Lip lift procedure elevates the upper lip, which in turn creates a shorter distance between the nose and the [vermilion] border of the upper lip. Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has performed the surgery, which was posted on Snapchat.
The patient shown in the video did not like the expansive distance between her nose and upper lip, which prior to surgery was around 2 cm. For females, the ideal length is usually 1.1-1.3 cm, while for men it is slightly longer, about 1.3-1.5 cm.
Dr. Smiley says there are two ways to perform the upper lip lift: the first one involves placing incisions inside the mouth in order to “roll up” the upper lip, while the second technique entails the use of external incisions at the base of the nose to shorten the space between it and the lips.
Since the patient required extensive reduction the intra-oral (inside the mouth) technique would not suffice.
During surgery, Dr. Smiley created incisions at the base of the nose to remove a small strip of skin and tissue (measuring 0.4 cm). In the process, the upper lip has been elevated and so now the teeth are slightly visible in frontal view.
Elevating the upper lip has also increased the pink part or volume of the lips.
This incision pattern results in a hidden scar as it lies precisely at the natural skin fold of the nose.
After removing the excess skin and tissue, Dr. Smiley closed the wound in a way that the scar would settle precisely at the skin folds of the base of the nose to hide it from view.
Meanwhile, the surgery was performed under local anesthesia, which could pave way for shorter downtime.
After recovery from upper lip lift, patients may opt for lip filler (fat injection or dermal fillers) to further improve their volume and shape. It should be noted that lip augmentation, especially with over-zealous injection, tend to provide unnatural results (duck lip appearance) if there is too much space between the nose and the upper lip.
Dr. Smiley has explained the general rule of thumb to ensure natural results from lip fillers:
- There should be a 1.0-1.6 ratio in terms of volume distribution and height between the upper lip and lower lip (phi or golden proportions).
- The outermost corners of the mouth should have very little volume. Over-injection to this area results in unnatural lip contour.
- The volume of the lips gradually increases as it goes towards the center.
- To avoid the appearance duck lips, the philtrum (two columns right above the upper lip) is occasionally filled in.
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.
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.
Dermal fillers are primarily used to fill in depressions caused by facial aging or hereditary predisposition (e.g., flat cheeks). However, doctors are now starting to use them in non-surgical rhinoplasty although their use can be quite limiting.
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says fillers only suit patients with minor nasal deformity: a small hump or irregularity along their nasal profile. Those who require minimal bridge augmentation may also consider this non-surgical approach.
Patients with severe or more complex nasal deformity—e.g., drooping tip, significant nostril flare, large bridge, etc.—will need the standard rhinoplasty, a surgery in which the bony and cartilaginous framework of the nose is reshaped. It is important to consider the patient’s skin shrinkage to ensure that it can redrape well to the new contour, instead of appearing amorphous especially at the tip.
When performing non-surgical rhinoplasty, Dr. Smiley only uses FDA-approved fillers to conceal minor imperfections of the nose. Hyaluronic acid-based materials like Juvederm and Restylane are the ideal choice since they can be easily reversed should the patient is not happy with the results; an enzyme called hyaluronidase can be injected into the tissue to dissolve the particles.
Hyaluronic acid-based fillers generally last four to six months and so they require upkeep should the patients want to preserve their results.
For patients who want longer-lasting fillers, one possible alternative is to use Radiesse whose results can last between nine and 15 months. Its main ingredient is calcium compound, which is not easily broken down by the body.
Meanwhile, permanent fillers such as silicone injection should be avoided due to increased risk of lasting deformity, infection, and skin injury, Dr. Smiley says in a previous Snapchat post.
One of the selling points of fillers is the zero downtime, while rhinoplasty typically requires 7-10 days of social recovery due to the postop bruising and swelling.
Despite the impressive safety track record of FDA-approved fillers, they nonetheless demand meticulous injection to avoid skin changes (redness), lumpy appearance, and skin necrosis (death of tissue). Hence, a prudent patient ensures that only a licensed/qualified injector does her procedure.
Tummy tuck healing complications can be prevented or at least minimized with strict patient selection, preparation, meticulous surgical techniques, patient commitment, and follow-up care, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley shares his core principles to minimize tummy tuck healing complications and ultimately promote the best results possible.
- Identify patients with risk factors for delayed wound healing
Dr. Smiley requires all his patients to pass lab screening and disclose their drug use and medical history to ensure that they can handle the surgery. The idea is to identify risk factors such as bleeding problems, diabetes, weak immune system, and other chronic medical condition; ideally, any elective surgery must be postponed until these are well under control through medication and/or lifestyle changes.
