Facelift: Q&A

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What is my Plastic Surgeon Going to do?

My plastic surgeon is going to do a face lift revision due to descending jowls and neck banding. This time he said he will "undermine" along my neck and jaw line. What does this mean? Does it include fat removal? Is "undermining" like a deep plane procedure that increases the risk of motor nerve damage?

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26 Doctor Answers | Asked by NHaven in Oklahoma City, Oklahoma

Doctor Answers (26)
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What's involved in a face lift?

Undermining is a term that describes the act of using scissors or another instrument to go through layers of tissue, underneath the skin, in order to gain access so they can be manipulated (tighten and lift SMAS, Platysma). It's a standard part of any variation of a face lift. Underming can occur at different tissue layers, in the face, and hence the terms: skin only, SMAS, Deep Plane and subperiosteal face lifts. These are descriptive phrases that... more

Undermining lower face and neck skin is required to tighten jowls and neck during Facelift

Undermining is simply using surgical Facelift Scissors to separate the overlying skin of the face and neck from the muscles and tissues deep to the skin. Undermining is required to "free up" or loosen the facial and neck skin so that they can be pulled tight at the end of the Facelift and Neck Lift. Typically the surgeon will also use sutures to tighten the muscles (Platysma Muscle) of the neck with a procedure called a Platysmaplasty. The SMAS-a muscle like membrane that... more

How to facelift: 101

Exactly what is to be done and how it is done should be explained by the surgeon. I always do. Undermining refers to the separation of the skin from the deep layers (muscle and fascia). I have an office in Beverly Hills and Rancho Mirage. The desert is resplendent with secondary facelift candidates. In fact, we rarely do a first-timer. So I am used to handling bands, adhesions and contour difficulties from previous facelifts. Never feel that you... more

Ritu Chopra, MD

4 reviews

Beverly Hills Plastic Surgeon

drrituchopra.com

Face Lift Undermining and Why Do II?

Sounds like your surgeon may have been a little conservative the first time. Lifting up the skin (undermining) is a critical and important part of any facelift and must be done to get good results. Conservative mini lifts with little if any undermining produces mini results that do not please. Get a few consults from surgeons certified by the American Board of Plastic Surgery and a Fellow of the Americal College of Surgeons. Get two consultations... more

Like moving a rug, you first have to lift it from the floor

Undermining means to separate the skin from the surface underneath it. This also allows the surgeon to manage the layers under the skin by either shifting them as well (SMAS lift) or adjusting the neck muscle (playsmaplasty) or any one of many other options. Dr. Mayl Fort Lauderdale

Nathan Mayl, MD

7 reviews

Fort Lauderdale Plastic Surgeon

Secondary facelift

Undermining, in surgical terms, means to free up tissue by means of surgical dissection. If you "undermine the cheek area", it means you separate the skin and fat from deeper anatomic structures. How the surgeon treats the tissues after that is open to debate. There are several possibilities - so ask your surgeon to explain which technique he will use to treat the deeper structures (SMAS in the cheek, or platysma muscle in the neck). It's important to... more

What undermining during a facelift means

Undermining refers to lifting the skin off of the underlying tissues. In and of itself undermining doesn't refer to removing any fat, although your surgeon may be planning this.

What does "Undermining" Mean in Facelift Surgery?

Regarding: "What is my Plastic Surgeon Going to do? My plastic surgeon is going to do a face lift revision due to descending jowls and neck banding. This time he said he will "undermine" along my neck and jaw line. What does this mean? Does it include fat removal? Is "undermining" like a deep plane procedure that increases the risk of motor nerve damage?" If you check dictionaries for UNDERMINE you will find preposterous explanations such as : 1. To... more

Explaining undermining with a facelift

Undermining is simply elevation and redraping of the tissues to rearrange them. A simple analogy would be similar to lifting the sheets of your bed down to the foot of the bed ("undermining") and pulling them forward to make them taut and flat.

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Revision Facelift

Although I agree that a more extensive discussion should be held with your Surgeon about technique and anatomic details, it sounds as if he feels that he initial procedure was not aggressive enough to address your aging changes. The term "undermining" simply means to surgically dissect or lift up. If your Surgeon is experienced and technically sound, there should be no greater risk with a more extensive procedure.

Undermining

Although it is hard to say what your surgeons plans to do it seems that he wants to do more extensive elevation. This does not necessarily increase the risk of motor damage but there may be more numbness

Sam Naficy, MD

80 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

Repeat Facelift?

