BBL surgery, also referred to as Brazilian butt lift or butt augmentation via fat injection, is a two-step body contouring surgery. Doctors first perform liposuction on multiple donor sites (e.g., lower back, flanks, bra rolls, and tummy) to collect large volume of fat, which is then processed and injected into the patient’s buttocks and hips.
While bruising is a normal part of recovery, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that all efforts are made to minimize this postop symptom to promote high survival rate of fat grafts.
Dr. Smiley recommends the use of compression garments for at least eight weeks. The idea is to control the swelling in the liposuction sites and to help remodel the tissue in the recipient site or buttocks.
Postop bruising happens when blood from ruptured capillaries or small blood vessels leaks out under the skin, resulting in a red or purplish mark that turns into green or yellow discoloration as the patient moves forward to her recovery.
In a recent Snapchat video, Dr. Smiley says that too much bruising causes “excessive pressure and tension, which is not good for the fat grafts.”
One way to control the amount of postop bruising and swelling, Dr. Smiley says, is to use gentle and correct fat injection technique; this also ensures high survival rate and smooth, natural contours of the buttocks and hips.
“It is important to inject fats in multiple layers of the muscle and subcutaneous tissue, and in a way that separate containers are being created. This technique results in less bruising and allows the buttocks to take more fats. About 70 percent is expected to survive long term, provided that fat injection is done in a highly meticulous manner,” Dr. Smiley says.
Aside from meticulous fat injection, the celebrity plastic surgeon highlights the importance of using medical grade compression garments, which are typically worn for eight weeks. The idea, he says, is to keep the swelling and bruising to a minimum, and ultimately to promote healing and smooth results.
The garments worn around the buttocks are designed to provide minimal compression, as too much pressure may “kill the fats” and lead to less than optimal results; however, the garments for the liposuction sites are usually tauter to control swelling and to prevent edema (fluid formation) beneath the skin.
While compression garments can aid in healing, Dr. Smiley says that most patients can see the final results about six months after surgery, as it takes a while for the skin to fully shrink-wrap to the new contour and the residual swelling from the tumescent fluids to subside completely.
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.
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.
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.
Over the past several years there has been a hype over mommy makeover surgery, which is a combination of two or more procedures that improve the post-pregnancy body of women. However, a new trend is now emerging, which some surgeons dubbed as grandma makeover surgery.
According to a survey released by the American Society of Plastic Surgeons, patients aged 55 years and older accounted for 23 percent of the total cosmetic plastic surgeries performed in 2016. This means that last year alone, more than 387,000 procedures were performed in seniors, a 4 percent increase from 2015.
Eyelid lift, facelift, and forehead lift, all off which are facial rejuvenation procedures, were the most commonly performed surgeries on seniors. Nonetheless, body contouring surgeries such as tummy tuck, breast lift, and liposuction were also popular, according to the survey.
Contrary to popular belief, the patient’s chronological age does not increase the risk of postoperative complications, says leading Los Angeles plastic surgeon Dr. Tarick Smiley. However, he warns that patients over the age of 65 are more likely to suffer from certain conditions as compared to younger people.
In an attempt to ensure patient safety during grandma makeover surgery, Dr. Smiley highlights the importance of conducting lab screening and consultation to determine any risk factors, many of which can be eliminated or at least controlled through lifestyle changes and medications.
In general, the right candidates for grandma makeover, says Dr. Smiley, are healthy seniors who have realistic goals and expectations.
Another common safety protocol is to limit the operative time to four hours. A team of researchers at UT Southwestern Medical Center in Dallas, Texas, has suggested that after 4.5 hours of surgery the risk of complication could triple.
And after about seven hours, the risk of complications following a surgery increased 4.7 times.
Aside from the operative time, other independent risk factors include smoking and use of blood-thinners (aspirin and non-steroidal anti-inflammatory drugs) well in advance of the surgery. Hence, it has become a common practice among plastic surgeons to require their patients to avoid them 2-3 weeks before and after their operation.
Despite some of the challenges in grandma makeover surgery, a study involving patients who have had some type of facial plastic surgery has suggested that seniors scored significantly higher in satisfaction rate compared to younger people. The researchers attributed this result to the older patients’ more realistic goals and expectations.
Tummy tuck with Exparel results in less pain and discomfort during the initial stage of recovery. Exparel is a long-acting local anesthetic (Marcaine) that is injected into the abdominal muscle right before closing the incisions with sutures.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, says Exparel can numb the treated area for up to four days, allowing his patients to rely less on postoperative narcotics that may cause vomiting, lethargy, nausea, and constipation.
