Buttock implants under the muscle or at least within this anatomical layer has been known to provide softer, more natural results compared to a placement technique in which the prostheses lie above the muscle.
Placing the buttock implants above the muscle, with only the skin and fat “supporting” their weight, is known to increase the risk of sagging (inadvertent displacement) and palpability.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley warns that the skin’s elasticity means it may stretch over time and lead to implant displacement and other surgical stigmata; hence, he always places buttock implants under the muscle or at least within this layer.
Furthermore, the under the muscle is known to minimize risk of infection especially in the event of poor healing since the muscle itself can serve as a protective barrier.
From the aesthetic point of view, buttock implants under the muscle technique can provide a more natural appearance—i.e., an S-shaped “behind” when viewed from the side.
Nonetheless, achieving natural and proportionate results also entails careful examination of the patient’s buttock dimension. The goal is to use implants that are within the anatomical boundaries, which in turn can also prevent skin thinning, implant malposition, and poor wound healing.
(Note: Patients of average frame are generally advised to stick to buttock implants whose size range is not more than 400 cc to prevent excessive tension on skin. It is important to note that too much tension is closely linked to poor healing and increased palpability.)
All buttock implants are positioned above the “sitting” area and so only the upper half of the butt is actually augmented, while its side (hips) and lower aspect receive no or very little improvement. For this reason, some patients may need a simultaneous fat transfer or fat grafting.
Incorporating fat transfer (which always starts with liposuction to collect fats) also allows the surgeon to “carve out” a more feminine contour by removing the excess fats along the flanks and lower back, says Dr. Smiley.
Liposuction uses a small hollowed tube inserted into tiny round incisions to remove the excess fat adjacent to the buttocks, further improving the contour and profile of the butt cheeks, he adds.
The collected fats from liposuction could be used to reshape the hips and lower aspect of the buttocks for a more proportionate, curvier silhouette, says Dr. Smiley.
The truth is, the most difficult part of recovery from facelift surgery is not actually the pain, which is fairly manageable, but the social downtime.
It is important to note that social recovery from facelift varies significantly from patient to patient due to factors such as individual healing, predisposition to bruising and swelling, type of surgery and use of ancillary procedures, and quality of postop care.
Inland Empire plastic surgery expert Dr. Tarick Smiley explains some of the most pertinent issues involving social recovery from facelift.
- Advance planning is critical
Patients who are planning for a big social event (e.g., wedding) are generally advised to have their surgery performed 1-2 months earlier just to be on the safe side. But for individuals who do not mind being seen with some mild “outward symptoms”, which can be easily hidden by camouflage make-up, a 1-2 week social recovery will generally suffice.
Some patients are able to return work (only desk job) after a week or so after surgery, although most will need at least two weeks before they look “presentable.”
After 1-2 weeks postop, most patients can use camouflage make-up to hide the bruising and swelling and some discoloration around the edge of the incision that remains on the face and/or neck.
- Winter might be a good way to schedule one’s surgery
The bulkier ensembles worn in cold weather (e.g., turtle neck tops and scarves) can make it easier to hide the outward signs of facelift. Furthermore, winter coincides with longer holiday season (Christmas and New Year), allowing the patient to have a longer time off.
- Avoid strenuous activities for a minimum of three weeks
While most patients already look presentable in 1-2 weeks postop, it remains important to avoid rigorous activities and heavy lifting for a minimum of three weeks because increase in blood pressure and heart rate can aggravate the swelling and bruising, which of course leads to longer social recovery from facelift.
- Control risk factors linked to increased swelling and bruising
Smoking, aspirin, hypertension (or any other types of medical condition linked to higher risk of bleeding), and strenuous activities before complete healing can lead to increased swelling and bruising and thus longer social recovery.
Meanwhile, head elevation, superb diet (low sodium, high protein, and more fresh fruits and vegetables), good hydration, and light activities (walking instead of bed rest) can help promote healing.
Travel for tummy tuck requires advance planning to avoid risk of complications, particularly relating to deep vein thrombosis. The problem with long travels (by plane or car) is the prolonged immobility, which could lead to blood clot in legs and more serious problems such as pulmonary embolism.
Inland Empire plastic surgery experts explain the basic guidelines to make travel for tummy tuck a safe endeavor.
- Wait at least a month before traveling by plane.
Many surgeons suggest postponing long flights for at least four weeks to avoid blood clots. Furthermore, staying within the immediate vicinity of the doctor’s office will allow him to monitor and ensure that his patient is healing nicely.
- Possible use of low-dose blood thinner.
Should the patient need to travel by plane sooner than ideal, some doctors recommend a low dose of blood thinner (aspirin) to reduce risk of deep vein thrombosis. “Waiting” nonetheless remains to be the best option.
- Perform light activities such as walking.
Most out of town patients can travel by car around two weeks postop. However, certain precautions are needed to prevent or at least reduce the risk of deep vein thrombosis. The general rule of thumb is to take several stopovers to stretch and walk around.
Good blood circulation through light exercise is one of the best defenses to prevent deep vein thrombosis. Furthermore, it can minimize the effects of narcotic painkillers such as constipation and lethargy.
