Chin and neck liposuction creates a sharper angle between the neck and jawline. When performed as a stand-alone procedure, it is mostly performed in “younger” patients (35-50 years old) who typically have good skin shrinkage.
But past the age of 55, chin and neck liposuction could result in saggy appearance unless performed concurrently with some type of facelift or neck lift. Also, when it is done too aggressively (too much fat is removed), it might unmask the platysma muscle, resulting in visible vertical bands.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated the surgery on his Snapchat. The patient shown in the series of videos had about 300 cc of excess fat removed behind her chin and neck, a procedure medically referred to as submental liposuction.
Submental liposuction typically uses a small around incision beneath the chin, specifically positioned within the natural skin fold for optimal scar concealment. However, the patient also required a pair of incisions below her earlobes due to the severity of her excess fat—i.e., it extended far beyond the center of her neck.
The additional two incisions placed behind the earlobes allowed Dr. Smiley to attack the excess fat from different directions and remove it in a fanlike fashion (multiple layers), paving way for smoother results.
Meanwhile, he left behind a sufficient layer of fat, particularly right beneath the skin, to prevent dents, bumps, and other surface irregularities. Meticulous liposuction would also ensure that the skin could shrink-wrap around the new contour instead of looking saggy.
To further promote smooth results, the celebrity plastic surgeon says he typically recommends patients to wear a compression garment (or chin-neck strap) for at least one week to help the skin heal closer to the body. This will also keep swelling to a minimum, which paves way for quicker recovery.
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ABOUT DR. TARICK SMAILI
Dr. Smaili is an active member of the American Society of Plastic Surgeons of which only board certified plastic surgeons can be admitted. He is also an active member of the Plastic Surgery Foundation for which he has received 1st place awards for his publications and presentations in 2001.
Tarick K. Smaili, MD, a native of Ohio, graduated from Whitmer High School in Toledo, received his Bachelor of Science from Ohio State University in 1989, and received his Medical Doctor degree from the Medical College of Ohio in 1994. As Medical Director of California Surgical Institute, one of the fastest growing private medical partnerships specializing in cosmetic surgery in the state of California, he is committed to setting the highest standards for quality of care in the field of plastic surgery.
The main goal of tummy tuck surgery, also known as abdominoplasty, is to create a flatter and more toned abdomen. This is achieved by removing the excess skin and tissue, and possibly restoring the separated muscles caused by previous pregnancies or massive weight fluctuations.
However, some would-be patients are put off by the tummy tuck scars, which typically span from hip to hip across their lower abdomen.
To hide the appearance of tummy tuck scars, plastic surgeons will make every effort to lower them to an area covered by their patients’ bikini. Nevertheless, postop variables remain important to further achieve “favorable” scarring.
Leading Beverly Hills plastic surgeon Dr. Tarick Smaili explains the four basic ways to help tummy tuck scars fade quicker, with most of them performed at home.
- Scar massage. The idea is to break up the scar tissue that may form within the dermis, although it should only be attempted when the incision wound is healed enough, which happens around four weeks after surgery.
The general rule of thumb is to pull the scar line horizontally and perpendicularly. Another technique is to stretch the skin next to it in a circular motion, clockwise and counterclockwise, for optimal results.
- Wound care. Avoid factors that can increase the risk of infection such as poor hygiene, dirty bed linen, soiled dressings, poor diet, and smoking. To further reduce its incidence, some doctors also recommend antibiotics.
Take note that proper wound care is a case-to-case basis, so you have to stick to your surgeon’s instructions.
- Sun protection. While the usual recommendation is to avoid exposing your incision under the sun for at least six months, it would be better to do this for a full year to further minimize the risk of hyperpigmentation in which the scars become darker and more obvious.
If you need to go outside, use protective clothing and/or sunscreen even in cloudy days because the sun’s UV rays can penetrate through clouds.
- Scar creams and topical treatments. Many surgeons prefer products that contain silicone and mild steroid (hydrocortisone) because these agents are known to reduce redness and/or hydrate the skin, leading to “better” scars.
Silicone tapes or sheets are also helpful because they constantly provide pressure that prevents or at least reduces scar tissue formation. Some doctors believe that combining them with scar tissue massage could further promote good scarring.
In the hands of a skilled board-certified plastic surgeon, facelift complications are infrequent or at least just a minor “inconvenience,” i.e., swelling, bruising and tenderness, which are supposed to significantly subside within a week or two.
Orange County plastic surgery expert Dr. Tarick Smaili says he requires regular follow-up visits to make sure the incisions are healing properly and there is no sign of skin necrosis or death of tissue, which is tied to “unnecessary” scarring and less than optimal results from facelift surgery.
The list below shows some facelift complications and their corresponding treatments, as explained by Dr. Smaili.
* Infection. Its common signs include fever, yellow or green discharge that may smell pungent, increasing pain and swelling, redness of the affected area, and excessive bleeding that soaks the dressing.
Wound cleaning, antibiotics, and debridement in which the infected, dead, or damaged tissue is surgically removed are used to treat infection.
* Hematoma. Clotted blood within the tissue could compromise the blood flow and lead to subsequent complications such as infection and skin necrosis. Oftentimes, small or superficial hematomas of the soft tissue respond well with rest, ice, compression, and elevation (RICE), although some experts may also recommend heat.
Large hematomas, meanwhile, are typically treated with surgical drainage.
