BBL surgery, also referred to as Brazilian butt lift or buttock augmentation via fat injection, can serve as a permanent solution for improving the appearance of flat buttocks and hips. However, it is a rather complex procedure because it entails different processes that must be done meticulously to achieve great results.
BBL surgery always starts with liposuction to collect donor fats from multiple sites. Renowned Orange County plastic surgery expert Dr. Tarick Smiley said he almost always treats the lower back and flank as donor sites because treating the adjacent areas of the buttocks can further improve their shape and projection.
Before and After Photos of a Patient Who Asked for a Conservative Fat Volume for Natural Results
In his recent Snapchat posts, the celebrity plastic surgeon said that liposuction should not be done too aggressively—i.e., remove too much fat in the donor area—due to risk of skin irregularities. The general rule of thumb to achieve smooth results is to predict how much skin shrinkage will occur, he added.
Moreover, the skin in the buttocks “should also be respected,” he warned, and thus “over-injection of fats” can lead to sagging appearance and unnatural results.
“It is important to preserve the strength of the fascia system. This thread-like anatomy holds the skin and determines the final shape of the buttocks. However, too much fat volume can weaken them, resulting in buttock sagging,” said Dr. Smiley.
He cited Kim Kardashian and Nikki Minaj’s “backside” as a poorly done BBL surgery because their buttocks look hugely disproportionate to their body. Furthermore, he mentioned the lack of smooth transition between the posterior thigh and the buttock.
“My strict rule is to create a nice transition between the thigh and the buttock. We don’t want a buttock in which the leg appears hanging from it, just like in the case of Nikki Minaj,” he said.
To avoid over injection of fat graft, Dr. Smiley said he always takes into account the patient’s body frame and her skin elasticity as well.
“Too much fat injection or too much weight can stretch out the skin and affect the stability of the fascia system that holds the buttocks shape. This is the key to achieve natural-looking, long-lasting results from BBL surgery,” said Dr. Smiley.
The use of breast implants on skinny women has certain challenges that stem from the lack of soft tissue coverage, making them susceptible to rippling, increased palpability, and less natural breast shape that is often described as too “globular.”
However, there are several ways to compensate for the lack of soft tissue coverage, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
The celebrity plastic surgeon has explained all the things to avoid when breast augmentation involves patients who are naturally thin or have little soft tissue coverage.
Saline implants are filled with sterile saltwater solution once propelled and positioned into their pockets. While women with sufficient soft tissue coverage (they’re wearing B cup bras at the very least) can achieve good results from them, patients with a skinny frame may end up with visible implant edges or a breast shape that is too globular.
Meanwhile, silicone implants are suitable for women who have little soft tissue coverage or low body fat percentage because their filler material closely resembles the breast fat and tissue.
- Avoid over the muscle position (subglandular)
Placing the implants over the muscle that the only thing supporting their weight is the tissue and skin can spell disaster for thin patients. Using saline implants can further aggravate the risk of rippling and palpability.
Under the muscle position, meanwhile, favors breast implants on skinny patients because this strong anatomical layer not just gives additional coverage but also more support that prevents bottoming out or any other type of inadvertent implant displacement.
- Avoid low profile implants
Low profile implants have a wider base dimension that could occupy too much horizontal space when used by thin patients. For this reason, they may end up with unusually flatter and “bubble-shaped” breasts that give them a heavy top look.
In general, thin patients are suitable for moderate profile implants especially if they want just the right amount of lateral bulge and mid cleavage; or high profile implants if they like a fuller upper breast pole (because it offers the most forward projection and has a relatively narrow base, which is the complete opposite of low profile).
To prevent unnatural breast contour and other surgical stigmata, a good rule of thumb is to use implants whose dimension is within the chest and breast measurement.
- Avoid hugely disproportionate implants
Arguably, this is the most influential factor. When implants are too large for the underlying anatomies, they will cause overstretching of the breast tissue and skin, which of course can spell disaster.
Small-framed women who want to achieve natural-looking results are generally advised to stick to 300-400 cc breast implant size range.
Controlling the amount of plastic surgery bleeding is one of the most critical steps to reduce risk of complications. Aside from the surgeon’s skills and techniques, patient cooperation will also play a crucial role in preventing increased bleeding.
