The effects of hourglass tummy tuck will depend on many factors such as the surgeon’s skills, ancillary procedures (e.g., liposuction and muscle repair), and patient’s anatomy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the fundamental factors affecting the final results of hourglass tummy tuck, which he regularly demonstrates on his Snapchat account.
Generally speaking, the more distance between the lowest rib and the pelvic bone the more definition one can achieve from tummy tuck.
Meanwhile, women with a markedly short distance between these two points could not get the same amount of definition achieved by individuals with a “great distance” between them, with or without hourglass tummy tuck.
- Adjunct procedure/s of tummy tuck
Dr. Smiley almost always incorporates muscle repair in his tummy tucks. This rather critical component of the surgery involves tying the pair of loose muscle that extends from the breastbone to the pubic region. Aside from creating a flatter frontal abdomen, he says the procedure makes the results less susceptible to the effects of “unplanned” pregnancy or even mild to moderate weight gain.
Meanwhile, the standard tummy tuck (hip to hip incision) cannot address the appearance of love handles (fat rolls along the flanks) or any excess skin on the sides.
Liposuction can further define the waist and hips by removing the excess fat beneath the skin, while extending the tummy tuck incision into the flanks can help the surgeon remove the excess tissue on the side.
- Surgeon’s technical and artistic skills
Tummy tuck, as with any body contouring surgery, combines art and science. The goal is to remove a precise amount of skin and fat without causing surgical telltale signs such as unacceptable scarring, contour irregularities, navel deformity, and skin asymmetries.
Dr. Smiley, who has performed over 7,000 tummy tucks to date, says that experience allows him to determine the ideal tension during muscle repair and the exact amount of skin removal and fat without destroying the natural curves and contours of the frontal abdomen and waistline.
Abdominal revision liposuction poses some unique challenges. First and foremost, plastic surgeons often have to deal with skin irregularities caused by over-removal of fat, and the internal scar tissue from the previous surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video showing a female patient who had botched liposuction that resulted in large dents below her navel, contour irregularity on the left flank, and less than optimal waistline.
The large dents and surface irregularities, according to Dr. Smiley, were primarily caused by over-liposuction or removing too much fat.
In the video, the celebrity plastic surgeon said a thin layer of fat must remain after surgery to ensure a smooth skin surface and to avoid a wide range of surgical stigmata.
To correct the ill effects of over-liposuction, Dr. Smiley performed fat transfer, which in essence is a reverse liposuction. After removing some fats along the flanks and waistline, instead of discarding them he injected them to smooth out the indentations.
To further achieve a smooth skin surface, Dr. Smiley released the scar tissue that was causing the skin to adhere to the muscle, which in turn also improved the contour of the left flank.
Moreover, he removed additional fat along the flanks to create a more hourglass silhouette (narrow waistline and wide hips).
Since revision abdominal liposuction is more complex than the initial surgery, Dr. Smiley always uses the tumescent technique combined with microcannula, or flexible hollowed tube with an outside diameter of less than 2-3 mm.
Tumescent liposuction involves injecting large amounts of tumescent fluids into the fatty area before the actual removal fat is performed. The idea is to make the fat cells swell up to pave way for a more precise, gentler extraction.
Furthermore, the tumescent fluids contain epinephrine that constricts the blood vessels and thus the amount of bleeding is reduced by up to 90 percent as compared to the “dry” or “no wetting solution” technique.
Precision is further improved with the use of microcannula during the actual extraction of fat, allowing the surgeon to remove excess fats in smaller bits, as opposed to larger chunks. For this reason, he avoids using large cannulas especially when doing some type of revision liposuction.
The female patient has presented Dr. Smiley her “wish pic” (Kylie Jenner’s voluptuous body). For this reason, he not just sculpted the four quadrants of the frontal abdomen and the flanks, but also the inner thigh and hips.
Overall, Dr. Smiley used 12 tiny liposuction incisions to meet the cosmetic goals of this particular patient; these are expected to fade into the background after 6-12 months.
Will a tummy tuck strengthen my core? Some patients ask this question in the hope of finding some relief or improvement in their back pain.
It is important to note that for most patients, tummy tuck surgery not just removes the apron-like skin hanging from their abdomen; muscle repair is also an important component to achieve a smoother, flatter appearance. To some extent this procedure also results in increased efficiency of the abdominal muscle.
While the surgery does not actually strengthen the core, it can restore the normal function of the abdominal muscle, said leading Beverly Hills plastic surgeon Dr. Tarick Smiley who has performed more than 7,000 tummy tucks.
By repositioning the loose abdominal muscle, its efficiency is improved and thus for some patients the surgery not just gives cosmetic enhancements, but functional-related improvements as well, he explained.
To access and repair the abdominal muscle, the celebrity plastic surgeon uses a hip-to-hip incision made very low so the resulting scar is well concealed by the patient’s underwear. Afterwards, he will separate and lift off the skin to reveal the pair of muscle that goes from the breastbone to the pubic region.
In his recent Snapchat video post, he explained his preferred suturing technique.
