Major tummy tuck surgery entails not just the removal of apron-like abdominal skin. To achieve more proportionate and natural-looking results, it typically combines other surgical maneuvers including liposuction (fat reduction), muscle repair, navel repair, and pubis lift.
Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgeon, has recently posted a series of videos on Snapchat to demonstrate one case of major tummy tuck in which the female patient has large redundant skin following massive weight loss.
While the standard tummy tuck uses a hip-to-hip incision pattern, the patient has required an extended version, meaning the scar slightly extends into the side. Nonetheless, Dr. Smiley has made every effort to place it “beneath” the bikini area (i.e., very low) for its optimal concealment.
But prior to the removal of excess skin, Dr. Smiley had performed liposuction of the flanks in which the unwanted fat was removed with a cannula (straw-like device attached to a vacuum pump). This additional step would allow the patient to achieve a more slender, curvier side.
In the past, tummy tuck and liposuction performed at the same time was greatly discouraged due to the perceived higher risk of complications. However, recent clinical studies and surveys have shown otherwise. Provided that liposuction is not too aggressive (i.e., only a small amount of fat is removed) and it does not involve the area above the navel, the combo procedure is reasonably safe.
Meanwhile, large volume liposuction or extensive liposuction involving the area above the belly button is ideally performed 3-6 months after tummy tuck to allow the body, particularly its blood supply, to recover from the surgical trauma.
Going back to the topic of major tummy tuck’s components, it is also critical to reshape the belly button, which might become distorted or enlarged following massive weight loss or pregnancy. In the video, Dr. Smiley is seen creating an incision around the inner rim of the navel to improve its appearance and to look more proportionate with the slimmer waistline.
To further create more proportionate results, the patient received pubis lift (the area is susceptible to sagging after massive weight loss). The idea is to encourage a smooth transition between the mons pubis and the lower abdomen.
Buccal reduction surgery aims to deliver a more chiseled face by removing some portion of the fat deposit deep in the cheek, specifically between the corner of the mouth and the nostril.
Instead of removing or obliterating completely the buccal fat pad in the cheek region, leading Inland Empire plastic surgeon Dr. Tarick Smiley says reducing it only (i.e., leaving behind some fat) will ensure a natural result and prevent the “scrawny” appearance, which may appear soon after surgery or several years down the road.
Aside from going to the “conservative route,” Dr. Smiley says the success of buccal reduction surgery also relies on strict patient selection; hence, he only reserves this procedure for patients with full, round face who are near their ideal weight.
(Note: Overweight people can have “chipmunk” cheeks, which may deflate to some extent after losing the extra pounds. Meanwhile, some normal weight individuals have a markedly round face due to large buccal fat pad, a feature that is generally hereditary.)
And while there is no “magic number” when it comes to the ideal age for buccal reduction surgery, many surgeons recommend postponing it until one has reached her mid-twenties. It is important to note that aging causes facial volume loss and so the face will thin out naturally.
The caveat with having buccal reduction surgery before reaching the age of mid-twenties is the perceived increased risk of looking scrawny several years down the road. In fact, dermal filler injection is the most popular non-surgical facial rejuvenation in women between late thirties to early fifties.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate buccal fat reduction surgery combined with chin implant. He created a small incision inside the patient’s mouth (between the cheeks and gums) to expose the buccal fat. Then, he teased some of the fat out with forceps to remove it.
To achieve a more proportionate result (and a more chiseled facial contour), the patient had a simultaneous chin augmentation in which a short inconspicuous incision was made beneath her chin in order to position a small implant. The incision is expected to fade into an invisible scar after 6-12 months.
Upper pole fullness after breast augmentation can be achieved with precise physical examination of the breasts. The idea is to identify the “challenges” and anatomical variables that must be overcome to achieve the best shape and projection possible.
Of course, the patient must be able to describe in details her cosmetic goals and expectations. Hence, patient-doctor communication plays a crucial role in the satisfaction rate, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos showing one patient whose primary goal was to achieve increased upper pole fullness after breast augmentation.
While the patient’s pre-operative breasts had adequate soft tissue, they were remarkably pendulous that her areola sagged a few centimeters from its breast fold (or submammary crease). Further aggravating the sagging appearance was the deflated or “empty” upper breast pole.
Due to the extent of her breast sag, Dr. Smiley performed the standard breast lift technique in which an incision goes around the areola’s perimeter, down the midline, and then across the breast fold. The resulting scar from this method resembles an anchor, and so it is also aptly named as anchor lift.
before and after photos
Despite the growing popularity of modified breast lift techniques, the patient remained suited for the standard incision pattern because her areola required more than 5 cm of elevation, something that cannot be achieved with shorter incisions.
The anchor lift has allowed Dr. Smiley to remove some tissue and skin at the bottom of the breasts before lifting and reshaping the remaining tissue with the use of internal sutures. But as a stand-alone procedure, breast lift cannot give ample fullness on the upper poles of the breast—this is where implants become helpful.
Because the patient was more concerned about the final breast shape and fullness of the upper pole, a smaller or conservative-sized implant would suit her.
While showing the patient’s before and after photos, Dr. Smiley said “there is no significant change in her breast volume even with the use of implants, although the upper pole has received significant improvement in terms of looking full and youthful.”
Male rhinoplasty for large nose is a highly customized procedure in which the patient must be able to describe his goals in the most exact detail. Furthermore, the surgeon must conduct a comprehensive physical exam to evaluate skin thickness, underlying structures of the nose (cartilaginous and bony framework), and even the entire face to achieve proportionate, natural-looking results.
Rhinoplasty, or in layman’s term nose-reshaping surgery or nose job, is one of the most technically challenging plastic surgery procedures that its success is determined by minute changes measured in millimeter. Hence, it requires deep understanding of the anatomy and respect of the patient’s ethnicity, gender, and facial and nasal anatomies.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a male patient who required rhinoplasty for large nose.
Aside from having a hugely disproportionate nose (relative to his “small” face), Dr. Smiley said the patient also complained of the following cosmetic issues:
- dorsal hump or excessive fullness along the bridge of the nose
- hooked or drooping tip
- bulkiness of the tip
For this patient, Dr. Smiley performed the closed rhinoplasty, meaning all the incisions were made inside the nostrils, specifically within their inner lining. Aside from eliminating the risk of visible scar, the technique is also known to result in shorter “social” recovery because of the minimal postop bruising and swelling.
The incisions allowed Dr. Smiley to access the cartilaginous framework of the nose and to remove the piece of cartilage causing the dorsal bump along the bridge. But instead of discarding this tissue, he resized and reshaped it so it could be used to support the tip and refine its appearance at the same time.
With additional tip support, Dr. Smiley was also able to address the excessive bulkiness of the tip.
Afterwards, the celebrity plastic surgeon rasped or shaved down the bone (the upper one-third of the nose is made up of bony framework, while the lower two-thirds is made up of cartilage that is relatively flexible) to further reduce the fullness along the bridge. This was done with the use of a device closely resembling a nail file.
Because the patient has thick nasal skin, the amount of reduction must be on the conservative side. The idea is to allow the overlying skin to redrape beautifully around the new contour, as opposed to looking bulbous or amorphous, which could happen after an over-aggressive tissue resection.
Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.
It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.
Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.
The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.
Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.
After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.
The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.
Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.
While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.