The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.
Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.
Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.
Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.
In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.
The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.
“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.
Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.
Great rhinoplasty results are impossible to identify because there are no surgical stigmata and the new nose looks in harmony with the face. Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he performs meticulous facial and nasal analysis that takes into account each patient’s ethnicity and gender as well as the established guidelines of aesthetics.
The ideal nose is not defined by a strict set of traits, although there are beauty tenets that can guide the surgeon to achieve natural results from rhinoplasty, or nose job in layman’s term. For instance, the width of the nose is ideally contained within the space or distance between the inner eyes; however, this does not apply to some ethnic noses such as the African that can tolerate a slight nostril flare without losing its attractiveness.
This before-and-after photo shows how meticulous rhinoplasty techniques can improve facial proportion, attractiveness, and even perceived youthfulness.
During the sixties and seventies, some doctors erroneously idealized the “ski jump” nose, which is manifested by having a narrow profile, with a dip in the middle and an upturned tip appearance. This highly specific aesthetic goal does not give justice to ethnic beauty and in fact may even look unnatural in a many Caucasian patient with strong chin and broad forehead.
Fortunately, the tenets of facial plastic surgery nowadays are culture and ethnic sensitive. After all, the vast majority of patients today define great rhinoplasty results as something that looks in harmony with their face.
But what constitute a natural-looking, attractive new nose?
Dr. Smiley says rhinoplasty is a “perfect amalgamation of art and science,” requiring precise measurement of the nasal and facial dimension. The quintessential goal, he says, is to create a new nose that “naturally occurs within the context of the patient’s ethnicity, gender, and pre-existing anatomy.” Hence, great results generally show subtle to moderate improvements, as opposed to a complete overhaul. After all, the basic architecture of the nose can only be changed to a certain degree.
Meanwhile, a nose that looks “done” is not in sync with the patient’s facial features, ethnicity, and gender. Or it has the classic signs of surgical enhancement such as hanging or very visible columella (wall between the nostrils), incorrect tip angle (too upturned or too elongated), collapsed appearance, and overly narrowed profile.
These classic signs give rhinoplasty a bad rep, while great results remain unseen or unappreciated because after all, they look as if the patients were born with the attractive nose.
Dr. Smiley, who has performed more than 2,000 rhinoplasties as of this writing, says that prudent patients should choose their surgeon carefully (he or she must have extensive experience and an eye for detail, and a member of the American Board of Plastic Surgery) to achieve results that will satisfy them long term.
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.
Complete smoking cessation a few weeks leading up to plastic surgery has become a common practice to reduce risk of skin necrosis, pulmonary- and heart-related complications, and poor healing and scarring, according to the California Surgical Institute website.
However, a recent study published in Plastic and Reconstructive Surgery has found that many patients receiving smoking cessation instructions had kick the habit for good or at least smoked less frequently years after their surgery.
Photo Credit: WebMD
Researchers at the University of British Columbia, Vancouver have suggested that “surgeons who request pre-operative smoking cessation may influence patients’ long-term smoking status.”
The researchers enlisted 47 patients who responded to a 5-year follow-up survey, although five social smokers were later excluded to make sure that the study only involved “bona fide” daily smokers. Most respondents were women whose average age was 40.
Most respondents requested for tummy tuck, breast lift, and facelift.
In the follow-up survey, 25 percent of patients had quit smoking since their cosmetic surgery, while 40 percent said they smoked less. Most patients said the frequency of their cigarette use was reduced to a varying degree, citing their surgery as a strong motivation to live a healthier life.
The authors of the study have concluded that people were more likely to quit smoking or at least reduce their tobacco use when they were presented with “specific negative effects of smoking” rather than with “general health benefits of smoking cessation.”
Male ethnic rhinoplasty is a broad term used to describe nose-reshaping surgery performed in men of ethnic descent. It is important to note that even within the same ethnicity variations do exist in terms of nasal anatomy, facial features, and aesthetic goals.
Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says successful nose surgeries are highly customized procedure, respecting the “starting” anatomy of the nose, the unique facial features of each patient, his aesthetic goals (which are partly influenced by his culture), and even his body-frame and height.
