Facial Plastic Surgery


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.

 

face and neck lift

frontal view

 

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.

 

face and neck lift

profile view

 

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.

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Buccal fat extraction aims to slim a markedly rotund face by reducing the cheek fat pad. However, the buccal fat in the cheek region should not be entirely removed because years down the road an overly aggressive approach can lead to a very gaunt countenance.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate this procedure performed in a female patient with a markedly plump face due to her chubby cheeks and “heavy” neck.”   Hence, she was also deemed as a good candidate for neck liposuction.

 

buccal fat extraction

Prior to surgery, Dr. Smiley examines the facial anatomy of the patient whose face is markedly full due to her chubby cheeks and heavy neck.

Dr. Smiley first performed neck liposuction with a creation of a small round incision beneath the chin, specifically within the skin fold for optimal scar concealment.

 

The surgeon performed neck liposuction with microcannula, a hollowed steel probe used to remove the fat. However, he made sure to leave behind a layer of fat to conceal the platysma muscle; going the conservative route also made sense to anticipate the progression of age-induced facial volume loss.

 

After suctioning the excess fat in the neck area, Dr. Smiley proceeded to buccal fat extraction with the creation of a small intra-oral incision on each side of the cheek. No external incision was used and so the risk of visible scar was eliminated completely.

 

Dr. Smiley said the intra-oral incisions should avoid the submandibular duct and the salivary glands to prevent excessive swelling and other complications.

The patient receives buccal fat extraction and neck liposuction for a more balanced result.

 

During the creation of incisions, the celebrity plastic surgeon used a cautery device, which also sealed off the blood vessels and tissues, resulting in minimal bleeding and ultimately shorter recovery.

 

Instead of removing the entire buccal fat pad, he just reduced its size in order to slim the face without making it look too gaunt and unhealthy. As stated earlier, conservative removal has always remained safe and “predictable.”

 

While the results of buccal fat extraction with neck liposuction are often immediate, the final outcome takes 1-3 months as the residual swelling takes a while to subside.

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Restylane for lip augmentation is a non-invasive way to improve the shape and fullness of the lips. In the hands of good injectors who have profound understanding of the beauty tenets and facial proportions, the technique can provide natural-looking results.

 

Dr. Tarick Smiley, one of the eminent Los Angeles plastic surgeons, has demonstrated how Restylane for lip augmentation can provide symmetric and natural-looking results, which were recently posted on his Snapchat.

 

restylane for lip augmentation

The gold-colored vibrating device tricks the brain into thinking that the sensation comes from vibration, as opposed to the prick of a needle.

Restylane, Dr. Smiley said, is formulated with hyaluronic acid, a naturally occurring substance that gives the skin its “youthful plumpness and glow.” Aside from enhancing the lips, this type of FDA-approved filler or “volumizer” also works in age-induced facial lines and hollowness of the face.

 

While Restylane is a biocompatible filler and thus the risk of rejection is almost zero, it comes with a caveat: The body breaks it down gradually and so results only last 4-6 months, although when used as a lip augmentation the effects may be slightly shorter because the lips are always moving.

 

Less mobile areas such as the nasolabial folds or laugh lines tend to break down Restylane slower and so the results can last up to six months.

 

Because Dr. Smiley’s utmost priority was to create natural-looking results from Restylane, he first injected the lips border to improve their contour before giving them additional volume.

 

To further ensure natural results and avoid the “dreaded duck lips,” he made sure that the lower lip would appear bigger than the upper lip. One of the most common traps is making their size the same, or worse, the upper lip appears hugely disproportionate, a “look” which does not occur naturally.

 

Dr. Smiley said that respecting the pre-existing contours of the lips is the key to achieve natural results.

 

During lip augmentation, Dr. Smiley also used a vibrating device he placed adjacent to the injection site to “trick the brain so it would not feel the prick of the needle and instead focus on the vibration,” thus ultimately reducing patient discomfort.

 

His technique is backed by science. According to a recent study, the use of vibration device during lip augmentation provides analgesic effects, with 92 percent of patients saying they experienced significantly less pain with the addition of vibration.

