A holistic facial rejuvenation surgery is typically a combination of facelift and structural fat grafting. Ocasionally, eyelid surgery, forehead lift, neck lift, and/or liposuction are combined to achieve a more natural and more “consistent” result. Combination procedures are particuarly common in patients 55 years and older due to their advanced facial aging.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has presented photos of two patients to demonstrate natural-looking results from facial rejuvenation surgery.
Patient no. 1 has received deep plane SMAS facelift and neck lift, a technique that pulls the skin, connective tissue, fat, and muscle as a single unit. The deeper structures need to be tightened and elevated before any excess skin is removed.
The SMAS layer beneath the skin is relatively thick and heavy, and so any facelift technique which does not address this deeper structure leads to short-lived results, overly tight appearance, and poor scarring due to the tension on skin. Hence, Dr. Smiley says he does not perform skin-only lift.
Dr. Smiley incorporated neck lift to ensure that it would not detract from the more youthful and tighter face. He positioned a small incision beneath the chin, specifically within the natural skin fold for optimal scar concealment, to tighten the separated platysma muscle that was causing the visible neck bands.
Despite the tightening effects of facelift, it has one major caveat: There is a reduction in the anterior dimension of the face as the soft tissue rests closer to the bone.
To counteract this untoward side effect of facelift, Dr. Smiley says structural fat grafting is typically combined with the surgery. The idea is to restore the youthful fullness.
For this particular patient, fat grafting was used to restore the fullness of the mid face, leading to the appearance of more prominent cheeks, which is one of the critical emblems of youth.
Patient no. 2 has also received deep plane SMAS facelift and neck lift due to the extent of her facial sagging. But to truly create “consistent results,” Dr. Smiley also performed a simultaneous upper eyelid surgery, or blepharoplasty.
Her blepharoplasty was performed with the use of small incision placed precisely at the skin fold so the scar could blend into the background. Afterwards, the excess “hooding” skin was removed, leading to more alert, more youthful eyes.
To prevent an abrupt transition between the lower eyelid and cheek, which is one of the most common facelift stigmata, Dr. Smiley injected fat into the “junction” to create smoother results.
And to eliminate the patient’s severe jowling, he pulled the skin at a 45 degrees angle, which is the correct vector of pull. Any direction otherwise can lead to skin pleating along the lateral neck, flat cheeks, and “lifted” appearance.