Abdomen liposuction on female patients is quite different than that of men due to gender-based beauty ideals and anatomies, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Men’s athletic abs have square-shaped ridges that are closely packed together, whereas in women’s there is often a pair of “soft” vertical indentations flanking the navel.
Also, women with athletic physique often have prominent anterior hipbone due to their low body fat percentage.
Dr. Smiley performs pre-operative marking to ensure natural and symmetric contours.
Recently, Dr. Smiley has performed abdomen liposuction on a female patient who specifically requested for a more athletic physique. She also had a concurrent Brazilian buttock lift in which the unwanted fats were injected into her buttocks and hips.
Dr. Smiley performed pre-operative marking while the patient was in a standing position; this would allow him to deliver symmetric results, “highlight” certain features, and ultimately create a more athletic but nonetheless feminine physique.
During the pre-operative marking, Dr. Smiley explained to the patient their surgical plans: create a soft parallel indentation on each side of the abdomen through high-definition liposuction, and to make the anterior hipbone slightly visible.
Her liposuction also included the lower back, flanks, bra rolls, and upper arm. Because she asked for a simultaneous Brazilian buttock lift, multiple donor sites were necessary to collect sufficient volume of fat.
During the actual surgery, which has been shown on Dr. Smiley’s Snapchat, he used microcannula, a stainless steel tube with blunt tip dotted with several small holes to suction the unwanted fat.
Dr. Smiley moved the microcannula parallel to the skin in a fan-like, back and forth motion to remove fats uniformly, which is the key to ensure smooth skin and natural contours.
After collecting large volume of unwanted fat, Dr. Smiley purified it—i.e., he removed the anesthetic solution, red blood cells, oil, and other biomaterials—before injecting it into the patient’s hips and buttocks.
Aside from improving the patient’s waist-to-hip ratio, which is the hallmark of feminine physique, Dr. Smiley was also able to improve the indentations in the buttocks.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted saline breast implants before and after photos on Snapchat to demonstrate their effects in terms of breast contour, perkiness, and symmetry.
Breast implants come into two types based on filler material: saline and silicone gel.
Most breast augmentations today are performed with silicone gel implants because of their more natural feel and contour compared with saline implants.
Saline implants, meanwhile, may cause feeling of firmness and/or rippling due to their filler material—i.e., saltwater solution. This is more pronounced when the patient lacks breast tissue or has low body fat percentage.
But since the patient shown in the photos has average-sized breasts, her saline implants are less likely to cause rippling and palpability.
To further minimize the aforementioned risks, Dr. Smiley created the implant pocket beneath the pec muscle, which provided additional soft tissue coverage. This implant placement has almost become the default mode when he uses saline implants; nonetheless, this remains beneficial even in patients having silicone implants.
In reality, the under-the-muscle implant placement, or submuscular technique, covers the upper half of the implant with muscle, while the bottom part is supported only by breast tissue and skin. This fosters a more teardrop breast contour due to the muscles pushing down the top of the implant.
Dr. Smiley says the upper pole fullness should have at least 30 percent of the breast volume; nonetheless, the exact volume distribution will depend on the patient’s specific goals. For instance, others may want the 45:55 ratio, which is believed to be the most natural or “classic” look.
During surgery, the patient’s saline implants were filled with 450 cc of sterile saltwater solution. These implants always come with a tube, which has a self-sealing mechanism when pulled out from the implant shell.
Since saline implants are rolled up like a cigar and propelled empty into the breast pocket they require a slightly shorter incision than silicone implants, which always come prefilled. Nonetheless, this aspect should not be the main reason for choosing one over the other.
Dr. Smiley says silicone implants remain more popular than saline implants due to the former’s more natural look and feel thanks to their cohesive filler material, which is less likely to cause rippling. Implant ripples are believed to compromise the device’s long-term stability.
The term Brazilian buttock lift or BBL is a misnomer because it is mainly designed to increase the backside’s volume—and ultimately its shape and proportion—with fat grafting or injection. Simply put, it is not for someone with a significant amount of sagginess unless a simultaneous excision-based surgery is performed as well.
Most patients will need at least 800 cc of fat to see a noticeable improvement in the shape and volume of their buttocks and hips. Hence, BBL typically requires large volume liposuction, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Actual results from Dr. Smiley’s meticulous BBL surgery.
Meanwhile, sagging buttocks—i.e., they droop over the lower butt fold—are often caused by massive weight loss. The only way to improve their appearance is to remove the redundant skin, typically made above the buttocks, specifically at the junction with the lower back.
