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Male liposuction ab etching, a procedure purported to turn a keg-shaped belly into a six-pack, has been receiving both media hype and controversy. While this sounds great in theory, in reality the final result still boils down to the patient’s underlying anatomy.


The six-pack appearance is caused by well-developed abdominal muscle that shows through the skin. However, some men have thick superficial fat that conceals any muscular definition.


male liposuction ab etching

Photo Credit: patrisyu at FreeDigitalPhotos.net

Unlike the deeper visceral fat surrounding the abdominal organs that is linked to obesity, the distribution of superficial fat is mainly influenced by genes and thus some men despite adhering to the strictest exercise regimen and diet do not achieve the appearance of six-pack abs.


Fortunately, liposuction cannula—a hollowed steel tube attached to a vacuum pump—can remove the superficial fat. Hence, this body contouring surgery is reserved for normal weight patients who are committed to healthy lifestyle, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Even the standard liposuction technique may lead to the appearance of six-pack provided that the patient has well-developed muscles that are concealed by a thick layer of superficial fat.


During a standard liposuction technique, doctors remove fats deep within the subcutaneous tissue.


Meanwhile, there is one specific technique purported to deliver six-pack even in patients with poor muscle definition.


Ab etching liposuction, which has always been hounded by controversies, involves very superficial and aggressive fat removal. The idea is to eliminate fats in a way that several “grooves” are created in the process.


These “grooves” have their skin almost sticking down to the underlying muscle, which is believed to increase the risk of poor healing and skin scarring.


Some doctors also stay away from ab etching liposuction because of the “manufactured” or unnatural look due to the presence of contour irregularities.


Because of the difficulty of creating natural-looking results from ab etching technique, plastic surgeons typically prefer the standard liposuction and occasionally complement it with a very small amount of etching in the midline (above the navel).

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Tummy tuck and waist size: Can this body contouring surgery result in a dramatic improvement in the size and contour of the patient’s abdomen?


Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of tummy tuck patients can expect drastic narrowing of their waistline with the right combination of surgical maneuvers.


tummy tuck and waist size

The patient is ecstatic after seeing the results of her tummy tuck.


(Note: The only tummy tuck patients who would experience limited contouring effects are those who have lost large amounts of weight but still remain overweight, and those with diabetes and other conditions that compromise their healing. Since the large apron-like skin causes pain and tissue breakdown, their doctors are more focused on improving their quality of life than refining their physique.)


Traditional tummy tuck uses a hip-to-hip incision to remove the excess skin from the lower abdomen; the skin above the navel is then pulled downward to close the wound in a way that the scar settles very low and is concealed beneath the underwear. However, this method alone is not enough to narrow the girth.


Prior to the creation of hip-to-hip scar, Dr. Smiley occasionally performs liposuction of the flanks to remove the excess fat. In his recent Snapchat post, he said this allows him to tighten and pull more skin centrally during tummy tuck, further contributing to the tapered waist appearance.


To further reduce the waist size and correct the barrel-shaped appearance of the abdomen, Dr. Smiley also incorporates tummy tuck with muscle repair.


Prior to pregnancy or large weight fluctuation, the pair of abdominal muscles is positioned immediately side-by-side right and runs below the sternum and above the pubic hairline.


However, the abdominal wall becomes separated due to the stretching of fascia layer (connective tissue) during pregnancy or large weight fluctuations. Hence, the once flat and athletic-looking abdomen is turned into something that resembles a “barrel.”


To correct the barrel-shaped abdomen, Dr. Smiley uses permanent sutures to bring the abdominal muscles closer to each other, back to their original configuration. He said that he prefers the “individual suturing technique” to the “running stitch” due to the former’s stronger support.


“The individual suturing technique means that each stitch is as strong as the next one,” Dr. Smiley said in his previous Snapchat post.


On average, patients can expect to lose 2-6 inches off their waist following tummy tuck surgery. Nonetheless, the celebrity plastic surgeon said that its long-term success still boils down to the patient’s commitment to healthy lifestyle—i.e., sustainable weight management.

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Complete smoking cessation a few weeks leading up to plastic surgery has become a common practice to reduce risk of skin necrosis, pulmonary- and heart-related complications, and poor healing and scarring, according to the California Surgical Institute website.


