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 before and after photos
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 before and after photos
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.
A simultaneous fat transfer for face wrinkles allows facelift patients achieve a more natural, three-dimensional rejuvenating effect.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says many of his facelift patients benefit from fat transfer for face wrinkles. This is particularly true for older individuals (55 years and above) and massive weight loss patients who generally experience significant facial volume loss.
In a series of Snapchat videos, Dr. Smiley has demonstrated two female patients who benefited greatly from facial fat transfer.
One of the patients had a lower eyelid surgery with simultaneous fat transfer to address the abrupt lid-cheek junction and the deep nasolabial folds, or in layman’s term, “laugh lines.”
Another female patient had facelift combined with fat transfer to conceal her deep tear trough and to create a softer cheek appearance. For additional rejuvenating effect, the sagging or displaced cheek fat pad, which had almost reached her jowl, was elevated during surgery.
For the vast majority of Dr. Smiley’s patients, he harvests the “unwanted” fat from the tummy area, which is later purified and re-injected into the face to correct its deep lines and hollowed regions.
In one of the recent videos, Dr. Smiley is seen placing the collected fats in tubes so the red blood cells will settle to the bottom (due to the effects of gravity), being the heaviest material. This is always discarded, together with oil and other impurities, to come up with the purest “golden” fat.
Afterwards, the fluids are put in a centrifuge to further remove other impurities before the purest fat is placed in a syringe with a blunt needle.
The special blunt needle allows precise placement of bead-like fat with the least amount of trauma, which in turn promotes the highest survival rate of grafts.
With gentle collection and injection of fat, combined with meticulous purification method, Dr. Smiley says that about 70 percent of the fat volume is expected to persist long term (average of 12-15 years, as suggested by studies and anecdotal reports).
Aside from the high survival rate of fat graft, Dr. Smiley also focuses on delivering natural results, which are achieved by precisely filling in the deep lines and wrinkles and avoiding the hyper-inflated appearance.
Facial plastic surgery and smoking do not mix. First and foremost, smokers have compromised healing due to the effects of nicotine and the hundreds of cancer-causing chemicals found in a single cigarette stick.
While instructions about complete cessation of tobacco products may differ from surgeon to surgeon, the consensus is that three weeks is enough to flush out most of their detrimental effects.
Tobacco products contain nicotine, which is a strong vasoconstrictor, i.e., it causes blood vessels to constrict therefore the nutrient- and oxygen-rich blood flows less efficiently. Ultimately, it takes a longer time for the patients to heal and they become more susceptible to infection and skin necrosis in which the tissue turns black and dies due to lack of oxygen.
Facelift for smokers is particularly risky. In this procedure doctors create skin flaps, which are healthy tissue that is partly detached and moved to create a tighter, more youthful appearance.
But with constricted blood vessels these skin flaps may not receive enough oxygen and nutrients and ultimately “die.” For this reason smokers are more likely to have revisions than non-smokers after facial plastic surgery to address poor scarring.
Also, smoking defeats the inherent purpose of facelift, i.e., to achieve a more youthful appearance, because it significantly accelerates the skin’s aging rate.
Smoking also has detrimental effects on patients having rhinoplasty, or more commonly referred to as nose job. According to California Surgical Institute website, because of the delay healing the grafts and the underlying anatomies of the nose are susceptible to injuries for a longer period of time.
After about two weeks, the grafts and the new contour created by rhinoplasty are more “stable.” But in smokers, the healing process occurs at a much slower pace that they are at an increased risk of inadvertent shifting of the bones due to trauma.
Coughing episode is another common issue with smokers since tobacco disturbs the lining of the lungs and bronchi.
It is important to note that coughing episodes could lead to hematoma (internal bleeding) and persistent swelling, further complicating the patient’s recovery.
Furthermore, a 2005 study has suggested that smokers require 23 percent more pain medications after an operation, and 33 percent more anesthesia during surgery than non-smokers.
