Brow lift scar is one of the main concerns of patients who seek surgery to correct the appearance of their sagging brow or forehead. While scar is an inevitable tradeoff, a good surgeon will make every effort to position it in hidden areas, says Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that one of the most influential factors affecting the final appearance of brow lift scar is the incision technique and placement.
The scar from this hairline incision brow lift technique is expected to blend into the background.
In the past, most brow lifts were performed by creating an ear-to-ear incision that ran across the top of the head.
While the scar is placed behind the hairline, this antiquated technique ultimately raises the hairline to about an inch, which can lead to unnatural appearance particularly in patients with a high forehead.
Due to the inherent problems of the antiquated brow lift technique, Dr. Smiley says that he prefers the hairline incision method, or medically referred to as trichophytic.
The hairline incision causes no direct hair loss and removes only the excess skin from the forehead (instead from the scalp). The incision generally fades into a thin and undetectable scar, provided that proper wound closure has been used during surgery.
Instead of using one long straight incision, Dr. Smiley says a serrated incision (or zigzag) technique is more ideal during a hairline incision brow lift because it allows for good wound closure—i.e., no tension on the skin and so the scar generally fades nicely after a few months.
Furthermore, the serrated incision technique allows the hair to regrow naturally.
While the surgeon’s skillset, particularly involving his wound closure technique, plays a critical role in the appearance of brow lift scar, the patient’s commitment to recovery will also influence the final result. The consensus is to avoid sun exposure for a minimum of six months to prevent hyperpigmentation.
Hyperpigmentation happens when the scar darkens permanently after being exposed to UV rays. Hence, the use of protective clothing (e.g., large brimmed hat) and sunscreen is crucial to promote the most favorable scar possible (i.e., it blends into the background).
Many patients are also encouraged to use scar creams and other topical treatments containing silicone, which is known for its hydrating effects. A scar that heals in a moist environment is known to fade into the background.
Generally speaking, after a brow lift patients should expect 1-2 weeks of social downtime, i.e., no outward sign of the surgery.
Tummy tuck with pubic lift aims to achieve a smoother, more natural transition between the lower abdomen and the pubis. Oftentimes, massive weight loss patients not just suffer from apron-like abdominal skin (pannus) but also from sagging mons pubis that needs to be lifted at the same time as the surgery.
To demonstrate the impressive contouring effects of tummy tuck with pubic lift, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat showing a female patient who had sagging mons pubis and large pannus after losing a significant amount of weight.
The patient is ecstatic with her final results as seen from the after photo.
While her body mass index was relatively high at the time of surgery, Dr. Smiley said that BMI should not be the only factor considered during the patient selection process.
“A good surgeon must be a good clinician, not a technician. Occasionally, patients with a relatively high BMI can benefit from tummy tuck provided that they are healthy, they have no chronic medical condition, and they are not expecting large weight loss in the future,” he said in the video.
(Note: Popular guidelines suggest that a normal BMI range is between 18.5 and 24.9, while a range of 25 to 29 is considered as overweight. Meanwhile, obesity is defined as 30 and higher.)
Despite having a relatively high BMI, the female patient’s pair of abdominal muscle, which runs between the sternum and the lower abdomen, was “relatively tight,” Dr. Smiley further explained. Nonetheless, he sutured them in the midline to further achieve a flatter appearance especially when she is “lying down,” he added.
Due to the extent of her pannus, Dr. Smiley used an extended tummy tuck technique in which the incision pattern went from flank to flank. Nevertheless, the resulting “curved” scar is positioned beneath the underwear area.
After tightening the muscle and removing the pannus, Dr. Smiley injected Exparel into the abdominal muscle to control the amount of postop pain. This numbing medication can provide comfort for up to four days, which in turn promotes healing.
When the patients feel less pain, they tend to move around more and breathe with more ease, all of which contribute to faster recovery, Dr. Smiley explained.
Before suturing the flank-to-flank incision, Dr. Smiley slightly elevated and anchored the mons pubis into the deeper tissue so it will not detract from the tighter and more refined lower abdomen.
Contrary to popular belief, BBL surgery procedure (aka Brazilian buttock lift or butt augmentation through fat injection) is more about the shape and body proportions than the actual size, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley in his recent Snapchat post.
