Lip lift procedure elevates the upper lip, which in turn creates a shorter distance between the nose and the [vermilion] border of the upper lip. Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has performed the surgery, which was posted on Snapchat.
The patient shown in the video did not like the expansive distance between her nose and upper lip, which prior to surgery was around 2 cm. For females, the ideal length is usually 1.1-1.3 cm, while for men it is slightly longer, about 1.3-1.5 cm.
Dr. Smiley says there are two ways to perform the upper lip lift: the first one involves placing incisions inside the mouth in order to “roll up” the upper lip, while the second technique entails the use of external incisions at the base of the nose to shorten the space between it and the lips.
Since the patient required extensive reduction the intra-oral (inside the mouth) technique would not suffice.
During surgery, Dr. Smiley created incisions at the base of the nose to remove a small strip of skin and tissue (measuring 0.4 cm). In the process, the upper lip has been elevated and so now the teeth are slightly visible in frontal view.
Elevating the upper lip has also increased the pink part or volume of the lips.
This incision pattern results in a hidden scar as it lies precisely at the natural skin fold of the nose.
After removing the excess skin and tissue, Dr. Smiley closed the wound in a way that the scar would settle precisely at the skin folds of the base of the nose to hide it from view.
Meanwhile, the surgery was performed under local anesthesia, which could pave way for shorter downtime.
After recovery from upper lip lift, patients may opt for lip filler (fat injection or dermal fillers) to further improve their volume and shape. It should be noted that lip augmentation, especially with over-zealous injection, tend to provide unnatural results (duck lip appearance) if there is too much space between the nose and the upper lip.
Dr. Smiley has explained the general rule of thumb to ensure natural results from lip fillers:
- There should be a 1.0-1.6 ratio in terms of volume distribution and height between the upper lip and lower lip (phi or golden proportions).
- The outermost corners of the mouth should have very little volume. Over-injection to this area results in unnatural lip contour.
- The volume of the lips gradually increases as it goes towards the center.
- To avoid the appearance duck lips, the philtrum (two columns right above the upper lip) is occasionally filled in.
Breast reduction with lift accomplishes two goals: shrink the breasts to make them more proportionate to the body, and improve their shape by elevating some of the tissue of the lower pole.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says breast reduction and breast lift have different goals, the former is often considered a medical necessity (to eliminate systemic discomfort that comes with overlarge, heavy breasts), while the other is viewed as a purely cosmetic procedure. Nonetheless, it always makes sense to combine them as they share the same incisions.
Dr. Smiley works on one breast first before operating on the other side. The goal is to create a nice template so both sides will have a good level of symmetry.
In a recent Snapchat video, Dr. Smiley says large, heavy breasts are almost always pendulous.
Dr. Smiley has recently performed breast reduction with lift on a patient. He also did a simultaneous areolar reduction to further ensure more proportionate and natural results.
Due to the significant breast ptosis (droop), Dr. Smiley elevated the nipple area by around 7 cm. The goal was to create a decent distance between the areola and the submammary fold; of course, the ideal distance primarily depends on the final breast size.
But before he was able to elevate the nipple, he removed the epidermis of the skin, a process called de-epithelialization. He was careful not to go deeper (ensuring that the dermis remained relatively intact) to minimize bleeding and to prevent inadvertent injury to the blood vessels.
By preserving most of the blood supply, Dr. Smiley says the risk of infection and healing problems is significantly reduced. Of course, lab screening prior to surgery is also critical to ensure that the patient is “healthy enough” to tolerate the operation and its ensuing recovery, he further explained.
Thereafter, he removed some breast tissue to reduce its size before elevating some of the lower pole tissue to give the patient more upper pole fullness and to correct the drooping appearance.
Instead of relying on skin tightening, Dr. Smiley says his breast reduction with lift depends more on internal lifting to ensure that the results can resist the effects of gravity and progressive aging.
After reshaping the internal structure of the breast, he closed the anchor-shaped incisions with multiple rows of sutures. The actual skin, meanwhile, was not included in the process and instead its wound edges were just allowed to “kiss” each other, similar to a jigsaw puzzle, to promote the best scar possible.
Reducing tension on the skin is the key to thin, faded scars, says Dr. Smiley.
Many people are curious about tummy tuck results after one year, particularly pertaining to issues such as scar appearance, flatness of the anterior abdomen, and over all contour of the midsection.
Renowned Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos on Snapchat showing one female patient who had tummy tuck about a year ago. Upon closer inspection, the scar has healed and faded nicely into the background.
Tummy tuck after one year
At one year postop, the tummy tuck scar has faded and flattened out considerably. However, some patients may notice that it looks a bit pink or slightly darker than the surrounding skin, which typically improves over time.
After two years, most scars have fully matured that they appear thin and silvery in color and thus barely imperceptible.
Tummy tuck scar after one year
Meanwhile, Dr. Smiley says tummy tuck renders lasting results provided that the patient has maintained a stable weight through healthy diet and exercise.