However, a recent study published in Plastic and Reconstructive Surgery has found that many patients receiving smoking cessation instructions had kick the habit for good or at least smoked less frequently years after their surgery.


Photo Credit: WebMD

Researchers at the University of British Columbia, Vancouver have suggested that “surgeons who request pre-operative smoking cessation may influence patients’ long-term smoking status.”


The researchers enlisted 47 patients who responded to a 5-year follow-up survey, although five social smokers were later excluded to make sure that the study only involved “bona fide” daily smokers. Most respondents were women whose average age was 40.


Most respondents requested for tummy tuck, breast lift, and facelift.


In the follow-up survey, 25 percent of patients had quit smoking since their cosmetic surgery, while 40 percent said they smoked less. Most patients said the frequency of their cigarette use was reduced to a varying degree, citing their surgery as a strong motivation to live a healthier life.


The authors of the study have concluded that people were more likely to quit smoking or at least reduce their tobacco use when they were presented with “specific negative effects of smoking” rather than with “general health benefits of smoking cessation.”

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In 2016, about 215,000 cosmetic plastic surgeries were performed in men, accounting for 13 percent of all aesthetic procedures; their popular requests included facelift, eyelid lift, and rhinoplasty (nose job), according to a survey released by the American Society of Plastic Surgeons.


Aside from gender-based beauty standards, men’s facial plastic surgery is different from women’s due to their underlying anatomy. For instance, their skin is more vascularized and thus more susceptible to bleeding and bruising compared to females.


men's facial plastic surgery

Men’s facial plastic surgery requires a different approach than women’s.

Furthermore, any scar that may result from facial plastic surgery is more difficult for men to hide since they do not wear makeup, as most women do.


Another notable difference is the men’s tendency to ask for subtler results because unlike women, they are less likely to disclose their plastic surgery to other people probably due to “double standard” stigma.


Fortunately, achieving subtle and natural results from men’s facial plastic surgery is possible with correct surgical maneuvers and deep understanding of universal guidelines of facial proportion and masculine beauty.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the three most commonly sought facial plastic surgeries of men and the core principles that help him deliver natural and gender-appropriate results.


  • Facelift


Men are more prone to hair loss than women, making it more challenging to hide the scar. It is important to note that facelift typically uses incisions within or behind the hairline to hide the scar, which can be difficult in patients with receding hairline, unless a short-scar or mini lift is used.


Another issue with male facelift is the surgical stigmata—e.g., flat cheeks, overly pulled appearance, and hollowing of the lower lid. However, these can be avoided with the correct vector of pull.


Aging causes the vertical descent of the skin and other soft tissue; hence, the correct vector of pull should be oblique and not a “blunt” horizontal.

By lifting the skin at a 45-degree angle, several wonderful things happen: the jowling is reduced, the softness of the cheek fat pad is restored, and the face appears tighter but not too taut.


Another nuance of male facelift is the propensity of patients to ask their surgeons to maintain a few small wrinkles for a more realistic, natural result.


  • Rhinoplasty


Men generally seek nose-reshaping surgery to reduce their hump and refine their tip without causing them to lose the masculinity of their face. Hence, great surgeons avoid over-resection of the tissue, which is also linked to increased risk of nasal collapse and other deformity.


The ideal nose is defined by universal beauty tenets instead of a highly rigid set of rules. The goal is to reshape the nose that will fit the face of the patients, respect their gender and ethnicity, and meet their aesthetic goals.


Several studies have attempted to describe what constitute an ideal male nose and these are some of their findings: It is “biologically” bigger than female’s possibly due to men’s increased muscle mass that requires more oxygen; it has a prominent dorsum or bridge; its tip has an angle of rotation around 90 degrees giving it a straighter profile (a slight upturned appearance is enough to feminize the face); and the overall profile appears strong instead of delicate.


  • Eyelid surgery


Eyelid surgery eliminates the hooding of the upper lid and the under eye-bags. However, even the slightest error—i.e., removing just a few millimeters of fat or skin than intended—can lead to stigmata such as lid retraction, deep tear trough, and abrupt lower lid-cheek transition.


To deliver natural and gender-appropriate results, doctors ensure that after surgery the upper lid appears “heavier” and lower compared to women’s, and there is a smooth lower lid and cheek junction.


