Arm liposuction is almost an exclusive procedure for women. Its primary goal is to remove just a small amount of fat to achieve a smooth contour and preserve the feminine appearance.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley warns that excessive liposuction almost always produces a masculine-looking arm and possibly some skin irregularities that could be difficult to correct.
Dr. Smiley says the effects of excessive liposuction can be improved by fat transfer, which in essence is a reverse liposuction. It collects donor fats from one area of the body, purifies them, and re-injects them to the “botched” sites, he explains.
To achieve good results from arm liposuction surgery, the celebrity plastic surgeon has explained his “guiding principles.”
- A thin layer of fat beneath the skin should remain.
A thin layer of fat will ensure smooth and natural results. The use of microcannulas (flexible tube whose outside diameter is less than 2.5 mm), and moving them at correct rhythmic speed are the key factors to produce a smooth skin surface.
- Most of the arm circumference must be liposuctioned,
It is of critical importance to treat 75 percent or more of the arm circumference so that the weight of residual fat on skin is well distributed. This guiding principle also ensures good skin shrinkage.
- Consider removing the armpit fat.
It is important that the armpit will not distract from the smoother, more feminine upper arm. For this reason, some patients need liposuction in this area as well.
The armpit fat may be positioned anteriorly or posteriorly, or even both.
- Examine the skin elasticity or shrinkage.
A liposuction-only approach is suitable for patients whose skin has a decent amount of elasticity, allowing it to shrink-wrap around the new contour as the body moves forward to recovery. Should there is any sign of tissue laxity, an excision-based surgery may be needed to achieve a proportionate result.
If skin laxity is quite limited, only affecting about a third of the upper arm, a short scar that lies precisely within the armpit skin fold can produce better results as compared to a liposuction-alone approach. But in severe cases of redundant skin—a typical problem of massive weight loss patients—the scar must be extended down to the elbow, specifically along the inner side of the arm for better concealment.
A mini tummy tuck after pregnancy can provide good results for the “right” patients who require minimal contouring, as suggested by renowned Los Angeles plastic surgery expert Dr. Tarick Smaili.
In most cases, mini tummy tucks only remove a small amount of excess skin and fat in the lower abdomen or below the level of belly button. But due to the natural diffusion of loose tissue, only a limited number of patients can benefit from this procedure.
Before-and-After Photos of a Mini Tummy Tuck Patient
Despite the limited amount of contouring, mini tummy tuck is noted for its shorter horizontal scar, i.e., 4-8 inches, compared to the standard technique in which a hip-to-hip incision is used. Nevertheless, a good surgeon will use every effort to place the scars close to the pubic area and concealed by the patient’s bikini or underwear.
Aside from tightening the skin and removing some excess fat, tummy tuck may also entail muscle repair, which is commonly used in female patients.
Due to pregnancy, the paired abdominal muscles positioned in the midline that run between the pelvis and the lowest rib become separated and will not return to their previous settlement despite rigorous exercise.
Because the entire vertical length of the muscle is affected by pregnancy, mini tummy tuck after pregnancy is generally not enough to provide optimal results because it just focuses on the lower abdomen.
For the vast majority of tummy tuck patients, particularly those who have experienced pregnancy, the standard or hip-to-hip incision is the most viable technique.
Despite the resulting hip-to-hip scar, which typically blends in well with the skin over time, a good number of patients are willing to accept this tradeoff to achieve a more feminine contour.
On the other hand, forcing the use of mini tummy tucks in patients who need their upper abdomen to be reshaped as well—which is generally the case—can lead to poor scarring (dog ear’s or puckery appearance) and unnatural contour of the abdomen.
However, mini tummy tuck via endoscope or small articulating camera probe makes it possible to reshape a small area of the abdominal muscle above the navel. However, this technique is only reserved for patients with long torso, high belly button, and little excess skin.
Regardless of the incision technique, tummy tuck is only suitable for normal weight, healthy patients who are done having children.
Through proper weight management and avoidance of pregnancy, the results of tummy tuck surgery are expected to last a lifetime.
The anchor breast lift procedure is reserved for patients whose bottom of the breast falls more than 5-6 cm from the inframammary fold and/or wear a large cup size, i.e., over 1,500 gram per side.
The procedure is sometimes referred to as an inverted T lift due to the resulting scars around the nipple-areolar complex, vertically within the lower breast pole, and inside the inframammary fold.
Meanwhile, some modified forms of breast lift eliminate the inframammary fold (lollipop lift) or even the vertical scar (donut lift), leading to shorter, less visible scars and possibly quicker recovery. However, these techniques are not suitable for women with overlarge and/or extremely saggy breasts.
Regardless of the incision pattern used at the time of surgery, leading Upland plastic surgery expert Dr. Tarick Smaili says that internal sutures are always crucial to maintain a good shape long term. He warns that any technique that relies heavily on shaping the skin will lead to short-lived results because of its tendency to stretch and “settle.”
While the anchor breast lift procedure results in an inverted T scar, a patient with realistic goals and expectations will understand that any surgery comes with a tradeoff, which should be “acceptable” for the most part.
