The appearance of belly button after tummy tuck can make or break the result. Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says he pays close attention to this anatomy during surgery, ensuring that it will not detract from the more streamlined abdomen.
Tummy tuck primarily removes the excess skin and fat caused by previous weight loss and pregnancy. Nonetheless, the navel, flanks, and even the pubis must also be taken into account to achieve smooth, natural-looking results, says Dr. Smiley.
Dr. Smiley places the scar inside the navel’s rim to hide its appearance. He also eliminates tension on the skin to prevent the umbilicus from shrinking.
In a recent Snapchat post, Dr. Smiley has shown a female patient who had tummy tuck to eliminate the posterior bulge caused by excess skin and fat, and to correct the weak abdominal muscle that further contributed to the barrel-shaped midsection.
After creating a hip-to-hip incision placed very low (underneath the “bikini” area), Dr. Smiley lifted off the skin using a cauterizing device and removed the excess skin tissue from the lower abdomen. Then, he pulled the upper abdominal skin downward and created a new opening for the navel.
During the entire surgery, the belly button remained attached to its stalk or main blood supply.
The new opening brought out the navel, which was sewn to the skin. Meanwhile, Dr. Smiley placed the incision along the inner rim of the belly button to hide the scar.
The celebrity plastic surgeon emphasizes the importance of closing the incision in which there is no or very little tension on the skin surface; this is done with the use of deep rows of sutures.
Excessive tension on the skin may cause the navel to contract (resembling a coin slot) or even close shut completely.
Navel contraction and less than optimal shape may also stem from too much activity soon after tummy tuck and delayed recovery (smokers and patients with chronic medical condition such as diabetes are susceptible to poor healing).
Correct suturing technique can also maintain the “innie” appearance of the navel, while preventing the appearance of “outie” or bulging umbilicus.
An off-centered navel is another dead-giveaway that surgery has been performed. However, Dr. Smiley says this can be avoided with precise skin removal and elimination of tension on the skin.
Rhinoplasty, or nose job in layman’s term, is either performed through an open or closed technique incision; this allows the surgeon to reshape the cartilaginous and bony framework of the nose to improve its “outside appearance.”
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says he prefers the closed technique in which the incisions are limited inside the nostril, thus reducing any risk of visible scar. The open rhinoplasty, meanwhile, cuts the columella or wall separating the two nostrils to lift the “roof” of the nose before reshaping the underlying framework.
The female patient receives the closed rhinoplasty technique known for its shorter recovery or social downtime.
“About 95 percent of my rhinoplasty is done through closed technique,” Dr. Smiley said in his recent posts on Snapchat that demonstrated two female patients who have had nose-reshaping surgery.
The celebrity plastic surgeon has explained the “core” benefits of closed rhinoplasty:
- More control and increased predictability over the final results
Some surgeons argue that the open technique provides more control over the final results due to the improved visibility since it allows them to raise the roof of the nose. However, Dr. Smiley says it comes with one major caveat: They do not see the “outside appearance” of the nose while they are reshaping the underlying framework.
Meanwhile, the closed rhinoplasty technique allows the surgeon to reshape the underlying framework and see and examine the outside appearance of the nose in “real time.”
“Just like you’re molding a piece of clay it is better to see it every time you do it step by step,” he explained in the videos.
Compared to the open technique, closed rhinoplasty causes less disruption and injury to the soft tissue, leading to less bruising, pain, and swelling, which in turn contributes to shorter recovery.
Contrary to popular belief, most patients are concerned about the “social downtime” than the pain (which in most cases is well controlled by medications). With closed technique, many patients can expect to look presentable after a week, versus 10-14 days when open rhinoplasty is performed.
With closed rhinoplasty, there is no external scar across the columella. It is important to note that open rhinoplasty often results in barely detectable scar, although a small percentage of patients have experienced less than optimal scar.
Tummy tuck surgery removes the hanging skin and excess fat often with the use of a hip-to-hip incision placed very low within the “bikini area” so the resulting scar is well concealed.
Aside from skin excision, the surgery also typically incorporates muscle repair, navel repair, and liposuction of the flanks to further create natural curves and contours.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a “special case” of tummy tuck: The female patient previously had appendectomy, resulting in a scar on the right side of the abdomen that was causing asymmetric skin folds [see the “before” picture below].
Dr. Smiley said the skin fold must be released during tummy tuck to achieve smooth results.
During surgery, Dr. Smiley placed a curved hip-to-hip incision very low that its mid aspect was at the same level as the pubic hairline; this allowed him to remove the loose skin along with the appendectomy scar.
The celebrity plastic surgeon said that prior to surgery he “marked” the patient standing up to assess more accurately how much skin must be removed.
“Marking should be done while the patient is standing since when one is lying down, everything shifts,” he said.
Aside from removing the large skin folds causing the unsightly “rolls,” the celebrity plastic surgeon also performed muscle repair with the use of permanent sutures.
The pair of vertical muscle, which runs between the lower and upper abdomen, is naturally placed side by side until pregnancy or large weight fluctuation causes it to become separated. Hence, Dr. Smiley tightens it with the use of individual permanent suturing technique known to provide additional support and narrowing effect on the waistline.
