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With the increasing demand for facelifts in the 1970s, greater efforts were made to develop cosmetic surgical techniques to achieve natural-looking results. These efforts have led to a number of different facelift techniques, the most recent of which is the 5D Facelift with Dr. Tarek Zahra, Consultant Plastic Surgeon.

• The 5D Facelift differs from traditional facelift techniques that address only the skin and superficial tissues because it involves lifting and repositioning the deeper facial structures, resulting in a comprehensive and natural-looking rejuvenation with longer-lasting results. 

• The 5D facelift offers multiple benefits in a single procedure. This surgery allows for the repositioning of accumulated fat, improving facial contours, correcting a sagging chin, and tightening the skin. The goal of the 5D facelift is not only to reverse the signs of aging but also to sculpt the face and restore a more youthful, natural appearance.

• The incisions used in a deep facelift are smaller than those in a traditional facelift, allowing for easy lifting of the deep connective tissues and facial muscles around the mouth corners and chin.

• A deep facelift starts from the back of the jawline to the outer corner of the eye, where soft tissue begins to sag with age.

• The 5D deep facelift releases four ligaments and stabilizes connective tissue and muscles. This ensures the face is re-tightened, resulting in a natural and noticeable improvement. Traditional facelifts stretch the face by holding the ligaments in place. Therefore, the deep facelift is safer, as it maintains the thickness of the skin's surface, so it reduces the risk of skin injury or necrosis.

• One of the most notable advantages of the 5D deep facelift is its long-lasting results. Unlike some traditional facelift procedures, which may require short-term adjustments, the deep facelift technique delivers lasting results. Therefore, clients can enjoy their rejuvenated appearance for over 10 years.

A facelift aims to restore youthful features. It involves a series of pre-determined steps, where the skin is opened, followed by the muscles. Dr. Tarek Zahra then tightens the muscles by a specific degree and in a specific direction.

The most important concern is to have enough facial tissue available to properly reconstruct the face. If more tissue is needed, the face can be reconstructed using autologous fat during the same surgery, and it usually goes smoothly.

Facelift surgery with permanent filler removal is similar to what is known as "free-style surgery”, as there is no fixed method to follow. The surgeon addresses the adverse effects the permanent filler has caused in the tissues and rebuilds accordingly, for example, by grafting tissues taken from other areas (the neck, in front of the ear, or the other side of the face) to achieve symmetry between the right and left halves of the face. 

Often, the right side differs from the left due to filler effects, with significant tissue loss and sometimes nerve or muscle injury, which requires reconstruction to achieve a natural, harmonious result.

Facelift surgery with permanent filler removal has no set procedures. It relies heavily on the plastic surgeon's experience in determining the right intervention required for each case and is tailored to each individual. Every face has its own unique characteristics, and each client has his own genetic traits, which Dr. Tarek Zahra, Consultant Plastic Surgeon, studies. Some patients have genetically weak or sagging faces, while others have excessively full faces.

• Grafting of a layer of skin, dermis, fat, or even nano-fat.

• Removing some cheek fat.

• Double chin liposuction.

• Neck lift.

• Client's age.

• Facial structure.

• Effects of permanent fillers.

• The need to remove or graft tissue.

• Filler migration: Filler migration refers to the movement of filler from its original injection site to adjacent areas. Migration occurs as a result of the inexperience and skill of the injector, unlicensed injection sites such as beauty salons and homes, excessive filler amount, or repeated injections at short intervals. This problem often occurs with lip fillers, causing the lips to appear unnatural and uneven.

• Appearance of lumps and bumps: Sometimes small lumps or bumps appear under the skin after filler injection due to the uneven distribution of the filler.

• Allergic reaction: In rare cases, side effects may occur, such as severe pain at the injection site, skin discoloration, or blurred vision. These symptoms indicate a blood vessel blockage due to the filler accidentally entering it. This is an emergency and requires immediate medical attention.

Permanent filler is a solid, non-liquid substance, so it cannot be easily suctioned, aspirated, or squeezed out. Non-surgical removal attempts have a success rate of less than 20% and can lead to adverse outcomes, such as the spreading of the filler into tissues or causing it to harden and adhere to muscles, making subsequent removal more difficult. Repeated liposuction cannula insertion can lead to facial sagging due to damage to the facial muscles.

Also, suction attempts sometimes remove facial fat instead of the filler, leading to facial volume loss, altered contours, and muscle sagging, while the filler is still partially present.

Therefore, Dr. Tarek Zahra, Consultant Plastic Surgeon, recommends first performing an MRI to determine the type of filler:

• If encapsulated (filled capsules): it is best to remove surgically with tissue reconstruction.

• If it is oily and injected into the home: it spreads into very small dots; if it does not have a negative aesthetic effect and does not cause inflammation, it can be ignored.

