Wrinkle Removal

Restylane Vs Facelift. The truth is, they are two different things, although when combined they can provide the most natural effects as they address the two main contributors of facial aging: sagging skin and soft tissue atrophy (shrinkage).


Restylane is just one of the many dermal filler injections used to “fill in” deep creases and gaunt facial regions caused by loss of volume/fat that comes with aging. But due to its impressive safety profile and highly predictable results, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says it is one of the most popular brands to date.


Restylane Vs Facelift

Restylane is a gel consisting of laboratory-made hyaluronic acid, which is naturally found in the body, particularly in the youthful skin. To further eliminate risk of allergic reaction, the product contains no animal or human DNA.


As a stand-alone procedure, Restylane and other similar dermal fillers are suitable for “younger” patients or those whose main concern is the appearance of laugh lines (nasolabial folds) and other deep creases caused by loss of fat, flat cheeks, and gaunt jawline.


In the hands of a skilled injector, Restylane can also “conceal” the under eye-bags by creating a smooth lower lid-cheek junction, and the appearance of “pre-jowl” by plumping up its “border.”


Despite the rejuvenating effects of Restylane, Dr. Smiley says no amount of volumizers can address sagging skin. This is where facelift comes practical as it provides more lasting results—i.e., five to 10 years, as suggested by medical literature.


Generally, the standard facelift focuses on tightening the jaw line and eliminating the “fleshy” neck appearance. And if needed, it will also involve elevating the entire muscle mass supporting the mid face, hence giving back the youthful plumpness of the lower lid and cheek.


If there is an indication that warrants the use of Restylane, a simultaneous facelift is not always necessary. But when the patient is deemed as a good candidate for surgical dissection, usually a simultaneous Restylane or any other form of volume restoration is ideal to achieve more natural, stable results.


Compared with other fillers in the market, the effects of Restylane and other hyaluronic acid-based products can only last for a shorter period of time, about 4-6 months.


For patients who want longer lasting results, fat transfer might be a good option. This involves collecting donor fats usually from the tummy area, purifying them to increase their survival rate, and re-injecting them to the recipient area.


The issues involving Restylane vs facelift can be solved by examining the patient’s underlying anatomies and knowing her cosmetic goals and personal preference, explains Dr. Smiley.

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Facelift surgery is not just about tightening the skin and deeper facial structure to rejuvenate one’s appearance. An equally important goal is to eliminate or at least hide any telltale sign of the procedure through proper scar placement, correct direction of pull, adjunct procedures, etc.

Facelift generally uses incisions behind the hairline that may extend in front, behind, or around the ear, specifically within the natural skin creases to hide the scars.


Around the incisions, temporary hair loss/fall may occur as the hair follicles go into a hibernation phase. For the vast majority of patients this will resolve on its own, although they could “accelerate” the healing process by using topical treatment such as Rogaine.

The general rule of thumb is to wait three months to see if there is any hair regrowth around the facelift scars.

Nonetheless, permanent bald patches do occur after a facelift procedure, particularly if there is an excessive damage to the hair follicles or due to incorrect wound closure. To prevent this complication, the general rule of thumb is to eliminate tension on the wound.

A technique called trichophytic closure is particularly helpful in preventing hair loss or bald patches following a facelift procedure. It involves suturing the overlapping edges of the wound, and removing a small piece of skin at an oblique angle (on one side of the wound), before the adjacent flaps are brought together to close the incisions.

With this wound closure, a piece of scalp tissue lies beneath the other, allowing the hair follicles from both flaps to grow and conceal the facelift scars. This technique is also helpful in hair transplant surgery.

To further eliminate any telltale sign of facelift, such as frontal hairline distortion or weird-looking sideburns, the direction and amount of pull should also be taken into account. The idea is to eliminate or at least minimize tension on the skin by contouring the SMAS (deeper facial structures) and not just the skin alone.

Should permanent bald patches occur after facelift, hair transplant surgery is the only permanent solution. This involves collecting hair follicles from the back of the scalp, grouping them together, and implanting them into the area that requires some coverage.

