There are lots of terminologies thrown around as regards to facelift surgeries—weekend lift, SMAS facelift, deep plane, skin-only lift, just to name a few—which add up to the confusion. For this reason, leading Los Angeles plastic surgeon Dr. Tarick Smiley says prudent patients should ask their doctors about the specific details of their surgery.
Dr. Smiley says he prefers the SMAS facelift technique due to its long-lasting, natural rejuvenating effects. It involves tightening the layer called superficial muscular aponeurotic system, which extends from the neck to the temple area.
The SMAS layer lies beneath the facial fat and skin and so tightening it means the deeper structure receives most of the tension, which in turn promotes good scarring as the skin receives very little of the “opposing” pull.
Meanwhile, older techniques (skin only lifts) can be problematic in terms of scar appearance and longevity. Because most of the tension is placed onto the skin, scar widening and overly tight appearance (done or fake look) are the usual results.
Furthermore, the skin is susceptible to the effects of gravity and continuous aging; hence, the celebrity plastic surgeon stays away from the procedure due to its unstable, usually short-lived results.
Dr. Smiley regularly posts educational videos on his Snapchat account to demonstrate the impressive results of SMAS facelift.
One patient was particularly impressed with her results that she allowed Dr. Smiley to showcase her outcome on social media.
The 60-year-old female patient had come to Dr. Smiley because of her sagging mid face, sunken lower lid, significant jowling, laugh lines (medically referred to as nasolabial folds), and neck bands. To address these problems, the celebrity surgeon performed SMAS facelift and neck lift.
He placed the incision “inside” the hairline (around the temple area), which extended behind the tragus (small bump in front of the ear) and then curved behind the ear for optimal scar concealment.
With SMAS facelift, Dr. Smiley was able to restore the softness over the cheekbone and reposition the sagging cheek fat pad, which in turn eliminated the laugh lines. Moreover, the technique allowed him to tighten the jawline and thus erase the appearance of jowling, and to improve the neck as well.
The SMAS facelift typically entails 3-3.5 hours of operative time and a social recovery (all the outward signs of surgery are gone) of two weeks. Nonetheless, all is worth it as it can erase up to 20 years off from one face, with the results expected to last 12-15 years.
Facelift at 70 can provide impressive rejuvenating effects with proper patient selection. But since at this age sagging skin is not the only problem—most patients also have turkey wattle neck appearance and loss of facial volume or fat—simultaneous procedures such as neck lift, fat transfer, and eyelid surgery are generally warranted to achieve more natural, balanced results.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says one of the most common misconceptions is that the patient’s chronological age has a large influence on one’s candidacy.
In his recent Snapchat video post, the celebrity plastic surgeon has shown a 70-year-old female patient who had facelift and neck lift about six months ago; she came to his office for a follow-up visit.
The patient shown in the video has expressed her satisfaction with the result. When viewed from the side, there is now a smooth angle between her chin and neck, as Dr. Smiley had incorporated her facelift with a highly individualized neck lift.
The patient’s postop appearance is a significant improvement from her “before” photos when the sagging skin along her jowl made her chin almost “disappear” from the neck, said Dr. Smiley.
Dr. Smiley had also tightened her platysma neck muscle in the midline using sutures. He was able to access this anatomical layer by creating a hidden incision precisely made at the chin’s natural skin crease for optimal scar concealment.
To further achieve a smooth transition between the neck and chin, he had also removed the fat pad beneath the platysma muscle.
While facelift at 70 can provide impressive results, health remains the most important issue since aging comes with increased risk of diabetes and other age-related conditions. For this reason, Dr. Smiley are extra strict when dealing with patients over the age of 65—i.e., he requires them to present medical clearance and to undergo comprehensive physical evaluation to ensure that they can handle the surgery.
To further ensure the safety of facelift at 70, aspirin, non-steroidal anti-inflammatory drugs, and supplements with blood thinning properties are discontinued 2-3 weeks before surgery and a week afterward, said Dr. Smiley.
The axillary lift is a type of body lift commonly performed in massive weight loss patients. This procedure deals with the redundant skin and fat along the armpit, which not only causes unsightly bulges but also poor odor, skin rashes, and non-healing irritation.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the axillary lift on his Snapcat account. He performed the surgery in a female patient who had lost a lot of weight and so she was left with redundant skin.
The celebrity surgeon created a wedge-shaped incision covering the armpit and the lateral chest, thus allowing him to remove a large amount of skin and fat. The wound was then closed in a way that the resulting scar would lie parallel to the transverse armpit fold.
