Plastic Surgery Science

A good surgeon will make every effort to eliminate or at least control risk factors associated with deep vein thrombosis or DVT in plastic surgery. This serious complication occurs when blood clots form in deep veins in legs, pelvis, or arms.


All surgeries carry some risk of DVT, although there are several ways to reduce its chances of developing, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.


dvt in plastic surgery

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The celebrity plastic surgeon explains the preparations, surgical techniques, and postop care that can reduce DVT in plastic surgery.


  • Strict patient selection


Plastic surgery is only reserved for patients who have achieved their optimal health through superb diet, regular exercise, and healthy lifestyle choices. For this reason, Dr. Smiley requires comprehensive lab test and blood work to rule out medical conditions linked to higher risk of DVT or any other types of complication.


It is important to note that obesity and blood disorder are linked to higher risk of DVT.


  • Avoid smoking


There is a strong link between smoking and increased risk of DVT in plastic surgery. A good rule of thumb is to avoid tobacco and smoking cessation products (patch and gum) for a minimum of three weeks prior to surgery and the entire duration of recovery (1-4 weeks). However, it remains ideal to quit the habit for good as the bulk of risk is perceived to be at three months postop, as suggested by recent studies.


  • Safety protocols during surgery


Surgical guidelines known to reduce risk of DVT include limiting the operative time (less than 5-6 hours); and using sequential compression device (stocking-like device that “massages” the limbs to promote good blood circulation in the area).


  • Light exercise after surgery


Instead of bed rest or prolonged immobility, which could increase the risk of DVT, light exercise such as taking short walks throughout the day is highly recommended. Moving around is also ideal to control the amount of postop swelling, which further minimizes the risk of blood clot formation.


  • Use of medical-grade compression stockings


They are known to control the amount of swelling, which in turn reduces risk of DVT.

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Plastic surgery and stem cells technology are two medical fields that are progressively becoming intertwined.   Over the past several years, there have been exciting developments that could help improve the lives of people with cosmetic deformities and terminal and congenital diseases.


However, plastic surgery and stem cells technology is still in the infancy stage and up to this point experts are still deciding how and when to apply this method in clinical practice.


plastic surgery and stem cells

Photo Credit: Advanced Cell Technology via AP

Stem cells, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley, are noted for their capability to turn into another type of cell, thus their application in cosmetic and reconstructive plastic surgery is almost infinite once their “core nature” and “power” have been harnessed and deeply understood.


In Dr. Smiley’s recent Snapchat video post, he has explained the impact of stem cells on the results of Brazilian butt lift, which in essence is buttock augmentation via fat transfer. In this procedure, excess fats are collected from two or more donor sites through liposuction, which are later purified and re-injected into the patient’s backside.


Because the procedure does not entail the use of artificial prosthesis, such as the case of butt implant surgery, it is perceived to be safer and more natural looking.


After collecting the fats from the donor sites, Dr. Smiley said it is of critical importance to purify them, i.e., remove the blood and other unnecessary materials. The goal, he further explained, is to get the healthiest fats that can survive long term once transferred to the buttocks.


Purified fats are loaded with stem cells, which he said “can promote high survival rate.” Nonetheless, he slightly “over-corrects” the re-injection process because some of the transferred fats will not survive despite best efforts.


“My goal is to achieve a survival rate of at least 70 percent. For this reason, during the initial weeks or months the patients may notice that their backside is swollen or slightly bigger for their liking. However, the long-term results are almost always satisfying,” Dr. Smiley said.


“The 70 percent that survives in the first 3-6 months will persist long term,” he added.

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Otoplasty long term results are possible with the right surgical techniques. In this procedure, the surgeon corrects the appearance of ears that stick out too much from the face.


Otoplasty is sometimes referred to as ear pinning surgery as it reduces its “sticking out” appearance. But the truth is, the procedure is highly technical and must be customized based on the patient’s underlying anatomies.


otoplasty long term results


Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgeon, has recently posted a Snapchat video to demonstrate how to achieve long-term and natural-looking results from otoplasty.


In the video, the surgeon placed an incision behind the ear, specifically within the natural fold of skin for optimal scar concealment. This would allow him to remove the excess cartilage that was causing the conchal or bowl of the ear to stick out significantly from the side of the face.


After removing the excess cartilage, he pinned the ear closer to the face with the use of sutures.


One of the most common mistakes of inexperienced surgeons, Dr. Smiley says, is that they stitch the ears closer to the face without removing the excess cartilage. The problem with this technique, he further explains, is that the cartilaginous framework has a “strong memory,” hence the results are usually temporary.


The male patient shown in the video had his ears not just significantly sticking out from his face; there was also visible asymmetry as the right ear protruded more than the other.


To create a more symmetric result, Dr. Smiley removed a larger piece of cartilage in the right ear.


To further produce a more symmetric appearance, the surgeon ensured that the lower aspect of the ear (i.e., earlobe) would protrude 1 ½ cm while the upper aspect would jut 1 cm from the face. Using a measuring stick, he also made sure that both the right and left ears would almost have the same projection.


Dr. Smiley says that the goal of otoplasty is to pin it closer to the head; it does not change the actual size of the ear bowl.

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Dermal fillers or fat transfer: Which one provides better results?


