Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.
Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.
The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.
Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.
After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.
In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.
Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.
“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.
When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.
Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.
The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.
But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.
The surgeon’s eyelid surgery before and after photos can shed light on his artistic skills, which play a critical role in any facial plastic surgery. Hence, a prudent patient should insist to view this material before scheduling her surgery.
The before and after photos should have no classic surgical stigmata such as skeletonized eye socket, abrupt lower lid and cheek transition, unnatural height of the upper lid, retracted skin lid, and visible scar.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video demonstrating a patient who has had upper and lower eyelid surgery to correct age-induced skin and soft tissue laxity. To achieve a more natural and more youthful result, he combined the procedure with fat transfer.
Lower Eyelid Surgery with Fat Transfer
The idea of fat transfer, also referred to as fat injection and structural fat grafting, is to create a smooth transition between the lower lid and cheek. Occasionally, a lower lid-alone approach can create or worsen the appearance of tear trough, a problem best avoided when fats are injected beneath the skin to serve as padding.
While the superficial fat beneath the lower lid skin tends to shrink with aging, the deeper fat behaves differently: It becomes more prominent and saggy, leading a crescent-shaped bulge. Hence, the right surgical maneuvers reverse these age-induced effects.
The deeper lower lid fat is often removed or reduced during surgery to correct lid herniation or “bagginess.” This is typically followed by fat injection beneath the skin to create a smooth lid-cheek transition.
To further create a smooth lower lid and eliminate the crepe-like appearance, during surgery Dr. Smiley removed a small amount of excess skin with the use of a thin incision placed very close to the lower lash margin. This is expected to heal into a thin scar that is invisible at a conversational distance.
Upper Eyelid Surgery
The patient also received upper eyelid surgery to eliminate the hooding and fullness of the lid-brow complex.
“I placed the incision inside the new skin fold to hide the scarring,” Dr. Smiley said in the video.
The incision allowed Dr. Smiley to remove the excess skin and fat that was causing the “heaviness” and drooping of the upper lid. However, he made sure that sufficient fat pad would remain after surgery to avoid the skeletonized appearance, which in any way does not look youthful.
The skin excision aspect was also done in a highly meticulous manner to preserve “normal blink” and to ensure that the “new” upper lid would have a height that is consistent with the patient’s facial feature, gender, and race. For instance, female Caucasians often have a lid crease height that is between 8 and 12 mm; this generalization does not apply to men and other ethnicities.
Brazilian buttock lift is a well-established plastic surgery technique in which the patients’ hips and buttocks are reshaped and augmented with their very own fat. Oftentimes, large volume of fat collected through liposuction is needed to deliver noticeable improvements.
Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgery expert, says the patient’s “starting anatomy” affects the results to a varying degree, with certain physical traits making this procedure more challenging. Nonetheless, the use of right surgical maneuvers and tools can counteract these “anatomical roadblocks” and ultimately achieve the desired results.
Dr. Smiley has shared some Brazilian buttock lift before and after photos depicting patients with challenging anatomy. He also explained the corresponding techniques that allowed him to overcome such anatomical roadblocks.
Before photo of patient no. 1. She has large lateral dent, which needs to be released so her hips can expand after fat injection.
Photo of patient no. 1 right after surgery. Notice the complete elimination of the lateral dent and smoother, fuller buttocks and hips.
Patient no. 1 had lateral depression along her buttocks caused by tethering of the fascia or connective tissue that was pulling the skin inward. Failure to release the skin would not allow the hips to expand after fat injection.
Dr. Smiley released the skin from the fascia or thread-like anatomy so he could expand and sculpt the hips, improving the feminine silhouette. This was done with the use of a surgical fork that resembled a thin two-pronged cylinder inserted into a tiny puncture wound.
He says “the use of surgical fork requires precision” because a slight error can lead to more skin asymmetries and herniation.
Patient no. 2 was thin, weighing only 115 lbs. during surgery and so it was a challenge to collect adequate amounts of fat. Hence, Dr. Smiley performed liposuction on a larger surface area to harvest enough volume to sculpt the hips and augment the buttocks.
Before and after photos of patient no. 2. She is thin and so she requires larger liposuction surface area to harvest sufficient fat volume.
To further create an illusion of fuller buttocks and curvier hips, Dr. Smiley used the flanks and lower back as donor or liposuction sites. By removing the excess fat in the area, even though the volume was relatively small, he was able to carve it out and allow the butt to “stick out more.”
Patient no. 3 had asymmetric fat distribution along her back, with more fats along the right flanks. Hence, she required “an extra meticulous” liposuction to achieve smoother, more symmetric appearance between the left and right side of her torso.
Before and after photos of patient no. 3. The surgery corrects the fat rolls along her armpit, bra line, and flanks. Furthermore, it improves the symmetry between the right and left side of the torso.
