Face and neck lift with fat transfer can provide a holistic facial rejuvenation effect by correcting not just the sagging skin and deeper soft tissue, but also the volume/fat loss that comes with aging.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate face and neck lift with fat transfer performed in a female patient with advanced signs of facing aging.
Dr. Smiley has described the patient’s facial aesthetic issues, which all required a customized approach to achieve the most rejuvenating effects without causing surgical stigmata such as flatness of the cheek, visible scars, and overly pulled countenance.
- drooping of the cheek
- loss of volume in the cheek, particularly the area between the mouth corner and the nostril
- recessed and sagging chin that almost disappeared from the neck
- appearance of jowl
- “heavy” neck due to excess skin
To improve the aforementioned aesthetic issues, Dr. Smiley used an incision pattern starting from the forehead area (behind the hairline) that went behind the tragus (small bump in front of the ear) and behind the earlobe and into the hairline at the nape; hence, all the scars would be hidden.
Afterwards, the celebrity plastic surgeon separated the skin from the SMAS, a layer of soft tissue that extends from the neck to the temple area. The SMAS and the platysma muscle of the neck move as a single unit, said Dr. Smiley in a recent Snapchat video.
“When doing the lifting, we have to do the deep lift, as a skin-alone lift is not enough to support the new elevated contour, Dr. Smiley further explained.
A deep lift also provides more natural results as the skin receives no or very little tension during wound closure, thus eliminating the risk of windswept appearance, overly flat cheeks, and other telltale signs of facelift, said Dr. Smiley.
Elevating the deeper layers of the soft tissue created immediate rejuvenating effects to the patient—i.e., her jawline appeared more defined, the upper cheek regained its “youthful plumpness”, and the angle or transition between the chin and neck was smoother.
To further improve the neck contour, Dr. Smiley created a small incision beneath the chin to access and tighten the platysma muscle towards the middle and side, thus creating a “sling effect on both directions.”
Because face and neck lift alone does not address facial volume loss, the patient also received fat transfer to the cheek, particularly the area between the nostril and mouth corner. The adjunct procedure was also used to create a smoother transition between the lower lid and the upper cheek.
Patients with aging countenance face this common dilemma: What works better, Botox or facelift?
One should realize that facial aging is a multifaceted process. The skin sags and thus creates jowling, the cheek fat pads deflate leading to a gaunt look, the face experiences soft tissue atrophy or shrinkage that results in the appearance skeletonized eye socket and concave temple, and the wrinkles become more prominent, says renowned Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that Botox and facelift work differently in erasing or at least minimizing the signs of facial aging. Botox paralyzes the muscles responsible for the appearance of dynamic wrinkles, while facelift surgery elevates the skin, fat, and soft tissue all as a single unit.
Occasionally, Botox is used to paralyze the muscle that is pulling down the brow, allowing the one responsible for elevating it to work more efficiently.
Botox, whose effects typically last 3-4 months, appeals to male patients who generally dislike going under the knife and the ensuing recovery. This approach also suits people who cannot afford the prolonged downtime of surgery.
However, Botox cannot improve a markedly sagging skin, which entails facelift. Also, this non-surgical treatment cannot reposition the drooping cheek fat pad nor improve the soft tissue deflation that comes with aging.
Facelift is generally the ideal choice for patients with more advanced signs of facial aging. Nonetheless, Dr. Smiley says that individuals as young as 45 can be a good candidate, particularly if they are seeking for subtle improvements and want their surgery to be “discreet.”
Postponing facelift until one has full-blown facing aging can lead to discernable and drastic changes that refuting surgery would be impossible. Hence, some “younger patients” resort to mini facelift and then undergo minor touch-ups down the road to maintain their youthful appearance in a more discreet manner.
Today’s facelift is commonly performed with fat grafting or injection, a critical component in holistic facial plastic surgery. This complementary procedure prevents surgical stigmata such as gaunt cheeks, abrupt lower lid-cheek transition, and overall pulled appearance.
Hence, facelift with fat injection is dubbed as 3D facelift surgery because it not just corrects soft tissue descent (i.e., skin sagging) but also loss of facial volume.
All efforts are made to hide the facelift scars and so the incision is always placed at the face-ear junction. Meanwhile, it is important to preserve the tragus or small knob in front of the ear to achieve natural-looking results.