Dr. Smiley says it is of critical importance to remove just the right amount of redundant skin to allow for proper wound closure and to prevent limited activities of the arm.
“We should strike the perfect balance between creating a tighter, smoother armpit area and avoiding too much tension, which happens after an over-aggressive skin resection,” says Dr. Smiley.
Hence, he highlights the importance of the surgeon’s experience and “eye for details” when performing any type of body contouring surgery after weight loss.
The resulting scar from the axillary lift could migrate or appear conspicuous if there is too much tension on skin. For this reason, Dr. Smiley always closes the wound in several rows so the tension on the superficial layer is mitigated, which also allows for good healing.
To further promote favorable scars, he recommends silicone sheets and gels as they hydrate the skin. Wound that heals in a moist environment is known to fade better.
Occasionally, the axillary lift is combined with other body contouring surgeries such as brachioplasty (arm lift), arm liposuction, and even breast surgery, says Dr. Smiley.
Eyelid surgery after care may differ from surgeon to surgeon, thus a prudent patient will only stick to her doctor’s specific advice. The main idea of postop care is to keep swelling and bruising to a minimum, ultimately resulting in shorter social downtime.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains his eyelid surgery after care tips.
* Pain Control. Most patients will only experience minimal discomfort that can be easily managed through acetaminophen such as Tylenol for a few days. Others do not even require medications.
* Head elevation for a few days. The goal is to keep swelling to a minimum and thus promote shorter social recovery, which typically occurs after 1-2 weeks.
* Cold therapy. In the first 48 hours cold therapy can control the amount of swelling; however, it should not be applied for more than 15-20 minutes at a time to avoid cold burns and blisters.
* Avoid or at least limit the consumption of alcohol and salty foods during the initial healing stage (2-3 weeks). They can cause fluid retention and thus aggravate the amount of swelling.
* Never rush one’s recovery. A good rule of thumb is to avoid rigorous activities that can result in increased heart rate and blood pressure for a minimum of three weeks. Nonetheless, bed rest is not good because it can lead to lethargy and may even aggravate swelling.
* Avoid activities that can dry the eyes. In the first week postop, activities that may dry up the eyes—e.g., using computer, watching TV, reading, and wearing contacts—must be avoided.
* Wear large dark sunglasses. The idea is to protect the sensitive eyes from harsh elements such as the wind, sun, and small particles.
* Expect 1-2 weeks of social downtime. Some patients may return work a week after their surgery, although they will most likely need a camouflage make-up to hide the outward signs of their surgery. At 2-3 weeks of their recovery, meanwhile, they can go outside without wearing eye make-up.
* Avoid drugs and supplements with blood thinning properties. These are best avoided 2-3 weeks before surgery and about a week afterward to prevent bleeding and persistent swelling and bruising.
High profile breast implants offer the most amount of forward projection relative to their [narrow] base diameter. For this reason, petite women—i.e., having slender torso and chest width—might be a good candidate for such design; this is particularly true if they want more obvious upper pole fullness.
Another perceived benefit of high profile breast implants is they appear bigger than low or moderate profile implants of the same size. Hence, patients with very little tissue who want to go big but are concerned about the increased risk of palpability and rippling may choose this “route” instead.
Despite the perceived benefits of high profile breast implants, the truth is they are not suitable for everyone. To achieve natural results and avoid a gamut of complications, a good rule of thumb is to measure the patient’s anatomy, particularly relating to breast and chest width and soft tissue coverage, during the implant selection process.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says he always starts the implant selection process by taking the breast and chest dimension. The goal is to use implants that are not too wide nor too narrow for the chest wall, he further explains.
Should the implant is too wide on the chest, the result is a top heavy appearance, and when too narrow for the torso the breasts may look like a torpedo. Simply put, a good surgeon must be able to strike the perfect balance between meeting the patient’s cosmetic goals and delivering natural-looking results by respecting the anatomy.
High profile implants in general do no suit women with wider chest wall because the diameter of their base is not enough to occupy the breast’s horizontal dimension, which in turn could lead to a torpedo-like breast. For these individuals, low or moderate profile implants are the right choice.
Low profile implants have the least amount of forward projection in relation to their [wide] base diameter. They suit women with a markedly wide chest wall.
Meanwhile, moderate profile implants are perceived to provide the most natural result (i.e., what “un-operated” attractive breasts look like) because they provide no excess upper pole fullness.
While the patient’s underlying anatomies will play a critical role in the implant selection process, Dr. Smiley says having lengthy consultation and honest communication between a surgeon and his patient will further ensure results that will satisfy both parties.