Forehead lift surgery can elevate the sagging brows, eliminate the vertical creases between the eyes and the horizontal lines across the forehead, and change the hairline height if the patient requests for it.
(Forehead lift surgery and brow lift are basically the same procedure—the incision patterns and “cosmetic effects” are similar—although there are techniques that can elevate or reshape the brows without lifting the entire forehead.)
Serrated incision during forehead lift surgery is made precisely at the hairline so the scar blends into the background.
As with any facial plastic surgery, the ideal forehead lift technique depends on the patients’ underlying anatomy and the “cosmetic effects” they are after. For instance, some like to shorten their forehead, while others want to maintain its height after elevating the brows.
If one of the goals is to reduce or maintain the forehead height, leading Los Angeles plastic surgeon Dr. Tarick Smiley says the ideal technique involves an irregular (serrated) incision made precisely at the hairline. This is different from the standard or coronal lift in which the incision goes from ear to ear, across the top of the head.
The coronal lift does not suit patients with high forehead because it inadvertently elevates the forehead by up to 1 inch, an “effect” some people humorously call “five-head.”
(“Four-head” is when the person can fit four fingers between her eyebrows and hairline. “Five-head” when it is too wide that five fingers can all fit on it.)
Fortunately, the hairline incision technique, or medically referred to as trichophytic, does not cause the dreaded five-head effect and in fact may even shorten the appearance of wide forehead by moving the hairline slightly more forward. Nonetheless, it should not be overdone otherwise the “primitive appearance” may ensue.
This is not to say that the hairline incision technique is superior to the coronal lift because it all boils down to the patients’ anatomy. For instance, women with a notably short forehead may consider getting the coronal approach to slightly increase its height.
Some surveys have suggested that women with a slightly large forehead, along with other “cute” or babyish features such as fuller lips, large eyes, and prominent cheeks, are generally regarded as attractive and youthful by other people.
Nonetheless, should there is a need to alter the hairline height during surgery, it must not be lifted excessively because a high hairline is masculinizing for women. And even in men, overzealous elevation is avoided to prevent unnatural results.
Lollipop breast lift with implants delivers two goals in one surgical setting: Correct the pendulous shape and add more volume with the use of breast implants, which are either filled with saline or silicone.
To demonstrate the results of lollipop breast lift with implants, leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat involving a patient who has had the procedure.
The patient had drooping, tubular shaped breasts prior to surgery.
The patient had severely drooping breasts in which the areolar complex, or the ring of pigmented skin around the nipple, settled beyond the breast crease, or the inframammary fold. Furthermore, her areola was disproportionately big relative to the breast mound.
“The patient needs the base of her breasts reconstructed. The base looks tubular and so we need to reshape it in order to deliver a fuller cleavage,” Dr. Smiley said in the video.
To reshape the breast and elevate its sagging tissue, Dr. Smiley performed lollipop breast lift technique in which a circular incision around the areola and a vertical line down the midline to the inframammary fold were used; hence, the resulting scar would resemble a lollipop.
The lollipop breast lift suits patients who need their areola lifted more than 2 cm, which the donut lift (i.e., only incisions around the areola’s border are used) cannot accomplish.
Meanwhile, several factors determine the ideal position of the areola, although the most critical one is the breast size. In general, its placement should promote a teardrop shape, or at least a 45:55 ratio, in which most of the volume is found in the lower breast pole.
Compared to the standard breast lift that also uses a crescent-shaped incision along the base of the breast, the lollipop lift generally results in shorter recovery and lower risk of wound dehiscence.
In standard breast lift, which is also referred to as anchor lift, the junction where the vertical and horizontal incisions meet is prone to wound dehiscence or delayed healing due to tension on the skin.
With lollipop lift, Dr. Smiley elevated the sagging tissue of the lower breast pole and reduced the areola by one-third of its previous size.
Afterwards, Dr. Smiley positioned implants beneath the muscle, which provides additional tissue coverage and support; these are particularly important in patients with a history of breast ptosis (sagging) and women with decreased skin thickness to prevent drooping recurrence, palpability, and rippling.
While the surgeon’s skill sets and qualifications will largely determine the success of liposuction—a body contouring surgery that breaks up and removes “unwanted” fat—the techniques and equipment will also have their influence.
Dr. Tarick Smiley, a leading Los Angeles plastic surgeon, has recently posted a video on Snapchat to demonstrate one of his liposuction machines imported from Germany.
Dr. Smiley says the Moller liposuction machine can perform “liposuction, lipo-filling, and infiltration all at the same time,” hence the operative time is shortened and thus may contribute to improved patient safety.
Hence, the liposuction machine is ideal for Brazilian buttock lift (BBL) in which large volumes of fat are suctioned out of the body, purified, and re-injected through a process called lipo-filling.
Nowadays, lipo-filling—also referred to as fat injection or structural fat grafting—is an established technique that can be applied to various plastic surgery procedures including BBL, three-dimensional facelift, cheek augmentation, and breast surgery (cosmetic and reconstructive).
