Buccal fat removal surgery basically reduces the cheek fat pad, as opposed to removing it entirely. The goal is to achieve a more chiseled appearance without resulting in a gaunt-looking face, which happens after an over-aggressive approach.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated buccal fat removal surgery on his Snapchat account. The patient shown in the video has excessive fullness in her lower cheeks, giving her the appearance of “chipmunk” cheeks. To further achieve a proportionate result, he also contoured the jawline and chin with “conservative” liposuction.
Reality TV star Kylie Jenner has long been rumored to have undergone buccal fat removal surgery. However, she denies having any facial plastic surgery. (Photo Credit: Lifestyle.one)
He performed buccal fat removal by creating incisions inside the mouth so the risk of visible scar has been completely eliminated. It is important to note that he only reserved this surgery for patients who have an extreme case of “moon-like” round faces.
Meanwhile, people with a milder case of accentuated cheek fat pad are generally discouraged to have the procedure because of the long-term substandard result. Advancing age causes some of the facial fatty tissue to “shrink” and thus resulting in bony faces later in life.
Aside from strict patient selection, the success of buccal fat removal also lies in a more conservative route—i.e., ensuring that some fats remain after surgery so the patients will not end up with a gaunt appearance years down the road.
To achieve a smoother, more contoured appearance, the patient also received minimal liposuction along her jawline and chin.
(Note: The buccal fat pad lies deeper in the cheek muscle; this is different from the superficial fat beneath the skin, which can be removed via liposuction procedure.)
Just like in buccal fat removal surgery, the celebrity plastic surgeon followed a conservative route during liposuction—i.e., ensuring that a thin layer of fat remains afterward—to offset and “anticipate” facial volume loss that comes with aging.
Fat transfer to face is no longer considered as an afterthought but rather an integral part of facial rejuvenation surgery. In fact, this has become a common complementary procedure for facelift whose primary function is to tighten the loose soft tissue and remove the excess skin, but not to address volume loss.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted an educational video on his Snapchat to demonstrate the rejuvenating effects of fat transfer to face, particularly in smoothing out the laugh lines (nasolabial folds which run between the nose and the corners of the mouth) and correcting the abrupt transition between the lower eyelid and the cheek.
The female patient shown in the video manifested early signs of facial aging: volume loss, which is medically referred to as soft tissue atrophy (shrinkage). The celebrity plastic surgeon decided fat transfer to face as a stand-alone procedure because she had no other “aesthetic concerns” such as loose skin, sagging mid face, jowl, neck bands, and droopy eyelids.
Dr. Smiley started the whole procedure by collecting some unwanted fats from the abdominal area, which were then processed with the use of centrifuge, a machine for separating biomaterials based on weight.
In the video, Dr. Smiley is seen holding a clear tube to show how separation is done based on weight. The oil is the lightest “material” so it floats above the processed fluid; it must be discarded before re-injecting the healthiest, purest fat cells to achieve near permanent results, he said.
At the other end of the spectrum, the blood cells, which are the heaviest biomaterial, were also discarded. The middle part of the processed fluid, meanwhile, contains the healthiest fat cells and some stem cells, he further explained.
Stem cells are unique because they are “unspecialized” and so they can turn into other types of cells. Furthermore, they can divide and renew themselves for long period; hence, combining them with fat cells help the latter survive in their new location. For this reason, the results of fat transfer are expected to last 12-15 years with proper handling and processing of fats, said Dr. Smiley.
Moreover, Dr. Smiley used a blunt-tipped needle during the injection process to ensure minimal bruising and ultimately shorter “social” downtime.
He used the “processed” fat to create a nicer transition between the lower eyelid and cheek and to eliminate the nasolabial folds appearance.
The patient also asked for fat transfer to her hands to achieve a more youthful, plumper appearance.
Brachioplasty techniques vary from patient to patient due to the amount of loose skin and its location. Nonetheless, surgeons will make every effort to hide the scar—i.e., within the armpit fold and/or on the inner aspect of the arm.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has explained the different brachioplasty techniques, focusing more on the benefits and their “target problems.”
Its resulting scar lies parallel to the armpit fold, an area that is highly resistant to keloids or any other types of aggressive scarring. Despite such benefit, this technique is only suitable for patients with mild tissue laxity—i.e., the loose skin is only limited to one-third of the upper arm.
This procedure usually removes a diamond-shaped excess skin before the wound that goes parallel to armpit skin fold is closed with sutures. Occasionally, it is combined with liposuction to remove the excess superficial fat around the arm’s circumference to achieve smoother, more proportionate results.
