Face and neck lift with fat transfer can provide a holistic facial rejuvenation effect by correcting not just the sagging skin and deeper soft tissue, but also the volume/fat loss that comes with aging.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate face and neck lift with fat transfer performed in a female patient with advanced signs of facing aging.
Dr. Smiley has described the patient’s facial aesthetic issues, which all required a customized approach to achieve the most rejuvenating effects without causing surgical stigmata such as flatness of the cheek, visible scars, and overly pulled countenance.
- drooping of the cheek
- loss of volume in the cheek, particularly the area between the mouth corner and the nostril
- recessed and sagging chin that almost disappeared from the neck
- appearance of jowl
- “heavy” neck due to excess skin
To improve the aforementioned aesthetic issues, Dr. Smiley used an incision pattern starting from the forehead area (behind the hairline) that went behind the tragus (small bump in front of the ear) and behind the earlobe and into the hairline at the nape; hence, all the scars would be hidden.
Afterwards, the celebrity plastic surgeon separated the skin from the SMAS, a layer of soft tissue that extends from the neck to the temple area. The SMAS and the platysma muscle of the neck move as a single unit, said Dr. Smiley in a recent Snapchat video.
“When doing the lifting, we have to do the deep lift, as a skin-alone lift is not enough to support the new elevated contour, Dr. Smiley further explained.
A deep lift also provides more natural results as the skin receives no or very little tension during wound closure, thus eliminating the risk of windswept appearance, overly flat cheeks, and other telltale signs of facelift, said Dr. Smiley.
Elevating the deeper layers of the soft tissue created immediate rejuvenating effects to the patient—i.e., her jawline appeared more defined, the upper cheek regained its “youthful plumpness”, and the angle or transition between the chin and neck was smoother.
To further improve the neck contour, Dr. Smiley created a small incision beneath the chin to access and tighten the platysma muscle towards the middle and side, thus creating a “sling effect on both directions.”
Because face and neck lift alone does not address facial volume loss, the patient also received fat transfer to the cheek, particularly the area between the nostril and mouth corner. The adjunct procedure was also used to create a smoother transition between the lower lid and the upper cheek.
Meticulous breast exam and surgical planning is the key to achieve breast augmentation and lift results that look natural and proportionate, said leading Inland Empire plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
Dr. Smiley has recently demonstrated this “combo surgery” performed on a patient who had these following aesthetic problems:
- Sagging breast tissue
- Deflated upper breast pole
- Disproportionately huge nipple that dropped below the level of the submammary fold
While the patient’s preexisting soft tissue was sufficient, a breast lift-alone approach would not give her the upper pole fullness she wanted; hence, the use of concurrent small implants was fitting to deliver her aesthetic goals.
The use of small implants would give her not just additional fullness of the upper pole, but would also improve the overall projection of her breasts, Dr. Smiley said.
To give her more cleavage and “overall fullness,” the celebrity plastic surgeon used moderate profile implants whose forward projection is predetermined by their width. They are perceived to be the standard design as the provide just the right amount of “roundedness” without causing excessive fullness in the upper breast pole; hence, they simulate the look of an attractive breast that occurs “naturally.”
In the context of breast lift, Dr. Smiley performed the standard technique in which the incisions were created around the new smaller areola. The incisions were then extended down the midline and across the base of the breast, leading to an inverted T scar.
To ensure lasting “perkiness,” the surgeon elevated the internal breast tissue with “special sutures” that would act as a sling. This “fine-tuning technique” also allowed the silicone implant to remain centrally behind the areola.
Furthermore, he created more distance between the smaller areola and the submammary fold (about 3 cm), further contributing to the perkier and more youthful appearance.
Dr. Smiley noted that “all efforts are made to eliminate tension” in order to promote the best scar possible. During the creation of areolar incisions, he made them into perfect circle so the tension could be equally distributed. In addition, the wound was sutured in several rows so the skin would not receive excessive “tautness.”
The use of smaller or conservative-sized breast implants also favored the patient because of the reduced tension. It should be noted that overlarge implants used concurrently with breast lift might create too much “opposing tension” on the skin, which could result in higher risk of unfavorable scars and poor healing.
The goal of fat transfer to hands is to provide additional padding or cushion beneath the skin, thus correcting the gaunt appearance and “concealing” the tendons and veins that become visible due to age-induced skin thinning and soft tissue atrophy (shrinkage).
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate fat transfer to hands or hand rejuvenation. Instead of injecting readily available dermal fillers such as Juvederm and Restylane, he used the patient’s own fat.
Fat transfer, also called fat grafting, is a more cost-effective technique than traditional fillers because of the near permanent results, with studies suggesting that on average they last 12-15 years. Dermal fillers, meanwhile, require 2-3 touch-ups every year to maintain their effects.