Thank you for the question. “Undermining” refers to surgical dissection in a certain anatomical plane. Often, but not always, this plane is the area between the skin/ subcutaneous tissue and the underlying structures. However, to be certain ask your plastic surgeon. Best wishes.

What is my Plastic Surgeon Going to do? are you kidding me?

This is not a question for the forums. this is precisely what informed consent is all about. when your doctor, any doctor, uses jargon that you do not understand. don't feel stupid or uninformed it is the surgeon's responsibility to use words and pictures that communicate with a pt, not frighten or impress them. If they can't explain it to you, they have no business doing it. go back and give the MD a second chance not to be such an condescending fool. good luck more

A facelift is not a facelift

There are many kinds of "facelifts' and undermining only means that the surgeon is going to go under the skin in that area, it does not mean that it is a deep plane elevation, and in fact it most likely is not. Furthermore, undermining may or may not include the removal of unwanted fat under the chin and neck. That depends on the individual's anatomy. As a surgeon that regularly performs deep plane facelifts, I would like to mention that it is EXTREMELY unlikely that you... more

Undermining in a facelift

Undermining simply means separating the skin from the underlying tissues. This allows the surgeon to work directly on those tissues and also to re-drape the skin and remove the extra.

Face Lift Revision

Undermining refers to the surgical maneuver involving carefully detaching skin and fat (and perhaps connective tissue and muscle) from deeper tissue. This detachment is necessary to reposition superficial tissues (skin) to a more youthful location. Continuous undermining is complete detachment from deeper tissues, and discontinuous undermining is incomplete detachment. ALL successful facelift procedures involve undermining to permit mobilization of aging (descending)... more

All facelifts involve undermining (lifting) of the facial skin

All facelifts involve undermining (lifting) of the facial skin. This allows proper redraping and repositioning of the skin as well as manipulation or elevation of the underlying deep tissues including the SMAS layer. Best, Stephen Weber, M.D., Ph.D. Lone Tree Facial Plastic & Cosmetic Surgery Center

Undermining with facelift

At Gill Plastic Surgery, a standard facelift involves widely undermining the skin off of the underlying SMAS muscle throughout the cheeks, jawline, and neck. The foundation of any well performed facelift is adequate correction of the underlying SMAS and platysma (neck) muscles by pulling them in the correct vector and tension. This can be accomplished by removal of the loose muscle or plication (tightening) of this. If performed correctly and the skin is widely... more

Revision Facelifts Not An Easy Procedure

A Revision Facelift is a complex operative procedure which requires significant understanding of the facial deformity as well as the aging face. Often, the patient will have to have the 4 R’s: Release, Re-Shaping, Re-Filling, and Re-Contouring. This requires significant expertise in correction of secondary facelift deformities.

Rod J. Rohrich, MD

10 reviews

Dallas Plastic Surgeon

Undermining means he is going to lift the skin off underlying tissues - very common technique

Undermining means he is going to lift the skin off of the underlying tissues. This is a common way of performing neck and facelifts. see video

Babak Azizzadeh, MD

4 reviews

Beverly Hills Facial Plastic Surgeon

www.facialplastics.info

Facelift Procedure

There are multiple ways to perform a facelift. It is important to discuss with your surgeon the exact procedure that will be performed and the results you should expect to receive.

Surgical Technique

Undermining means to create a surgical plane beneath the tissues. This is a step involved in the lifting procedure. There are a host of options after that step, available to the surgeon. You should ask the surgeon what their plan is so you better understand the procedure.

What does "Undermining" mean in Facelift Surgery

Undermining refers to releasing the skin from the deeper facial tissues (a.k.a. elevating a skin flap). Deep plane facelifts refers to the level of dissection to allow repositioning of sagging facial tissues (i.e. jowls). What your plastic surgeon has in mind in particular, is difficult to answer for anybody but your doctor. Discuss your revision facelift with him and let him explain the technical aspects you would like to know.

Facelift Revision

"Facelift" is a very generic term; there are many techniques and combinations of techniques. The surgery is individualized to meet the needs of each patient. Only your surgeon can answer your question.

Richard W. Fleming, MD

9 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Your plastic surgeon's treatment plan...

There are a lot of variations in technique for facelift and secondary (revisional) facelift surgery. I would ask this question to your surgeon who will be performing the procedure to get the exact answers.