Plastic surgeons might interpret the term facelift surgery differently, although the standard technique mainly tightens the jaw line and upper neck; it has no or very little effect on the mid face and forehead area. Also, the procedure can only address signs of aging caused by skin and muscle tissue laxity.
Meanwhile, facial volume loss, fine wrinkles, leathery skin, and pigment-related problems are beyond the scope of facelift surgery, explains celebrity LA plastic surgeon Dr. Tarick Smaili.
For a more rejuvenating effect, Dr. Smaili says most patients can benefit from facelift with adjunct procedures, which can be performed at the same time or at a later date.
The list below shows the exact reasons why complementing facelift with other procedures can give you more impressive results.
- Take up to 16 years off your face. A 2008 study published in the Journal of the European Academy of Dermatology has suggested that after removing wrinkles from an image, you could be perceived as 10 years younger than you really are. But if your skin is digitally altered to eliminate ugly pigmentation, you could look up to 16 years younger than your actual age.
For this reason, it is not surprising that facelift or any type of facial rejuvenation surgery is typically complemented by chemical grade peels, laser treatments, and other procedures that correct the appearance of dry and leathery skin, sunspots, and other discoloration problems.
- More balanced appearance. Standard facelift only tackles the sagging appearance in the lower third of the face. As a result, your deflated cheeks, forehead creases, and crow’s feet could look more obvious once your jaw line and upper neck have been tightened.
A possible solution is to undergo a full facelift, which is a general term that describes combining standard facelift with brow lift, eyelid lift, mid lift, and/or neck lift—or whatever you really need.
- More natural results. Facelift or any facial rejuvenation that uses skin lift and tissue tightening cannot address loss of volume or fat. In fact, relying too much on pulling and lifting could lead to a perennially surprised or windswept appearance that screams “I have had plastic surgery.”
To avoid the telltale signs of facelift and achieve a more natural result, Dr. Smaili says that loss of facial volume must be addressed at the same time. Dermal fillers injections, fat graft, or sometimes implants, are particularly helpful.
The term 3D facelift often refers to facelift combined with volumizers such as dermal fillers ad fat graft.
Touch-up after facelift surgery is performed either to restore the “impressive” results of the previous surgery, or to correct the botched appearance or poor scarring. Regardless of the reason, it remains imperative to find a qualified plastic surgeon specializing in revision facelift.
While facelift surgery can erase five to ten years off your face, take note that it cannot stop the aging process. For this reason, you may want to consider touch-ups in the future, which could be in the form of skin-only lift, mini or “isolated” facelift, dermal fillers, fat graft, and/or skin resurfacing treatments.
Take note that the standard facelift mainly targets the lower third of the face, specifically the jaw line and upper neck area. It does very little effect on the mid face, which can progressively sag as you age.
For some patients, the most ideal touch-up approach is a mid facelift. In this procedure, small incisions are typically placed in the temporal area behind or within the hairline to hide the scars; these will allow their surgeon to lift the displaced cheek fat pad and eliminate or at least soften the nasolabial folds between the nose and corners of the mouth.
Brow lift is another popular “isolated” facelift that is used as a touch-up. The procedure corrects the sagging brow and/or the horizontal creases in the forehead area.
In revision facelift, it is not uncommon for surgeons to use a skin-only technique since the previous surgery has already tightened and reshape the deeper structures of the face. With this approach, you could expect a shorter downtime and less postop swelling and bruising.
Touch-ups could also involve the use of volumizers—i.e., fat graft and dermal fillers—in which the goal is to correct facial volume loss. These treatments are particularly ideal in improving the appearance of hollowed temples, sunken eye socket, thinning lips, and deflated cheeks.
Fat grafts are particularly ideal if your problem is loss of facial volume because they feel as soft as the surrounding tissue. Dermal fillers, on the other hand, are believed to be more helpful in softening the deep wrinkles such as the nasolabial folds or “laugh line” and the marionette lines that run from the corners of the mouth down along the chin.
Meanwhile, touch-ups whose primary aim is to correct the botched results are often complicated, especially if too much skin has been removed in the previous surgery. If the problem is “over-correction,” sometimes the only option is to wait for the skin to sag again.
If you need immediate revisions to correct botched results, the general rule of thumb is to wait at least six months. The idea is to wait for the scars to mature and the skin to “settle,” allowing your doctor to make an accurate assessment of your problem.
Sometimes breast implant surgery needs to be performed in conjunction with other procedures to achieve optimal results and minimize certain risks such as palpability, visible rippling, and implant bottoming out, as suggested by renowned Beverly Hills plastic surgeon Dr. Tarick Smaili.
Fat graft has been one of the most commonly used auxiliary procedures of breast implant surgery. While it has many uses, the technology is particularly helpful in reducing palpability and rippling by “thickening” the soft tissue, common problems of thin and athletic women and post-mastectomy patients.
A recent study published by Plastic and Reconstructive Surgery magazine has suggested that transplantation of a small amount of patient’s own fat can improve the postop result, specifically the appearance of cleavage.
According to the findings, one of the telltale signs of breast implant surgery is the appearance of “separated breasts,” which can be corrected by injecting fat graft to soften the medial transition zone between the implant edges and sternum.
Twenty observers were asked to rate the attractiveness of breasts, which were digitally altered to show a narrower or wider vertical aesthetic line, or the distance between the medial border of the breasts.
