Bikini body after tummy tuck. This has always been the proverbial request of patients who ask for this type of body contouring surgery in which the apron-like hanging skin and fat from the abdomen is removed, typically with a hip-to-hip incision pattern.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently performed a tummy tuck in a female patient with barrel-shaped abdomen, redundant skin, lots of stretch marks, sagging pubis area, and “boxy” flanks. (Note: The surgery was recently shown on his Snapchat.)
Dr. Smiley places the incision below the pubic hairline so the scar is perfectly concealed by the patient’s underwear or bikini.
During surgery, Dr. Smiley placed the incision “very low and hidden” so the “resulting scar will not show when the patient wears an underwear or a bikini.”
“I place the incision way below the hairline [of the pubic region] to hide the scar and to slightly elevate the sagging mons pubis,” Dr. Smiley says in the video.
Conservative elevation of the mons pubis without excessive tension also ensures a smooth transition between the pubic area and the lower abdomen, further contributing to natural-looking results.
After the creation of tummy tuck incision, Dr. Smiley lifted the skin to reveal the pair of separated or splayed abdominal muscles, which he tied in a side-by-side configuration to help improve the patient’s barrel-shaped abdomen. This was done with the use of permanent sutures known for their additional support.
“By tightening the muscle with internal sutures and paying more attention to the area right above the belly button, we can prevent the appearance of unsightly bulges that tend to be more pronounced when a person is sitting,” says Dr. Smiley.
The celebrity plastic surgeon then removed the hanging skin before closing the wound in which a curved hip-to-hip scar would lie low “beneath the bikini area” for its optimal concealment.
To further improve the shape of the waist, Dr. Smiley tightened the skin with the “right amount of tension” so that a degree of muscle definition would show through. He also pulled the skin “more centrally” for additional “feminine curves.”
Dr. Smiley says that meticulous cutting and excision techniques, in addition to precise suturing methods, “have a significant impact on the healing and the final scar appearance.”
“When cutting the skin, the blade should be held at a 90 degrees angle and it should be moved in one direction. This paves way for meticulous suturing technique in which the goal is to close the wound edges just like you’re arranging puzzle pieces,” he says.
The use of two different sized breast implants is reserved for patients with at least a “half cup” difference. The goal is to make both sides appear the same in size, shape, and projection, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Recently, the celebrity plastic surgeon performed breast augmentation in a patient whose right breast was noticeably smaller than the other side, thus she entailed the use of two different sized breast implants to help improve the asymmetry.
During surgery, Dr. Smiley placed a 495 cc implant in the right breast, and 470 in the left. Both implants were filled with medical-grade silicone noted for its cohesiveness comparable to soft tissue.
The implants were placed via peri-areolar incision technique, also referred to as “through the nipple.” The incision was precisely made at the dark-light skin junction so it could blend well into the background.
Furthermore, the peri-areolar technique was particularly suitable for the said patient because of the stark color contrast between her areola and its surrounding skin, making it easier to hide the scar.
Aside from a more symmetric look, the patient was also concerned about having natural-looking appearance and “feel,” which silicone implants are known to provide. Saline-filled implants, meanwhile, are more likely to appear globular in shape and are firmer particularly when used in patients with very little soft tissue coverage.
To further ensure natural-looking results and soft feel, Dr. Smiley placed the implants beneath the pec muscle, which provided additional soft tissue coverage. This implant placement is also linked to lower risk of wrinkling, scalloping, and palpability, which are common cosmetic issues among thin or small-breasted patients.
Sometimes, the disparity is not limited to size. For instance, one of the breasts may be more saggy or flatter than the other, or the nipples are of different diameter or position. Hence, Dr. Smiley says that breast augmentation surgery requires a highly customized approach to address specific cosmetic issues and to achieve high patient satisfaction.
Occasionally, breast lift and areolar reduction are performed simultaneously with breast augmentation to further improve symmetry between the two sides, says Dr. Smiley.
Local anesthesia for upper eyelid surgery is a good option for patients who consider themselves “stoic” and have a relatively high pain threshold. In this technique, only numbing medications are used to provide comfort and so they are awake during the entire procedure.
Without general anesthesia that puts patients to a state similar to sleep, they avoid its common side effects such as nausea and lethargy, which in turn promote quicker recovery.
The patient receives local anesthesia alone during her upper eyelid surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated a surgery via Snapchat performed completely under local anesthesia. The patient requested for this procedure so she could drive herself home after surgery.
The patient was awake during the entire surgery, which involved removing some loose skin (and muscle) to eliminate the upper lid hooding that was aging her eyes and interfering with her vision.