Some doctors prefer placing the incision in front of the tragus, while others favor positioning it behind this small bump; hence some part of the scar lies inside the ear. Others do both depending on the patient’s request and/or anatomy.
Dr. Smiley ensures that the patient’s tragus remains the same after surgery, further contributing to the natural appearance.
Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video showing a post tragus facelift incision, which hid a portion of the scar inside the ear. Nonetheless, the technique is plagued with “potential traps” if used without extra caution.
Because the incision is behind the tragus, the bump made up of cartilage may become distorted or even disappear lest proper wound closure is employed. Dr. Smiley says all efforts are made to eliminate tension on the skin, which is also known to promote favorable scar.
The newly redraped skin may also need to be thinned so the tragus contour will show through.
Small Bump, Big Deal
Dr. Smiley says that one of the keys to achieve natural-looking results from facelift is to preserve the tragus in front of the ear, making it distinct from the face. The absence of this small bump can make the ear look like an extension of the face.
Simply put, the surgery should preserve the natural border that “signals” the separation of the ear and face.
Both the pre- and post-tragus facelift techniques can provide good results, although the latter is believed to entail a steeper learning curve in order to ensure natural-looking results.
Some doctors, meanwhile, only reserve the post tragus facelift incision in patients with these anatomical characteristics: The thickness of their cheek skin is quite similar to the skin on the ear cartilage; their ear cartilage is markedly flat; and they have wrinkles or skin webbing right next to the earlobe.
Mid facelift technique has two primary goals: correct the bulging of the lower eyelid fat, and elevate the drooping cheek fat pad, which in turn eliminates or softens the laugh lines (nasolabial folds).
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to explain his mid facelift technique—which is a combination of meticulous dissection and use of implants—that allows him to deliver natural-looking results that can persist long term.
A youthful face has an inverted triangle shape, which aging can reverse, leading to a straigh-up triangle appearance caused by jowling and mid face sag.
Dr. Smiley said that a young face as an inverted triangle shape (from the lower eyelid down to the jawline); however, aging causes the skin to lose its elasticity and the fats to shrink. The descent and atrophy of the soft tissue leads to a straight-up triangle shape, a key variable that gives away the age of the face.
Hence, the goal of mid facelift technique is to reverse such effect, he explained.
The patient shown in the video required a short incision behind the hairline in the temple area. Dr. Smiley highlighted the importance of going deeper into the fascia and muscle, which he separated from the underlying bone.
“This is a very deep lift, which does not result in visible scar,” he explained. Going deeper into the structures, he suggested, leads to stable and natural-looking results, which are difficult to achieve with the antiquated facelift techniques in which only the skin is lifted.
After separating the soft tissue from the bone between the lower eyelid and cheek, Dr. Smiley created another incision he placed inside the mouth so he could pass a “specialized implant to do the lifting of the entire mid cheek.”
Endotine implant has spikes to hold the tissue; the material is gradually absorbed by the body although the strong adhesion between the tissue it has created persists long term.
The implant, called Endotine, is an absorbable device with several hooks and spikes, meaning after a few weeks it is “totally absorbed by the body,” although not until it has created a strong adhesion to support the elevated position of the cheek fat pad, said Dr. Smiley.
To achieve a more balanced and rejuvenated appearance, the patient’s bulging orbital fat responsible for the appearance of hung-over bags was also repositioned and made closer to the lower lid during surgery.
Because the mid face is usually the first region of the face to experience aging, Dr. Smiley said that mid facelift generally suits “younger” patients between 40 and 55, while the standard technique favors 55 years and older with their more advanced soft tissue laxity.
A holistic facial rejuvenation surgery is typically a combination of facelift and structural fat grafting. Ocasionally, eyelid surgery, forehead lift, neck lift, and/or liposuction are combined to achieve a more natural and more “consistent” result. Combination procedures are particuarly common in patients 55 years and older due to their advanced facial aging.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has presented photos of two patients to demonstrate natural-looking results from facial rejuvenation surgery.
Patient no. 1 before and after photos
Patient no. 1 has received deep plane SMAS facelift and neck lift, a technique that pulls the skin, connective tissue, fat, and muscle as a single unit. The deeper structures need to be tightened and elevated before any excess skin is removed.
