Tummy tuck with Exparel results in less pain and discomfort during the initial stage of recovery. Exparel is a long-acting local anesthetic (Marcaine) that is injected into the abdominal muscle right before closing the incisions with sutures.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, says Exparel can numb the treated area for up to four days, allowing his patients to rely less on postoperative narcotics that may cause vomiting, lethargy, nausea, and constipation.
This drug is injected into the abdominal wall, numbing the surgical site for up to four days.
Exparel is also more convenient than using pain pumps, which are external devices (resembling a small balloon) that slowly release numbing medications into the surgical site.
It makes sense to control the postoperative pain as studies have suggested that when patients feel less pain, they breathe and move easier, which is the key to quicker recovery. Nonetheless, they should remain cautious about their postoperative activities to prevent tear sutures and wound breakdown.
The general rule of thumb is to avoid rigorous exercise and heavy lifting for three weeks. After this period, most patients may gradually increase the intensity of their activities provided they do not experience pain or discomfort, and their surgeons give their go signal.
Exparel can also help control postoperative pain after breast enhancement surgery. It can be injected into the surrounding soft tissue or muscle layer or simply released into the implant pocket.
The only downside to the use of tummy tuck with Exparel is the additional cost, although most patients wouldn’t mind it as long as they have a comfortable recovery.
Restylane for lip augmentation is a non-invasive way to improve the shape and fullness of the lips. In the hands of good injectors who have profound understanding of the beauty tenets and facial proportions, the technique can provide natural-looking results.
Dr. Tarick Smiley, one of the eminent Los Angeles plastic surgeons, has demonstrated how Restylane for lip augmentation can provide symmetric and natural-looking results, which were recently posted on his Snapchat.
The gold-colored vibrating device tricks the brain into thinking that the sensation comes from vibration, as opposed to the prick of a needle.
Restylane, Dr. Smiley said, is formulated with hyaluronic acid, a naturally occurring substance that gives the skin its “youthful plumpness and glow.” Aside from enhancing the lips, this type of FDA-approved filler or “volumizer” also works in age-induced facial lines and hollowness of the face.
While Restylane is a biocompatible filler and thus the risk of rejection is almost zero, it comes with a caveat: The body breaks it down gradually and so results only last 4-6 months, although when used as a lip augmentation the effects may be slightly shorter because the lips are always moving.
Less mobile areas such as the nasolabial folds or laugh lines tend to break down Restylane slower and so the results can last up to six months.
Because Dr. Smiley’s utmost priority was to create natural-looking results from Restylane, he first injected the lips border to improve their contour before giving them additional volume.
To further ensure natural results and avoid the “dreaded duck lips,” he made sure that the lower lip would appear bigger than the upper lip. One of the most common traps is making their size the same, or worse, the upper lip appears hugely disproportionate, a “look” which does not occur naturally.
Dr. Smiley said that respecting the pre-existing contours of the lips is the key to achieve natural results.
During lip augmentation, Dr. Smiley also used a vibrating device he placed adjacent to the injection site to “trick the brain so it would not feel the prick of the needle and instead focus on the vibration,” thus ultimately reducing patient discomfort.
His technique is backed by science. According to a recent study, the use of vibration device during lip augmentation provides analgesic effects, with 92 percent of patients saying they experienced significantly less pain with the addition of vibration.
Hump reduction rhinoplasty is a nose-reshaping surgery that corrects the excessive fullness along the bridge whose upper third is made up of bone while the remaining two-thirds is composed of cartilage (firm but slightly flexible tissue).
While the surgery may seem like a straightforward procedure, the truth is that it goes beyond rasping the excess bone and trimming some cartilage.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, shares the core principles of hump reduction rhinoplasty that allow him to deliver natural and permanent results.
- The deep radix must be addressed.
Occasionally, the fullness of the bridge is exacerbated by the deep radix, which is the root or origin of the nose from the forehead. Hence, some patients require this area to be filled in with soft tissue graft or cartilage to create smoother transition and balanced results.
Removing the excess cartilage does eliminate the hump, although this alone may result in open roof deformity, which is a visible gap. To prevent this surgical stigmata, a chisel-like device is used to cut the bone, allowing it to be narrowed and repositioned later on.
- Identify the most ideal amount of reduction.
Several variables determine how much reduction can provide the most natural and “stable” results; these include the nasal skin (particularly its shrinkage), facial features, gender, ethnicity, and even body frame (i.e., a bigger nose looks generally attractive in tall muscular men).
Over-aggressive reduction, especially in men, can result in unnatural appearance, disproportionately small nose (in relation to the face), and increased risk of nasal collapse and deformity.
- Closed rhinoplasty offers a unique advantage.
