The effects of hourglass tummy tuck will depend on many factors such as the surgeon’s skills, ancillary procedures (e.g., liposuction and muscle repair), and patient’s anatomy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the fundamental factors affecting the final results of hourglass tummy tuck, which he regularly demonstrates on his Snapchat account.
Generally speaking, the more distance between the lowest rib and the pelvic bone the more definition one can achieve from tummy tuck.
Meanwhile, women with a markedly short distance between these two points could not get the same amount of definition achieved by individuals with a “great distance” between them, with or without hourglass tummy tuck.
- Adjunct procedure/s of tummy tuck
Dr. Smiley almost always incorporates muscle repair in his tummy tucks. This rather critical component of the surgery involves tying the pair of loose muscle that extends from the breastbone to the pubic region. Aside from creating a flatter frontal abdomen, he says the procedure makes the results less susceptible to the effects of “unplanned” pregnancy or even mild to moderate weight gain.
Meanwhile, the standard tummy tuck (hip to hip incision) cannot address the appearance of love handles (fat rolls along the flanks) or any excess skin on the sides.
Liposuction can further define the waist and hips by removing the excess fat beneath the skin, while extending the tummy tuck incision into the flanks can help the surgeon remove the excess tissue on the side.
- Surgeon’s technical and artistic skills
Tummy tuck, as with any body contouring surgery, combines art and science. The goal is to remove a precise amount of skin and fat without causing surgical telltale signs such as unacceptable scarring, contour irregularities, navel deformity, and skin asymmetries.
Dr. Smiley, who has performed over 7,000 tummy tucks to date, says that experience allows him to determine the ideal tension during muscle repair and the exact amount of skin removal and fat without destroying the natural curves and contours of the frontal abdomen and waistline.
The ideal gynecomastia surgery techniques (male breast reduction) will depend on the underlying cause of the woman-like breasts. It is important to note that some patients will need an excision-based approach, others will benefit more from liposuction, or even a combination of these two.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says a good number of patients can benefit from excision-based surgery combined with liposuction. With this approach, he can remove the excess tissue, which is mostly behind the nipple area, and then further sculpt the breast (or even the surrounding area) by removing the excess fat.
Dr. Smiley prefers microcannula liposuction technique when dealing with the very dense or fibrous fat found in the male breasts. This involves the use of thin hollowed tube (less than 2.5 mm) to sculpt the breast and/ or its adjacent area by removing some of the excess fat.
Some patients can also benefit from liposuction of the flanks (in addition to the adjacent area of the breasts) so they will not deviate from the more masculine-looking chest.
While liposuction can serve as a stand-alone procedure, only patients with pseudo gynecomastia (the enlargement is only caused by the excess fat, as opposed to the excess breast tissue) can benefit from it.
Male breast liposuction typically uses 1-2 small incisions that are placed near the armpit and/or at the border of the areola for optimal scar concealment.
Patients with “real” gynecomastia (puffy nipple area due to the excess tissue) can only achieve good results from excision-based surgery. Oftentimes, it involves a small incision placed precisely at the lower border of the areola so when the scar heals it is almost invisible.
However, patients with substantial enlargement and/or significant amount of redundant skin—which typically happens after massive weight loss—will need a more extensive excision-based surgery, which of course results in additional scarring.
For patients who need substantial correction, they may have to accept the appearance of breast fold scar or even a vertical scar from the areola down to the breast crease. This rather extensive technique is reserved for massive weight loss patients.
- Two-staged gynecomastia surgery techniques
Some patients can benefit from a two-staged gynecomastia surgery. This is particularly true for young men (they typically have good skin shrinkage) who want to try first liposuction and wait a few months to decide if they need an excision-based surgery.
Some moderately overweight men and massive weight loss patients could also benefit from a two-staged gynecomastia surgery.
Body contouring plastic surgery is a broad term used to describe any techniques employed by surgeons to improve areas of the body that have redundant skin and sagging appearance, which commonly occur after massive weight loss and pregnancy. Meanwhile, the aging process can also contribute to tissue laxity.
Body contouring after massive weight loss almost always entails skin removal. Good examples include arm lift, tummy tuck, lower body lift, and thigh lift. The vast majority of MWL female patients also warrant some type of breast enhancement—e.g., breast reduction and/or breast lift.
Tummy tuck is arguably the most powerful tool in body contouring for MWL patients, according to the Inland Empire Plastic Surgery Institute. It removes the excess skin and fat between the navel and the pubic “hairline,” before redraping the skin in the upper abdomen to close the hip-to-hip incision.
All efforts are made to place the hip-to-hip scar very low so it remains concealed by the patient’s underwear. But for massive weight loss patients, the scar might be extended to their flanks or even around their entire torso, a technique referred to as lower body lift or circumferential lift.
