Downtime for tummy tuck may differ from person to person, although the general rule of thumb is to take things slow for at least 2-3 weeks. Ideally, patients should take a time off from work during this time so they can focus on rest and avoid stressors, which have been known to delay healing.
As expected, the first few days are the most challenging period; patients need help getting up from a reclined position, and when going to the bathroom as well. Despite decreased mobility, it is highly advisable to walk as frequent as possible to prevent blood clot formation (deep vein thrombosis), to keep swelling to a minimum, and to ultimately promote recovery.
Due to the pulling sensation and discomfort around the midsection, it is not uncommon to walk slightly bent at the waist for about a week postop. But after this period most patients can resume their normal posture.
After 2-3 weeks, patients can gradually increase their physical activities, although anything that involves straining the abdominal muscles and doing rigorous exercise are best avoided for one to three months. People heal differently and so each patient may receive a slightly different postop instructions from his/her surgeon.
Pain and Discomfort
The pain mostly stems from muscle repair in which the pair of abdominal muscles is stitched together to achieve a flatter appearance. However, the amount of tightness and discomfort greatly diminishes by one week.
Because pain is one of the most common concerns of patients, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has started using a new way to control pain: Exparel injection. This drug is injected directly into the muscle during surgery and is expected to provide numbing effects for up to four days.
Exparel has eliminated the need for pain pump, a somewhat cumbersome device that is worn underneath the clothes. It is similar to a balloon with tubes where local anesthetics slowly drip into the surgical site.
Going Back to Work
The ideal time depends on factors such as the patient’s type of work (office vs. physically demanding job), pain threshold, and individual healing. In general, a two-week off will suffice, whereas a three-week vacation is considered as a nice luxury.
At three weeks postop, most patients are back on their feet although it is not uncommon to tire easily or to feel like going to bed earlier than their usual routine. This is expected as their body is still in the process of healing.
The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.
A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.
To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.
The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.
Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.
Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.
Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.
Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.
Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.
Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.
However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”
“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.
When doctors mention 3D facelift procedure, they typically refer to a more holistic facial rejuvenation method, meaning that loose skin and soft tissue laxity is not the only thing addressed, but also the fat or volume loss.
As a stand-alone procedure, facelift tightens the skin and elevates the deeper structures of the soft tissue, bringing them closer the skeleton. While this mechanism creates a tauter appearance, it does not address facial volume loss; in fact, it may even aggravate the gaunt visage.
The patient has received facelift combined with structural fat grafting. Hence, at one year postop her appearance remains youthful and attractive.
To address the inherent problem of facelift, leading Beverly Hills plastic surgeon Dr. Tarick Smiley often combines it with structural fat grafting. It starts with collecting small amounts of fat from tummy or thigh (or any area that carries excess fat), filtering out any biomaterial aside from fat cells and stem cells, and then injecting them into the soft tissue.
By incorporating structural fat grafting, doctors are able to create a more youthful dimension—i.e., there is adequate plumpness commonly found in young faces—which is the main advantage of 3D facelift procedure over the standard approach.
3D facelift procedure also prevents the classic signs of facelift, which include abrupt lid-cheek transition and flatness of the cheeks. Moreover, this new approach can smooth out deep laugh lines and hide the pre-jowl sulcus, which is the dip on each side of the chin.
Furthermore, fat grafting has been tied to improvement in skin texture, one of the auspicious benefits of using fats that are naturally infused with stem cells, which are known for their rejuvenating effects; they have also been found to increase the survival rate of grafts.
Any amount that survives after 2-3 months is expected to be near permanent or at least 12-15 years, as suggested by Dr. Smiley.
In addition to structural fat grafting, facelift may also be combined with other procedures such as neck lift, brow/forehead lift, eyelid surgery, and chin implant. The idea is to create a more congruent result that is less susceptible to gravity and aging.
Breast augmentation transaxillary refers to the creation of a hidden incision at the deepest skin fold of the armpit, thus allowing the surgeons to propel implants into the breast pocket.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says breast augmentation transaxillary is one of his favorite incision techniques, along with the peri-areolar method (or “through the nipple”), due to the well-concealed scar.
The breast augmentation transaxillary incision technique results in a well-hidden scar.
Aside from the well-concealed scars, Dr. Smiley says the incision technique offers other advantages such as perceived lower risk of infection, implant contamination, nipple numbness, and breastfeeding difficulty.