While the ideal male nose is not defined by highly restrictive standards, the renowned facial plastic surgeon says there are definite philosophies and universal aesthetic guidelines that help doctors achieve more attractive and natural results from rhinoplasty.
- The attractive male nose has a strong appearance.
Several aesthetic variables that determine a strong, attractive male nose include a slight hump or fullness along the dorsum (bridge), an angle of tip rotation between 90-95 degrees, and a bigger size compared to women (of the same height).
The tip rotation, or the angle between the upper lip and nasal tip, is one of the most critical aspects of male rhinoplasty. It should appear straight or sometimes even slightly droopy to look gender appropriate; in no way it should be over-rotated since even the slightest upturned appearance can make the results look delicate and feminine.
- The patient’s face should be taken into account.
A good number of male ethnic rhinoplasty surgeries are performed to reduce the width and/or height of the nose, making it more proportionate to the face. However, over-reduction is avoided like a plague because a male nose is naturally bigger than a female nose.
- His height and body frame will partly determine the ideal nose size and appearance.
In general, a taller, more muscular male may benefit from a stronger and more elevated bridge and a longer nose than a shorter, leaner man.
- Consideration of some shared anatomies and features.
Respecting the patient’s anatomy is one of the keys to preserve natural-looking, long-lasting results. While “strict” generalization does not give justice to the wide variations of ethnic male noses, it is important to note that they have some shared traits such as thicker nasal skin, more bulbous tip (compared with Caucasians), and less supportive cartilage.
Markedly thick skin does not show all the details of rhinoplasty, although they are more forgiving compared to very thin skin which can show even the smallest contour irregularity.
Patients with markedly thick skin should not have their tissue over-resected because the overlying skin may not drape well especially around the tip, leading to its amorphous appearance.
It may come as a surprise that rhinoplasty, or nose job in layman’s term, could make someone look younger, an effect more commonly attributed to neck lift and facelift surgery.
An aging nose has some archetypal traits: more prominent hump along the dorsum or bridge, and drooping tip, which contributes to the elongated appearance.
When these before-and-after photos were posted on Dr. Smiley’s Instagram account, some followers pointed out the youthful effects of the surgery on her face.
Aging causes the skin to lose its elasticity and the cartilaginous framework of the nose to weaken, leading to the drooping nasal tip, which could create an illusion of a more acute nasolabial angle and a longer looking nose.
Sometimes, the aged-related drooping of the tip causes breathing difficulty and abnormal airflow, which are considered medical conditions and thus some insurance may agree to cover the cost of rhinoplasty surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley, who has performed over 3,000 rhinoplasties as of this writing, says the “inadvertent rejuvenating effects” of the surgery can be achieved when the drooping tip is de-rotated.
However, the amount of de-rotation should take into account the patient’s ethnicity, gender, nasal anatomies, and cosmetic goals, he says.
For instance, women of short stature in general can have more angle of tip rotation (i.e., angle between the tip and upper lip) with studies suggesting that they can tolerate up to 110 degrees angle.
The ideal angle of rotation of the nasal tip for men, meanwhile, is close to 90 degrees giving it a stronger, straighter profile. The upturned appearance is avoided like a plague during male rhinoplasty due to its feminizing effects.
De-rotating the tip entails improving its structural integrity; hence, Dr. Smiley often uses the patient’s own cartilage derived from the nose itself or the back of the ear to raise it a bit. The use of “living tissue” eliminates the myriad of risks associated with artificial implants.
Shaving down the prominent dorsal hump can also result in a younger, more feminine appearance. Nonetheless, it might be ideal to preserve some minimal fullness along the bridge when dealing with male patients to ensure a more natural and masculine result.
A 2012 study published by Archives of Facial Plastic Surgery has shown that patients who have had rhinoplasty looked 1.5 years younger on average compared with their “before” photos.
The researchers enlisted 53 rhinoplastic patients aged between 15 and 61 (35 was the average age) who were photographed before and one year after surgery; 50 “ordinary observers” were then asked to rate their appearance based on the perceived youthfulness.
The study noted that the rejuvenating effects were more evident for older patients than younger ones, although regardless of age, individuals who had dorsal hump reduction and greater nasal tip de-rotation appeared to lose more years than other patients.