Renowned facelift surgeon Dr. Tarick Smiley said the surgery should not solely rely on pulling tight the tissue and removing the excess skin lest it results in a “done” or “fake” look.
In his recent Snapchat video post, he has explained how he delivers natural results from facelift, which he almost always combines with ancillary procedures (e.g., fat transfer, neck lift, eyelid surgery, etc.) to achieve a more natural, proportionate result.
In the video, the celebrity plastic surgeon has enumerated the “age-related problems” of a certain patient.
Before-and-After Photos of the Patient
- Loose neck skin
- Fullness of the neck due to the excess fat
- Fullness of the upper eyelid
- Sagging of the mid face
Dr. Smiley started off the surgery with neck liposuction in which the excess fat has been removed. He placed a tiny round incision behind each ear where a slender probe called microcannula was moved back and forth to remove a small amount of fat.
Next, he proceeded to performing SMAS facelift in which all the incisions were hidden—i.e., inside the hairline and then curved behind the tragus (the small bump in front of the ear) before reaching the back of the ear or nape area.
The incision in front of the ear was positioned at the natural skin crease and so the resulting scar is expected to be invisible once healed.
Dr. Smiley said one of the most important elements is the vector of pull. After removing the excess skin, the tissue must be pulled at a 45 degrees angle before closing the wound.
“The right vector of pull results in natural fullness of the cheek and the best neck position,” he explained.
He has warned that the tissue should not be pulled straight up due to risk of skin pleating of the lateral face, nor horizontally because of the ensuing flat cheeks and poor neck appearance.
To further achieve proportionate results, Dr. Smiley also tightened the neck platysma muscle in the midline and removed the fat underneath. The goal is to create a smoother and tighter “angle” between the neck and chin, he said.
Then, he proceeded to upper eyelid surgery in which he removed a strip of excess skin with the use of incisions made precisely at the natural skin fold for optimal scar concealment. He also tightened the deeper muscle to further eliminate the appearance of fullness and thus achieve a more youthful eye.
He also injected fat to create a smooth transition between the lower lid and cheek, further contributing to the more youthful appearance.
There are lots of terminologies thrown around as regards to facelift surgeries—weekend lift, SMAS facelift, deep plane, skin-only lift, just to name a few—which add up to the confusion. For this reason, leading Los Angeles plastic surgeon Dr. Tarick Smiley says prudent patients should ask their doctors about the specific details of their surgery.
Dr. Smiley says he prefers the SMAS facelift technique due to its long-lasting, natural rejuvenating effects. It involves tightening the layer called superficial muscular aponeurotic system, which extends from the neck to the temple area.
The SMAS layer lies beneath the facial fat and skin and so tightening it means the deeper structure receives most of the tension, which in turn promotes good scarring as the skin receives very little of the “opposing” pull.
Meanwhile, older techniques (skin only lifts) can be problematic in terms of scar appearance and longevity. Because most of the tension is placed onto the skin, scar widening and overly tight appearance (done or fake look) are the usual results.
Furthermore, the skin is susceptible to the effects of gravity and continuous aging; hence, the celebrity plastic surgeon stays away from the procedure due to its unstable, usually short-lived results.
Dr. Smiley regularly posts educational videos on his Snapchat account to demonstrate the impressive results of SMAS facelift.
One patient was particularly impressed with her results that she allowed Dr. Smiley to showcase her outcome on social media.
The 60-year-old female patient had come to Dr. Smiley because of her sagging mid face, sunken lower lid, significant jowling, laugh lines (medically referred to as nasolabial folds), and neck bands. To address these problems, the celebrity surgeon performed SMAS facelift and neck lift.
He placed the incision “inside” the hairline (around the temple area), which extended behind the tragus (small bump in front of the ear) and then curved behind the ear for optimal scar concealment.
