Reconstructive Plastic Surgery

Breast reconstruction with internal lift aims to correct the sagging appearance without the extensive use of incisions. Some doctors refer to it as scarless breast lift, although the term might be confusing because it still uses a short incision right at the border of the areola.


breast reconstruction with internal lift

Anytime the skin is injured the body creates a scar—its natural way of repairing tissue. Nonetheless, the scar from breast reconstruction with internal lift is made precisely at the areola’s border (light-dark skin junction) so it blends well into background.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos and images on Snapchat to demonstrate the results of breast reconstruction with internal lift.


But to enjoy the full benefits of breast reconstruction with internal lift, Dr. Smiley says meticulous patient selection is critical.


“A lot of people are asking who are good candidates for it. Usually, patients with no severe sagging will be able to do this,” he said in one of the videos.


The patient shown in the video had minimal sag. While her areola was positioned lower than ideal, it was still above the inframammary fold or breast crease.


Dr. Smiley positioned a small curved incision precisely at the lower border of the areola for optimal scar concealment. Then, he used a surgical mesh that would serve as an “internal bra” to support the new contour without the appearance of long scars, which is an issue with the traditional breast lift.


In traditional breast lift, the appearance of scar down at the midline (between the areola and the breast crease) is one of the main concerns of patients due to its more conspicuous placement. The peri-areolar and horizontal breast crease scars, meanwhile, are more concealed and so many patients would find them “acceptable.”


Aside from the use of surgical mesh, the success of breast reconstruction with internal lift also boils down to meticulous suturing technique. Dr. Smiley says all efforts are made to eliminate tension on the skin to promote healing and fading of scar.


He says that he uses buried tension suturing technique in which several rows of stitches are used to close the incision. The skin, meanwhile, is not “picked up” by any suture, with its edges simply allowed to “kiss” each other. This method promotes the best scar possible because it eliminates most if not all of the tension.

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Extreme tummy tuck and panniculectomy is a reconstructive plastic surgery and so it is typically covered by health insurance. In this procedure, the primary goal is to improve the patient’s quality of life by removing the gigantic apron-like skin, or medically referred to as pannus.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on his Snapchat showing a patient whose pannus has almost reached her ankles, which of course results in a gamut of medical problems such as:


extreme tummy tuck

  • Skin breakdown and dimpling
  • Non-healing irritation
  • Difficulty moving since the gigantic hanging skin/flesh droops over her legs, almost reaching her ankles.
  • Stress on her heart and entire body
  • Swelling of her legs and feet due to the massive extra weight of the pannus


Dr. Smiley said the female patient will not just require panniculectomy or excision of the pannus. Aside from the large hanging flesh, she also has complete herniation of the abdomen, which happens when the fascia (a sheet of fibrous tissue) becomes weak that the internal organs protrude.


After conducting a comprehensive physical exam, Dr. Smiley said the patient will require an extensive abdominal reconstruction in which one of the goals is to create a new synthetic wall (with the use of mesh) to keep the abdominal contents inside.


Mesh acts as a scaffolding to prevent the abdominal organs from herniating (protruding). This material, which is either positioned under or over the weak or “defective” part, allows for tissue re-growth, meaning it incorporates into the surrounding tissue over time.


While it cannot be denied that the patient’s extreme tummy tuck and panniculectomy is medically and vitally warranted, Dr. Smiley said there is an increased risk because of the extent of the pannus.


Significant blood loss (due to the long blood supply of the pannus) and fluid imbalance/shift are to be expected, thus Dr. Smiley said he is “debating” and recommending “ICU admission” to further ensure patient safety.

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Revision breast augmentation typically requires techniques similar to those used in reconstructive breast surgery to achieve the most natural contour and highest level of symmetry possible, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


For this reason, breast augmentation reconstruction requires higher level of technical skills (and experience) on the surgeon’s part to achieve good results from the surgery, Dr. Smiley said.


breast augmentation reconstruction


The celebrity plastic surgeon has recently posted a case study on his Snapchat account involving a patient who had breast augmentation 10 years ago and was seeking revision to correct several aesthetic-related problems, which the surgeon has enumerated in the video.


  • Enlarged areola
  • Visible rippling along the mid cleavage
  • Too much cleavage (the breasts were too far apart)
  • Excessive lateral bulge
  • Sagging or bottomed-out implants


Dr. Smiley first started with the areola reduction in which he used a cookie-cutter device to delineate the new areola and make it smaller. The scar from this technique goes precisely at the dark-light skin junction so it will blend nicely to the background.


To correct the sagging appearance, he made vertical incisions from the areola down to the submammary fold, and another incision pattern that goes parallel to the breast crease. (Basically, this is an anchor breast lift technique due to the shape of its final scar, which is expected to fade into the background about a year postop.)


The anchor breast lift allowed Dr. Smiley to remove some loose skin and tighten and elevate the breast tissue, leading to a perkier appearance.


To further achieve good breast shape and to correct the excessive lateral bulge, he repaired the breast pocket (by making it smaller) and so the implant will not migrate.


Meanwhile, he addressed the visible rippling by replacing the old saline implants, which have a natural deflation rate of 1 percent per year due to evaporation. And since the patient had hers for 10 years, the implants had already lost about 10 percent of their volume, and thus resulting in rippling.


Oftentimes, silicone implants are considered as good replacements if the patient wants to prevent or correct rippling and palpability since they have no deflation rate and they are filled with a cohesive medical-grade silicone gel that resembles that of the breast tissue and fat.

