Board Certified
Plastic Surgeon
Since 1989


Halloween may have passed, but scary results from poorly performed cosmetic surgery continue. In the words of a registered nurse, “One woman I took care of recently had terrible scarring around the ears from a badly done facelift by a ‘cosmetic surgeon’ she later found was not a plastic surgeon. He was really an ENT man, (an ear, nose and throat surgeon), but he hadn’t been board certified in plastic surgery,” she recalls. “The scars behind her ears were wide and thick, and she was complaining that her earlobes were lopsided and misshapen.”  The nurse continues, ““It happens all the time. I hear there’s a gastroenterologist who’s doing liposuction, because he took a weekend course. So now he has a certificate in lipoplasty!”

Despite these frightening stories, the benefits of cosmetic surgery are far more positive when placed in experienced, skilled hands. For example, my full and partial MACS, (Minimal Access Cranial Suspension), procedures lift the saggy deep tissue which presents as deep nasolabial folds, jowls and ‘turkey’ bands. This is accomplished by using strong permanent sutures that are weaved into the deep tissue and anchoring them to higher, strong structures such as bone etc. This method provides longevity to the facelift. Additionally, the skin is elevated vertically, creating a very youthful and natural look. This procedure is suitable for both young and mature patients with different skin laxity and tone.

Today’s facelift surgeries are much different than in the past. There are numerous techniques used, depending on the age of the patient, as well as the condition of the skin, and amount of laxity. Some techniques address the skin’s surface only, while others go deeper into the underlying tissues. In addition, a full facelift will address the entire face, while a forehead lift, cheek lift, or neck lift, addresses the top, middle, and/or bottom sections alone. Some of the more common variations are Skin Only, SMAS Facelift, Deep Plane Lift.


Skin only: Also known as a cutaneous facelift, this facelift procedure is less invasive due to the fact that it addresses the skin only. The recovery is much quicker and the results are a bit more subtle than some of the other more invasive facelift procedures. Scarring is minimal as it is placed in the hairline just near the temple. This particular facelift offers the lowest risk to patients.

SMAS facelift: This is considered a traditional facelift approach, which in many cases is the gold standard for facelift surgery. It is a process that goes beneath the superficial layer of skin and manipulates a group of muscles known as the superficial musculo-aponeurotic system (SMAS). This surgery does garner more dramatic results with a longer recovery period. The incision is placed along the hairline from behind the earlobe to the temple so that the skin can be separated and lifted. Once the facial structures are in their new position, sutures are used to tighten, and secure the skin for a natural appearance.

Deep plane lift:This lift is appropriate for older patients with severe sagging and drooping. Facial cosmetic surgeons who are experienced in facelift surgery can create natural results even though this is the most invasive of all facelift procedures. This procedure goes deeper than the other approaches and adjusts the tissues and muscles so that deeper wrinkles can be addressed. Loose skin is removed and pulled gently tight for a rejuvenated appearance.

The bottom line in avoiding misinformation is to consultwith aplastic surgeon Certified by the American Board of Plastic Surgery. You will receive a thorough examination and be provided with an astute evaluation as to which Facelift approach is the best for you. My practice will be pleased to provide you with in-depth educational information at no charge. So, feel free to call: (703) 506-0300.

What Type of Face Lifts Are Possible?

The American Society of Plastic Surgeons (ASPS) reported in 2012 that the number of facial rejuvenation procedures grew more than any other minimally-invasive cosmetic procedure for that year.  The level of interest isn’t surprising – enhancements for the face have long been a focus for beauty-seekers.  Because facial procedures show no signs of decreasing in popularity, Northern Virginia’s premier plastic surgeon, Dr. Shlomo Widder, shared some choices in facial surgery for this article.


MACS facelift surgery and Restylane injections are both prominent among the possibilities for achieving your personal ideal facial features.  Dr. Widder uses the Maximal Access Cranial Suspension technique (MACS) for natural-looking facelift results that last.  When the face sags due to aging, the fat of the face and the skin can be lifted back up to its youthful position.  Depressions and concave areas are tightened and filled by the natural facial fat in by this MACS lift technique.  Because this natural and viable fatty tissue,  with good circulation from the face itself, is used in the procedure, patients can look forward to a successful facelift and a positive, rejuvenated appearance.

Dr. Widder also favors the use of Restylane (hyaluronic acid) injections to fill the nasolabial fold and other facial depressions  The substance is sure to stay in place, but for a limited time.  In general, Restylane injections last 6 to 8 months.  If repeated after 3 months, Restylane may last up to 18 months.

While many doctors use fat injections for facial rejuvenation, Dr. Widder is clear about the problems that may arise from the use of fat injection.  He has long stated that fat injections for buttock enhancement often disappears not long after the procedure; it is also not a reliable and is inconsistent method even when smaller amounts of fat are used for the face.  Because fat injection is a surgery that entails downtime due to bruising and swelling and also has a high level of unreliability, Widder does not recommend it.

Among patients who have experienced both Restylane and fat injections, Dr. Widder says, most prefer the confidence they have in Restylane.  With Restylane, patients who are going to an important event or traveling can do so right after a treatment.  While theoretically, the fat injection may last forever if the fat survives, and that is a big “if.”  Patients generally prefer the assurance and predictability of Restylane, fortified by the lack of downtime that fat injection requires.

The face makes the first impression more than ever in this age of the internet.  For many women, it is important to take extra measures to make sure they look good all the time in person and online.  Today, even a Facebook profile image is worth a thousand words and Dr. Widder makes it his business to keep his patients looking great.

Dr. Shlomo Widder, known as the “The D.C. Butt Doctor,” is the only surgeon in the Washington, D.C./Northern Virginia area offering buttock implants and has made it his mission to help each patient achieve the very best behind.  Contact Widder Cosmetic and Plastic Surgery at 703-506-0300.

