Facelift for laugh lines, or medically referred to as nasolabial folds, requires going deeper than the skin to achieve natural results that can last for many years. It is important to note that relying on skin alone will lead to a short-lived outcome due to the relative weakness of this layer.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that a youthful face has its malar fat pad attached to the cheekbone high, giving it a relatively plump look.
The high cheekbone appearance gives younger faces an inverted triangle shape, which aging gradually reverses, he adds.
Aging causes the facial skin and supportive structures to lose their strength, which in turn also causes the malar fat pad to descent. Dr. Smiley says this contributes to the nasolabial folds, which run from the corner of the nostril down to the mouth.
Facial volume loss can further aggravate the appearance of nasolabial folds, making the patient appear perennially tired or even angry. On top of that, repeated smiling (and other facial expressions) deepens this fold throughout life, he adds.
Facelift for laugh lines warrants elevating the SMAS, a layer overlying the muscle. With this facelift technique, the celebrity plastic surgeon says the skin, malar fat pad, and tissue are raised all at the same time, leading to more natural, longer-lasting results.
Moreover, the SMAS facelift technique allows the surgeon to eliminate most of the tension on the skin, further contributing to favorable scars and better wound healing.
The sagging cheek fat pad that contributes to the laugh lines is pulled upward so it will lie over the cheekbone. To further smooth out these “folds,” Dr. Smiley says that some patients require a simultaneous fat injection in which the goal is to replace lost facial volume.
Fat injection for the correction of laugh lines can serve as a stand-alone procedure in patients whose mid face has not yet sagged to a significant degree. Another option is dermal fillers (e.g., Perlane, Radiesse, Restylane, and Juvederm) whose effects last an average of 4-6 months and so they require regular touch-ups.
The results of fat injection, meanwhile, can last 12-15 years, says Dr. Smiley.
While the upfront cost of fat injection is higher than most dermal fillers, in the long run it is less expensive because it does not require touch-ups.
In the first few weeks of recovery, the use of post facelift makeup can help conceal the bruising and swelling. However, cosmetics are best avoided for at least a week to prevent irritation, infection, and permanent tattooing, which may happen if the cosmetics get into the incision site.
Moreover, post facelift makeup can help some patients show up for work sooner (without drawing some unwanted attention); however, others forego the use of camouflage cosmetics and just patiently wait for their social recovery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that most patients look socially presentable at two weeks postop, although it all depends on the type of skin, extent of surgery, individual healing, and propensity to bruise (some are less likely to bruise than others).
Mineral- and water-based cosmetics with hues slightly lighter than the patient’s skin are the best way to conceal discoloration. It is highly ideal to use brand new makeup, sponges, brushes, and applicators to minimize risk of irritation and infection.
On the other hand, oil-based cosmetics are best avoided while the skin is still sensitive because they may cause irritation; they also require a special remover and are harder to take off than mineral and water-based makeup.
However, camouflage cosmetics are not the only thing that can hide postop symptoms. Large sunglasses, turtle neck tops, and scarves can also come in handy, and of course less “troublesome” than applying makeup to conceal skin discoloration.
Once the postop symptoms are gone, makeup application becomes a breeze. In fact, most facelift patients have mentioned that the reduction in their wrinkles makes it easier for them to apply creams and foundation.
The problem with deep lines—e.g., nasolabial folds, or more commonly referred to as laugh lines, and marionette lines, or creases that run straight downwards from the mouth’s corners—is they can trap powder, foundation, or cream, further accentuating their appearance.
To correct facial lines and wrinkles, Dr. Smiley highlights the importance of lifting the SMAS layer (and not just the skin alone). By going deeper into the facial layer, he can deliver more natural results that can persist long term.
To further smooth out the lines, some of his patients require simultaneous fat injection, which can also be used to create a smoother lid-cheek transition, and to plump up the gaunt cheeks.
And with less facial lines and sagging appearance, and “softer” cheeks, most patients find makeup application more pleasant after surgery.