- A capable adult must always accompany the patient.
Travel by plane means rushing from one airport to the next with a heavy luggage in tow. It is important to avoid strenuous activities, bending from the waist, and over exertion for 3-4 weeks to prevent complications. For this reason, it always makes a sense to bring a friend or family member along when traveling for plastic surgery.
Also, driving is inadvisable when under narcotic painkillers, which cause poor coordination and drowsiness. Just to be safe, patients must have someone to drive them home.
- The patient should build good rapport with a local primary care physician.
Travel for tummy tuck requires advance planning, which typically includes finding a local primary care physician ideally before to the operation. He may be the one to order a pre-op physical exam and fax its results to the plastic surgeon to rule out any medical condition.
The local primary care doctor will also monitor the patient for up to 2-3 months to ensure the latter is healing nicely.
Facelift preparation primarily aims to prevent or at least reduce risk of complications, and thus allow the patient to achieve optimal results from surgery. Sometimes, it entails waiting until one has controlled certain medical conditions (e.g., hypertension and obesity) before going under the knife.
Inland Empire plastic surgery expert Dr. Tarick Smiley has explained the generally agreed upon guidelines on facelift preparation.
- Control medical condition prior to surgery
Patients with medical conditions known to increase the risk of healing problems are poor candidates for any type of plastic surgery such as facelift until these are controlled through medications, diet, weight loss, and/or lifestyle change.
Hence, it is of utmost importance to notify the surgeon if one has medical conditions no matter how seemingly simple or innocuous they seem. Previous surgeries, past and current medications, use of supplements, and smoking should also be disclosed to prevent risk of complications.
- Discontinue drugs known to inhibit healing
Some drugs and nutritional supplements are known to increase bleeding, interfere with anesthesia and painkillers, or cause cardiovascular disturbance. In general, these must be discontinued at least two weeks prior to surgery, and two weeks afterward or until most of the postop bruising has subsided.
Aspirin, ibuprofen, birth control pills, and a gamut of supplements including ginger, green tea, ginkgo biloba, kava kava, St. John’s wort, and ginseng are known to cause increased bleeding.
- Discontinue smoking and avoid second-hand smoke
While the general rule of thumb is to avoid tobacco products and second-hand smoke for a minimum of three weeks prior to surgery, some doctors are stricter that they require patients to discontinue them for a few months to ensure their “full commitment.” During the initial healing stage, i.e., 2-3 weeks postop, nicotine is best avoided as it is causes the blood vessels to shrink, inhibiting the oxygen-rich blood from effectively reaching the wound.
While sticking to a diet rich in micronutrients, i.e., vitamins and minerals, is the “universal” guideline, some doctors feel that increasing protein intake can also improve healing as it plays a critical role in tissue repair.
Meanwhile, it is best to avoid or at least minimize the consumption of salty, sugary, and highly processed foods because they suppress the immune function and aggravate postop swelling.
While many surgeons do not recommend specific or special skin care regimen, they all agree that using sunscreen prior to surgery can improve skin healing. It is important to note that excessive sun exposure can make the skin extra sensitive.
Others require mild glycolic acid and Retin-A treatment a month prior to facelift to promote collagen grown in the skin.
Recognizing the “inherent” challenges of bra rolls liposuction is the first step to achieve impressive results from the procedure. This guiding principle applies to all types of cosmetic and reconstructive plastic surgery.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley explains the challenges of bra rolls liposuction and the corresponding ways to “counteract” them.
Photo depicting a successful bra rolls liposuction
The back contains highly fibrous fats—they have more connective tissue—that large cannulas cannot penetrate them easily. For this reason, the use of microcannulas is a prerequisite to achieve smooth results from liposuction of bra rolls.
Microcannulas are flexible tubes with an outside diameter that is typically less than 2.5 mm.
- Increased risk of sagging appearance and skin asymmetries
Fortunately, the use of microcannulas has significantly reduced the risk of over-correction, which is typically manifested by surface irregularities. Meanwhile, large cannulas are best avoided because they remove bigger chunks of fat, which can be problematic when the treated site requires a high level of precision.
Furthermore, Dr. Smiley highlights the importance of moving the microcannula in a rather swift motion to prevent inadvertently removing too much fat. It is also critical to move the probe precisely parallel to the skin to ensure a smooth result.
In addition, the use of compression garments for several weeks or even months is known to ensure smooth results from bra rolls liposuction.
Meanwhile, some patients are poor candidates for a liposuction-alone surgery due to significant skin laxity. To achieve a good outcome, they will require excision-based procedure as well. Simply put, patient selection process is critical to achieve impressive results.
- Risk of hyperpigmentation, i.e., dark marks
For some reason the back is prone to hyperpigmentation of skin, leading to small round dark marks; hence, it is of critical importance to minimize the number of liposuction sites.
To further promote favorable scarring (faded scars that blend in with the skin), microcannula is ideal because it reduces surgical trauma on the skin; and all efforts are made to place the incisions as far laterally as possible.
Should there is a really need to place incisions “centrally,” they must be positioned along the bra line for optimal scar concealment.