This drug is injected into the abdominal wall, numbing the surgical site for up to four days.
Exparel is also more convenient than using pain pumps, which are external devices (resembling a small balloon) that slowly release numbing medications into the surgical site.
It makes sense to control the postoperative pain as studies have suggested that when patients feel less pain, they breathe and move easier, which is the key to quicker recovery. Nonetheless, they should remain cautious about their postoperative activities to prevent tear sutures and wound breakdown.
The general rule of thumb is to avoid rigorous exercise and heavy lifting for three weeks. After this period, most patients may gradually increase the intensity of their activities provided they do not experience pain or discomfort, and their surgeons give their go signal.
Exparel can also help control postoperative pain after breast enhancement surgery. It can be injected into the surrounding soft tissue or muscle layer or simply released into the implant pocket.
The only downside to the use of tummy tuck with Exparel is the additional cost, although most patients wouldn’t mind it as long as they have a comfortable recovery.
Facial fat transfer results should look smooth and natural and thus it entails a “perfect marriage” of art and science. While it is often combined with facelift or some type of facial rejuvenation surgery, it can also serve as a stand-alone procedure to improve the overall contour of the face.
Dr. Tarick Smiley, an eminent Beverly Hills-based plastic surgeon, has explained the three core guidelines that help him deliver smooth and natural fat transfer results.
This young patient has hollowed temple, which Dr. Smiley improves with fat transfer and ultimately the overall contour of her face.
- Harvest the right kind of fat.
In Dr. Smiley’s recent Snapchat post, he has explained that the abdomen and flanks are the two most ideal donor sites as their fat is more liquescent and thus provides smoother results. The back area, meanwhile, is best avoided because of its highly fibrous fat that may lead to bumps and other surface irregularities when injected into the face.
- Purify the fat prior to injection.
All the biomaterials (e.g., blood and oil) except from fat are removed prior to injection; this is mainly done with the use of centrifuge that separates fluids based on weight. This paves way for smoother results and long-term survival of fat grafts, Dr. Smiley explained.
With proper handling and injection, fat transfer results are near permanent (12-15 years).
- Perform meticulous injection.
Dr. Smiley said the purified fat is injected below the skin-and-fat layer and above the muscle. This provides not just smooth and natural results, but also prevents risk of nerve damage and other complications.
To further minimize risk of nerve damage, facial fat transfer uses a blunt needle during the injection process.
To further ensure smooth fat transfer results, injection is done through micro-droplet technique in which less than 0.1 cc of purified fat is inoculated one at a time into the tissue. This creates a honeycomb arrangement and thus allows tissue integration and blood supply ingrowth needed by the grafts’ long-term survival.
The appearance of six pack after tummy tuck might be possible with the right surgical maneuvers. Nonetheless, some factors are beyond the surgeon’s control and thus the right candidate for the surgery should understand that to some extent their results are determined by their underlying anatomies and lifestyle.
The appearance of six pack primarily stems from two factors: a well-developed abdominal muscle, and a thin layer of fat between the muscle and skin.
The “after” photo shows more athletic “grooves.”
During tummy tuck, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the hanging skin and excess fat is removed. However, this is not enough to deliver the appearance of six pack and so other surgical maneuvers are utilized as well.
In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had tummy tuck, which resulted in an athletic appearance. This has been possible with a combination of techniques: performing muscle repair, thinning out the fat above the muscle, and placing enough tension during wound closure.
During surgery, Dr. Smiley performed muscle repair in which the pair of vertical muscles between the upper and lower abdomen were tightened in the midline with the use of permanent sutures, which were individually stitched to promote additional support.
By incorporating muscle repair with skin excision tummy tuck, the anterior abdomen appears narrower and there is no or very little bulge every time the patient sits down.
A well-developed abdominal muscle will not show through a thick fat. Hence, the fatty tissue beneath the skin must be thinned out, but not completely obliterated.
It is important to preserve some fats between the skin and the muscle to ensure smooth and natural results.
To further ensure the appearance of six pack after tummy tuck, it is important to use the right amount of tension during muscle repair and wound closure.
The patients are in control of some factors such as their diet and exercise. Hence, the right candidates for tummy tuck or any other forms of body contouring surgery understand the importance of healthy lifestyle to maintain the results long term.