The vast majority of thigh lift procedures are performed on massive weight loss patients who for the most part are willing to accept the appearance of scar in exchange for some remarkable benefits. After all, the scars, while they are a permanent tradeoff, are generally placed in discreet areas such as the groin and thus easily covered by most underwear.
Moreover, patients with large redundant skin often suffer from skin lesions and tissue breakdown. Consequently, thigh lift not just gives aesthetic benefits, but also improves body functions, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
inner thigh lift incision pattern
Basically, thigh lift procedures either improve the inner/medial thigh or lateral thigh. Depending on the location of excess skin, the incision pattern may appear like an oval or a wedge. Nonetheless, all efforts are made to ensure that the scar settles within the most inconspicuous areas possible (i.e., groin and bikini line).
The inner thigh lift uses an incision pattern that removes the loose skin along the medial aspect of the thigh. The resulting scar, meanwhile, may lie within the groin and so it is hidden beneath the underwear, or may extend down towards the top of the knee should there is a significant amount of excess skin.
On the other hand, lateral thigh lift tightens the front and outer-lateral region of the leg, typically with an incision that extends between the hips and lower portion of the groin; hence, on frontal view the resulting scar resembles a V shape.
outer thigh incision pattern
After the redundant skin is removed, the remaining skin is pulled up to tighten the contour of the leg and the incisions are then closed with multiple rows of sutures. The idea is to eliminate most of the tension on the skin surface, which is tied to better healing and scarring.
Compared with most body contouring surgeries, thigh lift may involve a tougher recovery due to the amount of swelling that stems from gravity and tension when walking (especially in medial thigh lift). Nonetheless, there are several ways to keep the postop inflammation to a minimum such as the use of compression garments, light exercise such as walking, low-sodium diet, and possible use of homeopathic remedies.
Facial aging happens differently from person to person. For instance, some people have sagging skin that is mostly concentrated around their eyes, while others have most of the bagginess along their jaw line and neck.
Nonetheless, facial aging often affects multiple areas almost to a similar degree and thus facelift and neck lift are commonly performed together. Combining them in one surgery also makes sense because the standard facelift incision is simply extended into the nape.
This is an incision pattern used in facelift and neck lift approach. Take note that all scars are hidden.
(Note: Standard facelift entails an incision that starts inside the hairline at the temple area, which then curves in front of the ear and behind it. And with a concurrent neck lift, the scar is slightly extended into the nape, specifically behind the hairline, to hide any surgical stigmata).
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated on Snapchat the rejuvenation effects of this combo approach, particularly when combined with a SMAS lift technique.
SMAS refers to a soft tissue layer found beneath the facial skin and fat. During facelift, Dr. Smiley not just removes the loose skin and elevates the remaining skin; he also tightens this underlying structure.
To further ensure a congruous result, he also tightens the platysma muscle of the neck by using internal sutures, which essentially act as a sling.
The compounded effects of these techniques are tauter jawline, restored volume of the cheek, more youthful chin-neck transition, and smoother neck appearance.
The direction of pull also plays a critical role in facelift and neck lift. The correct vector can create a tauter jawline and restore the youthful plumpness of the cheek, whereas an incorrect one can spell disaster—e.g., wind tunnel effect or overly tight mid face, lateral pleating of the neck skin, and skin bunching around the earlobe.
In a recent Snapchat video, Dr. Smiley says the correct direction of pull is 45 degrees angle, adding that in no way that the soft tissue should be pulled in a blunt horizontal or vertical manner to avoid any telltale sign of surgery.
Mommy makeover procedures are body contouring techniques that reverse the effects of pregnancy—e.g., sagging breasts and apron-like skin that hangs from the abdomen. Tummy tuck, breast lift, and breast augmentation best exemplify these surgeries.
Oftentimes, plastic surgeons who use the term mommy makeover refer to a combination of two or more surgeries.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted on Snapchat before-and-after photos of one patient who has had extensive mommy makeover procedures: breast implant, breast lift, flank liposuction, and tummy tuck.
Multiple procedures surgery is a reasonable approach provided that its estimated blood loss and the time under general anesthesia are within the standard safety limit.
Most surgeons agree that a surgery performed within 4-5 hours is reasonably safe, while going beyond this duration may lead to increased risk of certain complications. Consequently, some patients may need a team of plastic surgeons who can work simultaneously on them to shorten the operation time.
Blood loss is another issue with mommy makeover procedures and other multiple surgeries. Specifically, the main concern is the drastic fluid shift, which can lead to longer and tougher recovery, and higher risk of healing problems.
To keep blood loss to a minimum, Dr. Smiley says that prior to making incisions he injects epinephrine into the tissue; this is a drug that constricts blood vessels and thus it is particularly ideal in tummy tuck, which typically removes huge redundant skin hanging from the abdomen.