Amazing facelift results can be achieved when the surgeon uses the correct vector or direction of pull, according to leading Beverly Hills plastic surgeon Dr. Tarick Smiley who specializes in facial rejuvenation procedures.
Previous facelift techniques were plagued by problems that typically included short-lived results, hollowness and/or elongated appearance of the lower eyelid, prominent eyelid-cheek junction, and flat cheeks.
Dr. Smiley regularly posts Snapchat videos to demonstrate the importance of the correct vector of pull to eliminate the aforementioned “stigmata,” and ultimately to deliver amazing facelift results that can persist for more than a decade.
*The correct vector of pull is somewhat oblique or 45 degrees angle,” he said in one of his Snapchat video posts.
Aside from eliminating the abovementioned surgical stigmata, Dr. Smiley said pulling the soft tissue of the face at a 45 degree angle accomplishes “wonderful effects” such as the preservation of the softness of the cheeks, smoother transition between the lower eyelid and cheek, more defined jaw line, and tight but not overly tight results overall.
Dr. Smiley has warned that pulling the facial soft tissue horizontally can lead to flat or overly tight cheeks, development of the prominent “eye socket,” skin pleating around the incision site (in front and/or behind the ear curvature), and bunching of the anterior neck.
Using a blunt vertical pull, meanwhile, also creates unnatural results due to the appearance of lateral skin pleating, bunching of the mid face, and residual laxity along the anterior neck.
To further achieve long-lasting, natural results, the leading facial plastic surgeon said facelift techniques that go beyond the skin are the best option. (It is important to note that previous methods only deal with sagging skin, which inevitably stretches out due to continuous aging.)
Dr. Smiley says that SMAS and deep plane facelifts provide the most amazing facelift results, particularly when combined with fat transfer or fat injection in which the goal is to address facial volume loss.
In SMAS facelift, the facial layer enveloping the muscle is lifted and tightened, while deep plane facelift goes deeper into this layer, he explained.
Despite some surgeons claiming that a specific technique is superior to others, studies have suggested that the results are dependent on the doctor’s skillset and his ability to decide which method will suit a patient based on “starting” anatomy.
A simultaneous fat transfer for face wrinkles allows facelift patients achieve a more natural, three-dimensional rejuvenating effect.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says many of his facelift patients benefit from fat transfer for face wrinkles. This is particularly true for older individuals (55 years and above) and massive weight loss patients who generally experience significant facial volume loss.
In a series of Snapchat videos, Dr. Smiley has demonstrated two female patients who benefited greatly from facial fat transfer.
One of the patients had a lower eyelid surgery with simultaneous fat transfer to address the abrupt lid-cheek junction and the deep nasolabial folds, or in layman’s term, “laugh lines.”
Another female patient had facelift combined with fat transfer to conceal her deep tear trough and to create a softer cheek appearance. For additional rejuvenating effect, the sagging or displaced cheek fat pad, which had almost reached her jowl, was elevated during surgery.
For the vast majority of Dr. Smiley’s patients, he harvests the “unwanted” fat from the tummy area, which is later purified and re-injected into the face to correct its deep lines and hollowed regions.
In one of the recent videos, Dr. Smiley is seen placing the collected fats in tubes so the red blood cells will settle to the bottom (due to the effects of gravity), being the heaviest material. This is always discarded, together with oil and other impurities, to come up with the purest “golden” fat.
Afterwards, the fluids are put in a centrifuge to further remove other impurities before the purest fat is placed in a syringe with a blunt needle.
The special blunt needle allows precise placement of bead-like fat with the least amount of trauma, which in turn promotes the highest survival rate of grafts.
With gentle collection and injection of fat, combined with meticulous purification method, Dr. Smiley says that about 70 percent of the fat volume is expected to persist long term (average of 12-15 years, as suggested by studies and anecdotal reports).
Aside from the high survival rate of fat graft, Dr. Smiley also focuses on delivering natural results, which are achieved by precisely filling in the deep lines and wrinkles and avoiding the hyper-inflated appearance.
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.