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Facelift surgery is not just about lifting the skin and soft tissue of the face; a more important goal is to deliver results that look natural, with no “stigmata” or visible signs of the procedure.

Aside from your surgeon’s credentials—such as his board certifications, plastic surgery affiliations, training, and relevant experience—you should also scrutinize his facelift before and after photos, which will reveal a lot about his artistic skills.


Most surgeons’ who maintain a website also make some of their before and after photos accessible online.

Leading Los Angeles plastic surgeon Dr. Karan Dhir explains the variables that you should look into when gauging the “after” facelift photos.

  1. There should be no visible scars. The incisions used in any facelift procedure are within the ear’s contour and/or behind the hairline to hide the scars, although excessive tension on the skin and incorrect direction of pull could lead to scar migration.
  1. The hairline and side burn should look normal. They should maintain their preoperative appearance before the surgery is considered a success.

Meanwhile, the disappearance or distortion of side bun and lack of hairline “continuity” are telltale signs of the surgery that must be avoided at all cost. Should they appear, you may need to undergo hair transplantation, scar excision surgery, or skin flap rotation.

  1. The ears in the after photos should maintain their original position and appearance. Pixie ear deformity is arguably one of the most blatant signs of surgery since it appears “pulled” inferiorly.

To correct the pixie ear deformity, the earlobe must be released from the lateral cheek and then reattached in a higher position; it is equally important to use a layered wound closure to eliminate or at least reduce the tension on the skin.

In addition, the ears in the after photos should have no excessive fullness in front of the ear canal, which is generally caused by under-correcting the loose, excess skin.

  1. The overall result should look balanced. A good facelift should also include the neck to achieve a more rejuvenating effect; failure to address the signs of aging in the lower third of the face will make them appear more obvious.

While facelift does not completely eliminate all the signs of aging, the postop appearance of the jaw line and neck area should appear smoother and tighter than the “before” photos.

  1. The result should look smooth, not overly tight. Nowadays, skin-only lifts are rarely used because they can lead to “surprised” or windswept appearance, flat cheeks, distorted hairline, and slanted eyes.



Contrary to popular belief, the goal of breast augmentation procedure is not just about creating a bigger cup size, but more importantly, to deliver results that look and feel natural.

Good results from the procedure is only possible in the hands of a qualified plastic surgeon, or to be more specific, a board-certified doctor who regularly performs the surgery and has impressive breast augmentation pictures.


(Note: The general rule of thumb is to choose a member of the American Board of Plastic Surgery, which is recognized by the American Board of Medical Specialties. Meanwhile, there is no recognized certifying board with “cosmetic” or “aesthetic” surgery in its name.

You can visit ABPS website or its online database to check if a surgeon is a member of this reputable certifying board.)

All plastic surgeons have before-and-after photos to showcase their artistic skills and also help their future patients make an informed decision, as suggested by Beverly Hills plastic surgery Dr. Tarick Smaili.

Take a look at the breast contour of the “after” photos. They should appear like a teardrop, with most of the volume in the lower poles while the upper cleavage must look concave rather than globular—unless there is a specific instruction from the patient who wants exaggerated fullness in the area.

A slight lateral bulge is also deemed attractive as it contributes to the hourglass figure, although remember that one’s underlying anatomies also affect the final appearance, says Dr. Smaili.

You should also look at the distance between the lower edge of the areola and the inframammary fold, which primarily depends on the breast size although for the “average” women it is normally 5-6 cm. But in general, the bigger the cup, the greater the gap tends to be.

Once you are confident with a doctor’s qualifications, you may schedule a consultation with him. This will allow you to assess his “principles” and surgical approach that will help you achieve your desired results from breast augmentation procedure; it is equally important that you are comfortable with that provider.

During consultation, ask for the chance to talk to some of your surgeon’s patients who have undergone the procedure. This is also an opportunity to prepare yourself emotionally and psychologically during the initial healing stage when pain, lethargy, bruising, and swelling will contribute to your “postop blues.”



It is not uncommon for the breasts to appear too high on the chest wall after breast augmentation surgery, although they are supposed to “drop” or “settle” in three to six months, resulting in a more natural appearance.

Take note that it takes time for the breast skin and soft tissue to adjust to the new contour, thus high-riding implants are not uncommon during the initial breast augmentation recovery. Meanwhile, the postop swelling further aggravates the appearance of “excessive” upper cleavage.


While high-riding implants are not uncommon during the initial healing stage, leading Los Angeles plastic surgeon Dr. Tarick Smaili instructs his patients to perform regular massage, or medically referred to as implant displacement exercise, to accelerate the “settling.”

Breast implant massage is also known to maintain the natural softness of the breast tissue and internal scar tissue that forms around the device, explains Dr. Smaili.

Other postop solutions for high-riding breast implants include compression garments and upper pole bands, although Dr. Smaili says time remains the best “treatment.”

Remember that the aforementioned solutions will only accelerate the settling of the implants, and any high-riding appearance that remains “stubborn” after four to six weeks will always need a revision breast augmentation, warns the leading Los Angeles plastic surgeon.

