The reasons for having a revision breast augmentation can range from the desire for an “upsize” or “downsize,” improvement of the breast shape and symmetry, and to implant-related issues.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat video showcasing a patient seeking revision breast augmentation to correct these three aesthetic issues:
The laser reveals the significant asymmetry between her breasts, particularly in terms of her submammary fold placement.
- Asymmetric breast fold. The right breast has its submammary crease settling lower compared to the other side due to implant sagging. Dr. Smiley said repairing the implant pocket during a revision surgery, along with correct implant selection, can solve this problem.
- Lack of upper pole fullness. The bottoming out of the right implant has an inverse effect on the upper breast pole as it now lacks fullness (only 10-15 percent of the total breast volume). Dr. Smiley said the aim is to allocate at least 30 percent volume to this area, resulting in a more natural, youthful appearance.
- Desire for bigger implants. The patient has expressed her desire for bigger implants without resulting in a top-heavy or unnatural look. Smiley said that physical exam is the first and most critical step to ensure that the surgery can achieve such goal.
During breast exam, Dr. Smiley measured the base of the breast and told the patient that her anatomy would only allow implants whose width is not more than 13 cm due to her narrow chest. Going beyond the anatomy, he warned, can lead to a myriad of problems such as uniboob appearance, excessive lateral bulge, implant wrinkling, and other telltale signs of the surgery.
One possible way to create a bigger appearance without resulting in the aforementioned problems is to use high profile implants, which offer the most forward projection—i.e., they stick out more from the chest wall—relative to their [narrow] width.
To further promote natural results, the patient is deemed as a good candidate for silicone breast implants, which are noted for their more natural feel and shape than saline implants.
Some plastic surgeons use the term bikini tummy tuck scar to describe an incision technique in which the resulting scar is concealed by the patient’s underwear. While this has become a standard approach nowadays, it is equally important to preserve the natural curves of the feminine physique.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley explains the surgical techniques and aesthetic tenets that help his patients get bikini ready for the summer.
Six months after her tummy tuck, the patient remains happy with her results, citing that the well concealed scar and the more streamlined waistline allow her to don a two-piece swimwear, which she hadn’t done for many years.
All efforts are made to place the curved hip-to-hip scar beneath the bikini area, very close to the pubic hairline. This allows the patients to wear a two-piece swimwear without having to worry about visible signs of tummy tuck.
Despite the media hype venerating the mini tummy tuck in which the scar is just a few centimeters (almost the same as a C-section scar), it rarely provides smooth results due to the natural distribution of excess abdominal skin. And paradoxically, it does not promote the best scar possible.
It is important to note that a longer scar that is faded and concealed by the patient’s underwear is much better than a shorter scar that rides higher than ideal and has a dog ear’s appearance (i.e., bunching of skin at one or both ends of the scar).
The goal is to allow the incisions to fade into a thin, barely perceptible scar. This is achieved by suturing the wound in deep rows, with the skin surface receiving no or very little tension.
- Concomitant liposuction of the flanks
Before the actual tummy tuck—i.e., removal of loose skin—a large percentage of Dr. Smiley’s patients receive liposuction of the flanks, allowing him to tighten more skin towards the center, leading to smoother and more athletic looking results.
Muscle repair is one critical element in tummy tuck that further flattens the anterior abdomen. The idea is to “tighten suture” the fascia or connective tissue so the pair of vertical muscles is returned to its side-by-side configuration.
Pregnancy and large weight fluctuations can have some detrimental effects on the appearance of navel, turning the once innie into an outie. The belly button may also appear larger or distorted.
Bra rolls liposuction surgery eliminates the unsightly bulges that tend to become more prominent in tight clothes. But as with any body contouring procedure, its success boils down to strict patient selection and meticulous surgical execution.
Patients who can benefit from bra rolls liposuction have excess superficial fat (beneath the skin) caused by hereditary distribution and thus no matter how skinny they get, the “bra bulge” remains there.
The patient receives bra rolls liposuction immediately followed by fat injection into the buttocks, a procedure more commonly referred to as Brazilian buttock lift.
Meanwhile, no body contouring surgery suits significantly overweight and obese individuals whose main problem is the excess [deeper] visceral fat linked to obesity. This type of fat only responds to dieting and exercise, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
These are the bra rolls liposuction guidelines that help the celebrity plastic surgeon deliver natural and smooth results from the surgery.
Due to the natural distribution of superficial fat, most patients who think they need bra rolls liposuction can achieve smoother results if their surgery also includes the upper-outer back near the armpit, posterior waist fat, and/or flanks (above the waist and below the shoulder).
Simply put, women seeking bra rolls liposuction may actually need their entire back, or at least a large surface of this region, re-sculpted to achieve smooth and natural results.
