Buccal fat extraction aims to slim a markedly rotund face by reducing the cheek fat pad. However, the buccal fat in the cheek region should not be entirely removed because years down the road an overly aggressive approach can lead to a very gaunt countenance.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate this procedure performed in a female patient with a markedly plump face due to her chubby cheeks and “heavy” neck.” Hence, she was also deemed as a good candidate for neck liposuction.
Prior to surgery, Dr. Smiley examines the facial anatomy of the patient whose face is markedly full due to her chubby cheeks and heavy neck.
Dr. Smiley first performed neck liposuction with a creation of a small round incision beneath the chin, specifically within the skin fold for optimal scar concealment.
The surgeon performed neck liposuction with microcannula, a hollowed steel probe used to remove the fat. However, he made sure to leave behind a layer of fat to conceal the platysma muscle; going the conservative route also made sense to anticipate the progression of age-induced facial volume loss.
After suctioning the excess fat in the neck area, Dr. Smiley proceeded to buccal fat extraction with the creation of a small intra-oral incision on each side of the cheek. No external incision was used and so the risk of visible scar was eliminated completely.
Dr. Smiley said the intra-oral incisions should avoid the submandibular duct and the salivary glands to prevent excessive swelling and other complications.
The patient receives buccal fat extraction and neck liposuction for a more balanced result.
During the creation of incisions, the celebrity plastic surgeon used a cautery device, which also sealed off the blood vessels and tissues, resulting in minimal bleeding and ultimately shorter recovery.
Instead of removing the entire buccal fat pad, he just reduced its size in order to slim the face without making it look too gaunt and unhealthy. As stated earlier, conservative removal has always remained safe and “predictable.”
While the results of buccal fat extraction with neck liposuction are often immediate, the final outcome takes 1-3 months as the residual swelling takes a while to subside.
Patients with aging countenance face this common dilemma: What works better, Botox or facelift?
One should realize that facial aging is a multifaceted process. The skin sags and thus creates jowling, the cheek fat pads deflate leading to a gaunt look, the face experiences soft tissue atrophy or shrinkage that results in the appearance skeletonized eye socket and concave temple, and the wrinkles become more prominent, says renowned Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that Botox and facelift work differently in erasing or at least minimizing the signs of facial aging. Botox paralyzes the muscles responsible for the appearance of dynamic wrinkles, while facelift surgery elevates the skin, fat, and soft tissue all as a single unit.
Occasionally, Botox is used to paralyze the muscle that is pulling down the brow, allowing the one responsible for elevating it to work more efficiently.
Botox, whose effects typically last 3-4 months, appeals to male patients who generally dislike going under the knife and the ensuing recovery. This approach also suits people who cannot afford the prolonged downtime of surgery.
However, Botox cannot improve a markedly sagging skin, which entails facelift. Also, this non-surgical treatment cannot reposition the drooping cheek fat pad nor improve the soft tissue deflation that comes with aging.
Facelift is generally the ideal choice for patients with more advanced signs of facial aging. Nonetheless, Dr. Smiley says that individuals as young as 45 can be a good candidate, particularly if they are seeking for subtle improvements and want their surgery to be “discreet.”
Postponing facelift until one has full-blown facing aging can lead to discernable and drastic changes that refuting surgery would be impossible. Hence, some “younger patients” resort to mini facelift and then undergo minor touch-ups down the road to maintain their youthful appearance in a more discreet manner.
Today’s facelift is commonly performed with fat grafting or injection, a critical component in holistic facial plastic surgery. This complementary procedure prevents surgical stigmata such as gaunt cheeks, abrupt lower lid-cheek transition, and overall pulled appearance.
Hence, facelift with fat injection is dubbed as 3D facelift surgery because it not just corrects soft tissue descent (i.e., skin sagging) but also loss of facial volume.
