Plastic Surgery Science

Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.


Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.


fat transfer buttock augmentation


The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.


Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.


After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.


In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.


Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.


“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.


When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.


Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.


The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.


But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.

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While the surgeon’s skill sets and qualifications will largely determine the success of liposuction—a body contouring surgery that breaks up and removes “unwanted” fat—the techniques and equipment will also have their influence.


Dr. Tarick Smiley, a leading Los Angeles plastic surgeon, has recently posted a video on Snapchat to demonstrate one of his liposuction machines imported from Germany.


liposuction machine

Dr. Smiley says the Moller liposuction machine can perform “liposuction, lipo-filling, and infiltration all at the same time,” hence the operative time is shortened and thus may contribute to improved patient safety.


Hence, the liposuction machine is ideal for Brazilian buttock lift (BBL) in which large volumes of fat are suctioned out of the body, purified, and re-injected through a process called lipo-filling.


Nowadays, lipo-filling—also referred to as fat injection or structural fat grafting—is an established technique that can be applied to various plastic surgery procedures including BBL, three-dimensional facelift, cheek augmentation, and breast surgery (cosmetic and reconstructive).


Because BBL typically requires “aggressive” or large volume liposuction, one of the most pressing issues is the increased bleeding. During fat extraction, the cannula (straw-like device) inadvertently removes some blood.


Large blood loss can result in longer recovery, more fluid imbalance, and higher risk of complications; therefore all efforts are made to minimize the amount of bleeding. For this reason, Dr. Smiley uses another equipment called Cell Saver.


Cell Saver is a liposuction machine that can process the fluids, collect the red blood cells, and re-infuse them into the patient while the surgeon is doing liposuction. This piece of equipment is also used in hospitals to control bleeding, which is a risk when an operation takes too long (more than 6 six hours).


To further reduce the amount of bleeding, prior to liposuction Dr. Smiley infiltrates the fatty area with tumescent fluids, which are infused with several drugs that include epinephrine.


The renowned plastic surgeon says that epinephrine works by constricting the blood vessels, ultimately reducing the amount of blood loss by up to 90 percent compared to the dry liposuction, which is now a passé technique as it entails prolonged recovery and increased risk of skin asymmetry.


(Note: Dry liposuction means the fatty area is not infiltrated with tumescent fluids or any wetting solution before the fat is removed with cannula.)

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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.


safety in plastic surgery

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.

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Brazilian buttock lift is basically a body contouring procedure that combines liposuction and fat injection. Liposuction allows the surgeon to collect unwanted fats, which are then used to reshape and augment the patient’s backside.


Despite its name, in no way that the Brazilian buttock lift can “lift” sagging buttocks, which typically follows massive weight loss. Nonetheless, augmenting the upper half of the butt in a way that it projects more than the lower aspect can give an illusion of a lifting effect provided that the patient has no skin and tissue laxity.

Brazilian buttock lift and hips

Before and after photos of Dr. Smiley’s patient who have had Brazilian buttock lift. She is very happy with the final contour, particularly of the curvier hip appearance.

However, creating great results from Brazilian butt lift entails more than just injecting fats. An equally important goal is to reshape the backside in which it looks proportionate to the rest of the body, and wherein there is a smooth transition to the adjacent areas—e.g., lower back, flanks, posterior thigh, and hips.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that Brazilian buttock lift and hips enhancement are almost always combined to achieve a smoother, more feminine physique. The idea is to not just improve the anterior “projection” but also give additional lateral bulge.


The hips, or to be more specific, the lateral aspect of the buttocks, typically receive about one-third of the fat volume injection, while the rest goes to the “anterior” projection and shape, says Dr. Smiley in his previous videos on Snapchat.


In general, patients will need at least 800 cc of purified fat (liposuctioned fats that have been filtered) on each butt cheek to achieve visible improvements in their buttocks and hips. In fact, Dr. Smiley says that a good portion of his patients have had more than 1000 cc on each side to achieve their desired results.


However, the celebrity plastic surgeon has warned that too much fat injection—i.e., there is too much stress on the skin and fascia, which in turn leads to sagging buttocks, cellulites, and dimpling—is to be avoided to ensure that the results are near permanent.

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Several studies have been conducted to evaluate long-term liposuction results. In this procedure, the unwanted fats—specifically the subcutaneous fat found beneath the skin—are suctioned out with the use of a flexible tube called cannula.


