Facelift for cheek enhancement must address these following problems: hollowness below the cheekbone, sagging of the mid face, and laugh lines (nasolabial folds).
It is important to note that the cheeks can easily reveal a poorly executed facelift. With incorrect direction of pull or excessive tension, the patient can end up with flat cheeks, overly tight mid face, and/or skin pleating behind the ears where the wound is closed with sutures.
To avoid these aforementioned problems, renowned Inland Empire plastic surgery expert Dr. Tarick Smiley explains the critical components of facelift for cheek improvement:
- Going beyond skin pulling and tightening
Dr. Smiley warns that relying too much on skin pulling and tightening can lead to flatness below the cheeks that can appear immediately after surgery or years down the road. For a more stable and natural-looking result, he highlights the importance of “deeper” tissue reposition, which is only possible when the underlying structure beneath the skin (fat, tissue, and muscle) is tightened and reshaped as well.
Dr. Smiley prefers deep plane SMAS technique in which the fat, connective tissue, and muscle are all being lifted to achieve natural and long-lasting results.
The SMAS technique has also been known to prevent flatness of the cheek, sunken mid face, and other surgical stigmata, he further explains.
- Volumizers in the form of fat transfer
Fat and tissue reposition alone has no or very little effect on patients with gaunt appearance due to advancing age or inherited feature. For this reason, Dr. Smiley often incorporates fat transfer in his facelift surgeries for a more natural, three-dimensional rejuvenating effect.
Fat transfer not just corrects the hollowness below the cheekbone; it can also create a smooth transition between the lower lid and cheek, and soften the laugh lines.
Buttock implants under the muscle or at least within this anatomical layer has been known to provide softer, more natural results compared to a placement technique in which the prostheses lie above the muscle.
Placing the buttock implants above the muscle, with only the skin and fat “supporting” their weight, is known to increase the risk of sagging (inadvertent displacement) and palpability.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley warns that the skin’s elasticity means it may stretch over time and lead to implant displacement and other surgical stigmata; hence, he always places buttock implants under the muscle or at least within this layer.
Furthermore, the under the muscle is known to minimize risk of infection especially in the event of poor healing since the muscle itself can serve as a protective barrier.
From the aesthetic point of view, buttock implants under the muscle technique can provide a more natural appearance—i.e., an S-shaped “behind” when viewed from the side.
Nonetheless, achieving natural and proportionate results also entails careful examination of the patient’s buttock dimension. The goal is to use implants that are within the anatomical boundaries, which in turn can also prevent skin thinning, implant malposition, and poor wound healing.
(Note: Patients of average frame are generally advised to stick to buttock implants whose size range is not more than 400 cc to prevent excessive tension on skin. It is important to note that too much tension is closely linked to poor healing and increased palpability.)
All buttock implants are positioned above the “sitting” area and so only the upper half of the butt is actually augmented, while its side (hips) and lower aspect receive no or very little improvement. For this reason, some patients may need a simultaneous fat transfer or fat grafting.
Incorporating fat transfer (which always starts with liposuction to collect fats) also allows the surgeon to “carve out” a more feminine contour by removing the excess fats along the flanks and lower back, says Dr. Smiley.
Liposuction uses a small hollowed tube inserted into tiny round incisions to remove the excess fat adjacent to the buttocks, further improving the contour and profile of the butt cheeks, he adds.
The collected fats from liposuction could be used to reshape the hips and lower aspect of the buttocks for a more proportionate, curvier silhouette, says Dr. Smiley.
The truth is, the most difficult part of recovery from facelift surgery is not actually the pain, which is fairly manageable, but the social downtime.
It is important to note that social recovery from facelift varies significantly from patient to patient due to factors such as individual healing, predisposition to bruising and swelling, type of surgery and use of ancillary procedures, and quality of postop care.
Inland Empire plastic surgery expert Dr. Tarick Smiley explains some of the most pertinent issues involving social recovery from facelift.
- Advance planning is critical
Patients who are planning for a big social event (e.g., wedding) are generally advised to have their surgery performed 1-2 months earlier just to be on the safe side. But for individuals who do not mind being seen with some mild “outward symptoms”, which can be easily hidden by camouflage make-up, a 1-2 week social recovery will generally suffice.
Some patients are able to return work (only desk job) after a week or so after surgery, although most will need at least two weeks before they look “presentable.”
After 1-2 weeks postop, most patients can use camouflage make-up to hide the bruising and swelling and some discoloration around the edge of the incision that remains on the face and/or neck.
- Winter might be a good way to schedule one’s surgery
The bulkier ensembles worn in cold weather (e.g., turtle neck tops and scarves) can make it easier to hide the outward signs of facelift. Furthermore, winter coincides with longer holiday season (Christmas and New Year), allowing the patient to have a longer time off.
- Avoid strenuous activities for a minimum of three weeks
While most patients already look presentable in 1-2 weeks postop, it remains important to avoid rigorous activities and heavy lifting for a minimum of three weeks because increase in blood pressure and heart rate can aggravate the swelling and bruising, which of course leads to longer social recovery from facelift.