- Use of microcannula and tumescent fluids
Tumescent fluids are injected into the fatty area, triggering the fat cells to swell up before they are suctioned out with the use of microcannula, a hollowed probe with an outside diameter less than 2.2 mm.
Microcannulae remove fats in smaller bits, making them ideal for highly fibrous fat, meaning it is tightly intertwined with the connective tissue. Furthermore, they tend to provide smoother results than the standard cannula, which suction out fats in bigger chunks.
The success of bra rolls liposuction primarily depends on the patient’s anatomy. For instance, anyone with excess skin, which can be verified when the rolls remain even after the arms are elevated, will require skin excision rather than just liposuction.
Sometimes, the bra rolls are also caused by how the ligaments are arranged and thus require to be “released” to achieve smoother results from surgery. To further ensure smooth appearance, it is ideal to treat the “bra bulge” individually during liposuction.
Brazilian buttock lift not just focuses on augmenting the butt with the patient’s own fat. An equally important aesthetic goal is to improve the shape of the backside based on the established aesthetic guidelines, leading Beverly Hills plastic surgeon Dr. Tarick Smiley said in his recent Snapchat video.
But what constitutes the ideal butt shape? And are there some Brazilian buttock lift guidelines to achieve it?
While the standard of beauty varies greatly among different cultures and ethnicities, which is further complicated by the patient’s preference and aesthetic goals, the inverted heart shaped buttocks are deemed to be the most attractive, followed by the round buttocks.
The inverted heart shape and round buttocks are perceived to be the ideal shape, while the square and V-shaped buttocks are the least attractive because these are tied to poor waist-to-hip ratio.
These two buttock shapes have always been depicted in artworks throughout history as visual cues for female sexuality and fecundity.
Dr. Smiley said the inverted heart shape buttocks can be achieved by Brazilian buttock lift when volume distribution follows the 40:60 ratio on profile view, meaning the upper half of the buttocks should possess 40 percent of the total volume, and the rest goes to the lower half.
This volume distribution on profile view results in the much coveted inverted heart shape buttocks.
Nonetheless, some women ask that most of prominence should be allocated to the upper half of the buttocks, ultimately creating a “round” or bubble-shaped buttock appearance. Hence, during consultation the patient must be able to describe her goals in detail to achieve results that will satisfy her long term.
Dr. Smiley said that these two buttock shapes are closely tied to the ideal waist-to-hip ratio of 0.7, which means that the hip circumference is 30 percent wider than the waistline.
To create a smaller waistline and enhance the buttock shape and projection, Dr. Smiley said the flanks and lower back are always treated as “fat donors” or liposuction sites.
“There should be a Smiley scoop or an inward slope of the lower back,” the celebrity plastic surgeon said.
Meanwhile, the two least desirable butt shapes—i.e., the V and square buttocks—can be improved by reshaping the hips through more fat injection. To further highlight the lateral curves and forward projection, Dr. Smiley said the waistline typically entails aggressive liposuction.
Brazilian buttock lift starts with liposuction to collect “troublesome” fats usually along the waist line, which are then purified and re-injected into the buttocks and hips. The results are often dramatic—i.e., smaller waist and curvier derriere, which ultimately improves the waist to hip ratio.
Across cultures and geography, there is a strong preference for a female physique with a WHR of 0.7 or at least near this ratio in which the waist accounts for 70 percent of the hips circumference. Scientists have found a strong correlation between this much-coveted figure and fecundity and good health and genes.
One of the keys to achieve high satisfaction rate is to listen to the patient’s input, focusing more on her aesthetic goals and the ideals of beauty, many of which vary drastically by region and ethnicity. For instance, African-American women generally love their full-bodied curves and rarely desire for the lithe and petite figure, which then appeals to Caucasian women. Nonetheless, making a sweeping generalization does not do justice to each patient and thus a prudent surgeon conducts extensive consultation prior to surgery.
To achieve more prominent curves in all the right places, African-American women seeking Brazilian buttock lift often ask for larger augmentation and more projection, which of course entails more aggressive liposuction in order to collect large volume of fat. Caucasian and Asian patients, meanwhile, are usually more concerned about the butt shape than its size and so they may need less fat volume injection. Again, each patient has specific aesthetic goals and a unique set of anatomies and so the ideal approach is a highly customized one.
If there is a desire for larger augmentation, a 360-degree liposuction is almost always warranted. This means that the donor fats are collected from the patient’s anterior abdomen, flanks, and lower back. Occasionally, the “bra rolls” and upper arms are treated as well to collect additional amount of fat.
Round buttocks in which the maximum prominence is found at the mid and upper region are deemed as the most attractive butt shape in women. A multitude of cultures and artworks seem to agree on this beauty standard; hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley adheres to this template to deliver a more natural, proportionate result.
To further achieve a more feminine physique, Dr. Smiley says that during fat injection he allocates about one-third of the purified fat to the hips, which are basically the outer lateral aspect of the buttocks.