Large volume liposuction is almost a prerequisite for patients having a Brazilian buttock lift in which the basic principle is to collect and transfer unwanted fats to improve body proportions. Scientists and artists alike suggest that a waist-to-hip ratio of 0.70, or at least near this volume distribution, is the most ideal feminine physique.
Having a 0.70 WHR means that the waist circumference is 70 percent o the hips measurement.
The “after” photo shows the results of Brazilian buttock lift preceded by large volume liposuction.
Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has shown large volume liposuction before and after photos on his Snapchat account. Fat transfer to the buttocks and hips was immediately performed thereafter.
The patient shown in the photos had liposuction to her abdomen, flanks, lower back, “bra rolls,” and axilla (around the armpit).
In regard to cosmetic goals, African-American patients tend to ask for curvier results and so they typically require large volume liposuction. Caucasians, meanwhile, often prefer subtler improvements—i.e., they are focused more on improving the shape of their buttocks, with minimal to moderate amount of augmentation.
Despite strong predilection to certain beauty goals due to cultural influence, Dr. Smiley says it remains imperative to identify the specific goals of patients through an honest and comprehensive consultation with them.
“It is inimical to assume that everyone has a standardized beauty ideals. Hence, I always ask my patients about their specific goals. After all, elective surgeries are here to elicit a smile from them, says Dr. Smiley on his previous Snapchat post.
As seen in the recent videos, Dr. Smiley injected tumescent fluids into the fatty area to help expand the fat cells, paving way for their gentler and more precise extraction. The solution also contains epinephrine, a drug known to reduce bleeding by up to 90 percent compared to the dry technique.
Dry liposuction is an antiquated technique in which no wetting solution is infiltrated into the fatty area.
Meanwhile, epinephrine works by constricting the blood vessels, which in turn provides another auspicious consequence: It prolongs the numbing effects of local anesthesia, thus allowing the patients to avoid or at least take less pain relief in the first few days post-op.
Thanks to large volume liposuction, Dr. Smiley was able to inject more than 1,000 cc of purified fat into each butt cheek to meet the patient’s desire for additional augmentation. Furthermore, he injected about one-third of the fat volume into the hips, which is basically the outer-lateral aspect of the buttocks, to deliver a more feminine physique.
In periareolar breast augmentation technique, doctors place a small incision right at the lower border of the areola, which is a ring of pigmented skin surrounding the nipple.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he prefers the technique due to its well-hidden scar, thanks to the areola’s thin skin that makes it highly resistant to aggressive scarring (keloids). Moreover, placing the scar at the dark-light skin junction means it can blend easily into the background.
This patient receives saline breast implant, which is propelled into the pocket empty. Once filled with saline, the tube, which has a self-sealing mechanism, is pulled out.
To further promote well-concealed scars, Dr. Smiley says it is important to close the wound with multiple rows of sutures without picking up the skin.
“The skin edges must be close enough that they are somewhat kissing. With no or very minimal tension, the skin can heal better as well as the ensuing scar,” says Dr. Smiley in a video he recently posted on Snapchat.
Dr. Smiley says he uses running stitch technique with the use of fine absorbable sutures (almost as thin as a human hair) that dissolve within 3-6 weeks.
One of the most common concerns of patients is the risk of reduced nerve sensation, which could also have an impact on their capacity to breastfeed in the future. However, Dr. Smiley says the risk is very small because the incision “goes down” and so the nerves and milk ducts are spared from significant injury.
“Because we’re not cutting above, which could injure more nerves around the nipple, the risk of reduced nipple sensation is very low, just less than 4 percent,” says Dr. Smiley.
Meanwhile, one major caveat of periareolar breast augmentation is that the incision is placed close to the nipple, which is believed to harbor staph bacteria that are linked to infection and capsular contracture.
To avoid complications, before implantation Dr. Smiley says he always irrigates the implants and breast pockets with strong antibiotic solutions, whereas other surgeons simply use Betadine in an attempt to sterilize the tissue and implants.
“Betadine is too caustic for the internal tissue and implants. At one point, the manufacturer even mentioned that their product should not be used in breast augmentation surgery,” Dr. Smiley says.
“Irrigating with antibiotics remains the best way to prevent or minimize risk of infection and capsular contracture, a complication in which the copious scar tissue forms around the implant, leading to unnatural breast contour and pain,” he adds.
To further minimize the risk of complications, Dr. Smiley uses the Keller Funnel technique in which a disposable cone-shaped device is used to propel the implant into the breast pocket with just one squeeze.
Dog ears tummy tuck refers to skin puckering and/or excessive fullness at one or both ends of a scar. While there are ways to prevent or reduce the chance of this minor complication, certain types of patients remain susceptible.
For instance, massive weight loss patients—i.e., those who had lost more than 50 percent of their excess weight—have large redundant skin and markedly poor skin tone that makes them prone to dog ears tummy tuck, with medical literature suggesting that 15-20 percent will even require some type of revision to improve the appearance of their tummy tuck scar.
The first and most critical step to prevent dog ears tummy tuck is to use the right incision technique during surgery.