Dr. Smiley says that the success and safety of tummy tuck also boils down to patient candidness during consultation. They must fully disclose their drug and supplement use, previous surgeries, medical condition, results of previous tests, and other health-related information.
By knowing this information, surgeons can help their patients eliminate or at least control risk factors through right preparation.
Furthermore, patients are often instructed to avoid aspirin and other blood-thinners, too much alcohol consumption, and large weight loss a few weeks in advance of their surgery.
- Performing good wound closure
Each doctor has his own preferred wound closure technique, although there are generally agreed upon guidelines such as closing the hip-to-hip tummy tuck incision in multiple rows of sutures, and placing most of the tension on the deepest structures and progressively reducing it as one reaches the superficial layers and skin.
- Taking it slow during recovery
Over-exertion should be avoided for a minimum of three weeks, although most patients can safely return to work within two weeks provided that they are not doing rigorous activities.
Any activity that causes pain, discomfort, and persistent swelling might be a sign of over-exertion or over-straining. Hence, women taking care of small children are typically advised to arrange for childcare for at least 10 days.
A common advice is to stop smoking one month before and after tummy tuck, which typically involves large skin excision. It is important to mention the detrimental effects of nicotine on healing and blood supply, causing it to become constricted and thus increasing the wound complication rate.
The ideal neck liposuction incision placement will depend on the extent and location of excess fat. Nonetheless, all efforts are made to position the scar, usually 2-5 mm diameter, in concealed areas such as beneath the chin and behind the earlobes.
Renowned Inland Empire plastic surgeon Dr. Tarick Smiley regularly performs neck liposuction and other surgical enhancements whose aim is to create a more youthful, smoother transition between the neck, chin, and jaw line.
Recently, he performed extensive neck liposuction on a female patient with a full-looking neck. Hence, instead of the usual single incision placed behind the chin (specifically at the natural skin fold for optimal scar concealment), he also created a pair of incisions behind the earlobe.
With three small incisions, Dr. Smiley says the excess fat can be accessed from different angles, leading to smoother and more natural results.
To further promote smooth results, he moved the microcannula (a blunt-tipped hollowed tube) back and forth in a fan-like motion and avoided staying too long in one area so as to prevent surface irregularity.
Extensive neck liposuction may involve as much as 300 cc of fat, while a minor correction may just remove as little as 20 cc. Contrary to popular belief, the success of liposuction boils down to how much fat remains after surgery, as opposed to how much the surgeon removes. After all, over-correction can lead to “cosmetic” disasters—e.g., surface irregularities, sagging appearance, and visible platysma muscle.
The platysma muscle along the neck may show through the skin if all the fats, which serve as a carpeting, are removed during surgery.
In general, neck liposuction, especially if it involves large amounts of fat, is only reserved for younger patients who typically have good skin shrinkage, whereas neck lift (excision-based) is more suitable for individuals with loose skin. Occasionally, they are combined in one surgery to achieve the most desired results.
After neck liposuction, Dr. Smiley says he recommends the use of chin strap (compression garment) for at least a week to help remodel the skin and to keep swelling at a minimum.
The appearance of double chin is actually caused by neck fullness, which in turn stems from excess subcutaneous fat (fat beneath the skin), redundant skin, or even both. Identifying the underlying cause is the most critical step to determine the best approach.
It is important to note that facelift for double chin is suitable for patients with age-induced skin laxity. As the body ages, the skin and deeper structures of the soft tissue start to lose their tightness and plasticity, leading to neck fullness and jowling.
Before and after photo of a patient who had facelift combined with neck lift.
Facelift surgery uses incisions around the ear’s curvature, which allows the surgeon to remove the excess skin responsible for the double chin and neck fullness.
Should the double chin appearance is notably pronounced, patients may also need liposuction to remove the localized fat deposit; this is an ancillary procedure commonly performed with facelift, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley, who regularly posts videos on Snapchat to demonstrate liposuction of the neck and jowl, says it is important to preserve some fats beneath the skin, instead of removing them altogether. The idea is to ensure that a “carpet” will remain to hide the platysma muscle down to the sides of the neck.
Over-aggressive liposuction of the neck can make the platysma muscle visible; they appear like two parallel bands along the neck.
Meanwhile, non surgical methods generally work in younger patients with good skin shrinkage—it can snap back once the localized fat deposit is removed. One possible option is Kybella injection, an FDA-approved drug that can melt away the fat that is causing the double chin appearance. Occasionally, patients may require up to six treatments performed a month apart to achieve the desired result.
CoolSculpting is another non surgical option to eliminate the appearance of double chin. It works by freezing fat cells, which are crystalized and then die before they are flushed out gradually from the body within a few months. Most people will need at least two treatments to see a noticeable improvement.