How does the surgeon know what the result will be if working on a patient laying down if marked when sitting up?

Good question.It is the combination of experience and it is functionally better, easier, and safer to perform the procedures with the patient laying in the supine position.  I know this is confusing to some patients but when you think about it there are many professions where something is made or completed when it is in a different position.  For example, when your clothes are tailored they do not do the stitching and material cutting with the dress or suit on you.  Or when a carpenter fabricates a wall it is commonly constructed on the ground before it raised to its vertical and final position.I hope this helps.  

The translation of preoperative evaluation into operative plan is the reason that facelift should be done by surgeons with vast experience. Achieving outcome comes from knowing how a manipulation in the operating room will translate into a postoperative result. You can't learn this from the weekend course.

Things look very different when upright as compared to when lying down, that is why surgeons do their markings when patients are upright.  With extensive experience, a good surgeon then translates those markings into a well executed surgery when the patient is lying down even though lying down the markings may seem off.

Markings are typically done in order to map out where the incisions will go as well as any other important landmarks that the surgeon wants to identify.  This way, when the patient does lay down, the drawings are actually still located at the appropriate landmarks.  The result obtained is based on experience and knowing what things should "feel" like (regardless of markings).  A facial plastic surgeon or plastic surgeon with natural looking results in their surgical portfolio is a great place to obtain your consultation.    

The marks are actually placed while you're sitting upright for this very reason. When you're laying flat during the surgery the markings tell me where the important landmarks are located. When you lay down, the neck relaxes, cheeks fall back and the jowls move. The markings tell your surgeon where all of that tissue is typically located. The ability to properly reposition these tissue improves with experience. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

This is an excellent question!The markings as well as experience best determine the outcome.This principle also applies to breast and body contouring.A board certified Plastic Surgeon with several years of experience is your best option for having a result to meet your expectations.Good Luck!

Before performing a facelift or facial surgery, patients are normally marked while they are sitting in order to determine the placement of incisions, as the face does move when a person is lying down.  Once this is done, the patient can be lowered down to perform the surgery because the surgeon has marked where the incisions need to be.  The amount of tightening is based on the preoperative condition of the patient and the experience of the surgeon.  

   The markings are placed around planned incisions and vector of lift markings could also be placed. as surgeons become more experienced they may not place these marks because marker ink may stay on the skin for a few days after surgery. A surgeon may pull up on the neck or the cheek during pre-operative evaluation to determine those vectors. In addition the direction of pull on the skin is different than direction of pull on deeper tissues. I try to communicate my thoughts to the patient by placing them in front of a mirror and demonstrating the direction of the lift.  The pre-operative plan is drawn out during initial consultation and is used as a roadmap during surgery. Hope this helps.

The markings we make while you are seated or standing are only guidelines. In operating room, judgement and artistry dictate what truly needs to happen, with the marks serving as a starting point. 

guide us in trying to have the best result as laying down makes those lines go haywire.  But if you trust in your markings and don't deviate too much from it, you will have more predictable result.  And that is what we all want.