These two treatments (both are injected into the soft tissue) are also referred to as volumizers as they replace facial volume loss that results in nasolabial folds (laugh lines), flat cheeks, deep tear trough, and thinning lips.


dermal fillers or fat transfer

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In order to answer which one provides better results, dermal fillers or fat transfer, several factors are taken into account such as the treatment site, cosmetic goals, and use of ancillary procedures such as facelift, if there is any.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that despite of the more natural effects of fat transfer, under certain circumstances the use of dermal fillers might be a better option.


For instance, the thinning lips are best treated by dermal fillers, particularly hyaluronic acid-based products like Restylane. Because the “site” constantly moves (while eating, speaking, yawning, etc.), the fat grafts may not settle properly or gain their new blood supply to become a permanent fixture.


And since the effects of dermal fillers are just temporary, usually 4-6 months, they are ideal for patients who want to see first the effects of volumizers before resorting to more permanent treatments like fat transfer or even facial implants.


Nonetheless, most patients with facial volume loss are good candidates for fat transfer in which a small amount of fats, not more than a few teaspoons, is collected from the donor sites, usually the tummy and hips, says Dr. Smiley.


The celebrity plastic surgeon even treats fat transfer as an integral part of facelift surgery. With a multifaceted approach in which the sagging skin and gaunt appearance are treated simultaneously, he believes that the results look more natural and are more “stable.”


“Stable” results mean that the face is less susceptible to the effects of continuous aging. Dr. Smiley warns that failure to address the loss of volume in the lower eyelid could lead to an abrupt transition between the lid and upper cheek, which can present itself right after surgery or years down the road.


Fat transfer and facelift are best performed simultaneously so the patient will only experience recovery once, he explains.


Because the results of fat transfer are near permanent (studies have suggested that on average they can last 8-10 years), in the long run they are cheaper than having regular dermal fillers injections.

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Plastic surgery pain pump is commonly used after breast augmentation, tummy tuck, and mommy makeover procedures. This pain control system makes the initial healing phase more comfortable and may even promote quicker recovery, according to California Surgical Institute website.


It is important to note that patients who are comfortable breathe better, move around more easily, and drink and eat better, factors that contribute to healing.


plastic surgery pain pump

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Moving around, as opposed to lying in bed the whole day, is also known to minimize the risk of blood clot formation in legs, a condition referred to as deep vein thrombosis. If left untreated, it could travel up to the lungs and cause more serious complications.


Plastic surgery pain pump resembles a small [portable] balloon with a catheter that delivers pain medications directly to the surgical site. And since the numbing drug does not affect the rest of the body, the patient does not experience nausea and other side effects of oral meds.


The use of oral narcotic drugs is closely linked to nausea, dizziness, and even constipation. For this reason, they must be stopped or reduced once the pain becomes more manageable.


Pain pumps are usually worn for three to five days and afterward the patient can take Tylenol or other non-narcotic painkillers. Meanwhile, they should always remain dry.


Numbness around the incision site is very common when pain pumps are used, so the patient must be consciously aware of anything that could cause injury or bleeding. It is also important to avoid rigorous activities and heavy lifting for at least three weeks, which could delay healing and lead to bleeding.


Aside from plastic surgery pain pumps, postop pain can be reduced with correct surgical techniques. The goal is to minimize bleeding, surgical trauma (i.e., excessive dissection of the soft tissue), and operative time.


With proper surgical techniques and pain management, most patients are back on their feet three to seven days after surgery, depending on their procedure, pain threshold, and individual healing.

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Brazilian butt lift results are primarily determined by these three factors: the patient’s underlying anatomies, the surgical techniques, and the most important of all, the surgeon’s skill set and experience.


In essence, Brazilian butt lift is a combination of liposuction and fat transfer. Instead of throwing away the unwanted fats, they are later used to reshape and/or augment the buttocks. Nowadays, most surgeons prefer this approach to butt implants, unless the patient has very little donor fats.


brazilian butt lift results

Before-and-after Brazilian butt lift results of a satisfied patient


Dr. Tarick Smiley, a celebrated Beverly Hills plastic surgeon, has recently posted a Snapchat video to demonstrate how Brazilian butt lift is performed.


The “case study” involved a patient with very flat backside and had visible indentations in the lower aspect of her butt cheeks. Also, there was mild skin laxity that further contributed to the less than optimal shape of her “behind.”


Dr. Smiley performed liposuction to collect donor fats from the lower back, flanks, and bra rolls. He used a cannula or flexible tube to break up and suction the fats out through small round incisions; these are expected to fade and blend with the surrounding skin after 6-12 months.


The collected fats were purified so the surgeon would only use the healthiest cells, ultimately resulting in high survival rate of fat grafts.


The purified fats were then re-injected into the backside. Dr. Smiley made sure that the new shape and profile would adhere to the patient’s specific goals and personal preference—i.e., more forward projection, wider hips, elimination of the unsightly indentations, and smoother results overall.


From the posterior view, the patient’s new contour resembles an hourglass, thanks to liposuction that has removed the fat rolls from her back and flanks, and fat transfer that has enlarged her hips and has augmented her backside.


Compared to the buttock implant approach, Brazilian butt lift results are more natural in terms of shape and “feel” since the patients use their own tissue, explains Dr. Smiley.


Furthermore, Dr. Smiley says the use of fat grafts allows him to reshape the hips and the lower aspect of the buttocks, areas that receive no or very little improvement from buttock implants.


Buttock implants are positioned above the patient’s sitting area, hence they only reshape and augment the upper mid and uppermost aspect of the butt, says Dr. Smiley.

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