Facial Plastic Surgery


Although chin reduction surgery is done in several ways, the goal remains the same: to improve facial proportions and physical attractiveness, which scientists and artists believe can be quantified by mathematical ratios.

 

Renowned Inland Empire plastic surgeon Dr. Tarick Smiley says the chin, along with the nasal tip and forehead, plays a critical role in facial profile and harmony.

 

chin reduction

Chin plays a critical role in facial profile and harmony. (Photo credit: Ambro at FreeDigitalPhotos.net)

To determine if the chin is too long for the face, the latter is divided into three horizontal segments—from the hairline to the middle of the eyes, from the middle of the eyes to the base of the nose, and from the base of the nose to the chin. Ideally the distance should be [approximately] equal to each other.

 

Oftentimes, chin reduction is done by shifting the chin backwards and shaving the bone margins. This is either accomplished through incisions made inside the mouth or behind the chin.

 

It should be noted that shaving the chin would not just change its vertical height and profile, but also its inherent shape.

 

Contrary to popular belief, markedly prominent chins are not just a simple bone “problem.” Oftentimes, abnormal projection and height also stems from too much skin and muscle, which if not properly addressed could result in sagging and other surgical stigmata.

 

Occasionally, chin reduction also involves cleft removal and symmetry improvement.

 

Unlike its antithesis chin augmentation (which can be done via implant or fillers), reduction surgery involves a more invasive approach and thus it leads to longer downtime. In fact, “social” recovery can take up to six weeks due to the amount of swelling and bruising.

 

It should be noted that while most patients are back on their feet 10-14 days postop, strenuous activities and heavy lifting should be avoided for 4-6 weeks to prevent healing problems.

 

Also, patients are generally asked to stick to soft food or liquid diet in the first few days postop to minimize movement of the jaw and chin, which in turn can promote healing.

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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.

 

liquid facelift

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.

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Buccal fat reduction is a procedure that can slim the face or create a more chiseled visage by removing some of the cheek fat pad through an incision made inside the mouth.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that buccal fat pad is a large unit of fat that extends from the temple region, the cheek, and to the back of the upper jaw.

 

buccal fat reduction

A youthful face has an inverted triangle shape. But with age-induced soft tissue laxity, its contour changes into a triangle one.

For the vast majority of patients, Dr. Smiley says only the portion of the buccal fat pad in the lower cheek is removed, resulting in a more youthful and chiseled face that is generally described as having an inverted triangle shape. Sometimes, a small amount of fat from the upper cheek is reduced as well, a procedure that is only reserved for a few patients with blatant fullness in the area.

 

The celebrity plastic surgeon says buccal fat reduction requires meticulous execution because the cheek fat pad sits next to the parotid duct, which plays a critical role in saliva secretion. Furthermore, total or over-aggressive removal should to be avoided because it can result in a gaunt and unhealthy appearance.

 

Meanwhile, Dr. Smiley says it is a sacrosanct rule to preserve some fullness in the upper cheek to maintain the inverted triangle shape of the face. Hence, some patients even need a simultaneous fat injection or fat grafting into the upper cheek.

 

Facial fat grafting starts with the collection of a small amount of fat (just a few teaspoons) usually from the tummy area. The fat is then immediately processed to remove any impurity before it is inoculated into the soft tissue.

 

Aside from a concurrent fat grafting, Dr. Smiley says that some patients also need Botox injection to reduce the width of the jaw, further creating a more chiseled and angular face. Meanwhile, the effects of Botox typically last between four and six months.

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Some people consider having a chin implant in order to elongate or slim their face. However, it should be noted that the prosthesis is primarily designed to improve the profile or forward projection thereby correcting the appearance of a recessed chin, according to the California Surgical Institute website.

 

Nonetheless, customized chin implant can give a few millimeters of added height to the chin and thus may give an illusion of a more elongated face, although the effect is very subtle.

 

chin augmentation for round face

Chin implant is primarily used to correct the weak or recessed chin.

 

Simply put, chin augmentation for round face provides no or very little improvement.

 

When the patient’s primary goal is to slim a markedly round face, her surgery should take into account several factors that may include a weak or recessed chin, wide jawline, chubby cheeks, or a combination of them. Some people require more than one procedure to achieve proportionate results and more slimming effects.

 

Chubby cheeks are often caused by excess fat, which can be removed with a procedure called buccal lipectomy. This involves a small incision created inside the mouth in order to remove a walnut-sized fat and thus improve the facial contour.

 

Most surgeons prefer calling the procedure buccal fat reduction, instead of removal, because removing the fats entirely can result in a gaunt appearance, which might become apparent right after surgery or years down the road due to age-induced facial volume loss.

 

Hence, the vast majority of doctors offering buccal fat reduction take the conservative route—i.e., they remove only small amount of fat—to prevent premature aging of the face.

 

Occasionally, a markedly round face is caused by wide jawlines. In the past, most surgeons would perform a surgery in which the masseter muscle, the one responsible for chewing, was shaved down. But nowadays, Botox injection can serve as a great alternative without the prolonged downtime and other risks associated with surgery.

 

Botox weakens the masseter muscle and thus causes it to shrink. However, the effects can only last 4-6 months and thus it entails regular touchups.

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Stem cell facial fat transfer has transformed how plastic surgeons approach facial rejuvenation. In the past, doctors focused on pulling and tightening the loose skin and other soft tissues with no or very little regard to age-induced soft tissue shrinkage.

 

The caveat of a facelift-alone approach is its tendency to aggravate facial volume loss as it entails lifting and bringing the soft tissue closer to the bone. Before fat transfer has become a well-established procedure, surgeons resorted to dermal fillers and facial implants.

 

stem cell facial fat transfer

The fat cells (light colored material) float to the surface, while stem cells (they are more vibrant colored) settle to the bottom of this tube.

Compared to other facial “volumizers,” fat transfer is perceived to provide superior results because it uses the most natural material: the patient’s own fat.

 

Prominent Beverly Hills plastic surgeon Dr. Tarick Smiley says that fat is naturally abundant with stem cells, which are dynamic cells that can transform themselves into other cell types (fat, skin, muscle, etc.). Doctors first noticed their remarkable healing effects when injected into non-healing wounds.

 

In his recent Snapchat post, Dr. Smiley has explained how stem cell-rich fats are collected.

 

Dr. Smiley often collects donor fats from the tummy. In small recipient areas such as the face, only a few teaspoons of purified fat are needed to restore the lost volume.

 

Purification is done with a use of centrifuge, a device that separates red blood cells, fat cells, and stem cells based on their weight. Being the heaviest biomaterial, the red blood cells settle to the bottom of the tube and are drained out.

 

Fat cells, being the lightest material, float to the surface. Meanwhile, right below them is a relatively thin layer that plays a critical role in facial rejuvenation surgery: the stem cells.

 

The fat cells and stem cells are injected into multiple layers to ensure high survival rate of fat grafts (70 percent or more). The injection technique called “microdroplet” ensures that the grafts occupy larger surface area in order to promote better blood vessel ingrowth.

 

“Without blood vessel ingrowth, the body will just absorb the fats. We don’t want this as our goal is to achieve near permanent results,” says Dr. Smiley.

 

A properly executed stem cell facial fat transfer, says Dr. Smiley, can last between seven and 12 years, depending on the person’s “pace of aging.”

 

Because the fat grafts “behave” like the local fat and other adjacent tissues, they feel natural. Cheek implants, meanwhile, may only appear natural in the first few years but has the tendency to look “done” as the soft tissue continues to experience atrophy or shrinkage.

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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.

 

Ultherapy or facelift

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.

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