Selfies and social media are driving the popularity of lip augmentation, as people nowadays see their online photos regularly and might feel the pressure to always look good, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
In 2015 alone, about 27,450 lip implant surgeries were performed in the US. On top of that, lip fillers accounted for a large percentage of the 9.2 million facial injection procedures, according to data released by the American Society of Plastic Surgeons.
This patient receives lip augmentation via Restylane, an FDA-approved filler commonly used to correct facial volume loss.
Dr. Smiley says that the vast majority of patients today desire for a more natural look, which can be achieved when there is a profound understanding of what constitutes an ideal “pout,” which of course is determined by gender factors and the pre-existing facial features.
And despite varying views on the ideal lips, Dr. Smiley says that recent studies have shown that most people found attractive “pouts” had their the lower lip about two times bigger than the upper lip. Also, female lips that took up about 10 percent of the lower third of the face scored higher in terms of attractiveness.
While most lip augmentation patients are women, there has been a significant increase in the number of men seeking some type of lip enhancement procedure. This new trend has a ramification—i.e., surgeons should understand the subtle but key differences between attractive female lips and male lips.
For instance, lip augmentation involving men should not create a well-defined “Cupid’s bow” shape; however, a slightly prominent bottom lip sulcus (dip) is perceived to be attractive. Also, a one-to-one lip corners ratio is desired to prevent feminine-looking lips.
Another “beauty” parameter, according to a recent study conducted by German researchers, is that female lips have a lower ratio between the lower vermillion height (lower lip) and the chin-nose distance than attractive male lips. This means that attractive female faces have a bigger “pout” in relation to the lower third of their face compared to men.
While several studies have pointed out that lips play a crucial role in the perceived facial attractiveness, Dr. Smiley says that other features also have their influence, adding that the “attractive faces are greater than the sum of their parts.”
Trends in breast augmentation are greatly influenced by media, social and cultural-based beauty standards, and prevalent lifestyle. Nonetheless, all efforts are made to create results that will satisfy the patients on a long-term basis.
While some trends in breast augmentation come and go, there remain some well-entrenched guidelines that aim to promote patient safety. For instance, board-certified plastic surgeons only use FDA-approved breast implants whose manufacturers are mandated to participate in longitudinal studies to further determine the safety and long-term effects of their medical products.
Liposuction collects fats from multiple donor sites. Then, these are purified and injected into the breasts to prevent implant wrinkling and palpability and other surgical stigmata.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that a growing number of breast augmentation patients today are choosing a more conservative implant size, leading to a more natural proportion.
The conservative implant size range is also becoming popular as more women these days follow a healthy, active lifestyle. In the past, it was not uncommon for patients to ask for significant augmentation (i.e., bigger than D cup) even though the size would not match their physique.
Some patients are more concerned about the breast shape than the size, making them an ideal candidate for conservative-sized implants. A survey published in Evolution and Human Behaviour has suggested that while men’s preference in breast size greatly varies, almost everyone agrees that no matter what the size is, the aesthetically pleasing ones are always “perky.”
Hence, many breast augmentations today are performed concurrently with mastopexy (i.e., breast lift). The idea is to correct the droopy appearance and the insufficient “cup size” in one surgery.
And since there is a strong inclination to natural-looking results, many surgeons nowadays complement breast augmentation with fat grafting or injection. The idea is to create additional soft tissue padding to further conceal the implant edges, resulting in softer feel and more teardrop breast contour.
Nonetheless, fat grafting is rarely used as a primary method in breast augmentation, although many surgeons believe that it is a powerful supplemental tool in order to make the results more natural.
A simultaneous fat grafting is often warranted if the patients have very poor cleavage and little soft tissue coverage. Some women with pre-existing deformities (due to previous surgeries or congenital defects) can also benefit from this supplementary procedure.
BBL surgery, also referred to as Brazilian butt lift or butt augmentation via fat injection, is a two-step body contouring surgery. Doctors first perform liposuction on multiple donor sites (e.g., lower back, flanks, bra rolls, and tummy) to collect large volume of fat, which is then processed and injected into the patient’s buttocks and hips.
