Obesity and plastic surgery simply don’t mix. Several studies have already shown that obese patients—i.e., their body weight is at least 20 percent higher than it should be—face higher risk of wound infections, heart attacks, nerve injuries, and urinary tract infections after surgery.
Furthermore, morbidly obese patients, meaning their weight is more than 100 lbs. over their ideal weight, are twice more likely to die as a result of any non-cardiac surgery.
Due to higher risk of postop complications, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that obese patients also tend to incur more hospital bills, citing a 2015 study suggesting that they paid additional $7,100-$7,400 after tummy tuck and breast reduction.
The study has also suggested that obesity was linked to higher risk of serious complications that required hospital admission within 30 days after plastic surgery: About 72 percent higher compared to non-obese patients.
Obese patients are also at an increased risk of poor scarring and healing problems because they typically suffer from some type of malnutrition and their skin has been damaged by the excess weight over the years, as suggested by experts.
While it might be easy to turn down obese patients seeking an elective body contouring surgery, this may not be the case with someone considering breast reduction to help improve her mobility, which could allow her to increase physical activities to promote weight loss. In this scenario, Dr. Smiley says the benefits should always outweigh the potential risks.
Furthermore, the celebrity plastic surgeon says obese patients should be made aware of the risk so they can make an informed decision.
“Letting them know of the increased risk in terms of wound breakdown and delayed healing also allows them to handle postop complications better should they happen,” says Dr. Smiley.
Should a plastic surgery is deemed necessary to improve the patient’s quality of life, experts recommend at least a 24-hour hospital stay for closer monitoring.
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.
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.
Brazilian buttock lift is perceived to be safer than butt implant. Instead of synthetic prosthesis, doctors reshape and augment the backside with the most natural material—i.e., the patient’s own fat derived from other areas of the body, typically the abdomen, flanks, and lower back.
Despite the impressive safety record of Brazilian buttock lift, news of fatal complication due to fat embolism has been circulating the Internet recently.
Dr. Smiley uses a blunt cannula to perform microdroplet fat injection, a technique known to deliver natural results and to improve safety.
Fat embolism happens when fat particle or droplet is inadvertently injected into the blood vessels. In mild cases it simply causes low oxygen level in blood, but in serious conditions it leads to lung and brain impairment. According to medical literature, the risk of death is 10-20 percent.
However, fat embolism can be prevented with proper injection of fat. Hence, a prudent patient always ensures that her surgery is performed by a board-certified plastic surgeon—i.e., certified by the American Board of Plastic Surgery.
The list below explains the basic guidelines known to improve the safety of Brazilian buttock lift.
- Avoiding the deeper muscle during injection
A US study has suggested that fat embolism generally happens when fat injection is performed deep into the gluteas muscle, which has large blood vessels. To prevent this complication, fat grafts are ideally injected into the existing buttock fat (more superficial layer than muscle).
Simply put, doctors with deep understand and respect of the anatomy can avoid fat embolism and other serious complications.
- Honeycomb or microdroplet injection technique
Beverly Hills plastic surgeon Dr. Tarick Smiley says the honeycomb or microdroplet fat injection (inoculation of less than 0.1 cc of fat at a time) increases the survival rate and helps achieve near permanent results from Brazilian buttock lift.
Furthermore, the injection technique, which also entails continuously moving the cannula (hollowed steel probe), prevents fat embolism that happens when fat is inadvertently injected into the blood vessels.
- Use of the most innovative liposuction devices
The use of blunt cannulas not just prevents accidental injection of fat into the blood vessel; studies have also suggested that it promotes higher survival rate of fat grafts (70 percent and higher).
- Accredited surgical facility
Dr. Smiley has previously posted a video on Snapchat explaining the importance of having one’s surgery in an accredited ambulatory center, which means that it has passed the rigorous patient safety standards imposed by health authorities.
Accredited surgical facilities are staffed by board-certified anesthesiologists and emergency personnel who can treat patient should an untoward event occur.
In body contouring plastic surgery, breast reduction has one of the highest patient satisfaction rates, as suggested by medical literature. This is not surprising since it can provide immediate relief from painful bra strap grooves, back pain, nerve and disc damage, postural problems, and other symptoms caused by being too “endowed.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who performs breast reduction on a regular basis, says that most complications are minor or “just nuisances,” as opposed to health-threatening problems.
The standard breast reduction incision technique favors women who require large downsizing, i.e., more than 600 gram of tissue per side.
Nonetheless, Dr. Smiley says he requires all his patients to pass lab screening to determine that they are fit for the surgery and its ensuing recovery. A careful preoperative evaluation, he adds, also allows him to identify breast reduction risk factors, many of which can be eliminated or at least controlled to minimize risk of complications.
A 2013 study, which involved more than 500 women who had bilateral breast reduction, has shown that infection at the surgical site (16 percent) and delayed wound healing (10) were the most common complications.
