Stem Cells, Fat Grafting, & Facelifts

The facelift operation as practiced by Board Certified Plastic Surgeons continues to relentlessly evolve as surgical science and cell biology uncover new applications which can be utilized to improve our already outstanding results.  Responding to the wishes of our patients, operations have tended to become less invasive and shorter in duration with less swelling, bruising, and a much shorter down-time.  The short scar facelift has seen a resurgence with new and original methods of dealing with the SMAS, such as our progressive, multiple vector SMAS plication.  The blending of the improved mid-facelift with the lower eyelids and less invasive neck surgery when possible had been our idea of a modern facelift.  Due to the teachings of Sydney Coleman in New York City, we added structured fat grafting to our lips much improving the perioral area and enhancing the cheeks and what has been architecturally described as the facial “ogee.”  I believe fat grafting as now practiced was a huge step forward in facial rejuvenation completely replacing foreign body fillers such a Juvederm® and Restylane®.  In some circles, the efficacy of fat grafting is still questioned even as the evidence of graft takes in the 80-95% range are routinely described.  Over the last couple of years, the basic science of cell biology has given us new information on adipose biology and the nature of adult adipose derived stem cells.  The term “stem cell” occupies front page position in almost every modern women magazines.  Until recently, it has been unclear how this new information could be applied to Plastic Surgical science.

The evolution of stem cell biology including the fact that we could isolate stem cells from our own body fat seemed almost too good to be true.  Rather than throwing away the fat we obtain with liposuction, we can now take this fat, process it in the office, obtain stem cells, and then utilize the stem cells for improving fat graft take even further as well as adding growth factors to the fat grafts that have a beneficial effect on aging skin.  Body contouring with liposuction complimenting facial rejuvenation is truly a “scots” efficiency as Dr. Ralph Millard would say.  The beneficial effect of growth factors on healing and facial skin aging has been known for several years, but exactly how to utilize this knowledge never progressed after the discovery of its use as “fibrin glue.”  More recently, we have added platelet rich plasma (PRP) obtained by drawing blood at the onset of the surgical procedure, processing the blood to get PRP which adds large quantities of growth factors when added to fat and fat stem cells used for facial contouring and rejuvenation.  All of these biologic enhancements to fat grafting are obtained from the patient and therefore are autologous with no problem with rejection such as that which occurs with foreign body fillers.

To summarize our current facelift techniques, incisions are of the “short scar” variety, the SMAS is handled with progressive tension suturing in multiple vectors, micro-drains are used for 24 hours to reduce bruising, the glabella, cheeks, lips, chin, and perioral areas are enhanced by fat grafting augmented with stem cells and PRP.  Cost controls include doing the procedure in the office with local anesthetics and mild sedation.  The sum of these procedures we like to call the “Howard Lift” for lack of a more descriptive term.

Read more about top facelift surgeon Dr. Paul Howard in Birmingham, Alabama.

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How Smart is the Smart Lift?

The Smartlift™ facial surgery procedure is the latest trademarked surgery marketed directly to the patient as an answer to facial aging problems.  The Smartlift™ procedure differs significantly from the copyrighted or trademarked procedures in that the so-called Lifestyle Lift® is based on the aggressive marketing of a procedure (the Lifestyle Lift®) which only distinguishes itself by its simplicity leading to certain claims of reduced recovery and reduced operative times leading in some way to superior results.  The Smartlift™ is different in that the sales pitch has to do with technology rather than the marketing of a procedure.  The Smartlift™ is the facial rejuvenation procedure performed with the Cynosure® laser used for the laser assisted Smartlipo® procedure.  While the use of the Cynosure MPX® laser is accepted for liposuction, it is less accepted in the face and may be contra indicated when used to liquefy facial fat.

The Smartlift™ is the use of a laser underneath the surface of the skin (internally) as opposed to other laser platforms used on the surface of the skin (externally) resurfacing for fine lines and wrinkles.  The premise behind using a laser as an adjunct for facial rejuvenation is that due to the heat generated by the laser, facial skin contracts causing some small amount of skin tightening.  At the same time, the skin is heated and the laser emulsifies the facial fatty tissue violating the premise that you shouldn’t remove fat from the aging cheek.  The Smartlift™ is the procedure using the laser as described above to effect facial skin tightening with no actual surgical lifting performed.  Even with the addition of CO₂ fractionated laser to the external surface of the skin, the actual skin tightening is minimal.   With the aggressive attempt to tighten the facial skin by internal heating one runs the very real risk of removing facial fat excessively leading to a fairly dramatic skin laxity and worsening of the facial aging signs as well as severe skin contour deformities.

