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On a Facelift, How Does the Skin Reattach to the Tissues when It's Redraped?

I am worried about how the skin can be pulled up in a facelift (back to the cheek area), and then after the underlying work, it is redraped and tightened, so how does the skin "reattach", and what is the protection for not taking too much skin so the mouth doesn't close, etc.

Doctor Answers (22)

Healing and Surgical Redraping after Facelift Surgery

+3

During a "facelift" procdure the underlying tissues are "injured" in a controlled fashioned, as the platysma and deeper tissues are tightened.  The overlying skin has been surgically lifted off these tissues also creating a "controlled injury".  The body then heals these area by laying down sheets of collagen - which are the bodies own natural glue.  The collagen is smooth, and provides the facial skin a new smooth not overly tight look.


Washington Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Facelift draping

+3

Your question cuts to the heart of a successful facelift. The operation is not at all about skin tightening or pulling. It is about the tightening and support of the underlying muscle and fascia (SMAS). Once this is done, the skin is allowed to lay done and there will immediately be seen an amount of redundancy or extra to be be trimmed or removed. Only an amount that will leave what is left to lay without pull or tension should be removed. That will promote better healing and natural appearance. The normal healing process of the body will then let the skin adhere to the new position.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Reattachment of skin after facelift

+2

The skin on the face is elevated just enough to put sutures underneath the fascia so as to give the pole.  The skin in the neck is also pulled back after sutures are placed in the front of the back part of the platysmal muscle. To allow the skin to reattach to the underlying structure as quickly as possible, we use drains to create a vacuum underneath the skin during the first 48 hours after the procedure to prevent any hematoma and seroma formation.  It is important to have an experienced surgeon who does not pull the skin too tight so that the end results are look natural.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

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Facelift skin tightening and healing

+2
As discussed by many of the other surgeons the formation of collagen begins at an early stage after the surgical procedure it is your bodies own form of glue you could say. As far as the mouth not being able to close or look unnatural go to a good surgeon and this should not be an issue. When consulting surgeons speak with their recent facelift patients, look at their pre and post operative photographs and decide if their results are similar to the aesthetic result you desire. It is important to view patients in your same age range and with similar problems so you will be realistic to your goals and expectations as well as the surgeons. The goal of a facelift is to shave seven to ten years off giving you a refreshed natural and youthful appearance. Not a pulled appearance and certainly not a "joker smile" as you refer to. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 127 reviews

Skin to tissue reattachment

+2
Immediately after surgery, the body begins to produce new collagenous tissue which causes adherence of the skin to the subcutaneous tissue. This is an excellent question! The protection against excessive skin excision is in selecting a board certified plastic surgeon with years of experience and excellent clinical judgment.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

On a Facelift, How Does the Skin Reattach to the Tissues when It's Redraped?

+2

 I have performed Face Lifts for over 20 years and this is a very insightful question.  The way to avoid pulling the corners, of the mouth and eyebrows, IMHO is to avoid the subperiosteal or Mid Face Lift (that pulls the entire forehead and face in that direction) and to be sure the Face Lift addresses the SMAS layer with imbrication and not plication or suspension.  Impeccable aesthetic judgement as well as experience in performing Face Lifts, should be the main requirements in selecting a Face Lift Surgeon, IMO.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Facelift skin tightening

+2

Within 30 minutes or less of redraping the skin, the body begins to produce a sticky layer between the skin and the underlying tissues.  The body will then begin to produce immature collagen as early as 24 hours, which will give the connection between the layers more strength.

With respect to your second question, it is very difficult to tighten your skin to the point of being unable to close your mouth and not be noticeable on the operating table.  The deformity would be obvious to all.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon
3.5 out of 5 stars 6 reviews

The body is an amazing thing.

+2

Within seconds of redraping the skin, the body begins the healing process.  The same wound healing mechanisms that heal a small cut also go to work healing the skin lifted as part of the facelift.  In fact these mechanisms are so effective that they are adapted as the basis for fibrin glue.  In this case you heal using your bodies own fibrin glue.  This matures into the new collagen that provides the long term strength for the facelift.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

Reattaching Skin & Tissue After Facelift

+1

A multiple layer facelift (SMAS), such as the “Lift & Fill” facelift that I perform, includes “lifting” the deep layers and “filling” the central fat compartments as one has to re-drape and reshape the deep fat compartment layers so they are in harmony and provide a natural and youthful appearance.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 15 reviews

How Does the Skin Reattach to the Tissues when It's Redraped?

+1

Good question:

The skin is only trimmed after the deep layers are tightened and it is trimmed under no tension so there is no risk of the mouth not closing from tension.

The tissues will reattach using the body's natural glue - fibrin.  This adhesion is aided by use of drains that suck the skin down as well as a compression dressing.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 137 reviews

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.