And to preserve smooth transition between the lower lid and cheek, eyelid surgery is now commonly performed together with fat injection.


Another issue with male eyelid surgery is the risk of scar. This can be avoided by placing the incision precisely at the skin fold of the upper lid, and very close to the lower lash line margin.


All efforts are made to ensure that the scar remains concealed because men do not wear makeup to hide surgical stigmata.

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Breast augmentation through fat transfer offers unique benefits: Lack of any risks associated with artificial implants, more natural shape and feel, and more control over the final cleavage appearance (i.e., upper breast pole and mid cleavage).


And because the procedure entails liposuction, which is the process of harvesting fats from “troublesome” areas of the body, patients can also expect a more holistic improvement compared to the standard breast augmentation.


breast augmentation fat

The deflated breast has its implant removed. The “perky” side, meanwhile, has already received fat transfer giving it ample volume and projection with the use of the most natural material possible–the patient’s own fat.

Renowned Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a female patient who has had breast implant removal immediately followed by fat transfer.


During surgery, Dr. Smiley removed the implant through an incision made precisely at the upper border of the areola (this was the same incision created during her previous breast augmentation).


Removing the implant could lead to deflated-looking breasts, particularly in the upper pole; hence, Dr. Smiley performed a simultaneous fat transfer.


To harvest sufficient fat volume, Dr. Smiley performed liposuction on different body areas including the abdomen, flanks, and lower back. The collected amount is then washed and sorted to remove dead cells and other “non-fat” biomaterials such as blood to ensure high survival rate.


The purified fat volume was then injected into the breast, specifically above the implant pocket. Dr. Smiley said microdroplet (less than 0.1 cc) of fat has been inoculated into the tissue and muscle to promote vascularization or blood supply ingrowth, which allows the fat cells to persist long term.


About 70-80 percent of the injected fat volume is expected to survive long term, while the remaining is resorbed within a few weeks of injection. Hence, it is a common practice to slightly overfill the breast to anticipate this “consequence.”

breast augmentation through fat transfer

Final result from the surgery

Another issue with breast augmentation through fat transfer is the varying permissible amount of fat injection. It is important to note that overzealous augmentation may lead to low survival rate because of the excessive pressure experienced by the fatty cells; this is particularly true for patients with markedly tight skin.


In general, 200-300 cc of purified fat can be injected into each breast without worrying about low survival rate and other complications caused by excessive pressure.


In the video, Dr. Smiley said the main advantage of breast augmentation through fat is that it “provides more control over the final width of the breast,” making it easier to improve the mid cleavage and upper breast pole compared to implants.

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The appearance of six pack after tummy tuck might be possible with the right surgical maneuvers. Nonetheless, some factors are beyond the surgeon’s control and thus the right candidate for the surgery should understand that to some extent their results are determined by their underlying anatomies and lifestyle.


The appearance of six pack primarily stems from two factors: a well-developed abdominal muscle, and a thin layer of fat between the muscle and skin.


The “after” photo shows more athletic “grooves.”


During tummy tuck, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the hanging skin and excess fat is removed. However, this is not enough to deliver the appearance of six pack and so other surgical maneuvers are utilized as well.


In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had tummy tuck, which resulted in an athletic appearance. This has been possible with a combination of techniques: performing muscle repair, thinning out the fat above the muscle, and placing enough tension during wound closure.


  • Muscle repair


During surgery, Dr. Smiley performed muscle repair in which the pair of vertical muscles between the upper and lower abdomen were tightened in the midline with the use of permanent sutures, which were individually stitched to promote additional support.


By incorporating muscle repair with skin excision tummy tuck, the anterior abdomen appears narrower and there is no or very little bulge every time the patient sits down.


  • Thinning out the fat


A well-developed abdominal muscle will not show through a thick fat. Hence, the fatty tissue beneath the skin must be thinned out, but not completely obliterated.


It is important to preserve some fats between the skin and the muscle to ensure smooth and natural results.


  • Tension


To further ensure the appearance of six pack after tummy tuck, it is important to use the right amount of tension during muscle repair and wound closure.


  • Diet and exercise


The patients are in control of some factors such as their diet and exercise. Hence, the right candidates for tummy tuck or any other forms of body contouring surgery understand the importance of healthy lifestyle to maintain the results long term.

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