- Control risk factors linked to increased swelling and bruising
Smoking, aspirin, hypertension (or any other types of medical condition linked to higher risk of bleeding), and strenuous activities before complete healing can lead to increased swelling and bruising and thus longer social recovery.
Meanwhile, head elevation, superb diet (low sodium, high protein, and more fresh fruits and vegetables), good hydration, and light activities (walking instead of bed rest) can help promote healing.
Travel for tummy tuck requires advance planning to avoid risk of complications, particularly relating to deep vein thrombosis. The problem with long travels (by plane or car) is the prolonged immobility, which could lead to blood clot in legs and more serious problems such as pulmonary embolism.
Inland Empire plastic surgery experts explain the basic guidelines to make travel for tummy tuck a safe endeavor.
- Wait at least a month before traveling by plane.
Many surgeons suggest postponing long flights for at least four weeks to avoid blood clots. Furthermore, staying within the immediate vicinity of the doctor’s office will allow him to monitor and ensure that his patient is healing nicely.
- Possible use of low-dose blood thinner.
Should the patient need to travel by plane sooner than ideal, some doctors recommend a low dose of blood thinner (aspirin) to reduce risk of deep vein thrombosis. “Waiting” nonetheless remains to be the best option.
- Perform light activities such as walking.
Most out of town patients can travel by car around two weeks postop. However, certain precautions are needed to prevent or at least reduce the risk of deep vein thrombosis. The general rule of thumb is to take several stopovers to stretch and walk around.
Good blood circulation through light exercise is one of the best defenses to prevent deep vein thrombosis. Furthermore, it can minimize the effects of narcotic painkillers such as constipation and lethargy.
- A capable adult must always accompany the patient.
Travel by plane means rushing from one airport to the next with a heavy luggage in tow. It is important to avoid strenuous activities, bending from the waist, and over exertion for 3-4 weeks to prevent complications. For this reason, it always makes a sense to bring a friend or family member along when traveling for plastic surgery.
Also, driving is inadvisable when under narcotic painkillers, which cause poor coordination and drowsiness. Just to be safe, patients must have someone to drive them home.
- The patient should build good rapport with a local primary care physician.
Travel for tummy tuck requires advance planning, which typically includes finding a local primary care physician ideally before to the operation. He may be the one to order a pre-op physical exam and fax its results to the plastic surgeon to rule out any medical condition.
The local primary care doctor will also monitor the patient for up to 2-3 months to ensure the latter is healing nicely.
Facelift preparation primarily aims to prevent or at least reduce risk of complications, and thus allow the patient to achieve optimal results from surgery. Sometimes, it entails waiting until one has controlled certain medical conditions (e.g., hypertension and obesity) before going under the knife.
Inland Empire plastic surgery expert Dr. Tarick Smiley has explained the generally agreed upon guidelines on facelift preparation.
- Control medical condition prior to surgery
Patients with medical conditions known to increase the risk of healing problems are poor candidates for any type of plastic surgery such as facelift until these are controlled through medications, diet, weight loss, and/or lifestyle change.
Hence, it is of utmost importance to notify the surgeon if one has medical conditions no matter how seemingly simple or innocuous they seem. Previous surgeries, past and current medications, use of supplements, and smoking should also be disclosed to prevent risk of complications.
- Discontinue drugs known to inhibit healing
Some drugs and nutritional supplements are known to increase bleeding, interfere with anesthesia and painkillers, or cause cardiovascular disturbance. In general, these must be discontinued at least two weeks prior to surgery, and two weeks afterward or until most of the postop bruising has subsided.
Aspirin, ibuprofen, birth control pills, and a gamut of supplements including ginger, green tea, ginkgo biloba, kava kava, St. John’s wort, and ginseng are known to cause increased bleeding.
- Discontinue smoking and avoid second-hand smoke
While the general rule of thumb is to avoid tobacco products and second-hand smoke for a minimum of three weeks prior to surgery, some doctors are stricter that they require patients to discontinue them for a few months to ensure their “full commitment.” During the initial healing stage, i.e., 2-3 weeks postop, nicotine is best avoided as it is causes the blood vessels to shrink, inhibiting the oxygen-rich blood from effectively reaching the wound.
While sticking to a diet rich in micronutrients, i.e., vitamins and minerals, is the “universal” guideline, some doctors feel that increasing protein intake can also improve healing as it plays a critical role in tissue repair.
Meanwhile, it is best to avoid or at least minimize the consumption of salty, sugary, and highly processed foods because they suppress the immune function and aggravate postop swelling.
While many surgeons do not recommend specific or special skin care regimen, they all agree that using sunscreen prior to surgery can improve skin healing. It is important to note that excessive sun exposure can make the skin extra sensitive.
Others require mild glycolic acid and Retin-A treatment a month prior to facelift to promote collagen grown in the skin.