It is important to note that the latest plastic surgery trends should not supersede patient safety and satisfaction. Therefore, the goal of any prudent plastic surgeon is to enhance one’s appearance based on her “realistic” goals and, of course, within the safe limit.
Dr. Tarick Smiley, who is the medical director of the renowned California Surgical Institute, has explained some of the latest plastic surgery trends in Beverly Hills.
Thanks to recent improvements in fat transfer—allowing most of the grafts to persist long term—buttock augmentation is now more commonly performed with the use of the most natural material available—i.e., the patient’s very own fat.
In 2016, board-certified plastic surgeons performed about 18,000 buttock augmentations via fat transfer, a 26 percent increase from the previous year. The growing popularity of this procedure, also dubbed as Brazilian butt lift, is attributed to curvy celebrities like Kim Kardashian, Jennifer Lopez, and Beyonce Knowles.
- Sayonara to the over-inflated breasts
In the past decade, a good number of breast augmentation patients sought for an over-inflated chest appearance (e.g., DD and E cup). But with more women today following a healthier and more active lifestyle, it is not surprising that they now gravitate towards smaller “improvements.”
With smaller breast implant sizes, the results generally appear more natural and proportionate. In addition, they do not interfere with the patient’s active lifestyle.
“Instead of simply augmenting the breasts, most patients today want something more, but subtle. They desire for a more natural appearance and so they are also focused on improving their breast shape. Therefore, implants are now typically combined with some type of breast lift,” says Dr. Smiley.
In the past, facelift received notoriety due to its unnatural effects—flat cheeks, lateral skin pleating, overly tight face, and weird brow position. However, things have changed when surgeons started recognizing that simultaneous procedures like fat transfer, neck lift, and eyelid lift can make a huge difference.
Dr. Smiley typically combines facelift with fat transfer—a method dubbed as three-dimensional facelift—to achieve a more natural, more youthful result.
To further achieve natural results, Dr. Smiley highlights the importance of the correct vector of pull. In his previous Snapchat video posts, he demonstrates how pulling the skin at a 45 degrees angle can restore the softness of the cheeks (as opposed to making them flat and gaunt) and provide impressive rejuvenating effects.
- Quick fix facial procedures
Some patients, particularly men, deter the idea of surgery and the ensuing recovery and so they resort to Botox, dermal fillers, and Kybella injection (i.e., double chin eliminator).
According to a survey conducted by the American Board of Plastic Surgery, about 7 million Botox injections, and 2.6 million dermal fillers were performed last year alone.
Simply put, one of the latest plastic surgery trends favor non- or minimally invasive methods.
It is important to note that plastic surgeon experience directly correlates to the cosmetic results following liposuction or any other forms of body contouring surgery.
While education and formal training are the foundations of good plastic surgeons, experience allows them to further hone their eyes for detail. It is important to note that body contouring surgery is a combination of art and science.
Although beauty is not confined by strict definition or mathematical equation, most scientists, visual artists, plastic surgeons, and even “ordinary observers” know it when they see it. Hence, experts have come up with standards in an attempt to define attractiveness.
Dr. Tarick Smiley, who is the medical director of California Surgical Institute, explains how plastic surgeon experience affects the results of liposuction, a body contouring surgery in which the unwanted fat is removed with a slender steel probe called cannula.
- “Feeling” the surgical site
Contrary to popular belief, great liposuction surgeons do not rely mainly on their eyes during surgery, but more on “feeling” the treated site, as explained by Dr. Smiley on his recent Snapchat video post.
“While I move the cannula back and forth with my right hand, my left hand feels the skin, allowing me to decide if I need to stop or continue what I’m doing. It is critical to leave behind a layer of fat afterwards, as opposed to removing it entirely, to ensure a smooth skin surface,” he said.
Dr. Smiley, who has performed more than 9,000 liposuctions, said that board certified plastic surgeons with extensive experience have a notably low complication rate.
Inexperienced and unqualified surgeons, meanwhile, may commit a serious mistake of removing too much fat and causing excessive injury on the skin. Aside from surface irregularities, being too aggressive results in tissue necrosis (death of tissue) and poor scarring (liposuction is supposed to result in nearly invisible scar).
The consensus is to choose a board certified plastic surgeon who performs liposuction almost every week, or someone who conducts over a hundred surgeries every year.
Major revisions after liposuction (due to surface irregularities) can be serious that sometimes that it is better to leave the area alone than risk having a more severe problem. Hence, Dr. Smiley believes that the surgery must be performed correctly the first time.
