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.
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.