Facelift: Q&A

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How Come a Face Lift is Muscle Repositioning Oposed to Just Pulling the Skin Back?

When you hear about a face lift you hear the doctors say they have to re position the muscles in the face opposed to what seems to be the obvious thing to do and that is to just pull the skin back and sow???

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Facelifting is a 3-dimensional procedure

Aging occurs at several levels, including loss of facial fat, sagging of the connective tissue layer that encloses the muscles of expression (called the SMAS), and also skin laxity. Puliing on skln without addressing the other issues can produce the flat, pulled, unnatural look that no one wants. Think of it as a 3-dimensional procedure rather than skin tightening alone. That is why all of the procedures called "nonsurgical facelifts" are not a facelift at all.

How a Facelift is performed

It is not actually the facial muscles that are repositioned in a facelift, but the investing layer of fascia, called SMAS for short. By tightening the SMAS, overlying fat and skin are also tightened, but without direct tension on the skin, so the skin will not look stretched.

Roy A. David, MD

11 reviews

San Diego Facial Plastic Surgeon

Facelift - How Come a Face Lift is Muscle Repositioning Opposed to Just Pulling the Skin Back?

Actually, it's both. The oldest approach is called "Skin-only." It was the only thing done for many years and, in truth, it may be adequate for many situations. More recently though (ie, the past 25 years or so) and ADDITIONAL layer of tissue has been addressed. Called the muscles, or the SMAS (an acronym that refers to the tissues that partially invest the muscles), adding tension at this layer prolongs the effect of a facelift and, arguably, improves... more

Face Lift - Muscle Repositioning VS Just Pulling the Skin Back?

Good question. After all,"skin only" facelifts have been performed since the early 1900's. With a century of experience in facelifts why should there be so many ways to perform a facelift. Let's take a step back. CHANGE IS HARD AND SLOW. Doctors and Medicine observe Newton's First Law of Motion (Inertia): "An object at rest will remain at rest unless acted on by an unbalanced force... " Or, stated another way, they are creatures of habit and... more

Facelift and How It Should Be Done

To borrow a quote from Dr. Bruce Connell, "If skin were a tension bearing structure, pregnancy wouldn't be possible." The amount of tension that can be safely and aesthetically placed on the skin is limited. Therefore, in the 1970's emphasis was placed on elevation of the deeper structure, or "SMAS" which is an acronym for the fibro-fatty covering of the facial musculature. Therefore, most Facelift surgeons in this day and age rely on some form of SMAS based procedure to... more

Skin vs SMAS facelifts

Several studies have shown longevity with either type of facelift. However, the SMAS repositioning probably prevents some rather unnatural results. Kenneth Hughes, MD Los Angeles, CA

Skin only facelift

The skin only face lift has been attempted centuries ago with minimal improvement and minimal duration. Facial aging is much more complicated than just removing skin and the best and most natural results are obtained when all tissue layers are addressed together and when the lost facial volume is restored such as in the link below

Sam Naficy, MD

80 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

Facelift Procedure

A facelift is essentially a reversing of the aging process. What happens with aging is that not only the skin but also the muscles begin the drop- thus, these are all areas addressed with the facelift, including the elevation of the SMAS, that deeper level which is attached to most of the facial muscles that need to be redraped.

You will get a longer lasting result with nicer scars

The first time a muscle based facelift was done in 1978 it was met with skepticism by plastic surgeons. But within a few years it became widely embraced since it gives longer lasting results, requires less dissection of the skin itself and when the sowing is done on the muscles the skin can be tacked down, not pulled. The facelifts where all the tension is in the skin and not the muscles in general have much less fine lined scars. I don't do any facial work without... more

Why the new facelift techniques reposition the muscle...

Thank you for the very good question. The old facelift was pulling the skin back which left patients with the "facelift look." The jowls and cheeks were not repositioned. You've seen these people and I'm sure you thought to yourself, "that woman definitely had a facelift." Plastic surgeons strive to make people appear more attractive and the best compliment would be that someone looks more attractive without looking like they had surgery. It is... more

Facelifts. Muscle and Skin

Plastic Surgeons have debated the optimal soft tissue placement in facelifts for decades, (from just the skin, to right above the bone, and every layer in between). Most will use the SMAS muscle layer as the strength layer in a facelift. This will usually reposition the tissues in the correct place. Then one will redrape the skin over the tissue. This method gives good soft tissue lifting and repositioning, without the "wind tunnel" look. The results... more

How to do a facelift

The modern facelift involves tightening the skin, however, most plastic surgeons will also tighten the deeper structures of the face because these sag just as the skin seems to sag and in fact the laxity of the deeper structures may appear to cause sagging of the skin. Addressing the skin by itself will not produce as long lasting result as a facelift with tightening of the deeper structures. Also the skin will have to be excessively tightened to get the deeper structures to move which... more

Ralph R. Garramone, MD

7 reviews

Fort Myers Plastic Surgeon

Facelift

When we age, our faces go through a digression of bone, muscle and soft tissue (fat) loss creating the appearance of hallows in the cheeks and under the eyes. Think of the process a grape goes through to become a raison. The face sags down and inward. The best way to restore the youthful appearances is to reverse the aging process bringing the skin upward and out. Just pulling the skin will not accomplish this. Pulling on the plains of the muscles and adding volume and restoring the fat with... more