Further complicating her case was the extent and distribution of fat that her armpit area—along with her flanks, lower back, and “bra rolls”—was even included during liposuction. The idea is to create a smooth silhouette from the posterior view.
Moreover, her skin buttock prior to surgery had visible dents and so Dr. Smiley filled in these tiny depressions with the use of microdroplets technique (0.1 cc of fat inoculated one at a time). This method of injection not just deliver smooth results, but also high survival rate in which 70-75 percent of the fat volume is expected to be near permanent.
Forehead lift surgery can elevate the sagging brows, eliminate the vertical creases between the eyes and the horizontal lines across the forehead, and change the hairline height if the patient requests for it.
(Forehead lift surgery and brow lift are basically the same procedure—the incision patterns and “cosmetic effects” are similar—although there are techniques that can elevate or reshape the brows without lifting the entire forehead.)
Serrated incision during forehead lift surgery is made precisely at the hairline so the scar blends into the background.
As with any facial plastic surgery, the ideal forehead lift technique depends on the patients’ underlying anatomy and the “cosmetic effects” they are after. For instance, some like to shorten their forehead, while others want to maintain its height after elevating the brows.
If one of the goals is to reduce or maintain the forehead height, leading Los Angeles plastic surgeon Dr. Tarick Smiley says the ideal technique involves an irregular (serrated) incision made precisely at the hairline. This is different from the standard or coronal lift in which the incision goes from ear to ear, across the top of the head.
The coronal lift does not suit patients with high forehead because it inadvertently elevates the forehead by up to 1 inch, an “effect” some people humorously call “five-head.”
(“Four-head” is when the person can fit four fingers between her eyebrows and hairline. “Five-head” when it is too wide that five fingers can all fit on it.)
Fortunately, the hairline incision technique, or medically referred to as trichophytic, does not cause the dreaded five-head effect and in fact may even shorten the appearance of wide forehead by moving the hairline slightly more forward. Nonetheless, it should not be overdone otherwise the “primitive appearance” may ensue.
This is not to say that the hairline incision technique is superior to the coronal lift because it all boils down to the patients’ anatomy. For instance, women with a notably short forehead may consider getting the coronal approach to slightly increase its height.
Some surveys have suggested that women with a slightly large forehead, along with other “cute” or babyish features such as fuller lips, large eyes, and prominent cheeks, are generally regarded as attractive and youthful by other people.
Nonetheless, should there is a need to alter the hairline height during surgery, it must not be lifted excessively because a high hairline is masculinizing for women. And even in men, overzealous elevation is avoided to prevent unnatural results.
A holistic facial rejuvenation surgery is typically a combination of facelift and structural fat grafting. Ocasionally, eyelid surgery, forehead lift, neck lift, and/or liposuction are combined to achieve a more natural and more “consistent” result. Combination procedures are particuarly common in patients 55 years and older due to their advanced facial aging.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has presented photos of two patients to demonstrate natural-looking results from facial rejuvenation surgery.
Patient no. 1 before and after photos
Patient no. 1 has received deep plane SMAS facelift and neck lift, a technique that pulls the skin, connective tissue, fat, and muscle as a single unit. The deeper structures need to be tightened and elevated before any excess skin is removed.
The SMAS layer beneath the skin is relatively thick and heavy, and so any facelift technique which does not address this deeper structure leads to short-lived results, overly tight appearance, and poor scarring due to the tension on skin. Hence, Dr. Smiley says he does not perform skin-only lift.
Dr. Smiley incorporated neck lift to ensure that it would not detract from the more youthful and tighter face. He positioned a small incision beneath the chin, specifically within the natural skin fold for optimal scar concealment, to tighten the separated platysma muscle that was causing the visible neck bands.
Despite the tightening effects of facelift, it has one major caveat: There is a reduction in the anterior dimension of the face as the soft tissue rests closer to the bone.
To counteract this untoward side effect of facelift, Dr. Smiley says structural fat grafting is typically combined with the surgery. The idea is to restore the youthful fullness.
For this particular patient, fat grafting was used to restore the fullness of the mid face, leading to the appearance of more prominent cheeks, which is one of the critical emblems of youth.
Patient no. 2 before and after photos
Patient no. 2 has also received deep plane SMAS facelift and neck lift due to the extent of her facial sagging. But to truly create “consistent results,” Dr. Smiley also performed a simultaneous upper eyelid surgery, or blepharoplasty.
Her blepharoplasty was performed with the use of small incision placed precisely at the skin fold so the scar could blend into the background. Afterwards, the excess “hooding” skin was removed, leading to more alert, more youthful eyes.
To prevent an abrupt transition between the lower eyelid and cheek, which is one of the most common facelift stigmata, Dr. Smiley injected fat into the “junction” to create smoother results.
And to eliminate the patient’s severe jowling, he pulled the skin at a 45 degrees angle, which is the correct vector of pull. Any direction otherwise can lead to skin pleating along the lateral neck, flat cheeks, and “lifted” appearance.