Despite best effort, minor revisions may be sometimes necessary to further improve the initial results after liposuction. Nonetheless, a major “overhaul” is not to be expected if the surgery is performed by a qualified, reputable plastic surgeon, Dr. Smiley has explained.
A lower eyelid surgery for puffy eyes is a highly individualized procedure, which entails meticulous physical examination to determine the factors causing the problem. Excess deeper fat, loose skin, abrupt transition between the lower lid and cheek, cheek descent, or a combination of these might be the culprit.
It is important to note that factors such as lack of sleep, allergies, and fluid retention and other causes of intermittent swelling must be ruled out prior to surgery.
Simply put, eyelid surgery for puffy eyes only applies when there is a true excess skin and/or fat around the lower eyelid.
California Surgical Institute medical director Dr. Tarick Smiley says that some patients have lower lid puffiness caused by deep fat, with no or very little loose skin. For these individuals, a transconjunctival approach in which a small incision is made inside the lower lid, thus the risk of visible scar is almost zero.
The incision allows the surgeon to remove the deeper fat, which becomes herniated due to aging (i.e., tissue laxity/weakness). But for a more rejuvenating and natural result, Dr. Smiley says he almost always complements it with fat injection to create a smooth transition between the lower lid and upper cheek.
Unlike the deeper fat along the lower lid that becomes more prominent with aging, the superficial fat “shrinks,” a condition referred to as soft tissue atrophy, thus resulting in an abrupt transition between the lid and cheek. Further contributing to the problem is the cheek fat pad descent.
Dr. Smiley says fat injection or transfer involves collecting just a few teaspoons of unwanted fats in the tummy area, which are then processed before injected around the lower lid.
Most patients will only need small amounts of purified fat (less than 1 ½ cc) to correct the abrupt lid-cheek transition and eliminate the appearance of deep tear trough.
Meanwhile, some patients have puffy eyes that are not just caused by excess fat, but also by loose skin. In this scenario, a small linear incision is made very close to the lower lash margin to remove some excess skin and thus achieve a tighter, more youthful appearance.
The resulting scar from the external incision technique is expected to fade into the background, particularly when it is hidden by the patient’s lower eyelashes.
Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.
The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.
Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.
Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.
- Achieve one’s optimal health
Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.
- Accredited surgical facility or hospital
This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.
Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.
Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.
The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.
If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.
Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.
It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.
Rhinoplasty bleeding is often minimal provided that the surgeon uses meticulous techniques, which can also lead to shorter social recovery (no outward signs of the surgery), and natural results that can last a lifetime, according to California Surgical Institute website.
Rhinoplasty, or nose job in layman’s term, typically results in 1-2 weeks social downtime, which is closely linked to the amount of postop bruising and swelling.
The list below shows the “core principles” in minimizing the amount of rhinoplasty bleeding.
- The patients should be in their optimal health.
Hypertension, blood disorder, and other chronic medical conditions can lead to increased bleeding. Hence, rhinoplasty or any other elective plastic surgeries require all patients to pass a rigorous lab screening.
While some of these conditions can be controlled through medications or healthier lifestyle, it is important to note that some factors are not within the patient or surgeon’s control. For instance, older individuals often have more fragile blood vessels than younger ones and so they may experience more bleeding and postop bruising.
All drugs and supplements with blood thinning properties are discontinued for at least 2-3 weeks before surgery and about a week afterwards to prevent bleeding and excessive postop bruising. The same rule may also apply to smoking and alcohol.
However, some doctors recommend Arnica montana (homeopathic remedy) and some “special” diet known to promote healing.
- Use of drugs known to constrict the blood vessels
The use of local anesthesia combined with epinephrine—a drug that results in the constriction of blood vessels and thus reduces the amount of bleeding—is known to promote healing.
Decongestants like Afrin may also minimize the amount of bleeding by constricting the blood vessels.
- Keep blood pressure low at the time of surgery
Board-certified plastic surgeons only work with board-certified anesthesiologists to ensure patient safety.
Qualified anesthesiologists know that keeping the patient’s blood pressure low during surgery under general anesthesia can reduce bleeding. Also, one of their tasks is to monitor the patient’s vital signs to prevent serious complications.
- Avoid certain activities during the initial healing stage
Sneezing and blowing one’s nose should be avoided for 2-4 weeks because doing so can trigger bleeding.
It is important to note that despite best efforts, some patients remain susceptible to bleeding and thus they are required to use nasal packing while they recover.