Chin and neck liposuction creates a sharper angle between the neck and jawline. When performed as a stand-alone procedure, it is mostly performed in “younger” patients (35-50 years old) who typically have good skin shrinkage.
But past the age of 55, chin and neck liposuction could result in saggy appearance unless performed concurrently with some type of facelift or neck lift. Also, when it is done too aggressively (too much fat is removed), it might unmask the platysma muscle, resulting in visible vertical bands.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated the surgery on his Snapchat. The patient shown in the series of videos had about 300 cc of excess fat removed behind her chin and neck, a procedure medically referred to as submental liposuction.
Submental liposuction typically uses a small around incision beneath the chin, specifically positioned within the natural skin fold for optimal scar concealment. However, the patient also required a pair of incisions below her earlobes due to the severity of her excess fat—i.e., it extended far beyond the center of her neck.
The additional two incisions placed behind the earlobes allowed Dr. Smiley to attack the excess fat from different directions and remove it in a fanlike fashion (multiple layers), paving way for smoother results.
Meanwhile, he left behind a sufficient layer of fat, particularly right beneath the skin, to prevent dents, bumps, and other surface irregularities. Meticulous liposuction would also ensure that the skin could shrink-wrap around the new contour instead of looking saggy.
To further promote smooth results, the celebrity plastic surgeon says he typically recommends patients to wear a compression garment (or chin-neck strap) for at least one week to help the skin heal closer to the body. This will also keep swelling to a minimum, which paves way for quicker recovery.
Breast augmentation fat transfer precludes the need for implants and thus it avoids risk of capsular contracture (hardening of the breast tissue), implant malposition, rippling, and palpability.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video on Snapchat demonstrating a patient who requested for breast augmentation fat transfer to achieve more fullness to the upper breast pole and the lateral side.
One of the notable advantages of fat transfer over breast implants is the additional contouring effect.
“The patient needs more volume to her upper breast pole and the lateral side, which fat grafting can help improve. But in breast implants, we are highly reliant on their base. Simply put, using fat allows us to focus more on the area that needs the most correction,” Dr. Smiley says in the video.
But in terms of size, the effects of fat grafting can be limited particularly in patients with low body fat percentage.
“There are many breast implant sizes to choose from. Fat grafting, meanwhile, can only give one to two cup size increase,” says Dr. Smiley.
Dr. Smiley says that breast has fibrous tissue, which does not allow large volume fat transfer due to risk of pressure.
“Pressure is the enemy of high survival rate of fat grafts,” he further explained.
Aside from injecting just a conservative amount of fat, Dr. Smiley says another way to promote high survival rate is to inject fat cells closer to the muscle, which contains more blood supply.
Fat grafts need to integrate with the existing blood vessels, which can provide them the much needed oxygen and other nutrients. Also, their amalgamation with the extracellular matrix, which resembles a mesh that holds the blood vessels and other tissues together, is critical to ensure long-term results.
Meanwhile, Dr. Smiley collected the “unwanted fat” from multiple areas including the abdomen, flanks, and lower back. Prior to its injection, it was washed, sorted, and purified to remove all the biomaterials (blood and oil) and the anesthetic solutions used during surgery.
Tummy tuck with muscle repair ensures a flatter, more athletic abdomen after surgery. Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has demonstrated this technique on Snapchat as part of his patient awareness campaign.
The patient shown in the photos had extensive stretch marks, loose skin, and bulging tummy prior to surgery.
Tummy tuck is more commonly known as a surgery that removes the excess skin and fat hanging from the abdomen. However, this technique alone may not be enough to deliver optimal results unless complemented by muscle repair.
The excessive protrusion of her abdomen, according to Dr. Smiley, was caused by “weakness or poor integrity of the abdominal muscles.”
While the abdominal muscles are elastic, the fascia that holds them together is relatively inelastic; hence, some women with flat tummy may end up with barrel-shaped contour after pregnancy or large weight fluctuations.
Compared to most patients, the woman had a more severe case of abdominal wall weakness, which fittingly required additional suturing and tightening during surgery.
Dr. Smiley started the surgery with the creation of a hip-to-hip incision placed very low—i.e., a few centimeters below the pubic hairline. This incision placement would allow him to remove the excess skin and elevate the sagging mons pubis at the same time.
This is the suture pattern used to repair the loose rectus abdominis muscle. However, the patient’s oblique muscles are included as well due to the extent of her muscle weakness.
After the creation of the hip-to-hip incision, Dr. Smiley separated and lifted off the skin, revealing the loose abdominal muscles.
