Major tummy tuck surgery entails not just the removal of apron-like abdominal skin. To achieve more proportionate and natural-looking results, it typically combines other surgical maneuvers including liposuction (fat reduction), muscle repair, navel repair, and pubis lift.
Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgeon, has recently posted a series of videos on Snapchat to demonstrate one case of major tummy tuck in which the female patient has large redundant skin following massive weight loss.
While the standard tummy tuck uses a hip-to-hip incision pattern, the patient has required an extended version, meaning the scar slightly extends into the side. Nonetheless, Dr. Smiley has made every effort to place it “beneath” the bikini area (i.e., very low) for its optimal concealment.
But prior to the removal of excess skin, Dr. Smiley had performed liposuction of the flanks in which the unwanted fat was removed with a cannula (straw-like device attached to a vacuum pump). This additional step would allow the patient to achieve a more slender, curvier side.
In the past, tummy tuck and liposuction performed at the same time was greatly discouraged due to the perceived higher risk of complications. However, recent clinical studies and surveys have shown otherwise. Provided that liposuction is not too aggressive (i.e., only a small amount of fat is removed) and it does not involve the area above the navel, the combo procedure is reasonably safe.
Meanwhile, large volume liposuction or extensive liposuction involving the area above the belly button is ideally performed 3-6 months after tummy tuck to allow the body, particularly its blood supply, to recover from the surgical trauma.
Going back to the topic of major tummy tuck’s components, it is also critical to reshape the belly button, which might become distorted or enlarged following massive weight loss or pregnancy. In the video, Dr. Smiley is seen creating an incision around the inner rim of the navel to improve its appearance and to look more proportionate with the slimmer waistline.
To further create more proportionate results, the patient received pubis lift (the area is susceptible to sagging after massive weight loss). The idea is to encourage a smooth transition between the mons pubis and the lower abdomen.
Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.
It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.
Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.
The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.
Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.
After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.
The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.
Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.
While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.
Male breast reduction preparation aims to ward off infection or any other types of complications, and to help patients achieve the best results possible, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Male breast reduction, or medically referred to as gynecomastia surgery, usually involves a small U-shaped incision at the lower border of the areola to remove the excess breast tissue, ultimately correcting the appearance of woman-like breasts. Occasionally, it is combined with liposuction.
Liposuction uses a few small puncture wounds where a flexible tube (cannula) is moved back and forth to remove the “unwanted” fat. These round incisions heal and fade into almost invisible scars.
Anytime the skin is cut open there is always a risk of infection and wound healing problems. For this reason, Dr. Smiley requires all his patients to undergo lab screening to ensure that they are healthy enough for the surgery and can handle the ensuing recovery.
Should lab screening show any medical condition (anemia, bleeding disorder, hypertension, etc.) known to impede healing, Dr. Smiley says he will not proceed with the surgery unless it becomes well under control by diet, change in lifestyle, weight management, and/or medications.
Patients who pass their lab screening are then instructed to “prepare” for the surgery. Dr. Smiley recommends complete discontinuation of smoking and smoking cessation products, and aspirin and other drugs and supplements with blood thinning properties.
For clarity, Dr. Smiley provides his patients written instructions of things and activities they have to avoid two weeks before and after surgery.
But sometimes, male breast reduction preparation can take more than two weeks. For instance, patients who are markedly overweight are generally instructed to shed the extra pounds first before they undergo the knife. The idea is to allow the skin to snap back to the best of its ability, making it much easier to achieve a tighter, more masculine breast appearance.
Nonetheless, some patients who are slightly or even moderately overweight may proceed with the surgery provided that they are healthy and are happy with their weight or are not expecting to lose significant amount of body mass, says Dr. Smiley.
Brazilian buttock lift is basically liposuction with fat transfer to the buttocks. Instead of discarding the “unwanted” fats, these are injected into the patient’s backside and hips to achieve a more feminine figure.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says a good result should present high symmetry between the left and right side, not just of the buttock, but also of the entire torso of the patient when viewed from the back.
After and before photos of a patient who have had Brazilian buttock lift. Hers was a special case due to her scoliosis.
In one of his recent Snapchat videos, Dr. Smiley has presented a rather special case of Brazilian buttock lift.
The female patient has scoliosis that her torso slightly “curves” to the right. Hence, her fat rolls and skin fold along this side were more prominent compared to the left side of her back.
In the video, Dr. Tarick Smiley said he almost always treats the lower back and flanks as donor/liposuction sites because of the areas propensity to accumulate “unwanted” fats that can show through tight clothing.
However, performing liposuction on the lower back and flanks of the patient with scoliosis could “highlight” the asymmetry between the left and right side of her torso unless “appropriate adjustments are made” during surgery, he explained.
To achieve a more symmetric result, Dr. Smiley removed more fat volume from the right side of the torso than its left side.
“It is important for any surgeon performing Brazilian buttock lift to have an eye for detail. Essentially, this is a combination of science and art,” he said.
After removing sufficient fat volume from the donor sites, Dr. Smiley purified it with the use of a centrifuge, a device that separates biomaterials based on their weight.
For instance, the lightest material is the oil, which floats above the fluid after centrifugation; this is discarded to achieve a high survival rate of fat graft (at least 70 percent).
Then, Dr. Smiley injected the purified fat into the patient’s backside, allocating about a third of the volume to reshape the hips and the remaining amount was used to improve the buttock’s shape and projection.
Moreover, Dr. Smiley smoothed out the visible indentations on the buttocks with meticulous fat injection techniques.
BBL surgery results should appear smooth—i.e., the skin surface must show uniformity and there should be a smooth transition between the buttocks and the “adjacent areas” such as the posterior thigh, hips, flanks, and lower back.
BBL, which is an acronym for Brazilian buttock lift, is basically a combination of two procedures: liposuction and fat transfer/injection.
Liposuction is the process of removing the “unwanted” fat, which is then re-used to augment and reshape the buttocks and hips to achieve a more feminine figure.
Fat injection, meanwhile, is the process in which the buttocks and hips are reshaped in a way that they look natural and proportionate to the patient’s underlying anatomy. The final results should also reflect the individual’s cosmetic goals and expectations, which she must be able to describe in details during the preoperative consultation.
Inland Empire plastic surgery expert Dr. Tarick Smiley, who performs over a hundred BBL surgeries every year, says that fat transfer is a meticulous process. Instead of dumping the fats all out once, the use of microdroplet injection technique is critical to achieve smooth results and high survival rate of fat grafts.
Any amount that survives after a few months of fat injection is expected to last a lifetime, he says in one of his recent Snapchat videos.
Dr. Smiley warns that incorrect fat injection and over-filling the buttocks can lead to a gamut of aesthetic-related problems such as cellulites, dents, and sagging appearance.
Cellulites and other skin surface irregularities are generally caused by “disturbing” the fascia system, which resembles a cluster of threads connecting the muscle into the skin.
When too much fat volume has been injected into the buttocks, the extra weight causes the fascia to weaken and the butt cheek to sag. This “problem” can be further aggravated by aging and large weight fluctuations.
To avoid skin irregularities and sagging appearance, Dr. Smiley says he never injects “fat volume that goes beyond the capacity of the patient’s fascia system and other relevant anatomies.”
“The key to achieve natural, proportionate BBL surgery results is to respect and acknowledge the anatomical limits. This core principle has also helped me avoid most known complications,” he says.
To further avoid “unnecessary weight” that could make the buttocks susceptible to sagging, Dr. Smiley says he avoids or at least minimizes fat injection into the lower aspect of the butt cheek, focusing more on the upper half portion and the lateral side (hips) instead.