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Facial fat transfer results should look smooth and natural and thus it entails a “perfect marriage” of art and science. While it is often combined with facelift or some type of facial rejuvenation surgery, it can also serve as a stand-alone procedure to improve the overall contour of the face.

 

Dr. Tarick Smiley, an eminent Beverly Hills-based plastic surgeon, has explained the three core guidelines that help him deliver smooth and natural fat transfer results.

 

fat transfer results

This young patient has hollowed temple, which Dr. Smiley improves with fat transfer and ultimately the overall contour of her face.

  1. Harvest the right kind of fat.

 

In Dr. Smiley’s recent Snapchat post, he has explained that the abdomen and flanks are the two most ideal donor sites as their fat is more liquescent and thus provides smoother results. The back area, meanwhile, is best avoided because of its highly fibrous fat that may lead to bumps and other surface irregularities when injected into the face.

 

  1. Purify the fat prior to injection.

 

All the biomaterials (e.g., blood and oil) except from fat are removed prior to injection; this is mainly done with the use of centrifuge that separates fluids based on weight. This paves way for smoother results and long-term survival of fat grafts, Dr. Smiley explained.

 

With proper handling and injection, fat transfer results are near permanent (12-15 years).

 

  1. Perform meticulous injection.

 

Dr. Smiley said the purified fat is injected below the skin-and-fat layer and above the muscle. This provides not just smooth and natural results, but also prevents risk of nerve damage and other complications.

 

To further minimize risk of nerve damage, facial fat transfer uses a blunt needle during the injection process.

 

To further ensure smooth fat transfer results, injection is done through micro-droplet technique in which less than 0.1 cc of purified fat is inoculated one at a time into the tissue. This creates a honeycomb arrangement and thus allows tissue integration and blood supply ingrowth needed by the grafts’ long-term survival.

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Fat transfer to the face can have a dramatic effect on its perceived attractiveness and youthfulness, provided that the “injector” has a good grasp of the well-established aesthetic guidelines, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

Dr. Smiley has recently posted a series of Snapchat videos to demonstrate a young woman who received fat transfer to the face. While most patients ask for the procedure to reverse the effects of age-induced facial volume loss, her gaunt appearance is an inherited feature.

 

fat transfer to the face

 

These were her aesthetic issues:

 

  • Notable hollowness of her temple
  • Abrupt transition between the lower lid and upper cheek
  • Nasolabial folds, a.k.a., laugh lines

 

Prior to surgery, Dr. Smiley performed meticulous facial examination to determine the ideal fat volume injection and to assess how he could further highlight the patient’s nice features. After all, she has an angular but still feminine jaw line and a prominent cheekbone.

 

In one of the videos, Dr. Smiley said the goal is to create a more oval-shaped face, which is the quintessence of a youthful countenance. In many cultures, there is also a strong preference for this highly feminine facial contour (of course, it does not apply to men in which the ideal shape is more of a square due to the prominent jawline).

 

During surgery, Dr. Smiley injected fat, which he harvested from the patient’s tummy, into the hollowed temple. A small amount was also used to slightly elevate the tail end of the eyebrow, leading to a more feminine and attractive shape.

 

Next, he injected fat into the patient’s lid-cheek junction, ultimately eliminating the hollowness and “darkness” that made her look older than her chronological age.

 

The celebrity surgeon also injected fat to obscure the patient’s laugh lines, ensuring that each fat graft has been inoculated into several layers of the tissue, paving way for near permanent results. He said that about 70 percent of the fat volume is expected to survive long term, making fat transfer to the face more cost-effective than standard fillers (e.g., Restylane and Juvederm), which require several touch-ups every year.

 

Aside from improving the volume distribution of the face, and ultimately its perceived attractiveness, Dr. Smiley said the surgery can also rejuvenate the skin where the fat has been injected because fat graft is replete with stem cell known for its rejuvenating effects.

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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.

 

post tragus facelift incision

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.

 

Ideal Choice

 

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.

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