The use of epinephrine is also ideal in large volume liposuction.
Another auspicious benefit of epinephrine: It prolongs the numbing effects of local anesthesia, which in turn allows the patient to avoid or take less oral painkillers within the first few days of their recovery.
Aside from a well-thought planning and a meticulous surgical execution, Dr. Smiley says the safety of mommy makeover procedures also boils down to identifying the right candidates.
Instead of going by the BMI, which Dr. Smiley says is not always an accurate criterion, the surgeon puts more importance on the patient’s physical fitness and willingness to follow a healthy lifestyle. Therefore, he recommends all his patients to pass a lab screening.
Furthermore, Dr. Smiley says multiple plastic surgeries or combo procedures entail more emphasis on patient safety due to the perceived challenges. For this reason, he only works with board-certified anesthesiologists and qualified medical staff during surgery.
Breast implant removal with smaller replacement can pose some challenges such as risk of sagging appearance and poor breast contour, although with close attention to details great results can be achieved.
Recently, leading Los Angeles plastic surgeon Dr. Tarick Smiley has performed a surgery on a woman with 500 cc silicone implants who wanted them replaced with 270 cc, which could slash her breast size by almost half.
The patient asked for breast implant removal immediately followed by replacement. But since the new implants were significantly smaller than the old ones, a simultaneous breast lift was performed to maintain natural breast contour.
Due to the significant downsize, she was deemed as a good candidate for a simultaneous breast lift. Without this procedure, her implants would settle too low, resulting in a drooping appearance and deflated-looking upper breast pole.
To remove the old implants along with their scar capsule, Dr. Smiley created a small incision within the breast crease (submammary fold), which would result in a well-concealed scar. He then replaced them with a new pair of smaller implants.
Next, he performed a standard breast lift in which the incision pattern ran around the areola, which was extended downward towards the crease and then across the base of the breast. This would result in an inverted T or anchor-shaped scar that is expected to blend into the background 1-2 years postop.
For long-lasting effects, breast lift should not just be about skin tightening and resection. After all, its elasticity makes it susceptible to the effects of gravity and aging. Hence, the celebrity plastic surgeon creates a more resilient support by remodeling the deeper tissue.
The use of “deep tissue work,” according to Dr. Smiley, also allows the surgeons to elevate some of the tissue of the lower breast pole, resulting in additional upper pole fullness. According to studies, the most preferred breast shape has a 45:55 upper to lower pole ratio (resembling a teardrop shape).
To further promote youthful and natural-looking results, the new position of the nipples should be horizontally and vertically aligned with each other.
Furthermore, tightening the deeper tissue allows the skin to receive no or very minimal tension, which is the key to good healing and “nice looking scars,” says Dr. Smiley.
Dermal fillers are primarily used to fill in depressions caused by facial aging or hereditary predisposition (e.g., flat cheeks). However, doctors are now starting to use them in non-surgical rhinoplasty although their use can be quite limiting.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says fillers only suit patients with minor nasal deformity: a small hump or irregularity along their nasal profile. Those who require minimal bridge augmentation may also consider this non-surgical approach.
Patients with severe or more complex nasal deformity—e.g., drooping tip, significant nostril flare, large bridge, etc.—will need the standard rhinoplasty, a surgery in which the bony and cartilaginous framework of the nose is reshaped. It is important to consider the patient’s skin shrinkage to ensure that it can redrape well to the new contour, instead of appearing amorphous especially at the tip.
When performing non-surgical rhinoplasty, Dr. Smiley only uses FDA-approved fillers to conceal minor imperfections of the nose. Hyaluronic acid-based materials like Juvederm and Restylane are the ideal choice since they can be easily reversed should the patient is not happy with the results; an enzyme called hyaluronidase can be injected into the tissue to dissolve the particles.
Hyaluronic acid-based fillers generally last four to six months and so they require upkeep should the patients want to preserve their results.
For patients who want longer-lasting fillers, one possible alternative is to use Radiesse whose results can last between nine and 15 months. Its main ingredient is calcium compound, which is not easily broken down by the body.
Meanwhile, permanent fillers such as silicone injection should be avoided due to increased risk of lasting deformity, infection, and skin injury, Dr. Smiley says in a previous Snapchat post.
One of the selling points of fillers is the zero downtime, while rhinoplasty typically requires 7-10 days of social recovery due to the postop bruising and swelling.
Despite the impressive safety track record of FDA-approved fillers, they nonetheless demand meticulous injection to avoid skin changes (redness), lumpy appearance, and skin necrosis (death of tissue). Hence, a prudent patient ensures that only a licensed/qualified injector does her procedure.