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Tuberous breast augmentation surgery is not just about using implants to correct the restricted appearance of the lower breast pole. To achieve good results, leading Los Angeles plastic surgeon Dr. Tarick Smiley highlights the importance of addressing these other critical issues:


  • Short distance between the areola to the submammary fold
  • Herniated or puffy looking areola
  • Enlarged areola
  • Breast ptosis or sagging, which comes in varying degree
  • Wide space between the breasts


Tuberous breast deformity occurs when the breast fails to develop fully and normally during puberty. It is also referred to as torpedo breast due to its elongated and tubular appearance.


Tuberous breast augmentation surgery typically uses silicone implants due to their more natural feel that closely resembles that of the breast tissue. Saline implants, meanwhile, could lead to more palpability in patients whose deformity is usually manifested by little soft tissue coverage.


Furthermore, patients with this type of deformity generally requires the peri-areolar incision technique in which the resulting scar goes around the entire border of the areola, allowing the surgeon to reduce its size and correct its herniated appearance as well.


Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate how inconspicuous the scar is with the peri-areolar incision technique. Aside from ensuring that the scars lie precisely at the dark-light skin junction, he also highlights the importance of closing the wound with very little tension on the skin.


“The difference between a great wound closure and a good closure is that we don’t really pick up the skin. We only suture the dermis. We want the edges of the skin to kiss each other; hence, we achieve the most hidden scar possible,” says Dr. Smiley.


While the use of implants can correct the unusually short distance between the areola and the submammary fold, it is only true when they are positioned correctly. Dr. Smiley says they should lie approximately at the center of the areola.


With proper implant placement relative to the vertical and horizontal measurement of the breast, even a round implant can produce a natural breast shape—i.e., a ski slope appearance in the upper pole while more fullness in the lower pole that the breast profile appears like a teardrop.


Because tuberous breast deformity is also associated with sagging that comes in varying degree, most patients also require a simultaneous breast lift in which the actual tissue is elevated through internal sutures, with some doctors specifically advocating the permanent type for stronger support.

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The benefits of septoplasty, a procedure that straightens the curved septum or wall of tissue between the nostrils, are beyond cosmetic. Basically, it eliminates nasal blockage, which in turn leads to improved breathing and immediate relief from snoring, sleep apnea, chronic sinus, recurrent headaches, and frequent nosebleed.


Some cases, the benefits of septoplasty can be lifesaving, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


On his recent Snapchat video post, the surgeon has explained that during sleep, the heart needs to rest, which can be impossible if it does not take enough oxygen due to poor breathing functions caused by the deviated or curved septum. Over time, its chambers become enlarged and may lead to its failure, hypertension, and pulmonary edema.


Because of the detrimental effects of deviated septum, Dr. Smiley said it is generally considered as a medical condition and thus many patients can ask for insurance coverage.


One particular patient of the celebrity plastic surgeon has significant nasal obstruction, with her right nostril almost completely blocked because of the deviated septum and the enlarged turbinates (they are small protrusions that keep the air warm and moist).


benefits of septoplasty


The turbinates actually accounted for about 90 percent of the nasal obstruction. Hence, Dr. Smiley removed them along with the deviated septum whose mucosa lining was then sutured in the midline.


Instead of forcing the deviated septum into a midline position, sometimes it is better to remove it completely and then suture the mucosa lining draping over it to make the “wall” between the nostrils straighter.


The problem with forcing the deviated septum in the midline is the tendency to spring back into its previous position due to its “strong memory.”


It is important to note that septoplasty, with or without turbinate reduction, does not improve the outside appearance of the nose. Nevertheless, it can be combined with rhinoplasty, or more commonly referred to as nose job.


Should there is a desire to improve the outside appearance of the nose at the same time as septoplasty, it actually makes sense to do them together than separately, as it allows the surgeon to re-use the septum to further refine and reinforce the new contour.


By using the septal cartilage, the patient avoids synthetic implants and their associated risks such as protrusion, visibility, and less than natural results.

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Septoplasty insurance coverage might be possible provided that the patient and his doctor are able to prove that this type of nose surgery aims to improve breathing functions. For this reason, proper medical documentation is of critical importance.


While septoplasty is commonly combined with rhinoplasty, or more commonly referred to as nose job, its only aim is to improve the function of the nose—not its outside appearance or “aesthetics.”


septoplasty insurance coverage

Septoplasty primarily “aligns” the deviated septum, which is the strip or wall of tissue between the nostrils, ultimately eliminating the “obstruction” of airflow. In general, it has no or very little effect on the outside appearance of the nose, according to California Surgical Institute website.


Should the patient and his doctor are able to demonstrate that septoplasty is a medically warranted procedure, health insurance is possible. Many surgeons these days have well-trained staff who can verify insurance coverage and possibly help individuals secure proper medical documentations.


Nonetheless, septoplasty insurance coverage typically means that the patient will still pay for the deductibles, copays, etc.


It is not uncommon to combine septoplasty and rhinoplasty in one surgery. Should the insurance agree to cover the cost of the “reconstructive part” of the operation, the patient will still have to pay for the anesthesia “time” associated with the cosmetic aspect of the procedure.


It is almost always ideal to combine septoplasty and rhinoplasty (should the patient wish for cosmetic improvements as well) instead of performing them separately. With combo procedure, he will only experience recovery once and possibly lower the overall cost of the surgery.


Doing them together also gives the surgeon more “options” and better control over the aesthetic aspect of the nose. For instance, instead of throwing away the removed [excess] septal cartilage, which contributes to the abnormal airflow, he is able to re-use it to refine the tip and/or create a stronger structural support.


As of this writing, the average cost of septoplasty combined with rhinoplasty varies from $5,000 to $8,000.

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