To prevent excessive fullness in the upper breast pole, Dr. Smaili highlights the importance of correct implant pocket dissection. One way to do this is to perform the surgery while the patient is sitting up, a technique that allows any surgeon to correctly assess the breast size, projection, and contour.

To further create natural-looking results, Dr. Smaili says that some patients may require their inframammary crease to be lowered; the idea is to position the implants approximately at the center of the breast mound, behind the nipple area.

Also, the additional distance between the inframammary fold and nipple area might also create some lifting effect, further contributing to the perkier, more youthful appearance.

In addition, using the correct breast implant base diameter (side to side dimension) and size also plays a crucial role in simulating the natural projection and shape. The general rule of thumb is to respect and acknowledge the existing measurement of the breasts.

Meanwhile, an implant whose base and profile goes beyond the existing dimension of the breast can lead to “over-projection” and excessive upper breast pole fullness. Other possible results include palpability, rippling especially along the sides, and globular/unnatural shape.



The reasons for facelift revision surgery vary from patient to patient. Others want to regain the impressive results of the initial procedure that they lost due to continued aging, while some need correction of hairline and ear deformities due to a poorly executed surgery.

Facelift surgeries often use an incision that starts in the hairline at the temple, which continues around the ear; however, there are “shorter versions” that lead to shorter scars. The idea is to hide them behind or within the hair-bearing scalp, and inside the natural creases of skin.

facelift ear scars

Aggressive or incorrect direction of pull is one of the causes of unnatural temporal hairline, loss of side burn and hair behind the ear, and bald patches around the incisions. While some hairstyles could camouflage them, most patients will want to correct these telltale signs of surgery.

The aforementioned problems are typically treated with hair transplantation in which hair follicles from the back of the scalp are moved to the area that needs correction or “coverage.” But to achieve impressive results and avoid the doll’s hair appearance, it is crucial to group the hair in smaller units.

Other possible methods to correct the distortion or loss of side burn and temporal hairline include scar excision surgery and skin flap rotation, with the latter being more suitable for patients who need their hairline “continuity” to be restored.

Regardless of the approach being used, it is a sacrosanct rule to use a tensionless, layered wound closure, as suggested by Beverly Hills plastic surgery expert Dr. Tarick Smaili.

Another reason for facelift revision surgery is to correct ear deformities—e.g., excess skin or too much fullness in front of the ear, pixie ear or “pulled appearance,” and visible facelift ear scars.

Fullness in front of the ear is usually corrected with a minor procedure (under local anesthesia) in which a small portion of skin is removed in front of the ear canal.

A pixie ear deformity, meanwhile, is best addressed by releasing the earlobe from the cheek skin then reattaching it in a higher position. It is also crucial to close the tension with no or very little tension on the skin to prevent the ears from stretching inferiorly.

And for the facelift ear scars that appear visible—i.e., they migrate outside the contour of the ears—treatments such as scar excision, steroid injection, silicone tapes, and topical creams could improve their appearance.



Facelift for jowls comes in several incision patterns because aging differs from patient to patient; further complicating things is that each of them has a different underlying anatomy. The general rule of thumb is to customize the surgery to achieve impressive, natural-looking results.

Jowls might be caused by several factors such as redundant skin, excess fat, soft tissue or fat atrophy (receding or disappearing), or cheek fat that has sagged to a significant degree. For some patients their jowling is caused by two or more variables, thus careful analysis must be done to achieve good results.


For most patients their jowl can be addressed by a SMAS facelift procedure in which the connective tissue below the skin is reshaped and tightened, creating strong framework and results that can last longer than a skin-only lift.

The length and position of incision greatly varies, although the general rule of thumb is to place it behind the hairline and/or “inside the ear,” or specifically within the natural skin creases. The idea is to hide the scars that no one can detect them even at a conversational distance.

SMAS facelifts not only reshape and tighten the jaw line, but also correct the appearance of nasolabial folds, or more commonly referred to as “laugh lines,” as it can elevate the corners of the mouth.

Another benefit of going deeper is the “favorable” scarring—i.e., fine flat scars that are barely imperceptible. Because most of the tension is on the SMAS layer, which carries the skin, the wound can heal without the unnecessary pull.

Skin-only facelifts, meanwhile, are often criticized for their thicker, wider scars because the skin receives most of the tension. Another downside is the short-lived results because the deeper structure of the face has not been tightened and reshaped.

Aside from loose skin, fat or facial volume loss might also contribute to the appearance of jowling, with the deep laugh lines further aggravating the aged look. In this situation, volumizers such as dermal fillers or fat grafting can be of great help.

The idea of combining SMAS facelift and volumizers is to address facial aging in a 3D approach, thus creating a more natural and more rejuvenated appearance without having to worry about the windswept or perennially surprised look.

Meanwhile, some patients can benefit from a minimal facial liposuction to correct the appearance of jowl, although the soft tissue must be tightened as well if they appear hanging. Nevertheless, it is crucial to preserve some fat to avoid the jaw line from appearing skeletonized.

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