Tummy tuck on large belly poses some unique challenges, which should be recognized prior to surgery to achieve the best results possible and to avoid or at least minimize the incidence of complication.
To shed light on the effects of tummy tuck on large belly, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted videos and photos of a female patient who had this anatomy.
Before and after photos of a patient with large redundant abdominal skin and fat rolls along her flanks and back—“cosmetic” issues addressed during surgery.
Aside from the apron-like abdominal skin, the patient also had “bra and back rolls” caused by excess superficial fat, which sits close to the skin. This is different from the deeper visceral or intra-abdominal fat that is linked to obesity and so the only way to eliminate it is through weight loss.
To eliminate the fat rolls along the flanks and upper and lower back, Dr. Smiley performed liposuction prior to the creation of tummy tuck incision.
“I always perform liposuction along the flanks first so I would know how much skin to pull and tighten during tummy tuck,” he said.
During liposuction, Dr. Smiley created several small puncture wounds where a hollowed tube called cannula was inserted and used to break up and remove the superficial fats responsible for the “unsightly rolls” that are more apparent in tight clothing.
Afterwards, the celebrity plastic surgeon created a flank-to-flank tummy tuck incision that was made very low, slightly below the pubic hairline, so “the resulting scar is hidden by the patient’s underwear.”
Dr. Smiley said bleeding is one of the issues in tummy tuck and so all efforts are made to minimize it.
“I pre-treat the abdominal area. Epinephrine is injected prior to the creation of tummy tuck incision; this is a drug that constricts the blood vessels to reduce bleeding,” he explained.
Keeping the patient’s blood pressure relatively low, which is possible because of general anesthesia (administered by board-certified anesthesiologist), also contributes to less bleeding and reduced risk of large fluid imbalance, Dr. Smiley added.
Dr. Smiley measures the thickness of the apron-like skin he removes during tummy tuck surgery.
In his previous Snapchat posts, Dr. Smiley said he only works with board-certified anesthesiologist to ensure patient safety.
(Note: Anesthesiologists not just administer numbing medications and sedatives; they also monitor the patients’ vital signs such as blood pressure, oxygen level, and heart rate during surgery.)
Meanwhile, Dr. Smiley removed a chunk of excess skin and fat that almost reached the patient’s knee; it also had a thickness of about 2 inches.
After removing the excess skin and tightening the abdominal muscle, he closed the wound in several rows so the skin would receive no or very minimal tension, which is the key to “favorable” scar, he said.
Brazilian buttock lift is basically a butt augmentation through fat injection. It always starts with liposuction to harvest unwanted fat from two or more donor sites; this critical step contributes to the more holistic contouring effect of this technique compared with butt implant surgery.
Buttocks come in different shapes and sizes, which to some extent affect the results of Brazilian butt lift. Simply put, the right candidates have cosmetic goals that are in line with what the surgery can accomplish.
The patient has square-shaped buttocks and poor waist-to-hip ratio, which Tarick Dr. Smiley improves with meticulous Brazilian butt lift.
The surgery has a certain appeal to women with square-shaped buttocks, which lead to a less feminine figure. Studies have all pointed out the most ideal female physique has a waist-to-hip ratio of 0.7, meaning the waist circumference accounts for 70 percent of the hips measurement.
The preference for 0.7 WHR is seen across all cultures; even the world’s best artworks depict women with this physique, or more commonly referred to as an hourglass figure.
Women with square-shaped buttocks have poor WHR due to their thick waist, narrow hips, and flat buttocks.
Liposuction can reduce the waist circumference, although it is critical to pay closer attention to the flanks and lower back to create a smooth inward slope. Despite the relatively thick waist, a good number of patients with square buttocks have less dispensable fat in the area. Hence, other donor sites might be considered such as the upper arms, bra rolls, and thighs.
For “average built” patients, at least 800 cc of fat on each butt is needed to see a notable improvement.
But even with large fat volume collected by liposuction, the elasticity of butt skin will still determine the degree of augmentation. A skin that is too tight resists large expansion, and too loose the patient runs the risk of sagging appearance and cellulites if over-injection has been performed.
Over-injection must also be avoided because of the increased risk of skin surface irregularities. This applies to every patient, regardless of the “starting” butt shape and size.
Despite the anatomical roadblocks facing patients with square-shaped butt, in the vast majority of cases Brazilian buttock lift can still provide impressive contouring effects provided that the surgeon is meticulous during patient selection and is adept in the surgery, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
The top heavy look is one of the most recognizable breast implant effects. Hence, patients who want the natural look always take into account their body frame, particularly their upper body dimension, waist-to-hip ratio, and height when selecting their implant size.
In general, the breast implant size range between 300 and 450 cc provides “smaller” augmentation that suits petite women. Also, going the conservative route favors patients with little soft tissue coverage who are prone to rippling, globular shape, and increased palpability particularly when overlarge implants are used.
Conservative-sized implants also suit athletic patients who typically have low body fat percentage that makes them prone to rippling if overlarge saline implants are used.
