I have scars under my eyes. If I have a facelift, would it mean that the scars could be removed as excess skin as the face is pulled up tighter?
Does Facelift Involve Literally Pulling the Skin to Tighten?
Doctor Answers (24)
Basis of a good facelift
The basis of a facelift is not pulling the skin rather it is repositioning of tissues under the skin and then re-draping the skin over the more youthful understructure. In some patients fat grafting and other procedures to the eyes or forehead are done concurrently.
Most modern face lift procedures involve tissue deeper than skin
Thank you for the question. A skin only face lift can be performed and for some select patients may be a good option. Most facial rejuvenation procedures, however, involve tightening and repositioning of the deeper tissues. Even with this, however, some extra skin is recruited and therefore some skin removal is often needed. This extra skin may be able to impact the lower eyelid scars that you have mentioned.
All the best,
Dr. Remus Repta
Skin Tightening in Facelifts
Modern facial rejuvenation is much, much more than just skin tightening. One can see this in the current franchise and heavily marketed “facelift type” procedures. These procedures are done under local anesthesia and the scar is in front of the ear and the skin is only pulled tightly. This does not last long nor does it look good. True facial rejuvenation is a deep layer manipulation using a “Lift & Fill” technique as aging is both facial skin laxity with facial fat atrophy (fat loss). Therefore, to perform modern facial rejuvenation one must restore a normal and youthful face without distortion. You need to restore facial fat through the fat compartments, re-augmentation and deep layer facelift manipulation of the SMAS.
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Eye scars being removed during a facelift
The skin that is removed during a face-lift is mostly the skin in front of the ear. I cannot imagine that you have enough loose skin that a scar on or around the lower lid would be remove during a face-lift. If the scar is close to the lash line and you have loose skin of the eyelid, it might be able to be removed using an eyelid incision though.
Facelift and Skin Tightening
An anatomically correct facelift is actually designed to lift up the deeper tissues of the face. When the deeper tissues of the face are suspended, the excess skin is removed without tension.
While it seems intuitive to just cut and remove skin, the skin only lift will place excess tension on the skin and relies on delicate skin to lift up heavier face tissues. The reason this technique does not work is that ultimately the skin stretches back, leaving the patient with the exact same result as before, but now with obvious scars. Skin only lifts were popular many years ago but have fallen out of favor out of most surgeons who perform facelifts.
Facelift tightens the fascia and structures underneath the skin
A comprehensive face/neck lift involves tightening the fascia and structures underneath the skin in the face, the tightening of the muscles in the neck, removal of fat deposits both above and below the muscle in the neck, and then gently removing any excess skin that is present after the muscle and fascial layer has been tightened. It will not affect any scars on the eyelids.
A midface lift could recruit more skin and perhaps allow scar improvement
The typical facelift done to improve the neck, jowls, and cheeks would do little for the eyelid scars. A midface lift, however, done at a deeper level elevates the cheek almost directly upwards and can recruit tissue into the lower lids. This has been well shown by a number of studies including one by Quatela in the Archives of Facial Plastic Surgery. Depending on the situation the scar could then be improved. Various peels and laser treatments could be added depending on the situation.
Facelift versus lower eyelid scar revision
It depends on how bad the scars appear and other factors such as lid tone, skin excess and the type of facelift you are going to have performed. If, for example the surgeon performs midface/ cheek lift with the facelift a fineline scar revision is certainly possible, but conservative laser resurfacing or chemical peel may do more to correct lower lid wrinkles or loose skin than another skin removing procedure. If there are other eyelid deformities (pseudoherniation, tear trough, hollowing, etc) the surgeon may advise transconjunctival blepharoplasty, fat transfer or other alternatives to improve the lower eyelid appearance.
A facelift, which lifts the side of the face and the neck, would have no effect on lower eyelid scars. A check-lift, done through a lower eyelid incision, could be used to revise the lid scar if there is tension of the skin on the lower eyelid.
Lower lid scars
To answer your question directly, a facelift will likely do very little for your lower lid scars (and I assume some of these scars go onto the cheeks). Even fillers may be risky in the lower lid skin itself, but not on the cheek. You may consider some form of peel or better yet the Fraxel laser Re:Pair. First you must see a board certified plastic surgeon or facial plastic surgeon to assess these scars. Only then can an assessment be made as to what technique may help. Do not expect the scars to be "erased". The goal is to get enough improvement that they are less noticeable or minimally so.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.