Dr. Paul Howard - Facelift Plastic Surgeon Birmingham, Alabama

The patient above is a 65-year-old woman 11 months after having the so-called Smartlift™ facial procedure on her sagging neck and aged jaw-line.  Additionally, she had upper and lower blepharoplasty.  She related her request for improvement in her aging face, neck, and eyelids after the Smartlift™ laser procedure.

The first challenge was to re-drape the skin of the neck which was no small feat due to effects of the laser on the submental fat and skin.  The jaw-line, cheeks, marionette lines, and nasolabial folds were addressed with a midface lift.  The cheeks were blended with the lower lids and the upper lids re-done.  Fat was liposuctioned from her abdomen, processed and enhanced with her stem cells to be injected in her nasolabial folds, lips, chin, and marionette lines.  Her neck continues to be a problem and has required several steroid injections to help soften the scarring caused by the Smartlift™ lift.  It has come to my attention that the Cynosure Corporation through its marketing people are now touting several other procedures based on the Smartlipo® laser with the addition of incisions in the mini-lift pattern as well as the full facelift incision pattern.  Succumbing to the philosophy that all of these procedures deserve a trademarked name, i.e. the mini-lift plus laser is the “Ultra mini-lift™,” the full facelift plus laser is the “Laser Smartlift™.”  I was surprised that the “Ultra Mini Smartlift” was kept out of the marketing “lift” bonanza.

Read more about Dr. Paul Howard and his popular Howard Lift Facelift in Birmingham, Alabama.

Unveiling the “Lifestyle Lift*” by Paul S. Howard, MD

The Truth about the marketing madness

One of the most disturbing aspects of medical care as practiced today is the unpleasant
marriage of medicine and industry creating what is known as the medical-industrial complex.  The medical-industrial complex is manifest in many ways including the extinction of the private, solo medical practitioner and the rise of things like copyrighted medical procedures.  In the not too distant past, most doctors were solo practitioners and thus provided the kind of medical care that made physicians respected and pillars of the community.  Among surgeons the attempt to copyright a surgical procedure is distasteful as the important surgeons we have known in our training taught surgery without taking credit or financially benefiting from their ideas and procedures, even if revolutionary in nature.  If an operation shows particular promise and represents a true advancement in medical care, it is usually submitted to a peer reviewed journal where its merits are debated among professionals in the field and either accepted for publication or not, depending on the originality of the idea and its ability to advance medical knowledge, but never for financial gain.

The recent introduction of the copyrighted named surgical procedure uncovers one of the weaknesses in trademark and copyright law as the procedure on which the trademark is licensed does not have to be in any way original except the name itself has to be unique.  The only reason to give an operation that is not original a trademarked name is for the purpose of marketing for financial gain.  Many less informed patients may believe that a trademarked name for a surgical procedure implies that the procedure, whether unique or not, is the most important aspect of patient care usually proven with a slick marketing plan.  It is clear that the “named” procedure is of minuscule importance when compared to the ability of the surgeon and whether the procedure is the correct one to treat the problem addressed.

The “Lifestyle Lift” is the latest marketing madness purposing a questionable procedure by marketing the name rather than the credentials of the physicians who perform the trademarked “Lifestyle Lift.”  I suspect that on occasion the “Lifestyle Lift” may actually provide a satisfactory result, if by luck the right patient sees the advertisement and gets a surgeon provided by the company, who performs the procedure resulting in a happy patient.  I get to see the results of the “Lifestyle Lift” and are asked to explain why such a well marketed operation did not accomplish the facial rejuvenation promised.  Many times, the patient dissatisfaction results from the limited improvement on the cheeks only while the neck, eyes and mouth, of equal importance, are not addressed with the “Lifestyle Lift.”   Most plastic surgeons find that addressing all of the aging issues usually allows the procedures to be “blended” together for optimal results.

Life Style Face Lift Revision Surgery

Alabama facelift specialist Dr. Paul Howard is a Board Certified Plastic Surgeon in Birmingham, Alabama. To schedule a consultation with Dr. Howard, call 205-871-3361.

*The LifeStyle Lift is a registered trademark, registered by Lifestyle Lift Holding, Inc. Michigan.

