Tummy tuck swelling comes in various degrees depending on whether the patient has received simultaneous liposuction and muscle repair. Nevertheless, most people can expect noticeable improvement in their abdominal area after 2-3 months when most of the inflammation has subsided.
Tummy tuck swelling is primarily due to the interruption of blood vessels and lymphatic channels that occurs at the time of surgery.
More and prolonged swelling is expected when muscle repair is performed, which has become an integral part of tummy tuck as it “holds” the new contour and minimizes to some extent the impact of unintended pregnancy and weight gain, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
In addition to the actual swelling in the soft tissue, the postop swelling is also caused by fluid accumulation between the abdominal wall and the skin. For this reason, some surgeons recommend lymphatic drainage massage, which involves gentle pressure techniques to eliminate the waste fluids (seroma and hematoma) from the affected area.
Some doctors allow their patients to start their lymphatic drainage massage one week postop, while others feel that waiting at least 2-3 weeks is more ideal.
Furthermore, the use of medical-grade compression garments is believed to control tummy tuck swelling. Some proponents even suggest wearing them round the clock for the first two weeks postop.
The goal of compression garments is to prevent seromas or fluid accumulations and ultimately encourage the skin to heal smoothly and evenly.
As previously stated, most of the swelling will resolve after 2-3 weeks. But if it remains persistent beyond this period, it might be caused by the unintended separation of the sutures that hold the abdominal muscle in place. To prevent this complication that warrants a revision surgery, Dr. Smiley says he prefers making “individual stitches,” as opposed to “one long running suturing” technique, when performing muscle repair.
With the use of individual permanent stitches, the risk of muscle separation is almost eliminated, explains the celebrity plastic surgeon.
Another possible cause of persistent tummy tuck swelling is the presence of fat, which can be diagnosed on physical examination. Again, this can be avoided with proper surgical execution and possibly the use of simultaneous liposuction, says Dr. Smiley.
Breast implant sizers kit is one of the most effective methods to help patients select the “right” size based on their personal preference, body frame, and chest/breast dimension. Along with good patient-doctor communications, it can further provide results that will satisfy both parties.
Breast implant sizers are cup-like devices filled with soft but solid silicone gel; they are inserted in a bra to help patients during the implant selection process.
Patients are asked to try on different sizers (based on the amount or cubic centimeter), which can be as small as 125 cc or as big as 800 cc. Anecdotal reports show that the most popular size range is 300-500 cc.
Orange County plastic surgery expert Dr. Tarick Smiley says that while breast implant sizers kit can help patients describe their goals, it does not provide 100 percent accuracy since the implant placement, implant profile or forward projection, and chest/breast dimension (which to some extent can change by weight fluctuations) also have their effects.
For instance, a 300 cc high profile implant can appear rounder and fuller than a low profile implant of the same size.
High profile implants offer the most forward projection based on their base diameter, while low profile implants have the least amount of projection, says Dr. Smiley.
When trying on different types of breast implant sizers, most patients are encouraged to bring along their favorite or usual clothing, from casual outfit to cocktail dress.
With breast implant sizers kit, the patients can assess the ideal size range that will fit their body frame, particularly in terms of their weight, height, waist-to-hip ration, chest dimension, shoulder width, and so on. For this reason, petite women who are after the natural look are often encouraged to choose smaller implants, while taller ones with broad shoulders are more suitable for bigger implants.
To further help patients during the implant selection process, some doctors offer 3D imaging technology (e.g., VECTRA), which basically takes 3D photos of the patient, loads these into the system, and allows the surgeons to “morph” the images to reflect the most possible results of a certain implant size.
However, some doctors feel that 3D imaging technology is not as helpful as breast implant sizers kit because the altered image is not really a “photo,” but more like a diagram or “avatar” of the patient’s body.
Poor neck lift results are generally caused by over-resection of skin and/or fat. Hence, the goal is not about removing optimal amounts of tissue, but more importantly, leaving behind enough to ensure that the results look natural and the scar will not spread or migrate.
Leading Orange County plastic surgery expert Dr. Tarick Smiley explains how he prevents poor neck lift results:
- Use the right incision pattern based on the underlying problems and anatomy.
In an attempt to minimize scarring, inexperienced surgeons use shorter or fewer incisions despite the presence of large amounts of hanging skin. It is important to note that for most neck lift patients with loose skin, a small incision behind the ear, specifically within the natural folds of skin, is used.
To further create a smooth and youthful angle between the chin and neck, a small incision is placed underneath the chin.
Interestingly, the use of correct incision pattern based on the underlying anatomies (even though the incisions seem long and extensive) results in favorable scars as they remain hidden within the natural skin folds.
- Over-resection of skin and fat must be avoided at all cost.
Poor neck lift results due to over-correction—i.e., removing too much skin and/or fat—is remarkably difficult to improve with a revision surgery. In fact, the patient might be advised to just wait for the skin to relax and “settle.”
