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.
During a secondary liposuction surgery of the same area, plastic surgeons deal with more challenges due to the scar tissue created by the previous surgery.
Scar tissue forms within the fatty layer that has been previously suctioned through a liposuction cannula, a slender steel probe attached to a vacuum pump. Hence, during a revision surgery the area is very “tough,” making it more difficult to move the instrument back and forth.
A secondary liposuction surgery is performed to correct the unsightly rolls and contour irregularities caused by a previous liposuction. Afterwards, the patient receives BBL surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a female patient who underwent secondary liposuction surgery that was shortly followed by Brazilian butt lift or BBL.
In standard liposuction the fats are discarded, but in BBL they are “re-used” in order to improve the volume and contour of the buttocks and hips, thus obviating the need for synthetic implants.
Dr. Smiley said the patient previously had botched liposuction of the back done by another surgeon, leading to the appearance of rolls and contour irregularities.
The celebrity plastic surgeon corrected the botched results by using liposuction microcannula, which has a narrower diameter compared to the standard design. With this technique, he was able to remove small bits of fat, as opposed to large chunks, leading to smoother results.
The use of microcannula also favored the patient because of the internal scar tissue in her back.
To further ensure smooth and natural results, Dr. Smiley preserved a thin layer of fat beneath the skin.
“Liposuction is not about removing all fats. What is more important is to preserve a smooth skin surface, which is only possible when you leave a carpet of fat beneath the skin,” he said in a previous Snapchat video.
Because the patient also requested for BBL and thus required large volume liposuction, Dr. Smiley also used the axilla (armpit area), bra rolls, anterior abdomen, thighs, and knees as donor sites.
The patient also requested for “wider and curvier hips,” Dr. Smiley said he allocated a large portion of the purified fat into the area.
It should be noted that most patients will need 600-900 cc of purified fat (after removing all the impurities such as the oil and blood inadvertently collected during liposuction) to see a noticeable difference. But for more impressive results, some may even need up to 1,200 cc.
With meticulous patient selection and surgical execution, male chest liposuction can result in a more athletic appearance, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
But what constitutes the ideal male chest?
As with any body contouring surgery, male chest liposuction demands a profound understanding of the established aesthetic guidelines. For instance, most cultures prefer a V-shaped male torso that exhibits broad shoulders and a defined chest that tapers to the flat waist.
Scientists recon that the athletic V-shaped male physique might serve as visible cue for health, virility, and good genes.
Knowing the aforementioned aesthetic guideline is one of the keys to achieve natural results from male chest liposuction. After all, men generally want an outcome that appears like they were born with it or at least work on their physique through good ol’ fashion exercise and healthy diet.
Dr. Smiley says one common mistake of inexperienced surgeons doing male chest liposuction is focusing only on the lower part of the chest wall, while ignoring other critical areas such as the lateral and outer aspect of the muscle. This results in “fullness” or indentation of the adjacent sites.
Due to the natural diffusion of superficial fat whose distribution is genetically predetermined rather than caused by poor lifestyle, male chest liposuction entails a larger surface area—i.e., the lower and lateral and outer areas of the muscle must be contoured as well to ensure smooth transition and natural results.
All efforts are made to promote natural results, as men are generally more reticent about their aesthetic plastic surgery than women.
To further ensure a more “cohesive” result, a good number of patients can also benefit from liposuction of their anterior abdomen and/or flanks. Compared to women, men in general require less fat volume removed due to the natural distribution of their fat and muscle composition.
It should be noted that male chest liposuction only works in normal weight men with pseudo-gynecomastia, which means that their overdeveloped breasts are caused by excess fat instead of glandular tissue, which does not come out with liposuction cannula (hollowed steel tube attached to a pump).
The only way to remove the excess glandular tissue is to create a short incision along the lower edge of the areola (dark pigmented part of skin). And over time, the scar is expected to fade into the background.