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.
The approach to rhinoplasty should be individualized as the goal is to reshape the nose in a way that it suits the face or as if the patient was born with it. Nonetheless, some people remain adamant that they want the nose of their celebrity idols and so bring their “wish pics” during consultation.
In the 70s and 80s, it was fashionable to have a nose with a ski-slope look—i.e., markedly narrow and with a slight upturn tip—which was commonly seen among famous female celebrities at the time. Of course, it rarely gave natural-looking results especially in people of ethnic background.
The patient’s new nose suits her face thanks to a conservative elevation of the tip and a hump reduction.
And even in Caucasian patients, the ski-slope look may not provide the most natural results. This is particularly true for women with elongated face and of “high stature.”
More recently, one of the most common requests is the “button nose” or something that closely resembles Kate Middleton’s. The slight aquiline look is also “fashionable” thanks to the growing influence of Ivanka Trump.
Renowned Beverly Hills plastic surgeon Dr. Tarick Smiley says the ideal nose is not confined by strict beauty standards, although there are some “anatomic benchmarks” based on some complex angles and measurements. Nonetheless, the results should look natural rather than “manmade,” and must complement the patients’ ethnicity, gender, body frame, and ultimately their face. Even the great philosopher Aristotle, who coined the phrase “the whole is greater than the some of its parts,” would likely agree to such idea.
Of course, the person’s cosmetic goals are also of paramount importance. After all, rhinoplasty is a cosmetic, elective procedure in which the goal is to elicit a smile from the patient.
The celebrity plastic surgeon says that many patients today like subtle or moderate improvements—e.g., reduction of the hump, slight narrowing of their tip, conservative augmentation or reduction of the entire nasal profile, etc.—instead of dramatic changes.
Going the conservative route also prevents common problems associated with drastic changes that often warrant over-aggressive removal of the cartilage, which is the framework of the nose. After all, the nose is an organ whose function must be preserved or improved by the surgery lest the patient is not going to be happy regardless of how much the new nose looks good.
When too much cartilage has been removed, the nose may collapse and result in deformity and breathing functions.
Breast implant profile refers to how much it projects off the chest wall. In the past, the only available design was the moderate profile implant, which is now considered the normal or standard projection.
But nowadays, patients have other options that include low, moderate Plus, high, and extra high profile implants.
High profile implants stick out more, giving an illusion of a bigger breast. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that women with a narrow chest are often a good candidate for such design because it occupies just the right amount of space.
Dr. Smiley has recently posted high profile breast implants before and after photos on his Snapchat account to demonstrate its effects on a patient who specifically asked for additional fullness in her upper breast pole.
Prior to surgery, Dr. Smiley performed breast and chest exam to determine the ideal implant profile, size, and shape based on the patient’s underlying anatomies. Of course, the surgeon also interviewed her to identify the aesthetic goals and to explain to her the surgical approach and implant design that could help meet her objectives.
During physical exam, Dr. Smiley used a pair of calipers to measure the breast width and identify any pre-existing asymmetry between the two breasts.
The celebrity plastic surgeon noted the patient’s highly symmetric breasts that had nice overall projections and ample soft tissue coverage, making it easier to achieve natural and balanced results from breast augmentation surgery.
“It is quite unusual to have highly symmetric breasts. For the vast majority of patients, one of the pre-existing breasts is bigger or wider than the other side,” he said in a Snapchat video.
Based on physical exam and consultation, Dr. Smiley decided to use 375 cc silicone high profile implants; these were the perfect choice as the relatively thin patient was more concerned about the upper pole fullness than the actual augmentation.
It should be noted that 375 cc implants would provide just a moderate amount of augmentation, leading to a more proportionate, natural result.
During surgery, Dr. Smiley positioned the silicone implants beneath the pec muscle, which provided additional soft tissue coverage, resulting in a softer feel and a more natural breast contour. This implant placement also reduced the risk of traction rippling and palpability.
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.