With SMAS facelift, Dr. Smiley was able to restore the softness over the cheekbone and reposition the sagging cheek fat pad, which in turn eliminated the laugh lines. Moreover, the technique allowed him to tighten the jawline and thus erase the appearance of jowling, and to improve the neck as well.
The SMAS facelift typically entails 3-3.5 hours of operative time and a social recovery (all the outward signs of surgery are gone) of two weeks. Nonetheless, all is worth it as it can erase up to 20 years off from one face, with the results expected to last 12-15 years.
Facelift for cheek enhancement must address these following problems: hollowness below the cheekbone, sagging of the mid face, and laugh lines (nasolabial folds).
It is important to note that the cheeks can easily reveal a poorly executed facelift. With incorrect direction of pull or excessive tension, the patient can end up with flat cheeks, overly tight mid face, and/or skin pleating behind the ears where the wound is closed with sutures.
To avoid these aforementioned problems, renowned Inland Empire plastic surgery expert Dr. Tarick Smiley explains the critical components of facelift for cheek improvement:
- Going beyond skin pulling and tightening
Dr. Smiley warns that relying too much on skin pulling and tightening can lead to flatness below the cheeks that can appear immediately after surgery or years down the road. For a more stable and natural-looking result, he highlights the importance of “deeper” tissue reposition, which is only possible when the underlying structure beneath the skin (fat, tissue, and muscle) is tightened and reshaped as well.
Dr. Smiley prefers deep plane SMAS technique in which the fat, connective tissue, and muscle are all being lifted to achieve natural and long-lasting results.
The SMAS technique has also been known to prevent flatness of the cheek, sunken mid face, and other surgical stigmata, he further explains.
- Volumizers in the form of fat transfer
Fat and tissue reposition alone has no or very little effect on patients with gaunt appearance due to advancing age or inherited feature. For this reason, Dr. Smiley often incorporates fat transfer in his facelift surgeries for a more natural, three-dimensional rejuvenating effect.
Fat transfer not just corrects the hollowness below the cheekbone; it can also create a smooth transition between the lower lid and cheek, and soften the laugh lines.
Facelift at 70 can provide impressive rejuvenating effects with proper patient selection. But since at this age sagging skin is not the only problem—most patients also have turkey wattle neck appearance and loss of facial volume or fat—simultaneous procedures such as neck lift, fat transfer, and eyelid surgery are generally warranted to achieve more natural, balanced results.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says one of the most common misconceptions is that the patient’s chronological age has a large influence on one’s candidacy.
In his recent Snapchat video post, the celebrity plastic surgeon has shown a 70-year-old female patient who had facelift and neck lift about six months ago; she came to his office for a follow-up visit.
The patient shown in the video has expressed her satisfaction with the result. When viewed from the side, there is now a smooth angle between her chin and neck, as Dr. Smiley had incorporated her facelift with a highly individualized neck lift.
The patient’s postop appearance is a significant improvement from her “before” photos when the sagging skin along her jowl made her chin almost “disappear” from the neck, said Dr. Smiley.
Dr. Smiley had also tightened her platysma neck muscle in the midline using sutures. He was able to access this anatomical layer by creating a hidden incision precisely made at the chin’s natural skin crease for optimal scar concealment.
To further achieve a smooth transition between the neck and chin, he had also removed the fat pad beneath the platysma muscle.
While facelift at 70 can provide impressive results, health remains the most important issue since aging comes with increased risk of diabetes and other age-related conditions. For this reason, Dr. Smiley are extra strict when dealing with patients over the age of 65—i.e., he requires them to present medical clearance and to undergo comprehensive physical evaluation to ensure that they can handle the surgery.
To further ensure the safety of facelift at 70, aspirin, non-steroidal anti-inflammatory drugs, and supplements with blood thinning properties are discontinued 2-3 weeks before surgery and a week afterward, said Dr. Smiley.