* Skin necrosis. This happens when the blood supply is compromised usually due to smoking (nicotine constricts the blood vessels), pressure to the skin, hypertension, and uncontrolled bleeding or hematoma. In this condition, the affected skin tissue literally dies and turns black.
Skin necrosis treatment generally involves medical removal of damaged and dead tissue in an attempt to improve healing of the remaining healthy tissue.
* Loss of hair. Oftentimes hair shock resolves on its own without any treatment, although patients must wait at least three months to notice some improvement. But to “accelerate” the process, they may consider using Rogaine.
Surgical hair transplant would be the last resort if bald patches around the incision sites (behind the hairline near the temple) seem to be a permanent fixture. In this procedure, hair follicles from the back of the scalp are transferred to the area that needs “coverage.”
* Unfavorable facelift scars. Scar migration and thick scar tissue can be problematic after facelift surgery, although there are several options to improve its appearance such as silicone sheets and creams, scar massage, and steroid injection.
On the other hand, scar migration happens because of incorrect or excessive pull, thus another surgery might be needed to reposition it in a way that it is hidden.
Asian rhinoplasty or cosmetic nose surgery performed on patients of Asian background often involves augmenting the low or near absent dorsum or bridge. But to achieve a more streamlined appearance, the mid section, nasal tip, nostrils, and/or overall profile must be also enhanced.
According to California Surgical Institute website, the vast majority of rhinoplasty patients will require all or most of the aspects of their nose to be reshaped. Only a few people can benefit from an “isolated” procedure, e.g., removing the dorsal hump or augmenting just the bridge.
To augment the Asian nose, most Beverly Hills plastic surgeons prefer the use of cartilage grafts to synthetic implants such as solid silicone. The former is believed to provide a more natural result because the patient uses his own tissue, which can be harvested from the septum or wall dividing the nostrils, ear, or rib.
But in Asia, the use of silicone implants in augmentation rhinoplasty remains popular. First and foremost, they are well tolerated by the Asian nose because of its thick nasal skin, thereby reducing the risk of implant protrusion or visibility—a problem commonly encountered with the use of artificial prosthetic in Caucasian patients.
As a readily available material, nose surgery via silicone implant is usually quicker than rhinoplasty through cartilage graft techniques that may entail a separate procedure to collect the tissue from the donor site.
Silicone implants might also be a good option if one needs larger augmentation.
However, the disapproval of many US plastic surgeons with the use of silicone implants and other synthetic implants has its own valid reasons. Medical literature has suggested that around 10 percent of patients over a 10-year period will require removal of these prostheses usually due to extrusion, displacement, and over prominence.
Some surgeons avoid the use of silicone implants altogether, arguing that in most cases they will cause the skin to thin out that they poke through it.
The rate of infection is also higher with the use of silicone implants and other artificial materials compared with cartilage grafts.
The consensus is that using the patient’s own tissue rather than silicone implants to augment the Asian nose is generally considered as a better option. Oftentimes, there is an adequate amount of cartilage in the nasal septum, thus a separate procedure is not needed.
But if there is a deficiency in septal cartilage, grafts are harvested elsewhere such as the bowl of the ear, without affecting its function or outside appearance or causing visible scars. Rib cartilage is another good option in augmentation rhinoplasty, although it is a more challenging technique since it is hard to reshape and has the tendency to warp over time.
The appearance of scars after breast augmentation surgery is determined by several factors such as the type and size of implant, incision site, surgical techniques, and predisposition to adverse scarring (i.e., ethnic skin is more prone to keloids and hypertrophic scars than fairer skin).
The list below shows the four breast augmentation incision sites and the appearance of their postop scars, as explained by one of the leading LA plastic surgeons Dr. Tarick Smaili.
1. Inframammary fold. The scar is positioned within the natural skin fold so it remains hidden, making this particularly ideal for women whose pre-surgery breast fold is relatively deep.
The IMF incision is the most commonly used technique because of the hidden scars and the preservation of breast functions such as breastfeeding and normal sensation. And to further minimize scarring, some doctors use a cone-shaped device called Keller Funnel that aids in the quick and “no-touch” deliverance of silicone implants.
Another benefit of this breast augmentation incision technique is that it can be used again in future revisions, avoiding the appearance of another scar.
2. Trans-axillary. The scar is situated in the natural skin folds of the armpit, further helping it blend well into the skin. And because the area is not susceptible to keloids, the incision site is believed to be ideal for ethnic patients who might be prone to adverse scarring.
However, the trans-axillary breast augmentation is not ideal for patients who have asymmetry because the surgeon works far away from the breast. Another potential downside is that future revisions will require another incision site.
3. Peri-areolar incision. Also referred to as “through the nipple” technique, it uses a U-shaped incision around the areola’s edge, specifically from 4 o’clock to 8 o’clock. The scar must lie exactly where the dark skin meets the light skin so it will remain undetectable.
But even with a slight migration of scars, it is enough to make them visible. Another possible downside is the higher risk of partial or complete loss of sensation (thus breastfeeding difficulty might be an issue) because the incision site is where most of the vital nerves and milk ducts are located, making this a less popular choice of women who are planning to have children in the future.
4. Trans-umbilical breast augmentation (TUBA). Also referred to as “through the navel” approach, the incisions are placed within the belly button’s rim so there is no scar on the breast skin. For this reason, some beauty clinics call it as scarless breast implant surgery.
Because of the distance between the breasts and incision site, TUBA is not an option for women with breast asymmetry and ptosis (sagging), patients who choose pre-filled silicone implants, and those who need revision surgeries.