There are two basic methods to perform rhinoplasty: closed and open. The closed technique refers to placing all the incisions along the inner lining of the nostrils, while the open technique includes cutting the columella (wall of tissue between the nostrils) so the “roof” of the nose can be lifted, thereby giving more visibility during surgery.
While the open technique provides improved visibility, Dr. Smiley said closed rhinoplasty paves way for more predictable results.
“Because the columella and the roof of the nose remain intact during closed rhinoplasty, we see the outside appearance as we change the underlying framework step-by-step,” Dr. Smiley said in his previous Snapchat post.
Hump reduction rhinoplasty entails trimming the excess cartilage that is responsible for the “fullness.” But instead of throwing this away, in many circumstances it can be reshaped and later on used to reinforce the new contour of the nose, especially its tip, giving it a more refined appearance.
Upper arm liposuction can result in a leaner, more contoured appearance when performed on the “right” candidate. Nonetheless, it entails profound understanding of aesthetically pleasing arm and its anatomy as well.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, explains the challenges of upper arm liposuction, which must be recognized beforehand to deliver feminine and aesthetically pleasing arms. (Note: The procedure is almost an exclusive procedure for female patients.)
Dr. Smiley places the incision in the elbow to access the heavy fat deposit that causes the posterior surface of the upper arm to sag.
- Identifying the ideal candidates.
Not everyone with “thick” upper arms is a good candidate for the surgery. As with any body contouring, it is only reserved for healthy, normal weight patients with realistic goals and expectations.
The quality of skin is another critical factor that identifies good candidates. During physical evaluation, the patient is asked to extend her arms horizontally or with the elbows bent to determine the location of fat deposits and the degree of tissue laxity. If the “sag” is less than or equal to the thickness of the subcutaneous tissue layer (the layer beneath the skin’s dermis and epidermis), satisfactory results are most likely achieved.
Skin shrinkage can also be assessed by asking the patient to contract her triceps and biceps simultaneously. In general, younger people who have not experienced large weight fluctuations and do not have sun-damaged skin are good candidates for upper arm liposuction.
Meanwhile, patients with too much fat in the anterior surface of the upper arm are often considered poor candidates since this fat distribution is linked to obesity. Also, individuals with significant skin laxity cannot achieve good results from liposuction unless combined with standard arm lift (brachioplasty).
- Understanding the quintessential elements of an attractive feminine arm.
While most people agree that the aesthetic arm has an overall lean appearance, there must remain minimal convexity of the posterior (between the arm and elbow) and the anterior surface as well. Hence, Dr. Smiley says that over-liposuction must be avoided to prevent unnatural contour or too muscular appearance.
The superficial fat layer of the upper arm is circumferential and therefore smooth results are generally achieved when most of the circumference or at least 75 percent of its surface is treated by liposuction cannula. Nonetheless, the medial or inner aspect of the arm is prone to sag due to its thin skin and thus it requires less aggressive removal compared to the posterior surface.
Due to the circumferential distribution of superficial fat, most patients need incisions both in their armpit and elbow, which are notably small and thus expected to fade into the background. In general, the scars are barely visible after 6-18 months.
In nipple incision breast augmentation technique, the surgeon places a small scar right at the border of the areola, which is the heavily pigmented skin. When the scars heal nicely, which is often the case, they are almost invisible even to the patients themselves.
(Note: The nipple incision breast augmentation is just another term for the peri-areolar technique.)
For Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, the incision technique offers unique benefits, although as with any method it requires meticulous examination of the patient’s underlying anatomies to reap its full benefits and reduce the risk of complications as well.
The celebrity plastic surgeon regularly demonstrates the nipple incision breast augmentation on his Snapchat account to shed light on its benefits, the challenges or caveats, and the corresponding methods to offset them.
The U-shaped scar will almost always blend in with the surrounding skin. This is particularly true when it is precisely made at the areola’s border and the wound closure technique ensures no or very little tension on the skin.
Meanwhile, patients whose areola is distinctly darker than the surrounding skin are at an advantage.
- The areola complex can be slightly elevated
Some patients with mild breast sagging can benefit from a modified form of nipple incision breast augmentation in which the faint scar is positioned along the upper border of the areola. With this technique, Dr. Smiley can remove a small piece of skin above the areola to slightly elevate it.
- The enlarged areola can be corrected
To achieve a more proportionate result, some patients ask for simultaneous areola reduction in which a cookie-cutter device creates an “imprint” to guide the surgeon.
- More options in terms of breast implant placement
The nipple incision breast augmentation allows the surgeon to place the implants over or under the muscle.
- The incision technique gives the surgeon more control over the final result
Because the surgeon works in close proximity to the breast (which is not the case of “through the navel” or “through the armpit” incision technique), it gives him a great deal of control. And for this same reason, the technique favors women with some type of asymmetry or less than optimal breast shape.