Proper wound closure plays a crucial role to achieve “favorable” scars. The idea is to redistribute the tension on the skin to prevent wound breakdown and scar migration and keloids.
With the anchor technique, the scars are supposed to lie at the junction of two differently colored skin and within the natural breast fold for optimal concealment. However, the vertical scar between the bottom of the nipple and the inframammary crease is positioned in a more visible manner, although over time it is expected to fade and blend in with the skin.
While breast lift does not remove any breast tissue, it is not uncommon for patients to notice that their new “size” no longer “fills” their preoperative bras, i.e., it appears that they lost about a half-cup size. With perkier and more “compact” breast tissue after surgery, this should be anticipated.
For some patients, their anchor breast lift is combined with reduction, a fitting complementary procedure if there is a desire to have a smaller cup size.
Breast reduction not only improves body proportions but also alleviates physical symptoms such as rounded shoulders, postural problems, and painful bra strap grooves caused by overlarge breasts.
Mommy makeover surgeons focus on plastic surgery procedures that reverse the effects of pregnancy, such as tummy tuck and breast enhancement. But to achieve good long-term results, these are best performed when the patient is done having children, as suggested by renowned body contouring expert Dr. Tarick Smaili.
Qualified mommy makeover surgeons must meet the strict requirements stated below.
As of this writing, there are several medical boards that “certify” doctors who want to offer cosmetic plastic surgeries. However, the American Board of Plastic Surgery, which requires the highest and most stringent requirements, remains the “gold standard.”
ABPS doctors are also required to take a rigorous oral and written exam every 10 years, and are mandated by board regulation to perform surgery only in accredited operating rooms and to adhere to a high level of patient care.
- Extensive and relevant experience
Plastic surgery has a wide range of subspecialties, e.g., facial rejuvenation, nose reshaping surgery, body contouring after weight loss, mommy makeover, breast enhancement, etc.
The general rule of thumb is to choose a surgeon whose patients are mostly women who want to reverse the effects of pregnancy. Ideally, he should be performing mommy makeovers for 10 years on a regular basis.
- Extensive collection of before-and-after photos
The before-and-after photos from previous surgeries can help the patient evaluate her doctor’s technical and artistic skills. It is also ideal that she finds a few “subjects” whose body frame (i.e., height, body shape, and area of concern) closely resembles hers.
- Offer good rapport and honest discussion
A good surgeon will make every effort to promote honest and transparent communication, which in turn could allow his patient to settle realistic goals and feel comfortable with whatever surgery she may choose.
Meanwhile, a prudent patient should avoid anyone who makes unrealistic promises or forces her to have more surgeries than she actually wants.
- Prioritize patient safety above all
A good surgeon will always prioritize patient safety above anything else. For this reason, he only performs surgeries in accredited hospitals or outpatient centers, uses all efforts to minimize surgical trauma (e.g., limiting the operating time), and conducts strict patient selection.
It is important to note that patients with healing problems and other serious medical conditions and those with unrealistic goals are poor candidates for any type of cosmetic plastic surgery.
The ideal breast implants based on body type—What are the specific anatomies the surgeons take into account to deliver natural-looking results, meet their patient’s cosmetic goals, and minimize risk of complications all at the same time?
If the primary goal is to achieve natural results from breast augmentation via implants, a skilled surgeon will look at his patient from head to toe, measure body proportions such as the hip-to-waist ratio, and consider her height and body shape.
Aside from the body type, a good surgeon will also take into account his patient’s lifestyle and how she wants to be perceived by the people around her.
In small-framed women, a conservative sized implant is perceived to be the best way to achieve natural and proportionate results. Meanwhile, large augmentations—or using more than 500 cc—could predispose them to increased risk of unnatural breast contour, rippling, palpability, and other surgical stigmata.
Choosing the “conservative route” is even more important if the lean or small-framed patient is living an active lifestyle.
Leading Los Angeles plastic surgery expert Dr. Tarick Smaili warns that choosing disproportionately large breast implants could lead to back pain and poor posture, in addition to cosmetic-related problems such as rippling and palpability.
On the other hand, large-framed women—i.e., they are tall and with a strong build—can easily carry larger, heavier implants. In fact, some may even need to choose a size that is bigger than 500 cc to see a noticeable “cup” increase.
Of course, the safest maximum implant size is also determined by the pre-existing soft tissue coverage. While it may sound paradoxical, patients with little tissue to begin with should ideally choose smaller implants, while women with bigger “cup” can opt for larger augmentation.
Aside from the implant size, its vertical and horizontal measurement, projection, and shape should also reflect or at least contained within the patient’s preoperative anatomy.
Age is another deciding factor for choosing the ideal implant size. According to anecdotal reports and small surveys, “older” patients tend to choose a conservative amount of augmentation to avoid accelerated aging of the breasts.
It is important to get the “right” size the first time to avoid revisions. According to a recent study that involved around 200 patients who had breast augmentation, 13 percent wished they chose a bigger implant, while 2 percent thought their postop size was too big for their liking.
To recap, choosing breast implants based on body type, underlying breast and chest anatomies, cosmetic goals, age, and even lifestyle can play a crucial role in high patient satisfaction rate.