The Misunderstood Facelift

Facelift procedures have been a part of the plastic surgery lexicon since the early 1900’s. At that time, there were no board certifications, Teddy Roosevelt was President, the Great World Wars had yet to begin and antisepsis and anesthesia were in their infancy. Against this backdrop of medical history facelifts, eyelid surgery, and rhinoplasty were performed in doctor’s offices and in front of crowds of people for marketing purposes. Howard Crum, MD wrote of his experiences with live surgery demonstrations in front of “thousands” of rapt on-lookers as well as a number of psychologically disturbed voyeurs hoping to see some blood and maybe a mishap or two. Cosmetic surgery was done in hotel lobbies, at conferences, and in ballrooms to standing-room-only crowds punctuated with a police presence. The surgeons performing these dramatic operations were the “rock-star” doctors of the day carrying reputations about reproach. As the market for these surgeries expanded the number of unscrupulous practitioners increased dramatically. The unskilled and poorly trained surgeons were making a mockery of cosmetic surgery and in fact, became dangerous to the point where one such surgeon tried to make a patient taller by breaking her legs and resetting the normal bones. Unfortunately, the patient lost both of her extremities. Reputable surgeons responding to these rogue doctors tried to limit physician marketing seeing these advertisements as a way to circumvent the tried and true patient referral sources which tended to enrich doctors with good results at the expense of those whose results were not as good. Marketing expertise had taken the place of surgical expertise. Plastic surgical training programs began to spring-up across the country after WWI where the horrific injuries associated with “trench” warfare were shipped to England and the USA for reconstruction. The best surgeons were on the front lines of repairing war injuries and as far back as the 1920’s Sir Harold Gillies of England and New Zealand was of the early proponents of the so-called “cosmetic reconstruction.” That is, reconstructive surgery of the face with the ultimate goal being not only a good or reasonable appearance but an attractive face. Dr. Gillies and his famous trainee, Dr. Ralph Millard, wrote a textbook to this effect in 1954 and Dr. Millard continued to be the “poster child” for the relationship between reconstructive and cosmetic surgery. It sounds foolish and ignorant for a surgeon to claim some sort of providence in facial aesthetics yet offers no educational training or pertinent experience as a surgeon to back up their improvable claims of superiority in our field of plastic surgery. In fact, aesthetic considerations are so pervasive in the plastic surgery residency that almost every patient and every challenge, whether cosmetic or reconstructive, is evaluated under the prism of Drs. Gillies and Millard. We aspire to surpass the normal and attempt to achieve the “Ideal Beautiful Normal” (D. Ralph Millard, MD).

Trying to answer the question “who are the best cosmetic surgeons” is impossible because the question applies to each individual surgeon and not entire groups of surgeons. On a group basis, competence can only be determined by training and education, and subsequent board certification and not by marketing skill.

Dr. Howard has been a Top Facelift Plastic Surgeon for over 20 years.  To learn more, please visit his web sites:

Read more about top facelift surgeon Dr. Paul Howard in Birmingham, Alabama.

Read more about Dr. Paul Howard’s popular short incision face lift with no general anesthesia.

The Mid-Facelift by Paul S. Howard, MD, FACS

Facial aging is complicated by genetics, environment, sun damage, smoking, and drinking.  There is not a single procedure that works for everyone, therefore it is important that individualized evaluation leads to an operation which is specific for that person.  The uniqueness of all faces as well as the patient’s desires may lead to a slightly different surgical approach for each individual.  Another way to say this is that the one-size-fits-all facelift has become antiquated.  To facilitate individualized care we prefer to look at each part of the face separately leading to a unique surgical treatment plan.

We divide the face into its component parts; forehead, eyes, midface, and neck with primary emphasis on the midface.  Midface aging is characterized by sagging of the facial soft tissues causing a deepening of the nasolabial folds, dark circles beneath the eyes, and the development of marionette lines from the corner of the mouth to the jaw line.  The jaw line becomes less defined as the sagging facial soft tissues drop below the mandible causing jaw line “bubble.”  In addition to the sagging soft tissues aging always involves a loss of volume and a loss skin elasticity.  It is the surgeon’s charge to address individual manifestations of aging for each component part of the face.  Elevating the soft tissues must be done and requires a specific vector or direction of elevation which may be unique for each face.  This maneuver defines the jaw line, improves the deep nasolabial folds, addresses the marionette lines, and elevates the lower eyelid skin.  This procedure is always required and must be performed accurately with minimal incisions.  Elevation of the cheek tissues is so important that it must be done under direct vision with the results being technique dependent.  The incisions are much less obvious than the old facelift scars.  While elevating the cheek and malar tissues some augmentation of the malar prominence (cheek bones) is achieved.  The need for additional volume can be affected by adding autogolous fat to the procedure.  As a rule of thumb, we rarely, if ever, remove fat from the midface but frequently add fat back to replace the soft tissues we lose over time.

The next issue to be addressed is the blending of the cheek elevation with the lower eyelids.  These procedures are typically done together; that is lower blepharoplasty and midface lift.  The elegance and effectiveness of the midface lift sets up the rejuvenation of the remaining parts of the face.

Dr. Paul Howard

Read more about Dr. Paul Howard’s minimal incision face lift with no general anesthesia.