The study, along with other previous findings, was able to identify the risk factors or predictors of complications following breast reduction surgery.
Smokers were twice more likely to experience infection and poor wound healing than non-smokers because of the nicotine’s constricting effect on blood vessels, preventing the efficient delivery of nutrient- and oxygen-rich blood to the wound.
However, complete smoking cessation for a minimum of two weeks prior to surgery and throughout the recovery is enough to reverse most of the detrimental effects of tobacco use.
Diabetic patients have compromised healing and so they face a higher risk of necrosis (death of tissue) of the areola. Hence, prior to surgery it is highly ideal to eliminate or at least control serious medical conditions through medications and/or lifestyle changes.
The risk of poor wound healing and infection is markedly different between a patient having a 500-gram reduction and someone requiring a 1,000-gram excision.
Large breast reduction entails more breast tissue and skin removal, which could lead to increased bleeding and higher risk of comprising the blood supply. Furthermore, a significant downsize could make it extra challenging to achieve a natural breast shape.
The vast majority of liposuction patients will have their scars heal and fade well into the background. This has become possible with the use of microcannula, a straw-like device whose outside diameter is generally defined as 2.2 mm or smaller.
Aside from microcannula and the use of meticulous surgical techniques, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says “how well a scar fades” will also depend on patient commitment. For instance, sun exposure is best avoided for about a year to prevent the scar from turning dark and thus becoming more visible.
Photo Credit: Medscape
Furthermore, prudent patients should not apply any topical treatments (e.g., scar creams and gels) without first consulting their surgeons and avoid submerging their incisions in water (pools and bathtubs) until these are fully sealed, which happens around three weeks.
Nonetheless, liposuction and keloids risk remains an issue among patients with a history of aggressive scarring.
While having a history of keloids is not a contraindication to liposuction, prudent patients should disclose their susceptibility to aggressive scarring to their doctors who can explain the risks and the possible need for aggressive and proactive scar treatments and preventions.
Keloid is a tough scar that grows beyond the injury site (or liposuction incision). It usually appears pink or purple and has an irregular shape that tends to expand progressively.
To prevent visible scars, Dr. Smiley says all efforts are made to position the liposuction incisions within the natural skin fold and beneath the “bikini area.” To further allay the concerns of patients, he says that only certain parts of the body are prone to keloid scarring such as the earlobes, chest, and upper outer arms—places that are generally avoided during the creation of small puncture wounds used in liposuction.
While follow-up consultation is important for all patients after liposuction, this is particularly true of individuals with a previous history of keloids who require closer monitoring so their surgeons can aggressively treat scars that are becoming thick and unsightly.
The use of cortisone injections is arguably the most common treatment for keloids. However, they are only performed a few weeks apart to prevent skin changes such as depression and hypopigmentation (lightening of color).
Male breast reduction and tummy tuck performed at the same time offers advantages such as lower cost compared to having them separately. Furthermore, not everyone has the luxury to have two recovery periods.
Dr. Tarick Smiley, one of the leading Beverly Hills plastic surgeons, says that patient safety is the most important aspect of multiple-surgeries operations. Theoretically, the longer operative time under general anesthesia and the more incisions and cutting are made, the higher the risk of complication is.
The first and most critical step to make combo surgery reasonably safe is to conduct strict patient selection. In this respect, Dr. Smiley requires all his patients to pass lab screening to ensure that they can handle the “rigors” of any operation.
Lab screening typically includes blood work and EKG and cardiopulmonary tests.
After passing lab screening, the patients are instructed to “prepare” weeks or even months prior to surgery. The idea is to help them achieve their optimal health through superb diet and regular exercise.
Preparation for surgery also involves complete cessation from tobacco and smoking cessation products and discontinuation of all drugs and supplements with blood thinning properties. For clarity, Dr. Smiley provides his patients written materials that let them know all the things and activities they need to avoid before surgery and afterwards.
To further ensure patient safety, Dr. Smiley says in his recent Snapchat post that he only works with a board-certified anesthesiologist who requires a separate lab screening. Also, this specialist monitors the patient’s vital signs at the time of surgery.
Moreover, all efforts are made to complete the surgery in less than six hours to control the amount of surgical trauma and bleeding.
While combo procedures have a perceived higher risk of complications, Dr. Smiley says having separate surgeries also has problems—e.g., multiple recovery periods, higher cost, and “multiple” risks.
Because bleeding has a large effect on the recovery period and the risk of complications, Dr. Smiley uses different modalities to reduce blood loss. For instance, he injects epinephrine before making incisions.
Epinephrine is a drug that constricts the blood vessels, ultimately reducing the amount of bleeding. Furthermore, it “spreads” the effects of local anesthesia and so the patients rely less on oral narcotics to control their postop discomfort.