Philip Young, MD

6 reviews

Bellevue Facial Plastic Surgeon

Face Lift: Muscle tightening or skin pulling

Within the face are various layers of bone, muscle, soft tissue and skin which all contribute to a person’s appearance. For an effective, natural, long lasting aesthetic result, a facelift must be done properly. By simply pulling the skin tight, a patient will have a "wind-swept" appearance as well as very short term results. The correction and repositioning must be in the muscle layers and tissue below the skin. The muscle layer, when... more

Tightening of muscle layer with a facelift

The earliest facelifts performed at the beginning of the 20th century were non-aggressive skin tightening procedures, and they did not last very long. More aggressive dissection to tighten more skin produced only slightly better results. Eventually it was discovered that tightening of the deeper muscle layer would help restore aging structures to more youthful positions in the face. A facelift should not be limited to thightening. It should also be... more

Facelift and muscle repositioning

The key to the success of a facelift is to anchor the muscle underneath the skin in it's more natural, youthful position. The muscle will provide the strength of the facelift. Skin is not designed to hold tension. If tension is placed on the skin there is a risk of widening of the scar and hypertrophic scarring. The other downfall to a skin only lift is that it does not have the longevity that a true facelift has. A facelift that addresses the muscle is designed to have at least 8-10... more

Todd C. Miller, MD

10 reviews

Orange County Facial Plastic Surgeon

www.toddmillermd.com

Simple facelifts vs. muscular support facelifts

Years ago a facelift only involved pulling the skin and creating a firm appearing lift that would look pretty good for several years. The problem with this idea was that the hope of the patient was that a lift could persist for a longer period of time, The concept today is to strengthen the support for the lift by supporting the muscular structures with internal suturing. This will add many years to the longevity and strength of the lift. The current... more

Facelift with muscle repositioning

In the past, a facelift involved lifting the skin, excising the excess and closing the wound. this often resulted in a facelift that looked "overly pulled". Also, this type of skin-only facelift often did not last very long, before renewed skin laxity was again noted. In modern day facelifts the structures underlying the skin are also tightened and/or repositioned. These structures often include the platysma muscle in the neck along with the... more

Facelift structure or muscle repositioning versus skin pulling. Help!

Facelift surgery has been performed now for more than a century. what was initially a small undermining and skin pulling has been transformed into a procedure that can deliver a much more natural and long-lasting effect by including the underlying structure or muscles of the face as well. By contouring, tightening, and lifting of the underlying structure of the face, the procedure develops a more natural and long-lasting outcome. The skin is then redraped over the new lifted tightened and... more

Facelifting involves more than just pulling the skin.

A "facelift" can actually involve many different techniques depending on the individuals anatomy and extent of aging. But asking the skin, which is not getting stronger or more elastic with age, to support the lifting and reshaping of the tissues of the face is likely to lead to a "windblown look", too tight appearance and widened scars due to the tension required to close the incisions. Modern facelifts elevate the deep tissues of the face and secure... more

Jeffrey M. Darrow, MD

18 reviews

Boston Plastic Surgeon

Why Not Just Pull on the Skin in a Facelift?

In the past, facial aging theories believed that as the skin aged, it stretched and everything under it sagged and fell as it lost the support of the skin. That is why the old facelift techniques really just pulled on the skin, using the skin to lift and support the underlying structures. However, since skin stretches easily, the results of these procedures did not last long and with frequent revisions, gave that "pulled, windblown" look. Over the past years,... more

Pulling the skin in a facelift

There are many different types of facelift procedures. Most of the better techniques involve tightening or repositioning of the support tissue beneath the skin and then gently redraping the skin with mild pulling. This helps to keep a better natural look and avoid the "too tight", "windblown" look. These types of lifts are usually a bit more work and therefore usually have a bit more recovery and cost. They are well worth it. Pick your surgeon carefully, not just on price. more

Just pull back and "sow" ??

Pull the skin, and you get a pulled look. Carefully reposition the skin and underlying soft tissues at their youthful location and secure the deep tissue in this rejuvenated location, thus removing all tension from the skin, and you get a beautiful, natural result. Which would you rather face the world with every day for the rest of your life, pulled, or beautiful and natural?

Facelift Techniques

Early facelifts were performed just as you suggest. There are a few problems with pulling the skin tight, however. First, many of those lifts didn't last as long. The skin itself just wasn't a good anchor. Second, since the skin was closed under tension it resulted in that classic "wind swept" look which is undesirable. Third, this type of closure put a lot of tension on the ears and resulted in additional abormalities. Today,... more

Facelift - more than just pulling skin

The specialty of Plastic Surgery has been undergoing a 'paradigm shift' in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older 'subtractive' techniques to newer 'restorative' techniques. Surgery which consists mainly of removing (subtracting) skin and fat and pulling tissues tight will lead, in many instances, to a 'skeletonized' and therefore more aged (or... more