Fat transfer in plastic surgery has many uses, including hand rejuvenation, breast reconstruction and augmentation, buttock enhancement, scar revision, and facial rejuvenation.
Fat transfer uses donor fats collected via liposuction, which are then sorted, washed, and purified to come up with the healthiest cells to be re-injected into the area that needs to be augmented or reshaped.
Dr. Tarick Smaili, one of the leading Beverly Hills plastic surgeons, explains the circumstances that may warrant fat transfer.
Facial soft tissue atrophy or shrinkage is caused by significant weight loss and aging. The submalar, or the area below the cheekbone, is particularly prone to this age-related problem.
While dermal fillers such as Restylane, Radiesse, and Juvederm are easier to use—because they are readily available materials with good safety track record—proponents of fat transfer in plastic surgery suggest that it provides more natural results and feel because the cells have the same cohesiveness as the surrounding tissue.
Despite the benefits of fat transfer, it is not ideal for lips and other non-static facial areas due to poor survival rate and highly variable results.
- Breast reconstruction and augmentation
In breast reconstruction, fat transfer is more commonly used to hide the breast implant edges and other contour irregularities. The idea is to provide additional soft tissue coverage to achieve a more natural result and “feel.”
Fat transfer is also helpful in cosmetic breast augmentation, although most patients can only expect a “conservative” cup size increase, i.e., about one cup per session/surgery. It is important to note that injecting volume that is beyond what the tissue and skin capacity can hold will lead to poor survival rate of grafts.
Instead of butt implants, some patients have the option to use their donor fats to reshape and augment their “behind.” However, most will need a minimum of 500 cc of “processed” fat per butt cheek for a visible improvement. Of course, tall or “large built” individuals will need at least 800-1,000 cc per side to compensate for their body frame.
Nowadays, buttock augmentation via fat transfer is more commonly referred to as Brazilian butt lift.
Despite the benefits of Brazilian butt lift, patients will face some limiting factors such as the amount of healthy donor fats, skin tautness in their buttocks, and body frame.
Just like the face, the hand is also susceptible to age-related soft tissue atrophy, making fat transfer a possible option. However, some doctors prefer dermal fillers because of their more predictable results.
The surgeon’s arm lift photos will reveal a lot about his level of expertise. First and foremost, the results should look natural, gender appropriate, and proportionate to the rest of the body, according to Beverly Hills Plastic Surgery Institute.
Dr. Tarick Smaili, one of the leading Beverly Hills plastic surgeons, shares his tips on how to scrutinize your doctor’s arm lift photos.
- Take a look at the “before” photos
While a good surgeon will make every effort to hide the scars and deliver natural-looking results, there are limiting factors such as significant amount of redundant skin and poor skin elasticity, which are both caused by massive weight loss.
By examining the preoperative or “before” photos, you can see if your doctor is familiar with technically difficult cases so you can decide if he can provide natural results, or at least a good amount of improvement.
- Examine the scar in the arm lift photos
The resulting scars, while permanent, should not be unsightly. For patients whose skin laxity is limited to about a third of their upper arm, the incision must be hidden within or limited to the underarm.
But for patients who need an extensive amount of work, a bilateral armpit-to-elbow incision is needed to achieve the best contour possible. While it is often ideal to place the scar on the inner side of the arm, some patients may have to accept that a more posterior location is needed to allow their surgeons to remove more redundant skin.
To achieve favorable scars, the general rule of thumb is to use all efforts to minimize tension on the wound. Deep suturing techniques, internal sutures to support the new contour, proper patient selection, and use of silicone sheets and other similar modalities are known to result in more acceptable scar appearance.
- Examine the overall contour
Botched results are often manifested by webbing and “tissue pulling” that are visible between the arm and the lateral chest wall, especially when the arm is raised. In general, these are caused by a short-scar technique despite the presence of significant soft tissue laxity that warrants a longer incision.
Aside from smooth contours, the “after” photos should also look gender appropriate. For this reason, some female patients may require liposuction as an adjunct procedure of their arm lift surgery.
Liposuction results are supposed to look natural. While the term “natural” may have different meaning to each patient, in strictest term it should appear gender appropriate, proportionate to the rest of the body, and smooth, with no skin asymmetries and other surgical stigmata.
Upland plastic surgery expert Dr. Tarick Smaili shares his tips on how to achieve natural-looking liposuction results.
Only “good” candidates can enjoy the full benefits of liposuction or any body contouring surgery. First and foremost, the right patient should be near her ideal weight but has exercise- and diet-resistant superficial fat (it is just beneath the skin, as opposed to the deeper visceral fat closely tied to obesity).
It is important to note that yoyo weight has detrimental effects on liposuction results, so a good patient must accept that long-term weight management is the only way to preserve her new figure.
Meanwhile, obese people and individuals with beer belly appearance (this is generally caused by deeper visceral fat and/or weak muscle that allows the abdominal content to protrude) are generally considered as poor candidates.
They are hollowed tubes with an outside diameter of 2 mm or less. While they lead to longer operating time because they remove fats in smaller, more accurate bits, studies have suggested that they provide smoother contour and minimize risk of “over-correction.”