Photographs with a narrower VAL were rated as more attractive by 95 percent of participants, according to study.
Another possible way to “thicken” the soft tissue of the breast is to use acellular dermal matrix, which is also helpful in revision and reconstructive breast surgery. Older women, who are believed to be prone to excessive lateral displacement of the implants, could also benefit from this auxiliary procedure.
Acellular dermal matrix is sometimes referred to as internal bra procedure because they strengthen the deeper structures of the breast and/or tighten the implant pocket, thereby minimizing the risk of implant malposition such as bottoming out and lateral displacement.
Breast lift is another surgery commonly partnered with implants. The idea is to correct the saggy appearance and deflated breast mound, especially the upper poles, all at the same time.
While this combo procedure has become a common practice nowadays, Dr. Smaili warns that smaller implants positioned underneath the thick pec muscle are the ideal choice to prevent the acceleration of ongoing breast ptosis (sagging).
Oftentimes, breast implant surgery and lift are performed in one surgical setting to minimize cost and to experience recovery just once. But for patients who need more “lifting,” a staged-surgery is usually a better option to achieve results that are more predictable.
While the “standard” way to perform breast augmentation is to use breast implants, a growing number of patients are choosing fat transfer in which their own fat cells are used to increase their bust size. And because no artificial prosthetic is used, the technique is deemed safer and more natural.
Fat transfer, which is also referred to as fat graft or reversed liposuction, is also used to reshape the buttocks, rejuvenate the “aging” hands, and correct the hollowed facial regions, explains leading Los Angeles plastic surgeon Dr. Tarick Smaili.
Contrary to popular belief, naturally thin patients—i.e., those with low body mass index—could still achieve good results from breast augmentation via fat transfer as long as with the right methods.
For these patients, Dr. Smaili often suggests collecting fat from multiple areas to obtain a good amount of volume. This technique, he further adds, avoids the risk associated with over-liposuction such as skin asymmetry and gaunt appearance of the treated site.
As of this writing, there is no scientific study suggesting the best donor site for fat transfer. Nevertheless, the renowned Los Angeles plastic surgeon prefer to harvest fat that is deemed “stable,” meaning it has the least tendency to change with weight fluctuations. For instance, the thigh could be the most viable liposuction area if its size remains relatively consistent even after losing a good amount of weight.
In rare cases, a very thin patient is asked to gain a little bit of weight prior to surgery.
Despite the advantages of fat transfer as an alternative to breast implants, the amount of augmentation is often limited. In general, it can only enlarge the breast by one cup per surgery and any attempt to go beyond the breast tissue and skin’s capacity will only lead to low survival rate of fat graft.
If there is a desire to augment the breasts by more than one cup, it usually requires additional procedure such as the use of Brava. This bra-like device, which is worn several weeks prior to surgery, can expand the breast through its negative pressure.
Brava, according to one study, can also increase the blood supply and survival rate of fat graft. For this reason, the device is often recommended for small-breasted and/or very thin patients having breast augmentation via fat transfer.
Because fat is a fragile cell that can be easily damaged, Dr. Smaili highlights the importance of gentle liposuction, preferably with a manual syringe-based technique so the fats will not be exposed to excessive trauma that could lead to their low survival rate.
Facelift surgery is performed to remove or minimize the appearance of unwanted wrinkles. But instead of tightening the skin alone, Los Angeles plastic surgery experts suggest going deeper into the facial muscle and fat pads to create results that can last “longer” or at least five years (as suggested by some studies).
While the patient’s color of skin is not a contraindication to facelift, African-Americans face a unique set of challenges because they are more prone to adverse scarring—such as keloids and hypertrophic scars—than Caucasians and people with lighter complexion. Another concern is the risk of hyper- and hypo-pigmentation or unsightly skin changes.
But despite the challenges of facelift surgery for patients of African background, they are at an advantage when it comes to the quality of their skin. Because of melanin, which gives the skin its color, they have less facial wrinkles and photo-aging compared with Caucasians and people of lighter skin color.
But since African skin is quite susceptible to discoloration or uneven tone, some patients might need chemical peels and skin resurfacing treatments, which must be only done by a qualified doctor to avoid adverse scarring and unsightly pigmentation.
And because their skin is less susceptible to the detrimental effects of UV rays, they could benefit from a less invasive form of facelift (mini lift) in which shorter incisions are used. These techniques result in quicker recovery, less postop swelling and bruising, and less scarring.
Nevertheless, the “ideal” incision pattern technique largely depends on the amount of correction needed and the patient’s cosmetic goals. And while the appearance of scars is always a tradeoff, a good plastic surgeon will make every effort to position them within the natural creases of skin (around the ears) and behind the hairline.
In standard facelift, the incision typically starts from the temple area and runs around the ear. But for patients with a noticeable amount of jowling and saggy skin in the upper neck, the incision could extend further down the nape for an additional contouring.
Mini lift, meanwhile, uses short incisions in the temple area or around the ear, which also result in mini improvements. Nonetheless, it can still deliver the desired outcome for the right patients whose expectations are reasonable and achievable.
Because facial aging is not only about soft tissue laxity, some patients might need volume restoration procedures such as traditional fillers (Juvederm and Restylane) or fat graft (using their own fat to augment the hollowed or skeletonized areas). The process of combining facelift and volumizers is sometimes referred to as 3D facelift.