However, qualified surgeons (i.e., they are board certified and are performing facelift and neck lift on a regular basis) know how to avoid the signs of over-corrected neck lift—e.g., skin asymmetries, gaunt appearance, and visible platysma muscle.
Skilled surgeons know that there should be at least 5 mm of fat beneath the skin to prevent surface irregularities and visible platysma muscle; hence, they will avoid over-aggressive liposuction.
- Tighten the weak platysma muscle.
In young people the platysma muscle is tight but with aging it becomes weak and splayed, leading to the appearance of vertical neck bands. This “cosmetic” problem can also be a result of massive weight loss.
To create a smooth, youthful angle between the chin and neck, the platysma muscle needs to be tightened in the midline with the use of internal sutures. This is possible by placing a small incision underneath the chin.
Aside from correct scar placement, proper wound closure will also play a critical role to prevent surgical stigmata. The goal is to eliminate tension on the skin to preclude the scars from migrating or “pulling.”
BBL fat transfer to hips? Is it possible?
BBL, or Brazilian butt lift, offers a unique advantage over buttock implant surgery: Aside from augmenting the patient’s “backside,” the procedure can also reshape the flat hips, resulting in a more feminine contour.
Before and after photos of patients who have had bbl fat transfer to hips.
And because BBL also incorporates liposuction—a critical step as it allows the surgeon to collect donor fats—the waistline, flanks, and lower back can be reshaped as well to further highlight the contour and projection of the patient’s “behind.”
Dr. Tarick Smiley, a celebrity Orange County plastic surgery expert, has recently posted a Snapchat video to demonstrate BBL fat transfer to hips.
The patient shown in the video had narrow hips and flat buttocks, which were further “concealed” by the fat rolls in the lower back and flanks. For this reason, the celebrity plastic surgeon performed liposuction in the said areas to create a smoother transition between the trunk and the buttocks.
Instead of throwing away the fats collected from the lower back and flanks, Dr. Smiley used them in order to augment the buttocks and “widen” the hips.
The hips received about a third of the collected fat, while the remaining was injected into the buttocks to improve their shape and projection, he says.
Aside from reshaping the flat hips to complement the improved buttock projection, fat grafts can also correct the appearance of lateral or side depressions, further creating a smoother and more natural transition between the hips and buttocks.
A growing number of surgeons these days prefer BBL to buttock implants due to its more natural results and feel and the perceived lower risk of complications since no synthetic material is used.
And with BBL, most implant-related risks can be avoided such as inadvertent displacement and protrusion.
Despite the notable benefits of BBL, its technical difficulties must be acknowledged. It is important to note that the survival rate of fat grafts varies depending on the purification and re-injection methods. Nonetheless, Dr. Smiley says that a good surgeon should at least deliver a 70 percent survivability rate.
The fat grafts must form their new blood supply; hence, during the re-injection process there must be minute spaces between them to allow blood vessel ingrowth.
Also, the patient must avoid direct pressure (i.e., prolonged sitting) for at least three weeks to prevent low survival rate of fat or inadvertent shifting of grafts, Dr. Smiley explains.
The ideal mini tummy tuck candidate only requires minimal improvement—i.e., she has a small amount of excess skin above the pubic hairline that can be surgically removed. Oftentimes, this procedure results in a 4-6 inch scar that is concealed by the patient’s underwear.
The 4-6 inch scar is significantly shorter than the hip-to-hip scar resulting from the standard tummy tuck, as suggested by celebrity Orange County plastic surgery expert Dr. Tarick Smiley.
Before-and-After Photos of a Patient Who Have Had a Mini Tummy Tuck
But due to the natural diffusion of redundant skin caused by pregnancy and weight loss, only a small subset of patients are considered as a good mini tummy tuck candidate, says Dr. Smiley, therefore the vast majority should accept the appearance of hip-to-hip scar.
Interestingly, the resulting scar from the standard tummy tuck heals and fades better than “forcing” the use of a short-scar technique in patients who need a rather extensive “work,” explains Dr. Smiley.
Using mini tummy tucks despite the presence of an apron-like hanging skin extending into the hips can lead to the appearance of dog ears or skin puckering. To correct this type of skin irregularity, the patient will need her existing scar extended.
Dr. Smiley explains the ideal mini tummy tuck candidate:
* The patient only has a small amount of excess skin that is located in her lower abdomen. Unlike the standard technique, it cannot improve the appearance of the upper abdomen.
* The patient has no belly button “deformity”—i.e., it does not look stretched or “herniated.”
* The patient does not require extensive muscle repair, which is commonly incorporated during the standard tummy tuck. This additional step can further narrow the waist by suturing together the loose pair of muscle that runs between the lower and upper abdomen.
* The patient has no healing problem or other serious medical condition.
* The patient has realistic goals and expectations.
* The patient has already ruled out pregnancy in the future.
Removing more than 2 inches of excess skin below the navel with the use of mini tummy tuck can deform its shape and lead to dog ears appearance and other skin irregularities. A good rule of thumb is to preserve at least a 4-inch distance between the belly button and the pubic hairline.