Fat transfer to face is no longer considered as an afterthought but rather an integral part of facial rejuvenation surgery. In fact, this has become a common complementary procedure for facelift whose primary function is to tighten the loose soft tissue and remove the excess skin, but not to address volume loss.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted an educational video on his Snapchat to demonstrate the rejuvenating effects of fat transfer to face, particularly in smoothing out the laugh lines (nasolabial folds which run between the nose and the corners of the mouth) and correcting the abrupt transition between the lower eyelid and the cheek.
The female patient shown in the video manifested early signs of facial aging: volume loss, which is medically referred to as soft tissue atrophy (shrinkage). The celebrity plastic surgeon decided fat transfer to face as a stand-alone procedure because she had no other “aesthetic concerns” such as loose skin, sagging mid face, jowl, neck bands, and droopy eyelids.
Dr. Smiley started the whole procedure by collecting some unwanted fats from the abdominal area, which were then processed with the use of centrifuge, a machine for separating biomaterials based on weight.
In the video, Dr. Smiley is seen holding a clear tube to show how separation is done based on weight. The oil is the lightest “material” so it floats above the processed fluid; it must be discarded before re-injecting the healthiest, purest fat cells to achieve near permanent results, he said.
At the other end of the spectrum, the blood cells, which are the heaviest biomaterial, were also discarded. The middle part of the processed fluid, meanwhile, contains the healthiest fat cells and some stem cells, he further explained.
Stem cells are unique because they are “unspecialized” and so they can turn into other types of cells. Furthermore, they can divide and renew themselves for long period; hence, combining them with fat cells help the latter survive in their new location. For this reason, the results of fat transfer are expected to last 12-15 years with proper handling and processing of fats, said Dr. Smiley.
Moreover, Dr. Smiley used a blunt-tipped needle during the injection process to ensure minimal bruising and ultimately shorter “social” downtime.
He used the “processed” fat to create a nicer transition between the lower eyelid and cheek and to eliminate the nasolabial folds appearance.
The patient also asked for fat transfer to her hands to achieve a more youthful, plumper appearance.
The truth is, the most difficult part of recovery from facelift surgery is not actually the pain, which is fairly manageable, but the social downtime.
It is important to note that social recovery from facelift varies significantly from patient to patient due to factors such as individual healing, predisposition to bruising and swelling, type of surgery and use of ancillary procedures, and quality of postop care.
Inland Empire plastic surgery expert Dr. Tarick Smiley explains some of the most pertinent issues involving social recovery from facelift.
- Advance planning is critical
Patients who are planning for a big social event (e.g., wedding) are generally advised to have their surgery performed 1-2 months earlier just to be on the safe side. But for individuals who do not mind being seen with some mild “outward symptoms”, which can be easily hidden by camouflage make-up, a 1-2 week social recovery will generally suffice.
Some patients are able to return work (only desk job) after a week or so after surgery, although most will need at least two weeks before they look “presentable.”
After 1-2 weeks postop, most patients can use camouflage make-up to hide the bruising and swelling and some discoloration around the edge of the incision that remains on the face and/or neck.
- Winter might be a good way to schedule one’s surgery
The bulkier ensembles worn in cold weather (e.g., turtle neck tops and scarves) can make it easier to hide the outward signs of facelift. Furthermore, winter coincides with longer holiday season (Christmas and New Year), allowing the patient to have a longer time off.
- Avoid strenuous activities for a minimum of three weeks
While most patients already look presentable in 1-2 weeks postop, it remains important to avoid rigorous activities and heavy lifting for a minimum of three weeks because increase in blood pressure and heart rate can aggravate the swelling and bruising, which of course leads to longer social recovery from facelift.
- Control risk factors linked to increased swelling and bruising
Smoking, aspirin, hypertension (or any other types of medical condition linked to higher risk of bleeding), and strenuous activities before complete healing can lead to increased swelling and bruising and thus longer social recovery.
Meanwhile, head elevation, superb diet (low sodium, high protein, and more fresh fruits and vegetables), good hydration, and light activities (walking instead of bed rest) can help promote healing.