Plastic Surgery Blogs

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.


grandma makeover surgery


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.

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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.


tummy tuck with exparel

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.

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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.


fat transfer results

This young patient has hollowed temple, which Dr. Smiley improves with fat transfer and ultimately the overall contour of her face.

  1. 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.


  1. 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).


  1. 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.

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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.


  • Muscle repair


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.


  • Thinning out the fat


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.


  • Tension


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.


  • Diet and exercise


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.

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The ideal otoplasty techniques, or more commonly referred to as ear pinning, will primarily depend on the patient’s underlying anatomy, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Nonetheless, there are basic guidelines and “definite philosophies” that help doctors achieve permanent and natural-looking results. For instance, the cartilaginous framework of the ear must be “broken” and sutured in position so the new contour can persist long term.


The before photo shows the right ear protruding more than normal, while its helix or upper aspect is curled inward; these problems are corrected with a highly customized otoplasty surgery.


Relying solely on sutures, without breaking the cartilage known for its “strong memory,” will not hold up the new shape long term.


Dr. Smiley has recently posted a series of videos on Snapchat to present a special case of otoplasty. The female patient had deformity on the right ear, while the left side had normal appearance and so it did not require surgery.


The patient’s right ear deformity was caused by two major problems: overdeveloped concha, which is the bowl of the ear, and underdeveloped helix, which is the uppermost portion of the external ear.


The excess cartilage of the concha was causing the ear to stick out more than normal, while the weak or “unsupported” helix was curled inward, resulting in an unusually short ear (vertical measurement between the helix and the earlobe).


In the Snapchat video, Dr. Smiley said the right ear was about 1 ½ cm shorter than the left side, a prominent asymmetry that affects the entire face.


The ideal vertical height of the ear, he explained, should be about the same length as the nose (between the bridge and the columella, which is the visible wall of tissue between the nostrils).


The incision is placed behind the ear for optimal scar concealment.

Meanwhile, the ideal protrusion of the ear’s helix or upper region is 1 ½ cm, while the earlobe should stick about 1 cm, he said. In general, otoplasty is reserved for patients whose ears stick out more than 2 cm from the side of their head.


During surgery, Dr. Smiley placed the incision behind the ear to hide the scar. This revealed the overdeveloped cartilage of the concha, which he broke and sutured to a more normal position.


With the use of correct otoplasty techniques and deep understanding of beauty ideals and proportions, ear pinning surgery can provide permanent results that can improve facial symmetry as well.

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Brazilian buttock lift is a well-established plastic surgery technique in which the patients’ hips and buttocks are reshaped and augmented with their very own fat. Oftentimes, large volume of fat collected through liposuction is needed to deliver noticeable improvements.


Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgery expert, says the patient’s “starting anatomy” affects the results to a varying degree, with certain physical traits making this procedure more challenging. Nonetheless, the use of right surgical maneuvers and tools can counteract these “anatomical roadblocks” and ultimately achieve the desired results.


Dr. Smiley has shared some Brazilian buttock lift before and after photos depicting patients with challenging anatomy. He also explained the corresponding techniques that allowed him to overcome such anatomical roadblocks.


brazilian buttock lift before and after

Before photo of patient no. 1. She has large lateral dent, which needs to be released so her hips can expand after fat injection.

Photo of patient no. 1 right after surgery. Notice the complete elimination of the lateral dent and smoother, fuller buttocks and hips.

Patient no. 1 had lateral depression along her buttocks caused by tethering of the fascia or connective tissue that was pulling the skin inward. Failure to release the skin would not allow the hips to expand after fat injection.


Dr. Smiley released the skin from the fascia or thread-like anatomy so he could expand and sculpt the hips, improving the feminine silhouette. This was done with the use of a surgical fork that resembled a thin two-pronged cylinder inserted into a tiny puncture wound.

He says “the use of surgical fork requires precision” because a slight error can lead to more skin asymmetries and herniation.

Patient no. 2 was thin, weighing only 115 lbs. during surgery and so it was a challenge to collect adequate amounts of fat. Hence, Dr. Smiley performed liposuction on a larger surface area to harvest enough volume to sculpt the hips and augment the buttocks.


Before and after photos of patient no. 2. She is thin and so she requires larger liposuction surface area to harvest sufficient fat volume.


To further create an illusion of fuller buttocks and curvier hips, Dr. Smiley used the flanks and lower back as donor or liposuction sites. By removing the excess fat in the area, even though the volume was relatively small, he was able to carve it out and allow the butt to “stick out more.”



Patient no. 3 had asymmetric fat distribution along her back, with more fats along the right flanks. Hence, she required “an extra meticulous” liposuction to achieve smoother, more symmetric appearance between the left and right side of her torso.

Before and after photos of patient no. 3. The surgery corrects the fat rolls along her armpit, bra line, and flanks. Furthermore, it improves the symmetry between the right and left side of the torso.


Further complicating her case was the extent and distribution of fat that her armpit area—along with her flanks, lower back, and “bra rolls”—was even included during liposuction. The idea is to create a smooth silhouette from the posterior view.


Moreover, her skin buttock prior to surgery had visible dents and so Dr. Smiley filled in these tiny depressions with the use of microdroplets technique (0.1 cc of fat inoculated one at a time). This method of injection not just deliver smooth results, but also high survival rate in which 70-75 percent of the fat volume is expected to be near permanent.

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