Dr. Smiley says the surgery starts with gentle liposuction to collect fats ideally from the flanks or abdomen as they contain a type of fat that promotes smooth results. Fibrous fats that are commonly found in the back and “bra rolls,” meanwhile, are best avoided because of the increased risk of surface irregularities, he says.
Gentle fat collection is immediately followed by purification through centrifuge to separate out any biomaterial such as the blood and oil. With pure golden fats, about 70 percent (or even higher) of the injected volume is expected to be near permanent, provided that the grafts have formed their new blood supply.
In one of the Snapchat videos, Dr. Smiley is seen injecting purified fat beneath the skin to provide added cushion, leading to hands that now appear more rejuvenated, smoother, and healthier, he says.
The celebrity plastic surgeon says that fat transfer to hands entails meticulous injection to further promote high survival rate and long-term results.
“Minute droplet of fat ensures smoother and nicer results, as well as blood vessel ingrowth. The fat beneath the skin also creates a tauter appearance,” he further explains.
Dr. Smiley says that swelling is a common side effect of fat transfer to hands, which is expected to subside within a few weeks.
Breast augmentation and lift accomplishes two important things in one surgery: Increase the “cup size” and correct the sagging appearance. But sometimes, they are done separately to minimize risk of complications, which can be an issue if the patient wants bigger implants.
Breast augmentation, which is accomplished with the use of saline- or silicone-filled implants, increases the volume, while breast lift tightens the skin and deeper tissue. While combining these two procedures is known to enhance the overall contour, it is important to note that they have conflicting effects—tighten and expand the skin simultaneously.
The first step to achieve high satisfaction rate is to identify the ideal candidates for the combo procedure, and whether the surgeries can be performed simultaneously or in stages, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
The placement of the nipple is one of the key elements that determines if a concomitant breast lift is warranted. One established aesthetic guideline suggests that the ideal distance between the nipple and the sternal notch (dip between the collarbone and neck) is 17-21 cm. Of course, women with longer torso and larger breasts can have a “larger gap” without their breasts looking saggy.
Furthermore, the nipple area should lie a few centimeters above the submammary fold, but then again the exact distance will depend on the breast size. Nonetheless, one study has suggested that the nipple position should “support” the 45:55 breast volume “distribution” ratio, which leads to the teardrop shape.
If there is too much distance between the sternal notch and the nipple, or the nipple falls at the same level as the submammary fold or beyond, a simultaneous breast lift is warranted lest an implant-alone approach can exacerbate the sagging appearance.
The standard or anchor breast lift suits women whose “breast bottom” has sagged more than 6 cm below the submammary fold. This entails a donut-shaped incision around the areola’s border, a vertical one between the nipple area and the crease, and another one that goes across the base of the breasts.
Meanwhile, patients whose nipple area remains above the submammary fold but can still benefit from a conservative elevation of their areolar complex will only need a donut-shaped incision technique.
After elevating the breast tissue and repositioning the nipple higher, implants are then propelled into their pocket, which should lie centrally behind the nipple area. The use of overlarge implants (or more than 600 cc) is generally discouraged unless breast augmentation is performed at a later date, ideally 3-4 months after breast lift.
If overlarge implants are simultaneously used during breast lift, they tend to ride higher on the chest wall leading to unnatural fullness in the upper pole/cleavage. In addition, they increase the risk of poor wound healing and less than optimal results.
All efforts are made to hide the facelift scars and so the incision is always placed at the face-ear junction. Meanwhile, it is important to preserve the tragus or small knob in front of the ear to achieve natural-looking results.
Some doctors prefer placing the incision in front of the tragus, while others favor positioning it behind this small bump; hence some part of the scar lies inside the ear. Others do both depending on the patient’s request and/or anatomy.
Dr. Smiley ensures that the patient’s tragus remains the same after surgery, further contributing to the natural appearance.
Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video showing a post tragus facelift incision, which hid a portion of the scar inside the ear. Nonetheless, the technique is plagued with “potential traps” if used without extra caution.
Because the incision is behind the tragus, the bump made up of cartilage may become distorted or even disappear lest proper wound closure is employed. Dr. Smiley says all efforts are made to eliminate tension on the skin, which is also known to promote favorable scar.
The newly redraped skin may also need to be thinned so the tragus contour will show through.
Small Bump, Big Deal
Dr. Smiley says that one of the keys to achieve natural-looking results from facelift is to preserve the tragus in front of the ear, making it distinct from the face. The absence of this small bump can make the ear look like an extension of the face.
Simply put, the surgery should preserve the natural border that “signals” the separation of the ear and face.
Both the pre- and post-tragus facelift techniques can provide good results, although the latter is believed to entail a steeper learning curve in order to ensure natural-looking results.
Some doctors, meanwhile, only reserve the post tragus facelift incision in patients with these anatomical characteristics: The thickness of their cheek skin is quite similar to the skin on the ear cartilage; their ear cartilage is markedly flat; and they have wrinkles or skin webbing right next to the earlobe.