Plastic Surgery Science


The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.

 

A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.

 

facial plastic surgery

To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.

 

The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.

 

Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.

 

Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.

 

Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.

 

Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.

 

Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.

 

Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.

 

However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”

 

“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.

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Facial fat transfer procedure is an already established technique to rejuvenate the aging face. In the past, doctors were only focused on addressing the loose skin and soft tissue laxity without taking into account that facial volume loss (or fat loss) was also contributing to the aged appearance.

 

But nowadays, skilled plastic surgeons typically combine facial fat transfer procedure and facelift, a combo procedure that accomplishes two goals: tighten the loose skin and restore the lost volume. With this approach, which is also referred to as three-dimensional facelift, patients enjoy more natural and more “stable” results, meaning no surgical stigmata appear years after their surgery.

 

facial fat transfer procedure

Leading Inland Empire plastic surgeon Dr. Tarick Smiley, who commonly combines facelift and facial fat transfer procedure in one surgical setting, explains some of the most surprising facts about the latter.

 

  • Only a few teaspoons of unwanted fat is needed.

 

The tummy area is the usual donor site, where a few teaspoons is collected and is later processed and re-injected into the soft tissue of the face. Meanwhile, it is not uncommon practice to slightly over-fill the recipient site since it is expected that about 25-30 percent of the volume will be resorbed by the surrounding tissue; anything that remains 2-3 months postop is expected to be near permanent.

 

  • Facial fat transfer procedure is “cheaper” than dermal fillers in the long run.

 

The average cost of facial fat transfer is $2,000-$5,000, while dermal fillers are typically priced at $250-$600 per treatment. Despite its higher “upfront” cost, in the long run it is more affordable than the standard fillers because of its near permanent results—i.e., 12-15 years.

 

Dermal fillers, meanwhile, typically require touch-ups performed at 3-4 months interval should the patient desire to preserve her rejuvenated appearance.

 

  • It can be performed simultaneously with “hand rejuvenation” procedure.

 

In Dr. Smiley’s previous post on Snapchat, a female patient had fat injection not just to her face but also to her hands (and fingers) to correct their thin and wrinkled appearance.

 

  • All the biomaterials are removed prior to fat injection.

 

It is important to remove the oil, red blood cells, and other “non-fat” biomaterials to achieve near permanent results and high survival rate of fat grafts. Centrifuge is particularly helpful during the purification method because it separates materials based on their weight.

 

  • Blood vessels need to grow into the grafted fat.

 

In order for the grafted fat to persist long term, blood vessel ingrowth must occur. Hence, Dr. Smiley highlights the importance of micro-droplet injection in which layers of fat are gradually created (less than 0.1 cc at a time) during surgery.

 

Without blood vessel ingrowth, which is medically referred to as vascularization, the surrounding tissue will resorb the grafts within months.

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Facial proportions refer to the relationship in size and placement between features, while symmetry pertains to how similar the left and right side of the face appear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

Just like artists who need to an in-depth knowledge of facial proportions to create their masterpiece, facial plastic surgeons must also possess such critical but nonetheless hard-to-grasp concept of beauty and balance.

 

facial proportions plastic surgery

But what constitute a face that is deemed attractive? And what are the features that distinguish it from plain and not-so-pleasant ones? Or does the axiom “beauty is in the eye of the beholder” have merit despite claims made by scientists and researchers suggesting that there are indeed mathematical ratios that can quantify objectively the level of attractiveness or lack thereof?

 

On top of these conundrums surrounding physical attractiveness, some research studies have pointed out that the perception of beauty is affected by variables that include culture, media, and socio-economic background.

 

Nonetheless, Dr. Smiley believes that beauty does possess certain hallmarks that transcend culture and milieu; these hallmarks, he suggests, can help plastic surgeons deliver natural and pleasant results from rhinoplasty (nose reshaping), facial implants, fat injection, chin reduction, etc.

 

Chin and Jawline

 

When the face is divided into three horizontal segments—from the forehead hairline to the outside corner of the eyes, from the eyes to the base of the nose, and from the base of the nose to the chin margin—and their distances are all equal, the face is considered more attractive.