Due to the inherent strength of modern breast implants, most patients seeking revision surgery nowadays are not concerned with rupture or leak but want an implant exchange to upsize or downsize, as suggested by a recent survey.
Hence, the breast implant size and its “specific” results on each woman is one of the most important topics during consultation. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the patient’s candidness—describing her “bust goals” in precise detail—plays a critical role in the success of breast augmentation.
Of course, it is the surgeon’s responsibility to offer his patients all modalities that will improve their discussion. For instance, some doctors offer sizers that are put inside an unpadded bra to give women an idea on how a specific implant size will look on them.
Some doctors also offer three-dimensional imaging to further improve the discussion regarding the implant size and profile, or how much it projects from the chest wall.
Meanwhile, some studies and surveys have attempted to shed light on the ideal breast size in which individual preferences greatly varied. However, most respondents favored medium-sized breasts, namely, C and D cup.
One study has even suggested that medium-sized breasts that are firm and with a 45:55 ratio, which means most of the volume is in the lower pole, with the nipple serving as the delineating mark, as the most preferred breast appearance.
It is important to note that some patients seek breast implants to enhance their shape or correct the deflated-looking upper breast pole without resulting in significant augmentation.
Breast lift and implants is a “combination” surgery to reshape the pendulous breasts and provide additional volume especially in the upper breast pole, which tends to deflate with aging or following weight loss and pregnancy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted breast lift and implants before and after photos on Snapchat to illustrate its “contouring and volumizing effects.”
During breast lift with implants, Dr. Smiley always completes one breast before proceeding to the other side. The idea is to create a template for the other breast, leading to more symmetric results.
Prior to surgery, the patient shown in the photos had significantly drooping breasts whose areolar complex, which is the ring of pigmented skin around the nipple, settled below the level of the breast crease and were hugely disproportionate.
With the severity of her breast ptosis, or sagging, Dr. Smiley performed the anchor breast lift, which involved a donut-shaped incision around the areola that extended down the midline to the breast crease. Another incision shaped like a crescent was also created along the base.
The anchor breast lift is also referred to as inverted T lift due to the shape of the incision or scar pattern.
The donut-shaped incision around the areola allowed Dr. Smiley to drastically reduce its size. To achieve good symmetry between the two sides, he used a cookie-cutter device to delineate the new smaller areolar complex.
When making the areolar incision, Dr. Smiley says “it is important not to go too deep in order to preserve the blood supply,” and ultimately “minimize the risk of healing problems and delayed recovery.”
Before and after photos of breast lift with implants
During breast lift, Dr. Smiley elevated the tissue of the lower breast pole with the use of internal sutures, and repositioned the areolar complex higher, ensuring that it would lie approximately at the center of the breast mound. Meanwhile, studies have suggested that the ideal nipple position should be above the breast crease, and there must be a 18-21 cm distance between the nipple and the sternal notch, which is the small dip at the base of the throat.
Afterwards, he positioned the implants beneath the pec muscle, instead of placing them above this anatomical layer. This technique, referred to as submuscular implant placement, reduces palpability and risk of rippling and bottoming out due to the additional padding from the muscle.
Brazilian butt lift for older women can still deliver great results provided that the patients possess the “ideal” starting anatomy. For instance, the right candidates possess good skin tone and their weight is within the normal BMI range, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
Contrary to popular belief, the patient’s chronological age plays no role in her candidacy for most body contouring surgeries. Doctors consider more pertinent factors such as physical fitness, weight, skin quality, and condition of connective tissue and other soft tissues during patient selection process.
Nonetheless, it remains important to recognize the anatomical traits commonly found in older patients (55 years and above). For instance, the outer skin layer thins with aging, while its blood vessels become more fragile, which leads to more bruising and bleeding beneath the skin following surgery.
Also, certain health conditions are linked to advanced aging, although with healthy lifestyle these can be avoided or at least controlled. Hence, older patients may require more extensive lab screening to ensure that they can handle the surgery and its ensuing recovery.
Because there is a perceived increased risk of bleeding and bruising, older patients are suitable for the tumescent liposuction, which is the preferred technique of Dr. Smiley. This involves infusing the fatty area with tumescent fluids that contain epinephrine, a drug that constricts the blood vessels and thus reducing bleeding by up to 90 percent when compared to the dry technique (no wetting solution is injected into the liposuction site).
The fats collected during liposuction are then processed before these are injected back into the buttocks and hips.
Because older women typically have less skin elasticity and strength due to age-induced changes in its connective tissue, Dr. Smiley says over-injection of fat should be avoided to prevent sagging appearance and cellulites and other skin irregularities.
To further avoid the aforementioned side effects, Dr. Smiley says most of the fat volume should go to the mid and upper butt, while the lower half aspect should not receive too much weight or augmentation. This approach also ensures natural results as scientific studies and artworks throughout history have depicted attractive female buttocks having most of their prominence found in the upper half.
Meanwhile, the celebrity plastic surgeon says that about one-third of the purified fat should go to the hips, or the lateral aspect of the buttocks, in order to achieve a more hourglass figure.