Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.
Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.
The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.
Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.
After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.
In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.
Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.
“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.
When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.
Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.
The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.
But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.
The surgeon’s eyelid surgery before and after photos can shed light on his artistic skills, which play a critical role in any facial plastic surgery. Hence, a prudent patient should insist to view this material before scheduling her surgery.
The before and after photos should have no classic surgical stigmata such as skeletonized eye socket, abrupt lower lid and cheek transition, unnatural height of the upper lid, retracted skin lid, and visible scar.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video demonstrating a patient who has had upper and lower eyelid surgery to correct age-induced skin and soft tissue laxity. To achieve a more natural and more youthful result, he combined the procedure with fat transfer.
Lower Eyelid Surgery with Fat Transfer
The idea of fat transfer, also referred to as fat injection and structural fat grafting, is to create a smooth transition between the lower lid and cheek. Occasionally, a lower lid-alone approach can create or worsen the appearance of tear trough, a problem best avoided when fats are injected beneath the skin to serve as padding.
While the superficial fat beneath the lower lid skin tends to shrink with aging, the deeper fat behaves differently: It becomes more prominent and saggy, leading a crescent-shaped bulge. Hence, the right surgical maneuvers reverse these age-induced effects.
The deeper lower lid fat is often removed or reduced during surgery to correct lid herniation or “bagginess.” This is typically followed by fat injection beneath the skin to create a smooth lid-cheek transition.
To further create a smooth lower lid and eliminate the crepe-like appearance, during surgery Dr. Smiley removed a small amount of excess skin with the use of a thin incision placed very close to the lower lash margin. This is expected to heal into a thin scar that is invisible at a conversational distance.
Upper Eyelid Surgery
The patient also received upper eyelid surgery to eliminate the hooding and fullness of the lid-brow complex.
“I placed the incision inside the new skin fold to hide the scarring,” Dr. Smiley said in the video.
The incision allowed Dr. Smiley to remove the excess skin and fat that was causing the “heaviness” and drooping of the upper lid. However, he made sure that sufficient fat pad would remain after surgery to avoid the skeletonized appearance, which in any way does not look youthful.
The skin excision aspect was also done in a highly meticulous manner to preserve “normal blink” and to ensure that the “new” upper lid would have a height that is consistent with the patient’s facial feature, gender, and race. For instance, female Caucasians often have a lid crease height that is between 8 and 12 mm; this generalization does not apply to men and other ethnicities.
A holistic facial rejuvenation surgery is typically a combination of facelift and structural fat grafting. Ocasionally, eyelid surgery, forehead lift, neck lift, and/or liposuction are combined to achieve a more natural and more “consistent” result. Combination procedures are particuarly common in patients 55 years and older due to their advanced facial aging.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has presented photos of two patients to demonstrate natural-looking results from facial rejuvenation surgery.
Patient no. 1 before and after photos
Patient no. 1 has received deep plane SMAS facelift and neck lift, a technique that pulls the skin, connective tissue, fat, and muscle as a single unit. The deeper structures need to be tightened and elevated before any excess skin is removed.
The SMAS layer beneath the skin is relatively thick and heavy, and so any facelift technique which does not address this deeper structure leads to short-lived results, overly tight appearance, and poor scarring due to the tension on skin. Hence, Dr. Smiley says he does not perform skin-only lift.
Dr. Smiley incorporated neck lift to ensure that it would not detract from the more youthful and tighter face. He positioned a small incision beneath the chin, specifically within the natural skin fold for optimal scar concealment, to tighten the separated platysma muscle that was causing the visible neck bands.
Despite the tightening effects of facelift, it has one major caveat: There is a reduction in the anterior dimension of the face as the soft tissue rests closer to the bone.
To counteract this untoward side effect of facelift, Dr. Smiley says structural fat grafting is typically combined with the surgery. The idea is to restore the youthful fullness.
For this particular patient, fat grafting was used to restore the fullness of the mid face, leading to the appearance of more prominent cheeks, which is one of the critical emblems of youth.
Patient no. 2 before and after photos
Patient no. 2 has also received deep plane SMAS facelift and neck lift due to the extent of her facial sagging. But to truly create “consistent results,” Dr. Smiley also performed a simultaneous upper eyelid surgery, or blepharoplasty.
Her blepharoplasty was performed with the use of small incision placed precisely at the skin fold so the scar could blend into the background. Afterwards, the excess “hooding” skin was removed, leading to more alert, more youthful eyes.
To prevent an abrupt transition between the lower eyelid and cheek, which is one of the most common facelift stigmata, Dr. Smiley injected fat into the “junction” to create smoother results.