A local anesthesia-alone surgery also precludes the need for fasting; this is not the case with general anesthesia in which the patients are required to avoid foods and drinks for 8-12 hours prior to the operation.
While local anesthesia for upper eyelid surgery is a reasonably safe option—some doctors would even compare this to a dentist visit involving cavity fillers treatments—Dr. Smiley says that not everyone is a good candidate for this approach, particularly those requiring other concurrent procedures like facelift, fat transfer, and brow lift.
Also, patients who are anxious are poor candidates for “pure” local anesthesia as they might experience increase in blood pressure, which can result in more bleeding and thus the surgery becomes more difficult. For these individuals, the use of local anesthesia with sedation or general anesthesia remains the most ideal approach.
For patients who want to avoid general anesthesia but may be too nervous to be awake during surgery, a good alternative is to combine local anesthesia with sedation, which means that they will have no memory of the surgical experience.
Furthermore, sedation does not involve placing a tube in the throat, which the general anesthesia entails.
Breast implant consultation varies from patient to patient, although it usually lasts between 30 minutes and two hours. Others require more than one preoperative visit before they are completely comfortable going under the knife and have all their questions/concerns answered.
Dr. Tarick Smiley, a renowned Los Angeles plastic surgeon who performs cosmetic and reconstructive breast surgeries, gives his tips on how to make the most of your preoperative consultation.
After doing your own research by watching and reading contents from reputable sources, Dr. Smiley says the next step is to jot down the questions that will help you assess your surgeon’s qualifications, the most ideal breast implant size and design, and all the ramifications that come with the surgery.
You should bring this list of questions during your preoperative consultation so you would not overlook issues that are important to you, says Dr. Smiley.
Aside from the list of questions, Dr. Smiley says you should also bring the following during your consultation:
- A list of your complete medical history. This should include your previous surgeries, medical conditions, and drug allergies.
- You may bring along your spouse, friend, or family member. They may ask questions on your behalf that you may have overlooked.
- A list of medications you take. Remember that this should include not just prescription drugs but also over-the-counter medications, herbal supplements, and vitamins and minerals.
- Bring your “wish pics.” While these could help you explain your cosmetic goals more clearly, remember that the final results will still largely depend on your underlying anatomy.
- You may bring different types of clothing. Todays’ surgeons typically offer breast implant sizers that are worn inside an unpadded bra, allowing their patients to visualize the most likely results of their surgery.
Take note that you should not feel rushed during your consultation. In fact, you may meet with your surgeon as many times as you want should you still have lingering concerns.
Patients with aging countenance face this common dilemma: What works better, Botox or facelift?
One should realize that facial aging is a multifaceted process. The skin sags and thus creates jowling, the cheek fat pads deflate leading to a gaunt look, the face experiences soft tissue atrophy or shrinkage that results in the appearance skeletonized eye socket and concave temple, and the wrinkles become more prominent, says renowned Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that Botox and facelift work differently in erasing or at least minimizing the signs of facial aging. Botox paralyzes the muscles responsible for the appearance of dynamic wrinkles, while facelift surgery elevates the skin, fat, and soft tissue all as a single unit.
Occasionally, Botox is used to paralyze the muscle that is pulling down the brow, allowing the one responsible for elevating it to work more efficiently.
Botox, whose effects typically last 3-4 months, appeals to male patients who generally dislike going under the knife and the ensuing recovery. This approach also suits people who cannot afford the prolonged downtime of surgery.
However, Botox cannot improve a markedly sagging skin, which entails facelift. Also, this non-surgical treatment cannot reposition the drooping cheek fat pad nor improve the soft tissue deflation that comes with aging.
Facelift is generally the ideal choice for patients with more advanced signs of facial aging. Nonetheless, Dr. Smiley says that individuals as young as 45 can be a good candidate, particularly if they are seeking for subtle improvements and want their surgery to be “discreet.”
Postponing facelift until one has full-blown facing aging can lead to discernable and drastic changes that refuting surgery would be impossible. Hence, some “younger patients” resort to mini facelift and then undergo minor touch-ups down the road to maintain their youthful appearance in a more discreet manner.
Today’s facelift is commonly performed with fat grafting or injection, a critical component in holistic facial plastic surgery. This complementary procedure prevents surgical stigmata such as gaunt cheeks, abrupt lower lid-cheek transition, and overall pulled appearance.
Hence, facelift with fat injection is dubbed as 3D facelift surgery because it not just corrects soft tissue descent (i.e., skin sagging) but also loss of facial volume.