Patient commitment before the surgery also plays a critical role in the final results. For instance, avoiding tobacco products at least three weeks before tummy tuck and another three weeks thereafter is one of the keys to promote favorable scar and optimal healing.
Studies have shown that smokers are not just at an increased risk of poor healing and skin necrosis (death of skin tissue), but they are also susceptible to poor scarring.
Of course, the long-term results of tummy tuck also depend on how meticulous the doctor is during surgery.
Dr. Smiley says he almost always performs muscle repair at the time of tummy tuck. This involves the use of permanent sutures to tighten the fascia overlying the separated pair of muscles that runs between posterior sternum and the area above the pubis.
The celebrity plastic surgeon says the suture right above the navel must be extra strong to prevent breakage, which can lead to unsightly bulge that can detract from the flat tummy.
Despite the use of permanent sutures, Dr. Smiley says that patients can nonetheless enjoy a safe pregnancy because the abdominal muscle will simply expand to accommodate the growing baby.
Revision tummy tuck is generally more complex than the initial surgery due to the presence of old incision lines and scar tissue. Oftentimes, the patients also have some type of navel deformity, contour asymmetry, and residual excess skin, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate revision tummy tuck performed on a male patient.
A few years ago the patient underwent tummy tuck performed by a different surgeon. But instead of achieving a more masculine physique, the surgery left him with unnatural-looking navel (too big and round), visible asymmetry along his flanks, and high-riding and indented scars.
Aside from revision tummy tuck, the patient also asked for a simultaneous breast reduction to make his chest area congruent with the abdomen.
To conceal the high-riding tummy tuck scar beneath the patient’s underwear, Dr. Smiley created a new incision line (hip to hip) that was positioned very low that it settled within the groin and pubic hairline.
Through the new incision placement, he was also able to eliminate the appearance of indented scar by removing the residual loose skin. Furthermore, he removed more skin along the right flank to eliminate the contour irregularity.
Meanwhile, the celebrity plastic surgeon also performed navel repair, particularly with the intent to reduce its size and change its shape. He said that a natural-looking belly button has a more vertically oriented contour, as opposed to having a perfectly circular shape.
During navel repair, he placed the incision inside the belly button’s rim so the scar will remain imperceptible.
Afterwards, all the incisions were closed by multiple rows of stitches to promote the best scar possible. The skin, meanwhile, was not picked up by any suture and instead a surgical tape held its edges together to reduce superficial tension.
“The key to faded and favorable scar is to eliminate most of the tension on the skin,” says Dr. Smiley.
Dr. Smiley also injected Exparel directly into the abdominal muscle; this is a long-acting numbing medication that works for up to four days, thus allowing the patient to avoid or at least limit his use of narcotic pain relief.
Stem cell facial fat transfer has transformed how plastic surgeons approach facial rejuvenation. In the past, doctors focused on pulling and tightening the loose skin and other soft tissues with no or very little regard to age-induced soft tissue shrinkage.
The caveat of a facelift-alone approach is its tendency to aggravate facial volume loss as it entails lifting and bringing the soft tissue closer to the bone. Before fat transfer has become a well-established procedure, surgeons resorted to dermal fillers and facial implants.
The fat cells (light colored material) float to the surface, while stem cells (they are more vibrant colored) settle to the bottom of this tube.
Compared to other facial “volumizers,” fat transfer is perceived to provide superior results because it uses the most natural material: the patient’s own fat.
Prominent Beverly Hills plastic surgeon Dr. Tarick Smiley says that fat is naturally abundant with stem cells, which are dynamic cells that can transform themselves into other cell types (fat, skin, muscle, etc.). Doctors first noticed their remarkable healing effects when injected into non-healing wounds.
In his recent Snapchat post, Dr. Smiley has explained how stem cell-rich fats are collected.
Dr. Smiley often collects donor fats from the tummy. In small recipient areas such as the face, only a few teaspoons of purified fat are needed to restore the lost volume.
Purification is done with a use of centrifuge, a device that separates red blood cells, fat cells, and stem cells based on their weight. Being the heaviest biomaterial, the red blood cells settle to the bottom of the tube and are drained out.
Fat cells, being the lightest material, float to the surface. Meanwhile, right below them is a relatively thin layer that plays a critical role in facial rejuvenation surgery: the stem cells.
The fat cells and stem cells are injected into multiple layers to ensure high survival rate of fat grafts (70 percent or more). The injection technique called “microdroplet” ensures that the grafts occupy larger surface area in order to promote better blood vessel ingrowth.
“Without blood vessel ingrowth, the body will just absorb the fats. We don’t want this as our goal is to achieve near permanent results,” says Dr. Smiley.
A properly executed stem cell facial fat transfer, says Dr. Smiley, can last between seven and 12 years, depending on the person’s “pace of aging.”
Because the fat grafts “behave” like the local fat and other adjacent tissues, they feel natural. Cheek implants, meanwhile, may only appear natural in the first few years but has the tendency to look “done” as the soft tissue continues to experience atrophy or shrinkage.