Breast augmentation final shape will depend on several factors including the implant (particularly its shape, size, and profile), the patient’s underlying anatomies, and the surgeon’s skills.
In a recent Snapchat post, celebrity Los Angeles plastic surgery expert Dr. Tarick Smiley has explained his nine-point system to deliver great breast augmentation final shape that conforms to the [universal] beauty ideals.
1. Symmetry of the nipple area. The right and left areolas should lie almost on the same horizontal plane to achieve natural-looking results. To achieve this, precise pocket dissection is of critical importance.
2. Symmetry of the upper breast pole, especially in terms of fullness and projection. Some patients want a less rounded appearance, while others want a more prominent look. For this reason, there should be an honest discussion between the surgeons and the patients to produce satisfying results.
3. The upper breast pole should account for about 30 percent of the total fullness or volume. However, the personal preference of the patient will still play a critical role.
4. Symmetry of the lower breast pole, especially in terms of fullness and projection.
5. The lower breast pole should account for about 70 percent of the total fullness or volume. More than this amount and the patient could run the risk of having her breasts appear saggy.
6. The bottom edge of the areolar complex is about 2 cm above the breast fold. It is important to note that the nipple area serves as the delineating mark between the upper and lower breast poles.
7. The lateral bulge should account for just about 10 percent of the total breast volume. Too much and the breasts will appear too wide apart.
8. Symmetry of the cleavage. Generally, implant pocket is created between 10 o’clock and 2 o’clock to achieve cleavage that looks balanced. However, it is important to note that the preoperative breast location will still have a large effect on how much cleavage one would have after surgery.
9. There should be no visible scar and signs of implants, i.e., rippling and palpability. For this reason the celebrity plastic surgeon prefers the peri-areolar incision technique in which the scar lies precisely at the dark-light skin junction. To further achieve natural results, silicone implants favor a good number of patients, particularly those with little soft tissue coverage to begin with.
Tummy tuck and pubic lift are commonly combined to create a smooth transition between the lower abdomen and the pubic area (or mons pubis). The surgery uses a hip-to-hip incision that is positioned very low almost reaching the patient’s pubic hairline, thus her underwear conceals the resulting scar.
Celebrity Los Angeles plastic surgery expert Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate how tummy tuck and pubic lift is accomplished.
Tummy tuck and pubic lift before and after photos
In the video, the patient has a large amount of excess skin reaching her hips and a sagging mons pubis due to significant weight fluctuations in the past.
With the use of hip-to-hip incision, Dr. Smiley was able to lift the entire upper abdominal skin, allowing him to suture the loose muscle from the pubic area to the posterior of the breastbone. Instead of using a long “running” single stitch to support the underlying structure, the surgeon says he prefers creating a single stitch one at a time.
While placing individual stitches takes time, he prefers the technique due to the additional support, which could minimize the effects of inadvertent pregnancy or moderate weight gain. Nonetheless, it remains in the patients’ best interest to avoid these two “factors” that can affect the results of tummy tuck, he warns.
After tightening the abdominal muscle, the surgeon removed the excess skin to create a narrower and flatter waistline.
To further create a more balanced and tighter result, he re-anchored the mons pubis tissue to elevate it.
With tummy tuck tuck and pubic lift, it is of critical importance to position the scar lower so when it is lifted, it does not ride up or become visible “beyond” the patient’s underwear, says the celebrity plastic surgeon.
Aside from re-anchoring the mons pubis, some patients may also need liposuction or direct removal of excess fat in the mons pubis to prevent unsightly bulges or swelling in the area after surgery, he further explains.
Contrary to popular belief, liposuction does not aim to remove optimal amount of fat. In fact, it is critical to leave behind a sufficient layer to prevent skin irregularities and other surgical stigmata, says Dr. Smiley.
Thigh lift techniques come in different incision patterns based on the location and extent of the redundant skin caused by aging or massive weight loss. Oftentimes, the scars are concealed by the natural skin creases (e.g., groin or junction of butt cheek and posterior thigh) or at least by the patient’s undergarment.
Celebrity Los Angeles plastic surgery expert Dr. Tarick Smiley has explained some common thigh lift techniques and how they improve the leg contour.
The truth is, the inner thigh lift in itself comes in several variations since each patient has unique anatomies. But in general, people who need a minimal amount of correction—or to be more specific, the redundant skin is only limited to the upper third of their legs—removing a wedge of skin and fat on the inner thigh is enough to produce the desired results.
The aforementioned technique results in scars that are positioned within the groin; hence, the natural skin crease and the patient’s underwear conceal them very well.
Another common variation of the inner thigh results in a T-shaped scar. Aside from removing a wedge of excess skin around the groin area, it also involves a vertical scar to eliminate more skin from below.
It may involve using incisions located near the patient’s hipbone, which is ideal if she is also having a simultaneous tummy tuck since the scar is simply extended horizontally.
Another variation is to create diagonal incisions from the top of the leg (still within the natural skin crease of the groin) that are sometimes extended to the hips or even the upper buttock area.