Oftentimes, an elliptical shaped excess skin and fat is removed from the upper buttock before the remaining skin is sutured back together. The resulting scar lies across the uppermost aspect of the buttocks and is hidden along the bikini line to allow the patient wear a bikini bathing suit without having to worry about visible surgical stigmata.
Weight loss-induced sagging buttocks may also appear flat; hence, it is not uncommon to combine excision-based butt lift with BBL. Depending on the extent of surgery, they are sometimes performed separately to minimize risk of complications and to promote high survival rate of fat grafts.
However, a BBL alone approach will often suffice if the patient only has mild sagging. Just like breast augmentation via implant, adding volume into the flat buttocks can have a mild to moderate lifting effect.
The lifting effect becomes more potent when the excess fat is removed from the lower back and V zone (between the butt cheeks), while the apex of the buttock is filled with the fat collected during liposuction.
Regardless of the skin quality, it is important to avoid over-injection particularly in the lower buttock aspect near the fold to avoid harming the fascia, which holds the skin to the muscle. Aggressive augmentation may also cause too much weight, which of course makes the buttocks more susceptible to the effects of gravity.
Most patients want to know the ideal BMI for a tummy tuck, a body contouring surgery that removes the redundant skin and fat caused by large weight loss or pregnancy.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted videos on Snapchat to explain why he doesn’t always go by BMI and other “strict number-based guidelines” but instead depend on the patient’s actual physical fitness.
Dr. Smiley has shown a female patient who had tummy tuck six months ago. Her “before” photo appeared that she had high BMI readings, prompting some followers to ask why the surgeon nonetheless considered her a good candidate for the surgery.
Dr. Smiley said that BMI is supposed to estimate the amount of body fat based on a person’s weight in relation to her height. BMI readings below 18.5 suggest that one is underweight, while the 18.5-24.9 range is considered normal, and the 30 or higher is qualified as overweight and obese.
However, the celebrity plastic surgeon has argued that “BMI is sometimes misleading” because it does not take into consideration that different types of fat have varying metabolic effects on health. For instance, the visceral fat that develops around liver and other abdominal organs has a more deleterious effect than the superficial fat that sits beneath the skin.
“The patient had lots and lots of excess skin and fat over the muscle, thus we were able to remove it. In fact, she shed around 35 lbs. right after surgery due to the significant amount of hanging skin,” said Dr. Smiley on Snapchat.
The surgeon added that BMI should only be seen as one of the possible criteria when determining each patient’s candidacy for tummy tuck or other forms of body contouring surgery.
“Instead of relying solely on BMI readings, we require patients to send their current photos or, better yet, be examined,” said Dr. Smiley.
Male chest reduction surgery is not just about removing the excess tissue and fat that are causing the appearance of “man boobs.” Other equally important goals include creating high level of symmetry between the two sides, ensuring smooth and natural contour, and avoiding surgical stigmata such as surface irregularities and visible scars.
Prominent Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted male chest reduction before and after photos on Snapchat to demonstrate what the surgery can [realistically] accomplish.
Dr. Smiley combined liposuction and direct excision technique to achieve a more masculine physique. This “combo” surgery has allowed him to extract up to 2 liters of fat and copious amounts of glandular [breast] tissue.
He first performed liposuction to remove the excess fat through a small cannula (hollowed tube) that could fit into a puncture hole placed right at the lower border of the areola for optimal scar concealment.
When doing liposuction, Dr. Smiley said he preferred the tumescent technique in which large volume of fluids that contain saline, lidocaine (local anesthesia), and epinephrine (to constrict the blood vessels and thus limit the amount of bleeding) are injected into the treatment site.
With liposuction, he was able to remove around 1 liter of unwanted fat on each side.
Next, Dr. Smiley created an incision still right at the lower border of the areola so the scar would remain hidden. The idea, he said, was to remove the excess glandular tissue.
“The white glandular tissue is extremely fibrous and so it will not come out with liposuction alone. Most patients really need an excision-based technique to achieve a nicer and flatter chest,” Dr. Smiley said on Snapchat.
Before closing the incisions, the surgeon examined both sides to ensure that high level of symmetry has been achieved and possibly to address any contour irregularities while the patient was still on the operating table.
He then closed the incisions with multiple rows of tiny sutures without picking up the skin whose edges were instead held together by surgical tape. With this suturing technique, the skin received no or very little tension, which is the key to favorable scar.