Fat grafting, also called fat injection and fat transfer, involves removing fat tissue from other parts of the body, which is immediately processed into liquid to be injected into the soft tissue that requires additional volume. In facial rejuvenation surgery, this has completely revolutionized how surgeons eliminate or reduce signs of aging.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to demonstrate liquid facelift via fat grafting performed on a female patient.
Dr. Smiley uses liquid facelift to conceal the patient’s pre jowl sulcus.
“Liquid facelift is a non medical term used to describe fillers or volumizers that are used to correct the appearance of gaunt cheeks, poor transition between the lower lid and cheek, and other signs of soft tissue atrophy or shrinkage,” says Dr. Smiley.
The female patient shown in the Snapchat videos had sought liquid facelift via fat grafting to correct three specific problems: prominent lines below her eyelids, flat mid cheek, and pre jowl sulcus.
Pre jowl sulcus is different from “true” jowl, which is the appearance of slack flesh along the jaw.
Pre jowl sulcus is a subtle bulge on both side of the chin that is a precursor to a full-blown jowl. Instead of standard facelift, this early sign of aging can be concealed by liquid facelift, which can be in the form of fat grafting or traditional fillers such as Radiesse and Juvederm.
Some doctors call liquid facelift via fat grafting as a minimal downtime procedure because patients are back on their feet immediately afterwards; however, the social downtime is almost comparable to facelift surgery—i.e., the swelling and bruising will take about 1-2 weeks to subside.
Bruising particularly affects the tear trough in which the skin is the thinnest. But by the third week, most patients are happy with the results although that they would lose a bit of volume (as the swelling further subsides) over the next 3-6 months.
For most patients, the final results of their surgery become apparent after six months.
Aside from volume improvement, Dr. Smiley says fat grafting also provides some lifting effect although not as substantial as the standard facelift surgery in which long incisions are made behind the hairline and within the ear’s curvature.
Also, patients who receive fat grafting can expect some improvements in the texture and appearance of their skin as fats contain copious amounts of stem cells, says the celebrity plastic surgeon.
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.
Botched facelift is easily recognizable, while good results remain low-key that patients can lie about their surgery and attribute their more rejuvenated look to better sleep or “special” diet.
The first and most critical step to avoid botched facelift results is finding the right doctor—i.e., he must be board certified in plastic surgery and possess the right skill set, experience, and knowledge to understand the anatomical nuances and facial harmony.
This before-and-after photo shows that with meticulous facelift techniques natural results can be achieved.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says the classic signs of botched facelift include windswept appearance (overly tight effect), flatness of the cheeks, and abrupt lower lid-cheek junction.
The elongated earlobes, visible scars, uneven hairline, overfilled cheeks, and skin/contour irregularities also reveal (poorly done) facelift, says Dr. Smiley.
Dr. Smiley shares his techniques that promote natural results, which can remain “stable” for many years.
- Concomitant fat injection
Facelift alone does not address age-induced facial volume loss or atrophy. In fact, it may even aggravate the thinning of the face as it elevates the soft tissue and brings it closer to the bone. But with a simultaneous fat injection, this adverse effect is avoided.
Fat injection or fat grafting to the face involves harvesting a small amount of fats usually from the tummy, which are immediately processed and injected into the facial soft tissue to correct flat cheeks and abrupt lid-cheek transition.
Dr. Smiley says the key to natural and longer lasting facelift is “going beyond the skin.” By elevating the fat, tissue, and muscle all as a single unit, a truly rejuvenating effect is achieved.
Furthermore, going deeper into the tissue plane allows the surgeon to put most of the tension to this area, thus preventing overly taut skin, which is a dead giveaway that facelift has been done.
- Oblique direction of pull
Pulling the skin at about 45 degrees angle can turn a jowl into a more chiseled jawline and can also smooth out the skin in the neck. In the past, facelift received notoriety due to the overly flat cheeks caused by incorrect direction of pull (horizontally).
A sagging neck or a hollowed lower eyelid juxtaposed with smoother, more rejuvenated face can look worse than it really is. Hence, great surgeons often complement facelift with other facial procedures such as fat injection, neck lift, blepharoplasty, etc.
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.