The principle of BBL surgery procedure may seem too simple and straightforward: Harvest the unwanted fats from two or more liposuction sites and later inject them into the patient’s buttocks.
The new buttocks look proportionate to the upper body. Dr. Smiley believes the shoulder width is one of the factors determining the ideal shape and size of the postop buttocks and hips.
But the truth is, Dr. Smiley says the surgery requires a meticulous set of methods to increase the survival rate of fat and thus make it possible to achieve near permanent results; and deep understanding of beauty and ideal body proportions.
To shed light on the issue of “ideal body proportions,” he recently posted before-and-after photos of a female patient whose “starting buttocks” were markedly flat, an appearance further aggravated by the presence of fat rolls along her flanks and lower back.
Instead of giving her a “conservative” result, Dr. Smiley injected large amounts of fat volume into her buttocks.
“A lot of people would ask me if the new buttocks look too big for her legs. The truth is, one of the most important factors is the shoulder. This patient’s shoulder is big and wide and so we must reshape the buttocks and hips in a way that the latter will almost have the same width as the upper body, leading to the much coveted hourglass physique,” he explains.
To further create a more feminine silhouette, Dr. Smiley says he always treats the lower back and flanks as his donor or liposuction sites, adding that his idea is to “scoop out” this area so the buttocks and hips will have more projection and curvier appearance.
Occasionally, Dr. Smiley says a 360-degree liposuction (i.e., fats from the frontal abdomen, flanks, and back are all removed) is even more ideal in order to achieve a narrower waistline.
In terms of the ideal distance between the “new” buttocks, Dr. Smiley says the V-shape effect [see pictures below] will primarily determine this.
Dr. Smiley marks the buttocks and draws a V-shaped pattern between the two “cheeks” to guide him during the fat injection process.
Augmentation rhinoplasty procedure is a general term to describe a nose-reshaping surgery in which the goal is to increase the height of the nasal bridge. Oftentimes, the surgery also involves the tip and/or nostrils to create a smoother and more natural result.
A good number of augmentation rhinoplasty is performed in ethnic patients (e.g., Asian and Hispanic descent). The vast majority of them want to enhance the appearance of their nose without making it look out of sync or “ethnically inconsistent” with the rest of their facial features. Hence, patient satisfaction is closely tied to “how natural the nose appears.”
Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains what augmentation rhinoplasty can accomplish.
- Increase the height of the nasal bridge
Aside from ethnic patients, augmentation rhinoplasty is also commonly sought by people with nasal collapse and other deformities (due to congenital, disease, or injury). Nonetheless, their appearance can be improved when their nasal bridge receives additional height.
Despite the reasonable safety and proliferation of alloplastic and other synthetic materials, Dr. Smiley believes that using natural material (i.e., derived from the patient’s body such as the nose itself, ear, and rib) remains the most ideal method as it has the least chance of extrusion, rejection, infection, and unnatural results.
- Improved definition of the bridge when viewed from the front
Patients seeking augmentation rhinoplasty typically have flat and undefined (or even excessively wide) bridge on front view. While the surgery can improve this “feature,” it should be done within the confines of the underlying anatomy and facial harmony to achieve natural-looking results that can last a lifetime.
In general, augmentation rhinoplasty should not raise the bridge all the way to the radix (i.e., it defines the nasal root or the nose’s origin from the forehead area) in female patients because of the too masculine effect, and in ethnic patients due to the unnatural appearance.
Meanwhile, men and patients with a prominent or strong jawline can generally tolerate a stronger nose.
- Tip and nostril refinement
By taking into account the appearance of the tip and nostril, doctors are able to create a smoother, more natural result. Oftentimes, increasing tip projection is enough to improve the nostril and alar base (or width of the nostrils) without using incisions to narrow them.
Again, when doing tip refinement and nostril reduction, it should be done in a way that respects the underlying anatomy (to prevent nasal collapse and breathing problems) and the patient’s ethnic features, gender, and personal goals.
