Fibrosis from liposuction happens because the body invariably creates scars in the areas where the cannula (or suction tube that removes fats) has passed through. This creates adhesion that results in surface irregularities and firmness, which tend to improve with time.
In a nutshell, most patients can expect smooth results as the scars remodel and soften with time, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley uses gentle liposuction techniques to minimize injury and internal scarring, which is tied to surface irregularities.
However, a small number of patients can have fibrosis that can last for many years (or even permanent) and thus they necessitate some type of revision. The flanks and upper abdomen are areas believed to be susceptible to this problem.
If excessive scars form internally under the skin surface and do not improve with time, subcision can help minimize skin puckering or firmness. This is a rather straightforward procedure in which a special needle is inserted adjacent to the scar and is moved back and forth in a fan-like motion to release the fibrous bands.
Nonetheless, there are ways to prevent aggressive formation of fibrosis, which is tied to contour irregularities and other surgical stigmata. For instance, Dr. Smiley highlights the importance of correct motion when using the liposuction cannula.
- The cannula is moved back and forth in a criss-cross fashion to remove fats uniformly.
- Avoid being too close to the skin. Meanwhile, the cannula must be moved at varying levels to achieve smooth results and to avoid dermal damage, which is tied to excessive scarring or fibrosis.
- Use microcannula, as opposed to large cannula, because it removes smaller bits of fats and causes less amount of trauma.
- Prolonged aspiration in one spot should be always avoided.
Aside from meticulous surgical techniques, the celebrity plastic surgeon says other modalities can further promote smooth results and prevent fibrosis from liposuction. These include the use of good-fitting compression garment for at least two weeks, massage to control swelling, VelaShape, or a combination of them.
VelaShape, which is an FDA approved non-surgical treatment, is particularly ideal after liposuction. This uses a handheld device that improves contour deformities through massage, suction, infrared light, and radio frequency.
Most patients will need 4-6 weekly VelaShape treatments to achieve smoother skin surface following liposuction surgery.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley has recently shared a photo of a patient who had BBL after one year. In general, the surgery’s longevity varies greatly from patient to patient, although most can expect to maintain their results between seven and 12 years.
BBL, which is an acronym for Brazilian buttock lift, typically involves large-volume liposuction to collect fats from multiple donor sites. After they are purified, they are injected into the buttocks and hips at a varying layer to ensure high survival rate of fat grafts.
Dr. Smiley says it is also critical to inject fats not too close to the skin to minimize bruising and swelling. It should be noted that too much swelling results in additional pressure, which is the enemy of high survival rate.
Aside from meticulous surgical techniques, Dr. Smiley says that long-term results also depend on the patient’s commitment, especially in the first three weeks when the fat grafts are in their most delicate stage, as they are still developing their own blood supply and the extracellular matrix, a mesh-like anatomy that integrates the grafts with other tissues, is yet to stabilize.
“In the first three weeks postop, we ask our patients to use medical donut pillow, Boppy, or pregnancy cushion. The goal is to eliminate or at least minimize pressure on the fat grafts, thus allowing them to stabilize in their new location,” he says in a video posted on Snapchat.
“We even teach our patients on how to sit on the back of their legs, as opposed to their buttocks,” he further explained.
To further promote high survival rate, Dr. Smiley says he recommends a “special sleeping position” in the first three weeks postop.
“Pillows are put behind the knees and back to somewhat elevate the buttocks when the patient is in supine position,” he added.
Patient commitment should also include avoiding tobacco products particularly in the first few months postop because they contain nicotine that robs the body of its oxygen, which is the key element to promote high survival rate of fat grafts.
Beverly Hills plastic surgeon Dr. Tarick Smiley has recently shared Brazilian butt lift photos demonstrating a female patient who used to complain about her square buttocks that primarily stemmed from the lack of hips.
It should be noted that patients with square buttocks, or H-shaped backside, also have thick waist line and ultimately poor waist-to-hip ratio. According to studies, there is a strong preference for WHR that is near 0.7, a predilection that is seen across different cultures and socio-economic backgrounds.
(Note: This mathematical ratio is gender specific.)
Interestingly, the 0.7 WHR is seen across different body sizes, height, and weight. From curvier stars such as Beyoncé to lithesome beauties like Natalie Portman, this ratio is seen.
To narrow the patient’s waist, Dr. Smiley performed liposuction (fat removal) around her midsection, particularly focusing on the excess fat along her flanks and lower back that contributed to the flat-looking buttocks.
Then, Dr. Smiley purified the fat before he injected it into the buttocks and hips, resulting in an inverted heart shape backside, which is generally considered to be the most feminine butt shape.