“I prefer using the individual stitch technique, as opposed to one continuous stitch, to ensure that the next stitch is as strong as the previous one,” he said.
For additional strength, Dr. Smiley said he also used permanent sutures to tighten and support the separated or splayed muscle in the midline, thus it is less susceptible to aging or even unplanned pregnancy and mild to moderate weight gain.
After tying the abdominal muscle in the midline, Dr. Smiley then removed the excess skin from the lower abdomen before pulling down the skin above in order to close the wound.
The skin removal aspect of the surgery involves high precision to allow for proper wound closure and favorable scarring in which the scar is positioned very low that the patients can wear a two-piece bikini without having to worry about visible surgical stigmata, Dr. Smiley said.
Meanwhile, Dr. Smiley said that recovery after tummy tuck entails avoiding rigorous activities, particularly if they involve strengthening and resistance exercise, for 3-4 months to avoid healing problems.
However, most patients can resume light exercise (walking and other low-impact aerobics) at 2-3 weeks postop, he added.
Revision breast augmentation typically requires techniques similar to those used in reconstructive breast surgery to achieve the most natural contour and highest level of symmetry possible, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
For this reason, breast augmentation reconstruction requires higher level of technical skills (and experience) on the surgeon’s part to achieve good results from the surgery, Dr. Smiley said.
The celebrity plastic surgeon has recently posted a case study on his Snapchat account involving a patient who had breast augmentation 10 years ago and was seeking revision to correct several aesthetic-related problems, which the surgeon has enumerated in the video.
- Enlarged areola
- Visible rippling along the mid cleavage
- Too much cleavage (the breasts were too far apart)
- Excessive lateral bulge
- Sagging or bottomed-out implants
Dr. Smiley first started with the areola reduction in which he used a cookie-cutter device to delineate the new areola and make it smaller. The scar from this technique goes precisely at the dark-light skin junction so it will blend nicely to the background.
To correct the sagging appearance, he made vertical incisions from the areola down to the submammary fold, and another incision pattern that goes parallel to the breast crease. (Basically, this is an anchor breast lift technique due to the shape of its final scar, which is expected to fade into the background about a year postop.)
The anchor breast lift allowed Dr. Smiley to remove some loose skin and tighten and elevate the breast tissue, leading to a perkier appearance.
To further achieve good breast shape and to correct the excessive lateral bulge, he repaired the breast pocket (by making it smaller) and so the implant will not migrate.
Meanwhile, he addressed the visible rippling by replacing the old saline implants, which have a natural deflation rate of 1 percent per year due to evaporation. And since the patient had hers for 10 years, the implants had already lost about 10 percent of their volume, and thus resulting in rippling.
Oftentimes, silicone implants are considered as good replacements if the patient wants to prevent or correct rippling and palpability since they have no deflation rate and they are filled with a cohesive medical-grade silicone gel that resembles that of the breast tissue and fat.
The exact instructions as regards to breast lift wound care may differ from surgeon to surgeon; nonetheless, there are generally agreed upon guidelines such as preventing or treating infection immediately, avoiding over-exertion while healing is not yet complete, just to name a few.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that aside from the quality of breast lift wound care, the suturing technique will also play a critical role in the prevention of wound separations and healing problems.
The goal is to eliminate most of the tension on the skin surface by placing it on the deeper tissue, says Dr. Smiley.
Aside from meticulous wound closure technique, risk factors such as obesity, smoking, serious medical conditions, and use of aspirin and other drugs with blood thinning properties must be eliminated or at least controlled well ahead of the surgery.
In standard breast lift (i.e., anchor or T-shaped incision technique) wound separation is not uncommon in the T junction (or the area where the vertical incision meets the horizontal incision along the submamammary fold) because of the opposing tension. Hence, patients who only need mild to moderate tissue elevation is encouraged to choose the modified form in which the inframammary crease incision is eliminated, a technique referred to as lollipop lift.
Meanwhile, Dr. Smiley explains the postop care that can prevent or at least reduce risk of wound separations.
- Prevent or treat immediately signs of infection
Persistent swelling, pus or foul discharge, fever, and increasing pain are common signs of infection. To prevent this complication, a good rule of thumb is to achieve one’s optimal health well ahead of the surgery.
The use of antibiotics and good hygiene (washing one’s hands before and after changing the dressing) can also reduce risk of infection and its subsequent problems such as wound separation and poor healing.
The truth is, patient cooperation will also play a crucial role in the prevention of complications. It is important to avoid heavy lifting and strenuous exercise for a minimum of three weeks postop to avoid wound separations, persistent swelling, and other things that could compromise one’s recovery.
- Avoid premature removal of sutures
Non-dissolvable stitches, which are usually used to “hold” the superficial layer of the wound, should not be removed prematurely lest wound breakdown may occur.
Furthermore, certain suturing techniques such as monofilament are believed to be less prone to “spitting.”
The general rule of thumb is to avoid smoking three weeks before and after surgery to give the body ample time to flush out the effects of nicotine, which is a strong vasoconstrictor (it shrinks the blood vessels that the nutrient supply going to the wound is greatly diminished).