Extended tummy tuck surgery with PAL liposuction is generally reserved for patients who have lost a significant amount of weight, leaving them with large pannus or apron-like skin along their abdominal area. Pannus not just causes unsightly rolls beneath one’s clothing, but it also results in skin breakdown, non-healing irritation, and foul odor due to the trapped sweat and moisture.
Compared to the standard technique in which the resulting scar goes from hip to hip, the extended tummy tuck uses an incision pattern that goes a bit longer and so the scar may be visible along the flanks (or lower back).
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the length of tummy tuck incision must cover the “entire rolls of skin and excess tissue” to achieve a smooth and natural contour. Attempting to use a shorter scar technique despite the extensiveness of the redundant skin, meanwhile, will inevitably result in poor outcome due to the residual rolls.
In Dr. Smiley’s previous Snapchat post, he showed one patient who had extended tummy tuck and PAL liposuction as its ancillary procedure. The idea is to further contour the flanks and achieve a more feminine silhouette.
PAL, which is an acronym for power-assisted liposuction, uses a cannula (straw-like device) that has a vibrating tip that makes fat extraction more precise and quicker, thus leading to shorter operation, improved safety, and less surgical trauma.
He first performed PAL liposuction along the lateral aspect of the torso before placing a flank-to-flank incision. The idea was to remove the unwanted fats, allowing the skin to “shrink down” before removing the pannus through an extended tummy tuck technique.
Liposuction uses tiny round incisions about the size of a grain of rice. The goal is to remove the excess superficial fat beneath the skin. It is important to note that it cannot suction out the obesity-related visceral fat (it is positioned deep within the abdominal organ and cavity) that only responds to real weight loss.
After liposuction, Dr. Smiley proceeded to tummy tuck to remove the pannus and then performed muscle repair in which the idea was to tighten the pair of vertical muscle by suturing them in the midline, further contributing to the cinching effect on the waistline.
Before closing the tummy tuck incision (ensuring that the scar would lie very low that it is hidden beneath the patient’s underwear), Dr. Smiley injected Exparel, a drug that can numb the surgical site for up to four days.
The Brazilian buttock lift effects may differ from patient to patient, depending on their cosmetic goals, their “starting” anatomy (e.g., body frame), and the amount of “disposable” fat (or the fat that can be harvested through liposuction and later injected into their “backside”). Of course, the surgeon’s skillset will also play a significant role on the long-term success of the surgery.
Basically, Brazilian buttock lift (BBL) is buttock augmentation via fat injection or fat grafting. It always starts with liposuction to collect adequate amounts of fat from two or more sites; the fat is then purified before it is injected into the buttocks and hips to achieve a more feminine physique.
Compared to buttock implants which can only reshape and augment the upper half of the butt, Brazilian buttock lift gives doctors more control over the final result as the fat can also be injected into the lateral side (hips), lower aspect of the butt cheek, and dents and other skin irregularities.
The “overall” Brazilian buttock lift effects—i.e., body proportions—will also depend on liposuction. Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley almost always harvests fat from the lower back and flanks to further improve the butt shape and projection. Other common donor sites include the bra rolls, outer thigh, and anterior abdomen.
Dr. Smiley, who regularly posts before-and-after photos of his actual patients on Snapchat, says it is not uncommon for women to name-drop a celebrity to describe their “booty goal.”
For instance, the leading plastic surgeon says that patients who bring Kylie Jenner’s photo as their “booty goal” often have one specific goal in mind—achieve a heart-shaped backside. This is typically accomplished by injecting more fats into the upper aspect of the buttock and hips and so the backside tapers downward into a pair of slender legs.
Jessica Biel’s backside, meanwhile, is popular among patients who are more into shape improvement than the actual size. On the other end of the spectrum, women who bring photos of Kim Kardashian and Nicki Minaj as their “booty goal” generally ask for extreme results.
While the patient’s cosmetic goals are a critical component when reshaping and augmenting her backside, Dr. Smiley says that the “starting” anatomy must be respected nonetheless to prevent sagging appearance, cellulites, dents, and other skin irregularities.
“The fascia, which connects the skin and muscle and gives the buttock its shape and perky appearance, should not in anyway be compromised during surgery. The problem with over-injection is that the excessive weight of the fat and the over-stretching of skin causes poor shape and skin irregularities,” he says in his previous Snapchat post.