Meticulous breast exam and surgical planning is the key to achieve breast augmentation and lift results that look natural and proportionate, said leading Inland Empire plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
Dr. Smiley has recently demonstrated this “combo surgery” performed on a patient who had these following aesthetic problems:
- Sagging breast tissue
- Deflated upper breast pole
- Disproportionately huge nipple that dropped below the level of the submammary fold
While the patient’s preexisting soft tissue was sufficient, a breast lift-alone approach would not give her the upper pole fullness she wanted; hence, the use of concurrent small implants was fitting to deliver her aesthetic goals.
The use of small implants would give her not just additional fullness of the upper pole, but would also improve the overall projection of her breasts, Dr. Smiley said.
To give her more cleavage and “overall fullness,” the celebrity plastic surgeon used moderate profile implants whose forward projection is predetermined by their width. They are perceived to be the standard design as the provide just the right amount of “roundedness” without causing excessive fullness in the upper breast pole; hence, they simulate the look of an attractive breast that occurs “naturally.”
In the context of breast lift, Dr. Smiley performed the standard technique in which the incisions were created around the new smaller areola. The incisions were then extended down the midline and across the base of the breast, leading to an inverted T scar.
To ensure lasting “perkiness,” the surgeon elevated the internal breast tissue with “special sutures” that would act as a sling. This “fine-tuning technique” also allowed the silicone implant to remain centrally behind the areola.
Furthermore, he created more distance between the smaller areola and the submammary fold (about 3 cm), further contributing to the perkier and more youthful appearance.
Dr. Smiley noted that “all efforts are made to eliminate tension” in order to promote the best scar possible. During the creation of areolar incisions, he made them into perfect circle so the tension could be equally distributed. In addition, the wound was sutured in several rows so the skin would not receive excessive “tautness.”
The use of smaller or conservative-sized breast implants also favored the patient because of the reduced tension. It should be noted that overlarge implants used concurrently with breast lift might create too much “opposing tension” on the skin, which could result in higher risk of unfavorable scars and poor healing.
The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.
Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.
Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.
Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.
In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.
The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.
“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.
Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.
Breast augmentation and lift accomplishes two important things in one surgery: Increase the “cup size” and correct the sagging appearance. But sometimes, they are done separately to minimize risk of complications, which can be an issue if the patient wants bigger implants.
Breast augmentation, which is accomplished with the use of saline- or silicone-filled implants, increases the volume, while breast lift tightens the skin and deeper tissue. While combining these two procedures is known to enhance the overall contour, it is important to note that they have conflicting effects—tighten and expand the skin simultaneously.
The first step to achieve high satisfaction rate is to identify the ideal candidates for the combo procedure, and whether the surgeries can be performed simultaneously or in stages, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
The placement of the nipple is one of the key elements that determines if a concomitant breast lift is warranted. One established aesthetic guideline suggests that the ideal distance between the nipple and the sternal notch (dip between the collarbone and neck) is 17-21 cm. Of course, women with longer torso and larger breasts can have a “larger gap” without their breasts looking saggy.
Furthermore, the nipple area should lie a few centimeters above the submammary fold, but then again the exact distance will depend on the breast size. Nonetheless, one study has suggested that the nipple position should “support” the 45:55 breast volume “distribution” ratio, which leads to the teardrop shape.
If there is too much distance between the sternal notch and the nipple, or the nipple falls at the same level as the submammary fold or beyond, a simultaneous breast lift is warranted lest an implant-alone approach can exacerbate the sagging appearance.
The standard or anchor breast lift suits women whose “breast bottom” has sagged more than 6 cm below the submammary fold. This entails a donut-shaped incision around the areola’s border, a vertical one between the nipple area and the crease, and another one that goes across the base of the breasts.
Meanwhile, patients whose nipple area remains above the submammary fold but can still benefit from a conservative elevation of their areolar complex will only need a donut-shaped incision technique.
After elevating the breast tissue and repositioning the nipple higher, implants are then propelled into their pocket, which should lie centrally behind the nipple area. The use of overlarge implants (or more than 600 cc) is generally discouraged unless breast augmentation is performed at a later date, ideally 3-4 months after breast lift.
If overlarge implants are simultaneously used during breast lift, they tend to ride higher on the chest wall leading to unnatural fullness in the upper pole/cleavage. In addition, they increase the risk of poor wound healing and less than optimal results.
All efforts are made to hide the facelift scars and so the incision is always placed at the face-ear junction. Meanwhile, it is important to preserve the tragus or small knob in front of the ear to achieve natural-looking results.
Some doctors prefer placing the incision in front of the tragus, while others favor positioning it behind this small bump; hence some part of the scar lies inside the ear. Others do both depending on the patient’s request and/or anatomy.
Dr. Smiley ensures that the patient’s tragus remains the same after surgery, further contributing to the natural appearance.
Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video showing a post tragus facelift incision, which hid a portion of the scar inside the ear. Nonetheless, the technique is plagued with “potential traps” if used without extra caution.
Because the incision is behind the tragus, the bump made up of cartilage may become distorted or even disappear lest proper wound closure is employed. Dr. Smiley says all efforts are made to eliminate tension on the skin, which is also known to promote favorable scar.
The newly redraped skin may also need to be thinned so the tragus contour will show through.
Small Bump, Big Deal
Dr. Smiley says that one of the keys to achieve natural-looking results from facelift is to preserve the tragus in front of the ear, making it distinct from the face. The absence of this small bump can make the ear look like an extension of the face.
Simply put, the surgery should preserve the natural border that “signals” the separation of the ear and face.
Both the pre- and post-tragus facelift techniques can provide good results, although the latter is believed to entail a steeper learning curve in order to ensure natural-looking results.
Some doctors, meanwhile, only reserve the post tragus facelift incision in patients with these anatomical characteristics: The thickness of their cheek skin is quite similar to the skin on the ear cartilage; their ear cartilage is markedly flat; and they have wrinkles or skin webbing right next to the earlobe.
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.