The celebrity plastic surgeon first worked on the rectus abdominis muscles. This is a pair of vertical muscles that is attached between the ribs and the pubis in the center of the abdomen. It should be noted that this anatomy is commonly repaired during standard tummy tuck.
But due to the extent of her abdominal wall weakness, she required additional muscle repair, particularly of the oblique muscles found on the more lateral side of the tummy.
By tightening the oblique muscles, Dr. Smiley says the patient “can expect more tightening effect and less bulging of the tummy every time she sits down.”
To complement her flatter abdomen, Dr. Smiley reduced the size of her navel with the use of an incision made inside its rim to hide the scar.
The “right” breast implants on a bony chest can help improve its appearance. Patients with this “anatomical feature” also typically have wide cleavage gap and little soft tissue coverage, which must be improved as well.
Dr. Tarick Smiley, one of the leading Orange County plastic surgery experts, has recently shown on his Snapchat the effects of “meticulously selected” breast implants that have had improved the bony chest appearance and visible dents of a female patient.
Dr. Smiley used a pair of slightly wider breast implants to “conceal the visible dents” along the sternum and to improve the wide gap between the breasts. Nonetheless, the implants’ base matched the horizontal measurement of the chest otherwise the patient would face a higher risk of scalloping, rippling, and malposition.
To further ensure natural-results—i.e., proportionate to the patient’s body and with no surgical stigmata—the celebrity plastic surgeon used small silicone implants (i.e., 400 cc).
The use of smaller silicone implants particularly suit the patient because of her limited breast tissue coverage and low body fat percentage. These implants were filled with a medical-grade silicone gel designed to simulate the cohesiveness of natural soft tissue.
Saline implants, meanwhile, would not suit the patient because of her little soft tissue coverage that could predispose her to higher risk of rippling and increased palpability. These implants have outer silicone shell filled with salt-water solution; hence, they may lead to firmer results and too globular breast contour when used by thin and small-breasted women.
To further ensure soft and natural contour, Dr. Smiley positioned the implant beneath the patient’s pec muscle, which provided more coverage than the over-the-muscle implant placement.
Even without fat grafting, the right implant design and volume was enough to conceal the patient’s bony indentations of her cleavage.
In general, Dr. Smiley says he reserves fat grafting for patients with “very poor upper-inner breast pole” that an implant-alone approach may not be enough to deliver satisfying results.
Fat grafting that is a part of composite breast augmentation, he says, also suits patients with certain types of deformity.
Bikini body after tummy tuck. This has always been the proverbial request of patients who ask for this type of body contouring surgery in which the apron-like hanging skin and fat from the abdomen is removed, typically with a hip-to-hip incision pattern.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently performed a tummy tuck in a female patient with barrel-shaped abdomen, redundant skin, lots of stretch marks, sagging pubis area, and “boxy” flanks. (Note: The surgery was recently shown on his Snapchat.)
Dr. Smiley places the incision below the pubic hairline so the scar is perfectly concealed by the patient’s underwear or bikini.
During surgery, Dr. Smiley placed the incision “very low and hidden” so the “resulting scar will not show when the patient wears an underwear or a bikini.”
“I place the incision way below the hairline [of the pubic region] to hide the scar and to slightly elevate the sagging mons pubis,” Dr. Smiley says in the video.
Conservative elevation of the mons pubis without excessive tension also ensures a smooth transition between the pubic area and the lower abdomen, further contributing to natural-looking results.
After the creation of tummy tuck incision, Dr. Smiley lifted the skin to reveal the pair of separated or splayed abdominal muscles, which he tied in a side-by-side configuration to help improve the patient’s barrel-shaped abdomen. This was done with the use of permanent sutures known for their additional support.
“By tightening the muscle with internal sutures and paying more attention to the area right above the belly button, we can prevent the appearance of unsightly bulges that tend to be more pronounced when a person is sitting,” says Dr. Smiley.
The celebrity plastic surgeon then removed the hanging skin before closing the wound in which a curved hip-to-hip scar would lie low “beneath the bikini area” for its optimal concealment.
To further improve the shape of the waist, Dr. Smiley tightened the skin with the “right amount of tension” so that a degree of muscle definition would show through. He also pulled the skin “more centrally” for additional “feminine curves.”
Dr. Smiley says that meticulous cutting and excision techniques, in addition to precise suturing methods, “have a significant impact on the healing and the final scar appearance.”
“When cutting the skin, the blade should be held at a 90 degrees angle and it should be moved in one direction. This paves way for meticulous suturing technique in which the goal is to close the wound edges just like you’re arranging puzzle pieces,” he says.