Most Los Angeles plastic surgery experts suggest waiting at least a year before considering hair transplant since hair regrowth is possible with time, or the patient could find hairstyle options that may hide their small bald spots.

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A growing number of US plastic surgeons are using fat grafting techniques to complement the results of facelift surgery, according to a survey published in the July issue of Plastic and Reconstructive Surgery journal.

Fat graft techniques use the patient’s own fat, which is collected from a “stable” donor site such as the abdomen and flanks, to correct the gaunt appearance or loss of facial volume.


The survey involved randomly selected 309 board-certified plastic surgeons who are members of the American Board of Plastic Surgery. According to findings, about 85 percent of respondents said they used fat graft during facelift surgery to further rejuvenate the face, while 70 percent said they have been using the “adjunct procedure” for the past ten years.

The researchers also collected details on collection, handling, processing, and injection of fat graft, and found that the abdomen was the most common donor site for the said procedure. Meanwhile, the “average” total amount of transferred fat was between 11 and 25 cubic centimeter. (Note: A teaspoon can hold approximately 4.9 cc of fluids.)

The most common recipient site was the cheek area, which is susceptible to age-related deflation or facial volume loss. Other commonly treated regions included the lower eyelids, and the nasolabial folds or laugh lines between the corners of mouth and nose.

Some of the transferred fat was reabsorbed by the surrounding tissue over time, although proponents of fat graft techniques have suggested that most of the result can last more than a year after facial rejuvenation surgery.

Renowned Los Angeles plastic surgeon Dr. Tarick Smaili, who is not part of the survey, says that gentle fat removal or liposuction, proper handling of collected fat, purification to eliminate biomaterials, and “judicious” re-injection of purified fat all play an important role in achieving near permanent results.

Because the surrounding tissue will absorb some of the transferred fat within a couple of months of surgery, Dr. Smaili says he might inject extra fats to “counteract” this effect. Nevertheless, he warns that some patients may need follow-up procedures—usually just minor revisions—to address some residual asymmetry or refine the results.

By combining facelift and fat graft, Dr. Smaili says it is easier to simulate the natural results and “youthful plumpness of the face” since the surgeons will rely less on skin elevation and tightening, which if done aggressively could lead to a perennially surprised appearance.

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With the aging baby boomers in the US, in 2011 alone about 119,000 facelift surgeries were conducted by board-certified plastic surgeons, making it the fifth most popular cosmetic surgery.

While facelift aims to rejuvenate the face by minimizing the wrinkles and sagging appearance, it does not offer a lasting result or stop the aging process.  But knowing that the surgery’s lifespan is affected by a patient’s lifestyle, at least she could do certain things that may prolong her youthful appearance.

The exact lifespan of facelift largely depends on the technique used by surgeons.  For instance, a surgery involving only the loose skin does not give long lasting results, making the procedure less popular nowadays.  With skin-only facelift, the rejuvenated appearance could only last between three and six years.

On the other hand, SMAS facelift in which plastic surgeons go deeper into the tissue layers and muscles can provide results that may last for up to eight to ten years.  In addition, the approach can significantly rejuvenate the face by tightening the jaw line and neck area.

But some younger patients deem SMAS facelift too invasive for them, so they ask for a minimally invasive approach such as the mini lift, which targets the mid facial region.  But one downside is that they will eventually need the traditional technique if they want to maintain their appearance.

With mini facelift, patients should expect that the result would last an average of 2-4 years.

In case the wrinkles and sagging return, there is no problem repeating the procedure.  However, patients should realize that revision facelifts only last an average of 2-7 years, depending on the surgical technique applied.

Because some of the tissue manipulation has already occurred, a revision facelift does not provide the same rejuvenating effect of the initial surgery.

One way to prolong the result of facelift is by complementing it with volume restoration, i.e., fat transfer or dermal fillers, and ancillary procedures like neck lift, eyebrow lift, and eyelid lift.  While this means additional cost, at least patients enjoy a rejuvenated appearance that could last for up to 12 years.