And to eliminate the patient’s severe jowling, he pulled the skin at a 45 degrees angle, which is the correct vector of pull. Any direction otherwise can lead to skin pleating along the lateral neck, flat cheeks, and “lifted” appearance.
Tummy tuck on large belly poses some unique challenges, which should be recognized prior to surgery to achieve the best results possible and to avoid or at least minimize the incidence of complication.
To shed light on the effects of tummy tuck on large belly, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos and photos of a female patient who had this anatomy.
Before and after photos of a patient with large redundant abdominal skin and fat rolls along her flanks and back—“cosmetic” issues addressed during surgery.
Aside from the apron-like abdominal skin, the patient also had “bra and back rolls” caused by excess superficial fat, which sits close to the skin. This is different from the deeper visceral or intra-abdominal fat that is linked to obesity and so the only way to eliminate it is through weight loss.
To eliminate the fat rolls along the flanks and upper and lower back, Dr. Smiley performed liposuction prior to the creation of tummy tuck incision.
“I always perform liposuction along the flanks first so I would know how much skin to pull and tighten during tummy tuck,” he said.
During liposuction, Dr. Smiley created several small puncture wounds where a hollowed tube called cannula was inserted and used to break up and remove the superficial fats responsible for the “unsightly rolls” that are more apparent in tight clothing.
Afterwards, the celebrity plastic surgeon created a flank-to-flank tummy tuck incision that was made very low, slightly below the pubic hairline, so “the resulting scar is hidden by the patient’s underwear.”
Dr. Smiley said bleeding is one of the issues in tummy tuck and so all efforts are made to minimize it.
“I pre-treat the abdominal area. Epinephrine is injected prior to the creation of tummy tuck incision; this is a drug that constricts the blood vessels to reduce bleeding,” he explained.
Keeping the patient’s blood pressure relatively low, which is possible because of general anesthesia (administered by board-certified anesthesiologist), also contributes to less bleeding and reduced risk of large fluid imbalance, Dr. Smiley added.
Dr. Smiley measures the thickness of the apron-like skin he removes during tummy tuck surgery.
In his previous Snapchat posts, Dr. Smiley said he only works with board-certified anesthesiologist to ensure patient safety.
(Note: Anesthesiologists not just administer numbing medications and sedatives; they also monitor the patients’ vital signs such as blood pressure, oxygen level, and heart rate during surgery.)
Meanwhile, Dr. Smiley removed a chunk of excess skin and fat that almost reached the patient’s knee; it also had a thickness of about 2 inches.
After removing the excess skin and tightening the abdominal muscle, he closed the wound in several rows so the skin would receive no or very minimal tension, which is the key to “favorable” scar, he said.
Brazilian buttock lift is basically a butt augmentation through fat injection. It always starts with liposuction to harvest unwanted fat from two or more donor sites; this critical step contributes to the more holistic contouring effect of this technique compared with butt implant surgery.
Buttocks come in different shapes and sizes, which to some extent affect the results of Brazilian butt lift. Simply put, the right candidates have cosmetic goals that are in line with what the surgery can accomplish.
The patient has square-shaped buttocks and poor waist-to-hip ratio, which Tarick Dr. Smiley improves with meticulous Brazilian butt lift.
The surgery has a certain appeal to women with square-shaped buttocks, which lead to a less feminine figure. Studies have all pointed out the most ideal female physique has a waist-to-hip ratio of 0.7, meaning the waist circumference accounts for 70 percent of the hips measurement.
The preference for 0.7 WHR is seen across all cultures; even the world’s best artworks depict women with this physique, or more commonly referred to as an hourglass figure.
Women with square-shaped buttocks have poor WHR due to their thick waist, narrow hips, and flat buttocks.
Liposuction can reduce the waist circumference, although it is critical to pay closer attention to the flanks and lower back to create a smooth inward slope. Despite the relatively thick waist, a good number of patients with square buttocks have less dispensable fat in the area. Hence, other donor sites might be considered such as the upper arms, bra rolls, and thighs.
For “average built” patients, at least 800 cc of fat on each butt is needed to see a notable improvement.
But even with large fat volume collected by liposuction, the elasticity of butt skin will still determine the degree of augmentation. A skin that is too tight resists large expansion, and too loose the patient runs the risk of sagging appearance and cellulites if over-injection has been performed.
Over-injection must also be avoided because of the increased risk of skin surface irregularities. This applies to every patient, regardless of the “starting” butt shape and size.
Despite the anatomical roadblocks facing patients with square-shaped butt, in the vast majority of cases Brazilian buttock lift can still provide impressive contouring effects provided that the surgeon is meticulous during patient selection and is adept in the surgery, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.