You might be surprised to hear that the benefits of tummy tuck surgery transcend cosmetic improvements. For instance, several studies have found that it can reduce appetite-inducing hormones, which could help patients sustain their weight loss.
Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained some surprising health benefits of the surgery.
After massive weight loss, patients are generally left with apron-like skin and fat hanging from their abdomen. Hence, tummy tuck typically involves a hip-to-hip incision to remove this excess soft tissue.
According to a 2013 study, tummy tuck could help sustain weight loss because it removes copious amounts of fat cells from the abdomen. Researchers have concluded that these cells affect appetite and thus after surgery patients might improve their satiety.
Other studies, meanwhile, have pointed out that sustained weight loss is more likely caused by “tangible” cosmetic improvements that may encourage people to keep a healthy weight.
- Relief from skin-related problems
Sagging skin can trap perspiration, which can lead to non-healing rash and tissue breakdown. In fact, it is not uncommon in MWL patients to use powder, cornstarch, and fabric to minimize the risk of rashes and yeast infections in their skin folds.
The trapped perspiration and moisture not only lead to skin irritations, but also to poor hygiene and foul odor.
- Increased physical activities
Some MWL patients have large redundant skin hanging from their abdomen that weighs as much as 40 lbs. Others even have difficulty moving around due to skin lesions and pain.
Removing the large redundant skin can help improve mobility, which of course is the key to sustained weight loss and physical fitness.
The large apron-like skin and fat may upset a person’s center of gravity, leading to postural problem. Hence, some tummy tuck patients who were previously obese have reported improved posture after surgery.
Tummy tuck also tightens the weak muscle with the use of internal sutures. Consequently, some patients have reported improved posture (and possibly relief from lower back pain) since the stronger abdominal muscle provides better support to the spine.
Ultherapy or facelift for facial rejuvenation? While both can rejuvenate the face by reducing skin laxity, they work quite differently and so the ideal approach will depend on the patient’s underlying anatomy, amount of correction required, and aesthetic goals.
Ultherapy is an FDA-approved non-invasive treatment that tightens not just the skin but also the deeper soft tissue. Just like facelift, it also reaches the SMAS plane (fat, tissue, and muscle) by releasing ultrasound designed to bypass the skin in order to reach the deeper layers.
Photo credit: Ultherapy website
The ultrasound triggers more collagen production, leading to tighter skin. Nowadays, it is most commonly used to tighten the jawline, peri-orbital area (around the eyes and brows), neck, and décolletage (chest region that is visible when one is wearing a low neckline dress/top).
Most patients will only need one treatment, although a few may require a touch-up to achieve their desired results. Meanwhile, this 1-1.5 hour treatment provides rejuvenating effects that last 18-24 months.
One of the selling points of Ultherapy is the little to no downtime, a far outcry from the 1-2 weeks social recovery required by facelift surgery.
But as with any non-invasive facial rejuvenation treatment, Ultherapy only suits patients who require less amount of correction and thus it is commonly performed in people 50 years and younger.
For patients who require more correction, i.e., they are usually 55 years and older, the standard facelift still provides the best and most predictable results, says renowned Orange County plastic surgery expert Dr. Tarick Smiley.
During facelift, the SMAS plane, which is beneath the skin, is elevated and tightened to create more chiseled jawline, smoother neck, and fuller cheeks/mid face. In addition, a small amount of excess skin is removed with the use of incision made behind the hairline that runs around the ear’s curvature for optimal scar concealment.
One caveat of facelift is the social recovery that often takes a week or two. Furthermore, it is only reserved for patients who are physically fit and have no healing problems.
The results of SMAS facelift, according to anecdotal reports, can last an average of 10-12 years. This is particularly true for patients with good skin elasticity and will receive touch-ups, which may be in the form of Ultherapy, fillers, medical-grade chemical peels, or a combination of them.
The “right” breast implants on a bony chest can help improve its appearance. Patients with this “anatomical feature” also typically have wide cleavage gap and little soft tissue coverage, which must be improved as well.
Dr. Tarick Smiley, one of the leading Orange County plastic surgery experts, has recently shown on his Snapchat the effects of “meticulously selected” breast implants that have had improved the bony chest appearance and visible dents of a female patient.
Dr. Smiley used a pair of slightly wider breast implants to “conceal the visible dents” along the sternum and to improve the wide gap between the breasts. Nonetheless, the implants’ base matched the horizontal measurement of the chest otherwise the patient would face a higher risk of scalloping, rippling, and malposition.
To further ensure natural-results—i.e., proportionate to the patient’s body and with no surgical stigmata—the celebrity plastic surgeon used small silicone implants (i.e., 400 cc).
The use of smaller silicone implants particularly suit the patient because of her limited breast tissue coverage and low body fat percentage. These implants were filled with a medical-grade silicone gel designed to simulate the cohesiveness of natural soft tissue.
Saline implants, meanwhile, would not suit the patient because of her little soft tissue coverage that could predispose her to higher risk of rippling and increased palpability. These implants have outer silicone shell filled with salt-water solution; hence, they may lead to firmer results and too globular breast contour when used by thin and small-breasted women.
