Tummy tuck and BBL (acronym for Brazilian buttock lift, which is essentially buttock augmentation via fat transfer) can be performed under one surgical setting, provided that the patient is physically fit and is committed to healthy lifestyle.
It is important to note that healthy lifestyle, particularly relating to weight management, is the most important factor to maintain the results of tummy tuck and BBL or any other types of body contouring plastic surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos to illustrate one patient who have had tummy tuck and BBL performed together.
Dr. Smiley first required the patient to undergo a comprehensive lab screening to ensure that she could handle the extent of surgery and its ensuing recovery. To further guarantee her safety, her operation was performed at an accredited surgical facility under the supervision of board-certified anesthesiologist and licensed/highly trained medical staff.
The celebrity plastic surgeon started off the “combo surgery” with liposuction in which the goal was to collect adequate amounts of fat from the bra rolls, flanks, and lower back. Then, the fat was purified—all the red blood cells and oil were discarded—before it was injected into the buttocks.
Basically, BBL is a reversed liposuction. Instead of discarding the fat, it is later utilized to improve the shape and projection of the patient’s backside with the use of the most natural material.
After BBL, Dr. Smiley and his staff moved the patient into supine position to begin the tummy tuck operation.
The patient required the standard or hip-to-hip incision tummy tuck technique, which allowed Dr. Smiley to remove most of her stretch marks (including those above her navel), repair the loose abdominal muscle, correct the herniation above her belly button, and give a cinching effect on her waist.
Despite the length of her tummy tuck incision, it is expected to fade into a thin, barely detectable line after 1-2 year. Moreover, the scar is positioned very low that her underwear or bikini bottom can easily conceal it.
While multiple-surgeries procedure typically entails a “tougher recovery,” it offers benefits such as lower cost and one-time healing period. Nonetheless, Dr. Smiley only reserves this for patients who have achieved their optimal health prior to surgery.
Major breast reduction surgery is a technically complex procedure since the goal is not just to downsize the breast in order to provide immediate relief from neck and back pain, constant skin irritation, and other physical symptoms. Most patients are also concerned about getting a perkier, natural-looking breast contour.
However, the more breast tissue and skin excised during surgery, the more difficult it is to achieve a good shape and projection. Furthermore, the risk of poor healing and other complications increases as well, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Nonetheless, great results from major breast reduction surgeries can be achieved with meticulous dissection and deep understanding of the anatomy, he says in his recent Snapchat posts.
He has shown a female patient with hugely disproportionate breasts that hung too low, drooping over her tummy area.
Aside from the disproportionate appearance, prior to surgery the patient also complained that her overlarge breasts were causing “rounded” and painful shoulder, back pain, skin breakdown, and discomfort when doing exercise and other physical activities.
(Note: Because a good number of breast reduction patients have physical symptoms, it is not surprising that the surgery has one of the highest patient satisfaction rates among plastic surgery procedures. According to a 2012 survey released by the American Society of Plastic Surgeons, about 90 percent of patients rated their results “good” or “very good.”)
Dr. Smiley says major breast reduction requires the standard or anchor technique, which is named after the shape of its resulting scar. It uses an incision around the areola, which goes down the midline, and then across the bottom of the breast.
A modified form of breast reduction eliminates the horizontal incision across the bottom of the breast; hence, the resulting scar resembles a lollipop. This technique is referred to as lollipop or vertical reduction, says the celebrity plastic surgeon.
The patient required the anchor breast reduction technique, which has allowed for the removal of more than 600 grams of breast tissue on each side.
Meanwhile, the lollipop breast lift only suits patients who require smaller reductions, between 300 and 500 grams of breast tissue on each side.
One of the main issues with major breast reduction is the scar appearance, particularly the vertical scar because of its more obvious location (the scars around the areola and within the submammary fold are more discreet). But with meticulous wound suturing technique, Dr. Smiley says most patients can expect “almost invisible” or “very faded” scar after 6-18 months.
He highlights the importance of closing the incisions in several layers, while just allowing the skin to “kiss each other” instead of closing their edges with stitches. The idea is to eliminate tension on skin, which promotes favorable scars and good healing, he says.
In the first few weeks of recovery, the use of post facelift makeup can help conceal the bruising and swelling. However, cosmetics are best avoided for at least a week to prevent irritation, infection, and permanent tattooing, which may happen if the cosmetics get into the incision site.
Moreover, post facelift makeup can help some patients show up for work sooner (without drawing some unwanted attention); however, others forego the use of camouflage cosmetics and just patiently wait for their social recovery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that most patients look socially presentable at two weeks postop, although it all depends on the type of skin, extent of surgery, individual healing, and propensity to bruise (some are less likely to bruise than others).
Mineral- and water-based cosmetics with hues slightly lighter than the patient’s skin are the best way to conceal discoloration. It is highly ideal to use brand new makeup, sponges, brushes, and applicators to minimize risk of irritation and infection.
On the other hand, oil-based cosmetics are best avoided while the skin is still sensitive because they may cause irritation; they also require a special remover and are harder to take off than mineral and water-based makeup.