The inverted heart shape butt has a tapered waist line and more fat distribution around the hips and lower portion of the buttocks.
Right after surgery, the surgeon was able to create a WHR of 0.6, which is expected to gradually turn into something near 0.7 after the swelling around the buttocks and hips subside, and some of the fat grafts are resorbed (about 25-30 percent of the original volume).
After 3-6 months, any volume that remains is expected to be near permanent, thanks to blood supply ingrowth.
Meanwhile, Dr. Smiley has warned that any attempt to create a 0.55 WHR and below leads to fake-looking results as this “volume distribution does not occur in nature.”
“What we aim for is the creation of subtle difference with S curves. We don’t want small legs juxtaposing huge buttocks,” he says in the video.
Aside from disproportionate results, the celebrity plastic surgeon has warned that over injection could also predispose patients to increased risk of cellulites, dents, and other surface irregularities, along with risk of sagging appearance.
The key to natural results, aside from the WHR guideline, is to take into account the patient’s anatomy such as the skin elasticity, shoulder width, and height.
Breast implants for thin skin and little soft tissue coverage can pose challenges since there is a perceived higher risk of implant palpability, rippling, and unnatural breast shape. Nonetheless, Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated some surgical techniques and “core principles” that help him reduce such risks.
In Dr. Smiley’s recent Snapchat video post, he performed breast augmentation on a thin, small-breasted patient.
Dr. Smiley generally prefers the peri-areolar incision technique (i.e., a small scar blends into the dark-light skin junction); however, the patient has small areolas, which could make it difficult to conceal the scar, and thus he recommended the submammary fold instead in which the incision was concealed within the natural skin fold.
The celebrity plastic surgeon said the submammary fold incision measured only 3 cm thanks to the use of Keller Funnel technique; this involved a cone-shaped device that was lubricated profusely so the implant could be propelled inside the pocket in just one squeeze.
Because of the patient’s little soft tissue coverage, Dr. Smiley positioned the breast pocket beneath the chest muscle, which provided additional padding to reduce implant rippling and palpability.
Aside from implant placement (relative to the soft tissue layers), Dr. Smiley said natural results are further guaranteed when the implant’s size and dimension reflect the patient’s underlying anatomy, particularly relating to her chest and breast measurement.
Because the patient has a narrow chest wall, Dr. Smiley used high profile implants—i.e., they have narrower base but offer more vertical height—to ensure natural and proportionate results, which were the specific aesthetic goals of patients.
The high profile implants also suit the patient because she wanted additional projection. Furthermore, it complemented her thin frame.
Dr. Smiley warned that implants with lower profile (they have a wider base and project less) may not suit thin patients, particularly if these come with a base dimension that occupies too much space on the chest wall. Aside from higher risk of rippling along the edges of the breast, they could also result in excessive lateral bulge that looks anything but natural.
After ensuring that both breasts look symmetric, Dr. Smiley closed the incisions; the tissue beneath the skin was closed with absorbable sutures to ensure the best scar possible. The skin, meanwhile, was not picked up and instead “sealed” with a surgical tape to make certain that it would receive no or very little tension.
Tummy tuck is one of the most popular body contouring surgeries after massive weight loss. This involves removal of loose skin and fat that hangs from the abdomen; oftentimes, it also combines some type of muscle repair (tightening) to further contour and narrow the waistline.
The tummy tuck incision, which typically runs from hip to hip and is beneath the undergarment, generally takes 3-4 weeks to heal—i.e., all the scabs are gone and so there is no longer risk of wound irritation and infection. At this point, patients can start using scar treatments such as silicone sheets and gels.
TUMMY TUCK RECOVERY PHOTOS
While most of the swelling and bruising are already gone by 2-3 weeks, tummy tuck scars take longer time to “stabilize” or reach its maturity. Oftentimes, they look worst at 4-6 weeks postop due to the reddish color stemming from new blood vessels growing beneath their surface.
And after about six weeks following tummy tuck, the scar appearance starts to improve. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says most scars fade gradually over a period of 12-18 months until they leave a white or silver mark that is barely visible.
Meanwhile, a few patients end up with a less than optimal scar appearance (due to keloids or hyperpigmentation in which the scar is noticeably darker than the surrounding tissue). Laser treatments, medical-grade chemical peels, steroid injections, and scar revision are some of the options that can help improve its appearance.
Two months postop.
While certain risk factors of scar are beyond the surgeon and the patient’s control (e.g., genetic propensity to keloids), some methods remain useful in promoting faded scars; these include the use of scar treatments such as silicone patch or gel, sun protection, and scar massage.
In general, tummy tuck scar should never be exposed to the sun for a minimum of six months to prevent hyperpigmentation.
Scar barely detectable after two years.