Breast augmentation for asymmetry does not only rely on using two different sized implants. Occasionally, the lopsided appearance is not just caused by size disparity between the two sides, but by the difference in the nipple position/width and/or projection of each breast.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says all women have uneven breasts, which is normal to a certain extent; however, it only becomes an “issue” when the asymmetry forces them to change the way they dress or when they hide it by padding out one side.
The success of breast augmentation for asymmetry boils down to good patient-surgeon communication. Moreover, Dr. Smiley says that the right candidate should be able to explain her goals in details.
The celebrity plastic surgeon says that some patients want the smaller breast to be as large as the other side, although others like augmentation on both breasts with the use of different sized implants to close the size gap.
While it is possible to operate on just one breast to make it bigger and more symmetric with the other side, Dr. Smiley warns that breast augmentation does not only deal with the issue of size, but also with the shape and projection of breasts.
Furthermore, the augmented and non-augmented breasts do not behave similarly and are expected to age at different pace. Hence, Dr. Smiley says that most patients will need surgery on both breasts to achieve a good level of symmetry that can persist long term.
Aside from using different sized implants, a good number of patients also require areola reduction and/or elevation to further improve symmetry between the two sides. This ancillary procedure requires incisions around the areola’s perimeter, with the resulting scar lying precisely at the dark-light skin junction for its optimal concealment.
Breast augmentation for asymmetry requires a meticulous set of procedures; hence, a surgeon performing this operation must have formal training and relevant experience that have allowed him to develop an eye for detail.
Recovery from mommy makeover surgery—a combination of body contouring procedures that can reverse the effects of pregnancy—may vary greatly from patient to patient. Nonetheless, patients are generally advised to avoid strenuous activities and heavy lifting for six weeks to prevent healing problems.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says most of the pain will come from muscle repair performed during tummy tuck, a surgery that contours the frontal and lateral aspect of the waist. The discomfort from breast enhancement such as breast lift and augmentation, meanwhile, is much easier to control.
To minimize the postop pain resulting from tummy tuck, which in turn can promote healing, Dr. Smiley says he always injects Exparel into the abdominal muscle at the very end of his surgery. The effects of this numbing medication can last for up to four days, allowing his patients to reduce their use of narcotics or even avoid them altogether.
In the first few days postop, Dr. Smiley recommends his patients to arrange for help at home so they can focus on their recovery instead of stressing over routine chores like childcare, cooking, driving kids, etc. Simply put, they need all the help they can get during the initial healing phase.
Taking care of small children (under the age of 2) at home is particularly discouraged during the initial healing stage. For this reason, mommy makeover really requires advanced planning for a more convenient recovery.
Patients should also expect lethargy that can last 4-6 weeks and so they may need to sleep more; additionally, they may lack the energy to do their usual activities, he adds.
In general, young patients bounce back sooner than older patients, although recovery from mommy makeover surgery still boils down to individual healing. For this reason, the celebrity plastic surgeon requires lab screening to ensure that they are healthy enough to handle the surgery and the ensuing recovery.
When going back to “desk” work, Dr. Smiley typically recommends 1-2 weeks off; however, some patients file for a longer leave or choose to work part time until they regain their preoperative energy level, which can take up to six weeks.
Some patients with “fat flabs” on their knees can benefit from knee liposuction, which is essentially a minor surgery. It is important to note that the superficial fat (it lies beneath the skin) is often genetically predetermined and so it may not always respond to exercise and diet.
The deeper visceral fat, meanwhile, will only respond to weight loss—i.e., superb diet combined with regular exercise. For this reason, liposuction or any form of body contouring surgery is only reserved for patients of normal weight, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
In his recent Snapchat video post, Dr. Smiley has showcase a female patient undergoing knee liposuction. Her inner thigh was also included in the surgery to achieve a more attractive contour. The idea is to create a smooth transition between the knee and its adjacent areas, which is seen in “supermodels,” he explained.
The celebrity plastic surgeon positioned small round incisions on the inner side of the knees; these are expected to fade into scars that are almost invisible. This has become possible thanks to microcannula, a stainless steel tool with an outside diameter of less than 2-3 mm.
Dr. Smiley said he prefers the use of microcannulas to large cannulas because they remove fats in smaller, more “precise” bits and so the risk of over-correction is significantly reduced, if not almost eliminated.
To further improve “precision” during fat extraction, Dr. Smiley injected the knee and its adjacent areas with tumescent fluids, which contained local anesthesia for numbing effects, and epinephrine to reduce the amount of bleeding.
Dr. Smiley also performed liposuction along the inner thigh to achieve proportionate results. He has warned that the area is highly susceptible to surface irregularities (dents and cellulites) and thus a layer of fat must remain afterwards.
“In liposuction, regardless of the treated area, the most important thing is to leave a layer of fat beneath the skin in order to deliver a smooth result,” he said.
Furthermore, the volume of fat removed during liposuction should always take into account the skin shrinkage; it is important for the skin to “snap back” to achieve a tight and smooth appearance, he further explained.
After removing the “unwanted fat,” Dr. Smiley wrapped the liposuction sites with bandages and compression garment to control swelling and to speed up healing.
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.
There are lots of terminologies thrown around as regards to facelift surgeries—weekend lift, SMAS facelift, deep plane, skin-only lift, just to name a few—which add up to the confusion. For this reason, leading Los Angeles plastic surgeon Dr. Tarick Smiley says prudent patients should ask their doctors about the specific details of their surgery.
Dr. Smiley says he prefers the SMAS facelift technique due to its long-lasting, natural rejuvenating effects. It involves tightening the layer called superficial muscular aponeurotic system, which extends from the neck to the temple area.
The SMAS layer lies beneath the facial fat and skin and so tightening it means the deeper structure receives most of the tension, which in turn promotes good scarring as the skin receives very little of the “opposing” pull.
Meanwhile, older techniques (skin only lifts) can be problematic in terms of scar appearance and longevity. Because most of the tension is placed onto the skin, scar widening and overly tight appearance (done or fake look) are the usual results.
Furthermore, the skin is susceptible to the effects of gravity and continuous aging; hence, the celebrity plastic surgeon stays away from the procedure due to its unstable, usually short-lived results.
Dr. Smiley regularly posts educational videos on his Snapchat account to demonstrate the impressive results of SMAS facelift.
One patient was particularly impressed with her results that she allowed Dr. Smiley to showcase her outcome on social media.
The 60-year-old female patient had come to Dr. Smiley because of her sagging mid face, sunken lower lid, significant jowling, laugh lines (medically referred to as nasolabial folds), and neck bands. To address these problems, the celebrity surgeon performed SMAS facelift and neck lift.
He placed the incision “inside” the hairline (around the temple area), which extended behind the tragus (small bump in front of the ear) and then curved behind the ear for optimal scar concealment.
With SMAS facelift, Dr. Smiley was able to restore the softness over the cheekbone and reposition the sagging cheek fat pad, which in turn eliminated the laugh lines. Moreover, the technique allowed him to tighten the jawline and thus erase the appearance of jowling, and to improve the neck as well.
The SMAS facelift typically entails 3-3.5 hours of operative time and a social recovery (all the outward signs of surgery are gone) of two weeks. Nonetheless, all is worth it as it can erase up to 20 years off from one face, with the results expected to last 12-15 years.