The benefits of this technique stem from the fact that the implants will not pass through the milk ducts, which are known to harbor staph bacteria.
But as with any breast augmentation technique, Dr. Smiley says the ideal candidate candidate should have aesthetic goals and breast anatomy that are in line with what the transaxillary incision can accomplish.
- Women whose breasts are relatively symmetric and perky.
Since there is no direct incision on the breast, there is no way that the surgeon can elevate or transpose the sagging breast tissue. Hence, the technique is only reserved for women whose pre-existing bosom has a relatively good shape and projection.
Meanwhile, patients with sagging or pendulous breasts and those with deformity (e.g., tubular or torpedo breasts) are not good candidates for the “through the armpit” technique.
- Patients who asking for moderate-sized silicone implants or saline implants of any size (provided they are within the breast/chest dimension).
It is important to note that silicone implants are always prefilled, while saline implants are propelled into the breast pocket empty (they are rolled up like a cigar) before they are inflated with sterile saltwater.
Hence, extra large silicone implants (or 600 cc and higher) require longer incision than that of saline implants, which of course makes it difficult or even impossible to hide the scar within the armpit.
Nonetheless, most patients today prefer silicone implants due to their softer, more natural results than saline implants. For this reason, Dr. Smiley typically uses Keller Funnel during surgery to ensure that the scar remains relatively short and well concealed within the armpit.
Keller Funnel is a disposable device that closely resembles a piping bag. This is used to propel the silicone implant into its pocket with one squeeze and so the implantation process is quicker and less traumatic to the tissue. Furthermore, doctors are able to use a shorter incision with this technique.
- Patients with a strong history of keloids.
Several studies have suggested that darker skin is susceptible to keloids; hence, ethnic patients tend to choose breast augmentation transaxillary since the incision is placed in this hidden area, which is also known for being highly resistant to aggressive scarring.
Aside from ethnic patients, younger women (i.e., Millenials) often find it unacceptable to have scars on their breast and so they typically inquire about the possibility of placing the incisions within their armpit.
It may sound like a paradox, but the results of brow lift surgery primarily depend on the final shape, as opposed to the amount of elevation. In fact, lifting the eyebrows a few millimeters than intended can lead to a perennially surprised or quizzical look.
Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley focuses more on improving the shape of the brow to achieve a more rejuvenated and youthful appearance without the dreaded classic signs of plastic surgery.
Several factors determine the ideal brow position and shape; these include the patient’s gender, ethnicity, and facial features. Nonetheless, certain “templates” or universal beauty standards do exist. For instance, female brows have a more arched appearance and more height compared with male brows.
Male brows, meanwhile, are more horizontally oriented and have less height—i.e., most of the bulk lies at the same level as the bony rim of the eye socket, or sometimes even slightly below this margin. But in female brows, they are deemed more attractive and youthful when they rest above this border.
Studies have shown that it is quite rare for patients to experience complete brow descent. In many cases, only the tail end or lateral aspect of their brow sags, while the medial or inner aspect remains barely unchanged despite advancing age and gravity.
However, inexperienced surgeons and antiquated techniques often elevate the entire brow, which almost always leads to unnatural effect. Sometimes, patients have no choice but to wait several years for their soft tissue to relax, ultimately reducing the effects of their botched surgery. Hence, Dr. Smiley emphasizes the importance of getting the surgery right the first time.
While the amount of elevation and the ideal shape will depend on several variables, Dr. Smiley says that female patients generally benefit from lifting the lateral or outer brow to resume a more arched appearance. The same principle also applies to male patients, although the lift should be done in a more conservative manner to avoid feminizing their face.
When reshaping the female brow, it should be noted that the apex of the arch should be at the same level as the lateral or outside border of the axis to ensure natural-looking results.
The trichophytic brow lift is a new technique which does not alter the height of the hairline.
The success of brow lift will also rely on the scar placement, which depends on the incision technique. The standard method uses an incision that goes from ear to ear, a few millimeters above the hairline and so the hair conceals the resulting scar.
But the standard brow lift technique has an inherent problem: It elevates the hairline by about half an inch since doctors are forced to remove tissue from hair-bearing skin. Consequently, patients with a wide forehead may end up aggravating this appearance.
A new technique called trichophytic brow lift solves the intrinsic problem of the standard method since it uses incisions made precisely at the hairline and so the resulting scar blends into the background.