There are several neck lift options due to varying anatomies and underlying cause/s of the problem. For instance, some patients are concerned about the appearance of neck bands in which excess fat may be culprit, while others have “turkey wattle” that is typically caused by weak or splayed platysma muscle.
A comprehensive physical is always necessary to determine the best course of action. And during consultation, the patient must also share her motives and cosmetic problems, allowing the surgeon to explain and offer methods that can improve her appearance.
Before-and-After Photos of a Patient Who Have Had Neck Lift Surgery
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, explains the three most popular neck lift options, which are occasionally performed simultaneously to achieve the best result possible:
1. Double chin and neck band appearance. If these are caused by excess fat beneath the skin, minimal liposuction can create a smoother, more rejuvenated neck contour.
A small round incision, about 1 cm in diameter, is positioned beneath the chin where a microcannula or hollowed tube is used to suction out the fat. However, it is crucial to preserve some fatty cells to maintain the natural contours of the lower face and anticipate soft tissue shrinkage that tends to progress with advancing age.
Over-aggressive liposuction must be avoided at all cost because the platysma muscle in the neck will become prominently visible beneath the skin—immediately after surgery or years afterwards—further contributing to the aged appearance.
2. Loose skin in the neck and jowling. A direct skin excision is needed to contour the lower portion of the face; this is generally accomplished by placing incisions around the ear’s contour that may sometimes reach the nape to achieve more rejuvenating effects.
Oftentimes, this excision-based neck lift is combined with standard facelift in which the incision starts from the temple behind the hairline that curves down and behind the ear, or even the nape if the neck requires contouring as well.
Proper wound closure is imperative to prevent scar migration and poor healing.
3. Weak platysma muscle. Sometimes, the vertical muscle in the neck that has become splayed causes the sagging appearance. To address this problem, a small incision beneath the chin is used to reshape or sometimes even remove a tiny portion of the muscle.
Patients with thin skin and very little fat may choose a non-surgical alternative in the form of Botox, which can be done in 15 minutes.
Plastic surgery for men must take into consideration certain factors such as the masculine beauty ideal, underlying anatomies like skin thickness, ethnicity, and personal goals of each patient.
Inland Empire plastic surgery expert Dr. Tarick Smaili explains what makes plastic surgery for men different from women’s.
(Photo credit: imagerymajestic at FreeDigitalPhotos.net
In facial rejuvenation surgeries such as facelift and brow lift, surgeons follow certain guidelines. For instance, men generally require a more conservative approach than women—i.e., minimal lifting of the forehead area and less work on the lower face—to preserve their masculine appearance.
An over-aggressive brow lift often results in effeminate appearance (high and more arched eyebrow) instead of a masculine brow, which appears lower and “heavier” than women’s.
The same rule applies to body contouring surgeries for men, such as liposuction and pec implants, in which the goal is to recreate the ideal masculine silhouette, or the V-shaped, athletic-looking body.
Men’s skin is generally thicker and more vascularized (more blood vessels), so they are more prone to hematoma or pooling of blood under the skin than women. For this reason, proper dissection is more important than ever when treating male patients during facelift, brow lift, and rhinoplasty (nose job).
To minimize bleeding at the time of surgery and postop hematoma, all patients are required to avoid blood thinners (aspirin and aspirin like products), certain herbal supplements, and tobacco products a few weeks before and after surgery.
Aside from gender-appropriate results, plastic surgery for men must also respect the patient’s ethnicity and his cultural based standard of beauty. This is particularly true of rhinoplasty, eyelid surgery, and other procedures that involve ethnically sensitive areas of the face.
It is important to note that what works for Caucasian patients do not always apply to people of Hispanic, Asian, and African background.
Cosmetic plastic surgery is a highly individualized procedure in which the goal is to make the patient’s happy and possibly improve his body image and self-esteem. For this reason, good communications are of paramount importance to achieve satisfying results.
Meanwhile, anyone who exhibits signs of body dysmorphic disorder, schizophrenia, and other mental issues is a poor candidate for any type of elective surgery.
Plastic surgeries are generally reserved for well-rounded and emotionally stable patients who know how to make an informed decision.