While bruising is a normal part of recovery, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that all efforts are made to minimize this postop symptom to promote high survival rate of fat grafts.
Dr. Smiley recommends the use of compression garments for at least eight weeks. The idea is to control the swelling in the liposuction sites and to help remodel the tissue in the recipient site or buttocks.
Postop bruising happens when blood from ruptured capillaries or small blood vessels leaks out under the skin, resulting in a red or purplish mark that turns into green or yellow discoloration as the patient moves forward to her recovery.
In a recent Snapchat video, Dr. Smiley says that too much bruising causes “excessive pressure and tension, which is not good for the fat grafts.”
One way to control the amount of postop bruising and swelling, Dr. Smiley says, is to use gentle and correct fat injection technique; this also ensures high survival rate and smooth, natural contours of the buttocks and hips.
“It is important to inject fats in multiple layers of the muscle and subcutaneous tissue, and in a way that separate containers are being created. This technique results in less bruising and allows the buttocks to take more fats. About 70 percent is expected to survive long term, provided that fat injection is done in a highly meticulous manner,” Dr. Smiley says.
Aside from meticulous fat injection, the celebrity plastic surgeon highlights the importance of using medical grade compression garments, which are typically worn for eight weeks. The idea, he says, is to keep the swelling and bruising to a minimum, and ultimately to promote healing and smooth results.
The garments worn around the buttocks are designed to provide minimal compression, as too much pressure may “kill the fats” and lead to less than optimal results; however, the garments for the liposuction sites are usually tauter to control swelling and to prevent edema (fluid formation) beneath the skin.
While compression garments can aid in healing, Dr. Smiley says that most patients can see the final results about six months after surgery, as it takes a while for the skin to fully shrink-wrap to the new contour and the residual swelling from the tumescent fluids to subside completely.
The success of Brazilian buttock lift surgery largely depends on how meticulous the surgeon is during physical exam and consultation. The goal is to identify the patient’s pre-existing anatomy and ascertain her aesthetic needs, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
In Dr. Smiley’s recent Snapchat video post, he demonstrated a patient with noticeable asymmetry between her left and right hips, poorly projecting buttocks, and excess fat along her flanks and lower back that further “concealed” her derriere.
Prior to surgery the left hip appears flatter compared with the right hip. Furthermore, the patient has pre-existing surface irregularities, which must be addressed at the same time as the surgery.
Dr. Smiley says it is critical to identify any pre-existing asymmetry prior to surgery to customize the procedure and achieve the most balanced results possible. For instance, the patient’s left hip was significantly flatter in comparison to the right side. Furthermore, her oblique and profile view showed that the buttocks were almost at the same level as the lower back.
Prior to surgery, the patient’s buttocks are flat that they are about the same level as the lower back.
During physical exam, Dr. Smiley also assessed the patient’s skin quality, particularly its elasticity and shrinkage, an anatomical aspect that would help him determine how much fat volume the buttocks could carry without resulting in sagging appearance or other surgical stigmata.
The pre-existing skin elasticity would also determine how much fat volume that could be harvested from the donor sites without predisposing the patient from surface irregularities and other telltale signs of liposuction.
“The skin of the liposuction or donor sites should be able to retract or shrink nicely. This is possible when the surgeon is able to assess the patient’s skin shrinkage,” says Dr. Smiley.
For the vast majority of patients, Dr. Smiley says the lower back and flanks “carry a large amount of excess fat, which makes them a great donor site,” adding that contouring them creates a more feminine “S” curve and a smoother transition between the back and upper buttocks.
Aside from the lower back and flanks, the celebrity plastic surgeon also collected fat from the patient’s “bra rolls” and tummy, areas that often carry excess fatty tissue as well.
Dr. Smiley allocated about one-third of the fat volume into the outer-lateral side of the buttocks, since the patient requested for curvier hips, while the rest was injected to improve the buttock’s profile.