About Widder Cosmetic & Plastic Surgery:

Dr. Widder is a member of the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).  The surgery center is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF).  He serves the Northern Virginia area, WashingtonD.C. metropolitan area and beyond.  He has performed plastic and cosmetic surgery for over 25 years.

Services include Facial Implants, Facelift, Botox and Facial Fillers, cheek, chin, and eyelids surgery, Liposuction, Breast Augmentation, Breast Lift, and Breast Reduction, Rhinoplasty, Otoplasty Ear Tuck, Pectoral Implants, Calf Implants, and Gynecomastia Surgery.  Widder Cosmetic & Plastic Surgery is the only area plastic surgery center offering Buttock Implants. For more information about “The D.C. Butt Doctor,” visit:

Facial Options in Cosmetic Surgery

There are many options available for Facial procedures. Some, like fat injections, involve significant healing time while others, such as Restylane injections, require no recovery period at all. Dr. Widder describes the pros and cons of these procedures as well as other options such as the MACS facelift surgery technique.

face lift options


Q: You’ve said before that fat injection is not a good plan for buttock enhancement. 

It’s not reliable – it doesn’t stay in the butt due to the injection of large quantities of fat without blood supply.  I only do implants for the butt.  I was going to start doing fat injections for the butt a few years ago, then this happened:  I purchased all the equipment, but then I started getting patients for butt implants who had had the fat injection before by other plastic surgeons and it all or almost all disappeared.  It was a moment of truth.  I started to think about it and I saw more patients coming in with the same situation.  I decided not to do it.  I can’t sell my patients on that extensive and expensive procedure knowing it will last only 6-12 months and then after that, they’re back to their original shape.  I just couldn’t do it.

Q: Fat injection is also used for the face.  Have you had better success with that?

The purpose of fat injection for the face is to fill up concavities or depressions.  Unfortunately, it is not very reliable even in those smaller amounts.  It is being done extensively on the face, but it doesn’t always last.  I use the “MACS” facelift technique, which stands for Maximal Access Cranial Suspension.  Through this technique, I lift up the fat of the face that has descended from its youthful and natural position and I bring it up to where it belongs.  So with my facelift, I don’t really need to do a fat injection.

If you bring up the fatty tissue that has moved downward due to aging and gravity – if you move it up to areas where the patient has concavities and depressions, it fills them up.  That’s viable tissue. It has good circulation and there’s no risk of losing the fat.  So, my facelift is very effective without fat injection.

Q: Are there other instances where you might use fat injection for the face other than during a facelift? 

Yes, I sometimes do it as a separate procedure.  For example, I might use it as an injection into the nasolabial fold.  As we age, the nasolabial fold gets deeper because the cheeks descend and overlap the fold or the crease.  If a patient is not ready for a facelift personally or financially, there are different options.  You can use fat injections, or you can use a filler like Restylane.

Restylane (hyaluronic acid) lasts 6 to 8 months.  If you repeat it after 3 months, it might last 18 months. So, it lasts for a limited period of time.  The fat, on the other hand, if it survives, will last forever.  So I tell my patients about those two options. The fat is not very reliable – it might survive, it might not.  The Restylane will stay there, but for a limited amount of time.  So they think about it and make up their mind.

So far, most of my patients prefer Restylane.  They like assurance.  They might have a party or some other event to go to and they want to look good.  For example, I have a patient who is going abroad to visit family and she wants to show up looking great.  She came to have the Restylane because there’s no bruising and no downtime.  Fat injection is surgery.  You have bruising, you have swelling, and you have downtime.

Q: How do you perform a fat injection procedure?

I obtain fat from another area of the body.  I can get it from the abdomen or the inner or outer thighs, for example.  It is done with a cannula- a special blunt metal tube so you’re not causing too much trauma and bleeding.  With that instrument, I go into the area and aspirate the fat. Next, the fat is “distilled – ” blood, fluids, and other elements are separated out before the fat is injected with a thin blunt cannula to the area that needs it.  It can be injected into the upper eyelids, the tear trough, the nasolabial fold, and also the jowl area. Fat injection can be good at smoothing the jowls.  It fills out the notch and the jawline becomes more defined.

Why is fat injection more invasive than using Restylane?    

Well, you have to take the fat from somewhere and inject it. You have to use a  cannula that injures the tissue.  With Restylane, you use a very small needle, 30 gauge.  For fat injection, I use a 2 mm cannula to inject it, but,  Obviously, you, still, will have trauma to the area.  Restylane is a natural material that we have in our bodies, so the body doesn’t react to it.  With fat injection, the body doesn’t react to the live fat, but it reacts to the blood and to the ruptured fat cells as foreign bodies.  There can be inflammation and swelling and some discomfort.  Restylane is a very simple and ready-to-go injection.  You can literally go to a party after Restylane.  You can’t do that after fat injection because you are swollen and bruised.

Another issue with fat injections is that if you gain weight, the area can get lumpy.  You can wind up with too much of the good stuff.  But most of the time, I would say, 70-80% disappears, and maybe 20-30% will survive.

I take the time to give patients all of the information so they understand all of the consequences and what it all means.  I have to be honest and truthful.   I can’t talk about fat injection as if it’s a panacea because it’s not.  Restylane has its benefits, and with fat injection, if the fat survives, it’s nice.

To learn more about facelifts using Restylane or fat injection contact Dr. Widder at Widder Cosmetic and Plastic Surgery which servers the greater D.C. and Northern Virginia area. Visit Or call: (703) 506-0300

*Individual results are not guaranteed and may vary from person to person. Images may contain models.