However, camouflage cosmetics are not the only thing that can hide postop symptoms. Large sunglasses, turtle neck tops, and scarves can also come in handy, and of course less “troublesome” than applying makeup to conceal skin discoloration.
Once the postop symptoms are gone, makeup application becomes a breeze. In fact, most facelift patients have mentioned that the reduction in their wrinkles makes it easier for them to apply creams and foundation.
The problem with deep lines—e.g., nasolabial folds, or more commonly referred to as laugh lines, and marionette lines, or creases that run straight downwards from the mouth’s corners—is they can trap powder, foundation, or cream, further accentuating their appearance.
To correct facial lines and wrinkles, Dr. Smiley highlights the importance of lifting the SMAS layer (and not just the skin alone). By going deeper into the facial layer, he can deliver more natural results that can persist long term.
To further smooth out the lines, some of his patients require simultaneous fat injection, which can also be used to create a smoother lid-cheek transition, and to plump up the gaunt cheeks.
And with less facial lines and sagging appearance, and “softer” cheeks, most patients find makeup application more pleasant after surgery.
While there is no specific liposuction method to get a “beach ready body,” leading Los Angeles plastic surgeon Dr. Tarick Smiley says there are core principles that help surgeons achieve impressive results from fat reduction surgery.
For instance, he always ensures that a thin fatty layer remains beneath the skin to achieve a smooth surface (instead of appearing like a cottage cheese) and to preserve the body’s natural curves and valleys.
To further ensure a smooth and natural result, he occasionally performs fat transfer or injection, which is particularly helpful in smoothing out pre-existing dents and cavities (e.g., lateral depression of the buttocks) or skin asymmetries caused by a previous botched liposuction.
Dr. Smiley, who regularly posts videos on his Snapchat and other social media accounts as part of his patient safety awareness campaign, says the ideal liposuction method will also depend on the target area. For instance, small areas such as the knee, calf, and ankle will require a high level of precision to avoid over-correction, which can lead to unnatural contour.
Areas that require a high level of precision warrant the use of microcannula or pen-like device with a hollowed narrow body use to suction the unwanted fat from the body. Large cannulas (outside diameter is 4-5 mm), meanwhile, remove large masses of fat and so there is a perceived higher risk of skin irregularities.
The celebrity plastic surgeon says he also uses vibrating microcannula, or more aptly referred to as power-assisted liposuction, when treating fibrous fat commonly found in the back (bra rolls), around the navel, and the male breasts. This special cannula releases tiny vibrations to dislodge the fat and so the “process” can significantly lessen operator’s fatigue.
(Note: Operator’s fatigue, which might be an issue when the surgery involves large volume of fat, could contribute to less than optimal results from liposuction.)
While the techniques and equipment play an important role in the success of liposuction, Dr. Smiley says that the surgeon’s skillset (which always includes having an eye for detail) remains the most important factor.
Having an eye for detail allows the surgeon to decide how much fat he needs to remove without causing surgical stigmata (e.g., skin asymmetries), and the “extent of the area” he needs to treat to achieve a congruous result. For instance, some patients with “saddle bags” may also need their hips addressed at the same time so the latter will not detract from the more slender outer thigh.
Power assisted liposuction equipment has revolutionized how plastic surgeons perform body contouring surgery. Unlike the standard cannula (hollowed steel tube), which is moved back and forth during the removal of unwanted fat, this cannula releases minute, rapid vibrations to break up the fatty cells before they are suctioned out of the body.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated on his Snapchat account how power assisted liposuction equipment removes the excess superficial fat, which lies beneath the skin. (Note: This is different from the deeper visceral fat closely tied to obesity, which only responds to “real” weight loss.)
In his previous Snapchat video post, Dr. Smiley said his “innovative liposuction machine” has been imported from Germany, a country known for its excellent medical equipment and cutting edge technology.
The renowned plastic surgeon has described the benefits of power assisted liposuction, or more commonly referred to as PAL technique.
The PAL device affords its operator better precision compared to the standard cannula. Nonetheless, no technology can substitute a surgeon’s skillset, training, and experience.
And with increased precision, the risk of over-correction or inadvertent removal of too much fat can be avoided or at least minimized.
To preserve a smooth skin surface, it is a sacrosanct rule to preserve a thin layer of fat beneath the skin. Fortunately, this has become much easier with the use of PAL device.
- Shorter operative time under general anesthesia
And with shorter operative time, patients can expect shorter recovery and less postop symptoms such as lethargy and discomfort. Furthermore, it is known to promote patient safety.
- Reduced bruising and swelling
Of course, less bruising and swelling results in quicker recovery. Nonetheless, it remains ideal to avoid over-exertion for at least three weeks postop.
- Ideal for treating “tough areas”
Dr. Smiley uses the term “tough areas” when describing the bra rolls (or back as whole), male breasts, and navel areas because compared to other liposuction sites their fats are denser and more fibrous as they have more connective tissue.
With standard cannula, these tough areas are difficult to sculpt and the operator may experience fatigue (from moving the device manually back and forth), which may contribute to suboptimal results.