Because BBL typically requires “aggressive” or large volume liposuction, one of the most pressing issues is the increased bleeding. During fat extraction, the cannula (straw-like device) inadvertently removes some blood.
Large blood loss can result in longer recovery, more fluid imbalance, and higher risk of complications; therefore all efforts are made to minimize the amount of bleeding. For this reason, Dr. Smiley uses another equipment called Cell Saver.
Cell Saver is a liposuction machine that can process the fluids, collect the red blood cells, and re-infuse them into the patient while the surgeon is doing liposuction. This piece of equipment is also used in hospitals to control bleeding, which is a risk when an operation takes too long (more than 6 six hours).
To further reduce the amount of bleeding, prior to liposuction Dr. Smiley infiltrates the fatty area with tumescent fluids, which are infused with several drugs that include epinephrine.
The renowned plastic surgeon says that epinephrine works by constricting the blood vessels, ultimately reducing the amount of blood loss by up to 90 percent compared to the dry liposuction, which is now a passé technique as it entails prolonged recovery and increased risk of skin asymmetry.
(Note: Dry liposuction means the fatty area is not infiltrated with tumescent fluids or any wetting solution before the fat is removed with cannula.)
Thigh lift after massive weight loss is typically beyond cosmetic improvement. A good number of patients also seek the procedure to find relief from non-healing skin irritation and tissue breakdown caused by the redundant skin rubbing each other every time they walk and move around.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that thigh lift after massive weight loss is commonly combined with tummy tuck and buttock lift. By simply extending the hip-to-hip incision of tummy tuck around the entire waistline, surgeons can reshape the outer thigh, anterior abdomen, and buttocks all at the same time.
Despite the contouring effects of the aforementioned technique (which is referred to as 360 degree lower body lift), patients with healing problems and other “risk factors” may have to stage their surgery to minimize risk of complications.
This is the typical incision pattern used in outer thigh lift surgery.
As a stand-alone procedure, the incision pattern used in thigh lift will depend on the location and the extent of redundant skin. For instance, the outer thigh requires an incision starting from the hip down to the groin and so the resulting scar lies precisely at the “panty line.”
Meanwhile, the inner or medial thigh lift requires incisions starting from the groin down to the knee and so the resulting scar is on the inner aspect of the thigh.
This is the actual scar resulting from a medial or inner thigh lift surgery.
Compared to other body contouring procedures, recovery from thigh lift is generally “tougher” because of the increased swelling due to gravity and the full weight of the legs. Hence, the first two weeks are the most critical period, requiring the patient to be extra cautious when moving.
The patient must move carefully and slowly to avoid pulling on the incisions. It is important to note that wound dehiscence (reopening) requires longer time to heal.
After two weeks, most patients can slowly increase their activity without causing an elevated heart rate. Over-exertion must be avoided for an additional 4-5 weeks to prevent more swelling and healing problems.
Most patients are advised to take 3-4 weeks off so they can focus on their recovery. Furthermore, protein supplements along with superb diet (more fresh fruits and vegetables and whole grains, while avoiding too much fats and sodium) can help patients improve their healing.
Oftentimes, thigh lift after massive weight loss is followed by other body contouring surgeries such as tummy tuck, arm lift, or back lift.
Safety in plastic surgery should be the main duty of your surgeon. Hence, you must practice due diligence when selecting your doctor, a decision that you should base on his qualifications instead of cheap cost or large discount. Remember, reputable and qualified surgeons will not join the “price war” just to lure patients.
Furthermore, any surgery that is priced way too low generally means there are some compromises. Take note that the cost not just boils down to your surgeon’s fee, but also to other expenses related to anesthesia, staff (including anesthesiologist), surgical facility, lab test, just to name a few.
Photo Credit: American Society of Plastic Surgeons website
Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares his tips on how to identify a surgeon who prioritizes safety in plastic surgery.
• The surgeon is a bona fide plastic surgeon. The general rule of thumb is to choose someone who is a member of the American Board of Plastic Surgery, giving you an assurance that he has passed rigorous background check and oral and written exam, which he must take every 10 years.
• Prudent and ethical plastic surgeons carefully select their staff. Furthermore, they only employ a certified anesthesiologist whose job is not just to administer anesthesia (and thus results in a pain-free procedure), but to also observe the patient’s vital signs such as blood pressure, oxygen level, and heart rate during surgery.
• They only perform surgeries in an accredited ambulatory facility. This means that the “surgical setting” has passed rigorous inspections conducted by several certifying agencies (or health authorities). All board certified plastic surgeons are mandated to operate only in an accredited surgical facility.
• Reputable surgeons know how to say no. They always require lab screening and lengthy consultation to identify if you’re healthy for the surgery and its ensuing recovery. Should you have any chronic medical condition, or have unrealistic expectations that you’re just setting yourself up for disappointment, a decent doctor will not operate on you.
• Reputable plastic surgeons exhibit good bedside manner (they listen to your input) and will make every effort to build good rapport. In doing so, their patients tend to be more honest and more cooperative and committed especially during recovery.