Some studies have suggested grim findings: After about a year all the benefits of liposuction were gone.


liposuction results

Nevertheless, several studies have also shown that good old-fashioned exercise can preserve liposuction results and prevent patients from regaining fats elsewhere in their body (i.e., areas not treated by the surgery). Of course, physical activities must always be complemented by superb diet, which is an equally critical aspect of long-term weight management.


To shed light on the long-term results of liposuction, a team of Brazilian researchers conducted a study in which 36 healthy but inactive women aged between 20 and 35 had undergone the surgery.


These non-obese participants had 2.5-3 lbs. of abdominal fat removed through liposuction. Afterwards, they were divided into two groups: half were asked to stick to their old habits, while the other half were required to follow a moderate exercise routine.


By six months after liposuction, the first group had regained all the fats previously removed by surgery. And not only that, they developed additional visceral fat—or fat deposition in organs such as the liver and intestines—and thus predisposed them to increased risk of insulin resistance (diabetes), inflammation, and a wide range of health problems.


The uptick in the percentage of visceral fat was notable—about 10 percent more compared to their pre-surgery level.


However, the participants who were asked to perform moderate exercise for four months did not regain fat and even achieve additional health benefits. (Note: The exercise regimen was “doable”—an hour of cardio and weight lifting three times a week.)


Furthermore, the women included in the “exercise group” have improved insulin sensitivity and physical fitness.


The researchers have concluded that exercise can prevent the body from [over] compensating for the abrupt change in the fat composition and distribution caused by liposuction. It is believed that the body has a strong predisposition to defend its fat stores, and a sedentary lifestyle can aggravate this propensity.


Meanwhile, separate studies have suggested that a sedentary/poor lifestyle after liposuction may cause the patients to regain fats in other parts of their body not treated by liposuction, which of course could lead to a disproportionate appearance.


The liposuctioned areas, meanwhile, were less likely to regain fat unless in the event of significant weight gain (i.e., more than 20 lbs.)


With these findings, Dr. Tarick Smiley, a board-certified plastic surgeon who has performed over 9,000 liposuctions, says the long-term success of surgery will always boil down to patient’s commitment to healthy lifestyle.

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Breast implant strength is one of the most pressing concerns of women who consider undergoing breast augmentation surgery. To shed light on the issue, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos in order to demonstrate how durable this artificial prosthesis can be.


In the first trial, Dr. Smiley asked a 125 lbs. woman to step on two breast implants, putting all her weight on them (one was saline-filled, while the other was silicone-filled). No leak or rupture occurred after the experiment.


In another trial to assess breast implant strength, Dr. Smiley asked one of his assistants to throw saline and silicone implants out the window four stories high. When picked up and closely observed, again, no rupture was seen.


To further demonstrate how strong [FDA-approved] breast implants can be, Dr. Smiley conducted another trial in which he literally ran his car over saline implant, then silicone implant. Both prostheses remained intact; the only sign that showed they were subjected to extreme load was the tire mark.


breast implant strength

The weight of this large sedan is not enough to cause implant rupture.

To further take it to the next level, he asked one driver of an SUV to pullover and run over saline implant, which instantly burst. Simply put, it would take about 4,200 lbs. of force or weight before the breast implants rupture or “explode.”


Dr. Smiley posted these trials on Snapchat to bust common myths about breast implants.


* The changes in air pressure during flight will not cause the implants to instantaneously explode.


* Weight lifting, strength training, rigorous aerobic exercises, and the likes will not affect implant durability.


* Modern breast implants have impressive durability that in the event of replacement, leak only accounts for a very small percentage. More common reasons for breast revision or replacement include capsular contracture, implant displacement (e.g., sagging), wrinkling, and wanting to downsize/upsize.


In an attempt to preserve the results of breast augmentation or at least minimize the revision rate, the celebrity plastic surgeon said he makes all the efforts to prevent capsular contracture, a condition in which the scar capsule around the implant becomes copious due to the over-production of collagen (scar tissue).


The body is believed to produce excessive scar tissue around the implant when the latter comes into contact with microbes and other “irritants.” Hence, Dr. Smiley said he utilizes all techniques to reduce risk of implant contamination at the time of surgery.

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