Nonetheless, there is one potent technique to avoid or at least minimize the risk of dog ears tummy tuck and other surgical “stigmata”: Use the right incision length, placement and shape during surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of patients need the standard hip-to-hip incision pattern due to the natural diffusion of loose skin. Meanwhile, the mini tummy tuck in which the scar runs just a few inches below the navel is rarely beneficial.
Using a tummy tuck incision that is too short—i.e., it does not cover the entire span of redundant skin along the abdomen and flanks—is the primary cause of large dog ears, surface irregularities, and less than optimal contour of the waistline.
In order to prevent dog ears tummy tuck, achieve smooth results, and ultimately promote faded and well-healed scars, Dr. Smiley says that massive weight loss patients may even have to accept a longer scar that reaches their posterior flanks.
Despite the longer scar resulting from extended tummy tuck technique, Dr. Smiley says all efforts are made to position it very low that it goes within the groin and pubic hairline. Furthermore, suturing the surgical wound in which there is no or very little tension on the skin surface can help promote the best scar possible (i.e., almost as thin as a human hair and so it blends into the background after 6-18 months).
Another possible way to prevent dog ears is to perform a simultaneous liposuction of the flanks and hips. In Dr. Smiley’s previous posts on Snapchat, he says that with this ancillary procedure he is able to pull and tighten more skin, ultimately resulting in smoother and flatter contour.
Despite best efforts from the surgeon, dog ears tummy tuck may still occur in patients with a markedly poor skin tone. Fortunately, most will only require minor revisions that are performed in-office.
Dog ears revision is usually performed by slightly extending the scar, which allows the surgeon to remove the loose skin. Occasionally, liposuction is used as well to further eliminate the “fullness” at the edge of the scar.
What causes dog ears tummy tuck? This is arguably the most common concern of people who want to get rid of their apron-like skin and fat that hangs from their lower abdomen.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to explain dog ears, which refer to puckering of skin usually at the end of a scar. This is not uncommon after tummy tuck and other body contouring surgeries that rely on skin tightening.
But should dog ears appear after tummy tuck, Dr. Smiley says about 90 percent of the time they go away on their own within a year postop.
In the event that dog ears persist after one year, Dr. Smiley says a small revision (office procedure under local anesthesia) is generally enough to eliminate the puckering or fullness at one or both ends of the tummy tuck scar.
A revision typically entails slightly extending the scar laterally to remove a small amount of skin; however, a few patients may need minor liposuction to further eliminate the fullness.
Dr. Smiley says one way to prevent or at least minimize the risk of dog ears after tummy tuck is extending the scar laterally; the idea is to use an incision pattern that reaches all the redundant skin and fat.
Recently, Dr. Smiley performed tummy tuck on a patient who did not care so much about the length of scar, provided that it would not result in dog ears appearance. Hence, during surgery the surgeon extended the incision line more laterally that it reached her flanks.
Nonetheless, Dr. Smiley placed the tummy tuck incision line within the groin and pubic hairline so the patient’s underwear or two-piece bikini could hide it with ease.
Aside from strategic placement of the incision line, the celebrity plastic surgeon says the use of meticulous suturing techniques also ensures the most favorable scar—i.e., flat, symmetric, and faded line.
The key to achieve the “best” tummy tuck scar is to close the wound in multiple layers without picking up the skin so that no excessive tension can pull its surface, which might cause the scar to migrate higher or thicken.
Breast implants and lift are commonly performed together to address two cosmetic issues: lack of volume and ptosis (sagging). Oftentimes, the surgeon also reduces the areola’s width to further achieve good proportions.
Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has posted Snapchat videos demonstrating a patient who had high profile breast implants with lift.
Anchor breast lift combined with silicone implants (high profile and 445 cc).
Prior to surgery, the patient had areolas that drooped past the inframammary fold, which is the hallmark of true breast ptosis. Moreover, she had a relatively ample breast tissue although she had always desired for additional volume.
After meticulous physical exam that involved breast and chest measurement, and comprehensive consultation to determine her exact cosmetic desires, she and Dr. Smiley came up with a decision: combine anchor breast lift technique with high profile 445 cc silicone implants.
The anchor breast lift, which has been the standard technique, is aptly named due to its incision pattern: it goes around the areola, down the midline, and across the base of the breast. With meticulous suturing technique, most patients can expect to have scars that blend well into the background 1-2 years postop.
Using the skin to lift the entire breast will almost always lead to short-lived perkiness due to its inherent weakness and plasticity. Whereas elevating the fibrous tissue, which is the main supportive structure of the breast, with the use of internal sutures can withstand the test of time, says Dr. Smiley.
After reshaping the drooping right breast internally and tightening the skin (i.e., a small amount of skin was removed), the celebrity plastic surgeon placed a silicone implant beneath the chest muscle, which provides additional coverage to minimize palpability and risk of implant rippling.
Dr. Smiley says he always works on one breast at a time so after completion it will serve as a “blueprint” for the other side.
Meanwhile, the patient was deemed a good candidate for high profile silicone implants due to her petite frame: The silicone gel “feels” like a natural breast tissue, while the additional height of the implant shell gives her more fullness to the upper breast pole.
And due to the smaller base diameter of high profile implants they also suit the patient with her narrow chest wall. Consequently, her breasts now have a more pronounced roundedness.