Other Important Considerations:
Thigh lift techniques that use longer incisions are reserved for massive weight loss patients who are very prone to large redundant skin. For these individuals, thigh lift is just one of the critical aspects of body contouring surgery to achieve a near normal appearance.
While performing simultaneous surgeries in one operation has become a common routine nowadays, Dr. Smiley says that MWL patients often need to have them in sequence to minimize the surgical trauma and bleeding. The general rule of thumb, he explains, is to keep any elective surgery under 5-6 hours.
Because of the extent of incisions required by body contouring for MWL patients, proper wound closure is particularly critical to avoid wound healing problems. Most surgeons agree that closing the deeper tissue layers first with more tension and then minimizing the tension as they approach the surface can improve healing and result in better scars.
The truth is, every time an incision is made the body naturally forms a scar. Nevertheless, the term scarless breast augmentation surgery has become a common lingo in Los Angeles plastic surgery.
Scarless breast augmentation surgery results in scar, albeit the placement and size of the incision makes it almost impossible to detect any reminder of the procedure. Oftentimes, this “technique” refers to the trans-axillary technique, TUBA, and fat grafting.
In trans-axillary breast augmentation technique, an incision as short as 2-3 cm (if saline implants are going to be used; however, silicone implants require a slightly longer slit to fit in) is made within the natural skin crease of the armpit. This area is highly resistant to keloids, thus it favors ethnic or dark-skinned patients who are susceptible to aggressive scarring.
Contrary to popular belief, silicone implants, which are always propelled into their pockets “prefilled,” can be used in the trans-axillary technique. However, they should not be too big lest the incision needs to be lengthened, thereby defeating the purpose of a scarless breast augmentation.
TUBA technique, meanwhile, uses incisions within the inner edge of the navel where an empty saline implant is pushed toward the pocket; the use of small instruments, including an endoscope which is a lighted articulating camera, has made this method possible.
While the trans-axillary and TUBA techniques do not result in any scar on the breast skin, they are not for everyone. In general, patients with existing deformity like tuberous breasts, ptosis or sagging, and large existing cup size are poor candidates for these procedures.
If there are pre-existing deformity or sagging appearance, there is always a need for direct incisions on the breasts in order to reshape them, tighten their underlying tissue, and reposition their areolas. With proper scar placement (exactly at the areola’s border or within the submammary fold) and wound suturing techniques, most patients are nonetheless happy with their results.
Meanwhile, some patients want to augment their breasts without resorting to the use of synthetic implants. Fat grafting, which is also touted as scarless breast augmentation, might be a possible alternative provided that they have sufficient donor fats and only want a conservative result (i.e., not more than a cup size increase).
Fat grafting starts with liposuction to collect the donor fats from two or more areas (e.g., tummy, hips, back rolls, flanks, etc.). Liposuction uses a few round incisions where a flexible steel tube is moved back and forth to harvest the fatty tissue.
Due to the small size of liposuction incisions, most patients can expect that these will fade to the point that even they would find them difficult to detect.
The collected fats are then purified to get the healthiest cells, which are later re-injected into the breasts. Most surgeons aim to achieve a 60-80 percent survival rate; the grafts that remain after about three months are expected to last a lifetime.
Mommy makeover combination procedure aims to reverse the effects of pregnancy such as sagging breasts, barrel-shaped abdomen, and exercise- and diet-resistant fats. But to achieve long-lasting results, the patient should be near her ideal weight and is done having children.
While mommy makeover combination procedure performed in Los Angeles plastic surgery is highly individualized due to varying anatomies and cosmetic goals, most patients choose to combine some type of breast enhancement surgery (implants and/or lift) and tummy tuck.
The combination of breast enhancement surgery and tummy tuck makes sense: The patient will only pay for one anesthesia and surgical facility fee. Another bonus is that she will experience recovery just once.
Despite the benefits of mommy makeover combination procedure, it remains in the patient’s best interest to limit it to less than 4-6 hours to reduce the risk of complications related to bleeding, fluid imbalance, and high surgical trauma. This safety guideline applies to all elective surgeries.
While healthy young patients might be allowed to have breast enhancement, tummy tuck, and liposuction all at the same time, they might be required to have an overnight stay just to err on the side of safety.
Patients who need a great deal of work (e.g., full tummy tuck with flank liposuction and breast augmentation with lift) are generally advised to have their surgeries in sequence to avoid poor healing and increased risk of deep vein thrombosis or blood clots in legs that could travel to the lungs.
Full tummy tuck in itself is an extensive procedure that many surgeons suggest to only perform liposuction along the waistline once the patient has fully recovered from the initial surgery. However, the ideal approach and “timing” will depend on several variables such as the patient’s health, amount of surgical trauma, and operative time.
Breast lift and augmentation surgery are also routinely combined, although in some occasions it is better to perform them in sequence. This is particularly true for women with significant ptosis (droop) and/or there is a desire for larger implants.
Larger implants can lead to excessive tension on the breast lift incisions (around the areola, along the submammary fold, and vertically between the nipple and the breast crease), which ultimately affects healing. In this scenario, it is best to perform each surgery at least six months apart.
However, patients who want a conservative amount of augmentation and only require minimal lift can have combo procedure without having to worry about the increased risk of complications.