Reducing plastic surgery bleeding is particularly critical in mommy makeover surgeries, body lift after weight loss, and other combo procedures that typically take more than four hours to complete.
Most patients are instructed to avoid or at least cut down on blood thinners for 2-3 weeks prior to surgery. Products with blood thinning properties include aspirin, ibuprofen (and other non-steroidal anti-inflammatory drugs), and anticoagulants (Warfarin). Certain herbal supplements and vitamins such as ginkgo biloba, ginseng, green tea, kava kava, garlic, and vitamin E (in high dose) also have similar effects.
Because the effects of many herbal supplements and remedies are still unknown, discontinuing them at least two weeks before surgery and about a week afterward remains the best course of action.
Smoking can also result in poor healing and increased risk of infection and skin necrosis; hence, all tobacco products are discontinued for a minimum of three weeks prior to surgery.
When doing tummy tuck and mommy makeover surgery, Orange County plastic surgery expert Dr. Tarick Smiley injects epinephrine drug into the surgical site before making incisions. This constricts the blood vessels and so the amount of bleeding is drastically reduced.
To further control the amount of plastic surgery bleeding, the celebrity surgeon uses electrocautery device, which cuts and seals off small blood vessels. This technique not only reduces the amount of bleeding, but also ensures that postop bruising is minimal.
The “before and after” surgery instructions are almost the same: The patient must avoid products with blood thinning properties for 1-2 weeks postop or at least until most of the bruising and swelling have subsided.
Furthermore, the patient must avoid heavy lifting, too much stress (that’s why working part time or telecommuting is preferable in the meantime), and rigorous activities for three to six weeks, depending on the type and extent of surgery.
It is important to note that rushing one’s recovery not just increases the risk of bleeding, but also leads to persistent swelling and bruising, which of course will result in protracted healing.
However, light exercise such as walking (as long as the activity will not result in increased blood pressure and heart rate) is important during the initial healing stage to promote healing. Prolonged bed rest or immobility, meanwhile, must be avoided because of the increased risk of deep vein thrombosis (blood clots), pulmonary embolism, and persistent swelling.
The ideal arm lift techniques will differ from patient to patient, although there are generally agreed upon guidelines known to provide smoother, more natural-looking results. For instance, some doctors almost always incorporate simultaneous liposuction to further contour the upper arm and possibly the armpit area as well.
In essence, arm lift surgery removes the excess skin with an incision that is limited to the armpit fold, or an inner arm scar that extends down to the elbow; the latter is reserved for massive weight loss patients due to the large amounts of their redundant skin.
But to further achieve smoother results, there is also a need to reshape the underlying supportive tissue with internal sutures. This additional step also allows the surgeon to eliminate most of the tension on the skin, thus allowing the scars to heal and fade better.
It is critical to remove most of the superficial tension, which is achieved with proper wound closure techniques, to prevent the scars from spreading and migrating, as suggested by Orange County plastic surgery experts.
A good number of patients also require simultaneous liposuction to further improve their arm contour.
Arm liposuction in general must involve most of its circumference to achieve a smoother, more feminine contour (this is almost an exclusive procedure for women). Nonetheless, there should remain a thin layer of superficial fat (beneath the skin) to prevent deformities and skin irregularities.
Aside from improving the arm circumference, simultaneous liposuction can also improve the appearance of fat pads in front and/or back of the armpit. This “unwanted” fat rolls become prominent with age or after significant weight loss.
It is almost always advisable to use microcannulas, which are narrow flexible tubes that remove the “unwanted” fats, instead of larger cannulas.
Microcannulas provide smoother results because they allow for more accurate fat removal, i.e., they remove fats in smaller bits. Furthermore, they require smaller round incisions (1-1.5 mm) that almost always disappear quickly in light-skinned patients.
It is also critical to move the microcannulas precisely parallel to the skin and in a rather swift manner to prevent removing too much fats and thus leading to “Swiss cheese” skin irregularities.
The right arm lift techniques and the use of ancillary procedures can provide long lasting results provided that the patient maintains a healthy, stable weight.
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.