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

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.

   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

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

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.

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 typically last longer than a "skin only" facelift.  Each patient is different.  Seek out an experienced Plastic Surgeon or Otolaryngologist, (ENT).  Talk with the surgeon and together you can slect the right operation for you.

 

 

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 them in a new rejuvenated position,  so the skin can be gently re-draped over these deeper tissues, giving a natural appearance.  As the skin is not closed under tension, the incisions will heal with a thinner appearance.  The results with repositioning the deeper tissues are longer lasting as well.

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.

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?

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 elevate soft tissues, allowing an appropriate amount of skin removal.

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, we lift the strong fascia under the skin (that the facial muscles insert into).  Once the fascia has been repositioned  the skin is actually replaced with as little tension as possible.  It is often difficult to evaluate surgeons based on their explanation of surgery.  I recommend patients examine instead the before and after photos.  Don't just focus on the neck--get global.  Do the patients have nice, natural outcomes that you can relate to?  That's important.  Good luck!