- Standard or full brachioplasty
The technique is suitable for patients with moderate to severe tissue laxity as it removes loose skin between the armpit and the elbow; hence, the resulting scar made on the inner aspect of the arm extends from the underarm to the elbow.
Most surgeons today avoid the posterior scar placement (so it is seen on the back of the arm) unless the patients require large amounts of skin excision or the risk of wound breakdown is rather high (the inner aspect scar placement is perceived to have increased risk of wound separation due to the natural tension in the area).
In essence, this combines the standard brachioplasty technique with vertical torsoplasty, which can remove the excess skin along the lateral chest. For this reason, the scar from the armpit is extended towards the side of the chest.
The extended brachioplasty is a good option for massive weight loss patients who want to improve the shape their arm, armpit, and lateral chest.
Regardless of the incision pattern, a good surgeon will make every effort to eliminate most of the tension on skin to achieve the best scar possible. This is done by closing the wound in several layers, with the deepest tissue receiving most of the tension, which is gradually reduced as they go nearer to the skin surface.
The areola breast augmentation technique uses a small incision placed right at the border of the areola, i.e., dark-light skin junction, where the breast pocket is created and the implant is propelled inside, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
On his recent Snapchat video post, Dr. Smiley has demonstrated the technique and its challenges since the patient has a small areolar complex that could make it difficult to hide the scar particularly when prefilled silicone implants are used.
All silicone implants are prefilled by their manufacturers; however, saline implants usually come “empty” and are only inflated with sterile saltwater (saline) by surgeons once positioned in their pocket. In terms of aesthetic superiority, silicone implants are the standard choice because their filler material closely resembles the glandular tissue and fat.
The patient shown in the video has a small areola but nonetheless had chosen the silicone implants, which “traditionally” requires longer incision than saline implants.
Despite the caveat of silicone implants when areola breast augmentation is used, the benefits far outweigh the potential drawbacks because the patient’s lack of soft tissue coverage could mean an increased risk of rippling and palpability when saline implants are utilized.
Because of the anatomical challenge or “dilemma” facing this particular patient, Dr. Smiley has used Keller Funnel that allowed him to use silicone implants without resorting to long incisions.
The Keller Funnel resembles an icing bag that holds the silicone implant. Its narrow tip is positioned into a small incision along the areola’s border so when it is squeezed the implant is propelled into the pocket.
With Keller Funnel, Dr. Smiley says he is able to shorten the incision even when silicone implants are used. Furthermore, the technique significantly minimizes the amount of pressure during the implantation process (compared to the standard finger push method), which in turn preserves the implants stability and reduces surgical trauma, he further explains.
And because there is very minimal trauma around the incision, the scar is further expected to heal and blend well into the background, says the celebrity plastic surgeon.
While silicone implants can already reduce the risk of rippling, palpability, and other surgical stigmata (which are real concerns because the patient has little soft tissue to begin with), Dr. Smiley positioned them beneath the chest muscle for additional coverage; hence, the patient’s breast is now softer and its contour more natural.
Gynecomastia surgery and liposuction can be a powerful body contouring surgery in men with breast enlargement (colloquially called as man boobs or moobs) and unsightly fat rolls especially along their flanks, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Gynecomastia surgery (i.e., the standard technique) creates an incision below the areola’s border so the resulting scar blends well into the dark-light skin junction. This allows the surgeon to remove the excess breast tissue that is causing the herniated-looking or “puffy” nipple area.
Liposuction, meanwhile, uses a few round incisions (usually less than ¾ cm) to remove the excess fat causing the appearance of “love handles” and other unsightly bulges. Despite being a powerful tool in body contouring surgery, Dr. Smiley warns that it is only reserved for healthy, normal weight patients who are committed to maintain a stable weight through superb diet and regular exercise.
“The caveat of liposuction is that we only remove the excess superficial fat right beneath the skin and not the deeper visceral fat linked to obesity. This stubborn fat rolls are mostly determined by genetics and so despite impeccable lifestyle that involves rigorous exercise some men simply can’t show good muscle definition. Hence, for these individuals liposuction could be a good option,” he says.
While gynecomastia surgery can be performed as a stand-alone procedure, a simultaneous liposuction could deliver smoother, more proportionate results.
“The goal is to create a more masculine torso by removing the appearance of love handles. We don’t want the waist line to deviate from the athletic-looking chest contour,” explains the celebrity plastic surgeon.
Gynecomastia surgery and liposuction generally entails a two-week off to allow most of the swelling and bruising to subside, although some patients may return to work/school within a week provided that they avoid heavy lifting, strenuous exercise, or anything that can raise their blood pressure and heart rate.
A good rule of thumb is to avoid over-exertion for at least three weeks and then after this period the patients may gradually resume their exercise provided their doctors give them permission.