Buccal reduction surgery aims to deliver a more chiseled face by removing some portion of the fat deposit deep in the cheek, specifically between the corner of the mouth and the nostril.
Instead of removing or obliterating completely the buccal fat pad in the cheek region, leading Inland Empire plastic surgeon Dr. Tarick Smiley says reducing it only (i.e., leaving behind some fat) will ensure a natural result and prevent the “scrawny” appearance, which may appear soon after surgery or several years down the road.
Aside from going to the “conservative route,” Dr. Smiley says the success of buccal reduction surgery also relies on strict patient selection; hence, he only reserves this procedure for patients with full, round face who are near their ideal weight.
(Note: Overweight people can have “chipmunk” cheeks, which may deflate to some extent after losing the extra pounds. Meanwhile, some normal weight individuals have a markedly round face due to large buccal fat pad, a feature that is generally hereditary.)
And while there is no “magic number” when it comes to the ideal age for buccal reduction surgery, many surgeons recommend postponing it until one has reached her mid-twenties. It is important to note that aging causes facial volume loss and so the face will thin out naturally.
The caveat with having buccal reduction surgery before reaching the age of mid-twenties is the perceived increased risk of looking scrawny several years down the road. In fact, dermal filler injection is the most popular non-surgical facial rejuvenation in women between late thirties to early fifties.
Dr. Smiley has recently posted a series of Snapchat videos to demonstrate buccal fat reduction surgery combined with chin implant. He created a small incision inside the patient’s mouth (between the cheeks and gums) to expose the buccal fat. Then, he teased some of the fat out with forceps to remove it.
To achieve a more proportionate result (and a more chiseled facial contour), the patient had a simultaneous chin augmentation in which a short inconspicuous incision was made beneath her chin in order to position a small implant. The incision is expected to fade into an invisible scar after 6-12 months.
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.
Today’s facial plastic surgery trends favor more natural results, as opposed to looking “done”—hyper-inflated lips, overly tight face, ethnically inconsistent nose, eyelid retraction, and over-elevated eyebrows.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has explained some of the current facial plastic surgery trends and the growing consumer preference.
- Smoothing out wrinkles with volumizers without creating the hyper-inflated look.
Volumizers such as dermal fillers and fat injections have received notoriety because too much of them can lead to hyper-inflated look—e.g., chipmunk cheeks and trout pout. However, all of these can be avoided with meticulous microdroplet injection in which the primary goal is to smooth out wrinkles and lines, as opposed to “thoughtless” augmentation of the deflated facial regions.
- Simultaneous fat injection during facelift
Facelift alone does not address all signs of facial aging, particularly relating to soft tissue atrophy (shrinkage) and fat loss. Hence, Dr. Smiley typically combines facelift with fat injection, particularly when the patient has abrupt transition between the lower lid and cheek, deep tear trough, or flat cheeks.
- Selfies and the proliferation of social media
Studies have suggested that selfies have contributed to the growing popularity of non-invasive and surgical procedures to improve facial features.
Furthermore, there is an uptick in the number of patients seeking “liquid” facelift, which is basically dermal filler injection such as Restylane and Juvederm, a trend also attributed to selfies.
- Non-surgical alternatives to facelift
The truth is, there is no “real” alternatives to facelift that can exactly replicate its rejuvenating effects. Nonetheless, non-surgical treatments remain good options in patients who have minimal signs of aging or want to postpone surgery in the meantime.
While the rejuvenating effects of non-surgical treatments do not compare with the benefits of facelift, combination therapy (e.g., Botox injection with dermal fillers) can help doctors address more signs of facial aging—without surgery.
Rhinoplasty, or nose job in layman’s term, was previously criticized for westernizing the face of non-Caucasian patients. However, over the past decade there have been revolutionary ideas acknowledging that beauty has no linear and strict definition.
With ethnic rhinoplasty, the goal is to enhance the nose’s appearance in a way that the result looks ethnically consistent with the rest of the face.