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.
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.
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.
Some type of body contouring and liposuction are often performed together to achieve a more holistic improvement. This “combo” procedure is particularly common after massive weight loss since the patients not just have loose skin but also have highly fibrous fat, which does not respond to further weight loss.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the most common body contouring procedure combined with liposuction.
- Tummy tuck surgery with liposuction
Before creating a hip-to-hip incision to remove the pannus (apron-like skin), Dr. Smiley often performs liposuction of the flanks. The idea is to remove the unwanted superficial fat (it lies beneath the skin; this is different from the intra-abdominal fat that only responds to real weight loss) so he can pull tight more skin.
By pulling more skin downward and centrally, Dr. Smiley says he can deliver a more hourglass torso, which is the quintessence of a feminine figure.
- Arm lift with liposuction
This combo procedure starts with liposuction of the entire circumference (or at least 75 percent) of the upper arm, allowing him to tighten more skin.
After removing the unwanted fat, he then creates an incision that will allow him to excise the loose skin and tighten the deeper structures as well. Meanwhile, the scar pattern will primarily depend on the extent of loose skin; for instance, massive weight loss patients will generally need to accept the appearance of a scar that extends from their armpit down towards their elbow.
The scar from arm lift surgery is typically positioned on the inner aspect of the arm, although some patients may have theirs in a more posterior location.
- Liposuction followed by buttock enhancement
Instead of the discarding the fats collected during liposuction, they are purified and injected back into the buttocks and hips; this staged surgery is colloquially known as Brazilian buttock lift or BBL.
During BBL, the flanks and lower back are typically used as a donor site because they normally carry adequate amounts of unwanted fat. Furthermore, “scooping out” this area allows the buttocks and hips to appear curvier.
- Back lift with simultaneous liposuction
Back lift typically uses incisions that are positioned where the bra strap would lie, leading to optimal scar concealment. The idea is to remove the excess skin responsible for the appearance of bulges that are seen beneath [tight] clothing.
However, a simultaneous liposuction can further “refine” the effects of back lift surgery.
Safety in plastic surgery should be the main duty of your surgeon. Hence, you must practice due diligence when selecting your doctor, a decision that you should base on his qualifications instead of cheap cost or large discount. Remember, reputable and qualified surgeons will not join the “price war” just to lure patients.
Furthermore, any surgery that is priced way too low generally means there are some compromises. Take note that the cost not just boils down to your surgeon’s fee, but also to other expenses related to anesthesia, staff (including anesthesiologist), surgical facility, lab test, just to name a few.
Photo Credit: American Society of Plastic Surgeons website
Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares his tips on how to identify a surgeon who prioritizes safety in plastic surgery.
• The surgeon is a bona fide plastic surgeon. The general rule of thumb is to choose someone who is a member of the American Board of Plastic Surgery, giving you an assurance that he has passed rigorous background check and oral and written exam, which he must take every 10 years.
• Prudent and ethical plastic surgeons carefully select their staff. Furthermore, they only employ a certified anesthesiologist whose job is not just to administer anesthesia (and thus results in a pain-free procedure), but to also observe the patient’s vital signs such as blood pressure, oxygen level, and heart rate during surgery.
• They only perform surgeries in an accredited ambulatory facility. This means that the “surgical setting” has passed rigorous inspections conducted by several certifying agencies (or health authorities). All board certified plastic surgeons are mandated to operate only in an accredited surgical facility.
• Reputable surgeons know how to say no. They always require lab screening and lengthy consultation to identify if you’re healthy for the surgery and its ensuing recovery. Should you have any chronic medical condition, or have unrealistic expectations that you’re just setting yourself up for disappointment, a decent doctor will not operate on you.
• Reputable plastic surgeons exhibit good bedside manner (they listen to your input) and will make every effort to build good rapport. In doing so, their patients tend to be more honest and more cooperative and committed especially during recovery.
Follow up care after plastic surgery differs from patient to patient. Nonetheless, most surgeons prefer to see their patients the morning after their surgery and a week afterward for monitoring the healing process.
The succeeding follow up visits become less frequent or will have longer intervals (e.g., one month, three months, and six months) provided that the patient heals nicely and does not encounter worrying symptoms such as persistent swelling and bruising, increasing pain, excessive bleeding, and fever.
Dr. Smiley requires regular follow up visits to ensure that his patients are healing nicely.
Should any of the aforementioned symptoms arise during recovery, patients should see their plastic surgeon ahead of the scheduled follow up to prevent more serious complications. Take note that fever is usually a sign of infection, while increasing pain and bleeding signal that the body is not coping well.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who regularly performs body contouring surgeries like liposuction and Brazilian buttock lift, may require follow up visits at six months to one year, although it will depend on patient’s availability.
There are specific protocols used by each surgeon during a follow up consultation. Oftentimes, he simply checks if the wound is healing well and asks the patients for symptoms that are bothering or worrying them. In some cases, he removes the sutures and/or dressing, or assess if the patient’s compression garment (commonly used after liposuction and body lift) fits snugly but is not causing skin changes or interfering with circulation.
Furthermore, during a follow up consultation doctors ask their patients about the progress of their healing and their level of pain. If needed, he may adjust the medications to help them cope with any discomfort.
Meanwhile, long-term follow up visits tend to be more important after a facial plastic surgery—e.g., facelift, neck lift, cheek lift, and fat transfer. This is particularly true for patients who want to maintain their more rejuvenated appearance for as long as possible. For instance, people who have had facelift may need minor tweaks in the form of dermal fillers or mini facelift to preserve their youthful look.
Nonetheless, the details of follow up care after plastic surgery depend on many variables such as the patient’s age, type of surgery she had, her expectations and level of commitment, and lifestyle.
Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.
It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.
Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.
The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.
Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.
After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.
The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.
Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.
While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.