Larger cannulas, meanwhile, are best avoided when treating small areas or those requiring high precision (e.g., chin, hip-flank, breast, calf, and ankle) because they remove fats in bigger chunks.
- Physical exam and proper markings
Prior to surgery, any asymmetry between the left and right side of the body must be identified. To further achieve natural, smooth contours, proper markings are done while the patient is in upright position. It is important to note that supine or prone positions could sometimes exaggerate the fat bulges and rolls, which could lead to inadvertent over-liposuction.
Contrary to popular belief, liposuction is not about removing all the fats in the treated area. To preserve the natural valleys and contours of the body and maintain a smooth skin, enough fats must remain especially beneath the skin.
Some patients have skin irregularities (dents or “orange peel” look) due to aging, poor lifestyle, yoyo weight, or previous botched liposuction. To create a smooth appearance, doctors may inject these areas with the recently collected excess fats from another part of the body.
To make the most out of your breast augmentation consultation, you must prepare certain things ahead of time. It is also helpful that you equip yourself with some knowledge about the surgery by reading reliable sources from the Internet, magazines, and newspapers.
Orange County plastic surgery expert Dr. Tarick Smaili advises patients seeking breast augmentation to bring the following:
1. List of questions. Take note that there is no silly question and it is your surgeon’s legal and ethical responsibility to explain to you every surgical option and its ramification. A prudent doctor will try to use layman’s term to promote good communications, as opposed to confuse you with jargons.
Your questions should always include your doctor’s qualifications (board certifications, training, and experience), how long and how frequent he performs the sought procedure, its benefits and possible risks, the surgical venue (accredited surgical facility center vs. hospital), and his contingency plans should complications occur during or after surgery.
2. Write down your lifestyle. Your doctor must know your lifestyle, level of physical activities, career, and “how you carry yourself” to help him predict your surgery and recovery. This information could also help him guide you to make the “right” decision.
3. Medications. You can write down all your drugs, including supplements and herbal remedies, or better yet, put them in a brown bag and show it to your surgeon, allowing him to read the actual ingredients and identify possible contraindications to surgery.
Bear in mind that aspirin, ibuprofen, NSAIDs, and certain vitamins and herbal supplements must be avoided for at least two weeks because they are known to increase bleeding and lead to prolonged recovery.
4. Favorite clothing and underwear. Most surgeons use implant sizers that their patients can actually “wear” beneath their unpadded bra, allowing them to see and “feel” the most likely results of their chosen implant size and profile.
Bringing along your favorite “tops” can further help you assess if your chosen implant size fits your style of clothing and career/profession, and how you want to be perceived by the public.
5. Bring pictures of women with a body you admire. Ideally, their body frame should closely resemble yours to further improve your communications with your plastic surgeon.
Early maintenance facelift is a new school of thought. In the past, facelift was typically performed when the face was already showing advanced signs of aging, however, some doctors nowadays feel that a proactive approach, as opposed to a reactionary one, can provide the most benefits.
Leading Brea plastic surgery expert Dr. Tarick Smaili advocates early maintenance facelift due to the benefits it provides, which he has explained below:
Before and After Photos of a Patient Who Had Early Maintenance Facelift
- More natural and possibly longer lasting results
Because skin elasticity and soft tissue volume are still relatively good around the age of 40, it is easier to achieve more natural-looking results, as opposed to waiting until one has reached 60 wherein the underlying tissue and muscle are way too “flimsy.”
Nonetheless, facelifts almost always reshape the deeper structures of the face, as opposed to a skin lift alone, to achieve longer lasting, more natural-looking results. Most doctors also use some kind of internal sutures to support the new contour and minimize the superficial tension, allowing the wound to heal and fade into an imperceptible scar.
- Fewer risk factors and shorter recovery
In general, younger patients heal quicker and experience lower complication rate after surgery. Nevertheless, it remains imperative to perform a complete medical evaluation to rule out healing problems or other conditions that could lead to undue risks.
Early maintenance facelift typically uses fewer and shorter incisions compared with the standard technique because it only targets a limited facial region—e.g., lower facelift, mid facelift, or neck lift.
- More options, including non-surgical alternatives
Choosing a proactive treatment for early signs of aging means more options, including non-surgical alternatives such as Botox injection, laser skin resurfacing, medical-grade chemical peels, and dermal fillers.
Meanwhile, a maintenance facelift is a highly customized procedure to meet the patient’s cosmetic goals and address his/her main concerns. For instance, anyone whose only problem is the jowling and upper neck laxity can benefit from a mini lift in which a bilateral short incision behind the ear contour is enough to rejuvenate the appearance.
Some patients choose to have early maintenance facelifts to achieve subtle results, followed by minor touch-ups (every a couple of years) in the form of revision surgery and/or non-surgical procedures such as dermal fillers. With this approach, they can claim to their friends that their youthful appearance is due to their good genes and healthy lifestyle.
Facelift surgery at a more advanced age, meanwhile, can lead to drastic changes that most patients will have no option but to admit that they have had a surgical enhancement. According to anecdotal reports, men are more private about plastic surgery compared to women.