To further ensure soft and natural contour, Dr. Smiley positioned the implant beneath the patient’s pec muscle, which provided more coverage than the over-the-muscle implant placement.
Even without fat grafting, the right implant design and volume was enough to conceal the patient’s bony indentations of her cleavage.
In general, Dr. Smiley says he reserves fat grafting for patients with “very poor upper-inner breast pole” that an implant-alone approach may not be enough to deliver satisfying results.
Fat grafting that is a part of composite breast augmentation, he says, also suits patients with certain types of deformity.
Extensive liposuction surgery often pertains to large volume fat removal, i.e., more than 5 liters of fluids (fat, blood, and wetting solution) from the patient. It may also refer to treating multiple areas of the body under one surgical setting.
Dr. Tarick Smiley, a prominent Orange County plastic surgery expert, has recently posted a series of videos on Snapchat to demonstrate one case of extensive liposuction involving the anterior abdomen, flanks, lower back, “bra rolls,” upper arms, inner thigh, and “double chin.”
One of the challenges of extensive liposuction is the increased risk of fluid imbalance, although Dr. Smiley says that certain steps can prevent or at least reduce the complication rate.
- Meticulous patient selection
The ideal candidate should have no chronic medical condition that may increase the risk of complications. Hence, all Dr. Smiley’s patients are required to pass lab screening prior to surgery,
- Accredited surgical facility
Accredited surgical facilities adhere to strict patient safety protocol and are staffed by licensed and well-trained medical professionals.
- Well-trained anesthesiologist
A well-trained board-certified anesthesiologist accompanies Dr. Smiley in every surgery to further ensure patient safety. It should be noted that the anesthesiologist’s tasks not just include administering anesthesia; he also monitors vital signs such as blood pressure, oxygen level, and heart rate during surgery.
Furthermore, the “ideal” anesthesiologist is properly trained in the infusion and removal of large volume of fluids, allowing him to identify the risks and keep these well under control.
While this equipment is more commonly used in hospitals during prolonged surgeries, in large volume liposuction this can also be helpful in controlling blood loss. It works by filtering out the red blood cells, which are inadvertently collected during liposuction, and infusing it back to the patient.
By almost eliminating blood loss, Cell Saver is known to promote patient safety and lead to shorter downtime.
- Tumescent liposuction technique
Despite the proliferation of new liposuction technologies (e.g., laser and ultrasound), the standard technique provides the most predictable results. This involves infiltrating the fatty area with tumescent solution, which is a concoction of saline (sterile saltwater), lidocaine (local anesthesia), and epinephrine.
Epinephrine constricts the blood vessels and thus reduces the amount of blood loss and surgical trauma.
While fat injections or dermal fillers can serve as an alternative to lower eyelid surgery, not all patients with under eye-bags can benefit from them.
The appearance of under eye-bag or “shadowing” is caused by different or even a combination of factors. Excess skin, herniated deep fat, loss or “shrinkage” of superficial fat (beneath the skin), or a combination of these variables may contribute to this aesthetic issue.
Before and after photos of a patient who have had fat transfer in her lower eyelid.
Basically, a “true” or standard lower eyelid surgery uses incision positioned very close to the lash line so the eyelashes can conceal the resulting scar. Referred to as an external incision technique, this allows the surgeon to remove excess skin and fat and possibly reshape the muscle.
However, not everyone with under eye-bags has excess skin. If the extra fat primarily causes this appearance instead, dermal filler injection (e.g., Restylane and Juvederm) can conceal the unsightly bulge.
The main purpose of dermal filler (as an alternative to lower eyelid surgery) is to make the lower lid bulge the same level as the upper cheek. This is a rather straightforward approach and does entail no or very little downtime; hence, it appeals in patients with busy schedule and cannot afford surgery and its ensuing “social recovery.”
But there is one caveat when dermal fillers are used to conceal the under eye-bag caused by excess fat: Touch-ups are generally needed at 6-12 months interval.
Meanwhile, fat injection or fat grafting is a method that provides longer-lasting effects than dermal fillers, with studies suggesting that its results last an average of 12-15 years. The procedure starts off with the collection of superficial fat (beneath the skin) usually in the tummy; only a few teaspoons are needed since the lower eyelid is just a small area.
The collected fat volume is then put in tubes and processed through centrifugation; the idea is to discard the oil, red blood cells, and other biomaterials except the fat cells. Afterwards, the purest form of fat is injected to conceal the bags.
It is important to note that fat injection and dermal fillers are basically volumizers (they add volume) and so they can also address the deep tear trough and the abrupt lid-cheek junction that come with aging.
It is not uncommon to combine volumizers with excision-based lower eyelid surgery to achieve the best results possible. This is particularly true for patients with excess skin, herniated deep fat, and abrupt lid-cheek transition, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
Due to the laxity of skin and other supportive structures, the deep fat along the lower lid becomes prominent (i.e., it bulges out) with aging. In contrast, the superficial fat “shrinks” and thus gives the appearance of deep tear trough or abrupt transition between the lid and cheek.
To address the aforementioned problems, a small linear incision is made within the lower lid that allows the surgeon to remove the excess skin and reduce the deep fat pad. For additional fine-tuning, fat injection is used to create a smoother lid-cheek junction.