A lower body lift basically combines tummy tuck, outer thigh lift, and buttock lift.
Meanwhile, body contouring plastic surgery also encompasses procedures to reverse the effects of pregnancy. Common examples include tummy tuck, breast augmentation, breast lift, and abdominal liposuction, which can help patients regain their pre-pregnancy body.
Whether liposuction is performed in MWL patients or individuals who have always managed a healthy weight but nonetheless have “stubborn” fat, skin elasticity—how much shrinkage it can allow—will determine the ideal amount of removed fat. Furthermore, it is important to preserve a thin layer of fat beneath the skin to avoid surface irregularities.
Implants are also used in body contouring plastic surgery. Their main objective is to increase volume of the “target” area, which could be the female breast, male chest, calf, and bicep.
Male patients who seek body implant surgery typically want to emphasize bulk; hence, a good number of them are body-builders. (Note: Some men do not have the muscle type that allows them to develop their calf, chest, or bicep muscle with weight lifting and other rigorous exercise routine, making them good candidates for implants.)
Women, meanwhile, generally seek body implants to improve their proportions. As a result they typically seek breast and buttock implants—two synthetic prostheses that can deliver a more feminine silhouette.
Buttock implants results will vary depending on the underlying anatomies, and the use of simultaneous procedures such as liposuction and/or fat graft, according to the California Surgical Institute website.
Due to the inherent position of the buttock implants—they are positioned above the bone where the patient sits—they can only augment about the upper half portion of the buttocks. The lower and the later aspect (or hips), meanwhile, will experience no improvement.
Despite the “limitations” of buttock implants, they remain the best option for patients with little fat to spare for buttock augmentation via fat transfer, or more commonly referred to as Brazilian butt lift.
To achieve smoother and “sultrier” buttock implants results, they are commonly combined with liposuction, which is particularly helpful in reshaping the flanks and lower back. Its goal is to “curve out” a more feminine silhouette and to further improve the shape and projection of the buttocks.
Liposuction can also eliminate the unwanted fat in the posterior thigh to further achieve proportionate results.
Instead of throwing the collected fats during liposuction, these could be later used to further reshape the “backside,” a technique medically referred to as fat transfer or fat graft. As a stand-alone procedure, this can provide good results provided that the patient has sufficient amount of unwanted fats.
If fat transfer is incorporated into buttock implants, it must be performed separately lest the pressure from the prostheses can lead to low survival rate of the fat grafts. It is important to note that blood vessel ingrowth is critical to achieve long-term results from this procedure.
Since the implants will have very little effect on the lateral aspect of the buttocks (or hips), about a third of the fat volume is ideally injected into the area. The remaining is then used to “thicken” the soft tissue and prevent or at least minimize implant palpability.
Simply put, buttock implants results combined liposuction and/or fat grafting can be impressive provided that the surgical techniques take into account the patient’s underlying anatomies and personal preference.
The ideal arm lift techniques will differ from patient to patient, although there are generally agreed upon guidelines known to provide smoother, more natural-looking results. For instance, some doctors almost always incorporate simultaneous liposuction to further contour the upper arm and possibly the armpit area as well.
In essence, arm lift surgery removes the excess skin with an incision that is limited to the armpit fold, or an inner arm scar that extends down to the elbow; the latter is reserved for massive weight loss patients due to the large amounts of their redundant skin.
But to further achieve smoother results, there is also a need to reshape the underlying supportive tissue with internal sutures. This additional step also allows the surgeon to eliminate most of the tension on the skin, thus allowing the scars to heal and fade better.
It is critical to remove most of the superficial tension, which is achieved with proper wound closure techniques, to prevent the scars from spreading and migrating, as suggested by Orange County plastic surgery experts.
A good number of patients also require simultaneous liposuction to further improve their arm contour.
Arm liposuction in general must involve most of its circumference to achieve a smoother, more feminine contour (this is almost an exclusive procedure for women). Nonetheless, there should remain a thin layer of superficial fat (beneath the skin) to prevent deformities and skin irregularities.
Aside from improving the arm circumference, simultaneous liposuction can also improve the appearance of fat pads in front and/or back of the armpit. This “unwanted” fat rolls become prominent with age or after significant weight loss.
It is almost always advisable to use microcannulas, which are narrow flexible tubes that remove the “unwanted” fats, instead of larger cannulas.
Microcannulas provide smoother results because they allow for more accurate fat removal, i.e., they remove fats in smaller bits. Furthermore, they require smaller round incisions (1-1.5 mm) that almost always disappear quickly in light-skinned patients.
It is also critical to move the microcannulas precisely parallel to the skin and in a rather swift manner to prevent removing too much fats and thus leading to “Swiss cheese” skin irregularities.
The right arm lift techniques and the use of ancillary procedures can provide long lasting results provided that the patient maintains a healthy, stable weight.