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.
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.”
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.
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.
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.
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.
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.
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.
Tummy tuck surgery removes the hanging skin and excess fat often with the use of a hip-to-hip incision placed very low within the “bikini area” so the resulting scar is well concealed.
Aside from skin excision, the surgery also typically incorporates muscle repair, navel repair, and liposuction of the flanks to further create natural curves and contours.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a “special case” of tummy tuck: The female patient previously had appendectomy, resulting in a scar on the right side of the abdomen that was causing asymmetric skin folds [see the “before” picture below].
Dr. Smiley said the skin fold must be released during tummy tuck to achieve smooth results.
During surgery, Dr. Smiley placed a curved hip-to-hip incision very low that its mid aspect was at the same level as the pubic hairline; this allowed him to remove the loose skin along with the appendectomy scar.
The celebrity plastic surgeon said that prior to surgery he “marked” the patient standing up to assess more accurately how much skin must be removed.
“Marking should be done while the patient is standing since when one is lying down, everything shifts,” he said.
Aside from removing the large skin folds causing the unsightly “rolls,” the celebrity plastic surgeon also performed muscle repair with the use of permanent sutures.
The pair of vertical muscle, which runs between the lower and upper abdomen, is naturally placed side by side until pregnancy or large weight fluctuation causes it to become separated. Hence, Dr. Smiley tightens it with the use of individual permanent suturing technique known to provide additional support and narrowing effect on the waistline.
To further ensure a feminine contour, Dr. Smiley performed navel repair to reduce its size and make it more proportionate to the flatter, narrower waistline. Furthermore, he placed it at the same level as the “stable bone” of the iliac crest or hipbone for the most natural effect.
During navel repair, he placed the incision inside the rim of the belly button to ensure that the scar would remain hidden.
The ideal otoplasty techniques, or more commonly referred to as ear pinning, will primarily depend on the patient’s underlying anatomy, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Nonetheless, there are basic guidelines and “definite philosophies” that help doctors achieve permanent and natural-looking results. For instance, the cartilaginous framework of the ear must be “broken” and sutured in position so the new contour can persist long term.
The before photo shows the right ear protruding more than normal, while its helix or upper aspect is curled inward; these problems are corrected with a highly customized otoplasty surgery.
Relying solely on sutures, without breaking the cartilage known for its “strong memory,” will not hold up the new shape long term.
Dr. Smiley has recently posted a series of videos on Snapchat to present a special case of otoplasty. The female patient had deformity on the right ear, while the left side had normal appearance and so it did not require surgery.
The patient’s right ear deformity was caused by two major problems: overdeveloped concha, which is the bowl of the ear, and underdeveloped helix, which is the uppermost portion of the external ear.
The excess cartilage of the concha was causing the ear to stick out more than normal, while the weak or “unsupported” helix was curled inward, resulting in an unusually short ear (vertical measurement between the helix and the earlobe).
In the Snapchat video, Dr. Smiley said the right ear was about 1 ½ cm shorter than the left side, a prominent asymmetry that affects the entire face.
The ideal vertical height of the ear, he explained, should be about the same length as the nose (between the bridge and the columella, which is the visible wall of tissue between the nostrils).
The incision is placed behind the ear for optimal scar concealment.
Meanwhile, the ideal protrusion of the ear’s helix or upper region is 1 ½ cm, while the earlobe should stick about 1 cm, he said. In general, otoplasty is reserved for patients whose ears stick out more than 2 cm from the side of their head.
During surgery, Dr. Smiley placed the incision behind the ear to hide the scar. This revealed the overdeveloped cartilage of the concha, which he broke and sutured to a more normal position.
With the use of correct otoplasty techniques and deep understanding of beauty ideals and proportions, ear pinning surgery can provide permanent results that can improve facial symmetry as well.
While custom chin implant generally costs more than the “pre-made” version, using it makes it easier to achieve natural and proportionate results. This is particularly true for patients with an extreme case of recessed chin or notable asymmetry.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted Snapchat videos demonstrating a female patient who required custom chin implant to address her receding chin, which contributed to her poor facial proportion.
Before-and-after photos of a patient with chin implant surgery
To achieve natural results from any facial implant, Dr. Smiley says the first step is to have a deep understanding of what constitute the ideal proportions and beauty paradigm, some of which transcend culture and ethnicity. For instance, he says that the ideal projection of the chin is “congruent with the anterior portion of the iris of the eye.”
Laser helps Dr. Smiley determines the ideal chin projection, which he says should be congruent with the anterior of the iris of the eye.
Other facial elements that are taken into account include the tip of the nose and the forehead projection. Together with the chin, they have a large influence on the perceived attractiveness of the facial profile and proportion.
The patient’s customized implant was made of firm silicone material (silastic), which has an impressive safety record. Unlike other chin implants that have microspores that allow tissue ingrowth, silicone implants are easier to remove in the event that the patient is not happy with the result.
Moreover, her implant has been designed to improve her chin profile or how much it projects from the lower jaw; it has no or very little effect on the vertical height of her chin.
During surgery, Dr. Smiley placed a small incision inside the patient’s mouth, a technique he says he prefers due to the “invisible scar.”
(The external incision technique is another option; it uses a small cut beneath the chin to position the implant right beneath the bone. In most cases, the scar fades into a barely visible mark, although the risk of visible scar cannot be completely eliminated.)
Dr. Smiley says the chin implant must be positioned precisely in the middle to achieve proportionate and natural-looking results. Hence, the implant always has a mark in the midline to guide doctors during the implantation process.
In the first few weeks of implantation, a thin scar tissue gradually encapsulates the prosthesis (this happens to any implanted device as the body attempts to contain any foreign material it detects), allowing it to stay in place.
Blepharoplasty with fat transfer is a modern approach in eyelid surgery that ensures natural and youthful results. It diverges from the antiquated technique in which the main focus is to remove the excess skin and fat with little regard to age-related volume loss.
The antiquated technique may cause skeletonized eye socket appearance especially along the lower eyelid. This is particularly true when the fat is entirely removed, leaving no “carpeting” beneath the skin to promote smooth results.
To prevent creating or aggravating the hollowed lower eyelid, Dr. Tarick Smiley of the California Surgical Institute says he often incorporates blepharoplasty with fat transfer. The idea is to create a smooth transition between the lid and cheek, which is one of the key elements of a youthful face.
In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had upper and lower blepharoplasty with fat transfer.
The patient’s upper blepharoplasty was performed to eliminate the hooding of the lid; this was done with incisions made precisely at the existing skin fold to hide the resulting scar. Only a very small amount of skin was removed to preserve the function or “normal blink” and to allow for proper wound closure, which is the key to optimal hidden scars.
While some doctors extend the incision into the crow’s feet, Dr. Smiley keeps it within the natural skin fold of the upper lid to ensure that the scar will remain hidden.
The patient’s lower blepharoplasty surgery, on the other hand, was performed with an incision placed very close to the lower lash line so her eyelashes can hide the resulting scar. The area has a markedly thin skin, which allows the scar to fade better into the background.
Meanwhile, the antiquated technique removes the entire fat in an attempt to remove the under eye-bags; however, this causes hollowness right after surgery or years down the road, as soft tissue volume decreases with aging.
There are several ways to prevent the appearance of hollowed lower eyelid, with fat transfer being the most popular option, says Dr. Smiley.
Other patients can benefit from the repositioning of their superficial fat (fat beneath the skin; this is different from the deeper “bulging” fat that often requires removal), specifically laying it over the upper cheekbone to maintain a smooth lid-cheek junction. Fat grafting or injecting can further fine-tune the results.