• The worst type (sand-like), often injected in beauty salons: it causes abnormal enlargement in the face, and if the person’s face is acceptable, it may be left without intervention.

Overall, Dr. Tarek Zahra, Consultant Plastic Surgeon, emphasizes that attempting to remove these types of fillers using aspiration is wrong and completely unsafe decision. Therefore, this method should be avoided to preserve tissue integrity and aesthetic results.

Dr. Tarek Zahra, Consultant Plastic Surgeon, emphasizes that the first goal of any nasal surgery must be to preserve nasal function, followed by the cosmetic aspect. The primary function of the nose is to allow adequate airflow without triggering allergies, airway obstruction, narrowed nostrils, or snoring. Therefore, any functional problems must be addressed first, followed by the aesthetic aspect of the nose.

Purely cosmetic rhinoplasty that ignores function or fails to reinforce the cartilages supporting the airway can lead, over time, to scar tissue (fibrosis). Initially, the nose may look fine, but as healing progresses, scarring can shrink the nasal openings and reduce airflow—especially if the nostrils were over-reduced to follow trends and fashion. After several months, the openings may become significantly constricted, breathing becomes difficult, and tissue damage can be extremely difficult to repair.

Ultimately, rhinoplasty should prioritize function over appearance. Some doctors yield to clients' requests for excessive nasal reduction to resemble celebrities or follow a trend, which can lead to severe nasal congestion, inadequate airflow, and even a change in the voice over time. Dr. Tarek Zahra, therefore, insists on preserving the nasal function, rather than sacrificing it for looks.

Smoking doesn’t just increase complications during facelifts; exposure to other kinds of smoke, such as incense, can also harm the outcomes. Dr. Tarek Zahra achieves exceptional facelift results using advanced techniques, so it’s important to follow his instructions to abstain from smoking to ensure the best results and avoid complications.

Facelifts involve lifting skin, tissues, and muscles, which require adequate perfusion through blood vessels that supply these layers with the oxygen and nutrients needed for recovery. 

Smoking and exposure to incense smoke cause vasoconstriction, resulting in a lack of oxygen and nutrients reaching the treated tissues. 

Because facelifts already remove excess skin and tighten the remaining skin—compromising some primary vessels—any nicotine product (e-cigarettes, nicotine patches, etc.) further affects the remaining vessels needed for blood flow, slowing recovery.

Smoking leads to multiple complications in facelift operations, such as:

• Poor wound healing and loss of skin elasticity in some areas, such as the cheeks.

• Infection.

• Death of fat cells, leading to the appearance of solid lumps.

• Impaired collagen production during recovery, hindering proper skin healing.

• Blood clots.

• Increased pain.

• Chronic smokers are more likely to develop respiratory disorders and heart disease, putting them at increased risk for complications from anesthesia, such as stroke, heart attack, and pneumonia.

Accordingly, Dr. Tarek Zahra recommends stopping smoking at least three weeks before and after surgery, avoiding secondhand smoke, and avoiding incense exposure—even a single exposure can trigger complications. If a patient has smoked right before surgery, it’s better to postpone the procedure than risk these serious issues.

 

Nano fat enhances skin beauty and radiance after facelifts by extracting the individual's own fat, processing it, and converting it into nano fat (tiny fat particles less than 0.1 mm in diameter). These fat particles contain high concentrations of stem cells and growth factors that help rejuvenate the skin.

The fat used is extracted using the latest liposuction technology from specific areas of the body, such as the abdomen and thighs, then finely emulsified until it becomes a fluid. It is then injected easily into targeted facial areas.

Adipose tissue acts as a natural reservoir for stem cells. Nano-fat contains large, concentrated amounts of stem cells of various types, which offer multiple benefits when injected after facelifts, such as:

• Giving the skin radiance and freshness, and providing a more youthful appearance in the long term.

• Getting rid of pigmentation and dark patches on the face.

• Enhancing the results of a deep facelift, as it is used in all cases, achieving results that last for a year or more; it can also be re-injected due to the simplicity of the procedure.

• Additional skin tightening after a facelift.

• Treating fine lines and scars resulting from acne.

• Reducing the chances of sagging, while achieving a better skin texture.

• Providing a natural solution for many skin problems.

• Nano Fat does not cause any complications and is considered a better solution than filler injections.

• Improving blood circulation in the skin after a facelift, thus providing faster recovery periods.

• Skin renewal and delayed signs of aging thanks to growth factors that stimulate collagen production.

Nano Fat is used for all facelift procedures without prior filler injections. However, if filler injections have already been performed, it is recommended to wait 4 to 6 months to ensure tissue recovery and achieve lasting results.

Nano fat doesn't plump or add volume to the skin, as it doesn't contain whole fat cells that contribute to greater volume in certain areas of the face. However, another type of facial fat injection, micro fat, is used after facelifts to add volume to the cheeks or treat facial depressions, especially after the removal of permanent fillers.