Tummy Tuck

Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.


It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.


Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.


tummy tuck and bbl

The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.


Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.


After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.


The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.

tummy tuck and bbl

Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.


While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.

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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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There is a growing mommy makeover trend: Today’s patients are more well versed in plastic surgery that they are demanding for more natural and more proportionate results.


Mommy makeover surgery, which is basically a marketing term, refers to multiple surgery procedures that restore or at least improve the post-pregnancy bodies of patients. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the most common “combination surgery” involves tummy tuck and some type of breast enhancement.


mommy makeover trend

Dr. Smiley, who regularly posts Snapchat videos to spread patient awareness and to share his knowledge with medical students and colleagues, has provided a list of mommy makeover trend that generally favors “subtle” and “realistic” results.


  • Curvier and slender waist with tummy tuck


In the past, most patients simply wanted the removal of their apron-like skin that hangs from their abdomen. But nowadays, women are more fastidious in terms of cosmetic results—they want the “corset effect” on their waistline.


To achieve a curvier and more defined waistline, Dr. Smiley highlights the importance of suturing the pair of splayed abdominal muscle, which prior to pregnancy is lined up closely side-by-side.


But during pregnancy that causes the abdominal wall to expand, the fascia (connective tissue) holding it together becomes weak, leading to a gap that could even become palpable. This gap is also causing the barrel-shaped waist that used to have an hourglass figure.


For additional contouring effect, Dr. Smiley pulls and tightens the abdominal skin “centrally.” And if needed, he also performs liposuction of the flanks to achieve a more hourglass figure.


  • Breast augmentation beyond size increase


Modern breast augmentation is focused not just on size increase, but also on the final shape and projection. The goal is to achieve the most natural results possible, which all boils down to implants settling in their most ideal position.


Due to the growing demand for natural and “realistic” breast augmentation results, it is now commonly performed together with breast lift. The idea is to achieve optimal breast shape so the “fullness” will look natural.


Dr. Smiley warns that failure to address pre-existing sagging or asymmetry can lead to surgical stigmata like “Snoopy deformity,” excessive lateral bulge, and bottomed-out appearance.


Aside from breast lift, other common ancillary procedures of implants include areola reduction and fat transfer.


  • Fat transfer for a more feminine figure


Fat transfer has revolutionized the way surgeons perform body contouring surgery, particularly buttock augmentation.


The growing popularity of fat transfer is attributed to the refinements in the purification techniques, allowing surgeons to increase the survival rate to more than 70 percent. It is important to note that any amount that remains about three months after injection is expected to persist long term.


Fat transfer as a way to augment the buttock is also a powerful body contouring procedure. Because it involves liposuction (in order to harvest the “unwanted” fats), it can contour the waistline at the same time, which in turn results in a more hourglass figure.

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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.


male breast reduction and tummy tuck

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.

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The tummy tuck suture technique greatly varies from surgeon to surgeon, although all efforts are made to promote the best scar possible. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the “core principle” is to eliminate or at least reduce tension on the skin to prevent indentations, aggressive scarring (wide or thick appearance), and scar migration.


In his recent Snapchat videos, the celebrity plastic surgeon has explained the importance of meticulous tummy tuck suture technique in the final appearance of the scar.


tummy tuck suture technique



Dr. Smiley said the hip-to-hip incision must be closed in several layers to promote favorable scarring. In the video, he is seen closing the deeper tissue with permanent stitches known for their “additional strength.”


Dr. Smiley has further explained that as he goes nearer to the skin layer, he reduces the tension and at the same time uses finer absorbable sutures when closing the wound.


The actual skin, meanwhile, is just allowed to “kiss each other” (the edges of the skin wound) with only a few staples holding them together.


“This suturing technique prevents indentations. When there is no or very little tension on the skin, the scar will find it easier to fade into the background six to 18 months after surgery,” he said.


Once the wound is clinically healed, Dr. Smiley said he recommends the use of silicone gel and other topical scar treatments containing silicone, which hydrates the skin and so the scars remain flat and faded.


Aside from using the “right” tummy tuck suture technique, Dr. Smiley said the scar placement will also play a critical role in patient satisfaction.


He always positions the hip-to-hip scar very low—almost “touching” the pubic hairline—so the patient’s underwear can conceal the surgical stigmata. Over time, the scar is expected to fade into the background and “contract” as thin as a human hair.


Dr. Smiley said that patient cooperation also plays a crucial role in the final appearance of tummy tuck scars. He said a good rule of thumb is to avoid over-exertion for at least six weeks and stay away from the sun for about a year.

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The appearance of tummy tuck scarring is one of the major concerns of patients who want to eliminate their apron-like abdominal skin and/or improve their barrel-shaped waistline, as explained by Dr. Tarick Smiley on his recent Snapchat video post.


Dr. Smiley said all his patients’ tummy tuck scar is made very low that they have no problem wearing the “lowest cut” two-piece bikini.


tummy tuck scarring

Most tummy tuck surgeries involve a hip-to-hip incision to remove a wedge-shaped excess skin in the lower abdomen (between the navel and the pubic region). Then, the upper edge of the incision is pulled down to close the curved wound, which lies very low. Of course, a hole is made through the stretched over skin where the navel is set.


In his recent Snapchat post, Dr. Smiley has shown an image of a patient who had her surgery 11 years ago. The scar has faded significantly into the background, which generally happens when someone has a fair complexion.


Nonetheless, many dark-skinned patients can also expect having a barely visible tummy tuck scarring years after their surgery.


The first and most critical step to promote favorable tummy tuck scarring is to use proper wound closure. The idea is to prevent excessive tension and migration, which can lead to scars becoming thick or riding up higher.


To prevent scar migration, Dr. Smiley said the incision site must be secured and anchored to the lower abdominal fascia (strong connective tissue beneath the skin). Furthermore, it is critical to take as much tension off the final layer of wound closure as possible, which is done with the use of deep sutures.


However, patient cooperation is also critical to promote favorable tummy tuck scarring. Aside from using silicone sheets and other similar scar treatments, Dr. Smiley said the scar should not be exposed to the sun for about a year to prevent hyperpigmentation or permanent darkening.


Moreover, the patient must avoid over-straining (e.g., heavy lifting and strenuous physical activities) in the first few weeks following their surgery to prevent wound breakdown and less than optimal scars, said Dr. Smiley.

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