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.
Preventing buttock augmentation risks should be the main objective of any prudent surgeon, said leading Beverly Hills plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
To demonstrate a poorly done buttock augmentation surgery, Dr. Smiley has posted photos of singer Nikki Minaj clad in a scanty two-piece bikini.
Dr. Smiley said the star’s backside clearly shows buttock implants that are too big for her underlying anatomy, particularly relating to her soft tissue coverage, skin elasticity, and body frame.
The hugely disproportionate buttock implants, he said, are clearly visible beneath the skin that they have also caused the tissue to become thin and over stretched, inevitably causing her “derriere” to droop, a complication medically referred to as ptosis.
Whether buttock augmentation surgery is performed through butt implants or fat transfer, Dr. Smiley said the patient’s anatomy, particularly the “elasticity and resiliency of the skin,” must always be respected to achieve natural-looking results and to avoid most known complications.
“The loss or weakness of the fascia system, which holds the skin and the overall shape of the buttocks, can cause ptosis,” he further explained.
“We should not overdo it. The weight of the implants or the amount of fat injected into the buttocks must always respect the anatomy lest the results will look terrible,” he warned.
To further minimize buttock augmentation risks, Dr. Smiley said he now prefers butt augmentation via fat transfer (or Brazilian buttock lift in layman’s term) to the use of implants, which he only reserves for a very small percentage of patients.
Brazilian buttock lift uses the most natural material—i.e., the patient’s own fat—to reshape and augment not just her backside, but her hips as well, leading to a more proportionate, feminine figure.
Despite the perceived benefits of Brazilian buttock lift, Dr. Smiley said it remains important to avoid over-filling the backside since too much weight can cause ptosis, which can happen right after surgery or years down the road.
To further prevent ptosis, Dr. Smiley said most of the fat volume should go to the hips and the upper half aspect of the buttocks (as opposed to its lower aspect). This fat volume “allocation” results in a heart-shaped backside, especially when the unwanted fats from the lower back and flanks are removed as well.
Liposuction is the surgical technique that allows the surgeon to harvest the “unwanted” fats from two or more donor sites; the fats are then purified and re-injected into the patient’s buttocks, said Dr. Smiley.
Hourglass body contouring surgery is a highly customized procedure, although it usually combines liposuction and buttock augmentation through fat transfer, as suggested by renowned Los Angeles plastic surgeon Dr. Tarick Smiley who regularly posts Snapchat videos involving this combo technique.
Dr. Smiley says most patients seeking body contouring surgeries want natural results (i.e., what nature intends) and so they must combine art and science to deliver the most desired results.
The celebrity plastic surgeon says the “core principles” that help him deliver natural results from hourglass body contouring are backed by science. He cites the studies that suggested women with an hourglass-shaped figure are the most appealing to men.
Some researchers have even suggested that having an hourglass figure is more important for most men than their facial features.
The consensus is that the waist-to-hip-ratio of 0.7, or a waist measurement accounting for 70 percent of the hip circumference, is the ideal feminine physique.
To achieve this ratio, Dr. Smiley highlights the importance of contouring, or to be more specific, narrowing the waistline, which can be achieved by 360-degree liposuction.
While liposuction removes the unsightly rolls caused by excess fats beneath the skin (they are genetically predetermined and so they may not always respond to exercise and diet), Dr. Smiley says it remains important to leave behind some fat to preserve a smooth skin surface.
Should the patient desire to improve the projection of her “backside” as well, Dr. Smiley almost always performs liposuction of the lower back and flanks.
For a more hourglass body contouring effect, instead of discarding the fats collected from liposuction they are purified and re-injected into the patient’s backside and hips, says Dr. Smiley.
In his Snapchat videos, Dr. Smiley is often seen allocating about one-third of the fat volume to “widen” the hips and the remaining is then used to improve the shape and projection of the actual buttocks.
When performed in the right patient (healthy, near normal weight), the surgeon says that hourglass body contouring surgery can provide near permanent results that look natural and proportionate.
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.