in the area.


However, large volume liposuction is best performed separately to avoid compromising the blood supply in skin and thus preventing wound healing problems.

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