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.
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.