Facial Plastic Surgery

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.


botched facelift

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.


  • Going beyond the skin


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).


  • Holistic approach


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.

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Fat transfer to face is now considered a well-established facial rejuvenation technique instead of an afterthought or an insignificant adjunct procedure of facelift, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.


Facial fat transfer, which is also referred to as structural fat grafting, involves transferring living fat cells from one part of the body to the face in order to improve its volume and contour. While this is a common procedure for patients with age-induced soft tissue shrinkage, younger individuals with inherited gaunt appearance can also benefit from it.


Just like facelift, fat transfer to face has gained notoriety due to some celebrities whose visage “screams” plastic surgery. Of course, this is an inequitable perception since good [natural] results are always indiscernible unless the patient reveals the surgery to others.


Simply put, bad results are highlighted by the media, while good results look natural that the patients can basically attribute their younger countenance to healthier lifestyle, better diet, or beauty rest.


Fat transfer to face demands great attention to detail and profound understanding of beauty ideals. Without these key elements, the surgery will leave patients feeling disappointed or even depressed.


The first and most critical step to achieve satisfying results from fat transfer is to find the right surgeon—i.e., he must be board certified in plastic surgery and has been doing fat transfer and its ancillary procedures (facelift, eyelid lift, brow lift) on a regular basis for a minimum of five years.


Unnatural results and asymmetry are often caused by overzealous injection of fat. It should be noted that the axiom “too much of a good thing is not a good thing” applies to any form of facial plastic surgery.


The surgeon’s fat transfer to face before and after pictures can reveal a lot about his artistic skills. After all, the procedure is a perfect marriage of science and art, says Dr. Smiley who shares some photos of his actual patients.


fat transfer to face before and after pictures

This young patient asks for fat transfer to correct her hollowed temples and gaunt lower cheeks, which are both inherited features.


This patient receives upper and lower eyelid surgery complemented by fat transfer to create a smooth transition between the lid and cheek, further contributing to younger, more natural appearance.


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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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