 

The aforementioned ratio can help guide surgeons during chin reduction/augmentation and jawline enhancement.

 

Rhinoplasty, aka nose job

 

A nose deemed attractive has a breadth that is similar to the distance between the eyes; however, it does not strictly apply to ethnic noses, which can even tolerate a slight nostril flare that may even contribute to facial attractiveness.

 

Furthermore, the length of the nose is ideally equal to the chin’s vertical height in order to increase the attractiveness of the face. It should be noted that the chin and the nose play a critical role in facial proportion and harmony and thus it is not uncommon to combine rhinoplasty and chin augmentation.

 

Cheek enhancement

 

Typically, the length of attractive faces is roughly one-and-a-half times longer than their width. This hallmark of beauty and youth may guide plastic surgeons during cheek augmentation (via implants or fat injection) and buccal fat reduction.

 

Furthermore, the lower two-thirds of a youthful face has an inverted triangle shape thanks to fullness of the upper cheek (or prominent cheekbone), which gently tapers toward the lower cheek and jaw.

 

Forehead and hairline

 

The ancient Greeks believed that the Golden Ratio, now more commonly referred as the Divine Proportion or phi (1.618), was the key to beauty and was seen in nature. When applied to facial proportions plastic surgery, it states that the ideal distance between the forehead hairline and the upper eyelid is 1.6 times the distance between the top of the upper eyebrow and the lower lid.

 

Hence, the concept of phi might be applied during brow and forehead lift surgeries.

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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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The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).

 

Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.

 

fat transfer to hands

 

Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.

 

Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.

 

Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.

 

In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.

 

The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.

 

“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.

 

Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.

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Great rhinoplasty results are impossible to identify because there are no surgical stigmata and the new nose looks in harmony with the face. Hence, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he performs meticulous facial and nasal analysis that takes into account each patient’s ethnicity and gender as well as the established guidelines of aesthetics.

 

The ideal nose is not defined by a strict set of traits, although there are beauty tenets that can guide the surgeon to achieve natural results from rhinoplasty, or nose job in layman’s term. For instance, the width of the nose is ideally contained within the space or distance between the inner eyes; however, this does not apply to some ethnic noses such as the African that can tolerate a slight nostril flare without losing its attractiveness.

 

great rhinoplasty results

This before-and-after photo shows how meticulous rhinoplasty techniques can improve facial proportion, attractiveness, and even perceived youthfulness.

 

During the sixties and seventies, some doctors erroneously idealized the “ski jump” nose, which is manifested by having a narrow profile, with a dip in the middle and an upturned tip appearance. This highly specific aesthetic goal does not give justice to ethnic beauty and in fact may even look unnatural in a many Caucasian patient with strong chin and broad forehead.

 

Fortunately, the tenets of facial plastic surgery nowadays are culture and ethnic sensitive. After all, the vast majority of patients today define great rhinoplasty results as something that looks in harmony with their face.

 

But what constitute a natural-looking, attractive new nose?

 

Dr. Smiley says rhinoplasty is a “perfect amalgamation of art and science,” requiring precise measurement of the nasal and facial dimension. The quintessential goal, he says, is to create a new nose that “naturally occurs within the context of the patient’s ethnicity, gender, and pre-existing anatomy.” Hence, great results generally show subtle to moderate improvements, as opposed to a complete overhaul. After all, the basic architecture of the nose can only be changed to a certain degree.

 

Meanwhile, a nose that looks “done” is not in sync with the patient’s facial features, ethnicity, and gender. Or it has the classic signs of surgical enhancement such as hanging or very visible columella (wall between the nostrils), incorrect tip angle (too upturned or too elongated), collapsed appearance, and overly narrowed profile.

 

These classic signs give rhinoplasty a bad rep, while great results remain unseen or unappreciated because after all, they look as if the patients were born with the attractive nose.

 

Dr. Smiley, who has performed more than 2,000 rhinoplasties as of this writing, says that prudent patients should choose their surgeon carefully (he or she must have extensive experience and an eye for detail, and a member of the American Board of Plastic Surgery) to achieve results that will satisfy them long term.

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