To further ensure a feminine contour, Dr. Smiley performed navel repair to reduce its size and make it more proportionate to the flatter, narrower waistline. Furthermore, he placed it at the same level as the “stable bone” of the iliac crest or hipbone for the most natural effect.
During navel repair, he placed the incision inside the rim of the belly button to ensure that the scar would remain hidden.
Male ethnic rhinoplasty is a broad term used to describe nose-reshaping surgery performed in men of ethnic descent. It is important to note that even within the same ethnicity variations do exist in terms of nasal anatomy, facial features, and aesthetic goals.
Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says successful nose surgeries are highly customized procedure, respecting the “starting” anatomy of the nose, the unique facial features of each patient, his aesthetic goals (which are partly influenced by his culture), and even his body-frame and height.
While the ideal male nose is not defined by highly restrictive standards, the renowned facial plastic surgeon says there are definite philosophies and universal aesthetic guidelines that help doctors achieve more attractive and natural results from rhinoplasty.
- The attractive male nose has a strong appearance.
Several aesthetic variables that determine a strong, attractive male nose include a slight hump or fullness along the dorsum (bridge), an angle of tip rotation between 90-95 degrees, and a bigger size compared to women (of the same height).
The tip rotation, or the angle between the upper lip and nasal tip, is one of the most critical aspects of male rhinoplasty. It should appear straight or sometimes even slightly droopy to look gender appropriate; in no way it should be over-rotated since even the slightest upturned appearance can make the results look delicate and feminine.
- The patient’s face should be taken into account.
A good number of male ethnic rhinoplasty surgeries are performed to reduce the width and/or height of the nose, making it more proportionate to the face. However, over-reduction is avoided like a plague because a male nose is naturally bigger than a female nose.
- His height and body frame will partly determine the ideal nose size and appearance.
In general, a taller, more muscular male may benefit from a stronger and more elevated bridge and a longer nose than a shorter, leaner man.
- Consideration of some shared anatomies and features.
Respecting the patient’s anatomy is one of the keys to preserve natural-looking, long-lasting results. While “strict” generalization does not give justice to the wide variations of ethnic male noses, it is important to note that they have some shared traits such as thicker nasal skin, more bulbous tip (compared with Caucasians), and less supportive cartilage.
Markedly thick skin does not show all the details of rhinoplasty, although they are more forgiving compared to very thin skin which can show even the smallest contour irregularity.
Patients with markedly thick skin should not have their tissue over-resected because the overlying skin may not drape well especially around the tip, leading to its amorphous appearance.
It may come as a surprise that rhinoplasty, or nose job in layman’s term, could make someone look younger, an effect more commonly attributed to neck lift and facelift surgery.
An aging nose has some archetypal traits: more prominent hump along the dorsum or bridge, and drooping tip, which contributes to the elongated appearance.
When these before-and-after photos were posted on Dr. Smiley’s Instagram account, some followers pointed out the youthful effects of the surgery on her face.
Aging causes the skin to lose its elasticity and the cartilaginous framework of the nose to weaken, leading to the drooping nasal tip, which could create an illusion of a more acute nasolabial angle and a longer looking nose.
Sometimes, the aged-related drooping of the tip causes breathing difficulty and abnormal airflow, which are considered medical conditions and thus some insurance may agree to cover the cost of rhinoplasty surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley, who has performed over 3,000 rhinoplasties as of this writing, says the “inadvertent rejuvenating effects” of the surgery can be achieved when the drooping tip is de-rotated.
However, the amount of de-rotation should take into account the patient’s ethnicity, gender, nasal anatomies, and cosmetic goals, he says.
For instance, women of short stature in general can have more angle of tip rotation (i.e., angle between the tip and upper lip) with studies suggesting that they can tolerate up to 110 degrees angle.
The ideal angle of rotation of the nasal tip for men, meanwhile, is close to 90 degrees giving it a stronger, straighter profile. The upturned appearance is avoided like a plague during male rhinoplasty due to its feminizing effects.
De-rotating the tip entails improving its structural integrity; hence, Dr. Smiley often uses the patient’s own cartilage derived from the nose itself or the back of the ear to raise it a bit. The use of “living tissue” eliminates the myriad of risks associated with artificial implants.
Shaving down the prominent dorsal hump can also result in a younger, more feminine appearance. Nonetheless, it might be ideal to preserve some minimal fullness along the bridge when dealing with male patients to ensure a more natural and masculine result.
A 2012 study published by Archives of Facial Plastic Surgery has shown that patients who have had rhinoplasty looked 1.5 years younger on average compared with their “before” photos.
The researchers enlisted 53 rhinoplastic patients aged between 15 and 61 (35 was the average age) who were photographed before and one year after surgery; 50 “ordinary observers” were then asked to rate their appearance based on the perceived youthfulness.
The study noted that the rejuvenating effects were more evident for older patients than younger ones, although regardless of age, individuals who had dorsal hump reduction and greater nasal tip de-rotation appeared to lose more years than other patients.