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.
Post plastic surgery drains are commonly used after tummy tuck, body lift, and other procedures in which seroma or fluid formation is a real concern. The goal is to control swelling, promote healing, and minimize risk of complications.
It is important to note that post plastic surgery drains are not always necessary. For instance, most breast augmentation patients can do without them, particularly if they receive smooth implants.
However, drains are more commonly used in breast augmentation involving teardrop implants, breast revision, breast reduction, and breast lift as they involve more tissue dissection, which in turn results in higher risk of seroma.
Seromas are caused by injury to the blood vessels and lymphatic channels. Large seromas should be avoided because they can inhibit healing, attract infection, and possibly lead to uneven skin surface, as suggested by Inland Empire plastic surgery expert Dr. Tarick Smiley.
Drains are commonly used in tummy tuck, a procedure in which an apron-like skin hanging from the abdomen is removed with the use of hip-to-hip incision. To further achieve a smoother result, the surgery also incorporates muscle repair in which the pair of muscle below the breastbone that extends to the lower abdomen is sutured in place.
Surgical drains have tubes that lead out of the body and have small bulbs to “hold” the fluids, which are usually emptied 2-3 times a day. Meanwhile, the fluids may appear reddish, yellowish, or brownish with some “bits” floating around; however, they should have no foul smell.
How long will the surgical drains remain in place depend on how much drainage they collect; hence, the patient needs to keep track of the amount every day. Sometimes these are removed as little as three days, while some people have to “wear” them for as long as 15 days.
The drains are removed in the office by simply pulling their tubes out. Most patients describe some discomfort or pain, which dissipates quickly.
Liposuction lower back can improve the shape and projection of the buttocks without actually “enhancing” them. However, combining it with buttock augmentation via fat transfer or implants one can expect a smoother, more feminine silhouette.
Renowned Inland Empire plastic surgery expert Dr. Tarick Smiley almost always performs liposuction lower back in patients having buttock augmentation via fat transfer, or more commonly referred to as Brazilian butt lift or BBL. The idea, he says, is to always treat it as a “donor site.”
(Note: The donor site is where the excess fat is removed and is later purified and injected into the recipient site, which in the case of BBL is the buttock.)
The celebrity plastic surgeon has demonstrated the importance of “carving out the lower back” with the use of “meticulous” liposuction. To further create a smoother silhouette, the hip-flank region is typically included as well.
However, some patients even require a 360-degree liposuction, meaning that the lower back, hip-flank region, and abdomen are all treated to further highlight the shape and profile of the buttocks, says Dr. Smiley.
Others require liposuction of their “bra and back rolls” as well to create a smoother transition between the torso and the buttocks, he further explains.
Eliminating the fat rolls and bulges not only results in smoother silhouette but also allows the surgeon to collect more fats whose amount will largely determine the final size and shape of the butt cheeks. Most patients will need at least 800 cc of purified fats (after all the impurities and biomaterials are removed) injected into each side to achieve a noticeable improvement.
The leading body contouring expert warns that removing large amounts of fat without taking into account skin elasticity or its “shrinkage” capacity can lead to visible and palpable irregularities.
To deliver a more feminine silhouette, Dr. Smiley highlights the importance of injecting fats to reshape the hips. In general, he allocates about one-third of the purified fat to the lateral side, while the remaining is used to improve the actual profile of the butt cheeks.
Dr. Smiley says with gentle liposuction technique, proper purification method, correct injection of fat grafts, and “100 percent” patient participation (e.g., avoiding direct sitting for 3-4 weeks), it is expected that at least 70 percent of the volume will “survive” long term.
Is it necessary to massage scar tissue after tummy tuck? Arguably, this is one of the most pressing questions of patients who are concerned with the appearance of their hip-to-hip scar.
The hip-to-hip scar from a full tummy tuck is an inevitable tradeoff to achieve a flatter and more contoured abdomen. While it is positioned very low that the patient’s underwear conceals it, proper wound care and scar massage will remain ideal to help it heal and fade better.
Massaging the scar can help break down the dense bands of collagen, and when combined with other modalities such as sun protection and silicone sheets and creams the appearance of scar is further improved.
In general, the scar must be fully healed (i.e., no scabbing present) before attempting any type of scar massage. For this reason a prudent patient will always check with her doctor first.
Celebrity Inland Empire plastic surgery expert Dr. Tarick Smiley warns that any type of massage scar tissue after tummy tuck performed too soon could aggravate scarring and delay healing.
Aside from deep/firm pressure on the tummy tuck scar, which is started approximately 3-4 weeks postop, the use of silicone sheets and creams, topical steroids, and good hydration could also improve its appearance.
While scar massage is best postponed for a couple of weeks, lymphatic drainage massage or LDM might begin as early as 4 days following surgery, although many proponents suggest that waiting until the beginning of the second week postop would be more ideal.
Unlike scar massage that relies on “deep kneading” to release the collagen bands responsible for keloids or other types of aggressive scarring, LDM uses relaxing and soft rhythmic massage that simulate how lymphatic system functions.
The lymphatic system (it primarily consists of vessels) pushes the excess fluids (seroma caused by surgery) into the blood stream so the body can eliminate it naturally. Hence, its proponents suggest that it might accelerate healing and reduce postop swelling.
Despite the use of these aforementioned modalities, scars will not disappear completely; however, all efforts are made to ensure that they will turn into a fine scar and remain in their concealed location.
Meanwhile, the techniques used at the time of surgery will also influence the final appearance of scars. For instance, Dr. Smiley closes the incisions in several rows of sutures so the skin will receive no or very little tension, thus paving way for good healing and finer scars.
Male eyelid surgery is different from women’s. First and foremost, the surgeon must deliver results that adhere to the masculine beauty ideals and avoid any surgical stigmata such as visible scars and lid retraction.
Celebrity Inland Empire plastic surgery expert Dr. Tarick Smiley explains the techniques used in male eyelid surgery that allow him to rejuvenate one’s appearance and preserve the masculine facial features as well.
Before and after photos of male eyelid surgery patient
- Precise removal of skin and/or fat
In the past, eyelid surgery was overly focused on removing the excess skin and fat in an attempt to eliminate the “puffy” or crepe-like skin around the eyes. However, this “approach” rarely provides good results because of the abrupt transition in the lid-cheek cunction and lid retraction.
Removing too much skin and fat not just results in deformity usually in the form of lid retraction. In men, this is particularly detrimental because it could also lead to rounder, doll-like eyes that look nothing close to masculine.
Dr. Smiley highlights the importance of removing just enough skin and/or fat without altering the natural or the pre-operative appearance of the eyes.
In upper eyelid surgery, the resulting scar should lie precisely at the natural fold of skin. If there is a need to extend the incision, a technique required by patients with a signficant amount of loose skin, it must fall within the crow’s feet laterally to prevent surgical stigmata.
A lower eyelid surgery, meanwhile, may require the use of incisions placed inside the actual lid to eliminate risk of visible scars. However, this technique is only suitable for men with excess fat but have no or very little loose skin.
In men with loose skin along their lower eyelid, the incision must lie very close to the lash line for optimal scar concealment.
While all efforts are made to prevent visible scars regardless of one’s gender, this is particularly critical in male patients because they rarely use makeup around their eyes.
- Height of the upper eyelid crease
It is generally accepted that men have a shorter eyelid margin, i.e., distance between the upper lid crease and the lash line. Aside from gender, one’s ethnicity and eye shape (and other relevant anatomies) are also taken into account to determine the ideal “eyelid platforms.”
For instance, Caucasian and African eyelids typically have wider eyelid platforms than Asian eyelids (7-12 mm versus 4-5 mm).