The SMAS layer beneath the skin is relatively thick and heavy, and so any facelift technique which does not address this deeper structure leads to short-lived results, overly tight appearance, and poor scarring due to the tension on skin. Hence, Dr. Smiley says he does not perform skin-only lift.
Dr. Smiley incorporated neck lift to ensure that it would not detract from the more youthful and tighter face. He positioned a small incision beneath the chin, specifically within the natural skin fold for optimal scar concealment, to tighten the separated platysma muscle that was causing the visible neck bands.
Despite the tightening effects of facelift, it has one major caveat: There is a reduction in the anterior dimension of the face as the soft tissue rests closer to the bone.
To counteract this untoward side effect of facelift, Dr. Smiley says structural fat grafting is typically combined with the surgery. The idea is to restore the youthful fullness.
For this particular patient, fat grafting was used to restore the fullness of the mid face, leading to the appearance of more prominent cheeks, which is one of the critical emblems of youth.
Patient no. 2 before and after photos
Patient no. 2 has also received deep plane SMAS facelift and neck lift due to the extent of her facial sagging. But to truly create “consistent results,” Dr. Smiley also performed a simultaneous upper eyelid surgery, or blepharoplasty.
Her blepharoplasty was performed with the use of small incision placed precisely at the skin fold so the scar could blend into the background. Afterwards, the excess “hooding” skin was removed, leading to more alert, more youthful eyes.
To prevent an abrupt transition between the lower eyelid and cheek, which is one of the most common facelift stigmata, Dr. Smiley injected fat into the “junction” to create smoother results.
And to eliminate the patient’s severe jowling, he pulled the skin at a 45 degrees angle, which is the correct vector of pull. Any direction otherwise can lead to skin pleating along the lateral neck, flat cheeks, and “lifted” appearance.
Aside from the surgeon’s core competencies, several factors can also affect facelift results such as the patient’s diet, skin quality, sun exposure, weight fluctuations, and commitment to recovery and healthy lifestyle.
Dr. Tarick Smiley, a prominent Inland Empire plastic surgery “figure,” has recently posted videos on Snapchat to explain the impact of skin elasticity on the feasibility and long-term effects of facelift.
The patient achieves impressive facelift results due to Dr. Smiley’s core approach and her starting anatomy. She has a relatively good skin tone and a great bone structure.
“It is important that you take care of your skin by limiting sun exposure. When the skin has significant sun damage, facelift will have no or very little effect,” he says.
Furthermore, he advises his patients to avoid sun exposure or at least use sunscreen and protective clothing for one year following their facelift surgery to prevent hyperpigmentation in which the scars turn darker permanently.
Aside from photo aging of the skin caused by sun damage, Dr. Smiley explains the other factors affecting facelift results to help people realize that its long-term success would also depend on their level of commitment.
Aside from natural effects of aging, sagging skin and lax facial soft tissue also stem from massive weight loss. Hence, the patient’s chronological age does not determine her candidacy for facelift.
Meanwhile, the right candidate for facelift should be near her ideal weight (at least 25-30 percent of her ideal BMI) and must be fully committed to healthy lifestyle to prevent weight gain, which can affect if not completely reverse the results of surgery.
While postop instructions may differ from doctor to doctor, there are generally agreed upon guidelines such as avoiding over-exertion for at least three weeks; complete smoking cessation one month before and after surgery; use of sun protection for one year; and sticking to the advice of one’s surgeon without any modification.
When the patient rushes her recovery, she runs the risk of less than optimal results, poor scars, and wound healing problems.
All facelift patients are required to achieve their optimal health prior to surgery, which a superb diet plays a critical role. Moreover, consuming the right nutrients can aid in healing and prevent delayed recovery and less than optimal scar appearance.
While the surgeon’s skillset will have a large effect on facelift results, it is important to note that the patient’s underlying anatomy, particularly her facial structure, will also dictate the outcome. For instance, someone with a thinner face generally achieves more rejuvenating effects than someone who carries more weight in her cheeks and neck.
Again, poor lifestyle choices can have a detrimental impact on skin quality. This is particularly true for smokers who are prone to premature skin aging and thus the rejuvenating effects of facelift become limited.
Furthermore, the vast majority of facial plastic surgeons discourage or at least limit the types of procedures they perform on smokers—unless they are committed to complete smoking cessation for at least one month—because of the increased risk of skin necrosis, poor healing, bleeding problems, and serious surgical complications.