But plastic surgery can only do so much.  Patients should also do their part to prolong the result of facelift; this includes living a healthy lifestyle, maintaining a normal weight, avoiding too much alcohol and smoking, and protecting the skin from the harmful UV rays.

Perhaps keeping a normal weight is the most crucial part of facelift “maintenance” as massive weight fluctuations more often than not result to jowling and excess skin and fats in the neck.

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Plastic surgeons can only do so much.  Remember that the long-term result of your facelift or any plastic surgery depends on you—i.e., how you maintain your weight, your lifestyle, and how much do you avoid factors that could reverse or affect the outcome.

For almost all plastic surgeries, it is advisable that you are near your ideal body weight; this is not only applicable to body contouring procedures like liposuction and tummy tuck but also to facelift.

If you had a facelift and then lose a large amount of weight, there is a chance that your skin and supporting tissue becomes lax again.  While a revision surgery is possible, you have to remember that there will be additional scar and the result may not be as natural or pleasant as the initial procedure’s outcome.

To put it succinctly, it is best to lose weight before facelift rather than after it.  However, make sure that you lose weight to a level that are “realistic,” i.e., something you can maintain for the rest of your life.

If you cannot maintain the weight and you gain it back after facelift surgery, the long-term result may not be predictable.  The rule of thumb is that a slight change in weight is not enough to cause detrimental effects, but of course massive weight loss is a different story.

Remember that losing a significant amount of weight after facelift might also lead to “deflation” from the loss of facial fats.  However, it may also be possible that “double chin” occurs even after shedding some extra pounds because some facial fats are simply stubborn.  Overall, the result is quite unpredictable so the best way is to avoid massive weight loss after surgery.

While most plastic surgeons agree that you lose the extra pounds before facelift, it should be done in a “sensible” way.  This means that you should avoid diet pills and other “quick fix” and instead eat healthy and moderately.  Remember that the success of any weight loss program depends on its “sustainability”

Can you stick to that kind of diet for the rest of your life? Remember that maintaining a healthy weight is not like sprint running but a marathon.

One effective diet plan is putting vegetables on two-thirds of your plate and lean meat on one-third.  However, remember that dieting may result to slower metabolism, making regular exercise more important than ever.

No need for high-impact exercises if you are not into them, just routine simple programs like brisk walking can help you maintain your ideal weight.

For any concerns, you should ask your doctor.  Remember that a good communication between the two of you will most likely lead to better results and avoid “surprises” that might leave you dissatisfied with the outcome.

Meanwhile, a well-executed facelift can make you look 10 to 15 years younger, although take note that it will not stop the aging process of your face.

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Simon Cowell has been recently photographed while driving on Los Angeles Sunset Boulevard with a plaster behind his ear, prompting some experts to think that the 52-year-old X Factor judge have had neck lift surgery.

Some plastic surgeons, who did not treat the celebrity notorious for his candid comments—sometimes to the point of sounding rude—said the plaster behind his ear is a common tell-tale sign of neck lift, a procedure that removes the sagging jaw line.

One facelift surgeon said that neck lift usually requires a 2cm incision on both ears in order to lift the sagging skin and manipulate the underlying tissue.  And with a short cut, the wound can easily heal between two to four weeks, although the scar will appear pinkish for a month or two.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili, who did not treat Cowell, said that neck lift is an “isolated” facelift technique that makes it less invasive compared to other facial rejuvenation surgeries.

And as with most “isolated” facelift procedures, the renowned plastic surgeon said that patients will most likely need touch-ups after five to six years, depending on the degree of visible aging.

“Minimally invasive facelift is ideal for patients who need less correction.  By contrast, full or traditional facelift is better for older patients who have more signs of aging,” Dr. Smaili said.

Going back to Cowell’s rumored plastic surgery, one of his friends said the speculations were not all true and that the celebrity had just “accidentally cut himself.”

This is not the first time Cowell has been rumored to have plastic surgery.  Previously, some tabloids have reported that he had hair transplant and eyelid surgery to remove the bags under his eyes.

In a previous interview, Cowell has admitted his vanity and even said that he is using Botox twice a year to keep the wrinkles at bay.

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